In my previous assignment, I have explored aged care facility as my caring environment to evaluate work culture from a compassionate care perspective. I selected person-centred care and interpersonal relationship or communication as the main themes of my story. In this assignment, with these themes, I will analyze the current caring culture in an aged care facility by using effective workplace culture framework in terms of attributes, enabling factors and consequences (Manley, Sanders, Cardiff and Webster, 2011). Further, I will discuss some recommendations for the improvements to the caring culture.
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The framework suggested by Manley, Sanders, Cardiff & Webster (2011) is focused on the necessity of exploring and analyzing the workplace culture to deliver safe and quality patient care. Using this framework, health team members would be able to evaluate their work culture and determine where change is necessary. This framework consists of three components and they are enabling factors, essential attributes, and consequences. After exploring the effective workplace culture framework, I related person-centred care (selected theme) with person-centredness which is one of the essential attributes and consequences of effective workplace culture. Similarly, another theme, interpersonal relationship or communication is another essential attribute which is open communication (Manley, Sanders, Cardiff & Webster, 2011).
The aged care facility is the special- purpose facility which provides care, support and accommodation including assistance with daily living, assistance towards independent living, and intensive form of care to weak and aged residents (Australian Institute of Health and Government 2010). In an aged care, caring culture and the workplace environment are interrelated and have an effect on resident’s experience, patient outcome, evidence-based practice, staff involvement, job satisfaction, and retention (NSW Government, 2013, p.5). The caring culture in a health care facility is influenced by the culture of person-centred care and open communication between caregiver and the care consumers (Manley, Sanders, Cardiff and Webster, 2011). Workplace culture is defined as norms, values, rules and regulations and characteristics of an organization (Sun, 2009). Workplace culture not only affects the service delivered to the users but also affect the service provider behavior and performance (Ng, Johnson, Nguyen & Groth, 2014).
Analysis of the themes of caring culture by using effective workplace culture framework
Person-centredness is one of the core shared values in effective workplace culture framework (Manley, Sanders, Cardiff and Webster, 2011) which help in meeting the need of the patient (resident) in person-centred way by developing mutual trust, respect, and understanding for person’s individual rights to self determination (van Lieshout, Titchen, McCormack & McCance, 2015). In any caring culture, person-centred care approach considers each person respectfully as an individual human being and not as a condition to be treated (Australian Commission on Safety and Quality in Health Care, 2011). It involves not just the patient, but the carers, families, and other supporters (Jonathan Evans, 2017). Patient centred care address the staff experience because the staff’s ability and inclination to care effectively for patients is compromised if they do not feel cared for themselves (Lusk & Fater, 2013). Person-centered nursing framework helps in identifying the nurse’s skills, knowledge, and behavior that should be executed in delivering compassionate and safe care (Van der Cingel et., 2016). This helps in better care, positive patient outcome and staff satisfaction (Manley, Sanders, Cardiff and Webster, 2011).
Person-centred care is important in an aged care facility to provide a caring environment as it focused on the residents as the locus of control and support them in making their own choices and having control over their daily living (Jonathan Evans, 2017). When the caring culture is person-centred then the carers (Nurse) are able to understand the resident more closely and clearly including their views, their cultural and religious needs, how they live and their financial situation, their preferences, difficulties and many more. This helps the care provider in the planning, coordination, and delivery of care (Gluyas, 2015). In other way, the resident feels more cared, valued, supported, safe, and honored and involved in sharing their feelings and thoughts with the caregiver or nurses. Such a mindset fosters empathy and nurtured healing (Lowe, 2013). The residents are far from their people and society who is often afraid and thus requires more love, care, assurance, and support. When they feel they are listened and valued then they feel more comfortable and associated in that culture of the facility. This makes them satisfied which will bring positive changes and improvements in their health, behavior, and wellbeing (Wasserman & McNamee, 2010).
