{"id":812,"date":"2015-11-16T08:20:36","date_gmt":"2015-11-16T08:20:36","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/ebn\/?p=812"},"modified":"2015-11-16T08:23:49","modified_gmt":"2015-11-16T08:23:49","slug":"person-centred-care","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/ebn\/2015\/11\/16\/person-centred-care\/","title":{"rendered":"Person-Centred Care"},"content":{"rendered":"<p style=\"text-align: center\">On <strong>Wednesday 18th November (8pm-9pm GMT)<\/strong> we are delighted to host our final #ebnjc tweet-chat of the year on <strong>person-centred care<\/strong> in nursing and healthcare with <a href=\"https:\/\/twitter.com\/ProfBrendan\" target=\"_blank\">Professor Brendan McCormack<\/a>.<\/p>\n<p style=\"text-align: center\"><a href=\"https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Professor-Brendan-McCormack-low-res-2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-814\" src=\"https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Professor-Brendan-McCormack-low-res-2-200x300.jpg\" alt=\"Professor Brendan McCormack (low res) (2)\" width=\"200\" height=\"300\" srcset=\"https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Professor-Brendan-McCormack-low-res-2-200x300.jpg 200w, https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Professor-Brendan-McCormack-low-res-2-683x1024.jpg 683w, https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Professor-Brendan-McCormack-low-res-2.jpg 1800w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/a><\/p>\n<p style=\"text-align: center\">Participating in the Twitter chat requires a Twitter account. If you do not already have one you can create an account at\u00a0<a href=\"http:\/\/www.twitter.com\/\" target=\"_blank\"><span style=\"color: #003399\">Twitter<\/span><\/a>.\u00a0 Once you have an account contributing is straightforward \u2013 follow the discussion by searching links to #ebnjc or <a href=\"https:\/\/twitter.com\/EBNursingBMJ\" target=\"_blank\"><span style=\"color: #003399\">@EBNursingBMJ<\/span><\/a>, or better still, create a tweet (tweets are text messages limited to 140 characters) to <a href=\"https:\/\/twitter.com\/EBNursingBMJ\" target=\"_blank\"><span style=\"color: #003399\">@EBNursingBMJ <\/span><\/a>and add #ebnjc (the EBN chat hash tag) at the end of your tweet \u2013 this allows everyone taking part to view your tweets.<\/p>\n<p style=\"text-align: center\"><strong>For further details on how\u00a0participate in this twitter-chat please <a href=\"https:\/\/stg-blogs.bmj.com\/ebn\/ebn-online-journal-club\/\" target=\"_blank\"><span style=\"color: #003399\">click here.<\/span><\/a><\/strong><\/p>\n<p style=\"text-align: left\">\u00a0<!--more Read Professor Brendan McCormack's Blog Here--><br \/>\nThe concept of \u2018person-centredness\u2019 has become established in approaches to the delivery of healthcare and particularly within nursing. In the United Kingdom, person-centredness is embedded in many policy initiatives. Recent research into person-centredness has attempted to clarify the meaning of the concept, explore the implications of the term in practice and determine the cultural and contextual challenges to implementing a person-centred approach. Evidence from research suggests that adopting this approach to nursing provides more holistic care. In addition, it may increase patient satisfaction with the level of care, reduce anxiety levels among nurses in the long term, and promote team working among staff. Existing evidence is consistent in the view that being person-centred requires the formation of healthful relationships between professionals, service users, families and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge. This evidence is also consistent with previous nursing literature on therapeutic caring where the concept of \u2018person\u2019 is central. The relationship between person-centredness and caring is strong and focuses on the centrality of concepts that are common to both, such as, relationships, values, caring processes and the environment of care (context). In a three year quasi-experimental research and development project to implement person-centred nursing across eight different clinical settings in an acute hospital setting, <a href=\"https:\/\/twitter.com\/ProfBrendan\" target=\"_blank\">McCormack<\/a> and <a href=\"https:\/\/twitter.com\/tanya_mccance\" target=\"_blank\">McCance<\/a> developed the \u2018person-centred nursing theoretical framework\u2019 (McCormack &amp; McCance,2006 and 2010) and this has been further developed through a range of research studies into the Person-centred Practice Framework (McCormack &amp; McCance, in press). The framework has been tested through a range of research projects internationally and the findings confirm its content validity, replicability, transferability and usability in practice.<\/p>\n<p style=\"text-align: left\">The figure below is the new version of the Person-centred Practice Framework (McCormack &amp; McCance) which is soon to be published in the 2nd edition of the book &#8211; Person-centred Practice in Nursing and Healthcare.