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How to promote person centered care

Promoting person centered care in health and social care is extremely important. Working in a person-centred way, you put the individual at the centre of their care and support so they can choose how they want it to be.

We all have a set of values that shape how we think and how we react to situations and other people. In fact, we go by these values in our everyday lives whether or not we are aware of it.

Values are beliefs and ideas about how people should behave.

They have been formed by our:

  • Childhoods.
  • Families.
  • Backgrounds.
  • Cultures.
  • Religions.
  • Relationships.

Every individual will have their own set of values. However, there are also values which are central to working in health and social care and are principles that:

  • Guide workers, so they understand right from wrong.
  • Emphasise what is important when providing care and support to individuals.

The 6Cs

Six values will apply to you as a health and social care worker. These are known as the 6Cs and are:

  • Care – Having a person’s best interests at heart and doing whatever is possible to maintain or improve their wellbeing.
  • Compassion – Being capable of feeling for a person and understanding them and their situation.
  • Competence – Having the ability to understand what a person needs, including possessing the knowledge and skills to provide what is required.
  • Communication – Having the ability to speak, and act in a way, so that the person can understand, and also listening carefully.
  • Courage – Not having the fear to try out anything new or to express any concerns.
  • Commitment – Possessing a dedication to provide care and support whilst understanding the responsibilities you have as a health and social care worker.

Person-centred values

An alternative way of looking at the 6Cs is by person-centred working, which means:

  • Each individual is placed at the centre of their care and support.
  • The care and support match the needs of the individual rather than trying to make a person fit existing routines or ways.

Person-centred values inform you how to work in a person-centred way. They give health and social workers a set of guiding principles so that everything you do is in the interests of the individual receiving care or support.

Examples of these values include:

  • Individuality.
  • Independence.
  • Privacy.
  • Partnership.
  • Choice.
  • Dignity.
  • Respect.
  • Rights.
Nurse working with service user to promote person-centered working

Individuality

We are all different, and each person has their own:

  • Identity.
  • Needs.
  • Wishes.
  • Choices.
  • Beliefs.
  • Values.

When providing care and support, you should be mindful that a ‘one size fits all’ approach does not work.

Independence

When promoting an individual’s independence, you are looking at what they can do for themselves. You are empowering them so that they do things for themselves as much as possible.

However, it does not mean leaving a person to cope alone. You should agree with the individual regarding the support they need and want.

When you empower a person that you care for and support, you give them the confidence, voice and power to:

  • Speak out on their own behalf.
  • Feel in control of their actions.

Privacy

All individuals have the right to private space and time when they need it.

  • Affects how and where care and support are provided, particularly where personal hygiene or intimate procedures are involved.
  • Includes not speaking to anyone regarding the individual’s private information, unless:
    – The individual gives their permission; and
    – It’s only on a need-to-know basis to improve their care and support.

Partnership

When you involve the individual and their family, and when working alongside other workers, you are working in partnership. The key to a successful partnership is:

  • Good communication.
  • Trust.
  • Valuing and respecting what others have to say.

Choice

Individuals should be:

  • Supported to make choices regarding their care and support.
  • Given information in a way so they can understand and make informed choices.

Where individuals are incapable of expressing their wants, needs and wishes, you must look at other ways to communicate. To help you develop these skills, you should consider additional training and supervision.

Dignity

When you treat an individual in a dignified manner, you are:

  • Treating the person with respect.
  • Valuing their individuality, and their ethical and moral beliefs.

To provide dignified care, you should:

  • Have an open and positive attitude.
  • Take the time to do things the way they want.
  • Never make any assumptions regarding how they want to be treated or other things they want or need.
  • Be aware of how personal care can affect their dignity.

Respect and Rights

Respecting a person means believing and showing them they are important as an individual. It also means respecting them when they have their own opinions and feelings, even though you may not always agree with them.

The main legislation that sets out the rights of people in the United Kingdom (UK) is the Human Rights Act 1998. Under the Act, you have the right to:

  • Speak your mind.
  • Be kept from harm.
  • Respect, dignity and equality.

You should also ensure that you, and others involved in care and support, respect individuals’ rights.

Nurse assisting and caring for patient with soup on sofa

Working in a person-centred way

Every individual has unique needs. Therefore, each person you care for and support will have their own needs, which will differ from everyone else’s.

When you work with an individual, to plan their care and support, you are working in a person-centred way to meet their unique needs. Working in this way means that it reduces the risk of negative, unfair or harmful treatment and neglect.

