The Foundation of
Nursing Studies
(FoNS)
In Partnership with
the Burdett Trust for
Nursing
Patients First
Supporting Nurseled 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
Patients First
Hopes,
fears and expectations
Getting
to know each other
Programme Aims
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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
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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
facilitation are in place (‘high’)
 The purpose is to enable person-centredness
(including the flourishing of people)
Assumptions within emancipatory
practice development
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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
Improving
patient-person
centred care
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
 We
and beliefs are often implicit
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
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I believe the ultimate purpose of x is …
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I believe this purpose can be achieved by …
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I believe that the factors that help us achieve
this purpose are …
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I believe the factors that hinder us from
achieving this purpose are …
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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:
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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
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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
 Any
learning point…?
areas for clarification…?
Patients First
Welcome 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
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Developing people and practice is an intentional
purpose of practice development
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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)
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Learning is not just focussed on personal and/or
professional development as this may or may not
impact on practice
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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
Coaching style
 Involving
 Explaining
 Collaborating
 Negotiating
Supporting style
 Turning or mulling
over
 Leaving alone
 Letting go
 Being available
Directing style
 Initiating
 Structuring
 Telling
 Guiding
Hersey and Blanchard, 1996
Heron’s Interventions
AUTHORITATIVE
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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’
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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’
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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
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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’.
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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?
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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 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
Survey
evaluation
monkey
Thank you for participating
Have a safe journey
www.fons.org