Introduction

You may have come across the terms person-centred care, patient-centred care or client-centred care in the literature or in practice during your course as these are all terms that are commonly used to describe care encounters across a range of settings where you will find ‘individuality’ is the common theme. However, while these terms are often used interchangeably, we would suggest that they have slightly different meanings. It may be argued, for example, that the term patient-centred care links primarily to the concept of individualised care, and while individualised care forms a part of person-centred care, it is only one part of person-centred care. Person-centred care is also a complex and highly skilled part of care delivery and as such it is important to ‘unpeel’ the different layers that make up this concept in practice.

Person-centred care is a complex concept and not only involves care delivery but also the way in which we conceptualise or ‘think’ about caring for and about an older person in our everyday practice. This ‘thinking’ forms part of our personal and professional values framework and consequentially is informed – and informs – our philosophy to caring. As part of your nursing course you may have been introduced to subjects that concern nursing philosophies or nursing theorists, for example Jean Watson and the Philosophy and Science of Caring or Patricia Benner From Novice to Expert.

Obtain a copy of Nursing Theorists and Their Work by Marriner-Tomey and Alligood (2006) from your library and see if you can start to define what is meant by the term nursing philosophy and how this relates to the development of nursing theory. You will also be able to consider how your own values and ‘thinking’ about care align with established theorists in this field and some of the key philosophical positions. Florence Nightingale also appears in this book, and if you remember back to Chapter 2, we mentioned Notes on Nursing and the emphasis that Florence Nightingale placed on the environment and the theoretical concepts that she promoted and which were central to her philosophy of nursing.

The reason we start this chapter with reference to nursing philosophy is because person-centred care is a multi-layered phenomenon. Arguably, in a similar vein to social policy, it has a philosophical basis, a theoretical framework or frameworks and is also ‘work in action’ as a practical approach to care. That is why in this chapter we explore the concept of person-centred care through three broad perspectives as follows:

1. Person-centred care as a philosophical approach to care.

2. Person-centred care as a practical approach to care delivery.

3. Person-centred care as a theoretical framework for delivering care.

However, before we consider each of these perspectives in detail, we start by briefly drawing your attention to the National Service Framework (NSF) for Older People (Department of Health (DH) 2001).

Person-centred approaches to care delivery have now become firmly embedded at a policy level. For example, The NSF for Older People has a whole standard (standard 2) devoted to the concept of person-centre care, while the Dignity in Care Campaign (DH 2006) aims to place dignity and respect for individuals at the core of healthcare services. From an organisational or policy perspective, therefore, we can see how person-centred care might be defined through the context of interprofessional working. For example, The NSF for Older People specifically refers to ‘integrated commissioning arrangements’ and ‘integrated provision of services’. However, despite the growing use of the term person-centred care within everyday nursing and healthcare discourse, there remains some confusion regarding the meaning of the term or how it is translated into practice.

The aim of this chapter, therefore, is to explore the concept of person-centred approaches to care of the older person and how this key concept may be developed within everyday practice and the various clinical placements where you may be caring for older people.

Activity

Before we consider all the issues above, take a few moments to consider what person-centred care means to you. You may wish to write down one or two phrases or words that sum up person-centred care both from your own life experience and from your nursing experience. We return to your original thoughts and notes at the end of this chapter.

Person-centred care as a philosophical approach to care

Part of the complexity surrounding person-centred care originates from the concept of ‘person’. In the simplest form, the word ‘person’, which derives from the Latin persona, is purely defined as the singular of people. However, if we ask the question ‘what does it mean to be a person?’, the definition of person becomes more complex (McCormack & McCance 2010). The concept of ‘person’ is arguably concerned with the way in which we express our ‘humanness’ and a consideration of the facets or attributes that make us who we are. Importantly, it is also concerned with our connections to others and the way in which we are treated, for example how we are spoken to or how we are perceived by others.

Acknowledgement and respect of the rights of an individual is the very essence of person-centred health care. While it is acknowledged that person-centred care is not exclusively the premise of older people, it is equally recognised that the potential for the erosion of the key facets of person-centred care, for example dignity, respect, equity and personal autonomy, may be far greater among older people (Health Advisory Service 2000).

In making explicit links between the nurse–patient relationship and participation, person-centred care becomes pivotal to the overall structures that support the context of caring relationships with older people.

In his seminal work on dementia care, Kitwood (1997) defined person-centeredness as placing the needs of the person as an individual at the heart of care provision. In essence, this means recognition of the individual and appreciation of their uniqueness and, more fundamentally, mutual respect:

[Person centeredness] is the status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust.

(Kitwood 1997:8)

Although Kitwood’s work has been focused predominantly in the field of dementia care, the underpinning tenets of his work have clear resonance within the healthcare setting in general and more particularly in terms of the ideology of contemporary models of nursing care and, as such, have been developed widely across a number of other care settings. Although Kitwood was writing in the 1990s, his work still remains the cornerstone and basis of many examples of person-centred care approaches that you will come across.

McCormack (2001), for example, identified through his own research the centrality of person-centred care in achieving optimum quality of care for older people. His definition of person-centred care is in keeping with Kitwood’s (1997), and does not simply relate to the provision of care in a practice sense, but rather encapsulates the more intangible facets of a whole philosophy of care involving recognition of the quality of the relationship overall through such concepts as autonomy, participation and reciprocity.

Person-centred care is now firmly embedded within the contemporary literature (McCormack 2004), and has traversed a range of health and social care boundaries (Barker 2001). Although the term ‘person-centred care’ has been utilised interchangeably with similar concepts, for example client-centred care (Chapman et al 2003), patient-centred care (Allhouse 1993) and more latterly the development of the concept of relationship-centred care (Nolan et al 2001), all would appear, at least in theory, to be synonymous with the recognition of the need to ‘see’ the person as an individual within the care process, resulting in the provision of quality care (Nolan et al 2004).

However, although the concept of person-centred care can be found explicitly embedded at a policy level and with increasing frequency within the literature, questions remain as to what is explicitly meant by person-centred care and, more challenging, how person-centred care can be translated into practice. With these questions in mind, in the following section of this chapter we consider the ways in which person-centred care can be translated and facilitated in the practice setting.

Person-centred care as a practical approach to care delivery

The concept of person-centred care has been explored extensively within the literature and has been described as the optimum way of delivering health care (Coyle & Williams 2001). It has been predominantly conceptualised in terms of organisational aspects of care delivery, for example seeking patients’ views regarding involvement in care and treatment (Coyle & Williams 2001), planning care interventions and day-to-day activities around the preferences of the individual (Draper 1996) and the recognition of the role of partnerships, both lay and professional, within the care process (Chapman et al 2003).

Activity

Consider the above statement by Ford and McCormack (2000). What are your thoughts about their definition of person-centeredness? Take a few moments to reflect on the attributes that are important to you as an individual. If you were in a care environment, for example on a hospital ward, what would you want nurses and other healthcare professionals to understand and acknowledge about you as a person? Read through the following section and then review this activity. Is there anything that you would change from your original observations?

Next time you go on a placement where you work with or care for an older person, think about this activity in terms of how you might ensure that you develop person-centred practice. How do you ensure that the older person is treated as an individual? What strategies do the nurses and other staff use to ensure that older people are treated as individuals? For example, you might come across ‘memory boxes’ or other initiatives of this nature – how are they used?

This exercise could form the basis of a goal in relation to achieving competence in the development of your own ethical and professional values when working with older people. It could also help you to achieve the Nursing and Midwifery Council (NMC) Domain Competencies (NMC 2010) in: