Person-Centred Practice

Introduction

This page explores the broad topic of person-centred approaches in health and social care.

After looking at what person-centred values are and how they can be embedded in our day-to-day work, we will examine the role of care plans and risk assessments in facilitating person-centred care, the importance of consent, active participation, the individual’s right to make their own decisions, promoting wellbeing and minimising pain, discomfort and distress.

What are person-centred values?

Person-centred values are a set of fundamental beliefs that underpin the way that all health and care staff work to ensure that each patient or care recipient is recognised as a unique individual. Below is a list of person-centred values:

  • Individuality: Each person is respected as a unique individual
  • Independence: Care workers empower individuals to maintain as much independence as possible
  • Privacy: The privacy of all individuals is respected by health and care workers. This includes confidentiality of their personal information as well as their right to time alone, without disturbance, if that is their wish
  • Partnership: Recognition that care is a collaborative process between individuals, their family, care workers and other health and social care professionals and it is essential that they are able to work in partnership with one another
  • Choice: Respecting each individual’s right to make their own choices in life and empowering them to do so
  • Dignity: Promoting and protecting an individual’s dignity if they are unable to do so themselves
  • Respect: Respecting each individual as a unique person
  • Rights: Promoting and protecting an individual’s rights and empowering individuals to understand their own rights

Why it is important to work in a way that promotes person-centred values

Working in a way that embeds person-centred values can have a positive effect on an individual’s confidence, self-esteem and overall wellbeing. This is because it values each individual’s unique needs, wishes and preferences, promotes independence, and empowers individuals to stand up for their rights and make their own choices.

In addition, person-centred approaches are enshrined in UK legislation and regulation (e.g. see the Care Act 2014, CQC regulations etc.) and not working in line with these principles can be considered poor practice, and in the worst cases, abuse.

How to work in a way that promotes person-centred values

Person-centred values should underpin all health and social care activities and can be used as guiding principles to help us make decisions and assess and improve our practice.

The table below shows how each of the person-centred values listed above may be incorporated into daily practice.

Person-centred valuePractice
IndividualityCare workers respect an individual’s right to choose their own hairstyle, even if they do not like it themselves.
IndependenceCare workers support individuals to learn and develop new skills so that they are less reliant on others
PrivacyCare workers do not discuss any individual’s personal information in areas where they may be overheard
PartnershipCare workers encourage individuals to be actively involved in their care plan reviews
ChoiceCare workers support individuals to make informed choices, without influencing them with their own personal beliefs
DignityCare workers ensure that doors or screens are closed before carrying out personal care tasks
RespectCare workers are polite and courteous to all individuals receiving care
RightsCare workers support individuals to challenge decisions that are made about them that they do not agree with
Person-centred practice examples

Collation and analysis of feedback

To ensure the quality of the service, which includes checking that practitioners are working in a person-centred way, it is necessary for care organisations to regularly request, collect and analyse feedback from those that have direct experience of it. As well as the individuals that are receiving care, this can also include their families, care staff and other health and social care professionals.

As well as providing an element of self-regulation, effective feedback processes can ensure that service provision is continuously improved over time.

The activities of care workers in relation to the collation and analysis will depend upon their particular role and responsibilities, but may include:

How care plans relate to person-centred care

Each individual that receives care services will have their own individual care plan that describes their unique needs, wishes and preferences and how care staff can support them effectively. Because each care plan is unique to an individual, they are in line with the person-centred value of individuality.

In addition, care plans should be developed and agreed to in collaboration with the individual and other stakeholders, which demonstrates both partnership and choice. Care activities will be agreed upon to ensure that the individual has as much independence as possible and that their privacy and dignity are respected and their rights are upheld.

Find out an individual’s history, needs, wishes and preferences

To develop a care plan as part of a person-centred approach, it will be necessary to establish each individual’s history, needs, wishes and preferences.

  • History: By knowing an individual’s history, you can understand how their experiences have shaped the person that they have become, which can make it easier to empathise with them and provide services that meet their needs
  • Needs: Individuals receiving care services have particular needs that the social care system has the responsibility to meet – these will vary between individuals
  • Wishes: An individual’s wishes are their ambitions and aspirations
  • Preferences: By knowing an individual’s preferences, care can be delivered in a way that promotes their overall wellbeing. Individuals can have the same needs but different preferences (e.g. two individuals require assistance with shaving but one likes to be clean-shaven and the other prefers to maintain a moustache)

One of the best ways to find out an individual’s history, needs, wishes and preferences is to spend time chatting with them and taking a genuine interest in them as a unique person. This will also help to build bonds of mutual trust and respect between one another and help the individual to feel valued.

