HSNS206

Person-centred
practice
 Objectives
• Definitions:
– Person Centred
– People, Family and Community Centred
• Differences with traditional model
• Caring in Nursing
• Ethnicity and Gender
• Self-care & Self-management
• Patient and Consumer Rights
 Definitions

Person centred care

•Person centred care is about care approaches and
practices that see the person as a whole with many
levels of needs and goals with these needs coming
from their own personal social determinants of
health.

•Hence, to be ‘person-centred’ means being

responsive to holistic needs and to tailor care to
individuals’ or group’s specific characteristics and
potential
 Definitions

People centred care

•People centred care goes beyond a model or care
that confronts common epidemiological population
profiles to one that considers holistic needs and
aims of the community in an evolutionary
movement that should strengthens individuals and
communities’ competencies and action towards
health and well-being.

•People centred care also encompasses person-

centred care.
 Definitions

Family centered care

“Family centred care is an approach to the planning,

delivery, and evaluation of healthcare that is governed
by mutually beneficial partnerships between
healthcare providers, patients and families. Family
centred care applies to patients of all ages, and it may
be practiced in any healthcare setting” [
Institute for Family Centered Care 2005 (Website)].
 Elements of Family Centred
Care
• Recognizing the family as a constant in the child's life
• Facilitating parent-professional collaboration at all levels of healthcare
• Honouring the racial, ethnic, cultural, and socio-economic diversity of
families
• Recognizing family strengths and individuality and respecting different
methods of coping
• Sharing complete and unbiased information with families on a continuous
basis
• Encouraging and facilitating family to family support and networking
• Responding to child and family developmental needs as part of health care
practices
• Adopting policies and practices that provide families with emotional and
financial support
• Designing health care that is flexible, culturally competent, and responsive to
family needs
(Shelton et al. 1987, Johnson 1990)
 Paired discussion
• Think about your own experience of a health care
episode, or that of someone you’re close to

• What do you want from a health professional, apart

from good clinical knowledge and skill?
 Regulations

Australian Health care industry is heavily regulated to

ensure care is the best it can be.

Some of the Regulation authorities include:

•Australian Commission on safety and Quality in Health care

•NSW agency for clinical innovation

•Australian Health practitioner Regulation Agency

•Nursing and Midwifery Board of Australia

•Clinical excellence commission

•Nursing and midwifery office – NSW health

 Standard of Care
• One of the domains of Code of conduct for nurses
includes person-centred practice

• Registered nurse standards for practice include a

patient centered care approachs

• What is it?
– Understand the individual, their aims and expectations in life
– Develop a frame of reference to their context (family, community,
social and cultural dimensions in their attitudes, values, beliefs)
– Understand their concepts of health and illness
 Code of conduct for nurses

Code of conduct for nurses: domains, principles and

values
Domain: Practise legally
1. Legal compliance
Domain: Practise safely, effectively and collaboratively
2. Person-centred practice
3. Cultural practice and respectful relationships
Domain: Act with professional integrity
4. Professional behaviour
5. Teaching, supervising and assessing
6. Research in health
Domain: Promote health and wellbeing
7. Health and wellbeing
 Principle 2: Person-centred
practice
Domain: Practise safely, effectively and collaboratively
2. Person-centred practice

Value
•Nurses provide safe, person-centred, evidence-
based practice for the health and wellbeing of people
and, in partnership with the person, promote shared
decision-making and care delivery between the
person, nominated partners, family, friends and
health professionals.
 Code of Ethics for Nurses

Code of Ethics for Nurses

1.Nurses value quality nursing care for all people.
2.Nurses value respect and kindness for self and others.
3.Nurses value the diversity of people.
4.Nurses value access to quality nursing and health care for
all people.
5.Nurses value informed decision-making.
6.Nurses value a culture of safety in nursing and health care.
7.Nurses value ethical management of information.
8.Nurses value a socially, economically and ecologically
sustainable environment promoting health and wellbeing.
Differences with traditional
model
How’s it different from the
triangular approach?
• The triangle is the
first stage
• The triangle helps
us conceptualise the
patient’s situation
• Person centred care
includes what we
then give out to the
patient
 Why is it important?
Patient‘s words…

To the typical nurse and doctor my illness is a routine

incident in their everyday work, while for me it’s the
crisis of my life. I would feel better if I had a nurse
who perceived this incongruity …. I just wish she
would …. give me hir whole mind just once, be bonded
with me for a brief space, survey my soul as well as my
flesh, to get at my illness, for each person is ill in their
own way

Anonymous patient
 How do we do it?
Effective nurse-patient relationship:

