The Foundation of Nursing Studies (FoNS) In Partnership with the Burdett Trust for Nursing Patients First Supporting Nurse-led Innovation in Practice

1
The Foundation of Nursing Studies (FoNS)In
Partnership with the Burdett Trust for
NursingPatients FirstSupporting Nurse-led
Innovation in Practice

• Welcome to Workshops 1 2

2
Patients First

• FoNS in partnership with the Burdett Trust for
  Nursing is offering expert support and
  facilitation to nurse-led teams over a 12 month
  period to
• Explore how nursing teams can work with patients
  and other stakeholders to develop practice
• Identify areas of patient care which can be
  improved
• Develop a proposal for a locally focused practice
  development project/initiative
• Enable the implementation of a strategy for
  developing, changing and evaluating practice

3
Patients First

• Hopes, fears and expectations
• Getting to know each other

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Programme Aims

• This workshop programme of support and
  development aims to explore and enable effective
  ways of working to develop and change practice
  including
• Sharing experiences
• Encouraging critical reflection
• Using a variety of evidence to inform practice
• Understanding the impact of context on practice
• Identifying and working collaboratively with
  patients and other stakeholders
• Developing effective workplace cultures which are
  person centred
• Clarifying practice issues
• Enabling development and change
• Developing and critiquing effective evaluation
  strategies

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Overview of Workshop 1 2

• Over the two days we will develop an
  understanding of how practice development can
  enable ongoing improvements in practice by
  exploring together
• Values and beliefs
• Facilitation
• Culture and context
• Evaluation
• Evidence
• Action planning
• Collaboration, inclusion and participation
• Reporting and disseminating

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Introducing Practice Development

• Practice development is defined as a continuous
  process of improvement toward increased
  effectiveness in patient-centred care. This is
  brought about by helping health care teams to
  develop their knowledge and skills and to
  transform the culture and context of care. It is
  enabled and supported by facilitators committed
  to a systematic, rigorous and continuous process
  of emancipatory change that reflects the
  perspectives of service users
• Garbett and McCormack, 2002

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Purpose of practice development

• Continuous process of improvement toward
  increased effectiveness in patient and/person
  centred care
• Brought about by enabling teams to develop their
  knowledge and skills
• Is a means of transforming the context and
  culture in which nursing and healthcare care
  takes place
• Reflects the perspectives of service users
• Is enabled and supported by facilitators
  committed to systematic and rigorous processes of
  emancipatory change

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Practice development continuum or ladder

• Technical Practice Development
• PD is a technical or task focused process led by
  an expert authority figure who directs a change
  in practice toward pre-determined outcomes i.e.
  the implementation of clinical guidelines
• Emancipatory Practice Development
• PD is a process that focuses on understanding of
  the social system of practice as well as
  empowering individuals and teams to understand
  their practice and to take action to change
  (rather than be led others). It also fosters a
  transformational culture.
• Manley and McCormack, 2003

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Practice development continuum or ladder cont

• Whilst both share the purpose to increase patient
  and/or person centred care, emancipatory or
  transformatory practice development has two
  additional purposes to
• Releasing people from old patterns of working
  and/or ways of being
• Transforming workplace culture

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Successful Practice development and
Implementation of change

• Evidence
• Context
• Facilitation
• (Rycroft-Malone et al 2002)

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Adapting the hypothesis

• The successful implementation of evidence into
  practice (through practice development) is more
  likely to occur in situations
• where the research evidence is strong (high),
  there is consensus about it and it matches
  patients preferences
• the context is conducive to change/the new
  practice (high)
• appropriate approaches and mechanisms of
  facilitation are in place (high)
• The purpose is to enable person-centredness
  (including the flourishing of people)

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Assumptions within emancipatory practice
development