Person-centered care makes workplace culture safer and of high quality which changes the physical environment of aged care facility to feel more like a home than an institution (Jonathan Evans, 2017). Deeper and trustful relationships, smooth interpersonal relationship is established between patient and carer and thus increase patient satisfaction and nurse satisfaction (Wasserman & McNamee, 2010). It is critical that the resident is able to make any decisions and are at the center of any decisions made about them. Person-centred approaches, such as shared decision making and self-management support, specifically aim to enable elderly and their family members to play a more active role in defining the outcomes that are important to them, deciding the treatment and support that is best for them, and managing their health and care (Bunn et al., 2018). Person-centredness is a core value enacted in effective workplace cultures and focuses on enabling personhood and flourishing of self and others (Manley, Sanders, Cardiff and Webster, 2011). Implementing person- centred care supports nurses to provide more holistic care and it increases patient satisfaction with the level of care, reduces anxiety levels among nurses in the long term, and promote team working among staff (Clayson, 2007). The workplace culture where person-centered care is valued influences the staff to deliver quality and safe care to the individual patient (McCance, Gribben, McCormack & Laird, 2013).
Recommendations to improve the caring culture
The most important recommendation would be communicating and modeling by the health team leaders regarding the person-centred purpose, vision, strategies, and understanding what they need to do to implement it. High-performing person-centred organizations should regularly monitor the satisfaction and overall wellbeing of their workforce. This enables them to identify instances of low wellbeing and implement changes to rectify them. Transformational leadership should be developed to inspire and motivates the care provider in achieving a shared vision of providing person-centred care by improving performance, generating new ideas, teamwork, and effective leadership (Fischer, 2017). The use of patient satisfaction survey (through mail, message or written) can be an effective way to collect timely information from the patient and that information can be used to identify opportunities for improvement (Lusk & Fater, 2013).
Person-centred practice, which includes compassion, needs to be well facilitated in order to flourish in the healthcare setting (van Lieshout, Titchen, McCormack & McCance, 2015). Continuous efforts and dedication in practice development (McCormack, Dewing & McCance, 2011) from each health team members is necessary for providing person- centred care which includes collaboration, inclusiveness and participation principles (McCormack ,2011). The development of effective teamwork, workload management, time management, and staff relationships should be highlighted in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person‐centred relationships (McCormack et al., 2010). Emancipatory practice development should be facilitated as it focuses on getting evidence into practice and create innovative and effective caring (McCance, Gribben, McCormack & Laird, 2013). Developing person-centred nursing requires a sustained commitment to the facilitation of changes in a culture like staff retention, staff satisfaction, and reduce stress through improvement (Clayson, 2007).
Creating a caring culture for the care provider nurtures a culture for patients. It begins with respectful communication and meaningful interaction. (Lowe, 2013). Open and effective communication is the key factor to influence effective workplace culture and caring culture in any organization (Clark, 2002) where the team members are motivated to raise their voice or ideas within the group (Fox, Jones, Davies, Power & Bolton, 2009). With competent communication skills, caregivers have the ability to assess an elderly patient’s concerns, show understanding, empathy, support and provide comfort. Thus, influence caring culture (Daly, 2017).
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In aged care, the most precious thing a nurse can give is their time. Being able to sit and talk for a brief period with the resident, knowing them and their feelings make them feel really satisfied and valued. Openness and transparency in the communication between carer and residents are vital to creating a caring culture where the residents are respected and valued which develops a positive attitude towards the carer and the health service (Manley, Sanders, Cardiff & Webster, 2011). This will encourage the residents to participate in their care and thus positive patient outcome and effective workplace culture are created. Effective communication prevents the occurrence of various errors that may occur due to misunderstanding and misinterpretation of the information that makes difference in caring culture and also help in solving them in case of their occurrence (Sibiya, 2018).
