sciencenurse patient relations
nursing standard:clinical · research · education
The RCN’s work on gerontological nursingexplicitly embraces the philosophy of person-centred approaches to practice and is heavilyinfluenced by humanistic philosophies thatemphasise the importance of recognising the‘lived experience’ of the older person in plan-ning care. Many argue that such an approach tohealth care continues to be rhetoric and thatperson-centred approaches are far from reality inpractice (HAS 1998, Help the Aged 1999).Acknowledging this, the RCN has developed agerontological nursing programme that integratesall of its work on policy, research, education andpractice development. The central aim is tomake person-centred practice a reality. However,as this article suggests, there is much to do toensure that the ideology of person-centredapproaches to care is dominant in contemporarygerontological nursing practice.This article seeks to explore what it means tobe a person and how this understanding is artic-ulated in person-centred approaches to practice.The article will focus on the issue of assessmentas the cornerstone to establishing the needs ofan older person and attending to these needs ina person-centred way.In the past five years there has been increasingconcern over the funding, level and quality ofhealth and social care provided for older peoplein the UK. Specifically, attention has beendrawn to the apparent lack of consistency inthe assessment of the individual’s need for care;the variability in provision of appropriate care tomeet these needs; the apparent confusion overthe sources of funding to provide these services;and the lack of involvement of individuals andtheir families and/or carers in the assessmentprocess (Audit Commission 1997, Ellis 1993,NHSHAS 1997, RCN 1998a and b). In long-termcare, these concerns led to a Royal Commission(DoH 1997) being set up.The drive to develop person-centred approachesto practice represents a stage in the developmentof healthcare services at which the needs of theindividual, rather than the professionals andorganisations who meet these needs, are heldcentral. Therefore, adopting a person-centredapproach goes far beyond simplistic notions ofindividualised care and instead represents a fun-damental shift of philosophy in caring practices.The word person aims to capture those attributesthat represent the humanness of people and thefactors that we regard as the most importantand the most challenging in our lives. The conceptof person would include attributes such as sight,taste, sexuality, memory and desires.But members of other species also have theseattributes – along with the capacity for thoughtand decision making. However, people are seen aspossessing a will that enables rational deliberationon action. As a result, the concept of freedom isan important aspect of personhood – being freeto do something and to take responsibility forchoices made (Frankfurt 1989).For nurses working with older people, such aconcept of personhood raises serious issues forpractice. If personhood is defined as being relianton rational decision making with reflection oncompeting choices, needs, wants and desires,then it is easy to see why so many users ofhealth and social care services become reducedto objects. Many older people in hospital andcare homes, for example, those with acute con-fusion or dementing illness, neither have thefreedom nor the ability to take rational and freeaction for themselves.If the preservation of autonomy relies on anindividual being capable and free to make rationalchoices, then respect for personhood becomes aparticular challenge because so many users of
What it means to be a personBackgroundIntroduction
Pauline Ford MA, RGN, DHMS,CMS, and Brendan McCormackBSc, DPhil (Oxon), PGCEA, RGN,RMN, are Directors,Gerontological NursingProgramme, Royal College ofNursing.
Keeping the person in thecentre of nursing
Ford P, McCormack B (2000) Keeping the person in the centre of nursing.
46, 14, 40-44. Date of acceptance: June 27 2000.
This article presents an overview of whatit means to be a person and how this isarticulated in person-centred approachesto practice. Nursing assessment is usedas an example of a person-centredapproach to care.
Nurse patient relations
These key words are basedon the subject headings fromthe British Nursing Index. Thisarticle has been subject todouble-blind review.