The work of the group moved to Stage 2 in which the participants were asked to provide evidence from their experience in practice of their understanding of person-centred, evidence-based hip fracture care. The evidence was provided in story form. Story telling is particularly valuable when working with diverse groups as it gives the participants a chance to share their experience whilst hearing the experience of others (Bray et al., 2000). This reflected the work already done in Stage 1 and it also gave the group an opportunity to provide evidence of the successes and difficulties experienced in the real world of practice.
3.8.2.1 Action meetings 4 and 5
The aim of these two meetings was for the participants to share their experiences that would provide evidence of person-centred practice. The participants were asked to bring examples from practice and they took turns to share these examples with the group. The process of telling the story uses
elements of reflective retreat was to encourage dialogue and to explore the assumptions, patterns of thinking and tacit knowledge about practice that previously they would not have had time to think about (Bray et al., 2000; Bradbury et al., 2008). The healthcare team intuitively related their own experience through discussions with the group. These oral stories provided by the participants were recorded and transcribed for future data analysis. This nature of storytelling develops a narrative that was full of evidence of the emotion of caring; the feelings, conflict, judgements, assumptions, distorted perceptions and values that were behind day to day interactions. The stories were full of tensions and contradictions, things said, half told and left unsaid; the complexities in each story were unique.
At this stage, it was not a case for ascertaining whether or not this approach worked but to accept the contributions for what they were. This had a level of ambiguity that some researchers would find difficult and uncomfortable but when perceived as virtue it led to detailed sharing of experiences and understanding and further discussion about how information could be used.
With the focus on evidence, the group agreed that it would be helpful to review a patient record to find evidence of the problems they had been talking about. The action for the next meeting was to review the record keeping process in order to identify strengths and limitations and identify examples of evidence- based person-centred hip fracture care.
3.8.2.2 Action meeting 6
The aim of the second part of this meeting was to consider the evidence of person-centred practice from the perspective of record keeping. After refocusing on the underpinning values, two participants agreed to present examples of records from practice, one from health and another from social care. The process involved listening to a presentation of the journey of care with examples presented from the records. Two other participants volunteered to take notes during the presentations and to feedback the key issues.
depth. The dialogue that ensued reflected on the strengths and limitations of the records as a source of evidence of person-centred practice. Dialogue is interconnected with critical reflection (Bray et al., 2000). When reflecting on practice in a safe, open and participatory environment, the distortions and assumptions that influence day-to-day work can be questioned and thinking is challenged. At the end of this meeting the group agreed that they would develop criteria for a unitary person-centred record (UPR).
The group found this process emotive and distressing to such an extent that one of the participants cried. Interestingly this was a nurse who recognised that the coordination element, which was clearly not done, fell to her professional group. This element is discussed in greater detail in Chapter 4. Care was taken to ensure that this participant had sufficient support and was not still distressed at the end of the meeting.
3.8.2.3 Action meeting 7
In response to the previous meeting the participants strove to develop criteria for person-centred record keeping for hip fracture care. Previously no local structure existed so this group were developing a new standard that was in line with national policy and built on their previous work. The participants divided into 3 groups. Each group were given an hour to focus on one of the following: the structure, process or outcome of record keeping. They were asked to write on a flip chart an account of their discussion, which they chose to describe as a wish list. Each group then shared their wish list of criteria for person-centred records.
Discussion ensued to clarify meaning. Implementation of the wish lists was a concern as there were potential barriers. Ways to overcome this were explored and the group agreed that involving their managers in a future meeting would help address this. As a result of this series of exercises the group recognised that they had little evidence of the patients’ and carers’ experience of hip fracture care. During the evaluation of this meeting the group agreed actions that would inform their practice and agreed that at the next meeting they would reflect on patient and carer stories.