Caring conversations as a method to facilitate dialogue

Caring conversations as a method to facilitate dialogue in health and social care contexts Professor Belinda Dewar Professor of Practice Improvement School of Health, Nursing and Midwifery DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

Relationship centred care - Tresolini and the Pew-Fetzer Taskforce (1994). • • Willingness to negotiate and compromise Willingness to see another perspective Promoting and accepting the emotions of others Sharing personal information Openness to other ideas Sharing insights when things are not going well Recognising the good in others DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

Relationship Centred Practice

DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

The Compassionate Care Study • 2008 -2011 • Overarching theoretical framework Appreciative inquiry and relationship centred practice • Observed over 240 hours of interactions DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

Compassionate Relationship Centred Model

Caring Conversations – – – What matters to you? What would happen if we gave this a go? Courageous Connect emotionally How do you feel? I feel? … Curious Help me to understand why this Collaborative happened? What would help you now? What might make a difference? can we work together to make Considerate of other How What. How do you think? this happen? would you What like toare be perspectives saying about involved? others Who else could helpthis? us? – Compromise What happen if we What is real andwould possible? How candid we nothing? work together to make this happen? – Celebrate What works well for you? I value the fact that you are…? Thank you for…

Bringing relationships to life in day to day practice DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

Stories using Emotional touchpoints

Language antennae DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

Being Provocative • Barrett and Cooperrider (1990: 232) claim that a good metaphor ‘provokes new thought, excites us with novel perspectives and enables us to see the world with fresh perspectives’. • Deal with relatives/explore with relatives • We are the experts/we are one expert among many • Caring for people like I would want my own family to be cared for/Caring for people like they themselves want to be cared for

This Spirit of Inquiry • • Wonder Intrigue Surprise Energy ‘The shyest people said the most amazing things. The people who usually tend to take over were being challenged by others who are usually quieter. This gave a sense of justice in the room. We got more qualified insights – for example, someone would say, ‘Yes, that does happen sometimes’. THE WISE Effect DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

New Possibilities • ‘I used the caring conversations framework to facilitate a discussion with a relative who I had a very poor relationship with. Just connecting emotionally with her – asking how she felt and sharing how I felt, which was frustrated and sad that we did not have a better relationship helped to open up dialogue. I would never normally say how I felt. [The 7 C’s] transformed our conversation to one that was balanced and respectful. I asked her at the end if she would mind if I shared some of our learning with other staff on the unit. She said this was not a problem and wondered if I would mind if she could join me in sharing our learning with staff. ’ DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

Development of framework • Developed in the context of compassionate care in an acute care setting caring for older people • Further tested in 5 care settings including residential care, community care and acute care • Expanded to use as a framework in to promote learning and knowledge into action in a range of other contexts e. g. action learning, academic supervision DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY

People were able to turn… • • Fear to courage Detached to emotionful Furious to curious Dogmatic to consider other perspectives • Conflictual to collaborative • Resolute to compromise • Disregard to celebrate

The compassionate organisation • In depth knowledge of caring/person-centred philosophy and its application to practice from senior members of the organisation. • Philosophy of caring/person-centredness underpinning all organisational process and activity • Active support of staff to enhance their well being • Constant and consistent messaging about caring/person centredness • Use of appreciative language • Celebration of success and clearly naming and sharing caring activity and behaviours across the organisation • Using measurement as a development tool to celebrate success and prompt insight, motivation and discussion about future development • Using a range of ways to build capacity/leaders

The poem – I used to but now I…. DREAMING / BELIEVING / ACHIEVING A 21 ST CENTURY UNIVERSITY