Tuesday, May 5, 2020

An Essay Analysing and Evaluating the Applicability of Person Centred Planning Within a Hospital Setting free essay sample

I will maintain confidentiality at all times using pseudonyms. Working within the nursing and midwifery code of conduct. (2008) In the1950’s psychologist Carl Rogers was the first person to use the term ‘person centred’ He pioneered the concept of personhood believing ‘The organism has one basic tendency and striving to actualize, maintain and enhance the experiencing organism’ (Rogers, 1951 p. 401) He believed that individuals are† experts of themselves and given the right conditions and environment are able to flourish†. He named three important values as key in achieving self-actualization. Empathy, congruence and unconditional positive regard’ (Rogers, 1951) The 1960’s was a time of great change socially, the civil rights movement was growing alongside the awareness of the rights and needs of individuals ‘social care was identified and defined in the late 1960’s with the formation of social services’ ( Thompson et al 2008) In 1969 the report into the conditions at the Ely hospital (HMSO 1969) opened the eyes of many to the appalling conditions and serious lack of care in all institutions, hospitals, prisons and care homes alike. A flurry of policy reviews were to follow including ‘Better services for the mentally handicapped’ (Department of health 1971). The paper focused on the rights of individuals to be a part their community and treated as individual citizens as opposed to being labelled by their condition or illness . The coming decades saw the end of asylums and institutes. The ideology of Carl Rogers ‘Person centred care’ was drawn upon in a more conceptual manner by Thomas Kittwood he defined personhood as ‘a standing or a status that is bestowed on one human being, by another in the context of relationship and ocial being’ (Kittwood, 1997: p8) Policies and theories continued to develop, eventually leading to the use of the person centred planning tools in use today. ‘A person centred approach to planning should start with the individual (not the service) and take into account their wishes and aspirations. Person centred planning is a mechanism for reflect ing the preferences of a person†¦.. ’ (Valuing people (2001p. 9) Used correctly PCP is ‘A way to empower a person and give them a choice ‘(Thompson, Kilbane, Sanderson, 2008) PCP requires commitment from both the patient and the health care provider empowering the patient to make their own choices and sharing the power over decisions they may make that influence their lives not exclusively their healthcare. The tools require active listening and responsive action when required from both sides. Once initially completed the tools should allow for change and development as and when needed, for the tools to work to their full potential the health care provider should be able to facilitate this accordingly. Improving patient centeredness is one of the six aims of the Institute of medicines (IOM) Health care quality initiative according to which health care should be safe, effective, patient centred, timely, efficient, and equitable. It is often helpful for the families of patients to be involved in the plans; this is applicable to all patients’ not just children or adults with learning difficulties. It helps the patient and the people they love to gain some control and a sense of responsibility back in their life. Being in hospital can very quickly have a detrimental effect on a patient’s mental state. The lack of choice in hospital has a negative effect, Often there are set times for meals, getting out of bed, you must wear a name band, and you can’t leave the ward†¦.. The list of ‘rules’ is endless. Patients very quickly become automatons. As Tillich puts it ‘The manipulation of conditional reflexes by social and psychological engineering reduces the man to the status of an object rather than a subject’ Tillich (1961) when the PCP tools are most effective and some sense of personal control of life is restored the overall wellbeing of the individual is greatly improved. †¦Ã¢â‚¬ ¦by less dependence on others, an increase in expressiveness as a person, an increase in variability flexibility and effectiveness of adaption, an increase in self-responsibility and self-direction†¦Ã¢â‚¬ ¦Ã¢â‚¬â„¢ (Rogers 1961) The importance of a person feeling whole, in control and valued has a positive effect not only for mental wellbeing but it is increas ingly understood on the physical self as well. Carl Rogers stated that ‘we are learning we can often heal or alleviate much of our disease through the intentional use of our conscious and unconscious minds. Holistic health is broadening our understanding of the inner capacities of a person’ (Carl Rogers 1995). The ‘holistic’ approach to health care embodies the theories behind Person centred care. Taking in all aspects that contribute to the patient’s life and using them to focus on the patient who is central to it all. I don’t wish to pretend that in gaining a positive mind-set illness and disease can be cured but a positive mind-set always has a beneficial effect on a person and PCP tools have been shown to result in that significant positive change. The PCP tools I am going to evaluate in this essay are. The one page profile, MAPs PLANs and The children’s passport. I choose to consider the children’s passport as it is a PCP tool new to the hospital that I am based and as of yet the only tool used in my specific area of work, a paediatric day surgery ward. It is much like the one page profile, I choose to evaluate this tool because of its simplicity compared to the other two that I will evaluate, MAPs and PLANs both of which are widely used and were the first tools implemented for the purpose of person centred planning. PCP developed from ‘The community of practise’ different communities were leading the way in advocacy and support for the disabled and communities of people that previously didn’t have a voice. Beth Mount worked on ‘circles of support’, a way of organizing a person’s allies around shared concerns, focused Personal futures planning on organising and extending a person’s social supports’ (Mount 1998) This led the way for MAPs originally developed out of concern about the children of a local school with profound disabilities having their needs, hopes and dreams overlooked and even dismissed as so often happens. It helped disabled children integrate into mainstream schools. MAPs is now used for varying groups of people including children without disabilities as a way to focus their minds on what is already around them and what they wish for the future. MAPs require commitment from both the user and provider and often involve close family and friends, as with PATHs these tools can be used throughout life. Needs, dreams, fears and anything else relevant in the clients life documented discussed and actualised at different intervals. The initial time spent on MAPs needs to be several hours, ideally two people would facilitate, one to guide the client and the other to document it both words and pictures are used. Typically it will be