Person-centred health care is the type of care whereby the patient is the centre of the nurse’s care and the nurse considers the needs of the patient. There exists a respectful and collaborative partnership between the patient and the carer. The nurse or the carer respects the contribution by the patient towards their health such as goals, decisions and health needs. The patient also respects the nurse’s contributions such as the nurse’s knowledge and expertise concerning the care, experience, values and their decisions concerning the care (State of Victoria, 2006). The following principles must be applied so that a person-centred care is effective; both parties should know each other well- this includes knowing the patient’s or nurse’s individual and holistic approaches, the patient and the carer should share power, duties and responsibilities; both parties should be accessible and flexible; they should integrate and coordinate well and create an environment conducive for a person-centred care. This article discusses on mental health care and how experiences with people living with mental disorder can contribute to person-centred health care.
The world is suffering from strain due to complexity in patients and community expectations, aging workforce, poor communication and nurse shortages, making it difficult to offer quality care to patients especially the mentally challenged patients. The mental health care has also suffered from disempowerment of carers and patient stigma. Poor coordinated and cross sectional responses are among the factors hindering quality mental health care, hence compromising the patient’s safety (Jones, 2014). The WHO (2010) define collaborative practice as a health care practice (both clinical and non-clinical) whereby nurses and carers from diverse backgrounds work in collaboration with the patient, their family and the society so as to deliver a high quality health care. Person centred collaborative health care is essential for patients with mental illness as it promotes coordination of response and hence the patient’s health care and outcomes are improved (Wood, 2009).
A good communication in a collaborative person centred health care (involves discussing about the patient’s understanding, feelings and expectations) leads improved and positive outcomes in the client’s health. There is increased nurse and patient satisfaction and the patient adheres more to the nurse recommendations. According to Reeves et al. (2011), person centred health care is hindered by factors such as time since it is thought to be time consuming, lack of autonomy to practice in the appropriate way, dissolution of professional power where power and responsibilities are wrongly shared, lack of clarity on what involves person centred mental health care and communication difficulties.
According to Jobb-Shanley & Shanley (2007), who worked with a mentally ill colleague claim that most mental health carers fail in helping their clients to live an optimal life due to may be negative attitude towards the patient’s involvement in the care practice (Happell, 2008). People with mental disorders need a straight forward way of communication and their involvement in the caring process. Sommerseth and Dysvik (2008) claim that if success is to be attained in person centered mental health care, the carers must come up with alternative ways of communicating and relating with patients with mental illness. White (2005) takes a bio psychological approach and thinks that according to his expertise in mental health care, the starting point to offer quality health care for people with mental disorders is the people’s resources. According to him, these people need to be engaged in dialogue and treat each one differently. The cares must understand the pathways so that they can plan on how to respond to the patients’ needs. Sommerseth & Dysvik (2008) discovered that every patient with mental disorder had different needs and therefore there is a need for a flexible framework to deal with their needs. This also means that every patient has a specific pathway and the nurses and carers should be available to offer the support they need. Involving the patient’s family is important in enhancing interpersonal relationship between the stakeholders involved in the health care. In most cases Featherstone (2006) thinks that the expertise of the family members is overlooked in the care delivery not realizing that they are important resources in the care practice.
Dementia care mapping (DCM) is a theory developed at Bradford University to help patients suffering from dementia. This theory states that most of the problems facing patients with mental disorders are due to the negative environment they find themselves in. This theory helps carers and nurses to identify factors triggering ill and well-being of the patients (Rochon et al. 2008). Multimodal sensory stimulation is another approach used to provide person centred mental care though Van de Ven et al. (2012) think that it has a limited approach as they are nurse and carer centred but exclude the psychological aspect in the mental health care delivery. It also does not include systematic and climatic adaptations.
Regnard et al. (2007) had an experience with a patient with mental disorder who was admitted to the hospital. This patient could call on her granddaughter anytime he wanted to visit the washroom but the nurses could not know why he kept calling that very name until they inquired from a family member. They then understood that whenever he called his granddaughter he wanted to help himself. Regnard and his colleagues therefore concluded that there is need to understand the needs and habits of the patient. They also discovered that unknown environment and unfamiliar carers could cause distress to the patient and therefore the need for a family member. Gluyas (2015) wrote that nurses should realize that not all family members are close enough to the patient to be their true advocates. This was after Gluyas encountered a case whereby a patient chose her best friend over her family members. Carey (2016) claims that effectiveness in care delivery for patients with mental disorders rotates around the convenience and organization of the service.
Most of the authors including Carey (2016) see poor communication and poor sharing of powers and responsibilities between the nurses and the patient as the largest shortcoming in achieving a high quality care for patients with mental disorders. Carey says that in most settings, the clinicians and carers make stepping decisions for the patients. When the patients need a higher level of therapy the doctors arrange it without involving the patient. It is not a routine for carers and nurses to ask patients if they need appointment reminders before they are issued. Though these appointment reminders could be of little importance to the patient, according to Australia Nursing & Midwifery Federation (2017), it is wrong to impose reminders to the patient following the carer’s preferences. In caring for a mentally ill patient, I would consider the patient perspective care needs and become my motives to the caring practice.
