Practice What You Preach: Developing Person-Centred Culture in Inpatient Mental Health Settings through Strengths-Based, Transformational Leadership

Abstract

The experience of nursing staff and consumers in inpatient mental health wards is often reported as being negative. Efforts to improve culture and practice have had limited success, with ineffective leadership, staff resistance, and unresponsive organisational culture identified as common barriers to change. Practice development has been promoted as an approach to developing person-centred culture that enables professional development through participation, learning and empowerment. For person-centred practice to flourish, organisational leadership at all levels must reflect the same principles. In preparation for the opening of a new integrated mental health service, an inpatient mental health team participated in a practice development project. An action research approach was used to facilitate a series of "away days," initially with the nursing team and then other members of the multidisciplinary team (MDT). Transformational leadership principles were adopted in the facilitation of team activities underpinned by strengths and solution-focused practices. Evaluation of the project by staff members was very positive and there was a high level of participation in practice development activities. The project resulted in the creation of a development plan for the ward, which prioritised five key themes: person-centred care, personal recovery, strengths-based principles, and evidence-based and values-based care. The project outcomes highlight the importance of leadership, which parallels the ideals promoted for clinical practice.

Person‐centred care: clarifying the concept in the context of inpatient psychiatry

“…In the analysed papers, the consequences of person-centred care are commonly discussed as positive and desirable outcomes that contribute to the improvement of care. Authors make references to person-centred care resulting in better care in terms of quality (10,15,29,34,39) and a change of culture (9,12,25) and environment (21). Authors discuss person-centred care in relation to a reduction of coercion (9,16,17,35), the prevention of harmful actions by caregivers (11,19,25), increased safety (10,15) and effectiveness (10,15,16,22,40).…”

“…Several authors also make references to caregivers involving patients in their own care (10,14,15,18,(31)(32)(33)(34), seeing the patient as an informed participant (35) involved in shared decision-making (15,36). Authors discuss customising care for a specific patient (23,30,37), focusing on the strengths of the patients (14,34), providing alternatives to coercion (9,16,17), self-administration of medication (33) and making decisions that respect patient's needs and preferences (2,(14)(15)(16)30).…”

“…Authors also talk about the context of care in terms of the structure, nature and function of a unit (18), setting (13), physical and psychosocial care environment (2), policies and procedures (11,19), therapeutic milieu (20,21) and systems and processes (22). Authors consider the competence of caregivers to be important for person-centred care, discussing the significance of leadership (10,17,23), adequate staffing (11,24), knowledge (15,19,(26)(27)(28)(29) and values (10,21). Authors discuss caregivers as using adapted forms of communication (25) and being culturally sensitive and competent (14,29,30).…”

“…In particular, authors stress the significance of competence, interprofessional collaboration and patient involvement. Several authors explicitly use person-centred care as relating to culture (9)(10)(11)(12)(13)(14)(15)(16)(17). Authors also talk about the context of care in terms of the structure, nature and function of a unit (18), setting (13), physical and psychosocial care environment (2), policies and procedures (11,19), therapeutic milieu (20,21) and systems and processes (22).…”

“…Relationships are discussed as mutual (15,18) and characterised by knowing and trust (34), engagement (20), closeness (27) and honesty (15,18). Caregivers are discussed as self-aware as they understand and respect patients (15), being person-centred (10), acknowledging the essence of the patient (21), listening to the patient (11,34), grasping the patient's meaning system (12), identifying with the patient as an individual (25), respecting the patient's dignity (11,19) and protecting the patients' rights (19).…”