Considering the person - Frailty and Resilience

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1 Considering the person - Frailty and Resilience Professor Brendan McCormack Head of the Division of Nursing/ Head of QMU Graduate School, Queen Margaret University, Edinburgh. Honorary Nurse Consultant (Gerontology), NHS Fife Professor II, University College of South East Norway, Campus Drammen; Extraordinary Professor, University of Pretoria, South Africa; Visiting Scholar, Dalhousie University, Halifax, Canada Visiting Professor, Maribor University, Slovenia Visiting Professor, Ulster University

2 Interventions to increase resistance to stress are more likely to come from focusing on ways to improve resilience than on ways to reduce frailty (Witham & Sayer 2015)

3 Not everyone who is poorly resilient is frail, and not everyone who is frail lacks resilience Static approaches to assessment The number of health deficits Individual coping abilities Holistic representation of self

4 Defining Frailty Frailty is a weakened state of being in which a person s reserve capacity is reduced to an extent where health, functioning and wellbeing are compromised. In the Precursor Stage a range of indicators can identify people who are vulnerable to frailty. Advanced frailty threatens life. Complications of frailty occur when the care delivered fails to compensate for the impact of frailty and other medical conditions on the person s physical, psychological or spiritual health, resulting in harm to the person. Complications are mostly avoidable but are occasionally unavoidable, despite evidence to show that appropriate care has been delivered. (Heath & Phair 2009)

5 Interventions Bolstering personal (psychosocial) resources Bolstering physiological and environmental resources and support

Person-Centredness respect for persons the rights of individuals as persons the values and beliefs of individuals mutual respect and understanding the development of healthful

6 Person-Centredness respect for persons the rights of individuals as persons the values and beliefs of individuals mutual respect and understanding the development of healthful relationships Being person-centred requires the formation of healthful relationships between professionals, clients and others significant to them in their lives. [McCormack McCance, in press]

7 Challenges - systems Physician-centred models Paternalistic and controlling cultures Reform of professional education Interdisciplinary working Outcome measurement

8 Key Challenges - Staff The constant tussle between conflicting priorities and the desire to live out personcentred values in practice while acknowledging that everyday practice is challenging, often stressful, sometimes chaotic and largely unpredictable... (McCance et al 2013)

9 An Outcomes Approach Quality of Life Personhood and well-being Daily functioning Health status Detrimental circumstances Outcomes for relatives/family, staff, environment

10 Vulnerability at the junctures of systems, care processes and nurses responses

11 (Health Foundation, 2014)

12 Don Berwick on Quality! Measurement and Compliance do NOT change practice, they create a culture of fear. FEAR restricts innovation and creativity. Need for person-centred services & cultures. Only learning through practice creates sustainable cultures of quality.

13 human flourishing is about individuals being in a continued state of well-being and being at their best for prolonged periods of time and when they're not, they have the resilience to bounce back stronger (Seligman 2012)

14 Collaborative practices with older people living at home with mental health problems: A personcentred approach Prof Brendan McCormack; Dr Astrid Sketvad; Ms Kristin Briesold; Dr Ann-Carin Wessel; Mr Arne Johansen; Dr Ellen Andvig, Buskerud Vestfold University College, Norway

15 Methodology Three stages: ethnography (12 months); person-centred model development (3 months); action research (practice development) (18 months) Participatory and collaborative

HCS TEAM Acknowledgeme nt & recognition Secure in decisionmaking/support for decisions made Trust within the hierarchy Cooperation Consistent assignment Flexibility & adaptability Communication space

16 HCS TEAM Acknowledgeme nt & recognition Secure in decisionmaking/support for decisions made Trust within the hierarchy Cooperation Consistent assignment Flexibility & adaptability Communication space Contact with mental health team Regime of Generosity SYSTEMS Equality/equal distribution of services [quantity control] Budget control Reputation management Meet national standards Acknowledgement & recognition PEOPLE Having a voice Acknowledgeme nt & respect Doing a decent job Respect for self [values] Working in a holistic manner Meaningful use of time Able to use expertise & competence Easily accessed support & help for low threshold needs Help to receive help Strong relationships MENTAL HEALTH TEAM Treatment & care Support the HCS team Expertise & special competence Collegiality & team building Team cohesion Mobilising positive team energy Continuing professional development

17 Common Themes Recognition and respect Good and robust relationships Recognition of own values Levels of care need Care thresholds Marginalised workers

18 The Dialogical Method A dialogue is a meeting of two beings, meeting in love, trying to understand each other. Not trying to argue, not trying to discuss just a very sympathetic attitude. Dialogue is participating in the being of each other... two friends talking with no antagonism inside, with no effort to prove yourself right and the other wrong (Arnkil, R 2008)

19 I: Yeah... mm. But eh, what I wondered in connection with this research then, it's uh, what kind of contact you have with, or cooperation you have with the municipality, that is Home Care or other stuff like that? SU: I don t have any cooperation with them. I: You have no cooperation? SU: No! They don t give a shit about me. (B11; service user - female)

20 The Dialogical Method in Action Two dialogue groups with community members and people of experience external facilitator Unstructured conversation Storytelling Story to action Stakeholder accountability

21 Outcomes Community supports and meeting places Cross-team working Reorganising work schedules to give time for relationships & enablement Ongoing development work

22 Some Thoughts on Care Priorities

23 Bounding and framing Strength & Gentleness

24 Co-existence

25 Embracing the known and yet to be known Connected Relationships

26 Living with conflicting energies

27 Being still Complementary Spaces Creating Stillness

28 Embodying contrasts

29 Harmony Capacity to be Human

30 If older people can actively determine, to the maximum extent possible, their priorities for quality of life and the services they want, care becomes more truly person-centred (Heath & Phair 2009)

31 Managing Frailty the Fife Way Discussion Panel

QI TALK TIME. Building an Irish Network of Quality Improvers. What is Person Centred Practice? Speaker: Professor Brendan Mc Cormack

QI TALK TIME. Building an Irish Network of Quality Improvers. What is Person Centred Practice? Speaker: Professor Brendan Mc Cormack QI TALK TIME Building an Irish Network of Quality Improvers What is Person Centred Practice? Speaker: Professor Brendan Mc Cormack 24 th Oct 2017 1-2 pm Connect Improve Innovate Professor Brendan McCormack