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Carlos Roberto Jaén - One of the best experts on this subject based on the ideXlab platform.
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primary care Practice Development a relationship centered approach
Annals of Family Medicine, 2010Co-Authors: William L Miller, Benjamin F Crabtree, Paul A Nutting, Kurt C Stange, Carlos Roberto JaénAbstract:PURPOSE Numerous primary care Practice Development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relation- ship-centered Practice Development approach to understand Practice and to aid in fostering Practice Development to advance key attributes of primary care that include access to fi rst-contact care, comprehensive care, coordination of care, and a personal relationship over time. METHODS Informed by complexity theory and relational theories of organiza- tional learning, we built on discoveries from the American Academy of Family Physicians' National Demonstration Project (NDP) and 15 years of research to understand and improve primary care Practice. RESULTS Primary care Practices can fruitfully be understood as complex adaptive systems consisting of a core (a Practice's key resources, organizational structure, and functional processes), adaptive reserve (Practice features that enhance resil- ience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the Practice's internal capability. With adequate motivation, healthy, thriving Practices advance along a pathway of slow, continuous Developmental change with occasional rapid periods of trans- formation as they evolve better fi ts with their environment. Practice Development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. CONCLUSIONS Successful Practice Development begins with changes that strengthen Practices' core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes.
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Primary care Practice Development: a relationship-centered approach.
Annals of family medicine, 2010Co-Authors: William L Miller, Benjamin F Crabtree, Paul A Nutting, Kurt C Stange, Carlos Roberto JaénAbstract:Numerous primary care Practice Development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relationship-centered Practice Development approach to understand Practice and to aid in fostering Practice Development to advance key attributes of primary care that include access to first-contact care, comprehensive care, coordination of care, and a personal relationship over time. Informed by complexity theory and relational theories of organizational learning, we built on discoveries from the American Academy of Family Physicians' National Demonstration Project (NDP) and 15 years of research to understand and improve primary care Practice. Primary care Practices can fruitfully be understood as complex adaptive systems consisting of a core (a Practice's key resources, organizational structure, and functional processes), adaptive reserve (Practice features that enhance resilience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the Practice's internal capability. With adequate motivation, healthy, thriving Practices advance along a pathway of slow, continuous Developmental change with occasional rapid periods of transformation as they evolve better fits with their environment. Practice Development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. Successful Practice Development begins with changes that strengthen Practices' core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes.
William L Miller - One of the best experts on this subject based on the ideXlab platform.
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primary care Practice Development a relationship centered approach
Annals of Family Medicine, 2010Co-Authors: William L Miller, Benjamin F Crabtree, Paul A Nutting, Kurt C Stange, Carlos Roberto JaénAbstract:PURPOSE Numerous primary care Practice Development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relation- ship-centered Practice Development approach to understand Practice and to aid in fostering Practice Development to advance key attributes of primary care that include access to fi rst-contact care, comprehensive care, coordination of care, and a personal relationship over time. METHODS Informed by complexity theory and relational theories of organiza- tional learning, we built on discoveries from the American Academy of Family Physicians' National Demonstration Project (NDP) and 15 years of research to understand and improve primary care Practice. RESULTS Primary care Practices can fruitfully be understood as complex adaptive systems consisting of a core (a Practice's key resources, organizational structure, and functional processes), adaptive reserve (Practice features that enhance resil- ience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the Practice's internal capability. With adequate motivation, healthy, thriving Practices advance along a pathway of slow, continuous Developmental change with occasional rapid periods of trans- formation as they evolve better fi ts with their environment. Practice Development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. CONCLUSIONS Successful Practice Development begins with changes that strengthen Practices' core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes.
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Primary care Practice Development: a relationship-centered approach.
Annals of family medicine, 2010Co-Authors: William L Miller, Benjamin F Crabtree, Paul A Nutting, Kurt C Stange, Carlos Roberto JaénAbstract:Numerous primary care Practice Development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relationship-centered Practice Development approach to understand Practice and to aid in fostering Practice Development to advance key attributes of primary care that include access to first-contact care, comprehensive care, coordination of care, and a personal relationship over time. Informed by complexity theory and relational theories of organizational learning, we built on discoveries from the American Academy of Family Physicians' National Demonstration Project (NDP) and 15 years of research to understand and improve primary care Practice. Primary care Practices can fruitfully be understood as complex adaptive systems consisting of a core (a Practice's key resources, organizational structure, and functional processes), adaptive reserve (Practice features that enhance resilience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the Practice's internal capability. With adequate motivation, healthy, thriving Practices advance along a pathway of slow, continuous Developmental change with occasional rapid periods of transformation as they evolve better fits with their environment. Practice Development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. Successful Practice Development begins with changes that strengthen Practices' core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes.
