Person Centred Care
Introduction
The number of older people who are requiring for acute care services is ascending as the population ages (Peek et al, 2007, Traynor, Brisco & Coventry, 2005, McCormack, 2002). As reported in McCormack’s (2002) research, the older people, represented 12.5% of the population, is 30% of all hospital discharge and 46% of all hospital bed days. Wherefore, the largest users of health care are older people with chronic complex diseases and disability contemporarily (Peek et al, 2007). Improving the care quality for older person in acute care setting in is becoming a significant issue. The best practice in the care of older people is considered to be person-centred care contemporarily (Peek et al, 2007).
This essay will discuss about …show more content…
what is person-centred care, how to put person-centred care in nursing practice, the barriers may influence the outcome of person-centred care and how to conquer the barriers to make a best result in three aspect.
Definition
The concept of person-centred care has been widely discussed for a long time and has variety explained by different authors.
Person-centred care is defined as ‘having the information they need to make informed decisions about their care and treatment and, where appropriate to support them to manage their conditions themselves’ (The Department of Health, cited in Williams et al 2005, p. 14). On the other hand, through Edvardsson, Winblad and Sandman’s (2008) opinion, the content of person-centred care included respecting individual’s rights, values and beliefs; knowing their biography and sharing information to help them making decision. Moreover, focusing on strengths of the persons what they can do rather than what they cannot do is the central of person-centred care (Edvardsson & Nay, 2009). In summaries, the right of individuals as persons is the underpinning of the concept of person-certred care. To respect the right of individuals as persons, the staff need to have an attitude of respect of patient to make decisions themselves (McCormack, 2003). Furthermore, Kitwood (cited in McCormack, 2004) also stated that person-centredness is ‘a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust.’ Therefore, seeing the patient as a person and building a trusting relationship is also important as respect patients’ rights as persons. Although the concept of person-centred care still has an unclear definition, it still been identified as a contemporary gold-standard model within sub-acute care for older people (Edvardsson & Nay, 2009). The aims of using person-centred care in acute ward are improving the quality of care which the professions provide, helping the older be individual and avoiding function decline (Edvardsson & Nay, 2009, Clarke, Hanson & Ross 2003, Gordge, Young and Wiechula 2009). We will discussion how to work out the aims in three
ways.
Building a trusting relationship
Building a trusting relationship between nurses and patients is a component of person-centred care. Moreover, Nolan et al (2004) suggest that relationship-centred care is more appropriate in gerontology. During Bridges, Flatley and Meyer’s research (2010), patients and their family considered the relationship between patients and staff as the key feature of patients’ acute care experience result in it is very important to build a trusting relationship between the professionals and patients. A trusting relationship also can reduce the feeling of being observed and cared for, or the discomfortable of been treated like an object and neglected (Edvardsson & Nay, 2009). Therefore, the first process for nurse to provide person-centred care is to establish a trusting relationship.
As acute hospital is an unfamiliar and confusing environment for the older people, some older people may have an episodes of acute confusion or cognitive impairment during hospitalization, especially for the patient who had dementia, delirium or communication problems (Edvardsson & Nay, 2009). For these patients, it is difficult to have an effective communication with them and hard to build a trusting relationship.
A trusting relationship for patients indicate that ‘staff recognized and would meet all their needs for treatment and care, and that they were safe, legitimate as a patient in receipt of acute care and significant as a human being that matter to others’ (Bridges, Flatley & Meyer 2010, p.96). Therefore, for the patient who is confusion or cognitive impaired, nurse should help the patient maintaining connections with family and social networks for feeling safe and supported, and help them be familiar with the environment, such as introducing the location of toilet and bathroom (Traynor, Brisco & Coventry 2005, Leplege et al 2007). Furthermore, it is helpful for nurse to build a trusting relationship to make patient and family feel cared for, respected and welcome, and to meet their need (Bridges, Flatley & Meyer 2010). Nurse can also provide some basic activities support to improve the relationship, such as reading the paper or helping serving lunch in the acute hospital setting (Edvardsson & Nay, 2009).
