Strategies for enhancing 'person knowledge' in an older people care setting.

This article presents findings from a study about compassionate care?the development of person knowledge in a medical ward caring for older people. Appreciative inquiry, an approach to research that focuses on discovering what works well and implementing strategies to help these aspects happen most of the time, was used. Staff, patients, and families participated in this study, which used a range of methods to generate data including interviews and observations. Immersion/crystallization was used to analyze these data using a reflexive and continuous approach to extracting and validating data. Findings uncovered that knowledge of the person and ways of promoting this were key dimensions of compassionate caring. The attributes of 'caring conversations' emerged through the analysis process, which we suggest are crucial to developing person knowledge. The political and public focus on compassionate care makes it opportune to raise discussion around this form of knowledge in academic and practice debates

"I know who I am; the real me, and that will come back." The importance of relational practice in improving outcomes for carers of people with dementia

Effective support to carers of people with dementia can be critical to maintaining quality of life for people with dementia, their families and to sustaining the future of health and care systems. Qualitative interviews were undertaken with 14 carers of people with dementia across Scotland, and the data analysed to identify the outcomes important to the carers. The importance of relationships emerged as the core theme, including relationship with the person with dementia, family members, other carers, and professionals. Although not evident in the literature, the authors noted the concept of self-relationship was important to carers in the context of changing relationships with others. A multi-layered approach to understanding relationships, and an approach to engagement that enables carers to define and express their priorities, is necessary to fit with the relational nature of care

Caring about caring : an appreciative inquiry about compasssionate relationship centred care

Abstract Background Compassionate caring and dignity are key priorities in current policy and research agendas and are central to the quality of experience for patients, families and staff. Developing relationships has been identified as a key component in enabling excellence in caring to be realised in practice. However there is little evidence that identifies the processes involved in delivering compassionate relationship-centred care. This study sought to address this gap in the knowledge base. Aims and research questions The study's aim was to examine and evaluate processes that enhance compassionate relationship-centred care within an older people care setting in an acute hospital. Key objectives were: to develop an understanding of the concept of compassionate relationship-centred care within the practice setting through exploring the views, perceptions and experiences of staff, patients and their families; to develop, implement and evaluate strategies that promote this concept; to examine the processes that need to be put in place to enable sustainability of these strategies; and to identify the lessons learnt to inform practice, education, policy and research. This study was part of a larger programme of work that aimed to integrate compassionate care across practice and education. Approach and methods My role as a senior nurse and practitioner researcher meant that I was in a unique position to be able to capture not just theoretical views of compassion but how this was enacted in practice. To do this the study used the approach of appreciative inquiry. A range of methods was used: participant observation, stories using emotional touchpoints, photo-elicitation, and group discussions to explore beliefs and values. Data were continually fedback to staff participants to involve them in analysis. An iterative and inductive process of immersion crystallization was used to analyse data. Findings A key finding was the development of a practice model to support practitioners to deliver compassionate relationship-centred care. This model suggests that, in order to deliver such care, people need to engage in the process of appreciative caring conversations in order to understand a) who people are and what matters to them; and b) how people feel about their experience. This in turn enables a process of working together to shape the way things are done. The findings support the notion that during these caring conversations the practitioner needs to connect emotionally, be curious, collaborative, able to compromise, considerate of others perspectives, courageous and actively celebrate when practices have worked well in order to promote compassionate relationship-centred care. This framework comprises the 7 ‘C's of caring conversations and makes a unique contribution to the body of knowledge in providing practical guidance as to the ‘how' of compassionate relationship-centred care. Key outcomes of implementing this model were that people felt comfortable to express emotions, developed stronger relationships, were more consistent in delivering compassionate care practice across the team, and had a sense of learned hopefulness in the face of complex and competing demands. Conclusions and implications Implementation of activities in practice to support this way of working revealed that these processes are complex, often requiring the practitioner to takes risks and therefore the provision of appropriate support, facilitation and strong leadership are important factors in helping to sustain such practices. The outcomes of this research build upon the existing knowledge base by providing a practice model that specifies how to deliver compassionate relationship-centred care, and they demonstrate the impact of using appreciative approaches to facilitate improvement within health care contexts.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Appreciative inquiry as an intervention to change nursing practice in in-patient settings: an integrative review.