In health and social care, person-centred planning has four key-rules:

1. The belief that an individual can plan for themselves, with a focus on their strengths and abilities.

Example – an individual wants to walk short distances instead of using their wheelchair. They would like to make their own decisions on the mobility aids that could support them to achieve this.

2. The care plan is written in the first person so that it is clear it is the individual who owns it.

Example – the care plan would state something like – ‘I would like to try to use a walking frame when I am moving around the house and for short distances outside rather than using my wheelchair’.

3. The individual has as much control as possible over the choices they can make.

Example – you support the individual to try to use the walking frame.

4. The plan is there to make the individual’s life better, not fit them into an existing service.

Example – the walking frame chosen is the best type for the individual with the resources available. An alternative may be to find a frame from somewhere else.

The delivery of person-centred care in health organisations, focuses on the following priorities:

  • Compassion, dignity and respect – Values which are essential when involving individuals in their own care.
  • Shared decision-making – Sees individuals as equal partners in their healthcare.
  • Public involvement – Involving people in decisions about the design and delivery of services, e.g. involving communities in deciding on the type of services provided.

Promoting dignity

Promoting dignity in health and social care means:

  • Focusing on the value of every individual.
  • Respecting individuals’ views, choices and decisions.
  • Not assuming how individuals want to be treated.
  • Working with compassion and person-centred values.

Two of the 6Cs, compassion and care, require you to put person-centred values into practice, which means providing individual-focused care. This demonstrates to the individual that you want to care for and support them.

Life history, preferences, wishes and needs

You will need to find out what you can about the individual to provide care and support that respects their wishes, needs and preferences. What you can find out will depend on your workplace.

You will gain a deeper insight into an individual’s likes and dislikes if you try some of the following activities:

  • Speaking to them to find out about their personal history.
  • Reading any relevant information you have.
  • Talking to family, friends and people who know them.
  • Using life storybooks to help them gather and review their past life events, e.g. if they have dementia.
  • Using one-page profiles, which are simple summaries that detail what is important to them and how they want to be supported, i.e. social care tool.
  • Reading their Advance Care Plan (ACP).

This will help to put an effective care plan together with the individual. A care plan is a required document that sets out in detail the way care and support must be provided to an individual. Care plans are also known as plans of support and individual plans.

Reviewing and updating care plans

Care and support plans are a vital source of information. They must be regularly reviewed and updated to take into account individuals’ changing needs and preferences. Therefore, care plans are dynamic records.

Reviewing care plans is important as it:

  • Provides up-to-date information and enables workers to provide the best possible standard of person-centred care regardless of whether they are:
    – Changing shifts.
    – Returning from holidays.
    – Temporary or from an agency.
  • Enables workers to provide effective care and support to individuals who are new to them.

If an individual makes a complaint about their care and support, care plans might be needed as evidence as they are legal documents.

A review of the care plan should be carried out with the individual and should look at:

  • What is working.
  • What doesn’t work.
  • What changes may be required.

Take the following example. An individual is taking a new type of medication that is affecting their ability to eat certain foods. Their diet will need to change, but should still reflect the foods they would like to eat.

To ensure that you understand how care plans are used in your workplace, you should ask your manager for different copies. They should be able to explain their use in further detail for you.

You should always speak to your manager or another responsible person if you think that an individual’s care plan needs to be changed.

Nurse writing out updated care plan for service user

Supporting individuals using the person-centred approach

The person-centred approach utilises the notion that every individual has an inner wish to fulfil their potential.

An individual can think about the things that are important to them and make the best decisions in a place that is:

  • Safe.
  • Non-judgemental.
  • Compassionate.

Non-judgemental means:

  • Accepting a person for who they are.
  • Seeing them as positive.
  • Believing they are capable of making their own decisions and choices.

Planning for the future

It is vital that individuals are supported to plan for the future, and this can help to ensure their wellbeing and fulfilment. It can improve their quality of life, even when their care is short-term.

It is particularly important for those who may not be capable of communicating their wishes and making decisions.

Wellbeing is described in the Care Act 2014 as relating to the following areas:

  • Personal dignity (including treating someone with respect).
  • Physical and mental health and emotional wellbeing.
  • Protection from abuse and neglect.
  • Control by the individual over day-to-day life (including over the way care and support is provided).
  • Participation in work, education, training or recreation.
  • Social and economic wellbeing.
  • Domestic, family and personal relationships.
  • Suitability of living accommodation.
  • The individual’s contribution to society.

