This paper aims to identify and explain the principles required in delivering effective person centred care. This will be done by looking at the principles involved, and providing an explanation in evidence to support why it is important in delivering such care to patients. Although person-centred care (PCC) is a term that has become increasingly recognised over the years within the care industry, the term ‘Patient-centred’ was first used 50 years ago by a psychologist named Carl Rogers (The Health Foundation, 2013).
PCC has since evolved and the principles are now recognised worldwide, yet the concept of PCC is not that new as America have been using it since 1970 (McCance, McCormack & Dewing, 2011). There have, however been variations of the term such as Family Centred Care (Shields, Pratt & Hunter, 2006), and Woman-centred care (Leap, 2009), but they all have the same goal of putting the service users’ needs first.
As PCC focuses on the individual, what may be important to one person may not be to another, therefore by providing dignity, compassion and respect, alongside, coordinated care and personalised care with support or treatment whilst ensuring the service user has complete autonomy, the care can be adapted accordingly to each person based on beliefs, values and needs (The Health Foundation, 2014). In order to ensure that the ideology of PCC was put into practice McCormack and McCance (2010) developed a person centred nursing framework (PCN).
The framework consists of prerequisites, care environment and processes and all of the stages need to be completed, in order to achieve a person-centred outcome. This paper will identify and explain just two of the processes which will be; Providing Holistic care and Shared Decision making. The first process this paper will look at is Providing Holistic Care. The term Holism was first used by Jan Smuts in 1926 when he published a book ‘Holism and Evolution’. It is thought that he chose the word holism as it sounded like ‘whole’ (Wade, 2009).
In the 2nd edition of this book Smuts (1927) suggests that there is an overflow of life, matter and mind. In modern days’ Holistic care is still strongly focused on the theory that the ‘whole’ of the person is taken into account where the persons psychological, spiritual, emotional and social needs are cared for, and this is believed to aid the person in their healing (Dossey and Keegan, 2015). Holistic care recognises that it is not just the physical needs of a person that requires attention, but also treating a person with dignity, compassion and respect as set out by the NHS Constitution (2015) is equally as important to the person.
Also seeing the person behind the patient and recognising that they have individual needs (Goodrich & Cornwell, 2008), will therefore improve the quality of the patients’ experience. It is important that the Health Care Provider (HCP) thinks about how the illness may be effecting the person physically, intellectually, emotionally and socially (PIES) and what needs to be implemented to help them (Practical Nursing, 2015).
In order to achieve this, the care provider needs to show emotional intelligence and interpret how the patient may be feeling at this vulnerable time in their lives which can then lead to better relationships between service users and providers (Akerjordet & Severinsson, 2007). It is looking at the person as an individual, and what may be right for one person may not be right for another with cultural and religious differences amongst others needing to be considered. For a nurse to provide spiritual care they need to connect with the patient, show compassion and be there to support the patient throughout (LaPorte Matzo & Witt Sherman, 2006).
Taking the time to get to know the patient so that the care provided, is unique to them, however; health care has become more and more target driven, and the efficiency and economy has become the forefront of it all (Battey, 2009), therefore it can be challenging to achieve this due to the time pressures on HCPs. It could be easier to simply treat the physical needs of the person in order to move onto the next patient but this would not be offering PCC or holistic care as the diagnosis is seen rather than the individual and their needs.
Perhaps this is why previous studies have shown many nurses do not engage in providing holistic care, and the results from the study suggested three themes that were needed in providing adequate PCC; Education system, professional environment and personality traits, suggesting that by educating care providers in how to apply and develop interpersonal skills, by having organisational systems in place to support staff whilst also providing encouragement to staff will essentially improve the standard of care provided (Zamanzadeh, Jasemi, Valizadeh, Keogh & Taleghani, 2015).
HCPs are required to be able to communicate effectively with service users and work within a multidisciplinary team to ensure the patients’ needs and requirements are met (National Institute for Health and Care Excellence (NICE), 2015). They are also required to ensure that procedures and policies are met alongside requirements of the law to ensure safe practice (RCN,2015). In the same way as suggested in the PCN framework that it takes several combined stages to ultimately provide the best person centred outcomes the same applies with the nursing process of Assessing, Planning, Implementing and Evaluating (A. P. I. E) and this process also provides a holistic approach to care.