Recognition and Respect
Another important part of person-centred care is known the patient as ‘a person behind disease’ and respect individual’s belief, value and habits. As McCormack (2003) argues, being conscious of patient’s biography does not tell the nurse what to do, rather is orientates the nurse to a particular way of being. Nurse need to know the patient’s biography, valuing the patient as an individual, and know the patient’s belief, value and habits (Peek et al 2009). All the information can help nurse to understand the older person’s behavior, needs and desires. Afterward, nurse can provide specific care to each individual and nurse and patient can work together to make their own care plan (Williams et al 2005). Moreover, gathering the information about biography of older people can help to keep and increase a sense of self for them (Edvardsson & Nay, 2009).
However, there may be some barriers to get the biography from the aged, such as older person cannot find any staffs to be a listener as all the staffs are so busy that have no time to implement it; even they share their life story with one staff, the staff is lack of knowledge to use the biographical appropriately; or some older people may refused to talk about their lives to staffs (Clarke, Hanson & Ross 2003, Edvardsson & Nay, 2009).
Consequently, nurses should encourage patient to share their story. A good listening skill is also required for nurses. They need to know how to react when patient talk about aspects of their lives that are distressing and try to make sure patient is comfortable when they talking about their lives (Clarke, Hanson & Ross 2003). Moreover, nurse also need to acquire the knowledge to use the biography in their daily work, have a better insight of patient’s need, desire and value to provide more appropriate care to patient (McCormack 2003). However, these approaches may not suitable for everybody, especially for the ones who have painful past experience. For example, the older person does not prepared to talk about a painful issue in their past experience; nurse should respect their decisions and keep their dignity as it is also a part of person-centred care. Moreover, the older person may share the difficult story with nurse when they build a trusting relationship and older person trusts nurse enough (Clarke, Hanson & Ross 2003).
Autonomy and Independence
Helping older people to be autonomy and independence is one central constituent of person-centred care. In acute care setting, the risk of function decline for older people is very common (Gordge, Young and Wiechula 2009). Therefore, preventing the functional decline, focusing on older person’s strengths and remaining abilities, sharing information with patient and helping them to make rational decision is the way to keep the older people autonomy and independence in an acute hospital setting (Leplege 2007, Bridges, Flatley & Meyer 2010, Gordge, Young and Wiechula 2009). A multidisciplinary team which includes nurse, occupational therapist, physiotherapist and geriatrician is required for the older people (Peek 2007). Multidisciplinary team and family members involve in the person’s care plan. The care plan needs to focus on what older people can do rather than the ability they lost in disease or disability. For instance, Gordge, Young and Wiechula (2009) have a project to reducing functional decline of older people. They set a communal dining room for patients in an acute care ward; staffs help the older patient take their meal tray from their room to dining area to have lunch (Gordge, Young and Wiechula 2009). Moreover, informed the older person the information about the treatment can help the patient make the rational decision by their own, and make the older person to feel much more involved (McCormack 2004).
The noisy environment in acute care setting may make older patient anxious, agitated or restless (Edvardsson & Nay, 2009). All the psych and physical disorder may disturb the older patient to maintain their function and make a right decision of the treatment. Accordingly, a slower pace of care and carers, reduced noise from telephones, televisions and buzzers can create a safe and relaxed environment for the older people(Edvardsson, Winblad & Sandman 2008); or home-like surroundings such as some little decorations from home can make older patient feel peaceful and relax(Edvardsson 2008). However, a home-like environment can be vary in different cultures and countries, for example, dose homelikeness mean the furniture from their home, or dose it involve action and event as well? Through Edvardsson’s (2008) research, environments incorporating familiar objects of everyday life can be interpreted as at-homeness.
Summarize
In conclusion, person-centred care is a golden model for older people in acute care setting. It can be composed with 3 components: building a trusting relationship, recognition and respect, autonomy and independent. As the older people could be anxiety, confuse in the noisy acute setting, or older people refuse to have an effect communication with staffs, nurse should take care of the patient in the cooperative with the multidisciplinary team and relatives.
