The sub-themes in this section so far have focused on recognizing emotion in order to be able to articulate feelings, pro-actively connecting with others by asking how they are feeling, trying to integrate this into day to day conversations in practice, and „noticing‟ what is happening so that you can be specific about how you are feeling about
experiences. The evidence above illustrates that when it works well it is valued, but it is not always easy to do, if feeling that everyone is too busy, and concerned about possible responses to being asked how you feel. Staff could feel powerless to do anything with or about the learning gleaned from hearing about others‟ experiences:
It‟s hard because you can hear about what somebody is saying but it can be difficult to do anything about it – sometimes there isn‟t anything you can do. This just makes you feel bad. If there is too much of this you just stop asking. (Staff Comment, Beliefs and values, 5).
Thus, seeking feedback could feel like taking a risk in that you have little control over what might emerge and might be uncertain about ability to respond. This uncertainty was highlighted in the previous section in this chapter where staff felt they had little control over responses to their questions that sought to know what mattered to the person.
Getting support to respond to feedback was not talked about by participants in the study.
People tended to focus on discussing negative feedback and often did not refer to positive comments. Throughout the course of the study I gave positive feedback to many of the staff. However, they tended not to feel comfortable about noticing and reflecting on the practices that had gone well:
I know you have come up to me and told me about things that I have done well but these are just ordinary things that I do and I feel embarrassed when you say these things. (Staff evaluation, SE4).
There were a few excellent examples in the data set where staff had heard and responded to feedback in a very positive way:
Beth (a patient who had a dementia) was served a cup of tea and a couple of biscuits were carefully placed on the table beside her cup. She said to me – „where is the plate – you wouldn‟t serve it like that from your own kitchen at home would you?‟ Sometimes things just happen on the ward and because you work there all the time you become de-sensitised to them and don‟t notice them. The absence of plates was one of these things. It made us think about this for all the patients on the ward. We need to think about changing this. It‟s those little things that matter sometimes. How important it is to hear Beth‟s voice. (Staff Story, SS10).
This demonstrated staff responsiveness to feedback rather than defensiveness. It is not known whether the normal reaction of staff to this type of interaction would have been one of defensiveness, as the process of the research was such that there was constant role
modelling of asking curious questions, suspending judgment, considering other
perspectives and discussing new understandings. The process of the research in itself was perhaps promoting a different way of relating in practice.
That said, the key thing that happened in the example above was that the feedback was given in a very clear and direct way, from the patient, and staff were facilitated to support each other through discussion to find a better way of giving care that took cognizance of other perspectives.
Staff were concerned that they may not be able to act on feedback. Thus, supporting people to hear and respond to feedback could feel like taking a risk. It can ask people to respond in a way that does not seem possible in an already stretched service. In the main, when participants talked about the term feedback, they related this primarily to negative feedback. Thus one can understand that starting to ask may not be something that people feel able or motivated to do as part of day to day practice. This raised questions about whether there were systems that could be put in place to help people to connect and directly ask how they were feeling in a way that would encourage respondents to work together to articulate both what worked well and what needed to be improved.
4.4 Chapter Summary
This chapter has described the person knowledge that was developed by staff, patients and families about each other. This knowledge had two key domains: knowing who I am and what matters and understand how I feel about my experience. When this knowledge was developed, it enhanced relationships, and enabled development of care that was compassionate and relationship-centred. Key interpersonal skills were required to develop this person knowledge, which involved:
having the courage to emotionally engage;
working collaboratively with people to consider other perspectives through a process of „checking out‟; and
being confident to make compromises with people.
For many, these skills were the invisible aspects of caring that were rarely talked about, recognised and valued and thus were not celebrated. For some staff, engaging in
discussions to generate this knowledge could feel like taking a risk, particularly if the discussions resulted in supporting people who were distressed or in trying to find creative ways to respond to a person‟s needs which may be outside the usual repertoire of
possibilities. In addition, not everyone felt confident to communicate in this way. A particular challenge related to working together to make decisions about, if and how, this knowledge could be used to inform care giving. People needed support to work together in this way. Development of this knowledge seemed to be influenced by the process of the research itself which role modeled a way of communicating that emphasised being considerate of others‟ perspectives, being curious, being celebratory about times when this worked well and being confident to use this knowledge in an open and legitimate way to inform care giving. This process of engagement through caring conversations is developed further in the next chapter.