• Commitment to action in the long term
• Involving all stakeholders , notion of
  collaboration, inclusion and participation
• Working with and clarifying values and beliefs
• Issues and best practice locally define from
  patient experience
• Understanding context and culture and enabling
  transformation
• Developing a shared vision
• Agreeing and implementing a systematic,
  evaluative approach
• Supporting and challenging individuals, teams and
  practice
• Focusing on the process of achieving outcomes
  rather than simply achieving outcomes

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Practice Development Model
transforming individuals and contexts of care
Improving patient-person centred care
Learning in and from practice
Systematic approaches
Values and beliefs
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Practice Development towards a new definition

• Practice development is a continuous process of
  improvement towards increased effectiveness in
  patient centred care. This is brought about by
  helping healthcare teams to develop their
  knowledge and skills and to transform the culture
  and context of care, It is enabled and supported
  by facilitators committed to systematic, rigorous
  continuous processes of emancipatory change that
  reflect the perspectives of service users
• Manley, McCormack, Wilson and Thoms (2008)

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Values and beliefs

• Values and beliefs affect our attitudes and
  behaviours
• Values and beliefs are often implicit
• We can assume that we share the same values and
  beliefs

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Values clarification

• Values clarification is a way of
• Making our values and beliefs explicit
• Developing a shared vision and purpose
• Helping us to recognise the gaps between what we
  say we believe/we do and what we actually do

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Values clarification exercise 1

• Working in 3 groups to explore our values and
  beliefs about
• Person-centred care
• or
• Nurse-led services/care
• or
• Engagement

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Values clarification exercise 2

• I believe the ultimate purpose of x is
• I believe this purpose can be achieved by
•  
• I believe that the factors that help us achieve
  this purpose are
• I believe the factors that hinder us from
  achieving this purpose are
• Other values/beliefs that I hold about x are  

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Creating a shared vision or purpose

• The following stem statements may help
•  
• The ultimate purpose of x is
• This purpose can be achieved by
• The factors that will help the achievement of
  this purpose are

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Evaluation

• Evaluation is
• A judgement of value/worth
• Happens on an informal level in everyday
  healthcare practice
•  
• In the context of practice development
• A clear evaluation plan is central to being
  systematic
• Evaluation is a systematic way of practitioners
  learning from a collection of evidence they
  analyse

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Evaluation frameworks

• An evaluation framework in practice development
  should answer the following questions about a
  programme or intervention
• Whether it works
• Why it works
• For who it works
• Under what circumstances it works
• What has been learnt to make it work
• Redfern,1998 McCormack and Manley, 2004

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PRAXIS evaluation

• Praxis evaluation
• Is offered as a collaborative process for
  evaluating practice change and workplace culture
• Reflects six core components of effective
  evaluation purpose, reflexivity, approaches,
  context, intent, stakeholders
• Praxis evaluation takes into consideration
• The evaluation process
• The experience of being engaged in that process
• Ways in which the outcomes that will improve and
  impact on how healthcare is experienced can be
  captured

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PRAXIS evaluation

• Purpose Have a clear purpose (aims and
  objectives)
• Reflexivity Answer critical questions about the
  way we work and should encourage critical
  dialogue within the workplace
• Approaches Use the best approaches considering
  how they fit with the context of the purpose
  (make use of the right tools for the job!)
• ConteXt - Appreciate and reflect on how the
  culture and context can impact/influence the work
  being done and the outcome of this
• Intent - Use clear, transparent, tried and tested
  methodology and be committed to doing more than
  scratching the surface
• Stakeholders - Involve all relevant stakeholders

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Review of the Day and Closure

• Liked most?
• Liked least?
• One learning point?
• Any areas for clarification?

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Patients FirstWelcome to Workshop 2

• Any areas for clarification overnight?
• Today's programme

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Practice Development towards a new definition

• Practice development is a continuous process of
  improvement towards increased effectiveness in
  patient centred care. This is brought about by
  helping healthcare teams to develop their
  knowledge and skills and to transform the culture
  and context of care, It is enabled and supported
  by facilitators committed to systematic, rigorous
  continuous processes of emancipatory change that
  reflect the perspectives of service users
• Manley, McCormack, Wilson and Thoms (2008)

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Knowing your workplace culture and context

• What does it look like?
• What does it feel like?
• What is an effective workplace culture?
• How can we evaluate it?
• How does it influence practice change?

