We all can probably recount our personal experiences of receiving some form of nursing care. This might have been as a patient in hospital, in a community or doctor’s clinic or in some other kind of health service provision. The personal relationships we formed with the nurses responsible for our care will have been important to us. For all patients, and their families, the relationships forged with nurses and other carers are central to the quality of their healthcare experience. The quality of these relationships is singled out in patient satisfaction surveys as being of particular importance. To engage successfully with their patients, nurses need to listen carefully, and to get to know their patients as people. Getting to know the person behind the patient is the raison d'être of person-centred nursing care.
So what is person-centred nursing?
A person-centred approach to nursing focuses on the individual’s personal needs, wants, desires and goals so that they become central to the care and nursing process. This can mean putting the person’s needs, as they define them, above those identified as priorities by healthcare professionals. In the words of Bob Price, a nurse academic writing for the Nursing Standard in 2006, ‘the term person-centred care is used…to indicate a strong interest in the patient’s own experience of health, illness, injury or need. It infers that the nurse works with the person’s definition of the situation, as well as that presented through a medical or other diagnosis’.
There are a number of different frameworks that have been developed by nurse academics to help practising nurses implement person-centred care. While these frameworks are all slightly different, they all share some key components:
- knowing the patient as an individual
- being responsive
- providing care that is meaningful
- respecting the individual’s values, preferences and needs
- fostering trusting caregiving relationships
- emphasising freedom of choice
- promoting physical and emotional comfort
- involving the person’s family and friends, as appropriate.
This model of nursing care contrasts with a more frequent approach called ‘patient-centred’ nursing. This focuses on the person as a patient, emphasising medical diagnosis and the identification of nursing problems. Personal needs may be acknowledged but only in as much as they relate to overall medical and nursing needs. In practice, this means that medical and nursing care needs take priority over other personal and, perhaps undeclared, needs of the person receiving care.
The importance of life stories
In order to achieve care that is person-centred, nurses need to understand the biographies of their patients and their relatives. Paying attention to the life stories and experiences of patients is the only way nurses will get to know their patients and their aspirations for the future. Achieving this can be challenging, as it requires time to listen and talk. Furthermore, the organisation of care, particularly in hospital settings, sometimes means that the focus is on ‘getting the job done’ rather than focusing on the importance of the individual’s needs and wants.
Moving forward, adopting truly person-centred care is a key objective for the nursing profession. To achieve this nurses need the right level of knowledge, skills and experience. At The Open University, we have argued that the move to an all graduate profession is a step in the right direction, as this will better equip nurses to respond to the increasingly complex care situations in which they practice. While there have been some recent examples of the way in which nursing has struggled to meet some of the essential care needs of patients, the reasons for this are often quite complex and are not just simply because nurses don’t care. So in addition to graduate education, supportive working environments, with appropriate nurse/patient ratios and good leadership are all important factors in ensuring person-centred nursing practice.
- Price, B. (2006) Exploring person-centred care, Nursing Standard, 20 (50), pp.49-56.
- Tetley, J. and Draper, J. (in press) ‘Slaying the myth’ of the over-qualified nurse: The graduate nurse and older people, International Journal of Older People