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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