What person-centred care means
You might hear person-centred care described as ‘patient-centred care’, ‘client-centred care’, ‘resident-centred care’ or ‘woman-centred care’. Each of these options has a very specific context.
We speak about patients as people who are accessing the health system for care and treatment in, for example, a hospital or GP surgery. The countries of the UK are moving towards integration of health and social care services. When we speak of the health system in the resource, it also applies to integrated health and social care systems in the UK
We often refer to people who access mental health services as clients, and we might also use this word for those accessing health or care services but who may not be ill – a young mother speaking to a health visitor about looking after her baby, perhaps. ‘Resident-centred’ is very specific to people who live, either temporarily or permanently, in care homes and other long-stay residences. And ‘woman-centred’ is how midwifery staff care for pregnant women.
So when we speak of person-centred care, we try to bring in all those options into a single definition. But what does it mean?
Put simply, being person-centred is about focusing care on the needs of the person rather than the needs of the service. Most people who need health care these days aren’t happy just to sit back and let health care staff do what they think is best. They have their own views on what’s best for them and their own priorities in life. So as health care workers, we have to be flexible to meet their needs – we have to make our system suit them, rather than the other way round.
It means that the person is an equal partner in the planning of care and that his or her opinions are important and are respected. That doesn’t mean that ‘what the person says, goes’, but it does mean that we have to take into consideration and act on what people want when we plan and deliver their care.
We can’t always assume, however, that a person will tell us what he or she thinks or wants. There are many reasons why people may feel awkward about this, or they may live with a mental health condition, dementia or physical or learning disability that makes communication challenging. So we may have to ask them what they want, using appropriate communication methods to actively encourage them to participate in their own care and be real partners in the decisions that are made. To support them with this, we need to make sure they get information in a format that is acceptable to them to help them make decisions about their care and treatment and to agree – or disagree – with the treatment plan that is developing. We should always be prepared to negotiate with patients/clients to agree a plan that’s acceptable to them and the health care team.
Being person-centred means that when we plan care with the person, we think about the effect of what we’re doing on the person as a whole. Think, for example, of a young female health care assistant planning to bathe an older man. The ‘mechanics’ of the procedure are very straightforward – ensure the water temperature and depth are appropriate, ensure the bath hoist is working and is used properly, make sure the person’s dignity is protected, end up with the person being clean and refreshed. The health care assistant is perfectly competent to ensure all these issues are addressed.
But what might the older man feel about being bathed by a young woman who might be no older than his own daughter, or even granddaughter? Will it make him feel helpless, humiliated and useless? And does he want a bath in the first place? When we begin to think of the care we give in this way – of the effect of what we’re doing on the whole person – we’re giving care in a person-centred way. And that might mean compromise – the health care assistant might, for instance, negotiate with the man and agree that for today, a wash from a basin at the bedside or the bathroom will be sufficient.
Being person-centred means that we always have the person’s safety, comfort and well-being uppermost in our mind. There is much we can do to promote people’s safety, and we look at this in some detail in promoting patient safety. Ensuring people are comfortable calls for us to be aware of the things that can cause discomfort – feeling cold or hot, having a thirst or being hungry, being in pain or having an itch, needing to go to the toilet or change a sitting position, for instance – and taking steps to relieve them. Having people’s well-being uppermost means that nothing we do – or don’t do – causes the person any physical, emotional or social harm.
And being person-centred means being aware of a person’s emotional and spiritual well-being. Spiritual care is not just about religious beliefs and practices: it also reflects a person’s values, relationships and need for self-expression. See: Spirituality in nursing care.
Many of the colleagues you will work with, including nurses, doctors and social workers, are bound by ethical codes of conduct. These set out standards of performance to ensure that their practice is fair, non-judgemental, respectful and non-prejudicial. They make individual professionals aware of their own responsibility to follow the steps of their code at all times in promoting the health, welfare and interests of the people they care for. The codes also define individuals’ accountability for the things they do as professionals: understanding the idea of accountability is a very important part of practice and is something we’ll return to in quality in care.
In each of the UK countries there are codes of conduct, which may be nationally or locally driven.
- England. Code of Conduct for healthcare support workers and adult social care workers
- Scotland. Code of Conduct for healthcare support workers
- Wales. Code of Conduct for healthcare support workers in Wales
Currently, the only health care assistants regulated in Northern Ireland are those working in social care. They are regulated by the Northern Ireland Social Care Council. See: Standards of Conduct and Practice.
These codes have been developed following consultations with many interested groups, including patients and the public. They set out to support you to provide care that is:
- safe and effective (meaning it brings positive benefits to the patient/client)
- compassionate and respectful
- always focused on doing what is best for patients/clients.
The codes help us to see patients/clients as individuals and to do everything in our power to preserve their dignity and independence. They also empower us to report appropriately when we see care that does not live up to these standards – again, we’ll return to this vital topic in raising concerns.
Much of this programme focuses on the ethical issues that underpin our codes of conduct and define our practice on a day-by-day basis – things like safeguarding vulnerable people, confidentiality and consent, raising concerns, reporting incidents and accidents, anti-discriminatory practice and preserving people’s dignity. So ethical approaches in general, and the codes of practice in particular, are threaded throughout the resource, providing a basis not just for what we learn from it, but also for how we must practice as health care assistants.
If you are not already familiar with the code of conduct for your country or workplace, you should take some time now to access and study it. You’ll also benefit from looking at codes from other countries or organisations – you’ll find that all codes share common ethical ground and a desire to ensure that everything we do brings positive benefits to patients/clients.