Recording Care through the PACE Framework
Research type
Research Study
Full title
Recording Care through the PACE Framework: Research Evaluation of an Innovative Approach to Person-Centred Care Planning
IRAS ID
275631
Contact name
Tanya McCance
Contact email
Sponsor organisation
Ulster University
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
2 years, 1 months, 9 days
Research summary
Research Summary
The challenge to achieve effective, person-centred care planning has a long history in nursing. Research relative to care planning within nursing has demonstrated a dissonance between using a preferred model to articulate care that is planned, and the reality of practice in any clinical environment. It is recognised that planning nursing care is complex, and requires a clear and accurate record of the planned, delivered and evaluated care that demonstrates individualised and person-centred practice to meet the needs of the individual. This view is set within a context where person-centred practice is promoted nationally and globally as an agreed approach to care and underpins effective cultures of improvement, focusing in equal measure on the needs of staff and patients or service users that receive care.
The aim of this research project is to evaluate the impact of the implementation of an innovative approach to planning nursing care (referred to as the PACE Framework). ‘PACE’ (Person-centred Assessment, Care planning and Evaluation) Framework was the product of a ‘ground up’ iterative process, that is used in conjunction with exisiting nursing practice theory, incorporating relevant risk assessments. The overarching aim of the research is to evaluate the impact of the implementation of planning nursing care through PACE to the development of person-centred practice.Summary of Results
INTRODUCTION: Planning nursing care effectively is complex, which requires insight into the person being cared for and working in partnership to acquire the necessary information and reach consensus on how care and patient goals will be achieved. Furthermore, a clear and accurate record of how person-centred care will be planned, delivered and evaluated to meet the needs of each individual patient should be documented and openly shared with the person it relates to. However, the evidence suggests that frequently care planning falls short of its partnership aspirations. This challenge led to the development of the PACE (Person-centred Assessment, Care planning and Evaluation) Framework, a regional initiative within Northern Ireland aimed at improving the quality of care planning within the nursing.
Building on the implementation of the PACE Framework, the Chief Nursing Officer (NI, DoH), Chief Executive NIPEC and Executive Directors of Nursing (NI), agreed that this Framework should be used throughout the region to support person-centred care planning practice. To ensure there was a systematic and rigorous evaluation conducted, two Higher Education Institutions in Northern Ireland (UU & QUB) were funded to undertake this piece of research.
BACKGROUND EVIDENCE: The challenge to achieve effective, person-centred care planning has a long history in nursing. Internationally, the challenge of achieving effective, person-centred care planning in nursing, has been extensively reviewed (e.g. Mackie et al., 2017; Reid et al., 2018; Donnelly et al., 2021). Continued research in this area has demonstrated a level of dissonance between using a preferred model to describe planned care , and the reality of delivering nursing care in the clinical environment (Sølvi & Høgskulen 2017; Mitchell & Elbourne, 2020). It is recognised that planning care is complex and requires a clear and accurate records of the planned, delivered and evaluated care that demonstrates individualised person-centred care, to meet the needs of people accessing care services. The evidence further suggests that effective personalised nursing care planning and associated documentation should be individualised (Doody et al., 2019; Glasper, 2020). To ensure an individualised approach, registered nurses need to engage with the people who access health services by working with the person’s beliefs and values, engaging in meaningful conversations and working towards authentic shared decision-making (McCance & McCormack 2021). This view is set within a context whereby person-centred practice is promoted nationally and globally as an agreed approach to care and underpins effective cultures of improvement, focusing in equal measure on the needs of nursing staff and people who use healthcare services and receive.
STUDY AIM: The aim of this research study was to evaluate the impact of the implementation of the PACE Framework on the development of person-centred practice. Specifically, the objectives sought to:
• explore the impact of the PACE Framework on patients’ and families’ experiences of nursing care; • explore the impact of the PACE Framework on staff’s experiences of providing nursing care; • identify the knowledge transfer that will support further development and ongoing implementation of this approach.PROJECT APPROACH: A mixed methods approach was utilised, underpinned by the Person-centred Nursing Framework (McCormack & McCance 2021). The project was conducted in two phases: (i) phase one generated mainly quantitative data using the person-centred nursing KPIs (McCance et al 2012) and (ii) phase two generated qualitative data through one-to-one interviews. The study was conducted across a range of wards and departments within acute care, drawn from each of the five Health and Social Care Trusts (HSCTs) across Northern Ireland.
KEY FINDINGS: The purpose of PACE is to promote person-centredness and the findings from this evaluation evidenced that recording care in this way does have a direct impact on registered nurses’ ability to engage in person-centred practices. The study findings indicate that PACE provides a vehicle for registered nurses to engage in effective person-centred processes. The PACE documentation was also viewed as a means of promoting an holistic approach, shifting the attention of registered nurses from a primary focus on clinical care and associated tasks towards an appreciation of understanding other perspectives of the patient as a person. The data also reflected the complex blending of the art and science of nursing, placing nurses in an ideal position to deliver person-centred care. Finally, within the PACE initiative, education sessions, follow up support and resource materials, delivered by local facilitators, all contributed towards involving registered nurses in the process of reducing perceived barriers of implementing the PACE framework.
CONCLUSION: This study confirms that the implementation of the PACE Framework has a positively impacted on the development of person-centred practice, and on the experience of care for patients, their significant others and nursing staff. Exploring the data and reviewing the evidence base it is apparent that PACE provides an effective framework to record care in a way that directly impacts on registered nurses’ ability to engage in person-centred practices. This assists registered nurses to move away from delivering task orientation care towards person-centred care that focuses on working in a holistic way; developing an understanding of what patients value and appreciate most about their care.
RECOMMENDATIONS: The following key recommendations are proposed for practice, education and further research for consideration by the nursing professions within Northern Ireland.
Practice
1. Continued investment in the role of PACE facilitators given their importance in implementation.
2. The PACE framework should guide nursing focused handovers and integrated into MDT processes where possible.
3. Role out PACE to other areas given the positivity of findings (e.g mental health).
4. Adaption to include other non-NHS settings (e.g. care home settings) 5. Future digitalisation of PACE to allow comparison across sites and standardisation of nursing work, whilst remaining cognisant that it is an approach to care planning not a static record.Education
1. Ensure the continued inclusion of PACE in undergraduate nursing programmes.
2. Enhanced understanding of the theoretical principle of person-centredness and it’s links to PACE.
3. Promote PACE amongst MDT colleagues to illuminate the key contribution/value of nursing work?Research
1. Consider further research projects to explore the value of PACE as a method of greater patient and carer involvement in decision making regarding planned care and evaluations of nursing effectiveness 2. Consider a longitudinal study to evaluate the sustainability of PACE.
3. Implement and evaluate the impact of PACE in a digital world.REC name
HSC REC B
REC reference
20/NI/0033
Date of REC Opinion
1 Apr 2020
REC opinion
Further Information Favourable Opinion