Exploring Person- Centredness in the Emergency Department

Exploring Person-Centredness in the

Emergency Department

Donna McConnell PhD Student

Prof Tanya McCance

Dr Vidar Melby

Dr Paul Slater (adviser)

Person-Centred Practice Framework(McCormack & McCance 2010)

Person-centred practice has shown to transform practices for patients...

• increased choice and involvement in decision making

• improved quality of nurse/patient engagements

• staff taking time to get to ‘know’ the person in a more meaningful way

• staff were more person-centred, in their language and team-work

• a reduction in ritual and routine

....and staff

• a shift in values to appreciate caring over the technical aspects of nursing care

• increased effectiveness of teamwork and workload management

• improved staff relationships with more effective collaborative working

• increased personal and professional job satisfaction - less intention to leave posts

• a more effective use of resourcesMcCormack et al (2010)

Themes from the literature• There is a distinct culture within EDs• The nature of ED work – saving lives, a medical-

technical environment where technology, medical status and patient throughput is valued over caring

• A culture of worthiness – appropriate pts for ED and the place of those who did not fit in with this

• Staff experience of working in ED• A stressful environment • Violence and aggression• Managing the patient journey – high responsibility,

low power

Themes from the literature• Fragmented care• Lack of privacy• A feeling of not being considered as an

individual and a lack of caring • Feeling abandoned, exposed, vulnerable,

ashamed, ignored, insecure, frightened forgotten or unwelcome

• Worse for vulnerable groups - older people, those with mental health issues and those at end of life

Aim

To explore person-centred practice within the ED environment.

• 2 stages

• Stage 1• Staff

questionnaire

• Stage 2

• Staff interviews

• Patient interviews

Methodology

Data collection

• Pilot study undertaken in August 2013

• Stage 1 - 714 questionnaires distributed to nursing and medical staff in 11 EDs in all 5 trusts in NI during March and April 2014

• Reminder letters sent

• Questionnaires returned 317 (44%)

• Effective responses 294 (41%)

Missing data n=13

Staff responded neutrally indicating that they neither agreed nor disagreed that they worked in a care environment

conducive to person-centred practice

Total mean score = 3.5(1 = Strongly Disagree to 5 = Strongly Agree)

Items comprising Supportive Organisational Systems scale

1 = Strongly Disagree to 5 = Strongly Agree

My team take time to celebrate achievements. 2.4

My organisation recognises and rewards success. 2.4

I am recognised for the contribution that I make to people having a good experience of care. 3.0

I am supported to express concerns about an aspect of care. 3.2

I have the opportunity to discuss my practice and professional development on a regular basis. 2.7

Staff agreed that they engaged in the necessary care processes to deliver person-centred practice

Total mean score = 4(1 = Strongly Disagree to 5 = Strongly Agree)