"A Whole New World" Facilitating Person-Centred Care: An Action Research Study

The impetus for this action research study arose from discussions between the Director of Care (DOC) of an Aged Care Facility (referred to by the pseudonym Beaches Care of the Aged, throughout this document) and myself regarding integration of person-centred care into practice. We agreed that many residential aged care facilities purport to have a person-centred approach to care, including Beaches Care of the Aged; however the question remains whether it is more an ideal rather than a reality in residential aged care. The aim of the study was to support managers and caregivers at three rurally located residential aged care services implement and sustain a person-centred care approach.

Beaches Care of the Aged first introduced person-centred care in 2007 following discussions at management meetings regarding the need to review the task-centred approach to care used at that time. Initial training and education occurred in mid-2008 and continued for a short time. However, due to the organisation taking over an aged care facility under sanction, the change management and training programs were not fully implemented. The DOC stated she would like to know unequivocally if the managers and staff at Beaches Care of the Aged understood and implemented a person-centred approach to the care they provided. She added that she was interested in the effect management and leadership had in the implementation of person-centred care, stating the importance of well-trained managers specific to the sensitive needs of residential aged care. Following discussions with her, I decided to undertake a PhD study examining person-centred care understanding and the implementation process. The DOC supported my decision and ensured her support of the study and that of the managers. A review of the literature demonstrated that person-centred care is considered the ideal approach in aged care rather than a task centred or biomedical approach. However, person-centred care is poorly defined and little understood, and there is a need for further collaboration and engagement of caregivers within organisations to assist integration of the philosophy into practice. Action research was the methodology of choice for the study as this collaborative change focussed research approach is empowering to participants who are both participants and researchers. The study included three aged care facilities: Beaches Care of the Aged; The Lighthouse, Seaview, and Sandcastles. Three action research groups were formed and six action research cycles at each facility were completed overall over a six-month timeframe. The study was a negotiated cyclical process; therefore, for the intent of my PhD, my facilitation of the process was limited. Each group consisted of between four and twelve participants, and participation was voluntary. All participants were employees of Beaches Care of the Aged working in one of the three facilities within the organisation. Multiple data generation approaches were adopted which included: observation, photo elicitation, reflective journals, memos, self-assessment, field notes, audio tapes and checklists. Group meetings were digitally recorded and subsequently transcribed to gather information for data analysis. The four elements of action research; planning, action, observation, and reflection, were applied throughout the study. Initially, data from all three sites were kept separate with analysis involving coding, reflection, thematic analysis, analysis of action research group data and interpretation.

The study makes an original and substantive contribution to the nursing body of knowledge and further research with the generation of new knowledge. It is of significant value to residential aged care: aiding understanding and insight into the complexities of implementing a person-centred care approach, improving care standards and practice, as well as the importance of change management.