Jan Dewing - One of the best experts on this subject based on the ideXlab platform.
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Implementing an e-learning Masters programme for Practice Development
2014Co-Authors: Ann M Price, L. Howatson-jones, Jan DewingAbstract:Introduction – The need for more effective person centred care has been propositioned for a number of years (Dewar and Nolan 2013; McCormack, Dewing and McCance, 2011; Dewing, 2004) and Practice Development (PD) has been viewed as one way to embed this into organisational culture (Manley, Sanders, Cardiff and Webster, 2011). More recently multiple policy reports echo this call (Age UK, 2012; Willis Commission on Nursing, 2012; Parliamentary Health Service Ombudsman, 2011). Joint work between the Department of Nursing and England Centre for Practice Development at Canterbury Christ Church University has validated an innovative Masters level programme in Practice Development, utilising workplace and e-learning approaches to facilitate creativity in the work setting. Aim: This paper will briefly describe the programme and then explore the experiences and challenges of implementing a work based and e-learning Masters Practice Development and Innovation programme. Approach: Practice Development is built on the key principles of person-centredness, shared values and vision, transforming individuals and culture through active learning, facilitation and engagement (McCormack, Manley, Titchen 2013). Thus, the approach to the Masters programme reflects these principles and utilises facilitation methods to enable Practice Development to transform the learner and work setting. As part of this process we, as lecturers, have been developing our own values and beliefs and expanded our knowledge and skills so that we can positively impact on the learner experience and work as learning partners. The programme is, therefore, evolving to embody these principles and enable learners to incorporate them into Practice. The programme is built around ten core Practice Development/Innovation principles and the process of Active Learning, which will be expanded on in the presentation. Our vision is to make this programme accessible to regional, national and international learners. The work-based and e-learning approaches make this achievable but bring challenges to ensure that the programme reflects the principles of Practice Development from a distance. This is further complicated by facilitating a range of learners from diverse clinical areas, experiences and cultures who have often been exposed to traditional forms of learning. Thus, facilitating the learners to engage with the material, and incorporate it into their own Practice setting, has led to careful consideration of materials for the learners to access. As the programme is progressing areas are emerging that need to be thoughtfully considered and addressed to ensure Development of learning. Considerations: Initial themes starting to emerge are: increasing lecturer knowledge and skills around both Practice Development and different tools for e-learning, learners previous experience of facilitation and willingness to take responsibility for their own learning, challenges of promoting active learning approaches online , enabling achievement of Masters level learning outcomes with a distance approach, new ways of working for individuals plus the organisational views around supporting learners in Practice. These require both lecturers and learners to be motivated to learn and devote time to engage with material and processes. However, it also requires lecturers and learners to make choices and reflect on activities to assess the relevance and usefulness to their situation. The programme encourages learners to be creative and examine issues differently which takes time to engage with and progress. Conclusion: Evaluation of this programme is in its infancy. A key learning point is that transforming Practice through Practice Development and innovation in the workplace also involves transforming University views on learning, engagement and creativity.
