Practice question

How can I care for older people in a more human way?

We all want to provide efficient and effective care for older people, but sometimes we focus so much on efficiency, effectiveness and achieving targets that we forget we are caring for fellow humans.

We all want to provide efficient and effective care for older people, but sometimes we focus so much on efficiency, effectiveness and achieving targets that we forget we are caring for fellow humans.

As long ago as 2009, the Patients Association published a report, Patients… Not Numbers, People… Not Statistics, which questions standards of care on a human level (Patients Association 2009).

Subsequent reports have also indicated that something is wrong in care. For example, the Francis (2013) report on Mid Staffordshire NHS Foundation Trust claims that a target-driven culture can lead to neglect of human care.

Meanwhile, advances in technical knowledge and procedures have made it more difficult to focus on the human aspects of care and more likely that treating patients as humans is lost.

The Humanisation of Health Care Framework was developed by Todres et al (2009) and Galvin and Todres (2013) to guide nurses in meeting patients’ needs as humans and offering a value base for care.

The framework responds to the timely challenge of reconnecting with a disillusioned public to focus on ‘what matters to them’ in health services.

It gives us a clear way to think about, and care for, people as humans. It also involves respecting their worth as humans and is therefore interrelated with the experience of dignity.

The framework has eight interlinked ‘dimensions’ (Box 1). This is not a list of ‘dos’ and ‘don’ts’ or of abstract ideas, such as the need for more ‘patient focus’ or ‘choice’. Rather, it is a series of eight experiences or qualities that make someone feel human, and that offer nurses directions for practice and help them to focus their efforts when improving care (Borbasi et al 2013).

Box 1

  • Agency
  • Embodiment
  • Insiderness
  • Personal journey
  • Sense-making
  • Sense of place
  • Togetherness
  • Uniqueness

(Todres et al 2009, Galvin and Todres 2013)

These eight dimensions provide a useful standard for nurses to keep in touch with their values as carers. They represent a different way of thinking and can help to identify humanising and dehumanising elements in care systems and individual interactions.

A summary of directions for practice using the framework built on the work of Hemingway et al (2012) is presented in Table 1.

Dimension Description Example
Agency Enhance people’s sense of being active participants in their care and avoid anything that assails their dignity by rendering them passive Offer choice and freedom in interactions and interventions and strive to give space for people to have ‘their say’
Embodiment Help people to expand their horizons beyond a definition of themselves in terms of ‘illness’ or ‘symptoms’. This helps focus care on bodily aspects, such as sleep, sleeplessness, thirst, hunger, pain, comfort, warmth, cold, fatigue and activity Avoid thinking about people in terms of categories, signs and symptoms, but focus on the person behind the diagnosis, illness or condition. This helps staff recognise each person as unique, contributes to treating them with respect and enhances dignity in care
Insiderness Connect with people’s ‘inward sense’ of how they are, and avoid practices that may make people feel like ‘objects’ Avoid treating patients as a list of issues and risks, but think of them as individuals who could be involved in solving problems. Understanding people’s sense of how things are is beneficial, even if you cannot change their situations
Personal journey Retain people’s sense of their own history Life has often been interrupted for patients so try to understand and help them manage their concerns in the context of who they are. Strive to understand and acknowledge personal history
Sense-making Communicate so that people do not feel like ‘cogs in a wheel’ Involve patients in what is happening. Ensure that they and their families understand their situation in their own contexts, and why things happen in certain ways. Strive to help patients make sense of what is happening to them
Sense of place Enhance the physical environment of care so that people can feel more ‘at home’ Hospitals and care homes can be unfamiliar and frightening environments so we need to find objects or interventions that give comfort through creating a sense of homeliness
Togetherness Address the need for belonging and find familiar interpersonal connections so that the sense of isolation when facing health conditions and treatments is reduced A sense of isolation can damage patients’ health and wellbeing. Enable patients to maintain established connections with people, and pets if appropriate, important to them and help build new relationships and friendships if they are wanted
Uniqueness Find ways in which people can feel that they are seen as individuals, not as categories or diagnoses Get to know your patients and their lives so you can build up trusting relationships and understand what is important to them ‘person to person’

The Humanisation of Health Care Framework is not necessarily simple, but then neither is caring in a human way, particularly for older patients.

Enable patients to maintain connections

We have been working with groups of older people and it is clear that they understand the framework and can guide us in trying to provide more human care.

The eight dimensions offer a way to focus on the everyday things in patients’ lives that can make them feel more human when they are coping with difficult situations.

Simple changes that take no extra time can have an enormous effect on patients, so we encourage you to think about the care you give, and the small but vital things that may help older people feel more human.

You could also discuss as a team how you can make care interactions, places and spaces more conducive to the human aspects of care.

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