This document summarizes a project aimed at advancing person-centered care in two dementia units in Donegal, Ireland. A project team used the method of identifying and recording "person-centered moments" over 6 weeks to map interactions onto a person-centered framework. They found 66 moments across both units that demonstrated person-centered processes like engaging authentically and providing holistic care, as well as outcomes like good care experience and feeling of wellbeing. The next steps are to have staff observe interactions between residents and each other to further develop person-centered team processes and shared decision making.

1. Celebrating Advances in Older Persons Nursing
Maura Gillen
& Donegal Practice Development Project Team
Person Centred Moments: Advancing Person Centred
Culture in Donegal Older People’s Services

2. M s M a u r a G i l l e n, B S c , R G N , M S c P G D i p
P D C o o r d i n a t or O l d e r P e r s o n s S e r v i c e D o n e g a l .
M s M a i r e a d O ’N e i l l , R G N , P G D i p .
C N M A r d A o i b h i n n , C a r n d o n a g h
3 r d M a y 2 0 1 8 – A I G N A C o n f e r e n c e , G a l wa y
Person-Centred Moments:
Advancing Person-centred Culture
in 2 Dementia Units in Donegal

3. County Donegal
Ard
Aoibhinn,
Carndonagh
Woodville,
Stranorlar

4. Project Team Members
•*Jan Dewing – External facilitator from QMU and Project Lead
•*Maura Gillen – Internal facilitator HSE / Practice Development OPS
•*Mairead O Neil – CNM Ard Aoibhinn / Internal facilitator
•*Liz Breslin - External facilitator NMPD Donegal
•Gwen Mooney – Service Manager Older Persons Service Donegal
•Kathleen Doherty – DoN St Josephs
•Finola Mc Colgan - A/DoN Carndonagh
•Eamon Glackin – DoN Carndonagh
•Sandra Gillespie – CNM Woodville
•Mags Kerlin – Community mental health Team
•Diane Donnelly – Carers Development Officer and Dementia Support Donegal
•Julie Bradley – Occupational Therapist in Ard Aoibhinn
 * Indicates members who contributed to the presentation

5. Espoused Dementia Care in Donegal
There are two specific assessment dementia care residential units for the County
of Donegal (St Joseph’s, Stranorlar and Ard Aoibhinn, Carndonagh).
Key Principles of care:
All individuals and their carers are at the centre of care.
Multi-disciplinary and multi-agency approach
Person-centre care philosophy
Nurse-led services
Resident and staff engagement
Community involvement
Does it happen in practice?

6. What is Practice Development?
Continuous process of development of person-centred cultures
and their outcomes.
 Enabled by facilitators who authentically engage with
individual and teams to blend personal qualities and creative
imagination with practice skills and practice wisdom.
Learning that what occurs brings about transformations of
individual teams practice.
Sustained by embedding both processes and outcomes in
corporate strategy
(adapted from Manley et al., 2008)

7. Project Frameworks (Research and Policy)

8. The Project in Donegal
 The Donegal Person Centred Practice Development Project, in partnership
with QMU Edinburgh, is in progress with teams in two dementia care units
in Donegal.
 Links to the HSE QI strategy / National programme
 The project draws explicitly on the Person Centred Framework
(McCormack and McCance 2017) as a theoretical model along with tested
practice development principles and processes;
 including external and internal facilitation and active learning to enable two teams and the
managers, to transform their culture and the way of caring for persons living with dementia.
 The project also intends to build capacity for practice development
processes so the culture transformation can continue after the formal
project has concluded.
 Exploring what person centred moments are and how they can be used for
learning has been an important step in that journey (McCormack et al
2011) and is the focus of this presentation.

9. Bigger Picture
Supporting Framework: Moving on from Moments
The Compliance Service Improvement and Innovation Model (CoSII ) (Dewing 2015; Dewing
& McCormack 2017)

10. Moving from Moments to Patterns
 Person Centred Moments exist in all of our workspaces and
cultures.
 In Practice Development we want everyone to recognise the
moments and move towards patterns of person-centredness that fit
with the values and beliefs of those engaged in care.
 Moving “moments” to “patterns” takes energy and leadership and
through the Practice Development processes of observation,
reflection and feedback, facilitators need to support colleagues to
move towards :
 Recognising a person-centred moment
 Joining moments together in an intentional way
 Learning to evaluate them for themselves
 Getting used to receiving and offering feedback
 Why do this – what is the bigger picture intention?