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ORIGINAL Practice Development AND RESEARCH PAPER Critical Ally and Critical Friend: stepping stones to facilitating Practice Development
2014Co-Authors: Michele Hardiman, Jan DewingAbstract:Background: The Critical Ally and Critical Friend are two models in the early stages of Developmental testing as part of a doctoral research programme. Together with the Critical Companionship model, they offer a theoretically coherent framework for developing expertise in the facilitation of learning about Practice from within the workplace. The two new models are sequentially related models underpinned by key principles of Practice Development and critical social theory. Unlike Critical Companionship, the Critical Ally and Critical Friend models are aimed at novice and proficient Practice developers respectively; we argue that, because of their design, they can offer stepping stones to Critical Companionship. Together, the three models offer a pathway for Practice developers and practitioners to gain, in a systematic way over a longer timescale, a repertoire of facilitation skills and to build expertise. Aims: To describe the two new models and demonstrate their theoretical coherence with Critical Companionship. We also invite other Practice developers and facilitators of workplace learning to debate the coherence of the two new models and the overall pathway, and to contribute to testing the models in a range of workplaces. Implications for Practice : • The two new models, when used in conjunction with the Critical Companionship model, offer a pathway for developing facilitation expertise within Practice Development • The models offer a broad based introduction to learning in and from Practice, which could be useful for preceptors, mentors, clinical supervisors and facilitators at all levels from novice to proficient • As the three models offer a pathway, they could be useful as part of strategic workforce
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Developing person-centred care: addressing contextual challenges through Practice Development
Online journal of issues in nursing, 2011Co-Authors: Brendan Mccormack, Jan Dewing, Tanya MccanceAbstract:Developing person-centred care is not a one-time event; rather it requires a sustained commitment from organisations to the ongoing facilitation of Developments, a commitment both in clinical teams and across organizations. Contextual factors pose the greatest challenge to person-centredness and the Development of cultures that can sustain person-centred care. We will begin with a general comment on 'context' and its meaning before exploring three particular factors that influence the Practice context, namely, workplace culture, learning culture, and the physical environment. Next we explore a particular approach to developing person-centred care through emancipatory Practice Development. We highlight the importance of facilitation through emancipatory Practice Development programmes and describe how person-centred care can be developed through the presentation of a case study that illustrates the principles and processes of emancipatory Practice Development as well as the outcomes achieved. We conclude with an application to clinical Practice. A key consideration for all organisations in the Development of person-centred care is to move from what we suggest are 'person-centred moments' (individual, ad hoc experiences of person-centredness) to 'person-centred care' as an underpinning culture of teams and organisations.
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Moments of movement: active learning and Practice Development.
Nurse education in practice, 2009Co-Authors: Jan DewingAbstract:Summary As our understanding of Practice Development becomes more sophisticated, we enhance our understanding of how the facilitation of learning in and from Practice, can be more effectively achieved. This paper outlines an approach for enabling and maximizing learning within Practice Development known as ’Active Learning’. It considers how, given establishing a learning culture is a prerequisite for the sustainability of PD within organisations, Practice developers can do more to maximize learning for practitioners and other stakeholders. Active Learning requires that more attention be given by organisations committed to PD, at a corporate and strategic level for how learning strategies are developed in the workplace. Specifically, a move away from a heavy reliance on training may be required. Practice Development facilitators also need to review: how they organise and offer learning, so that learning strategies are consistent with the vision, aims and processes of PD; have skills in the planning, delivery and evaluation of learning as part of their role and influence others who provide more traditional methods of training and education.
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Practice Development: Realising active learning for sustainable change
Contemporary nurse, 2009Co-Authors: Brendan Mccormack, Jan Dewing, Liz Breslin, Ann Coyne-nevin, Kate Kennedy, Mary Manning, Lorna Peelo-kilroe, Catherine TobinAbstract:AbstractThis paper explores the concept of Practice Development in the context of professional Development and strategies for facilitating learning in Practice. In this paper we present the background to the methodology of emancipatory and transformational Practice Development. Key concepts underpinning a contemporary definition of Practice Development are unravelled and nine principles for effective Practice Development proposed. An example of a large-scale national Practice Development programme with older people residential settings in the Republic of Ireland is presented to illustrate the processes in action. The findings of the first year of the programme are offered and these findings demonstrate the ways in which Practice Development systematically uncovers the deeply embedded characteristics of Practice cultures – characteristics that often inhibit effective person-centred Practice to be realised.
Brendan Mccormack - One of the best experts on this subject based on the ideXlab platform.
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p 279 using creative Practice Development methodologies to create a person centred recruitment process
BMJ, 2017Co-Authors: Melanie Legg, Anne Cleary, Caroline Dickson, Brendan MccormackAbstract:Background Marie Curie currently has 18 Practice Development Facilitators (PDFs) across the UK working in both hospice and community. The PDF role transitioned from the traditional Practice Educator role in August 2015, where the focus is now on facilitating learning and Development opportunities rather than mandatory training. In partnership with Queen Margaret University the Practice Development Team have developed their knowledge and understanding of Practice Development methodologies and the impact this can have on developing person-centred cultures. Aims Use creative Practice Development methodologies to bring about culture change where current staff engage with possible recruits and feedback into the recruitment process. To ensure that potential new recruits fully understand the role on which they were embarking and experience these methods in Practice during interview. To improve retention of new staff to this role. Methods The methods used were based on the Practice Development Workbook (Dewing, McCormack, & Titchen, 2014). The interview was conducted in three parts; the first two exercises are group activities. Using creativity to understand their journey to here; a values exercise to explore their values as well as Marie Curie’s and then a short individual interview. Results It has been challenging at times as the interview process is around three hours rather than the traditional style of interview of at least one hour. Feedback received from individuals who have completed this process have been highly evaluated. Conclusion To build authentic and meaningful relationships and cultures it is important to identify individual values and beliefs (Wilson, 2011). Establishing person-centred cultures requires a sustained commitment from individuals and organisations. The focus on staff and service users is vital to ensuring compassionate care and a flourishing culture.
