1 person-centred planning processes in action: a description and analysis of processes used to...
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Person-Centred Planning
Processes in Action:A Description and Analysis of
processes used to implement person centred planning in a residential centre
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Research Questions
• What are the implementation processes of St. Vincent’s Approach to Care?
• What appear to be the strongest and weakest aspects of these processes?
• What, if any, are the barriers to successful implementation of the processes?
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RESEARCH DESIGN
Review of the literature on PCP Q uestionnaire Instrum ent Holburn et al (2000)
Instrum ent required adaptation
Focus Group Interview N=10
Analysis of data- Form ulisation of 1st draft of IPPCPS
1st Draft of IPPCPS distributed - Pilot Study- N=21
Further Adaptation of Q uestionnaire Instrum ent
Final Draft of IPPCPS Instrum ent distributed -M ain Study- N=147
N=103 com pleted IPPCPS inputted into SPSS Statistical Package-Process Analysis of Data
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IPPCPS Instrument• Section A:Organisational Framework.
• Section B: Personal Planning.
• Section C:Collaboration.
• Section D:Spirituality.
• Section E: Demographic data of respondents
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Presentation of Significant Findings
Carestaff 18 P.E. Teacher 1
Speech Therapist 1 CNM2 8
Named Nurse Unit Based 53 Psychologist 2
Occupational Therapist 5 Social Worker 1
Named Nurse Day Service 9 CNM3 3
Psychiatrist 1 Manager 1
Total 103
No of respondents and relationship with service user
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Section A: Organisational Framework
•The study found that a number of core systematic processes were employed across nearly the entire organisation, which could be conducive to person-centred planning.
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A Lack of systematic processes were found:
• An advocate is the least proposed person to be at IPP meetings.
• Extra funding is seldom made available enabling the service user achieve his/her outcomes.
• Most nurses have had training in person-centred planning whereas only a few multidisciplinary team members and care staff attended training sessions.
• Responses varied in agreement relating to the presence of a skilled facilitator guiding the group in creating a common vision for the service user.
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Section B:Personal Planning (Significant Findings)
• Staff place more emphasis on identifying priorities and setting goals than identifying preferences and perspectives of the service user.
• Priorities are set and goals are achieved to the relative neglect of taking the service users preferences and perspectives into account. – Interestingly
• Staff who had attended training sessions in spiritual awareness/ reflective learning tended to place more emphasis on identifying preferences and perspectives of the service user.
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identifying outcomes(2)
0
5
10
15
20
25
30
35
alw
ays
usua
lly
50%
of t
ime
seld
om
neve
r
mis
sing
%of
res
pond
ents
N=1
03
Personal outcomes aredefined by the person
evidence is availabledetermining how theperson defined his/heroutcomes
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Cross Tabulation:Identifying Outcomes
• Highest numbers of nurses report that evidence is available determining how the person has defined his/her outcomes
• In contrast:
• Highest numbers of the multidisciplinary team members report evidence is rarely available.
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Processes supporting the achievement of personal outcomes
0
10
20
30
40
50
60
% o
f res
pond
ents
N=1
03
The service specif ically applies itspolicies and procedures to enablethis person to achieve his/heroutcomes
The person and/or those w ho knowhim/her best make decisions aboutboth major and minor uses ofresources
The person and/or those w ho knowhim /her best about major & minoruses of funding
A copy of the minutes of Individualprogramme meetings are sent tofamily
contributions of supportingmembers concentrate on w hat'simportant for the person from theperson's perspective
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Collaborationinformation sharing across disciplines
020406080
100el
ectr
onic
mea
ns
pers
onal
file
care
plan
% o
f res
pond
ents
TRUE
uncertain
not true
missing
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Variations in Responses:• More clinical nurse managers and named nurses
unit based have more beliefs regarding a service users preferences and perspectives of quality of life issues than multidisciplinary team members, named nurses day service and care staff
• More nurses and care staff report that evidence is available determining how the person has identified his/her outcomes than multidisciplinary team members and managers who report that evidence is rarely available determining how the person identified his/her outcomes.
• Disparities are present relating to whether or not personal outcomes are defined by the person irrespective of his/her level of disability.
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Highest no’s “Don’t know” Highest no’s • N=28 (27.2%) “don't know” how many personal
friends the service user has.• N=58 (56%) “don't know” if the service user has
a meaningful regularly recurring relationship with another person with L.D. living outside the centre.
• N=46 (45%) “don't know” if the service user has a meaningful regularly recurring relationship with somebody from the community other than family.
• N=29 (28.2%) of staff “don't know” if the service user has access to pets.
• N=42 (40.8%) of staff report that the service user would “properly not” be allowed have an intimate relationship.
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Recommendations
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Education
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Advocacy
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Get Big Ears and Listen until we HEAR
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Personal Vision -Competent Facilitation
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Common vision
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Family Involvement
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It’s My Money!!!!
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UNDERSTANDING HOW A PERSON WANTS TO LIVE
COMPARE WITH HOW THEY LIVE NOW
ADDRESS ISSUES OF HEALTH/SAFETY IN THE CONTEXT OF HOW THE
PERSON WANTS TO LIVE
A LIFE THAT MAKES SENSE TO THE
INDIVIDUAL (O’Brien, 2000)
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Accountability
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Spirituality -Friendships
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Terminology- “Nurse”
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Where Do We Go From Here????
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