11. Person-centred Moments: Our method
 Proposed by Jan Dewing, who also devised a simple recording method to
be tried out
 The process involved the PD team member identifying moments created by
others and recording the essence of the moment in a note.
 The project member reflected on the moment and on what feedback could
be offered and the best way to do this.
 Made time to share and feedback to colleagues and explore together, their
learning in the context of the Person-centred Practice Framework.
 After a period of 6 weeks, project team members were facilitated to group
moments together and then map these onto the Person-centred Practice
Framework; person centred processes and person-centred outcomes.
 Wider dialogue about what the findings mean
 Revised the record sheet
 Next step is to engage more team members in the method to ‘spread’ its use
across the unit teams

12. Person-centred Moments
Aim of Using the Moments:
 The overall aim is to enable practitioners to recognise ‘tasks’ are built around moments of
person-centredness.
 ‘Moments’ build person-centred cultures
 Moments need to be recognised and acknowledged by workplace facilitators on an ongoing
basis
 This first move is described as the most difficult. And was for us!
 What does a moment look like?
Examples:
 The staff member that takes an extra 5 minutes to sit with a person in silence - the comfort of
touch
 The staff member that supports the person living with dementia to stand on the deep grass that
hasn’t been cut and watch them smile
 That extra prayer that just has to be said by the resident despite the pressure of the ward
routine and dinners to go out
 Playing a favourite song and taking time to dance and move to the music as though at a dance in
days gone by
 A singsong that starts and grows into a group song where everyone is encouraged to take part
and sing the song they know, or just to ask for their song and to sit back and listen to their
favourite song being sung.

13. Processes involved in PcMs
 In the moment noticing and recognition of person-
centredess.
 Reflective space to review the person-centred moment
 Dialogue and Feedback among colleagues on what
has been noticed and shared
 Actions agreeing what will happen based on learning
 Values and Beliefs about person-centredness reviewed
and better understood

14. Feedback from the Team
“Giving feedback is
not easy .it made me
nervous the first
time I did it….”

15. Overview of Findings
 At the 6 month timeline, 66 PcM observations took
place across both units and mapped onto the PCP
Framework as:
Person Centred Processs Unit A Unit B Total
Working with patients Values
and Beliefs
2 7 9
Engaging Authentically 11 17 28
Shared Decision Making 0 2 2
Sympathetic Presence 5 2 7
Providing Holistic care 12 8 20

16. Findings continued
 The Person-centred Outcomes were recorded
as follows for the 66 recorded observations:
Person Centred Outcomes Unit A Unit B Total
Good Care experience 9 2 11
Involvement in Care 6 10 16
Feeling of Wellbeing 16 20 36
Existence of a healthful Culture. 2 1 3

17. Next Steps
 The project has looked at team to older person/resident
moments and now it will move into the space of team
members noticing at how they engage with each other.
 The project will also look at the interactions between
older persons/residents.
 We ‘feel’ this is most likely to lead us to
 Review and innovate team processes to enable better shared decision
making with the older persons living with dementia in the services.
 Test more widely the method and recording sheet
 Maguire Unit at St Luke’s in Cork
 National Practice Development Programme for HSE QI Strategy

18. Person Centred Moments: Conclusion
 There is now greater understanding of the Person Centred Framework
(McCormack and McCance, 2017)
 Team members recognise, through observation and dialogue, what a
“Person -centred Moment” actually means in practice for them and for
older persons and are working on joining up more and more moments
 Team members are gaining an understanding of how reflection and
feedback in the workplace contributes to culture movement
 There is a slow change emerging and the team, including managers, are
creating their own safe space to develop and become more person-centred
 The method helped the project team prepare for using an observation of
practice tool (Workplace Culture Critical analysis Tool – we are piloting the
revised version of the tool at present)

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