Person, Interaction and Environment (PIE)
What is PIE?
PIE is an observational method which aims
to:
- describe the culture for person-centred care experienced by
people with dementia or confusion in general hospital wards
- help the ward team reflect on and develop their approach to
working with people with dementia
What does it involve?
- Following a one-day workshop, two members of staff carry out
PIE on a different ward within the hospital that admits people with
dementia or communication difficulties (elderly care, stroke rehab,
acute medical or surgical).
- Real-time observations of 5-10 people with dementia or
cognitive impairment, delirium or communication difficulties take
place over at least two key times of the day in 2-hour time periods
(4 hours in total), one in the morning and one during a
meal-time.
- Background information about the people receiving care and the
ward are recorded as well as comments about their care made by
patients or their relatives/ friends.
- Patients, visitors and staff should be informed beforehand and
given the opportunity to have any questions or concerns addressed,
with an on-going process of consent. The observers can intervene in
a crisis but should otherwise aim to be as unobtrusive as possible
and respect patient privacy.
- Verbal feedback to the host ward team should be given as
soon as possible after data collection.
- An action plan to develop practice will then be agreed with the
ward team.
- Ideally, both observers will spend a shift of 7.5 hours to
undertake PIE in each ward. This is required for introductions to
the ward team, data collection including 4.5 hours observations (4
hours plus a practice of 30 minutes), reflection on the findings
between observers and feedback to the ward team.
What is observed?
The following prompts may help us to
consider the culture for person-centred care for people with
dementia in the ward at any given moment. These are (following the
PIE acronym):
- P – Person: whether staff are using what is
known, or not known, about the individual patient as a person to
personalise their care; observing what the patient is doing and how
they are affected.
- I – Interactions: a person-centred care
culture is particularly evident in the context of relationships, or
more specifically, through day-to-day interactions with staff.
- E – Environment: this looks at the modifiable
ward environment and its impact on the people receiving care.
What happens to the findings?
- The main impressions formed about the culture
for person-centred care will be discussed with members of the ward
team.
- Although members of staff may benefit from one-to-one feedback,
the focus is not on individual staff competencies per se,
but on the shared responsibility for the ward culture experienced
by people with dementia.
- Key action points will be derived to develop person-centred
care practice and improve patient experience, e.g. to engage people
with dementia more often in conversation.
- The main impressions and action plans for each ward will be
submitted to the Royal College of Psychiatrists and an overall
thematic analysis of the results from the participating hospitals
reported at the national level.
- The findings are expected to complement those from other parts
of the clinical audit, e.g. patient/carer questionnaire.
What are the potential benefits of using PIE?
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For people with dementia and their
carers
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For hospital staff
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Give a voice to people
who might otherwise find to difficult to convey their
experience
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Provide a means by
which staff can reflect on the culture of care from the patient
as well as staff perspective
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Assess aspects of care
which matter most to people with dementia and their carers’ in
acute care, particularly their interactions with staff
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Raise greater awareness
in the staff team about the impact that their way of working has on
people with dementia, including what is done well
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Raise awareness at the
local and national level about the quality of person-centred care
received by people with dementia in general hospital wards
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Empower staff to make
small but significant changes to everyday practice in their
ward
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Improve the experiences of
people with dementia in general hospital wards
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At the national level,
share elements of best practice and share solutions to problems
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