– Aim to integrate the patient’s perspective with the nurses

care plan to find common ground and make a mutual plan
– Communicate comprehensibly, enabling patient to reflect on
their own concepts, finding common ground for further
decision making
– Agree on decisions which respect patient’s autonomy
– Be aware of subjectivity on patient’s side (feelings, values,
preferences) and nurses/doctor’s (attitudes, values, feelings)

Making it Real - Part 1 (NSW Collaborative Nursing Model)

Caring
 Caring

• Compassion

• Competence

• Confidence

• Conscience

• Commitment

• Comportment
 NSW Health

Essential of care program

The aims of Essentials of Care

–The Essentials of Care (EOC) Program aims to enhance the
experiences of patients, families, carers and the staff
involved in the delivery of care through the ongoing
evaluation and development of safe, effective and
compassionate clinical care workplace cultures.

The Essentials of Care Program - Mid North Coast Local

Health District
 What is essentials care

Essential care is a term used in this context to help

health care professionals identify and articulate the
aspects of care that are fundamental to patients’
health and wellbeing. Effective essential care can only
be achieved when patients and their carers are
included in discussions and decisions, so the health
care team understands their individual needs and
works together in a person-centered way to achieve
them.
 Domains of EoC
For the purposes of helping us to understand how, when and
where aspects of care occur in day-to-day practice, they have
been categorised into nine care domains:

1. Documentation and communication

2. Promoting self-management
3. Medications/IV products
4. Privacy and Dignity
5. Clinical Interventions
6. Clinical Monitoring and management
7. Preventing risk and promoting safety
8. Learning and development culture
9. Personal care
10. Organisation of Care
 •Agency for Clinical Innovation 2017

Improving Patient and Staff

Experience Program (IPSE)
A growing body of evidence shows that patients’
experience of care has a direct correlation to their
health outcomes and that staff experience affects the
performance and efficiency of the whole system.
Patients often use different measures to health care
workers to assess their health experience. For
example, patients measure the quality of care
provided against the level of dignity and respect they
received, whereas staff may use how well they worked
together as a team to judge their coordination of care
(Agency for Clinical Innovation, 2017).
 Documentation and
communication
• AIDET – the Five Fundamentals of Patient/Customer Communication
• AIDET – is a structured way to communicate with patients and clients
which reduces anxiety and increases compliance. The mnemonic
A.I.D.E.T. stands for:
– Acknowledge the patient
– Introduce yourself
– Duration of procedure/ test/ interaction
– Explanation of procedure/ test/ interaction
– Thank the patient for their cooperation

• Watch the video: Nurse Patient using the AIDET

approach
 AIDET
• This tool is highly effective in both inpatient and
outpatient settings.

• Aim of the Tool:

– Improve patient safety, improved patient health and clinical
outcomes
– Improve patient compliance and reduced anxiety
– Improve patient satisfaction and patient and carer experience
– Implement good patient communications – always; every patient,
every time
– Standardise communication approach to all patients and carers
– Improve staff morale – Happier patients make it a better place to
work
 Hourly Patient Rounding
• Hourly Patient Rounding is then introduced and builds upon the
foundational activities of the Must Haves and AIDET. This tool allows
for regular proactive clinical service and care.

• Aim of the Tool:

– Improve patient health and clinical outcomes
– Improve patient safety
– Reduce clinical incidents
– Improve care planning
– Improve patient compliance & reduced anxiety
– Improve clinical outcomes
– Improve patient satisfaction and experience
– Decrease length of stay
– Improve nurse time efficiency.
 Dignity-conserving care
Harvey Chochinov, BMJ 2007;335:184-187

• Everyone deserves kindness, humanity and respect (core

professional values of nursing)

• ‘How patients perceive themselves to be seen’ is a

powerful mediator of their dignity

• We can think about this in a structured way:

– Attitudes
– Behaviours
– Compassion
– Dialogue
 Attitudes
• Questions
– How would I be feeling in the patient’s position? Why do I
think this? Am I right?
– How might my attitude be affecting them? Is that to do
with my own experience, anxieties or fears?

• Actions
– Reflect on your attitude in the care of each patient
– Discuss and challenge attitudes in case discussions
 Behaviours
• Behave with respect and kindness - it doesn’t take
extra time

• Remember that what’s routine for you may not be

so for the patient, e g examination or questions
they don’t expect to be asked

• Pay attention to all aspects of communication, not

just your words
 Compassion
deep awareness of the suffering of others
combined with the wish to relieve it

• How do you develop it?

– Natural to some people
– May develop with life experience
– Through the Arts - stories, novels, film, theatre, poetry

• How do you show it?

