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In person-centred care, health and social care professionals work collaboratively with the people who use their services to help them to make informed decisions about their own health and care. Person-centred care means treating patients and care users as individuals and as equal partners.
Over 2,000 years ago Hippocrates, a Greek physician, said, “It is more important to know what sort of person has a disease than to know what sort of disease a person has”, so the concept of person-centred care is nothing new.
What is Person-Centred Care?
Person-centred care is not a medical model and it should be regarded as multidisciplinary; that is, recognising that a person may need more than one professional or service to support them for their condition. It means communicating with people and identifying and recognising their capabilities and potential to manage and improve their own health and wellbeing, not simply seeing them as victims of disease or passive recipients of care. Most people want to help themselves to improve their own health, wellbeing and quality of life, but they often need professional help to acquire the knowledge, skills and confidence to do so.
The Health Foundation has identified a framework that comprises four principles of person-centred care:
1. Affording people dignity, compassion and respect.
2. Offering coordinated care, support or treatment.
3. Offering personalised care, support or treatment.
4. Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.
Person-centred care within any healthcare or social care experience will involve either all or a combination of these principles. In 2013, the Department of Health (now the Department of Health and Social Care) and all the system leading bodies across health and social care in England declared a shared commitment to “person centred coordinated care”.
Why is individualised Person-Centred Care important?
Person-centred care helps to minimise the risk of negative, unfair or harmful treatment and neglect to the recipients of health and social care services. The individual is put at the centre of the care and is able to choose and control how they want their care and support to be delivered.
Person-centred care is designed to help the individual make choices and assess any risks that might be involved in their treatment and care. It is important that the individual understands all the consequences of the decisions they could make. In this way those who receive treatment, care and support can contribute to their own safeguarding.
Unfortunately, sometimes the way treatment and care is delivered can have the opposite effect. Overly directive or paternalistic approaches create dependency and undermine people’s confidence to protect their own health, prevent illness and manage their own care.
By looking at what the individual needs, rather than imposing a particular treatment and/or care regime on them, person-centred care puts the care receiver at the heart of their own care and/or treatment package.
Person-centred care not only takes into account the individual’s physical and mental needs, but also their environment, lifestyle values and beliefs. It is a more holistic and compassionate view of treatment and care. Treatment and care packages are developed from the point of view of the individual rather than that of the treatment and/or caregiver.
What are the benefits of Person-Centred Care?
There are benefits of person-centred care to both the individuals receiving treatment and/or care and to the professionals giving the treatment and/or care.
For individuals some of the benefits include:
- Flexibility – One of the main benefits of person-centred care for individuals is that they get to make decisions and have input into their own treatment and/or care rather than having what the “system” thinks is best imposed on them.
- Responsibility – When given more responsibility for their own care decisions, individuals become more interested and emotionally engaged in their own wellbeing. They are also made to feel less helpless and dependent, and more in control.
- Autonomy – People who take responsibility for their own health tend to become more aware of their health, for example whether or not they are eating properly, getting enough exercise, drinking too much etc.
- Appropriateness – By informing and making decisions about their own care, individuals are more likely to get what they need so their care package is more suitable for them.
- Independence – Better care means better health and less reliance on health services and in the long term could lead to less care needs, allowing individuals to remain independent for longer.
- Happiness – Knowing they are getting the most suitable care for them will obviously make them feel less anxious, more confident about the “system” and therefore happier.
For caregivers some of the benefits include:
- Accomplishment – Delivering more suitable care for an individual means that the individual will be happier, healthier and, if unwell, they are more likely to get well faster. Also, if they are at the end of life, the person will have clear information about their care options at the right time to remain in control. This will make the caregiver feel as if they are indeed making a difference to the lives of people in their care.
- Relationships – Treating people as an individual, rather than as a “patient”, will result in a better relationship overall and will create a much more pleasant working environment for the caregiver.
Why is Person-Centred Care important in dementia care?
The Alzheimer’s Society believes that “family, carers and the person with dementia, wherever possible, should always be involved in developing a care plan based on person-centred care. Their knowledge and understanding of the person is extremely valuable to make sure the care plan is right for them.”
They say that the main benefits of person-centred care for people who are living with dementia are:
- That it helps to ensure that people with dementia can take part in the things they enjoy.
- That it can be an effective way of preventing and managing some of the behavioural and psychological symptoms of dementia.
When someone has dementia it is easy to just see the disease and forget about the person the dementia patient used to be. The person-centred approach to dementia was developed to stop this from happening and to ensure that the person living with dementia remains the focus, not the disease, and that they are always treated with respect and as unique individuals. The assertion, “nothing about me, without me,” is at the heart of the person-centred approach.
If you are caring for someone with dementia you can ensure your care is more “person centred” by, for example:
Giving the person a choice of food at mealtimes, either ask what they would like to eat or show them pictures of different foods on offer to help them decide. Failing that, whenever possible, give them something they have always enjoyed and would choose to make for themselves. You could also give a choice of when to eat “Lunch at 12 or 1, which do you prefer?”
Little things mean a lot to someone who is suffering with dementia, too much choice may be overwhelming for them but some choices are essential to make the dementia patient feel more in control of their own life. For example, choosing which necklace, lipstick, watch or tie to wear, might seem insignificant, but it can give someone with dementia confidence in their decision-making.
