Download Engagement class - DCU Moodle 2013

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WHAT GOOD ENGAGEMENT DOES
I am putting forward a hypothesis that good engagement develops the capacity for
better decision making
When you are involved in the right way with service users:
Something changes in your perspective that develops you professionally
Something changes in the patient/person with a disability that facilitates them to buy
into any health needs, other goals or programs.
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INTRODUCTION
Engagement can be taken for granted however when
looked at more closely engagement is complex
requiring a number of skills and attributes that
when worked together provide a backdrop to
nursing care that facilitates quality outcomes for
the person receiving care.
In this lecture we will discuss some of the elements
required to provide meaningful engagement with
the person that has a health issue requiring
professional intervention.
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AN OVERVIEW OF THE ELEMENTS
OF ENGAGEMENT
1. An understanding of human needs.
2. A mind set of involvement with people.
3. Person Centred Philosophy, Policies and Care
Planning.
4. A commitment to self development and self
awareness.
5. The use of creative and critical thinking.
6. Development of Good Communication Skills.
7. An Attitude of moving towards people rather than
away from.
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WILLIAM GLASSER ON NEEDS
Survival
Belonging
Freedom
Power (Significance, Identity and Achievement)
Fun and Education
Needs are like glass jars that need filling with water.
When engaging with patients/clients the nurse can do
this in a way that meets the need of the person.
This improves the level of engagement that takes place
leading to more openness to achieving health goals.
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ELEMENTS OF INTRINSIC MOTIVATION
Competence: we all need to feel that we are
skilled and effective at what we do.
Relatedness: we all need to be connected to
others in what we do.
Autonomy: we all need to feel that we are the
author of our own actions.
Nursing actions need to take the meeting of
these three needs into account.
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ENABLING PEOPLE
What can we do that will empower them to meet their health and holistic needs?
What can I do that will enable the person participating and buying into their care?
What path does the person need to reach full health, maintain well being and to
develop their lives in the way that they want to?
The person themselves knows what they need to get well again. We have to facilitate
the person to find that way by being involved with, asking questions , being
supportive and engaging in best practice (being professional)
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INVOLVEMENT
Formal: This includes interviews, assessments, care planning, giving care, evaluating
care and auditing care, reporting, educating and training.
Informal: This includes the many interactions that occur in an everyday context.
Does the person have enough respect for you that they will listen to what you have to
say . Respect has to be earned.
Good engagement creates a bonding that people can relate to and the consequence
of this is that they tune into what you have to say to them
The following slides focus on keys to getting more from engaging.
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A MINDSET OF INVOLVEMENT
WITH PEOPLE
The best way to do this is to find ways of connecting with the person.
This includes knowing understanding what the person needs now (from
their perspective), their coping styles and expectations.
From good engagement creates goal options that both of you can buy
into
Sometimes it is helpful to understand the person’s aspirations, hopes
and dreams. This can give keys as to how to motivate the person.
Sometimes sharing areas of common interest can forge a common
bond.
Benner 1984 describes how “professional friendship” leads to an
objectivity that allows the nurse to see the nursing and medical
issues for the person more clearly.
Often people need a role model to develop behaviours that will improve
their quality of life. The nurse can be this.
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INVOLVEMENT: PRACTICAL TIPS.
People need doing things “with” them.
People sometimes need the term “we” as this
breaks the isolation of the term “you”.
Showing empathy means that the person knows
you understand where they are coming from.
This relaxes them as they know they are being
listened to and cared for properly.
Some relationships are harder work than others.
Managing these relationships professionally is
decision that reaps benefits
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INVOLVEMENT MEANS
Active listening.
Thinking creatively around care.
Not criticizing (being judgemental). To criticize stifles
creativity.
Gently enabling the person to identify the health
challenges in front of them.
Developing trust.
Giving hope.
Creating fun.
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DIRECTION V NON-DIRECTION
Too much direction the person feels stifled.
Too little direction can create confusion and anxiety.
There is a rhythm created in the nurse/patient client
relationship dynamic. Use this rhythm to empower the
person to move towards their health goals.
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THE POWER DYNAMIC
Recognise that the power relationship between the nurse and the
patient/client is unequal.
This leaves the patient/client in an emotionally vulnerable position.
The nurse therefore has a responsibility to create a more equal
relationship.
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PARTICIPATION
This means our systems facilitate the person to be a partner in care rather than a
receive of care.
We work of improving health and quality of life together
This means encouraging the person to do their part and by showing them by your
actions that you are doing your part.
European health research is moving from profession centred to person centred care.
In Ireland it is nurses that need to lead the way here.
We need service users on service committees and involved in decisions as to how
services will be shaped in the future
We need sound advocacy and support groups so that the voice of the service users
becomes an important part of how services function.
There needs to be a space in any service where everyone is equal
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COLLABORATION
Compromise is when both parties lose something in order to
achieve a common goal.
Collaboration is when both parties move to understand the
other persons position and both work towards a solution so
as all parties get the optimal of what they are looking for in
a situation
A collaborative mind set lays the ground for the patient/client
gaining the most from their health care.