You may also find out information about an individual from others. This can include more experienced care workers that have worked with the individual for a long period of time. In addition, the individual’s family can often provide insights about an individual.

And, of course, the individual’s care plan will contain a lot of information about them. Before working with an individual, you should read and understand their care plan so that you know what care and support tasks should be provided and how they should be carried out.

Risk assessment

Risk assessment is a process that is used to identify the potential risks of an action or decision and find ways to minimise their impact. In a health and social care setting, there are a few different ways that they may be used:

  • Environmental risk assessments – used to identify and reduce environmental risks (e.g. trip hazards, fire risks, security risks etc.)
  • Individual risks assessments (e.g. risk of individual self-harming, individual’s level of road safety awareness etc.)
  • Risk assessments to help inform decisions (e.g. minimising the risk of an individual with dementia going out into the community alone, the risks and benefits of having life-changing surgery etc.)

The primary purpose of the risk assessment process is to minimise or eliminate risk, however, it can also be used to support individuals to make informed decisions about their life. By going through the risk assessment process, both the risks and rewards of a particular decision can be examined objectively, providing individuals with the knowledge that they need to weigh up the pros and cons and make an informed choice.

How to address the changing needs of an individual

It is important to recognise that an individual’s care plan is a working document and will need to be revised and updated over time as their needs wishes and preferences change.

Type of changeCauses
NeedsAn elderly individual may require more care and support as their health deteriorates. In contrast, a young individual with a learning disability may require less care and support as they learn new independent living skills.
WishesAn individual may have aspired to get a qualification from the local college but when they have achieved this, they may refocus on trying to get a job.
PreferencesAn individual may have previously preferred to have a takeaway once a week, but have now decided they would like a healthier meal plan instead.
Examples of changing needs, wishes and preferences

As care workers, it is important that we are observant of the changing needs of the individuals we care for so that we are able to plan and respond appropriately. This can include an individual’s physical and mental health – for example, if we notice that an individual is bumping into furniture a lot it could indicate a deterioration of their eyesight or if they are spending a lot of time on their own and becoming isolated, it may be an indication of depression. Although we are not qualified to diagnose such conditions, we can respond to these concerns by addressing the issue with the individual, their family or our manager and recommend a referral to a health specialist that may be able to make a diagnosis.

Similarly, we should observe and respond to changes in an individual’s emotional and spiritual wellbeing. For example, if an individual appears to be withdrawn, it could indicate that there is something bothering them and we may wish to encourage them to open up and talk about the issue.

In line with the person-centred values of respect, dignity and choice, we must always obtain consent before carrying out treatment or care activities on individuals that are receiving care services.

The process of obtaining consent involves explaining what you want to do and getting the individual’s authorisation to continue. Consent can be both explicit and implicit. An example of explicit consent would be if you asked an individual if they were ready for a spoonful of food and they replied “yes”. In the same situation, implicit consent would be if you moved the spoon towards their lips and they opened their mouth as an indication that they want more food.

For the majority of day-to-day tasks, verbal or gestural consent is sufficient. Written consent would be required for more serious situations, such as making a large purchase or undergoing surgery. In these cases, it is also good practice to ensure that the individual has been provided with sufficient information to make an informed choice and has had adequate time to process the information and weigh up the risks and benefits.

There will be times when care tasks cannot be completed because an individual does not or is unable to give their consent.

If an individual refuses to give their consent, it is important to respect their choice. You may tell them that you will come back a little later to see if they have changed their mind or ask a co-worker if they would mind trying. If consent can still not be established, a record should be made and it should be reported to a supervisor or manager.

There may be some cases where an individual is unable to provide their consent but it is not needed – for example, if an individual is unconscious and requires first aid, you would go ahead with it without the requirement of consent.

Some individuals may not be able to give their consent because they do not have the mental capacity to understand the implications. This may require the individual to be assessed for mental capacity and a best interest decision made on their behalf. It is important to understand that the Mental Capacity Act Code of Practice is clear that all individuals should be given reasonable support to make their own decisions before a decision is made on their behalf.