– Non verbal communication, e g understanding look, touch
on shoulder, arm or hand
– Saying things which acknowledge the person beyond their
illness
 Dialogue
Two-way communication

• Start with empathic communication e g I know this

must be frightening for you

• In a broad sense, find out who the patient is and

‘where they are coming from’
– What would it be useful for me to know about you?
– What is it you are most worried about?
– How is this affecting your life?
– Who else might be affected by this?
– Who have you got to support you?
– Who else should we get involved to help?
 Class discussions

Think about a time …

•When you felt you (or another nurse you observed)
were able to perceive the patient as a person and
treat them with kindness, humanity and respect

•When these things didn’t happen

Share with the class….

Ethnicity and Gender
Self-care & Self-management
 Australian Charter of
Healthcare Rights

The charter applies to all health settings

anywhere in Australia, including public
hospitals, private hospitals, general practice
and other community environments. It allows
patients, consumers, families, carers and
service providers to have a common
understanding of the rights of people
receiving health care.
 Roles in Australian Charter,
on Healthcare Rights
• A ‘patient’ or ‘consumer’ refers to a person receiving health
care. A ‘consumer’ also includes carers, families and
professional or chosen support people, who also have an
important part to play in achieving good health outcomes.

• The ‘healthcare provider’ is the trained health professional, or

team of health professionals providing health care.

• The ‘health service organisation’ is the organisation responsible

for providing healthcare services. Small organisations have to
work to achieve healthcare rights within existing systems and
available resources. In some cases support from external
agencies, such as telephone interpreters, may be needed.
Consumer Rights

• Access
• Safety
• Respect
• Communication
• Participation
• Privacy
• Comment
 Access

Health care providers

•Discuss any issues concerning access with the

patient, family or carer to enable them to understand
choices they may have and constraints that exist.

•Ensure efficient use of services and timely discharge

processes to enable access by others.
 Safety

Health care providers

•Provide healthcare services with professional skill,

care and competence.
•Provide healthcare services that are based on
evidence of safety and effectiveness.
•Involve yourself actively in patient safety systems
established by the health service organisation in
which you work.
•Work to provide effective continuity of care for
patients.
 Respect

Health care providers

•Demonstrate professional conduct that is based on

ethical standards and treat patients and consumers
with dignity and consideration.
•Provide care in a manner that is respectful of a
person’s culture and beliefs, and that is free from
discrimination.
•Interact with clinical colleagues, paramedical and
service staff and managers in a respectful manner.
 Communication

Health care providers

•Provide patients and consumers with open, complete and

timely communication throughout the period of care, including
when plans change or if something goes wrong.
•Provide comprehensive information regarding proposed
treatment, available options and continuing health care.
•Provide information to patients and consumers in a way that
can be understood.
•Ensure the appropriate transfer of information when care is
handed over to another health provider
 Participation

Health care providers

•Encourage patients and consumers to make fully informed

decisions by discussing treatment options available, including
expected outcomes, success rates and incidence of side effects.
This includes informing patients and consumers of their right to
refuse treatment or withdraw consent at any time.
•Ensure patients and consumers are invited to consent for any
care or treatment offered to them that is experimental or part of
teaching or research.
•Respect the role family members, friends, carers and advocates
may have in the patient’s or consumer’s care and treatment
 Privacy

Health care providers

•Ensure that patients’ health information is only

shared with other appropriate healthcare providers.
•Recognise that patients and consumers have a right
to access their records and be prepared to discuss the
contents of their records with them.
•Be sensitive to the privacy needs of patients and
consumers.
 Comment

Health care providers

•Acknowledge and take seriously all comments and feedback

made by patients and consumers.
•Establish feedback channels that are available throughout the
whole time of admission.
•Facilitate the efficient and equitable resolution of complaints by
participating in organisational processes.
•Establish ‘reflective practices’ to consider issues arising from
comment to determine possible improvements
 Health Care Complaints
Commission
The Health Care Complaints Commission acts to
protect public health and safety by dealing with
complaints about health service providers in NSW.

Charter
•The Commission is an independent body that was established under the
Health Care Complaints Act. The Act defines the scope of the
Commission's work, which is to:
– receive and assess complaints relating to health service providers
in NSW
– resolve or assist in the resolution of complaints
– investigate serious complaints that raise questions of public health
and safety
– prosecute serious complaints.
 Resources

• Australian Commission on safety and Quality in Health care

https://www.safetyandquality.gov.au/
• NSW agency for clinical innovation https://www.aci.health.nsw.gov.au/
• Australian Health practitioner Regulation Agency
http://www.ahpra.gov.au/National-Boards.aspx
• Nursing and Midwifery Board of Australia
http://www.nursingmidwiferyboard.gov.au/
• Clinical excellence commission http://www.cec.health.nsw.gov.au/index
• Nursing and midwifery office – NSW health Nursing and midwifery - NSW
Health - NSW Government