<\/p>\n<p style=\"text-align: left\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-813 aligncenter\" src=\"https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Picture1-2-292x300.png\" alt=\"Picture1 (2)\" width=\"320\" height=\"329\" srcset=\"https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Picture1-2-292x300.png 292w, https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Picture1-2.png 788w\" sizes=\"auto, (max-width: 320px) 100vw, 320px\" \/><br \/>\nSince the publication of the person-centred nursing framework in 2008, the field of person-centred nursing and person-centred practice has developed and expanded significantly and has adapted to significant changes in health and social care models of service design and delivery. Particular health and social care advancements that need to be taken account of are:<\/p>\n<ul>\n<li>An increased ageing population with the associated rise in long-term conditions, resulting in the need for health and social care services to be remodelled and redesigned.<\/li>\n<li>The focus on integrated care and a more overt focus on primary care and public health.<\/li>\n<li>The global economic down-turn and the need for high quality services to be delivered in a fiscal environment.<\/li>\n<li>The central focus on public engagement in health and social care services and the development of services that are responsive to individual need.<\/li>\n<li>The \u2018post-Francis\u2019 era where there is a greater emphasis on compassion in care instead of business delivery targets.<\/li>\n<li>The global attention paid to patient safety and service improvement with some links being made to person-centredness.<\/li>\n<li>The evidence of person-centred principles underpinning health and social care policy, strategy and service-delivery models.<\/li>\n<li>The beginnings of a focus on person-centredness in curriculum frameworks for nurses and midwives.<\/li>\n<li>Significant development in methodologies for developing person-centred practices and process &amp; outcome evaluation.<\/li>\n<\/ul>\n<p>However, all of this research and theoretical development has not resulted in a large-scale shift towards person-centredness. The values of mutuality, collegiality and care that are espoused in mission statements and organisational frameworks are often not easily realised by staff in practice. Despite a large literature on teams, team-effectiveness and team-culture, dysfunctional team relationships and dissonance between espoused and lived management and leadership values continues to exist in nursing and healthcare. The key goal in the development of a positive learning culture is to recognise and overcome individual, group and organisational barriers in order to move towards an effective culture and overcome the features of workplaces that nurture hierarchical management and horizontal violence, as illustrated by the following poem:<\/p>\n<p style=\"text-align: right\"><em>Twenty years as a nurse,<\/em><\/p>\n<p style=\"text-align: right\"><em>Moving through the ranks knowing who I am<\/em><\/p>\n<p style=\"text-align: right\"><em>Knowing me<\/em><\/p>\n<p style=\"text-align: right\"><em>Becoming a manager, being a manager<\/em><\/p>\n<p style=\"text-align: right\"><em>Managing<\/em><\/p>\n<p style=\"text-align: right\"><em>Discovering the joys of person-centredness<\/em><\/p>\n<p style=\"text-align: right\"><em>Unfurling the challenges of being a person-centred leader<\/em><\/p>\n<p style=\"text-align: right\"><em>Self growth<\/em><\/p>\n<p style=\"text-align: right\"><em>Discovery<\/em><\/p>\n<p style=\"text-align: right\"><em>Transformation<\/em><\/p>\n<p style=\"text-align: center\"><em>The winds of change blow from the west<\/em><\/p>\n<p style=\"text-align: center\"><em>Person-centred leadership devalued<\/em><\/p>\n<p style=\"text-align: center\"><em>Targets<\/em><\/p>\n<p style=\"text-align: center\"><em>Bullying<\/em><\/p>\n<p style=\"text-align: center\"><em>Devaluing<\/em><\/p>\n<p style=\"text-align: center\"><em>I am an \u2018It\u2019<\/em><\/p>\n<p style=\"text-align: left\"><em>Stats mean good care<\/em><\/p>\n<p style=\"text-align: left\"><em>Shared experiences mean coercion<\/em><\/p>\n<p style=\"text-align: left\"><em>Get out get out get out<\/em><\/p>\n<p style=\"text-align: left\"><em>Stay safe<\/em><\/p>\n<p style=\"text-align: left\"><em>Shut down<\/em><\/p>\n<p style=\"text-align: left\"><em>Hide<\/em><\/p>\n<p><em>But I need to keep listening to the patients<\/em><\/p>\n<p style=\"text-align: center\"><em>(poem written by a Clinical Leader, personal communication)<\/em><\/p>\n<p>&nbsp;<br \/>\nThere is no doubt that for person-centred nursing to exist, there is a need for a work organisation method that enables nurses to exercise power whilst simultaneously being able to negotiate the nature of that power in relationships with others (including patients and families). The language of empowerment is pervasive in nursing and contemporary nursing policy and strategy espouses the importance of nurses being empowered to exercise autonomous decisions, whilst at the same time empowering patients. Various authors have argued that the language of empowerment is complex and challenging, that nurses aren\u2019t empowered professionally or organizationally to exercise empowerment or to empower others. Organizations need to create and nurture the structural conditions in which clinical staff are enabled to facilitate empowerment.