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Practice comment

'My personal journey changes constantly, so how can I expect my patients' to remain consistent?'

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There are well-developed person-centred tools in all fields of nursing, but a tool is only a tool and can only be as good as the person using it

As a lecturer, I have been working with pre-registration learning disability (LD) students to explore the use of person-centred tools to support us in better understanding both who we are and who the people we support are.

If care is to be person centred, people with learning disabilities need to have the main influence on their assessments. However –as in all fields of nursing – the imbalance of power between nurse and patient can affect interactions with all people who are accessing support. Person-centred tools might help us to overcome this, but humanistic, enabling, person-centred care demands complex skills from the health professionals who touch people’s lives.

One of the person-centred tools used with people who have a LD is the “one-page profile”. This helps them to explore in collaboration with health professionals:

  • Who they are;
  • What is important to them personally;
  • What they like and don’t like;
  • How best they can be supported.

This is a great start but, as stated above, the tool is only as good as the person using it. In addition, the title even suggests it is possible to capture an entire person on just one page. Yet human beings are complex and inconsistent.

When I think about myself and my life, I am aware that I celebrate difference, new experiences and time with loved ones.  My personal journey changes constantly and this is largely as a result of my own choices and influences. All of this and more will shape my “set of encyclopaedias”, my footprint in the sand of life. What might be on my page today might not be on my page tomorrow, so how can I expect my patients to remain consistent day after day?

I have worked with managers who take pride in having a full set of one-page profiles for everyone on their caseload. However, this a futile and even harmful paper exercise if the profiles do not represent the individual.  How can we be sure that this paperwork fulfils an individual’s personal aspirations and their spiritual needs? It is important to ask how much this tool enables and how much is simply interference.

Recently, there has been a great deal of discussion on why people’s basic needs are not being met. Perhaps we should be considering if this relates to increasing amounts of paperwork distracting professionals from offering a person-centred approach. The exercises I use with students aim to inspire them throughout their educational journey to ensure the person is central at all times and that they inspire this approach in others.

Jo Marshall is a senior lecturer at Faculty of Health and Wellbeing at the University Of Cumbria.

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