Communication between carer and the resident in an aged care facility is one of the most valuable approaches of person-centered care and interpersonal relationship which leads to caring culture and positive patient outcome (Kadri et al., 2018). Understanding who the patients are as a person helps nurses to connect with them. When health care team members do not communicate effectively, patient care often suffers. (Lein & Wills, 2007). Communication incompetence among caregivers can lead to frustration among elderly people who have mental impairment and level of understanding situations is low. They feel agitated when their needs are not met. lack of interpersonal relations which leads to discomfort and thus makes the elderly patient unable to express their needs. In such condition, a healthy conversation about any topic they prefer to act as a healer and reduce their anxiety and build confidence. For instant, when a relationship has been established with the person with dementia, caregivers are given the response so sorely needed to feel that their work is meaningful, while persons with dementia feel a sense of well-being through the confirmation of their personhood. Similarly, communication is more than the words we say. The tone of our voice, attention, body language, and clarity is a key element of effective communication. Caregivers need good communication skills both verbally and non-verbal to boost elderly patients satisfaction (Dijkstra, Sprangers & Romijn-Luijten, 2015). When a nurse is a good listener and frequently checks in on her patients, she is able to reduce physical and emotional distress. Likewise, the patients and family members participate actively in the process of treatment and caring planning. Communication, therefore, is the key that caregivers can use to create good interpersonal relationships, improve care and wellbeing of the elderly.
Communication among healthcare team members influences the quality of working relationships, job satisfaction and profound impacts on patient safety (Lein & Wills, 2007). This allows them to take the problem and concern of the resident seriously, clear and viable information of the residents is exchanged which helps in clinical strategies planning and implementation of care can be done accordingly (Kornhaber, Walsh, Duff & Walker, 2016). When communication about tasks and responsibilities are done well, research evidence has shown significant reduction in nurse turnover and improved job satisfaction because it facilitates a culture of mutual support (André, Frigstad, Nøst & Sjøvold, 2015)
Recommendation to improve caring culture
In an aged care facility, losing the ability to communicate can be one of the most challenging problems for the people living with dementia and their carers. Therefore, observation and listening skills should be followed by the nurses to be able to understand the language and problems of expression (Ericsson, Kjellström & Hellström, 2011). Mandatory Workplace training and in-service education should be prioritized at least once a month to develop the care provider’s communication skills assessing and problem-solving skills (Cohen, Hatchett & Eastridge, 2008). when effective communication lacks, elderly patients usually feel threatened and thus end up withholding information that might be crucial for care. It’s important for caregivers to establish a good, Polite, and friendly relationship with their elderly patient. Allowing the patient enough time to talk and paying attention to their concerns can help improve their care and collaboration. In adopting a person-centred approach to communicating with older adults, it is necessary to get to know the person as an individual and ensure communication meets their needs and abilities. Not only this, job satisfaction of the staff should also be prioritized as it is linked with staff turnover, burnout, staff shortage, and time management (Akkerman, Kef & Meininger, 2017). Effective communication is essential in nursing practice and requires professional competence and engagement. (Daly, 2017). Similarly, When the care provider model positive communication behaviour and makes a core part of caring culture, they should be encouraged, evaluated, and praised to empower them. There should be a provision of rewarding, verbal complementation, and appreciation (Hsu et al. 2015). On the other hand, regular meeting and receiving feedback from patients and staffs should be emphasized so that necessary changes can be made to enhance communication among patients and staff (Boscart 2008). The family members should be encouraged to share their thoughts and ideas and their experiences with the staffs so that the staffs could step the necessary actions for the betterment of patients living. In fact, effective communication should be reinforced from entry level to executive management so that the organization culture (aged care facility) is better equipped to provide quality and compassionate care.
Workplace culture is experiencing various challenges and changes in the aged care setting. Absence of changing distressing working culture leads in negative patient outcome, dissatisfaction in patient and staff, and caring culture cannot be established. Analysis of the issues, setting shared goal and planning involving the health team members, patient, and their family, and the organizational team members are essential to work in a team to establish a caring workplace culture. The aged care facility is changing and improving to provide quality and compassionate care for the elderly through awareness. Evidenced-based practice and updated ways of caring alternatives should be followed to adopt the changing process of provided care. Person-centred care with effective and open communication must be put at the frontline to enable a caring culture to remain in any health care organization.
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