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Blending critical realist and emancipatory Practice Development methodologies: making critical realism work in nursing research
Nursing inquiry, 2011Co-Authors: Randal Parlour, Brendan MccormackAbstract:This paper examines the efficacy of facilitation as a Practice Development intervention in changing Practice within an Older Person setting and in implementing evidence into Practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory Practice Development activities and, in particular, how the former may be employed within an emancipatory Practice Development study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory Practice Development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five Practice Development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in Practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical Practice. A new framework for Practice Development is proposed that establishes methodological coherency between emancipatory Practice Development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation.
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Developing person-centred care: addressing contextual challenges through Practice Development
Online journal of issues in nursing, 2011Co-Authors: Brendan Mccormack, Jan Dewing, Tanya MccanceAbstract:Developing person-centred care is not a one-time event; rather it requires a sustained commitment from organisations to the ongoing facilitation of Developments, a commitment both in clinical teams and across organizations. Contextual factors pose the greatest challenge to person-centredness and the Development of cultures that can sustain person-centred care. We will begin with a general comment on 'context' and its meaning before exploring three particular factors that influence the Practice context, namely, workplace culture, learning culture, and the physical environment. Next we explore a particular approach to developing person-centred care through emancipatory Practice Development. We highlight the importance of facilitation through emancipatory Practice Development programmes and describe how person-centred care can be developed through the presentation of a case study that illustrates the principles and processes of emancipatory Practice Development as well as the outcomes achieved. We conclude with an application to clinical Practice. A key consideration for all organisations in the Development of person-centred care is to move from what we suggest are 'person-centred moments' (individual, ad hoc experiences of person-centredness) to 'person-centred care' as an underpinning culture of teams and organisations.
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Advancing the Practice Development outcomes agenda within multiple contexts
2011Co-Authors: Brendan MccormackAbstract:Demonstrating outcomes from our work is an essential consideration in all walks of professional life. We are all employed to do a particular job and the success or not of that job is whether we achieve what is required of us. So having to show outcome from Practice Development work should be no surprise to anyone. Kim Manley, Jackie Crisp and Cheryle Moss make the case for the advancement of a Practice Development outcomes agenda. The rationale for such an agenda are twofold – that Practice developers have been poor at paying attention to outcome and secondly that the published outcomes have largely been ‘process [intermediary] outcomes’. The authors argue the case for Practice Development as a complex intervention and thus there is a need to locate outcomes from Practice Development interventions in a broad health outcome agenda.
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Practice Development: Realising active learning for sustainable change
Contemporary nurse, 2009Co-Authors: Brendan Mccormack, Jan Dewing, Liz Breslin, Ann Coyne-nevin, Kate Kennedy, Mary Manning, Lorna Peelo-kilroe, Catherine TobinAbstract:AbstractThis paper explores the concept of Practice Development in the context of professional Development and strategies for facilitating learning in Practice. In this paper we present the background to the methodology of emancipatory and transformational Practice Development. Key concepts underpinning a contemporary definition of Practice Development are unravelled and nine principles for effective Practice Development proposed. An example of a large-scale national Practice Development programme with older people residential settings in the Republic of Ireland is presented to illustrate the processes in action. The findings of the first year of the programme are offered and these findings demonstrate the ways in which Practice Development systematically uncovers the deeply embedded characteristics of Practice cultures – characteristics that often inhibit effective person-centred Practice to be realised.
Kenneth Walsh - One of the best experts on this subject based on the ideXlab platform.
