When my friend Kendra’s sister suddenly suffered a hemorrhagic stroke, she required emergency brain surgery. Karen spent 10 days intubated and sedated in the ICU—in a strange place and a frightening situation.
In her sleep and when she was awake, she appeared to pull at her breathing tube and IVs—which could jeopardize her health or even her life as much as the stroke.
To protect Karen, the nurses put her in soft restraints. This way she couldn’t tear away the life supports that were meant to help her.
But Kendra knew something the staff didn’t know.
Kendra knew that Karen has severely sensitive skin.
“As I watched my sister’s behaviors,” Kendra wrote
, “I realized she was not really pulling at her breathing tube or IVs. What she was doing was trying to scratch her skin and remove items that were causing itches.”
Each day as Karen’s condition brought progress and setbacks, setbacks and progress, Kendra persuaded staff to treat the cause of Karen’s itching with antihistamine cream, and to protect her with a one-to-one nurse rather than restraints.
By the time Karen made her way out of the ICU and into the neuro unit, she was able to shower, use her own soap, and wear her own clothes to reduce the itching.
This is person-centered care.
Recognizing the cause of Karen’s scratching is person-centered care.
Using an individualized intervention is person-centered care.
Advocating for someone you love is person-centered care.
Honoring a patient’s preferences is person-centered care.
A definition of person-centered care
Person-centered care can be defined as a philosophy of service provision where services are maximally responsive to each individual’s unique needs, values, and preferences.
Like every person, Karen was not just a patient.
Like every person, Karen is an individual.
PCC in different settings
Whether you work in a hospital, dementia care, a residential treatment facility, with people on the autism spectrum, in education, social services, outpatient behavioral health—in any capacity with people who need your help—you’re likely using person centered approaches more and more every day.
Across fields, care professionals have been moving away from an institutional, task-oriented approach and toward a more holistic approach that honors the individual in care—as well as the caregiver.
in the American Journal of Alzheimer’s Disease and Other Dementias
reached findings that we at CPI see every day through our customers who use a person-centered, strength-based approach in a wide range of fields.
The study measured the reactions that people living with dementia had to being cared for with person-centered communication.
It found that person-centered communication resulted in people with dementia:
- Cooperating with staff
- Revealing personal information about themselves (showing trust and security)
- Contributing to conversations
- Asking for clarification
- Increasing politeness toward staff
The study also revealed that with person-centered communication, staff were more likely to regard their clients in a positive light.
PCC creates a positive feedback loop among staff and clients.
Person-centered communication begets positive client behavior and responses, which begets a positive view of clients for staff, which further elicits positive client behavior and responses.
In CPI training, this is what we call the Integrated Experience. We define the Integrated Experience as the concept that the behaviors and attitudes of staff impact the behaviors and attitudes of those in their care, and vice versa.
In any field, in any part of life, how I treat you has a direct effect on how you treat me.
The evolution of person-centeredness
Tom Kitwood, who was a senior lecturer in psychology at the University of Bradford, is considered the originator of the person centered approach in dementia care. His groundbreaking 1997 work, Dementia Reconsidered: The Person Comes First
, explores the concept of personhood and remains the authority on the topic, guiding policy makers, service planners, and thought leaders on best practices in dementia care. His work is central to best practices for many fields, and informs CPI’s Dementia Capable Care
and Nonviolent Crisis Intervention®
In 2001, person-centred planning (PCP) became part of government policy in the UK as part of the Putting People First initiative in social care. The Department of Health’s white paper on Valuing People
[PDF] outlines a strategy for using person-centred care with people who have learning disabilities.
Today, as Hazel Watson
of NHS England notes, “person centred care at its best” applies to people of all ages and all abilities—especially when they’re vulnerable.
The shift toward person-centeredness is indeed continuing in many environments, from long-term care facilities to schools, EDs, and psych units. Particularly in behavioral health, the focus is shifting to a recovery-model framework that’s trauma-sensitive and trauma-informed. In dementia care, CMS recently added new final rules for long-term care facilities that include a section on Comprehensive Person-Centered Care Planning
. PCC is also making its way into hospital security
, as security staff move away from an authoritative approach and work with clinical staff to balance care and welfare with safety and security.
