A Book Chapter Review: Nay Et. Al (2009) Person-Centred Care

Introduction

Nay et al (2009) article discusses in great detail the person-centred care (PCC) approach but narrows their scope on the applicability of this approach to people with dementia (PWD). The authors use the Lund trial in Sweden as well as the Australian replication in discussing the importance of culture and environment in enhancing quick healing through PCC. The authors also offer a set of recommendations on how PCC can best be applied by organisations in treating PWD. Overall, the authors suggest that the most important thing is not what is done but how it is done that counts towards PCC.

PCC from Nay et al Perspective

Nay et al gives a brief but comprehensive analysis of the historical perspective of the health care. They argue that the health professional was historically an expert with immense power over the client. The organisation of the health care facilities only reflected health professionals’ convenience and older patients were generally neglected. Treatment was task-oriented too. The authors therefore want their audience to believe that PCC replaced a rigid and biased task-oriented health care system that neglected the plight of older PWD. PCC is packaged as the best method to treat PWD. Essentially, the authors believe that PCC entails the “recognition of and connection with the person, a focus on the person’s strengths and goals, an interdisciplinary approach, and recognition of the centrality of relationships” (p.109). Using an experience of a health professional that underwent a PCC at the hands of highly professional and motivated health workers, the authors want their audience to believe that the environment and the quality of care a patient gets goes a long way in helping them to not only recover from illness but to also experience the healing process.

Nay et al offers a well thought-out analysis of the scope and practice of PCC on older PWD. They achieve this by drawing on past relevant studies. For instance, while acknowledging that past studies might not be exhaustive, the authors list the following indicators as the core characteristics of an ideal PCC:

Acknowledging an individual as an experiencing person despite the disease, offering and respecting client choices, using the person’s history and biography in care, focusing on abilities rather than disabilities, supporting individual rights, values, and beliefs, providing unconditional positive regard, interpreting all behaviour as meaningful, maximising potential and providing shared decision making (pp.109-110).

They posit that PCC takes place through two core stages, the “doing” stage and the “being” stage. While the “doing” stage covers the normal tasks performed in aid of PWD such as showing or feeding the “being” stage involves the quality of relationship developed between the carer and the client, for example, a careful and loving feeding experience. Overall, both “doing” and “being” stages are determined by the surrounding environment which the authors believe is responsible for sending caring or uncaring messages.

While using the Lund trial in Sweden and the Australia trial, Nay et al show that PCC is entirely about how care services are provided among the older PWD. They show that quality of staff-client relationships is critical for the cusses of PCC simply because staff and clients lives are shared by being together and doing together. This is true since the lack of communication between the staff and the client’s exacerbates dementia condition – clients feel a ‘sense of personal accomplishment … with more positive interactions with” staff (p.112). The authors therefore recommend a “whole-of-organisation” approach whose core premises are leadership, clear and easy to understand philosophy, and a positive organisational environment. They also caution that PCC should not be a “pulled out” accreditation but a well understood method that health workers can administer easily.

Personal Response

Nay et al article seem to agree in large extent with existing literature on the subject supporting the importance of PCC, what it entails, and how health practitioners can utilise it in treating older PWD. For instance, the article agrees with Johnson et al (2011) and Victorian Department of Human Services (2003; 2006) argue that PCC enhances the contact between the carer and the student. Both articles agree that PCC strengthens the quality of relationships between the care giver and the client in both residential and hospital facilities. The articles arrive at almost similar conclusions on how PCC can be used to treat different illnesses yet they pursue completely different approaches. While Nay et al (2009) use two case studies, in their work Johnson et al (2011) use past works in building and testing a set of hypotheses.

However, Nay et al (2009) fails to offer credible evidence on how PCC can be employed in treating diseases other than dementia. Yes, the authors make a good case in convincing their audience that indeed PCC can be employed in a number of situations but I feel that the article does not give much empirical evidence supporting the applicability of PCC in other environments such as treatment of terminal diseases such as cancer among people from poor backgrounds where home care is the only option. For instance, what would happen to a person suffering from cancer in a poor rural background where transport and communication networks are poor and the ratio of health care workers to patients is so high such that giving personalised treatment to a patient is almost impossible? Since the authors posit that environment and culture are critical to the success of PCC, then what would happen to patients in neighbourhoods that are so deprived of basic amenities that they cannot even afford to regularly visit qualified health practitioners for diagnosis and treatment?

Conclusion

Nay et al make a good case of PCC and its applicability in treating older PWD in developed world where the ratio of health practitioners to patients is normally balance but they fail to show how PCC can be applied in treating similar or different cases in poor backgrounds where basic health services are lacking. I strongly agree that PCC is a good treatment method but I strongly feel its applicability is limited to areas that have proper healthcare structures. Otherwise, developing countries still employ the historical health care system where the welfare of the patient is not a factor when designing and structuring hospital and residential environments.

References

Ekman, I. et al (2011). Person-centered care: Ready for prime time. European Journal of Cardiovascular Nursing.

Nay, R., Bird, M., Edvardsson, D., Fleming, R., & Hill, K. (2009). Person-centred care in R. Nay & S. Garrat (eds.) Older people: Issues and innovations in care. Chatswood, NSW: Elsevier, 107-119.

Victorian Department of Human Services (2003). Improving care for older people: A policy for health services. Melbourne, Victorian Department of Human Services.

Victorian Department of Human Services (2006). What is person cantered health care? A Literature review. Melbourne, Victorian Department of Human Services.