The number of older people who are requiring for acute care services is ascending as the population ages (Peek et al, 2007, Traynor, Brisco & Coventry, 2005, McCormack, 2002). As reported in McCormack’s (2002) research, the older people, represented 12.5% of the population, is 30% of all hospital discharge and 46% of all hospital bed days. Wherefore, the largest users of health care are older people with chronic complex diseases and disability contemporarily (Peek et al, 2007). Improving the care quality for older person in acute care setting in is becoming a significant issue. The best practice in the care of older people is considered to be person-centred care contemporarily (Peek et al, 2007).
This essay will discuss about …show more content…
what is person-centred care, how to put person-centred care in nursing practice, the barriers may influence the outcome of person-centred care and how to conquer the barriers to make a best result in three aspect.
Definition
The concept of person-centred care has been widely discussed for a long time and has variety explained by different authors.
Person-centred care is defined as ‘having the information they need to make informed decisions about their care and treatment and, where appropriate to support them to manage their conditions themselves’ (The Department of Health, cited in Williams et al 2005, p. 14). On the other hand, through Edvardsson, Winblad and Sandman’s (2008) opinion, the content of person-centred care included respecting individual’s rights, values and beliefs; knowing their biography and sharing information to help them making decision. Moreover, focusing on strengths of the persons what they can do rather than what they cannot do is the central of person-centred care (Edvardsson & Nay, 2009). In summaries, the right of individuals as persons is the underpinning of the concept of person-certred care. To respect the right of individuals as persons, the staff need to have an attitude of respect of patient to make decisions themselves (McCormack, 2003). Furthermore, Kitwood (cited in McCormack, 2004) also stated that person-centredness is ‘a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust.’ Therefore, seeing the patient as a person and building a trusting relationship is also important as respect patients’ rights as persons. Although the concept of person-centred care still has an unclear definition, it still been identified as a contemporary gold-standard model within sub-acute care for older people (Edvardsson & Nay, 2009). The aims of using person-centred care in acute ward are improving the quality of care which the professions provide, helping the older be individual and avoiding function decline (Edvardsson & Nay, 2009, Clarke, Hanson & Ross 2003, Gordge, Young and Wiechula 2009). We will discussion how to work out the aims in three
ways.
Building a trusting relationship
Building a trusting relationship between nurses and patients is a component of person-centred care. Moreover, Nolan et al (2004) suggest that relationship-centred care is more appropriate in gerontology. During Bridges, Flatley and Meyer’s research (2010), patients and their family considered the relationship between patients and staff as the key feature of patients’ acute care experience result in it is very important to build a trusting relationship between the professionals and patients. A trusting relationship also can reduce the feeling of being observed and cared for, or the discomfortable of been treated like an object and neglected (Edvardsson & Nay, 2009). Therefore, the first process for nurse to provide person-centred care is to establish a trusting relationship.
As acute hospital is an unfamiliar and confusing environment for the older people, some older people may have an episodes of acute confusion or cognitive impairment during hospitalization, especially for the patient who had dementia, delirium or communication problems (Edvardsson & Nay, 2009). For these patients, it is difficult to have an effective communication with them and hard to build a trusting relationship.
A trusting relationship for patients indicate that ‘staff recognized and would meet all their needs for treatment and care, and that they were safe, legitimate as a patient in receipt of acute care and significant as a human being that matter to others’ (Bridges, Flatley & Meyer 2010, p.96). Therefore, for the patient who is confusion or cognitive impaired, nurse should help the patient maintaining connections with family and social networks for feeling safe and supported, and help them be familiar with the environment, such as introducing the location of toilet and bathroom (Traynor, Brisco & Coventry 2005, Leplege et al 2007). Furthermore, it is helpful for nurse to build a trusting relationship to make patient and family feel cared for, respected and welcome, and to meet their need (Bridges, Flatley & Meyer 2010). Nurse can also provide some basic activities support to improve the relationship, such as reading the paper or helping serving lunch in the acute hospital setting (Edvardsson & Nay, 2009).
