Understanding the philosophy behind the framework
Developed by McCormack and McCance, the person-centred framework (PCNF) and its broader counterpart, the person-centred practice framework (PCPF), emerged from studies focusing on person-centred practice, especially for older individuals. The framework is not simply a set of rules but a philosophical approach rooted in humanistic principles, asserting that every person has inherent worth and should be a partner in their own care decisions. It moves beyond merely 'doing things to' or 'for' a person, instead emphasizing 'being with' the person to foster therapeutic relationships built on mutual trust and respect.
The four domains of the person-centred practice framework
The framework is structured around four interconnected domains that influence the delivery and experience of care:
- Prerequisites: This domain focuses on the attributes of the healthcare professional. It includes a caregiver's professional competence, interpersonal skills, clarity of personal beliefs and values, commitment to their job, and self-awareness. These attributes are foundational to creating a person-centred culture.
- Care Environment: This refers to the context in which care is delivered. It encompasses the organizational systems, skill mix, staff relationships, power-sharing, and the potential for innovation. A supportive and psychologically safe environment is crucial for both staff and patients to flourish.
- Person-Centred Processes: This domain describes the activities and interactions involved in delivering care. Key processes include working with a person's beliefs and values, genuine engagement, providing a sympathetic presence, sharing decision-making, and providing holistic care. This is where the therapeutic relationship truly takes shape.
- Person-Centred Outcomes: These are the results of effective person-centred practice. Outcomes go beyond clinical metrics to include patient and staff satisfaction, engagement in care, and an overall sense of well-being. Ultimately, the goal is a 'good care experience' for everyone involved.
The shift from patient-centred to person-centred care
For decades, healthcare has focused on a patient-centred approach, which primarily centers on the patient's immediate health issues. The person-centred framework expands upon this by recognizing the individual beyond their diagnosis. This evolution is a significant shift in philosophy and practice. The table below outlines some key distinctions.
| Feature | Patient-Centred Approach | Person-Centred Approach |
|---|---|---|
| Focus | Primarily on the illness or condition | On the whole person, including their history, beliefs, and values |
| Role of Individual | Passive recipient following instructions | Active partner in their own care planning and decisions |
| Care Planning | Driven by healthcare professionals | Collaborative and co-produced with the individual |
| Success Metric | Clinical outcomes (e.g., successful surgery) | A 'good care experience,' which includes well-being and satisfaction |
| Context | Limited view, often focused on specific care episode | Holistic view, considering the individual's life context, family, and social world |
Implementing the framework in senior care settings
Adopting the person-centred framework requires a systemic shift, not just a change in isolated practices. Here is how senior care facilities can begin to embed this philosophy into their culture:
- Cultural Change: Begin at the top with leadership committed to championing person-centred values. The organizational culture must support innovation, learning, and collaboration among staff.
- Training and Development: Invest in training staff on key prerequisites, such as communication skills and understanding individual beliefs. Staff must be supported to develop the skills needed to build genuine therapeutic relationships.
- Collaborative Planning: Move away from standardized care plans. Involve seniors and their families in creating personalized plans that reflect their goals, preferences, and values. This respects their right to self-determination.
- Flexible Processes: Implement flexible care processes that allow for shared decision-making. This could involve using standardized tools like the Comprehensive Geriatric Assessment to ensure a holistic approach, while still prioritizing individual input.
- Environmental Assessment: Regularly assess and improve the care environment. A psychologically safe and supportive environment is critical for both staff and residents. This means fostering effective staff relationships and supportive systems.
Overcoming challenges in practice
Challenges can arise when implementing this framework. Professionals may believe they already practice person-centred care, even when evidence suggests otherwise. Time constraints, varying interpretations of the framework, and inflexible organizational systems can also pose barriers. Overcoming these requires sustained effort, open dialogue, and a commitment to continuous practice development. Creating a shared vision and understanding among all staff is essential for successful implementation. Organizations must provide the resources and support needed to facilitate this culture change over time.
For more research and practical tools related to this topic, the Health Foundation offers a wealth of resources on person-centred care, including guidance on implementing it in practice.
Conclusion: The lasting impact of a person-centred approach
The person-centred framework is a transformative model for senior care that places the individual at the center of all processes. By focusing on therapeutic relationships, humanistic values, and a supportive care environment, it moves beyond a focus on illness to promote genuine well-being and human flourishing for both those receiving and delivering care. Its ultimate goal is to ensure a meaningful and positive care experience, affirming the dignity and uniqueness of every individual.