large and visual. There are eight steps. They methodically through discussion identify what the MAP is, the clients history, allowing discussion about milestones and events that have had an effect on the clients life. Next dreams and nightmares are discussed and documented; this will enable the client to focus on moving toward the dream and away from the nightmares. The next step gives the client affirmation of who they are by giving everyone a chance to offer words describing them. Followed by focussing on gifts and qualities, this then leads to what is required to achieve the clients dreams and finally an action plan is put into place. When it is possible to use MAP the effects can be life changing for individuals on many levels most importantly giving the client better self-esteem and with the commitment and guidance required of MAP will be able to achieve things they had previously not thought possible, in 2005 the DOH published a paper asking â€Å"does person-centred planning work? it noted that ‘†¦.. very little change was apparent in people’s lives prior to person-centred planning. After person-centred planning significant positive changes were found in the areas of social networks; contact with friends and family; community based activities; levels of choice†¦. ’ (DOH 2005) It was also later noted that bes ides the beneficial effect ‘†¦. it was achieved at no extra cost to councils other than the initial investment in training and support’ (DOH 2010) The problems however are many and for PCP tools to truly enable clients to reach their full potential then ‘†¦.. ultural change in the ways that services are comprised and  delivered†¦Ã¢â‚¬ ¦Ã¢â‚¬â„¢ (O`Brien amp; O`Brien 2000) People who are to facilitate MAPs require training; the usual constraints of cost and time are cited as reasons to not implement PCP. It also on a personal level requires the client to feel totally at ease with the facilitator thus able to share private thoughts. It is also difficult for a long term commitment to be made when outside of the PCP bubble real life isn’t always so accommodating, people change jobs, move become ill etc. The facilitator must lso have certain personal qualities to get the best from the client. They need to be good at listening, non-judgmental hav e leadership skills that enable the group to focus and move on when required, they should have empathy and be able to encourage to the group to cry when sad and celebrate achievements. They need to be flexible, committed have a sense of humour and confidence in themselves. PATHs is an adapted version of MAPs it too is visual and requires time in the first instance. It differs however in that it is more focussed the â€Å"path† to the end goal. Giving time constraints and at intervals in that set time the client is encouraged to examine how far they have got towards the goal and what needs to change if suitable development isn’t being made. It looks at barriers and how to remove them and what is required to remain strong and focused. The positives and negatives of a PATH are as with MAP above. The main negative that I feel differs slightly from MAP is with it being so focussed on the end goal not being able to achieve in the time set could set the client back and have a negative impact. A one-page profile typically has three sections: an appreciation about the person; what is important to that person from their perspective; and how to support them well. (Helensandersonassociates. co. uk) It can be used in a variety of ways sometimes it can be the first step in using more in depth PCP tools. It is a helpful tool in ways but by no means does it have the impact of either PATH or MAP. The tool used in my workplace it is called the child’s passport and is available online for parents to fill in, it’s then printed out and put into the front of the child’s notes. It works on a traffic light system red being essential information such as allergies, communication needs, medical history equipment needs and any other essential needs the parent/carer may wish to highlight. Amber looks at day to day activities, dietary requirements, how they express themselves i. e. British sign language, makaton or using special signs exclusive to them. The last section is green and is to acknowledge things the child likes, favourite toys, dvd’s etc. It also has a section for parents to give advice on ways to help calm the child f distressed. I work on a day surgery ward so it isn’t practical to implement any tool during the child’s short stay. I have however found the child’s passport useful when admitting patients who already have one. I don’t consider the child’s passport to be strictly person centred, it doesn’t give any insight into the child’s hopes or dreams or plan for the future. I am certain that on wards where children are acutely ill both MAPs and PATH tools would be extremely helpful. Children like adults can all too often feel defined by their illness or disability and person centred planning would be a positive way for them to feel valued, and to be seen for who they are first rather than their condition. In conclusion, for person centred planning to become a reality society as a whole has to change. It is possible that given time PCP will become fully integrated within society. It was after all only decades since the reforms that led to the closing of institutions and the dire care that was associated with them. Time needs to be given to any person that could benefit from PCP this in turn will ultimately benefit wider society. Word count 2,207 References Department of Health ( 2007) Valuing People Now. The stationary office London Department of Health ( 2010) Putting people first:Support planning and brokerage with older people and people with mental health difficulties. The stationary office London Department of health (1971). Better services for the mentally handicapped The Stationary Office, London Department of Health (2005) The Story so far†¦ Valuing People: A new strategy for learning disability for the 21st Century. The Stationary Office, London Department of Health (2007) Valuing people and research:The learning Disibility Research Initiative-overview report Institute of medicine Nursing amp; Midwifery Council (2004) The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics, London: Nursing amp; Midwifery Council. O’Brien and O’Brien (2000) Report on Ely Hospital Report of the Committee of Inquiry into Allegations of Ill – Treatment of Patients and other irregularities at the Ely Hospital, Cardiff . Presented to Parliament by the Secretary of State of the Department of Health and Social Security by Command of Her Majesty March 1969 Rogers, Carl. (1961). On Becoming a Person: A Therapists View of Psychotherapy. P 401London: Constable. Rogers, Carl. (1980). A Way of Being. Boston: Houghton Mifflin. Thompson J. Kilbane J. Sanderson H. (2008) Person Centred Practice for Professionals. Open University Press P. 72 Tom Kitwood (1997) Dementia Reconsidered: the Person Comes First P. 8 Tom Tillich (1961) cited in Understanding psychotherapy:fifty years of theory and practise C H Patterson (2000)

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