Recognition and Respect
Another important part of person-centred care is known the patient as ‘a person behind disease’ and respect individual’s belief, value and habits. As McCormack (2003) argues, being conscious of patient’s biography does not tell the nurse what to do, rather is orientates the nurse to a particular way of being. Nurse need to know the patient’s biography, valuing the patient as an individual, and know the patient’s belief, value and habits (Peek et al 2009). All the information can help nurse to understand the older person’s behavior, needs and desires. Afterward, nurse can provide specific care to each individual and nurse and patient can work together to make their own care plan (Williams et al 2005). Moreover, gathering the information about biography of older people can help to keep and increase a sense of self for them (Edvardsson & Nay, 2009).
However, there may be some barriers to get the biography from the aged, such as older person cannot find any staffs to be a listener as all the staffs are so busy that have no time to implement it; even they share their life story with one staff, the staff is lack of knowledge to use the biographical appropriately; or some older people may refused to talk about their lives to staffs (Clarke, Hanson & Ross 2003, Edvardsson & Nay, 2009).
Consequently, nurses should encourage patient to share their story. A good listening skill is also required for nurses. They need to know how to react when patient talk about aspects of their lives that are distressing and try to make sure patient is comfortable when they talking about their lives (Clarke, Hanson & Ross 2003). Moreover, nurse also need to acquire the knowledge to use the biography in their daily work, have a better insight of patient’s need, desire and value to provide more appropriate care to patient (McCormack 2003). However, these approaches may not suitable for everybody, especially for the ones who have painful past experience. For example, the older person does not prepared to talk about a painful issue in their past experience; nurse should respect their decisions and keep their dignity as it is also a part of person-centred care. Moreover, the older person may share the difficult story with nurse when they build a trusting relationship and older person trusts nurse enough (Clarke, Hanson & Ross 2003).
Autonomy and Independence
Helping older people to be autonomy and independence is one central constituent of person-centred care. In acute care setting, the risk of function decline for older people is very common (Gordge, Young and Wiechula 2009). Therefore, preventing the functional decline, focusing on older person’s strengths and remaining abilities, sharing information with patient and helping them to make rational decision is the way to keep the older people autonomy and independence in an acute hospital setting (Leplege 2007, Bridges, Flatley & Meyer 2010, Gordge, Young and Wiechula 2009). A multidisciplinary team which includes nurse, occupational therapist, physiotherapist and geriatrician is required for the older people (Peek 2007). Multidisciplinary team and family members involve in the person’s care plan. The care plan needs to focus on what older people can do rather than the ability they lost in disease or disability. For instance, Gordge, Young and Wiechula (2009) have a project to reducing functional decline of older people. They set a communal dining room for patients in an acute care ward; staffs help the older patient take their meal tray from their room to dining area to have lunch (Gordge, Young and Wiechula 2009). Moreover, informed the older person the information about the treatment can help the patient make the rational decision by their own, and make the older person to feel much more involved (McCormack 2004).
The noisy environment in acute care setting may make older patient anxious, agitated or restless (Edvardsson & Nay, 2009). All the psych and physical disorder may disturb the older patient to maintain their function and make a right decision of the treatment. Accordingly, a slower pace of care and carers, reduced noise from telephones, televisions and buzzers can create a safe and relaxed environment for the older people(Edvardsson, Winblad & Sandman 2008); or home-like surroundings such as some little decorations from home can make older patient feel peaceful and relax(Edvardsson 2008). However, a home-like environment can be vary in different cultures and countries, for example, dose homelikeness mean the furniture from their home, or dose it involve action and event as well? Through Edvardsson’s (2008) research, environments incorporating familiar objects of everyday life can be interpreted as at-homeness.
Summarize
In conclusion, person-centred care is a golden model for older people in acute care setting. It can be composed with 3 components: building a trusting relationship, recognition and respect, autonomy and independent. As the older people could be anxiety, confuse in the noisy acute setting, or older people refuse to have an effect communication with staffs, nurse should take care of the patient in the cooperative with the multidisciplinary team and relatives.