- Discuss how using a model of individualised personcentred nursing can enhance care for older people

- How can this raise awareness of the importance of

respect for the individual and the recognition that
older people can be equal partners in their care.
- Apply principles of person-=centred care in the
clinical practice
According to NIA (2007), the older adult body, those being of aged 65 years and
over, constitute 7% of the worlds population. By 2025, it has been estimated
that one third of Europes population will be aged 60 or over (World Health
Organization, 2002). This significant demographic change of increased proportion
of older people in society, however, calls for more than an increase in demand
for health and aged care services but, rather, emphasis on person-centered,
holistic, and humane care should be recognized and maintained to better patient
encounters and health outcomes (Pacala, 2014). The approach to personcentered care from patient-centered care, for instance, reflects a change in the
attitude towards the way health and aged care services are delivered (Nay and
Garratt, 2009).
In the past, the service system used by older people was comprised of acute
hospital care or long-term residential care for those who could not return home.
More recently, management of chronic disease in primary and community
settings have focused on the prevention of such services. Evidence has shown
that emphasis on palliative care and more intensive home-based care and
support result in better health outcomes (Starfield et al., 2005). More detailed
research has demonstrated that integrated primary and community care
significantly improves the prevention and management of chronic and complex
disease while at the same time reducing the overall costs of managing these
conditions (Wagner et al., 2001). Therefore, it is unsurprising that many longterm care facilities are making the transition from an institutional medical model
to a person-centered care model (Jones, 2011).
The concept of person-centeredness has become established in approaches to
the delivery of healthcare and particularly within nursing. In the United Kingdom,
person-centeredness is embedded in many policy initiatives
It is interesting to note, however, that while the term person-centeredness is
used freely within health and social settings, some argue that the use of this
term is an example of tokenism by those using it, because they use it without
any real sense of what the term actually means. While several analyses have
been conducted in an attempt to define core attributes of person-centeredness
(Dewing, 2008; Leplege et al., 2007; Slater, 2006), the early definition provided
by Kitwood (1997) or variations of it, continue to be widely used. Kitwood defined
person-centeredness as a standing or status that is bestowed upon one
human being by others, in the context of relationship and social being. It implies
recognition, respect and trust. Utilising the definition provided by Kitwood as a
basis in a three year quasi-experimental research and development project to
implement person-centred nursing in an acute hospital setting, McCormack and
McCance developed the person-centred nursing theoretical framework

(McCormack and McCance, 2006 and 2010) and this has been further developed
through a range of research studies into the Person-centred Practice Framework
(McCormack & McCance, in press). The framework has been tested through a
range of research projects internationally and the findings confirm its content
rationality, flexibility and usability in practice.
McCormacks findings lead him and his colleagues to argue that there are four
core concepts at the heart of person-centred nursing: being in relation, being in a
social world, being in place, and being with self. Being in relation emphasises the
importance of relationships and the interpersonal processes that enable the
development of relationships that have therapeutic benefit. Being in a social
world considers persons to be interconnected with their social world, creating
and recreating meaning through their being in the world. Closely linked to being
in a social world is being with self, which emphasises the importance of persons
knowing self and the values they hold about their life and how they make sense
of what is happening to them. Being in place encourages us to pay attention to
place recognising the impact of the milieu of care on the care experience. The
nursing literature is consistent in the view that being person-centred requires the
formation of particular relationships (often described as therapeutic) between
professionals, patients, and others significant to them in their lives, and that
these relationships are built on mutual trust, understanding, and a sharing of
collective knowledge (Binnie & Titchen, 1999; Dewing, 2004; McCormack, 2004;
Nolan et al., 2004).
Evidence shows that minimal disability in performing functional tasks such as
activities of daily living (ADL; i.e. tasks that involve caring for or moving the
body, such as walking) or instrumental ADL (i.e. tasks that support an
independent lifestyle, such as using the telephone or shopping) and normal
cognitive status are integral to healthy and successful aging as well (Cosco et al.,
2014). Life satisfaction experienced by the oldest older adults is poorest among
those with depressive symptoms, low self-rated health, and poor perceived
quality or social networks (Berg et al., 2006). However, the oldest older adults
still want to engage with life and people. (Nolan 2012). It is through personcentered care that these issues can be challenged, and the oldest older adults
can continue to thrive and enjoy an improved quality of life. Even simply the
ability to communicate, to be understood, and to understand others is an
important driver of social interactions and enjoyment of life and is at heart of
person-centered care. (Levinson et al., 2010).

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