person centredness, relationships

32
Person-centredness, relationships and meaning making Dr Trevor Adams University of Surrey

Upload: trevor-adams

Post on 07-Dec-2014

396 views

Category:

Health & Medicine


0 download

DESCRIPTION

dementia relationships

TRANSCRIPT

Page 1: Person centredness, relationships

Person-centredness, relationships and meaning making

Dr Trevor AdamsUniversity of Surrey

Page 2: Person centredness, relationships

‘After six months in certain hospitals, there areways in which psychiatric nurses are no longerlike ordinary people. Their attitude to mentalillness changes - as it does to old age, to cruelty, to people’s needs, and to dying. It is as if they become numbed to these things.’

(Sans Everything 1967)

Page 3: Person centredness, relationships

Diagnosed

Page 4: Person centredness, relationships

Diagnosed

Marginalised

Page 5: Person centredness, relationships

Diagnosed

Marginalised

Institutionalised

Page 6: Person centredness, relationships

Person-centred care

Page 8: Person centredness, relationships

Person-centred care

Person with DEMENTIA

Page 9: Person centredness, relationships

Person-centred care

Person with DEMENTIA

PERSON with dementia

Page 10: Person centredness, relationships

Person-centred care

Person with DEMENTIA

PERSON with dementia

Page 11: Person centredness, relationships

Dementia =

[biomedical factors]

+

[social/psychological factors]

Page 12: Person centredness, relationships

Dementia =

Physical Health +

Neurological Impairment +

Personality +

Biography +

Social Psychology

Page 13: Person centredness, relationships

“Personhood” is the central idea in person-centred care.

Page 14: Person centredness, relationships

“a standing or a status that is bestowed on

one human being, by another in the context of relationship and social being”

‘Dementia Reconsidered’ Tom Kitwood

Page 15: Person centredness, relationships

malignant social psychologies

• Disempowerment• Imposition• Disruption• Objectification• Stigmatisation• Ignoring• Banishment• Mockery

• Withholding• Outpacing• Infantilisation• Labelling• Disparagement• Accusation• Treachery• Invalidation

Page 16: Person centredness, relationships

positive person work

• Warmth• Holding• Relaxed pace• Respect• Acceptance• Facilitation• Collaboration• Recognition

• Celebration• Acknowledgement• Genuineness• Validation• Empowerment• Enabling• Including• Belonging

Page 18: Person centredness, relationships

problems with person-centred care

does not fully represent:

family carers and dementia care workers

Page 19: Person centredness, relationships

problems with person-centred care

does not fully represent:

family carers and dementia care workers

the embodied and bodily nature of dementia

Page 20: Person centredness, relationships

problems with person-centred care

does not fully represent :

family carers and dementia care workers

the embodied and bodily nature of dementia

the two-way nature of communication in dementia care

Page 21: Person centredness, relationships

Relationship centred care

Recognition that there is often three people oragencies involved in the provision of dementia care: the person with dementia, their family carer(s) and their paid-for carer(s) – the dementia care triad.

Sensitivity to how communication between each participant constructs personal experience, identity and meaning to each member of the dementia care triad.

Page 22: Person centredness, relationships

the senses framework – mike nolan and colleagues

• A sense of purpose - opportunities to engage in purposeful activities or to have a clear set of goals to aspire to;

• A sense of fulfilment - achieving meaningful or valued goals and feeling satisfied with one’s efforts;

• A sense of significance - to feel that you matter, and that you are valued as a person

Page 23: Person centredness, relationships

the senses framework – mike nolan and colleagues

• A sense of security - of feeling safe and receiving or delivering competent and sensitive care;

• A sense of continuity - the recognition of biography, using the past to contextualise the present;

• A sense of belonging - opportunities to form meaningful relationships or feel part of a team.

Page 24: Person centredness, relationships

Humanistic: putting humanity and the interests of the person first

‘Dementia Reconsidered: the person comes first’

Page 25: Person centredness, relationships

Humanistic: putting humanity and the interests of the person first

Existentialist: highlighting questions of existence rather than essence and the personal struggle to gain a meaning to one’s life

Page 26: Person centredness, relationships

Humanistic: putting humanity and the interests of the person first

Existentialist: highlighting questions of existence rather than essence and the personal struggle to gain a meaning to one’s life

‘In day to day interplay with persons with dementia it is inescapable to address existential struggles and innate Issues.’ Holly Queen-Daugherty 2002

Page 27: Person centredness, relationships

Humanistic: putting humanity and the interests of the person first

Existentialist: highlighting questions of existence rather than essence and the personal struggle to gain a meaning to one’s life Christian: people are created in the image of God, imago Dei and are relational and thus there is a deep vein of co-creativity in people through which they relate

to others and identity is displayed and gained

Page 28: Person centredness, relationships

Recently various people at Bournemouth University

have identified various areas in which health care provision needs to be ‘humanized’.

Todres, L. Galvin, K. and Holloway, I. 2009 The humanization of healthcare: A value framework

for International Journal of Qualitative Studies on Health and Well-being. 1-10,

Page 29: Person centredness, relationships

insiderness living in a personal world that carries a sense of how things are perceived

agency experience yourself as making choices and being generally held accountable for one’s actions

uniqueness actualizing a self that is unique which can never be reduced to a list of general characteristics

togetherness in community

Page 30: Person centredness, relationships

sense-making care for the ???, of things, events and experiences for personal life

personal journey on a journey

sense of place Come from a particular place where the feeling of at-homeness becomes reality

embodiment live within the fragile limits of human embodiment

Page 31: Person centredness, relationships

creativity helps people with dementia affirm their selfhood

Page 32: Person centredness, relationships

creativity helps people with dementia makesense what is happening to them