With PCC, a holistic view of the person in care evolves into:
- Checking assumptions
- Choosing language and vocabulary carefully
- Leveling the hierarchy within the organization
- Changing expectations and beliefs about people
- Adjusting attitudes
- Building support networks to wrap around those in care
Want some strategies to make your approach more person-centered than ever? See the expert roundup below, and try these 12 tips:
- Help the person manage their own care.
When someone needs your help, make sure they have input. Listen to their preferences. Empower them to be and feel involved with your team. Make them full partners in their own care. Put the person in the center, with all other players (family, clinicians, caregivers, teachers, administrators, therapists, etc.) comprising a customized circle of support. Show the person that their individual needs, interests, passions, likes, and dreams are always the core focus of every effort. Let them know that to the best of your ability, you will minimize what they don’t like and maximize what they do like.
- Ask the person about their preferences.
Offer choices and let the person know you aim to meet their needs. Our Life Story Questionnaire is great for this if you work with people who have dementia. And no matter where you work, our new Trauma-Informed Care Resources Guide includes a De-Escalation Preferences Form that can be a huge help to both you and the person in your care.
- Get to know the person.
- What’s their background?
- What are their interests?
- What are they good at?
- What makes them feel supported?
- What makes them feel happy?
- What makes them feel scared?
To find this out, talk to the person. Greet them by name in a friendly tone. Use supportive body language. Be calm and rational, and treat them like they’re calm and rational—even if they’re being anything but. Build their trust. Also talk to others: Ask your colleagues, other professionals, the person’s family, etc.
- Do tasks with the person.
Minimize doing things for them. Maximize their abilities. Focus on success, de-emphasize errors, and provide support where needed.
To do that . . .
- Be strength-based.
Working hand in hand with PCC is being abilities-focused and strength-based. Instead of focusing on deficits and disabilities, look for the person’s potential and recognize what they CAN do with your belief in them and your support of their abilities. Help them feel purpose, skill, accomplishment, and self-respect—and this will improve how they feel and act toward you.
- Offer comfort.
This could be a pat on the back, a hand on the shoulder, a wink, holding hands, a thumbs-up, or just being present with the person in a difficult moment.
Honor things the person likes. Sing along with them to their favorite song. And let them know when they’re doing a good job. As they achieve benchmarks—even small steps toward their ultimate goals—celebrate. People are more likely to stick with something when they feel that they’re supported and rewarded for their hard work. Be prepared for small steps backward or unanticipated barriers, but work through them and keep moving forward.
- Avoid physical intervention.
If the person you’re working with sometimes poses a physical danger to self or others, there may be times when you need to physically intervene. However, in many situations, there are ways to minimize the need for any physical intervention—and to reduce the risk of injury to you and the person. The very best way to avoid going hands-on is to avoid the need to restrain in the first place. Be aware of changes in the person’s behavior that can be warning signs of anxiety. Intervene early. Focus on proxemics and verbal de-escalation. Learn how to set limits effectively. Get training in how to assess risk. Avoid being drawn into power struggles. Choose the least-restrictive option possible in every situation.
Here are some tools to help:
Be sure to debrief after any crisis. This will help you find patterns and triggers—and prevent the situation from reoccurring. It will also help you help the person foster resilience and develop effective coping skills.
- Join hands.
A person-centered, strength-based approach is about self-determination, treating people with respect and dignity, and working together to enhance the person’s quality of life. Throughout your organization, collaborate as a team to adopt a consistent approach. Work to gain buy-in, not only from all staff departments and all organizational leaders, but from clients and their families as well. This allows everyone to take an active role in promoting their own personal safety, thereby enhancing the safety of others.
- Start immediately.
In many environments, you can get your person centered approach off the ground before the person even comes into your care: During the discovery process, prior to admission, during intake, etc. Being person-centered at every step of a person’s journey furthers their inclusion and engagement in their education, care, treatment, recovery, family, community, peer groups, growth, etc.
- Lead the way.
Model these strategies for your colleagues. Help staff shift from a deficit-based mindset to a strength-based mindset. Show them the results you achieve when you focus on a person’s abilities. Teach them how instead of looking at a person as “damaged,” they can view the person as a survivor.
What person-centeredness means to the professionals who use it
Below you’ll find insight into how pros like you use person centered approaches in their work.
As you browse, think about:
- What does “person-centered” mean to you?
- What does “strength-based” mean to you?
- What do these approaches mean to each person in your care?
- How do you practice these values in your day-to-day work?
And share your thoughts, expertise, struggles, and success in the comments. We want to hear how you honor every person as a person!