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What is culture?

• How things are done around here

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What do we mean by context?

• The setting and environment in which care is
  provided
• The context may change
• The context will be influenced by the culture

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Learning in practice development

• Developing people and practice is an intentional
  purpose of practice development
• Practice development integrates work-based
  learning with its focus on active learning and
  formal systems for enabling learning in the
  workplace to transform care. (Manley, K.,
  McCormack, B. and Wilson, V., 2008)
• Learning is not just focussed on personal and/or
  professional development as this may or may not
  impact on practice
• Learning is directly targeted at practice
  (patients, their needs and their care), hence the
  focus on WBL and active learning

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Reflection in practice development

• Reflection is a key activity in practice
  development
• Learning in practice development arises from self
  knowledge and awareness through structured and
  intentional reflection
• Critical analysis and reflection acts as a
  motivator for action

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Facilitating Person Centred Care

• Knowing the person
• Knowing self as person/professional role/carer
• Knowing own and others limitations
• Knowing the environment
• McCormack McCance , 2010 McCormack McCance
  2006 McCormack 2004

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Situational Facilitation

• Encouraging style
• Sharing
• Reinforcing
• Encouraging
• Praising
• Supporting style
• Turning or mulling over
• Leaving alone
• Letting go
• Being available

• Coaching style
• Involving
• Explaining
• Collaborating
• Negotiating
• Directing style
• Initiating
• Structuring
• Telling
• Guiding
• Hersey and Blanchard, 1996

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Herons Interventions

• AUTHORITATIVE
• Prescriptive A prescriptive intervention seeks
  to direct the behaviour of the patient/colleague,
  usually behaviour that is outside of the
  practitioner/patient relationship - For example,
  I would like you to discuss this issue with your
  senior colleagues
• Informative An informative intervention seeks
  to impart knowledge, information and meaning to
  the other person - For example, Grants are often
  made available for this type of work
• Confronting A confronting intervention seeks to
  raise the awareness of the patient/colleague/perso
  n about some limiting attitude or behaviour of
  which he/she is relatively unaware - For example,
  I notice this is the third time we have talked
  about this and you have still not been able to
  act I wonder what is going on?

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Herons Interventions

• FACIILITATIVE
• Cathartic A cathartic intervention seeks to
  enable the other person to discharge and express
  painful emotion, usually grief, anger or fear
  (Heron believed that unexpressed emotion could
  block development and creativity) For example
  I notice that whenever you speak about your
  research you look rather anxious.
• Catalytic A catalytic intervention seeks to
  elicit self discovery, self directed learning,
  and problem solving For example Tell me about
  a previous time when you had to work with a
  colleague who you found particularly challenging
  how did you deal with that?
• Supportive A supportive intervention seeks to
  affirm the worth and value of the other person,
  and their qualities, attitudes and actions For
  example It sounds like you handled that in a
  very mature and confident way.

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Critiquing how you intervene

• Which of the interventions do you use most often?
• Is there an intervention you do not use? Why not?
• Is there an intervention you use frequently? Why?
• Is this helping the group?
• Could you widen your repertoire of styles? How?

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Facilitation as enabling

• Enabling facilitators have
• A vision for practice development in the
  workplace
• A commitment to person-centredness
• An ability to use flexible a variety of
  approaches
• Are commited to Transformative action

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Action Planning

• Making plans to take action
• Using a framework to check you progress
• What will you being doing tomorrow?

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Ongoing Support

• Ongoing support from Diana
• Centre for Innovation
• Maintaining networking and communication
• Future workshops agreeing dates
• Other needs and/or suggestions

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Workshop Evaluation and Closure

• Doodle evaluation
• Survey monkey

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• Thank you for participating
• Have a safe journey

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