As we approach the big day, 25th December, I remember my personal values of family and fun. So here’s to a lovely family orientated Christmas for me and all who read this! Added to my usual festive havoc is studying for a doctorate. I am looking forward to family relaxation, but if I am really honest I know the doctorate will be in my thoughts too. However, this year feels better than last year, when I worked through the Christmas holidays to submit my 1st academic piece of work. Last year, it was all just beginning. This year I am ¾ way through the taught component of my doctorate, with just one more academically assessed piece to work on February – May 2016. Then onto the meat of the actual research process, blogging makes me realise how far I have come in the process and my thinking. Hopefully it will let those who read it “get” where I am too.
I was so pleased to finish and submit my last assessment, however afterwards I found myself unable to connect with my studies for a few weeks. They still occupied a daily part of my thinking, but I needed some time and space away from books, journals, websites, social media and writing. I told myself, once I get my results I will get myself back into it. I got them two weeks ago and I still feel I need space. With just 6 days until Christmas I find myself thinking, maybe leave it until the New Year. Then the guilt hits me, “I should be studying, I am letting go of my processes that work, I should go to Uni”! So here I am, but just for a little while. I am giving myself permission, to slow down my studies for a few weeks and then come back refreshed with my usual motivation. So where am I, at this point?
I am absolutely clear that my doctorate research will explore the essence of Person Centred Care (PCC) for older people in acute hospital (OPAH). What do I mean by this? The Scottish Government (2010) define Person Centred Care as “mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision making”. Political drivers are pushing for PCC cultures of care (Scottish Government 2010, 2011, Department of Health (DOH) 2009); in particular for OPAH (Health Improvement Scotland 2014). The intention of my research is to add to the PCC body of knowledge, positively influence OPAH care and PCC nurse education.
The intended primary impact will be on OPAH’s clinical care, initially in the area of the research then wider areas of practice as the research is disseminated. The impact will be, clinical staff will learn what really matters from patients / their families’ perspectives and hopefully adapt their care practices accordingly. This will not be without its challenges. By exploring PCC from the MDT perspective their interpretation of PCC will be elicited, to challenge ambiguity in the definition of PCC (De Silva 2014, McCrae 2013). The intended secondary impact will be in nurse education, initially within the my employing organisation, and then more widely once the research is disseminated. I have to plan this way, as mine is a Doctorate of Professional Practice (DPP), so must link to my areas of professional practice, nursing and nurse education; as well as add to the body of PCC knowledge. Throughout my doctorate programme, increased awareness of the PCC knowledge base will be incorporated into the pre registration nursing programme in my employing University. By engaging in public output associated with the research, throughout the doctorate, there will be wider impact on nurse education beyond the author’s own employing organisation.
Impacting change begins with developing an understanding of “why” things are the way they are in the current situation; for me this means discovering the reasons PCC is delivered and experienced in the way it is. I have learnt that this links to Habermas’ social theory (University of Stanford 2014) which advocates pragmatic communication, empowering people to be involved, in particular if there is the potential for personal gain, by being involved. This communication should be based on rational understanding but often aspects of society are colonised by powerful institutions, information is not heard.
In terms of PCC for OPAH, policy clearly states is the way to deliver high quality healthcare. However, the strategic philosophy of care can get lost in operationalization, as multiple public scandals of health care provision have shown. Indeed, my own motivation to study PCC at doctorate level stems from dissatisfaction the non person centred approached I witnessed throughout a loved one’s journey while in acute and primary care dying from cancer; where the sense of “whole person” disappeared into a process driven system. There was a level of acceptance my brother and my family that that was just the way things had to be, they were colonised, as Habermas describes by poor PCC operationally; despite the strategic drive. Bevan (2013) recognises that using Habermas’ critical social theory can give equality to research participants shared experience, where each participant’s contribution helps shape a more meaningful understanding of a phenomenon. Crucial to Habermas’ (1981) theory is giving a voice to those who are usually not heard, the older person, their families and the MDT could all fall into this category. By involving the latter groups in this research the intention is to positively use Habermas’ theory to empower those involved in PCC. This may well become my theoretical lens.
There is a body of evidence out there around PCC in OPAH, I hope to add to this, not re-invent around it. Despite the evidence out there PCC is not yet the way things are consistently done in healthcare, so there appears room in the evidence base for my contributions.
I read this and think WOW! I think I know what I am doing and Habermas really fits to this, there is a click in my mind. This also happened when I met with the Quality Improvement Advisor for OPAH in the area I intend to carry out my research. She understood where I was coming from, linking to MDT staff following processes instead of thinking about the person at the centre of the process. She linked this to Carper’s theory of knowing (1978); this empirical work, classified nurses’ ways of knowing into scientific, personal, ethical and aesthetic. Her personal view was at times this can get lost in the systematic processes of acute care, but the work of Quality Improvement within her area of influence was to re-institute this.
So, I guess when I reflect on where my doctorate thoughts are as I allow myself some time to rejuvenate, I am content that they are much further on than this time last year. I said at the start of this blog today, I am certain that my doctorate research will explore the essence of Person Centred Care (PCC) for older people in acute hospital (OPAH). This year has taught me that the doctorate research idea starts as a seed and grows into a monstrous tree that frequently requires pruning to allow it to blossom into something meaningful. So although today I have a degree of clarity, I realise until I get to the point of a completed proposal my plans will be open to change! This will be my next module in February. For now, I need some personal family fun times, I am still eager to pursue this doctorate that will hopefully make a difference, but right now it’s time to say Merry Christmas to all and to all a good night! See you next year!
Bevan, A. L. (2013). Creating communicative spaces in an action research study. Nurse Researcher, 21(2), 14 – 17.
Carper, B.A. (1978) Fundamental Patterns of Knowing in Nursing. Advances in Nursing Science 1(1), 13–24.
De Silva, D. (2014). Helping measure person- centred care. London: The Health Foundation.
Department of Health. (2009). Final report on the review of the department of health dignity in care campaign. Retrieved October 11th from http://sfx-44nhss.hosted.exlibrisgroup.com/44nhss?issn=&isbn=&volume=&issue=&pages=&title=Final report on the review of the Department of Health Dignity in Care Campaign.&doi=&aulast=
Habermas, J. (1981). The theory of communicative action – volume 1: Reason and the rationalization of society . Boston, MA, USA.: Beacon Press. IN Bevan, A. L. (2013). Creating communicative spaces in an action research study. Nurse Researcher, 21(2), 14 – 17.
Habermas, J. (1998). Remarks on legitimation, through human rights, The Modern Schoolman, LXXV, pp 87 – 101. Modern Schoolman, LXXV, pp 87 – 101.
Healthcare Improvement Scotland. (2014). Driving improvements in healthcare, our strategy, 2014 – 2020. Retrieved 5 January, 2015, from http://www.healthcareimprovementscotland.org/previous_resources/policy_and_strategy/our_strategy_2014-2020.aspx
McCrae, N. (2013). Person-centred care: Rhetoric and reality in a public healthcare system. British Journal of Nursing, 22(19), 1125-1128
Scottish Government. (2010). The healthcare quality strategy for NHS in Scotland. Edinburgh: Scottish Government.
Scottish Government. (2011). The patients rights act. Retrieved October 15th, 2015, from http://www.legislation.gov.uk/asp/2011/5/contents
University of Stanford. (2014). Jurgen Habermas,Stanford encyclopedia of philosophy [online] Retrieved September 28th, 2015, from http://plato.stanford.edu/entries/habermas