Person centred care: challenging stories

Person centred care: challenging stories

Karen Barrie: National Development Manager (Patient Experience) Healthcare Improvement Scotland

Anne Waugh: Senior Teaching Fellow School of Nursing, Midwifery & Social Care Edinburgh Napier University

Jenny Eames: Student Nurse School of Nursing, Midwifery & Social Care Edinburgh Napier University

‘Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making’

Person Centredness Quality Ambition

Overview

Use of story to explore some of the challenges of

‘delivering’ and ‘measuring’ person centred care:

• Meaning Matters – Learning from Patient Stories

• First Impressions – Learning from Student Stories

Workshop focus: older people’s care:

“Does the way that achievement is currently conceptualised, measured and rewarded promote and sustain the type of care / services that meet the needs of frail and vulnerable people with compassion and dignity?”

Patterson M et al (2011)

Rationale

Rationale

• “Perform or Perish” Vs “Relational and Responsive”

• Listening to patient, carer and staff stories

• Without attributing or assuming blame

• Or identifying over-simplistic solutions

• Building up a picture of complexity and diversity

Hold the thought

• How did you feel listening to this story? What did you

notice?

• What do you think / feel about Agnes and her situation?

• Did you reach any conclusions about her experience

and her relationships with staff?

• About her care?

Hold the thought

• How did you feel hearing May’s story? What did you notice?

• Has hearing May’s story influenced your thoughts about Agnes or her situation?

• Should it?

• Does it expose any assumptions made previously?

Discussion prompts

• What have you learned from your reactions to hearing Agnes and May’s stories?

• What do these stories tell us about some of the challenges of ‘delivering’ person centred care?

• What actions would you like to take in response to hearing the stories?

• What would be the main challenges of ‘measuring’ improvements resulting from your actions?

Using compassionate care stories in the curriculum:

sharing students’ experiences

Students wrote a story illustrating their experience of compassionate care in a placement to earn a place at the First Leadership in Compassionate Care Conference (2010)

Recognition of a useful resource

Background

Using the stories with students

• A regular reflective group session (15 students)• Formats:

AudioSet to music Digital stories

• Feedback from students:What did they like about the [specific] stories?How did the stories support their learning?Preferred formats?

Student feedback

• ‘Leaving the session feeling inspired’

• ‘Highlights how the small things we might often overlook

make a big difference’

• ‘Shows how daunting nursing can be’

• ‘Reassures you other people feel the same’

• ‘They are good for starting reflective discussion’

Student feedback

• ‘They give you a good starting point and focus’• ‘They promote discussion about feelings’• ‘Makes you feel bad if your mentor isn’t like

this one’• ‘Show confidence, compassion – inspiring!’• ‘It makes you reflect on practice you’ve

witnessed!’

Podcasts (audio files)• Students would like to hear more• Would be valuable to have situations like

these available to everyone• Many would use if sent to their phones and /

or available online

Digital stories• Most students preferred this format,

especially for classroom use

Preferred format?

Jenny’s reflection

• Choosing a story from placement• Stopping and thinking• The patient - I could find myself in their

shoes• Pulling everything together to produce a

digital story

Jenny’s reflection: making a digital story

• Creativity involved in the process• Sharing experiences• Useful for presenting good examples and

prompting improvements in care delivery• The impact........It only takes 3 - 6 minutes!

Reflection: using the stories with students

• Students would be happy to hear ‘less good stories’

• All formats worked well• ‘Short is good’• Very useful to initiate constructive discussion

involving emotions & feelings about experience in nursing practice

Discussion prompts

• How did hearing Kenneth and Jenny’s stories make you feel?

• How might the stories be useful in clinical settings?

• How else could student stories be used in learning and teaching?

Conclusion

• Learning from people’s experiences without resorting to blame or over-simplistic solutions

• And appreciating how someone is making sense of their experience:• When asking about experiences in

personalised and sensitive ways• When listening to stories in learning or

improvement contexts

Conclusion

• Students can offer a unique perspective on the quality of care

• As change agents of the future, this perspective should be heard and understood

• Multi-media formats increase the possibilities within and outside of the classroom

References• Bridges J et al (2009) Best Practice for Older People in Acute Care

Settings: Guidance for Nursing Staff Nursing Times RCN Publishing / City University London

• Nolan M et al (2006) The Senses Framework. Improving care for older people through a relationship-centred approach. Getting Research Into Practice (GRIP) Report No. 2, University of Sheffield

• Patterson M et al (2011) From Metrics to Meaning: Culture Change and Quality of Acute Hospital Care SDO

• Tadd W et al (2011) Dignity in Practice: An exploration of the care of older adults in acute NHS hospital trusts. PANICOA Publication