Caregiving and dementia/Topics/Person centred care

This page describes a Dementia Training Study Centre National Priority Area.

Person centred care

This NPA focuses on person centred care of people with dementia.

Person-centred care

“ We are guests in our patients’ lives, not hosts in our health care organisations. ” — Donald M. Berwick

Carl Rogers developed the concept of person-centred care (Rogers, 1951), which is based on a belief in genuine connection and communication (Rogers, 1951).

The notion of personhood and person-centred care of people with dementia was introduced by Tom Kitwood (1997). He promoted respect and preservation of dignity as core principles in providing care. He stated that these principles can only be upheld if caregivers recognise and incorporate understanding of the experience of living with dementia into care planning.

Person-centred care is therefore much more than providing choice. It is about relationship and connection with the individual. Nay, Bird, Edvardsson, Fleming, and Hill (2009) emphasised this in stating that:

“ the need for a recognition of, and connection with, the person, a focus on the person’s strengths and goals, an interdisciplinary approach, and recognition of the centrality of relationships” are essential components of person-centred care. ” — Nay et al., 2009, p. 109

To develop a person-centred approach to care first requires an understanding of self. It is from your understanding of self that you understand others. The following points offer important considerations in the development of this understanding. Person-centred care comes from the ability to:

• Recognise how you developed your own values and how they can impact on others
• Understand the nature of self, self-esteem, self-worth, dignity, respect and personhood
• Recognise the importance of control, independence and the dignity of risk
• Identify how your practices can increase or reduce a client’s autonomy or learned helplessness
• Describe ways in which you can support a client’s autonomy, dignity, rights and values

The majority, if not all, healthcare organisations espouse person-centred care. The discussion below aims to prompt health professionals to consider the meaning of person-centred care and how it might be implemented into everyday practice (NARI, 2006).

Recent research has focused on how person-centred care can be made tangible and measurable. One example of a person-centred care measurement tool is the Person-centred Care Assessment Tool (P-CAT) (Edvardsson, Fetherstonhaugh, Nay, & Gibson, 2010). P-CAT is a tool to measure person-centredness in a residential aged care facility in which people with dementia live, which identifies the elements necessary to support person-centred care.

Dementia Care Mapping

Founded in the work of Kitwood discussed above, Dementia Care Mapping is a process of observation of the person with dementia which aims to assist health professionals in formal care settings to develop person-centred practice. People with dementia are observed over a period of time and the mapper records the behaviour of the person with dementia as well as staff behaviours that both promote and undermine personhood. The information obtained is then used to inform a plan of care and to promote practice development (Brooker, 2005).

More information regarding Dementia Care Mapping can be obtained from the Bradford Dementia Group. The actual mapping process is copyrighted by the University of Bradford. The following websites provide brief explanations of the process:

• http://www.positiveaboutdementia.co.uk/Default.aspx?tabid=64
• http://www.nursingtimes.net/nursing-practice-clinical-research/dementia-care-mapping/201154.article

References

Brooker, D. (2005). Dementia Care Mapping: A review of the research literature. The Gerontologist, 45(1), 11–18.

Edvardsson, D., Fetherstonhaugh, D., Nay, R., & Gibson, S. (2010). Development and initial testing of the Person-centered Care Assessment Tool. International Psychogeriatrics, 22(1), 101–108.

Goffman, I. (1971). The presentation of self in everyday life. Harmondsworth: Penguin Books.

Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319–340.

Kitwood, T. (1997). Dementia reconsidered: the person comes first. Buckingham: Oxford University Press.

Mardon, C. (2012). Patients should be given a voice: Expert. Illawarra Mercury, December, 12.

Nay, R., Bird, M., Edvardsson, D., Fleming, R., & Hill, K. (2009). Person-centred care. In R. Nay & S. Garratt (Eds.), Older People: Issues and Innovations in Care (pp. 107–120). Sydney: Elsevier Australia.

National Ageing Research Institute. (NARI). (2006). What is person-centred care? A literature review. Victoria: Department of Human Services.

Rogers, C. R. (1951). Client centred therapy: Its current practice, implications and theory. London: Constable.

Seligman, M. (1975). Helplessness On depression, development and death. San Francisco: W H Freeman & Co.