The Department of Health’s Care and Support Statutory Guidance, which was issued under the Care Act 2014, provides further information on wellbeing.

Advance Care Planning (ACP)

Individuals should be allowed and encouraged to express themselves. They should also be able to change their mind about things when they want to.

You should take the time to speak to them about:

  • Their needs.
  • What they want.
  • What they don’t want.

The above is particularly true for those in end-of-life care where they may not be capable of voicing their wishes as they could previously. In situations like these, you would need to utilise different methods of communication. It may also involve working with an advocate who will communicate the individual’s wishes on their behalf; if they are unable to do so themselves.

If possible, the individual will have made future plans and expressed what they would like to happen regarding their care if they are no longer able to make decisions for themselves. Planning for the future in this way is known as advance care planning (ACP), which is backed by the Mental Capacity Act 2005.

Advocacy

As you have learned, an advocate can communicate the individual’s wishes on their behalf if they are unable to do so themselves.

They also ensure that individuals (particularly the most vulnerable in society) are capable of:

  • Having their voice heard on issues that are important to them.
  • Defending and safeguarding their rights.
  • Having their views and wishes genuinely considered when decisions are being made about their lives.
Nurses discussing about advocates for service users

Minimising pain, discomfort and stress

Factors that may cause discomfort or distress

There are things in the area around an individual and their environment that may cause them discomfort or distress. To promote wellbeing, the individual should feel comfortable, and there are ways to achieve this.

Things that could cause discomfort or distress Ways to promote wellbeing
Lighting If the lights are too bright, you could dim them if possible. You could also provide additional lighting, e.g. for reading.
Noise If it is too noisy, you could close doors or windows. You could also adjust the volume of the TV or radio.
Temperature You could adjust the room temperature if possible, e.g. the heating.
Unpleasant odours You could air rooms or clean away anything that may cause unpleasant odours.

It is vitally important to remember to ask the individual about anything that is making them unhappy. You should then do whatever’s possible to make the environment as comfortable as it can be for them.

Sometimes, it may not be possible, e.g. if you are night working, then it would be impossible to work in the dark or without making any noise. However, you will need to take care to minimise any discomfort or distress.

If you feel the environment is causing the individual distress and it is not possible to action it immediately, you should:

  • Speak to their carer or a manager for advice on how to make changes.
  • Consider family members as an additional source of information, as they know the individual better and may have solutions you have not considered.

You should always ask the individual if they want you to change their environment for their comfort. You should never assume what they want.

Actions that may cause discomfort or distress

In addition to environmental factors, certain actions may also cause discomfort or distress to an individual. As part of their care plan, you may have to do things that may be uncomfortable or even painful for them, for example:

  • Moving or assisting a person who has stiff muscles or joints.
  • Changing a dressing.
  • Opening the curtains and letting in bright light.
  • Making a loud noise.

When carrying out such actions, you will need to:

  • Do so with the greatest care and sensitivity.
  • Ask the individual and inform them that it may be uncomfortable or painful before beginning the task or touching them in any way.
  • Gain consent to carry out the task.

Consent

Always remember that consent is a crucial part of health and social care work, particularly where you have to carry out actions that may be unpleasant for the individual.

An example would be opening the curtains, which would let bright light in, or making unavoidable noise. In these instances, you should be respectful and polite, and inform the individual of what you are doing beforehand so that they are prepared.

If you think of any other ways of approaching a situation, so that it reduces the discomfort or distress to an individual, you should explore these options with your manager. Where necessary, you may require further advice and support, e.g. requesting a referral to the GP.

Raising concerns and handovers

You will have systems in your workplace where you can highlight any concerns regarding an individual’s distress and discomfort.

Examples of such systems are handovers or team meetings and they:

  • Take place at the beginning or the end of the shift when staff teams change.
  • Provide you with a good opportunity to inform your co-workers of any concerns you may have. You may find that your concerns are shared by others.
  • Enable staff to work together to explore ways of working that reduce distress and discomfort, e.g. identification of a procedural change.
  • Allow for vital information to be conveyed to the next staff team, which ensures that the quality of care is upheld.

Reporting your concerns is good practice, and it can improve the quality of care and support of individuals.

Occupational therapist caring and assisting elderly man to walk with aid, to minimise pain

Supporting individuals to minimise pain or discomfort

You must be able to identify when individuals are in pain or discomfort. Typically, if a person feels uncomfortable, they will adjust their position until it is more comfortable. However, individuals who have limited movement or mobility may struggle to do this.

