Person Centred Care Assignment

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This is the opening line of the popular 1960’s song and the title I choose for my change project.
I have worked in the area of care of the elderly for the past 20 years having transitioned from Sick Children’s Nursing. I have been fortunate to work in small units where there was good local knowledge of the residents.
However in recent times I have become shocked at the type of care given in these units. It appears prescriptive, medically based and care is based on the average needs with no recognition of the individual needs.
The idea of person-centred care seems obvious and ideal and it was with great relief that I found not only likeminded individuals existed but that research and education existed also. In particular the writings of Kitwood
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I had previously worked in Northern Ireland where many changes had taken place, single room accommodation with personal furnishings were standard 20 years ago. Individualised care plans were also in use. Care in our HSE units appears to be based on a very old model of care. Indeed it seems more welfare based and as I have often been told “they should be glad to be here” and “if they don’t like it let them take them back home” .Since the introduction of the Fair Deal Scheme, residents and families have become more empowered and critical of care standards.
This along with the regular inspection of care facilities by HIQUA has raised the standard of care for all residents in care.
However it seems while policy, documentation and building standards are visible and auditable, care is more difficult to change. Culture is the greatest barrier to change.
My vision was that education would illuminate our care; we would gain the knowledge and change our practises.
This seemed very achievable after all the nursing staff are educated to a very high standard with a wealth of experience to draw on .The carers are all now trained to NVQ standards. Dementia training, such as the 3 day course has been attended by all grades of staff employed in the unit including catering and household staff.
It would appear that all that was required was to apply our combined knowledge and forge ahead with better
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The unit is small 18 residents and local so good knowledge of each resident is already available. I found that residents with more advanced dementia did not bring with them a detailed personal history and family involvement was critical. It is evident that behaviours displayed viewed by staff as challenging were often reflective of past lives e.g. sleep patterns.
“The secret of health for both mind and body is not to mourn for the past, nor to worry about the future, but to live the present moment wisely and earnestly.” Buddha.
In order to effect this change I decided to reflect on the change model as outlined by Kurt Lewin. This allowed me to identify and understand where I could expect resistance and assistance. Drawing from Dr Kate’s lecture on change with regard to managing change it was easy to see that Transformational style would have the greatest chance of success
1. Create the vision 2. Motivate the change
3. Delivery of the vision.
“Learning is more effective when it is an active rather than a passive process “-Kurt

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