Working in a storied way-Narrative-based approaches to person-centred care and practice development in older adult residential care settings

Abstract

Aims and objectives: To evaluate the effects of the implementation of a methodological framework for a narrative-based approach to practice development and person-centred care in residential aged care settings.

Background: Care in long-term residential settings for older people is moving away from the biomedical approach and adopting a more person-centred one. Narrative can help shape the way care is planned and organised. The provision of person-centred care that is holistic and that takes account of resident's beliefs and values can be enhanced by incorporating narrative approaches to care within a practice development framework.

Design: The chosen methodology was participatory action research.

Methods: Between 2010-2014, a methodological framework of narrative practice was implemented in two residential care settings, comprising 37 residents and 38 staff, using an action research approach. Three action cycles: (i) narrative practice and culture identification, (ii) developing narrative practice and (iii) working in a storied way emerged during the implementation.

Results: Key outcomes emerged in relation to the findings. These were based on narrative being, knowing and doing and centred around the key outcomes of (i) how people responded to change (narrative being), (ii) the development of shared understandings (narrative knowing) and (iii) intentional action (narrative doing).

Conclusion: The implementation of a framework of narrative practice demonstrated that how people respond to change, the development of shared understandings and intentional action were interrelated and interlinked. It illustrated the importance of ensuring that practice context is taken account of in the implementation of action research and the importance of ensuring that narrative being, knowing and doing are clear and understandable for change to occur.

Relevance to clinical practice: Implementation of a narrative approach to care can develop new ways of working that value biography and promote the development of a co-constructed plan of care.

Keywords: action research; narrative; nursing; older person; person-centred care; practice development.