According to Bayliss-Pratt (2018), patient centred mental health care should be replaced with patient perspective mental health care. The clinicians and carers must understand the meaning of “care” and “help”. The helper cannot define the effectiveness of help but the helpee is in a position to tell the touch and the convenience of care and help. Therefore person centred mental health care should be patient centred in that the patient should dictate what kind of care they require not the care providers. In this way the care practice would be helpful to the patient. This calls for a high level of humility and curiosity from the carer. The carers and nurses should understand and accept that they cannot fully understand their patients and therefore stop assuming what the patients need. The carers should conduct routine checks on the patient to ensure that what is happening to the patient is what really should be happening according to the patient. This would see to it that mental health care delivery is acceptable to the patient and also delivered to their best interest (Hyde, 2009).
Dealing with irrational patients with mental disorder could pose a problem in determining what is best for them. In these cases the carers decide what is best for the patient but the patient perspective care approach requires that time is taken to determine the patient’s experience. Even when the patient cannot speak, systematic observation would help the carers know how and with who the patients spend their time and what is good and bad for the patient. I recommend that the priority for patient centred mental health care should be shifted to patient perspective mental health care if efficiency and effectiveness are to be achieved in caring for mentally challenged patients. The carers should understand and promote the patient’s right of self-determination. Therefore, in designing mental care delivery framework, the patient should considered as the core player not the nurses and carers.
References
Australian Nursing & Midwifery Federation. 2017, Lean on me: The challenges and opportunities facing mental health nursing. Retrieved from: https://anmf.org.au/featured-stories/entry/lean-on-me-the-challenges-and-opportunities-facing-mental-health-nursing
Bayliss-Pratt, L. 2018, Person-centred care improving patient outcomes during Mental Health Awareness Week. Retrieved from: https://hee.nhs.uk/news-blogs-events/blogs/person-centred-care-improving-patient-outcomes-during-mental-health-awareness-week
Carey, T. A. 2012, Beyond patient-centered care: Enhancing the patient experience in mental health services through patient-perspective care. Patient Experience Journal, Vo. 3 No. 2, pp. 46-49
Featherstone B. 2006, Rethinking family support in the current policy context. Br J Soc. Work.; 36:5–19.
Gluyas, H. 2015, Patient-centred care: improving healthcare outcomes. The Nursing Standard, Vol. 30, No. 4, pp. 50-59. Doi: 10.7748/ns.30.4.50.e10186
Hyde C. 2009, Putting patients at the heart of care delivery is key to nurse leadership. Nursing Times. 105: 9
Happell B. 2008, Determining the effectiveness of mental health services from a consumer perspective: Part 2: Barriers to recovery and principles for evaluation. Int J Ment Health Nurs.; 17:123–30.
Health Professions Network Nursing and Midwifery Office. (2010), Framework for action on Interprofessional education & collaborative practice. Geneva: World Health Organization. URL:https://www.who.int/hrh/nursing_midwifery/en/[March 6, 2011].
Jubb-Shanley M. & Shanley E. 2007, Trialing of the partnership in coping system. J Psychiatr Ment. Health Nurs; 14:226–32
Rochon P. A., Normand S. L., Gomes, T., Gill, S. S., Anderson, G. M., Melo M., Sykora, K., Lipscombe, L., Bell, C. M. & Gurwitz, J. H. 2008, Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med. 168:1090–1096. Doi: 10.1001/archinte.168.10.1090
Reeves, S., Goldman, J., Gilbert, J., Tepper, J., Silver, I., Suter, E., & Zwarentein, M. 2011, A scoping review to improve conceptual clarity of Interprofessional interventions. Journal of Interprofessional Care, 25(3), 167–174.
Regnard, C., Reynolds, J., Watson, B., Matthews, D., Gibson, L. & Clarke, C.2007. Understanding distress in people with severe communication difficulties: developing and assessing the Disability Distress Assessment Tool (DisDAT). Journal Intellectual of Disability Research. Vol. 51. No. 4. Pp. 277-292.
Sommerseth, R. & Dysvik, E. 2008, Health professionals’ experiences of person-centered collaboration in mental health care. Patient Preference and Adherence, 2, 259–269.
Van de Ven, G., Draskovic, I., Adang, E. M., Donders, R. A., Post, A., Zuidema, S. U. & Vernooij-Dassen, M. J. 2012. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial. BMC Geriatrics, 12, 1. https://doi.org/10.1186/1471-2318-12-1
White P. 2008, Biopsychosocial medicine an integrated approach to understanding illness. Oxford: Oxford University Press.
Wood, V. (2009), Road to collaboration: Developing an Interprofessional competency framework. Journal of Interprofessional Care, 23(6), 621–629.
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