Collaboration develops interdependence, respect, trust
empathy and shared vision in a culturally sensitive way.
Collaboration also includes other professionals and people
important to the patient/client.
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NETWORKING
Good communication happens as people network
Develop networks that meet both professional and
service user needs
Find places where best practice can be identified
Use networks to put pressure on administrations to
accept best practice
Use networks to develop evidenced base care
Use human rights as a foundation for any network
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NETWORKING
Requires an attitude of putting in to get nothing out . This foundation leads to a lot of
peoples needs being met.
These last few slides if put into place provides an environment of good transparent
communication that feeds into good engagement with service users
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PHILOSOPHY, POLICY AND CARE
PLANNING
Is the organisation working toward a person centred system?
Do individual units have a mission statement that is meaningful to the staff?
Is the person and their family involved with the care plan and is it easily understood
by them?
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CLINICAL COMPETENCE
Is it easy to access recent literature?
Do nursing staff identify their knowledge and
training needs?
Does the clinical team encourage the sharing of
updated information?
Is action taken on new information?
Is there a culture of openness learning and
unlearning?
Does the team enjoy challenge?
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SELF DEVELOPMENT AND SELFAWARENESS
If you do not understand yourself, how can you understand others?
Self-development is one way to develop self-awareness and self
awareness is a way into self development
This can be done through self-development courses, education, travel,
taking part in the arts, taking personal counselling or coaching,
considering spirituality, using a diary to reflect on life’s experiences
etc.
As you personally develop this gives you insight into others, you become
less judgmental, prejudiced and more tolerant of other peoples
positions on issues.
From the point of the person with PMID you have more empathy, are
kinder and you become more aware of what needs the person might
be needing to meet.
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HUMANISTIC THINKING
Humanistic thinking developed by people such as Carl Rogers, Abraham
Maslow and Victor Frankl during the 1950’s to 70’s.
The Role of a Professional is to give “positive regard”, i.e. to accept a
person in a non-judgmental way. This will enable them to engage
with their positive self concept a move towards a more healthy way
of being.
Humanistic thinking believes that a person themselves knows the way
forward for their own lives. A health worker therefore needs to
facilitate the person to tap into their own resources to get well as
well as giving care that the person can not give to them selves.
Victor Frankl wrote a classic book “Mans search for meaning” within in
this he described how each man and woman cries out for purpose in
their lives and the role of the professional is to enable the person to
come into contact with that purpose. This idea has profound
implications for nurses working in long-term care situations.
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HUMANISTIC THINKING
People need to be believed in. This is a practical nursing
attitude that has a profound effect on
patients/clients.
People need encouragement not to give up. Actions
change things.
People in long term care need to be able to try out new
things. Choices on how to meet needs can only be
made if a person has options.
Developing strengths develops the positive self and
helps balance the weaknesses.
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CREATIVE THINKING
Creative thinking is needed for people both staff and service users to develop their
lives .
Using the concepts in this presentation will encourage creative thinking
People in positions of leadership need to listen to the creative thinking of staff and
service users and develop their ideas with them
People on mental health medications will have less creative thinking. Creative
thinking is what they need for recovery and development
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CREATIVE THINKING
Be open to novel ideas.
Make unique connections, connections previously
unconnected.
View things from different perspectives and angles.
Develop options to find a way forward.
Work towards the concept of inclusion even if
working in an institution. The more normal you
make something the more normal people
become.
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CRITICAL THINKING
Seeks to understand other peoples perceptions to
enrich your own.
It is being open to ideas, even ones you don’t care
for and evaluate the merits of the different
positions.
It is considering assumptions about an issue so that
you can evaluate if those assumptions are valid.
It is seeking options so that decisions can be made
knowing that the right options are being chosen to
meet the health needs in a way that is congruent
with the person.
It is reflecting on an issue so that insight is gained.
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CRITICAL THINKING
It is holding up professional decisions to the light of the
literature so that they can be evaluated.
It draws conclusions so that judgments can be shown to
be valid and relevant for the situation.
It involves all the relevant parties
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CHARACTERISTICS OF CRITICAL
THINKERS
Active Thinkers: checking the reliability of information and their
interpretation of it.
Fair Minded: understanding the powerful influence their thinking
has on others and treats other view points with equal respect.
Persistent: Persevering even through the difficult times.
Independent Thinkers: willing to have their own view point rather
than rely on others.
Proactive: anticipating and responding ahead of time.
Flexible: willing to engage in the preferred route of the service user.
Realistic: shows a professional pragmatism.
Humility: aware of their own limitations.
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CONCLUSION
Engagement is a process that relies on two people developing
a constructive dialogue.
If the nurse can identify ways to develop engagement in their
practice this will provide a more dynamic process that will
lead to more effective health outcomes.
The concepts discussed in this lecture provides keys to enable
the nurse to improve their level of engagement with their
patient/client group.
If you put some of the concepts discussed into action within
your own personality style in your practice you will find that
you will be an inspiration to your service users. This will set
the tone for quality engagement leading to increased
health and improved quality of life.
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