Chapter 11
Helping health-care practitioners to flourish: critical companionship at work
Angie Titchen1 & Karen Hammond2
1Ulster University, Northern Ireland, UK
2East Kent Hospitals University Foundation Trust, Kent, UK
Opening space
Human flourishing occurs when we bound and frame naturally co-existing energies, when we embrace the known and yet to be known, when we embody contrasts and when we achieve stillness and harmony. When we flourish we give and receive loving kindness
Definition and image from McCormack and Titchen (2014, p. 19)
Person-centredness is central to helping practitioners to flourish at work. It manifests through relationships between colleagues and between practitioners and service users. These are relationships based on respect for persons, compassion, kindness, self-determination, mutual respect, trust and understanding. Such relationships are brought alive by working intentionally with the Person-centred Nursing Framework (McCormack & McCance 2006). Critical companionship (CC) (Titchen 2001, 2004) is a person-centred relationship that can help practitioners to develop the domains (prerequisites, care environment and care processes) of the Person-centred Nursing Framework. The companion aims to be a visible, living embodiment of person-centredness, helping practitioners to flourish through the relationship and by flowing and spiralling through inner and outer turbulence that occurs through change and transformation. CC is made visible through a metaphor of accompanying an individual or group on a co-learning/inquiry journey within their everyday practice and a conceptual framework.
We are critical companions helping each other in a critical-creative inquiry in which Karen is exploring her own development of CC in her practice development facilitator role and Angie is deepening her understanding of how she does CC in a critical creativity worldview. When we were invited to write this chapter we decided that we would use a ‘faction’ genre, which is fiction based on ‘fact’, derived from our own and others’ empirical research and experience. We want to give you a taste of how CC can contribute to developing and sustaining person-centred cultures through helping practitioners to become person-centred by exploring self, reflectively and critically, and using that knowledge and understanding to change their approaches to practice and engagement with service users.
The chapter tells the story of how imaginary critical companionships were set up to embed the Person-centred Nursing Framework in a large NHS Foundation Hospital Trust that integrates hospitals in different towns with rural-based clinics. We show you how two companions use the PCN and CC frameworks to create spaces for practitioners’ self-reflection and critique as they learn in and from practice. We draw on two other frameworks concerned with human flourishing (Titchen & McCormack 2010; McCormack & Titchen 2014) to touch lightly on the idea that it is the professional artistry of the critical companion that effectively creates the conditions for human flourishing.
Preparing the ground for critical companionship
Five years ago, a national quality inspection was carried out in the Trust and the report highlighted the need for culture change, beginning at the top. A new Chief Executive, Linda, was then appointed to lead the change. In her previous post as a Director of Nursing and Allied Health Professions, Linda had been a passionate supporter of staff who were using an emancipatory practice development approach (Manley et al. 2004) to create person-centred cultures throughout the organisation. She had seen the impact of such cultures on service users’ experiences of their care and had observed that culture change seemed to come about by paying attention to person-centred relationships between staff and service users and colleagues. In her new post, Linda set to work to help the hospital executive team become more person-centred in the way they worked together and with hospital staff, and to experience the challenges of transforming their relationships and ways of working and the need for support for themselves and all staff in creating person-centred cultures.
Simultaneously, Linda developed a proposal for a Trust-wide, inter-professional practice development programme to support transformation. A cornerstone of the programme would be to support experienced practitioners, clinical leaders and managers in developing facilitation skills. They would learn how to help their staff and the people they work with develop and strengthen their capacity to create person-centred care environments in their workplace and acquire care process and practice development skills. Joanna, a physiotherapist with experience in primary and acute care, practice development and research, was appointed to join the executive team as the practice development programme director. Joanna had impressed Linda at her interview by her vision of using the Person-centred Nursing Framework as an energising, dynamic framework to guide change, and the CC framework as a strategy for facilitating the change.
Joanna had explained then, ‘Here is a mandala1 of the CC framework superimposed on the person-centred framework, which I have symbolised by three spirals at the centre (Figure 11.1). Within the spirals (which have no beginning and no end), learning and inquiry spaces flow across the three domains of the Person-centred Nursing Framework. In other words, when companions work in a space in one domain there is an effect in the others too. In reality, these spirals are bigger than CC, but I have designed it this way to fore-ground CC at this point.’
Figure 11.1 Key components of the CC framework (for full framework, see Titchen 2001, 2004).
She went on, ‘There are four CC domains and each one has specific processes and strategies. The dotted lines show the potential for the processes to be brought together in a kind of improvisation according to the uniqueness of each person, context and situation and what is needed.’
Later, after Joanna had taken up her post, Linda wanted to check that she had understood how the two frameworks would work together. ‘So let me get this right, Joanna, the idea would be that we could support these experienced people in becoming critical companions whose work would promote the development of the whole of the Person-centred Nursing Framework and, in turn, they could help others, in their workplace to become companions. Over time, the strategy could snowball across the Trust?’
‘Exactly’, replied Joanna. She takes a deep breath and suggests to Linda that they could become critical companions to help each other work effectively with both frameworks across the organisation. Linda accepted.
Becoming critical companions
Over the next few months, Joanna set up a practice development support group and introduced them to the CC framework. She suggested that they start to reflect on their facilitation practice by identifying which processes they were using. She gave them a handout with the mandala (Figure 11.1) and a brief description of each domain and its processes to put in their metaphorical pockets.
- The Relationship domain has four processes. Particularity is about knowing the other(s) as a whole person in their situation and contexts, so as to devise helping strategies that are likely to work for that person or group. Reciprocity
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
