Archives
Editorial
Person Centered Care
A philosophy of care and management of carers
Helen Bellchambers
Senior Lecturer, Faculty of Nursing, University of Newcastle, Newcastle NSW
Carol Penning
Director of Residential Care Services, Uniting Care Ageing, Hunter, Central Coast & New England, Cardiff NSW
Article Text
Current literature increasingly recognises the need for person-centred rather than task-centred approaches to meeting the health care needs of clients. In the aged care sector this can be broadly interpreted to mean a focussed consideration of residents' and clients' emotional (as well as their physical) needs and preferences in their care and lifestyle planning. Recently developed and implemented strategic challenges for UnitingCare Ageing NSW-ACT affirm that the organisation ‘will have a unique person-centred model of care supported by a small number of staffing models which are efficient and managed to support quality of life for clients and carers'.
Although the term person-centred approach or PCA is being more readily adopted as part of the healthcare ‘lingo', many people struggle to understand its meaning. UnitingCare Ageing-Hunter, Central Coast & New England Region has adopted the interpretation derived from Professor Tom Kitwood's work (1997) on the broader concept of personhood. In this context, PCA includes and supports the consideration of each person's needs and preferences from a holistic perspective that includes associated relationships and the impact that other people, practices and/or the physical environment may have on the individual. More recently, Brooker (2004) has elaborated on a definition that characterises PCA as:
- Respecting and valuing the individual as a full member of society
- Providing individualised places of care that are in tune with people's changing needs
- Understanding the perspective of the person
- Providing a supportive social psychology in order to help people live a life where they can experience relative well-being.
The works of both Kitwood and Brooker build on the 1950s research of the psychotherapist Carl R. Rogers, who developed the person-centered approach as a method of facilitating psychological growth (Natiello 2001). Rogers' approach was a radical departure from the authoritarian assumption that professional experts could and should help by solving others' problems for them, with the expectation that clients would then somehow be better able to solve their own problems (Rogers 1977). Tom Kitwood applied this approach to clients experiencing dementia and developed responses that contrasted starkly with the more ‘technical' versions determined by the medical model at that time. Kitwood believed that a focus on dementia from the perspective of an organic mental disorder ignored the larger human issues and he therefore strove to create a new paradigmatic view of dementia in which ‘the person comes first' (Kitwood 1997: 2). His research sought to provide a better understanding of the different ways in which personhood (that is the way in which one person views the status of another) was undermined for those people who were living with a diagnosis of dementia.
One of the common theories upon which Kitwood built his research protocols was the assumption that all human beings have the five following fundamental psychological needs:
- Comfort, the provision of warmth and strength
- Attachment, the forming of specific bonds or attachments
- Inclusion, being part of a group
- Occupation, being involved in the process of life
- Identity, having a sense and feeling of who one is (Kitwood 1997: 81).
Based on this assumption and using the petals of a flower to represent five emotional needs and the core to represent the central need for love, Kitwood and his colleagues focussed their research into personhood on how biography and personality influence a person's experience of dementia. In addition they sought to understand how ‘good' dementia care could be implemented through the adoption of positive person work and dementia care mapping (Kitwood 1997: 86-97).
As comfort, attachment, inclusion, occupation and identity needs are universal, it is reasonable to assume, vis-à-vis care and lifestyle considerations for people with dementia, that care of all residents should be inclusive of emotional needs and preferences.
Person-centeredness is one of the core concepts underpinning
a clinical and lifestyle education program offered through Uniting Care Ageing.
The program incorporates the person-centred approach (PCA) as represented by
Kitwood and the Bradford Dementia Group as well as the core concepts of
enhancing well-being through evidence-based practice. One of the key aims of
implementing a person-centred approach is to put the person at the centre of any decision-making and in the case
of P-CAP, this notion extends to any person who is experiencing care and
lifestyle services from UnitingCare Ageing. Similarly, the ability to achieve
successful outcomes in an organisation that delivers a human service is the
...close parallel between the way employees are treated by their seniors, and the way the clients themselves are treated...if employees are supported and encouraged, they will take their own sense of well-being into their day-to-day work. (Kitwood 1997: 103).
References
Bradford Dementia Group School of Health Studies University of Bradford Bradford West Yorkshire United Kingdom. Retried from http://www.bradford.ac.uk/acad/health/bdg/index.php.
Brooker D (2004) What is Person Centred Care for people with dementia? Reviews in Clinical Gerontology 13(3).
Kitwood T (1997) Dementia reconsidered: the person comes first. Berkshire, UK: Open University Press.
Natiello P (2001) The person-centered approach: A passionate presence. PCCS Books. Retrieved June 26 2007 from http://www.person-centered.org/description.htm.
Rogers C (1977) On personal power. New York, Delacorte Press.
eContent Home