Philosophical stance underpinning an PAR into leading

the development of person-centred care

Shaun CardiffFontys University of Applied Sciences

(NL)Ulster University (UK)

WHY?

Explicating the philosophical stance contributes to the ontological and epistemological authenticity of the study (Titchen and Higgs, 2007) and helps the reader follow and assess rigour of decisions made during the study.

Background

PC culture

Effective workplace Culture

(Manley et al, unpublished)

PCN framework (McCormack & McCance, 2006)

Leadership:Transformational?(Bass & Riggio, 2006)

Person-centred?(Plas & Lewin,2001)

How can person-centred leadership be developed on a nursing unit?

How can person-centred care be developed on a nursing unit?

AIMS

Critical Social Science Critical Realisthelp participants free themselves from any shackles inhibiting their flourishing i.e. obstacles to person-centred relationships.enable participants to transform any undesirable aspects of social reality by journeying through Enlightenment and Empowerment towards Emancipation.

generate plausible explanations on how (transforming) social structures, practices and conventions give rise to a perceived reality of person-centred relationships.

Critical Realism

Realist ontology +

Relativist epistomology

Intransitivity – “what we percieve is not necessarily all that there is”

–Intransitive – the ‘what is’

–Transitive – the ‘what we can know’

13th:74pts

Philosophy - what do you believe in?

Stratification – “what we can percieve

emerges from what is”

❇ Empirical layer – perceivable

⇪ Actual layer – events

Real layer – generative mechanisms

Tulips from ..

Generative mechanisms

-> Germination

-> TulipsMechanisms can be:

unexercised;

exercised but not actualised or counteracted;

exercised actualised but not perceived;

exercised actualised and perceived by humans

Transformational model of

society

Social structures, conventions &

practices

Human activity

Existential relationship(not causal)

Mind independance (not people independance)

Reproduction/Transformation

Fay (1987)

Humans are:

• active-

• embedded-

• embodied-

• historical-

• traditional-beings

Ena

blin

g / L

imiti

ng

Enlightenment – know that

↓

Empowerment – know how

↓

Emancipation - transform

Application

• Units A&B, high turnover of staff.

• ‘B’ not perceive the reality (intransitive), nothing changes (reproduction). Apathy has a long history on the unit, is embedded and embodied

• ‘A’ perceives (transitive) investigates mechanisms (enlightenment) intends & attends to change (empowered) transform & continuously readdress culture (emancipation)

Knowledge

• Knowing that • Knowing how• Knowing what it is like

Surfacing knowledge only via (traditional) cognitive verbal communication limits the type of knowledge exposed.

Using creative expression enables the surfacing of pre-conscious & embodied knowledges

Rational & cognitive

Rational & cognitive and/or pre-conscious & embodied

Generation

Creating communicative spaces where:• Personal knowledges are shared

(creatively)• Reflection, critique, contestation takes

place• Intersubjective agreements, mutual

understandings and unforced consensus about what to do

• Co-constructing new knowledge & ‘plausible’ explanations

So, is this all just a fairytale

?????