When assessing the patients’ their full holistic needs are taken into account to ensure individualised care is provided (Roper, Logan & Tierney, 2008). The care required is then planned based around the assessment findings and then implemented, this means that the HCPs put the plan into action. Lastly the care that has been provided is evaluated to see if the plan has worked for them (Rodrigo, 2012).
No decision is made without the input of the service users, which leads onto the second process in this paper. The second process this paper will look at is Shared Decision Making (SDM). SDM is a standard of care which involves the individual and their families in the decisions regarding their health. It allows them to choose the treatment they receive and how they receive it. They are provided with all the information available regarding their health, which is explained to them in a clear concise way that they understand, without the use of jargon.
They are listened to and the service users’ views and beliefs are respected (Royal College of Nursing, 2009), regardless of what the healthcare professional (HCP) may believe. SDM became the responsibility of National Health Service (NHS) England after it ceased being part of the Quality, Innovation, Productivity and Prevention (QIPP) Right Care programme in 2013 (NHS England, 2015). It is now part of the NHS constitution and it states that the patient is at the heart of every decision made and they have the right to take part in the decisions made about them (NHS constitution, 2015).
As highlighted by Coulter (2012), nobody knows the patient better than themselves, hence the importance of involving two kinds of expertise, one being the clinician and one being the patient. The reason it is referred to as ‘Person’ centred care and not ‘patient’ centred care is because it involves more than just the patient, as described in the Royal College of Nursing (RCN) principle D, it includes everyone that is involved in the care such as family and carers.
Families are more likely to be involved in the decision making if the patient is too ill to make the decisions alone, or if the patient does not have the capacity, and it is important that HCPs actively listen to what the families are saying as it is the family that may be the ones who are providing the care once the patient is discharged (Frampton, 2009). The patient is provided with the information and options to help them understand which treatment would have the best outcome for them, taking their preferences into account whilst also looking at the risks as well as the benefits involved from evidence based knowledge.
This can only be achieved by affective communication between the HCP and service users with ample opportunity for questions to be asked freely (Barry & Edgman-Levitan, 2012). In the cases where it is end of life SDM, it can be incredibly beneficial to the patient and their loved ones as it gives them the opportunity to discuss with their family and carers what they want, and with the help of decision aids it empowers the patient by them having full autonomy over decisions, such as where they receive their care, how they receive pain relief and essentially where they choose to die with dignity and respect (NHS, 2012).
There is always the possibility that the patients can worry that their illness may be a burden on the family so by including them in the decision making can help to alleviate this worry as they can make plans together. The family can then also act as an advocate for the patient ensuring they receive the best quality care that abides by their beliefs and values and they can be there to provide emotional support for them too (Gerteis, Edgman-Levitan, Daley & Delbanco, 1993).
As per the PCN framework, to ensure the best possible outcome for the service users, SDM plays a fundamental role (McCormack and McCance 2010), nonetheless it was not always the case and previously, decisions about the care provided would have been decided by the clinician alone and the patient would then be informed of the procedure, treatment or medication and would only be required to give their informed consent and so in 2010 a Salzburg Global seminar took place where 18 countries attended and endorsed SDM (BMJ, 2011).
It had been recognised that in order for PCC to be met, then the patient and family simply had to be involved. A study has also shown that when HCPs shared medical notes with service users it helped both the patients and families to understand their condition better and therefore improved their experience during their stay in hospital (Weinert, 2015). This then results in satisfaction of care and a feeling of wellbeing as the service users are empowered.
The aim of this paper was to identify and explain the principles required in delivering PCC with two of the principles from McCormack and McCance’ PCN framework identified. An explanation was provided as to why those principles are important for ensuring that the patient is at the centre of all care delivered. The paper expanded on how sharing decisions empowers the patient and offers autonomy which essentially leads to a better experience for the service users.
It also showed the importance of providing holistic care ensuring the whole of the person is considered and not just the physical aspects of ill health and how by providing holistic care can help to build relationships with the patients and allows the HCP to provide unique PCC which is delivered in a safe and effective way with the patient being at the heart of all decisions made around their care.