You should be able to recognise if an individual needs support so they can feel more at ease. In addition to a person informing you they are in pain or discomfort, there are also non-verbal signs.

You should observe the way they look, their body language, gestures or facial expressions, for example:

  • Doubling over.
  • Gritted teeth.
  • Pale complexion.
  • Sweating.
  • Tears or crying.
  • Becoming quiet and withdrawn.
  • Becoming aggressive.
  • Furrowed brows.
  • Environmental factors such as soiled clothes or bed linen.

Taking action to minimise pain or discomfort

If you know or suspect that an individual is in pain or discomfort, you should work with them and try to find a way to make them more comfortable.

An example would be assisting the individual so they can alter their position.

When you help an individual, you should ensure that you:

  • Are supported by another worker, where necessary; and
  • Always follow the individual’s care plan.

Scenarios

Consider the following scenarios:

You notice the equipment an individual is using is causing them pain and discomfort.

  • You could take steps to change the position of the equipment if required.
  • You should always have the individual’s consent.
  • If you are uncertain about what to do, you should check with your manager or supervisor.

Additional environmental factors are causing distress to the individual, e.g. wet/soiled clothing or bed linen.

  • You should ensure that you dispose of, and change, soiled bed linen in line with your agreed ways of working.
  • When making any changes, you should talk through what you are doing with the individual, so they understand the reasons behind your actions.
  • You should reassure the individual and involve them in any changes.
Nurse promoting confidence with service user

Maintaining identity and self-esteem

Wellbeing

Wellbeing is a term used to describe feeling comfortable in one’s life. It can include a person’s:

  • Sense of hope.
  • Confidence.
  • Self-esteem.
  • Ability to:
    – Communicate their wants and needs.
    – Make contact with others.
    – Show warmth and affection.
    – Experience and show pleasure or enjoyment.

An individual’s sense of wellbeing relates to many aspects of their life, including:

  • Spiritual – Finding meaning and purpose in life, e.g. through religious faith.
  • Emotional – How we feel about ourselves.
  • Cultural – Our sense of belonging.
  • Religious – Our faith and beliefs.
  • Social – Our relationships.
  • Political – Peace and stability in our homeland.
  • Sexual – Our intimacies.
  • Physical – Leading an active life.
  • Mental – Realising our potential and ability to contribute to society.

Identity and self-esteem

All aspects of wellbeing contribute to who we are or our identity. This refers to how we view ourselves, who we are as people and what makes us who we are. People are all different, and they have different feelings, attitudes and goals.

Each aspect of your life also influences your self-esteem and feeling of self-worth, for example:

  • Being isolated from family and friends would quickly make you feel lonely and unloved.
  • Alternatively, leading an active life and having the choice to do what you want with lots of friends would make you feel valued and self-confident. You would also have a good sense of identity and self-worth.

To promote an individual’s wellbeing, they should be happy with as many aspects of their life as possible. If they believe that something could help them feel better, you should be:

  • Positive.
  • Understanding.
  • Empathic.
  • Non-judgemental.

Having empathy means seeing things from the individual’s perspective and putting yourself in their shoes to gain a better understanding.

You should listen to what they think is important in their lives and try to help them make desired changes, e.g. being able to practise their faith.

Raising concerns

It is vital that you raise any concerns regarding the emotional or spiritual needs of an individual to either:

  • Your manager.
  • Your supervisor.
  • A senior member of staff.
  • The individual’s carer.

They will be aware of how to explore the necessary actions to better meet the individual’s needs. It is also vital to work together with those important to the individual and other services.

If you have any concerns, the individual’s family should also be informed. They may be able to help directly or may be able to offer solutions due to their past experiences.

Supporting using person-centred values

All the different person-centred values work together and none of them standalone, for example:

  • Independence is associated with individuality and choice.
  • Choice is closely linked to dignity and respect.

The purpose of these values is to empower the individual to speak up and take as much control as possible so they live a fulfilled life.

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About the author

Michelle Putter

Michelle Putter

Michelle graduated with an MSc in wildlife biology and conservation in 2012, but her career has taken quite a different turn to the one expected. She started in health and safety in 2009 and has worked in several industries such as electrical engineering, aviation and manufacturing. She has been working with CPD Online College since 2018 and became NEBOSH Diploma qualified in 2020. In her spare time, Michelle's passions are wildlife and her garden. She has volunteered for many conservation organisations and particularly enjoys biological recording. Michelle also likes hiking, jogging and cycling.



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