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1 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. 2 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. 3 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. 4 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. 5 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. 6 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) 7 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. 8 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. 9 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 10 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. 11 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. 12 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. 13 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 14 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. 15 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 16 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 17 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? 18 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? 19 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. 20 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. 21 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. 22 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 23 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. 24 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. 25 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 26 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. 27 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. 28 REFERENCES Alfaro-Levevre, R. 1999. Critical Thinking in Nursing, a practical approach 2 nd ed. London: W.B. Saunders Arnold, E. and Boggs, K., 2006. 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