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Practice Development for midwifery education: An innovative way forward
Nurse education in practice, 2012Co-Authors: Jackie Donsante, Denise Edgar, Leeanne Gill, Ceri Thomson, Moira Williamson, Kenneth WalshAbstract:Within workplaces there can be several different cultures operating, and it is widely recognised that this occurs in health services. Midwifery and maternity care has, and continues to face many challenges as services continually change and develop to meet the needs of women and their families. To help meet these challenges a Practice Development initiative was undertaken within a large maternity service in Australia to improve the learning and workplace culture. This service consisted of four separate units providing care for women and their families in the antenatal, birthing, postnatal and neonatal periods. The coming together of these four units as a service began with the creation of a shared values statement which was adopted by all midwifery staff. To obtain evidence of the current workplace, observations of Practice, the review of women's stories, and audits of clinical data were undertaken. Nine midwives were trained and supported to facilitate critical discussions of the data. These critical discussions, reflections and analysis of the data, led to the identification of four domains or key areas the staff prioritised for change. This led to Practice Development groups being formed within the maternity service, who developed collaborative and creative ways of thinking about the issues or problems identified. This paper highlights how the processes of Practice Development were implemented to improve one of these domains "the learning and workplace culture", especially in relation to educational information and resources for women, their families and staff. The journey began over three years ago and continues to evolve.
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Psychodynamic perspectives on organizational change and their relevance to Transformational Practice Development
International Journal of Nursing Practice, 2011Co-Authors: Kenneth Walsh, Jackie Crisp, Cheryle MossAbstract:Psychodynamic perspectives on organizational change and their relevance to Transformational Practice Development In this paper we draw on the organizational psychodynamic literature, from Menzies 1960 seminal work to contemporary writers such as Manfred Kets de Vries and Adrian Carr as well as our own experience to highlight three critical paradoxes in the psychodynamics of health services. The paper highlights that behaviour and ways of interacting are influenced by intrapersonal mechanisms; and these mechanisms are critically important in the evolution of workplace cultures, and markedly influence organizational functioning. These mechanisms (and the paradoxes they pose) need to be considered in any initiative, such as Practice Development, that seeks to engage staff in workplace reform. By better understanding the psychodynamics of the workplace, we will in turn be better able to understand the mechanisms underlying the success of Practice Development processes, use these more deliberately and develop new and better processes in order to further improve the efficacy of Transformational Practice Development as an approach to Practice change. © 2011 Blackwell Publishing Asia Pty Ltd.
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Solution‐focused approaches and their relevance to Practice Development
Practice Development in Health Care, 2006Co-Authors: Kenneth Walsh, Cheryle Moss, Mary FitzgeraldAbstract:Drawing on experience as facilitators of Practice Development the authors in this article propose the use of solution-focused approaches to practical puzzles. Solution-focused work in Practice Development draws on solutions-focused therapy but is distinct from it in a number of important ways. In the article there is an emphasis on the energy that emanates from the recognition of internal (personal or team) strengths and the ways that facilitators may guide Practice developers to build confidence in their own ability to find solutions in the seemingly messy world of everyday clinical Practice. This article begins with two descriptions of solution-focused work in Practice Development situations and goes on to discuss the origins of solutions-focused work in therapy and the adaptations required for use in Practice Development and concludes with a recommendation for its adoption among the repertoire of Practice Development facilitator tools.
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The Development of an engagement tool for Practice Development
Practice Development in Health Care, 2005Co-Authors: Kenneth Walsh, Cheryle Moss, Jane Lawless, Caroline AllbonAbstract:This paper reports on the Development of a tool to guide clinicians in the process of engaging with each other around Practice change. As an essential element of Practice Development work, engagement has been under-theorized and under-explored. The tool described here was developed in consultation with clinicians involved in Practice Development and involves three parts: evidence, context and facilitation. The paper shares the basis and construction of the tool and identifies initial experience in its use in Practice Development activities. This paper will be of interest to clinicians involved in Practice Development as well as researchers involves in the theorizing of Practice Development principles and processes. Copyright © 2005 John Wiley & Sons, Ltd.
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motivating change using motivational interviewing in Practice Development
Practice Development in Health Care, 2004Co-Authors: Kenneth Walsh, Margaret Mcallister, Aerinn Morgan, Janet ThornhillAbstract:The present paper draws on experiences and insights gained by a group of psychiatric nurse Practice Development facilitators whilst working with consumers, carers, clinicians and managers in the context of a Practice Development programme in a large metropolitan psychiatric hospital. The paper describes how the Practice Development facilitators were able to adapt Miller's (Miller 1983; Rollnick and Miller 1995; Miller and Rollnick 2002) techniques of motivational interviewing, commonly used in drug and alcohol treatment services, to help motivate change in an aged care setting. The lessons embedded within this experience are that people do want change, and that sustained change requires ownership and support. Practice Development facilitators can assist in this process though the use of principles and strategies of motivational interviewing, which include increasing awareness of the need for change, supporting self-efficacy and managing resistance to change. Copyright © 2004 Whurr Publishers Ltd.