This practice question has be published with the kind permission of the Royal College of Nursing
‘Person-centred care’ is a much-used phrase in nursing. According to the Nursing and Midwifery Council (2010), nurses must ‘be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights’.
The term is increasingly used to refer to best practice in the care of older people and those with dementia. It describes an approach that is co-ordinated with and tailored to meet the needs of the individual.
Best practice
The Health Foundation (2014) identifies four principles of person-centred care:
- Affording people dignity, compassion and respect.
- Offering co-ordinated care, support or treatment.
- Offering personalised care, support or treatment.
Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.
Person-centred care can improve patient outcomes (de Silva 2011), as well as staff morale and performance (King’s Fund 2012).
Although it is emphasised in health policy (Department of Health 2012), achieving person-centred care is not always easy. The principles of seeing people as unique individuals and involving them in decision making about their care may seem obvious, but certain factors can present a challenge to implementing this in practice.
For example, in an observational study of care of people with dementia in hospital, Clissett et al (2013) found that opportunities to promote identity, occupation and comfort, which are vital to the delivery of person-centred care, were often missed. Organisational systems that prioritise targets and focus on task-based outcomes can also hamper individualised, person-centred care (Cowdell 2010, Francis 2013).
Guiding principles
Despite these challenges, it is essential that person-centred care remains a goal of health and social care delivery. Nurses are important to supporting this (Hoe and Thompson 2010). Approaches include:
- Person-centred nursing assessment, which includes gathering information about people’s biography, personal preferences, communication needs and preferred social environment, as well as their mental and physical health needs.
- Improving understanding of dementia and/or other conditions that affect people’s ability to communicate their needs and contribute to shared decision making.
- Promoting and developing skills in delivering person-centred practice and adopting relationship-centred strategies to working with patients and their families.
- Developing inclusive and supportive cultures of care, which not only value patients as individuals but also the staff who support them. This requires investment in supervision, training and leadership as well as challenging systems and practice that depersonalise and make person-centred care difficult to achieve.
Find out more
Resources are available to help you implement these person-centred approaches to care in your practice. They include the: Health Foundation’s person-centred care resources at http://personcentredcare.health.org.uk
Royal College of Nursing’s extensive dementia pages at www.rcn.org.uk/dementia
Social Care Institute for Excellence’s dementia gateway at www.scie.org.uk/publications/dementia/index.asp
References
Clissett P, Porock D, Harwood R et al (2013) The challenges of achieving person-centred care in acute hospitals: a qualitative study of people with dementia and their families. International Journal of Nursing Studies. 50, 11, 1495-1503.
Cowdell F (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing. 5, 2, 83-92.
de Silva D (2011) Helping People Help Themselves. tinyurl.com/pb88zcs (Last accessed: April 9 2015.)
Department of Health (2012) Equity and Excellence: Liberating the NHS. tinyurl.com/mk4m6hd (Last accessed: April 9 2015.)
Francis R (2013) Final Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. www.midstaffspublicinquiry.com/report (Last accessed: April 8 2015.)
Health Foundation (2014) Person-centred Care Made Simple. tinyurl.com/owkgwlt (Last accessed: April 21 2015.)
Hoe J, Thompson R (2010) Promoting positive approaches to dementia care in nursing. Nursing Standard. 25, 4, 47-56.
King’s Fund (2012) Leadership and Engagement for Improvement in the NHS: Together We Can. The King’s Fund, London.
Nursing and Midwifery Council (2010) Standards for Pre-registration Nursing Education. tinyurl.com/6f443py (Last accessed: April 9 2015.)