Fundamentals of Person-Centred Healthcare Practice. Группа авторов
Added to this, there are staff shortages on this shift with an additional five staff needed to meet safe staffing levels across the hospital. The bed manager indicates that to increase flow, more patients need to be sent home. One manager reports that:
‘The patient in room 33 will die soon which will free up a bed and we could send another home after 8pm in a taxi when her blood transfusion is finished.’ This person lives alone and has been in hospital for a week.
In this vignette, the culture of care appears to prioritise targets over people. This is demonstrated through the use of language that disrespects personhood and dignity. Decisions are being made that affect vulnerable persons, with no acknowledgement of risk management or collaborative working. There is limited opportunity for shared decision making or consideration of the policies and procedures that support safe and effective care delivery. Finally, you may question the manager's position as a leader and role model and the failure of those present to challenge these practices which are at odds with person‐centredness.
Such experiences within the practice setting can result in a level of moral distress. This is defined as: ‘The painful psychological disequilibrium that results from recognising the ethically appropriate action, yet not taking it. Because of obstacles such as lack of time, supervisory reluctance, an inhibiting medical power structure, institution policy or legal considerations’ (Corley 2002, p. 250). For more information on moral distress please see: https://journals.sagepub.com/doi/10.1191/0969733002ne557oa.
Creating person‐centred cultures
The Person‐centred Practice Framework provides a useful lens for professionals to view, guide and enhance practice. In the previous sections, we discussed prerequisites such as professional competence and developed interpersonal skills. We have also highlighted some of the care processes essential for person‐centred practice, such as working with a person's beliefs and values and sharing decision making. The practice environment, such as a ward, community hub, care home or health centre, and the wider organisational structures and leadership that support these environments are also significant in enabling professionals to support human flourishing. In the next section we propose strategies to support professionals to challenge issues that are at odds with their person‐centred values and beliefs. These strategies include reflection, self‐care and constructive challenge.
Critical reflection is a useful tool for professional learning (Gardner 2014) and can help professionals to discuss, deconstruct and learn from clinical issues. Deep learning is enhanced by a supportive culture and skilled facilitation (Dewing 2008; Mann et al. 2009). Reflective learning can be viewed as occurring at micro, meso, and macro levels. In the above activity, at a micro level John and his supervisor may analyse his actions with Mr Gregor and explore why he felt unable to ask for help. These reflections could be recorded to support continuing professional development and lifelong learning. At the meso level, his supervisor may use this as an opportunity to reflect on expectations of students and the learning culture of the unit. At a macro level, audit results of the learning environment may reveal a high number of critical incidents focusing on safe moving and handling, suggesting that lessons can be learned from this reflection that lead to action at institutional level.
Reflection can also support the development of self‐knowledge and such insights might lead to the consideration of strategies to support a professional's own well‐being. Some aspects of professional practice, such as long working hours, stressful encounters and placing people's needs ahead of our own, are known to have a detrimental impact on well‐being (American Dental Association 2019; Winkel and Morgan 2019), and can result in moral distress and burnout (Hamric 2010). It is important for healthcare professionals to demonstrate self‐care and to build resilience to ensure that their fitness for professional practice is not compromised.
In the vignette above we highlighted that staff may experience moral distress regarding discussions about the safety and dignity of people being considered for discharge. Through reflection, practitioners may realise that this is embedded in practice. Challenging values and behaviours that appear to be prioritised within the organisation can create anxiety and contribute to diminished well‐being. Strategies that might support well‐being could include engaging in clinical supervision to discuss matters and explore how to act. Practice development initiatives, where participants are supported to role play a range of alternative actions in a safe space, may be another means of challenging negative cultures. Additionally, learning mindful practices may support well‐being and stress management and help achieve a work/life balance. This is discussed in greater detail in Chapter 15. By engaging in such activities, practitioners may feel empowered to constructively challenge the behaviours and values that were observed at the meeting or speak to another manager to report the concerns that were witnessed.
Conclusion
The realities of current practice require professionals to operate in a challenging and complex system, that is fast paced and dynamic. In order for professionals to lead and influence person‐centred practice at micro, meso, and macro levels, they should be positive role models who demonstrate person‐centredness in their practice. In this chapter we have used activities to highlight the important role that professionals play in providing safe, effective, person‐centred practice. We have considered some of the tensions that arise when upholding professionalism whilst striving to be person‐centred and offered some strategies to support professionals in raising concerns or challenging practice that is unprofessional. As a health or social care professional, you will occupy a position of privilege and trust. This position brings with it certain expectations and responsibilities as set out by your regulator. Central to these responsibilities is the need to act at all times with honesty and integrity and to behave in a way that reflects well on the profession and how it is perceived by the public. Being a health or social care professional and acting professionally can also bring a great sense of personal and collegiate pride in knowing that individually and as a profession, you can make a positive difference to the lives of others.
Summary
Professional standards exist to protect the public and maintain public confidence in the health and social care professions.
It is important to be familiar with the requirements for professional practice and revalidation as set out by the regulator in the jurisdiction where you practise.
Reflection and sharing of constructive feedback with others enables health professionals to create accurate perceptions of their practice. This can be used as a basis for developing practice.
We all have a responsibility for maintaining and promoting acceptable standards. This includes raising concerns without delay when practices are not person‐centred.
Practising professionally involves acting in the best interests of people, being committed to professional development, leading by example and upholding the reputation of the profession to which you belong.
Additional learning activities
We have devised the following learning activities that can be undertaken before, after or during your reading of Chapter 6.
1 Positioning professionalism within the PcPFGo to the PcPF on page 000 and look at the different domains and make some notes on the following questions.Which components would you associate with professionalism?How do these fit with your earlier thinking of the meaning of professionalism?What other factors not stated in the model link to professionalism?Once you have read the chapter go back to your notes. Reflect on any ways in which your thinking has changed or your prior assumptions about professionalism have been changed as a result of your reading.
2 Standards for professional practiceIdentify the relevant documents for your professional group and at least one other.Explore the common elements of professional practice that are included in these documents.
3 Legal