22 September 2011
One of the mandatory units at the heart of the QCF Diploma in Health and Social Care is HSC026. The latest edition of 'Nursing and Residential Care' looks at why person centred approaches to care are important for both clients and care providers:
Putting the person rather than the ailment at the heart of care provision is the focus of HSC 026. This unit links closely with the common induction standards from Skills for Care (2010) and represents best practice in the working lives of carers and nurses throughout the UK.
Personal choice is a major part of personal identity. When your right to choose is removed, your quality of life and enjoyment of it may drop significantly. Just as you have your own likes and dislikes, habits and traditions, so do those in your care and it is important that those working in social care do not lose sight of that.
Person centred care relationships were originally developed by Dr Carl Rogers in the 1960s, as an approach to psychotherapy. This approach was intended to allow the individual to have more control over their own treatment and more confidence in that treatment. Person centred working relationships were quickly recognized as having benefits in other areas, such as teaching, child care and patient care.
The approach is intended to support relationships by providing an empathetic, understanding, accepting and genuine therapist, counsellor or carer relationship. Building a trusting relationship with a service user is essential for anyone working in social care. The person centred approach, although ground-breaking when it originated, is now an integral part of care services in the UK— whether as a recipient or practitioner.
Clients are recognized as individuals with their own aspirations, likes and dislikes, rather than as numbers or statistics, or a list of ailments. It is a far more holistic approach than many others have been and allows for, not only an individual’s right to life, but their right to quality of life. Without personalization a very uniform system of care emerges, where no client is catered for individually and everyone receives not only the same level of care, but the same style of care. Person centred approaches to care instead provide a system of care tailored to more than the physical needs of the person. In this system of care, a service user’s individual beliefs and preferences are considered. Taking this approach requires staff to ask consent before acting, enables participation in both big and small life choices, maintains identity and does not judge. It is a close approximation of Rogers’ original concept. Person centred thinking is central to any person centred approach; it recognizes the individual as being at the heart of their own care. Various skills and tools, such as active listening, can be used to learn about what really matters to that person and to establish ways of working together.
As well as being a requirement of HSC 026, taking a person centred approach to care is a common induction standard requirement (Skills for Care, 2010). Common induction standard number seven states that care workers must ‘Promote person-centred values in everyday work’.
Person centred values are shared values that define us as individuals. Each of us can identify with them and they are intrinsic to the way most of us live in the world around us. These values include privacy, dignity, choice, individuality, rights, autocracy, partnership, independence and respect. These values can be supported and demonstrated in your daily working lives, through the relationships you build with your clients and the care they receive.
As it is not always possible to be familiar with everyone you care for, a care plan is essential to acquainting yourself with service users. Care plans help in supporting your care for an individual for both your own reference and also so that other workers can maintain continuity of care for the individual. The care plan documents the day-to-day care, support and treatment required by a service user, but it can be much more than that. The patients Guide Your Health, Your Way (Department of Health, 2009) describes care plans as ‘an agreement between you and your health professional.’ A care plan is a contract outlining agreed ways of the service user and professional working together.
This personalized approach to planning allows service users to take more control of their own care planning and to have more control over how their needs are met. Without detracting from the medical aspects of care, many care plans also incorporate personal information given by the client, their support network or from careful observation.
Person centred planning means finding ways of planning with a person rather than for them. The common induction standards (Skills for Care, 2010) require care workers to ‘understand the importance of supporting individuals to plan for their future wellbeing and fulfilment, including end of life care where appropriate’.
Person centred approaches step away from the uniform, medical model of disability, which is designed to assess needs, allocate services and make decisions for people. Person centred approaches are instead linked to the social model and hand power and control back to the individual. Knowing your service user will mean that many issues can be resolved before they arise, effectively improving the service that your clients are receiving. Greater client involvement should produce more satisfaction and confidence in the care provided. Residential service users in particular may find that their house seems more like home when they have a say in how their lives are run.
Your approach to your clients can be affected by your own experiences and assumptions, or even by attitudes and approaches taken by others. Care providers should accommodate their client freely and openly without restrictions or limitations. Being aware of your own generalizations and stereotypes and taking steps to neutralize them can help ensure that the care you provide is always inclusive.
Ways of communicating to ensure person centred care include:
While most of these behaviours are commonplace, consciously implementing and maintaining them will help you to practice person centred thinking and develop as a nonjudgmental carer.
Consider the choices you made today: what clothes did you wear? What food did you eat? What TV programs did you watch? Who did you see? What did you do?
When control of these day-to-day choices is taken out of your hands, your enjoyment of them diminishes and you begin to lose confidence in your ability to make those decisions. This may result in increased dependence on others.
Person centred approaches to care are all about keeping the choice of the individual firmly in their hands, and supporting and assisting them in taking (and keeping) control of their own lives. Choices, however small, play a big part in our lives and it is important to establish consent whenever possible when caring for an individual. The choices offered in a care setting should always be informed choices, with as wide a range of options as possible included.
Consent may not always be possible or easy, but consent is necessary from everyone, not only those who can verbalize their needs. Where it is not possible to get the consent or refusal of an individual, your duty of care to the individual would mean that consent must be sought elsewhere, from the next of kin or other individual or team responsible for the care of that person.
If the client cannot communicate their consent, a pre-assessment may contain the necessary guidance for an existing issue or a new assessment of the client’s needs may be necessary. While this option can be beneficial when consent is not possible, it should never be used to override the informed choice of the individual.
Effective communication is an essential part of person centred care. Considered and practiced communication skills, such as active listening can make developing a working partnership with the client much easier. Clear and consistent communication between client and carer will mean that errors and misunderstandings are reduced, so body language, signals, facial expressions and recorded history can all inform you of consent or of refusal. It is essential that this consent is sought and received: having control over your own life is essential for both emotional and mental wellbeing. Consent should be well-informed and there should be options whenever possible. Asking a service user to choose between a cup of tea and going thirsty is no choice at all.
Source: Cox, Danielle. 'Implement person centred approaches.' Nursing and Residential Care 13, no. 9 (September 2011): 414-417.
Excerpt reproduced with kind permission of the editor.Return