- Am I seeing the world through their eyes?
- Am I treating them with dignity and respect?
- Do I know their likes and dislikes, their favourite music, hobbies or when they like to take a bath?
- Is their opinion, beliefs and personality understood and taken into account?
- Are they being valued as a human being, regardless of their age or how advanced their condition is?
If the answer is yes or that you do as much as you can, then you are using a person-centred approach and doing a great job.
Why is Person-Centred Care important in aged care?
In the past, some “care” establishments offered the opposite of individualised care; residents were treated to a regimented and depersonalised approach which destroyed self-esteem, identity and resilience. You only have to watch the film Mrs Caldicot’s Cabbage War to see the de-humanising effects of this kind of establishment-centred care. These traditional, service-led care operations offered little choice or variety, and treated everyone in the same way; this is not Equality.
The Care Act 2014 put person-centred care on a legal footing for the first time. It defines rights to choice, personalised care plans and personal budgets. It also requires local authorities to ensure that a range of high-quality services are available in their area. The principles of person-centred care are now central to social care law and policy.
Person-centred care can minimise the functional decline of older people; it recognises that every older person is a unique and complex individual. It respects their needs and preferences and the knowledge they bring about their health and healthcare needs. It can also result in decreased mortality rates, readmissions to hospital and healthcare-acquired infections, as well as improved functional status and increased patient and carer overall satisfaction.
Some things to keep in mind when planning person-centred care for an elderly person are:
- Have you taken time to get to know the person and recognise their individuality? Decisions should always be made from their perspective.
- People have a variety of different preferences, history, circumstances, tastes and lifestyles, so the planning process needs to adopt a personalised approach.
- Find out what is important to the person as well as what is important for them.
- Think outside the box to find solutions for the person to consider for themselves – give them choices.
- Person-centred planning needs to focus on achieving meaningful improvements in the person’s life and make a difference to it.
- Look at how the person’s independence and identity can be supported by person-centred care.
- The person’s needs are likely to change over time so make sure you review the care plan regularly.
Ask yourself the question “How can I care about a person if I don’t really know them?”
Why is Person-Centred Care important in nursing?
Caring has always been central to nursing practice and nurses’ relationships with their patients. Making sure that people are involved in and central to their treatment and care is now recognised as a key component of developing high-quality healthcare. In the UK there is increasing demand for health services and there are limited resources.
People are living longer and may often have many health conditions as they age. Research has found that person-centred care can help to improve people’s health and reduce the burden on healthcare services, so government policy is emphasising strengthening the voice of patients.
The NHS constitution in England has person-centred care as one of its seven core principles and has established these set of values:
- Working together for patients – Patients come first in everything we do.
- Respect and dignity – We value every person, whether patient, their families or carers, or staff, as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits.
- Commitment to quality of care – We earn the trust placed in us by insisting on quality and striving to get the basics of quality of care, safety, effectiveness and patient experience right every time.
- Compassion – We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need.
- Improving lives – We strive to improve health and wellbeing and people’s experiences of the NHS.
- Everyone counts – We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind.
This philosophy is also built into National Service Frameworks, monitoring requirements and legislation in all four countries of the UK.
Research within the NHS by the Kings Fund has found that person-centred care can have a big impact on the quality of healthcare.
Their research findings suggest that it can:
- Improve the experience people have of care and help them feel more satisfied.
- Encourage people to lead a more healthy lifestyle, such as exercising or eating healthily.
- Encourage people to be more involved in decisions about their care so they get services and support that are appropriate for their needs.
- Impact on people’s health outcomes, such as their blood pressure.
- Reduce how often people use services. This may in turn reduce the overall cost of care, but there is not as much evidence about this.
- Improve how confident and satisfied professionals themselves feel about the care provided.
Examples of person-centred care in nursing practice include but are not limited to:
- Respecting a patient’s values.
- Considering a patient’s preference and expressed needs.
- Coordinating and integrating care.
- Working together with other healthcare professionals to make sure there are good communications, information and education.
- Providing emotional support.
- Involving and updating patients’ family and friends.
- Ensuring a person has access to appropriate care when they need it.
National Voices carried out a survey about person-centred care, and it found that:
- 76% of inpatients who had an operation or procedure said that what would happen was “completely” explained.
- 78% of cancer patients were definitely as involved as much as they wanted to be in decisions about their treatment.
- 87% of general practice patients said their GP was good at listening to them.
- 33% of people using adult social care said they had as much control over their daily lives as they wanted; another 44% had “adequate” control.
- Only 3% of people with a long-term condition said they had a written care plan.
- 46% of inpatients said they did not get enough further support to recover or manage their condition after leaving hospital.
The primary goal of a person-centred care approach in health and social care is to improve an individual’s health and wellbeing outcomes.
This not only benefits the individuals being cared for but it also benefits those working in health and social care by:
- Enhancing and improving staff morale, job satisfaction, productivity and efficiency amongst care and healthcare providers.
- Improving service users’ satisfaction.
- Enhancing service reputation.
- Improving resource allocation and utilisation.
Crucially, person-centred care ensures that people are always treated with dignity, compassion and respect.