The Foundation of Nursing

Studies (FoNS)In Partnership

with the Burdett Trust for Nursing

Patients FirstSupporting Nurse-led

Innovation in Practice

Welcome to

Workshops 1 & 2

Patients FirstFoNS 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

Patients First

Hopes, fears and expectations

Getting to know each other

Programme AimsThis 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

Overview of Workshop 1 & 2Over 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

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

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

Practice development continuum or ladderTechnical Practice DevelopmentPD 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 DevelopmentPD 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

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

Successful Practice development and Implementation of change

Evidence Context Facilitation

(Rycroft-Malone et al 2002)

Adapting the hypothesisThe successful implementation of evidence into practice (through practice development) is more likely to occur in situationswhere the research evidence is strong (‘high’), there is consensus about it and it matches patients’ preferencesthe 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)

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

Improving patient-personcentred care

Learning in

and from

practi

ce

Systematic

approaches

Practice Development Model

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)

Values and beliefsValues and beliefs affect our

attitudes and behaviours

Values and beliefs are often implicit

We can assume that we share the same values and beliefs

Values clarification

Values clarification is a way of:Making our values and beliefs explicitDeveloping a shared vision and purposeHelping us to recognise the gaps between what we say we believe/we do and what we actually do

Values clarification exercise 1Working in 3 groups to explore our values and beliefs about:

Person-centred careor

Nurse-led services/careor

Engagement

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 … 

Creating a shared vision or purposeThe 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…

EvaluationEvaluation is:A judgement of value/worthHappens 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

Evaluation frameworks

An evaluation framework in practice development should answer the following questions about a programme or intervention:

Whether it worksWhy it worksFor who it worksUnder what circumstances it worksWhat has been learnt to make it work

Redfern,1998; McCormack and Manley, 2004

PRAXIS evaluation Praxis evaluation:Is offered as a collaborative process for evaluating practice change and workplace cultureReflects six core components of effective evaluation: purpose, reflexivity, approaches, context, intent, stakeholders

Praxis evaluation takes into consideration:The evaluation processThe experience of being engaged in that processWays in which the outcomes that will improve and impact on how healthcare is experienced can be captured

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

Review of the Day and Closure

Liked most…?

Liked least…?

One learning point…?

Any areas for clarification…?

Patients FirstWelcome to Workshop 2 Any areas for clarification overnight…?

Today's programme

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)

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?

What is culture?

“How things are done around here”

What do we mean by context?

The setting and environment in which care is provided

The context may changeThe context will be influenced by

the culture

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

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

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

Situational FacilitationEncouraging 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

Heron’s InterventionsAUTHORITATIVE

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/person 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?

Heron’s InterventionsFACIILITATIVE

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’.

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?

Facilitation as enablingEnabling facilitators have: A vision for practice development in the workplaceA commitment to person-centrednessAn ability to use flexible a variety of approachesAre commited to Transformative action

Action Planning Making plans to take action

Using a framework to check you progress

What will you being doing tomorrow?

Ongoing Support

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

Workshop Evaluation and Closure

Doodle evaluation

Survey monkey

Thank you for participatingHave a safe journey

www.fons.org