Background: High profile accounts of failures in patient care reflect an urgent need for transformational development in healthcare. Appreciative Inquiry is promoted as an approach to exploring and bringing about change in social systems. Appreciative Inquiry has been used extensively in North American business since the late 1980s. The application of Appreciative Inquiry may have merit in the complex world of human health experiences. Objectives: To identify, evaluate and synthesise the evidence about the impact of Appreciative Inquiry on changing clinical nursing practice in in-patient settings. Design: An integrative review and narrative synthesis. Setting: In-patient settings including paediatrics, maternity and mental health. Participants: Nurses of all grades, patients, carers, relatives, other healthcare professionals including allied healthcare staff, management and students. Data sources: An electronic search of the following electronic databases was performed in January 2015 and updated in July 2015: MEDLINE, EMBASE, Cochrane Library (Cochrane database of systematic reviews), Cumulative Index of Nursing and Allied Health Literature, PsychINFO, PsychARTICLES, Amed, Assia, Scopus and Web of Science. Hand searching of reference lists of included studies was undertaken. Limits were set to include literature published in English only and publications from 1990 to July 2015. Review methods: Three reviewers independently assessed eligibility for inclusion and extracted data. Full text articles were systematically appraised using a standardised data extraction instrument in conjunction with criteria to assess whether change using Appreciative Inquiry is transformational. Results: Eight studies (reported in 11 papers) met the inclusion criteria. Overall, these studies demonstrate poor application of Appreciative Inquiry criteria in a nursing context. This makes judgement of the impact difficult. One study achieved transformation against agreed criteria for Appreciative Inquiry. Other included studies demonstrated that Appreciative Inquiry is being perceived as a gateway to knowledge translation rather than transformative change in practice. Conclusions: Appreciative Inquiry offers potential for nurse practice development and change but not without cognisance of the pivotal components. If Appreciative Inquiry is to be perceived as a legitimate research endeavour, there must be engagement and attention to rigour. Findings suggest caution is required against the choreography of Appreciative Inquiry where participant experiences are moulded to fit a previously drafted master plan. Further research is needed to explore the role of expert facilitation in securing and sustaining successful outcomes of Appreciative Inquiry

Caring about caring: an appreciative inquiry about compassionate relationship centred care

AbstractBackgroundCompassionate caring and dignity are key priorities in current policy and research agendas and are central to the quality of experience for patients, families and staff. Developing relationships has been identified as a key component in enabling excellence in caring to be realised in practice. However there is little evidence that identifies the processes involved in delivering compassionate relationship-centred care. This study sought to address this gap in the knowledge base.Aims and research questionsThe study’s aim was to examine and evaluate processes that enhance compassionate relationship-centred care within an older people care setting in an acute hospital. Key objectives were: to develop an understanding of the concept of compassionate relationship-centred care within the practice setting through exploring the views, perceptions and experiences of staff, patients and their families; to develop, implement and evaluate strategies that promote this concept; to examine the processes that need to be put in place to enable sustainability of these strategies; and to identify the lessons learnt to inform practice, education, policy and research. This study was part of a larger programme of work that aimed to integrate compassionate care across practice and education. Approach and methodsMy role as a senior nurse and practitioner researcher meant that I was in a unique position to be able to capture not just theoretical views of compassion but how this was enacted in practice. To do this the study used the approach of appreciative inquiry. A range of methods was used: participant observation, stories using emotional touchpoints, photo-elicitation, and group discussions to explore beliefs and values. Data were continually fedback to staff participants to involve them in analysis. An iterative and inductive process of immersion crystallization was used to analyse data.FindingsA key finding was the development of a practice model to support practitioners to deliver compassionate relationship-centred care. This model suggests that, in order to deliver such care, people need to engage in the process of appreciative caring conversations in order to understand a) who people are and what matters to them; and b) how people feel about their experience. This in turn enables a process of working together to shape the way things are done. The findings support the notion that during these caring conversations the practitioner needs to connect emotionally, be curious, collaborative, able to compromise, considerate of others perspectives, courageous and actively celebrate when practices have worked well in order to promote compassionate relationship-centred care. This framework comprises the 7 ‘C’s of caring conversations and makes a unique contribution to the body of knowledge in providing practical guidance as to the ‘how’ of compassionate relationship-centred care.Key outcomes of implementing this model were that people felt comfortable to express emotions, developed stronger relationships, were more consistent in delivering compassionate care practice across the team, and had a sense of learned hopefulness in the face of complex and competing demands.Conclusions and implicationsImplementation of activities in practice to support this way of working revealed that these processes are complex, often requiring the practitioner to takes risks and therefore the provision of appropriate support, facilitation and strong leadership are important factors in helping to sustain such practices. The outcomes of this research build upon the existing knowledge base by providing a practice model that specifies how to deliver compassionate relationship-centred care, and they demonstrate the impact of using appreciative approaches to facilitate improvement within health care contexts

Compassion in the nursing curriculum: making it more explicit

Working with student nurses has taught me that the majority join the profession because they genuinely want to care compassionately but this does not mean that they know what this looks like in practice. I wanted to share with students what patients and relatives say about their experiences of care, to encourage them to ask what is most important to patients, and to respond to them in a compassionate way whatever the circumstance

Caring for older people with dementia in the emergency department.

Background: Admission to an emergency department (ED) may expose the older person with dementia to a range of negative consequences, including a deterioration in their behavioural symptoms. The authors conducted a review of primary research relating to the experiences of older people with dementia, their carers and ED nurses, to understand how these experiences might inform nursing practice. Methods: Integrative review with a search of the electronic databases of Medline, CINAHL and PSYCHINFO using specified inclusion and exclusion criteria. Results: Three themes were identified: carers and older people with dementia-waiting and worrying; nurses juggling priorities; and strategies for improvement-taking a partnership approach. Conclusion: Older people with dementia may be exposed to disparities in treatment in the ED. A practice partnership between carers and ED nurses may help to prevent this. ED nurses need support to blend technical- and relationship-centred care. Participatory research exploring the experiences of older people with dementia, their carers and ED nurses is needed