The vision of person-centred cultures is core to all policy and standards in healthcare in Ireland (Health Information and Quality Authority, 2012) and globally (World Health Organisation, 2007) implementing these strategies and standards require focused development of staff who deliver care in our health services (Department of Health and Children, 2010). In the acute hospital setting in Ireland this staff development has largely been technical in its approach to date. Evidence suggests that for person-centred cultures to emerge, purposeful Practice Development (PD) needs to be facilitated within the workplace (McCormack et al, 2010). The role of clinical nursing leaders is pivotal in developing and sustaining person-centred cultures and is therefore a key element of all PD activity (McCormack et al, 2010; Brown and McCormack, 2016). If PD is to become more meaningful to nursing leaders as part of their daily work, more focus must be placed on making the development and ‘doing’ of facilitation easier. Although complex facilitation frameworks such as Critical Companionship (Titchen, 2002) remain an exemplar in the development of expert facilitation skills, use of this particular framework has been minimal due largely to its complexity (Dewing and Wright, 2004; Greggans and Conlon, 2009). To address this gap two sequential facilitation frameworks Critical Allies and Critical Friends (Hardiman and Dewing, 2014) were developed by the author to provide a stepped approach to the development of work based facilitators. This doctoral research study uses Participatory Action Research to test the use of Critical Allies and Critical Friends within an acute hospital setting. The study is theoretically located in Critical Social Science and Person-centredness. The study is conducted using an insider researcher approach to work with clinical nursing leaders within their own workplace.
The study addresses the following research questions:
- What does a person-centred model for work based facilitation look like?
- How do work based facilitation skills enhance the development person-centred cultures?
- What are the implications for existing education/training frameworks in care services in Ireland should a work based learning facilitation model be established and adopted?
It also makes a contribution to the methods for achieving communicative spaces and discourse in busy workplaces and proposes that facilitation is not stationary and can be delivered by novice and proficient facilitators in certain conditions.
Outcomes
The frameworks and the associated tools offer novice and proficient facilitators a guide to the development of work based facilitation skills that can build up over time. This enables nurses to work with colleagues to help them to learn in and from work, grow their expertise and contribute to developing person-centredness in the workplace. The study has global application to contexts interested in developing person-centred cultures. It is unique in its focus on the development of novice and proficient facilitators that can impact on the development of themselves and on person-centred cultures.
