10 Chapter 9: Person-Centered Care
Tracy Everitt; Megan Davies; and Brittany Yantha
Chapter 9 Learning Objectives
At the conclusion of this chapter, students will be able to:
Learning Objectives
- Understand the components of person-centered care and how it can be applied at home or in practice.
- Describe the impact of person-centered care practices on clients.
- Describe examples of person-centered strategies and activities.
- Understand effective person-centered strategies to help older adults with neurological cognitive disorders and dementia.
- Understand the importance of informed consent for an individual’s care.
- Explain the process of advanced care planning.
Introduction
Person-centered care is an essential component of health care where clinical practitioners consider a person’s medical needs and preferences. This ensures the patient is an active participant in all aspects of their care and recovery. A critical element of person-centered care is providing an understanding of all risks and benefits so a person can make an informed decision about their care. Person-centered care supports people in developing the knowledge, skills, and confidence they need to manage and make informed decisions about their own health and health care more effectively. These strategies are coordinated and tailored to the needs of the individual. Person-centered care has become an important practice for providing care to those with neural cognitive disorders (NCDs) and dementia.
Moving away from institutionalized care to a person-centered care is associated with improved patient health outcomes (Kim SK, Park M, 2017). Fundamental skills in providing person-centred care include the ability to communicate effectively, adapt and individualize nutrition interventions, and build strong patient-practitioner relationships (Sladdin et al., 2017), to name a few. Research suggests that the positive impact of person-centered care for those with dementia includes improvement in the psychological status of the patient, lower rates of boredom and feelings of helplessness, and reduced levels of agitation (Brownie & Nancarrow, 2013). There could be adverse effects to person-centered care such as an increase in falls or choking, but these are risks accepted by the patient as part of their overall improvement in their quality of life. Re-evaluation of risks should be ongoing and continuous and adapt as the person’s health and status changes.
9.1 Informed Consent
Regulated health professionals have a legal and professional responsibility to obtain consent for delivering any treatment, with clear and complete information relating to the risks, benefits, and consequences of giving or refusing the intervention. The person (or substitute decision maker) can then make informed person-centered decisions about any treatment done for a therapeutic, preventative, palliative, diagnostic, or health-related purpose. Persons are assumed to be capable of consenting to treatment according to the Health Care Consent Act, 1996, despite their mental condition/capacity. Even if a person has dementia, they may be able to consent to simple diet interventions according to their wants, needs and preferences. Still, they may be unable to consent for a more complex medical intervention.
9.2 Advanced Care Planning
Patients deserve to receive care that reflects their values and wishes and to participate in decisions about their lives and care. Advance Care Planning can improve communication between staff, patients, and their caregivers. They can also help staff anticipate care needs at the end of life and avoid undesired treatments and interventions. Advanced Care Planning involves the following:
- Having essential conversations about the person’s values, which can be initiated by the resident, family, or a staff member
- Sharing information about the patient’s health condition/illness, so the person and their family, friends, and Substitute Decision Maker(s) understand what to expect as they age and their health changes (a national guide is in the initial stages of development)
- Providing clear, accurate information about the benefits and risks of different treatment options given their health issues
- Supporting patients, families, and Substitute Decision Maker(s) as they work through the ongoing process of Advance Care Planning
- Documenting the resident’s wishes and preferences for care
- Ensuring staff have the training and resources to engage patients and families in Advance Care Planning conversations, and support them as they work through the process
- Taking concrete steps to provide care that reflects the residents’ and families’ wishes.
Adapted from: Advanced Care Planning Canada. (2021). Essential Conversations: A Guide to Advance Care Planning in Long-Term Care Settings. https://www.advancecareplanning.ca/wp-content/uploads/2021/06/LongTermCare-Toolkit_EN.pdf.
9.3 Activity
Please read the Fazio et al. (2017) article and answer the following questions.
Fazio, Pace, D., Flinner, J., & Kallmyer, B. (2018). The Fundamentals of Person-Centered Care for Individuals with Dementia. The Gerontologist, 58(suppl_1), S10–S19. https://doi.org/10.1093/geront/gnx122
Learning Questions from Fazio, et al., 2017:
- Why is person-centered care an effective strategy for older adults with neural-cognitive disorders/dementia?
- What are the key components of person-centered care?
- What are some examples of person-centered care activities that caregivers can utilize in the long-term care setting?
- Is person-centered care only useful in long-term care settings?
- What are some person-centered strategies?
References
Advanced Care Planning Canada. (2021). Essential Conversations: A Guide to Advance Care Planning in Long-Term Care Settings. https://www.advancecareplanning.ca/wp-content/uploads/2021/06/LongTermCare-Toolkit_EN.pdf retrieved November 21, 2022.
Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in aging, 8, 1–10. https://doi.org/10.2147/CIA.S38589
Kim, S. K., & Park, M. (2017). Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clinical interventions in aging, 12, 381–397. https://doi.org/10.2147/CIA.S117637
Sladdin I, Gillespie B, Ball L, Chaboyer W. (2017). Patient-centred care to improve dietetic practice: an integrative review. J Hum Nutr Diet; 30: 453- 470.
