This chapter will review palliative care in the context of key elements of the McCormack and McCance (2010) Person-centred Nursing Framework that have particular significance for palliative care assessment and provision. Although palliative care is sometimes seen as a specialty domain, this chapter is appropriate to all health and social care professionals providing palliative care at all levels and in diverse settings. We will discuss areas of significance when developing skills in palliative care that relate to the Person-centred Nursing Framework.

The World Health Organization (2002) defines palliative care as:

an approach that improves the quality of life of individuals and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

The importance of a person-centred approach in health care is advocated internationally by the World Health Organization (2007, 2013, 2015), and in palliative and end-of-life care within national policy and direction both in the UK (Department of Health 2008, 2010; Scottish Government 2008, 2011) and in Ireland (Health Information and Quality Authority 2012; Health Service Executive 2014; Ryan et al. 2014). The words of Cicely Saunders, founder of the modern hospice movement, perhaps encapsulate the importance of person-centred care in palliative care:

You matter because you are you, and matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.

Palliative care is guided by health and social care professionals who recognise the inevitability of death, and provide opportunities for individuals, and their families should they so wish, to make decisions and set goals about their care (Health Service Executive 2014). Palliative care delivery requires enhanced emotional awareness and developed interpersonal skills (Bolton 2000). Effective interpersonal ability is linked to emotional intelligence and knowing self, identified as prerequisites to managing the care environment and providing person-centred care in the to Person-centred Nursing Framework.

When interpretations of person-centredness are not clarified there is a risk that the care and culture will be task focused. Manley et al. (2013) maintain that culture is about social contexts and not necessarily about the individual. Individual efforts to provide person–centred care will have limited effect on the overall care experience of service users and their families in the absence of a collective team approach. Developing person-centred cultures requires a focus on change that can maximise the potential for growth, development and human flourishing (Titchen & McCormack 2010). As human beings we need to have an ethical dimension as well as a technical one in order for us to flourish and feel satisfied (Hinchliffe 2004). Maximising potential requires us to engage our whole selves in the provision of care, including our valued competencies, wisdom, knowledge, experience and emotions.

Supporting individuals at times of great emotion proves to be a challenge for health-care professionals as they often do not know what to say (Wilkinson et al. 2008). Palliative care involves having ‘difficult conversations’, which includes sharing sad, bad and difficult news, and dealing with difficult questions including talking about prognosis and dying. It is important that information is shared sympathetically at a pace and depth that enables the person to retain a sense of control and be there in the moment (Schofield et al. 2008; Wilkinson et al. 2008; McCormack & McCance 2010). Honest disclosure of information can have an effect on patient outcomes including anxiety and depression. However, it is also important to have a sympathetic presence as well as good communication skills.

Well-being is a major consideration in palliative care assessment and places equal focus on four domains, namely physical well-being, social well-being, emotional well-being and spiritual well-being (Health Service Executive 2014). There is growing realisation that staff well-being impacts on care experiences and is a necessary consideration when developing cultures of person-centredness. The connection to positive care outcomes for service users becomes obvious when the right decisions are made and acted upon, and Titchen and McCormack (2010) uphold that individuals can recognise and flourish through the expertise of a particular nurse or health-care professional. Perhaps the account of flourishing by Senge et al. (2005) may explain this in part, when they say that there is an effortless transition from inner knowing to right action that is embodied when we flourish.

Feeling valued as a person enables us to flourish and requires us to engage in and nurture relationships with others that make us feel valued (Gaffney 2011). Creating environments where flourishing can take place requires a focus on transforming practice that releases creative positive energy with the purpose of seeing possibilities for change and where this energy is felt by individuals and their families (Titchen et al. 2011). According to McCormack and Titchen (2006) and Titchen and McCormack (2010), when we engage in transformational practice development we also engage our creative, ethical and spiritual senses, making it possible for us to be attuned to our personal attributes and see ourselves and others as whole human beings.

This chapter will now consider one of the components of the Person-centred Nursing Framework in relation to emotional engagement – having a sympathetic presence, knowing self, and clarity of values and beliefs. Having a sympathetic presence means ‘an engagement that recognises the uniqueness and value of the individual, and reflects the quality of the nurse-patient relationship’ (McCormack & McCance 2010, p. 37). An example of how this is carried out in practice is through the use of the following statements from health-care professionals while speaking with older patients with palliative care needs (Lannie 2014). These data were taken from a qualitative study comparing care delivery in two ward settings.