<\/p>\n<p>Developing person-centred nursing requires a sustained commitment to the facilitation of multiple aspects of culture change in clinical settings and organisations. However, despite many examples of well-intentioned projects, it continues to be the case that embedding person-centredness in team, unit and organisational cultures is a challenge, and indeed often seems \u2018elusive\u2019 in the everyday (chaotic) world of practice. In addition, for some, the whole agenda of person-centred nursing is merely a buzz term or a process of \u2018naming that which already exists\u2019, i.e. \u201cwe are doing it anyway aren\u2019t we?\u201d. Others however may have identified issues and ideas that stimulate new ways of thinking about practice and are wondering \u201chow do I move towards this way of nursing?\u201d Both these positions pose challenges to the facilitation of person-centred care developments. What is clear, is that for person-centred nursing to be realised, a sustained commitment to its development and maintenance in practice is required from organisations.<\/p>\n<p>The real challenge for all organisations is the movement from individual \u2018person-centred moments\u2019 to \u2018person-centred cultures\u2019. It is clearly evident from the international literature that this cannot happen by relying on the individual motivation of practitioners, but instead requires a sustained commitment to facilitated culture change with teams and across organisations.<\/p>\n<p>See two of Professor McCormack&#8217;s talks below.\u00a0 The first, a TEDx talk called &#8220;In search of (my) personhood&#8221; and the second, a keynote speech from the 2013 International Nursing Research Congress called &#8220;From Person-centred Moments to Person-centred Care: Creating flourishing healthcare cultures&#8221;.<\/p>\n<p><iframe loading=\"lazy\" title=\"In search of (my) personhood: Professor Brendan McCormack at TEDxUWS\" width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/krPt8z0okoQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" title=\"2013 International Nursing Research Congress (Prague)  Keynote Speaker - Brendan McCormack\" width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/LDfI2WmTYTU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/p>\n<p><u>REFERENCES<\/u><\/p>\n<p>McCormack B and McCance T (in progress) <em>Person-centred Nursing and Health Care \u2013 Theory and Practice, <\/em>Wiley Publishing, Oxford,<br \/>\nMcCormack B and McCance T (2010) <em>Person-centred Nursing: Theory, models and methods. <\/em>Blackwell Publishing, Oxford.<br \/>\nMcCormack B and McCance T (2006) Development of a framework for person-centred nursing. <em>Journal of Advanced Nursing, <\/em>56(5): 1-8.<\/p>\n<p><em>Professor Brendan McCormack,<\/em><\/p>\n<p><em>Head of the Division of Nursing\/<\/em><em>Head of QMU Graduate School<\/em><\/p>\n<p><em>\u00a0<\/em><em>School of Health Sciences<\/em><\/p>\n<p><em>Queen Margaret University<\/em><\/p>\n<p><em>Queen Margaret University Drive<\/em><\/p>\n<p><em>Musselburgh<\/em><\/p>\n<p><em>East Lothian<\/em><\/p>\n<p><em>EH21 6UU<\/em><\/p>\n<p><em>Email:\u00a0\u00a0<\/em><a href=\"mailto:BMcCormack@QMU.ac.uk\"><em>BMcCormack@QMU.ac.uk<\/em><\/a><\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>On Wednesday 18th November (8pm-9pm GMT) we are delighted to host our final #ebnjc tweet-chat of the year on person-centred care in nursing and healthcare with Professor Brendan McCormack. Participating in the Twitter chat requires a Twitter account. If you do not already have one you can create an account at\u00a0Twitter.\u00a0 Once you have an [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/ebn\/2015\/11\/16\/person-centred-care\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":814,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3606],"tags":[710,3665,3677,3681,3680,3678,3679],"class_list":["post-812","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ebn-journal-chat-ebnjc","tag-nursing","tag-nursing-issues","tag-person-centred-care","tag-person-centred-cultures","tag-person-centred-nursing-framework","tag-person-centredness","tag-personhood"],"jetpack_featured_media_url":"https:\/\/stg-blogs.bmj.com\/ebn\/files\/2015\/11\/Professor-Brendan-McCormack-low-res-2.jpg","_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/posts\/812","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/comments?post=812"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/posts\/812\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/media\/814"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/media?parent=812"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/categories?post=812"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/tags?post=812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}