Fundamentals of Person-Centred Healthcare Practice. Группа авторов
you with an understanding of what it means to be person‐centred. Moreover, I hope to provide you with my understanding of person‐centredness and how my learning on the topic has changed the way I view my practice. McCormack and McCance (2017, p. 41) have provided a definition of person‐centredness:
person‐centredness focuses on the formation and fostering of healthful relationships with service users and others significant to them in their lives, as well as between all care providers. It is underpinned by values of respect for persons (personhood), individual right to self determination, mutual respect and understanding. It is enabled by cultures of empowerment that foster continuous approaches to practice development.
The idea of person‐centredness has been formed from the theory of personhood which has been widely described in the literature. Many scholars have presented their views of the theory. One philosopher who has written about what it means to be a person is Immanuel Kant who believed that personhood was the ability for a person to think and act morally and this is what differentiated humans from other species (von Bertalanffy 1968). His philosophy is one which I most associate with. It is what I consider to be the basis of the care that I provide. My view of person‐centredness and particularly person‐centred practice is that it is focused largely on being with the person and connecting on a human level. I believe that the most person‐centred care I provide is when I have been completely authentic with a family. This has included connecting with them on a personal but professional level and remaining transparent throughout my work with them. I encourage the families with whom I have worked to speak freely about their concerns and I have been sympathetically present. I have shared my knowledge with them and worked in partnership to come up with a decision that is suited to their needs.
In addition, I believe that in order to engage authentically with families it is important to recognise our own limitations. A large part of shared decision making with parents and families requires having adequate knowledge/information about a particular illness or treatment. As I am still at the beginning of my career as a specialist community health nurse, I am aware that I do not always have the correct knowledge or information to share with families. Therefore, in order to engage authentically, I inform them of my limitations in knowledge and state that I will seek the correct information in order to support them in making the best decision for their child. This has been generally well received and on reflection it appears that most families appreciate honesty and transparency. So, as I start my career as a newly qualified specialist community health nurse, I will continue to be honest about the extent of my knowledge with families and ensure that I signpost them to the relevant service that will be able to better inform them. Ultimately, my view of person‐centred practice has moved on and I have learned that is important to work towards ‘person‐centred moments’ and increasing the frequency of these moments in practice to create a context where person‐centred practice can be realised.
I hope this letter better informs you of how I have viewed person‐centred practice and how it has shaped the way I will practise in future. I would like to welcome you to our planet and hope that you too can become part of the movement towards person‐centred practice.
Yours sincerely,
C Thomson
This letter was written by a student (Caitlin Thomson) who at the time of writing was undertaking education as a specialist community health nurse (also known as a health visitor) at Queen Margaret University, Edinburgh. Caitlin was engaging in an exercise of writing to a fictitious ‘alien visitor’ known as an Osclean explaining person‐centred practice to them.
Activity
Imagine you are ‘the Osclean’ Caitlin has written to. What would your response be to her regarding your expectation of your care? Does what she says sound interesting? Would you want to be a part of it – why/why not? Are there things missing from Caitlin's description that you would want to be included? Feel free to present your response in any creative way you are drawn to.
As Caitlin recognises in her reflection, consideration of the person and our understanding of personhood in the context of how we relate to each other have a long tradition in philosophy and you have been introduced to some of these perspectives in Chapter 1. In more contemporary theory, the term ‘person‐centred’ is often considered to originate from the work of Carl Rogers and his humanistic psychological and person‐centred therapy (Rogers 1961). Rogers' focus was on maximising our potential to fulfil our personal life goals, including our need to be autonomous, social, connected with and respected by others, i.e. to be known as a person.
Drawing on all of these traditions, we can summarise being person‐centred as implying the recognition of the broad biological, social, psychological, cultural and spiritual dimensions of each person (i.e. the whole person) in our ways of being and doing as persons.
The core principles of person‐centredness can be seen in an array of models and frameworks applied to different health conditions (for example, Parkinson's disease [Buetow et al. 2016]), different client groups – where the most concentrated work has happened with persons living with dementia (see for example Fazio et al. 2018), and different healthcare settings, for example in critical care units (see for example van Mol et al. 2016). In the context of psychiatric medicine, for example, Mezzich et al. (2009) suggest that person‐centredness can be seen to be operationalised within four dimensions of practice: (i) care of the person (of the totality of the person's health, including its negative and positive aspects), (ii) care for the person (promoting the fulfilment of the person's life project), (iii) care by the person (with clinicians extending themselves as full human beings with high ethical aspirations) and (iv) care with the person (working respectfully, in collaboration and in an empowering manner).
However, we would suggest that these perspectives of person‐centredness are myopic and exclusive – what do we mean by that? Earlier we described the core values that underpin person‐centredness and we highlighted the importance of these values applying to all persons, not just persons using health services. It therefore follows that these values also apply to persons who are directly providing, managing, co‐ordinating, funding and planning services. So when we think about person‐centred practice, we have to think about it in the context of all persons. It is not enough to just think about person‐centred practice in the context of ‘doing practice’ but we also need to think about it in the context of our ‘being’ as a person working in healthcare and how we relate to all other persons, and how they relate to us. In addition, we showed in Chapter 1, through an analysis of the work of Leibing (2008) and Smith (2003), that person‐centred practice cannot depend solely on the values of individual practitioners and their commitment to working in this way. Smith shows clearly that the prevailing moral values in particular cultures have a significant influence on our ability to work in this way, and so presenting person‐centredness from the lens of ‘quality of care experienced by service users’ is a necessary but insufficient approach to person‐centredness. What we need to think about is the continuous development of cultures that can create, nurture, support and reflexively evaluate person‐centredness in the everyday experiences of all persons.
Person‐centred culture
Imagine a situation where you are not respected at work, because your relationships with other team members feel ‘unsafe’, the management style is hierarchical and controlling, autonomy is limited and you don't feel you have a ‘voice’ in decision making. How easy would it be for you to provide person‐centred care to service users in that context? We would argue that whilst you might be able to do so intermittently, sustaining your values of person‐centredness would be challenging to your personhood and in the end the care you provide would suffer. Evidence of the relationship between the person‐centredness of teams in healthcare and quality of care provided to service users is increasing (for example, Albers et al. 2018; ACSQHC 2018; Sinah 2017) and