Working in a storied way.The development and evaluation of a narrative based approach to practice development in an older adult residential care setting.

This thesis presents the development, implementation and evaluation of a methodological framework for a narrative based approach to practice development and person-centred care in residential aged care settings. The study is underpinned by practice development, person-centred care and narrative methodologies. Narrative focuses on a way of being, paying attention to past present and future, and also as a way of doing, as the means through which action is understood and made meaningful. Carried out between 2010 and 2014 and underpinned by theories of narrative inquiry, person-centred care, practice development and action research, this study is guided by the philosophical perspectives of Heidegger (1962). Forty six interviews, collected as part of a national research programme, (Person-Centred Care Practice Development Programme 2007-2010), were analysed for key themes by myself, four focus groups of 12 clinical nurse managers and two independent experts. Themes were also derived from a focus group of eight residents who explored person-centredness and narrative. Combined, this analyses led to a single set of themes that were used to develop a Framework of Narrative Practice. This framework consists of four pillars, prerequisites, care processes, care environment and narrative aspects of care. The framework further includes three narrative operational elements, narrative knowing, narrative being and narrative doing. Working with the four foundational pillars and the three narrative elements enabled staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults. Using an action research approach with work-based learning groups, the framework was implemented in two residential care settings that were comprised of 37 residents and 38 staff. Three action cycles (1) narrative practice and culture identification, (2) developing narrative practice and (3) working in a storied way emerged during the implementation. Using these action cycles, staff developed action plans to address areas where changes could improve practice and quality of life for the residents. These plans included communication/intercommunication, homely environment, having more going on with and for the residents and meals and mealtimes. By taking account of their biography, the framework confirmed the identity of older people. Three key areas emerged, however, that warranted further conceptualisation. These were, how staff and residents responded to change (narrative being), development of shared understandings (narrative knowing) and intentional action (narrative doing).sub_nurunpub2191_ethesesunpu