Welcome to Workshops 1 & 2

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

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

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

ProgrammeAims 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

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

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 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

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 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 facilitationare 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

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

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 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

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

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

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 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…

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

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

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

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 change • The 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 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

Heron’s 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/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 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’.

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 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 commitedto 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 participating Have a safe journey www.fons.org

Welcome to Workshops 1 & 2