My name is Ciara Doyle. I’m a second year General Nursing student. As part of this programme there is a module called the ‘Older Adult and Other Populations.’ In this module I’m required to compose an essay discussing how using the McCormack and McCance model of individualised person centred nursing can enhance care for older people. I will include a discussion on how person centred nursing can raise awareness of the importance of respect for the individual.
Person centred care (PCC) is about focusing on the care on the needs of the individual. Ensuring that the patient’s preferences, values and their needs are being met in a way that is respectful to them (Person Centred-Care, NHS, 2014). PCC is professionally recognised as a key aspect of nursing practice. Patients who are admitted to the hospital often have to navigate through a fragmented healthcare system and are almost expected to adapt to the usual procedures in that specific environment, rather than receiving care designed to focus on their individual needs. This involves working with patients and their families, and gives them the opportunity to get involved in making choices about their healthcare (McCance T. et al, 2011). Evidence from research suggests that using this approach to nursing provides more holistic care. It may also increase patient satisfaction with the level of care, reduce anxiety levels among nurses, and promote team working among staff (McCormick B. McCance T. 2010). Evidence is consistent in the view that being person-centred requires the formation of relationships between professionals, patients and families. These relationships must be built on mutual trust, a sharing of collective knowledge and understanding. Today, PPC is widely used as a key component of patient care in the hospital.
The PCC nursing framework developed by McCormick and McCance (2010) offers specific concepts. ”The person-centred nursing framework of McCormack and McCance (2010) offers a theoretical model with descriptions of core concepts and their mutual relations. The framework is interwoven with a strategy known as transformational practice development and research methodologies that originate from the action research paradigm” (McCormack and McCance, 2016). The framework therefore is particularly suitable for empirical studies that aim to develop practical knowledge on the realisation of person-centred care. It has being published extensively, but in summary the framework is composed of four constructs:
– Prerequisites: This focuses on the attributes of the nurse. This involves having developed interpersonal skills, being competent, being committed to their job and the tasks at hand, and being able to demonstrate their beliefs and knowing self.
– The Care Environment: The focus here is on the care that is being delivered. This includes an appropriate skill mix, shared decision making and effective staff relationships and the physical environment. It also includes a supportive organisational system.
– Person-Centred Processes: This focuses on delivering the care by working with patients and taking into consideration their beliefs and values, engage with the patient, be sympathetic, including the patient in decision-making and providing holistic care.
– Outcomes: McCormick and McCance (2010) stated that this is the most central component. These are the results of effective PPC. This includes involvement in care, satisfaction with the care, and the creation of a therapeutic environment, defined as, decision making is shared, leadership is transformational staff relationships are collaborative and innovative practices are supported.
McCormack highlighted the move toward a more PCC approach to the care of the older person. This move represents a change from an organized and professional focused system and views the needs of the individual (McCormack B. 2003). People are individuals with a right to respect and dignity. Treating people with respect and dignity constitutes person-centred nursing (McCormick B. 2004). PCC places the individual and their needs and preferences at the centre of care. It avoids labelling people because of their diagnosis (Cassidy D. Mason S. Mayland C. 2017). It is a framework that offers building blocks for the realisation of good care (McCormick B. McCance T. 2016). PCC benefits the healthcare system in numerous different ways. Patients are more likely to stick to their treatment plans and medication if they feel respected, involved and in control. This can relieve the pressure on the healthcare system such as reduced re-admissions and wasted medication. Hospitals in Ireland are under strain with an enormous amount of admissions. A lot of patients admit themselves to the hospital when there is no real medical emergency. PCC improves the patients understanding of their condition.
The challenges facing the HSE are clear. The number of older people living with long-term conditions is increasing. At the same time health budgets are under increasing pressure. If we are to provide a high quality of care to patients we need to change the relationship between staff and patients. Services are starting to move away from the ‘one for all’ care plans and are starting to move towards care that is designed specifically for the individual (Pol-Grevelink A. Jukema JS. Smits CH. 2012). There is evidence that most patients want to play an active part in their own care, health professionals should allow them to do so. PCC includes shared decision making, enables people to play a more active role in defining the outcomes that are important to them, deciding the treatment and support that is best for them, and managing their care. There is evidence that people who have the opportunity and support to make decisions about their treatment and care in partnership with the healthcare staff are more satisfied with their care (Gibson PG. Powell H. Coughlan J. 2004). As healthcare workers, it is important to promote independence in older people. Promoting independence can keep elderly people physically, mentally, emotionally and socially engaged. It can also help them retain better cognitive function. Crucially, it ensures that patients are always treated with compassion, dignity and respect. In the UK, ‘The Care Act 2014’ was set up to personalise care plans, the principles of PCC are now central to social care law and policy. The Act aims to enable people to have more control in their own lives (Mandelstam M. 2017).
In the McCormick and McCance (2010) PCC model, they discuss Prerequisites. This focuses on the attributes of the nurse. With the ever increasing demand on healthcare staff, staff can lose sight of the individual person they are treating. This is why PCC is so important. It helps staff refocus on a crucial aspect of care (Fink R, Thompson CJ, Bonnes D 2005). As much as the caring relationship is of importance, so is the professional expertise of the nurse. Clinical reasoning is not only about knowledge and skills; it is good practice to take professional and personal experience into account as a source of knowledge. Professional knowledge is about good communication skills, an appropriate attitude and being kind. The nurse needs to know themselves and their personal qualities (Benner P 2010). For PCC to work, the relationship between healthcare workers and the patient needs to be a partnership rather than the healthcare worker being the expert and the patient simply follows instructions. A team approach is crucial for PCC to exist. Nurses have a major contribution to make and are vital in the multi-disciplinary team. In today’s strained health care system, it is impossible for any-one professional group to deliver PCC on its own. Healthcare workers have a role in supporting patients to develop the knowledge, confidence and skills to participate in their own healthcare ( De Silva D 2012).
The ultimate goal of person-centred care is to preserve, protect and cherish someone’s individuality as a person and their wellbeing. PCC fits a person’s needs, it acknowledges and gives priority to what is important for them. These priorities define personal outcomes of care. Person-centred care benefits healthcare professionals because they are able to express themselves as the person behind the professional role. The nature of PCC has the benefit in fostering a better understanding of the older people and healthcare workers. It gives healthcare workers the opportunity to see the person they are caring for and not just a name on the clinic list.
Person Centred Care is vital.