Active participation

Active participation is an approach that promotes individuals being actively involved in all aspects of their lives, including their receipt of care, rather than a passive recipient.

For example, when applying a medicinal cream to an individual’s foot, they may participate by raising their foot onto a stool and holding the tube of cream whilst the carer rubs it onto their skin. Another example would be encouraging an individual to provide feedback during a care plan review meeting.

Active participation supports several person-centred values including independence, choice and partnership. It has the benefits of making the individual feel valued and respected, which can have a positive impact on their self-esteem. In turn, this can have a positive effect on their overall well-being.

It is important to collaborate with an individual about how active participation should be implemented. Identifying what an individual is able to do for themselves and the areas where they require support will factor into any agreements that are made about how care is provided. The individual’s personal preferences should also be considered – for example, do they have a preference in relation to the gender of the carers performing personal care tasks.

Barriers to active participation

There may sometimes be barriers that must be overcome to ensure the effective implementation of active participation. Some of these are highlighted in the table below.

BarrierHow it may be overcome
Indifference by the individualThe individual should be encouraged to participate and the benefits explained to them
Poor staff trainingStaff should be retrained in the importance of active participation
Environmental (e.g. a visually impaired individual not feeling safe in their environment)Adaptations should be made to make the individual feel safer
Barriers to active participation and how they may be overcome

Supporting an individual’s right to choice

As we discussed earlier, it is important that individuals receiving care services do not have the right to make their own decisions taken away. Care staff should actively encourage individuals to make their own choices because of the positive effect it can have on their general well-being as well as ensuring that they maintain control over their lives.

Care staff can support individuals to make informed choices by providing them with sufficient information to weigh up the options and ensuring that they have enough time to make their minds up – we have seen above how the risk assessment process can help with this. Where specialist information is required, care staff can help individuals to obtain it, however, it is important that care staff do not influence the individual with their own personal views and opinions.

Care staff can also help to promote an individual’s rights by supporting them to challenge or question decisions that are made about them that may not agree with. This can be carried out by educating them about their rights or raising questions on their behalf. It could also involve helping the individual to appoint an independent advocate on their behalf.

Promoting wellbeing

Historically, health and care services have focused solely on the issues relating to an individual’s health and care needs. In response to growing research, the 21st century has seen a shift to a holistic approach to health and social care that encompasses an individual’s whole wellbeing. Poor physical health can lead to a deterioration of mental health, which can also affect social relationships and emotional wellbeing. It is now recognised that all these aspects of wellbeing are interlinked, leading to a holistic approach.

Factors that can contribute to wellbeing include:

  • Physical health
  • Mental health
  • Emotional wellbeing
  • Social relationships
  • Spiritual wellbeing
  • Economic wellbeing
  • Accommodation
  • Having a purpose
  • Autonomy
  • Feeling valued
  • Contributing to the community

Physical health can be affected by what we eat and drink as well as the exercise that we get. Environmental factors, such as our housing, can also contribute to our well-being. For example, living in a clean and tidy home with adequate noise levels can help us to feel content. If our accommodation is dirty and cluttered and the neighbours play loud music 24 hours a day, it can harm our physical and mental health.

As care workers, it is important that our attitudes and behaviours facilitate the promotion of the well-being of the individuals that we care for. We can do this by helping them make healthy choices in their diet, ensuring they always have access to fresh water, facilitating social events and helping them maintain their relationships, providing emotional support when required, and helping them achieve their ambitions. Of course, this is by no means a comprehensive list!

The inter-relationship between identity, self-image, self-esteem and well-being

Our identity is essentially who we are and what makes us different from other people and our self-image is how we see and feel about ourselves. Whilst our identity is fixed (although it does evolve over time) our self-image about our identity can be either positive or negative. For example, if we are shy, we can treat this as a positive because it helps us to make informed decisions about who we interact with, however, we may also see it as weakness because find it difficult to make new friends.

Our self-esteem is the level of regard that we have for ourselves or how much we value ourselves. A poor self-image can lead to a low level of self-esteem and, conversely, a positive self-image can lead to high self-esteem.

Low self-esteem can result in emotional distress, poor social relationships and a deterioration of mental health, which can have a negative effect on our overall well-being. On the flip side, high self-esteem means that we are more likely to feel good about other aspects of our lives and can have a positive effect on our overall well-being.

Minimising pain, discomfort & distress

Some of the individuals that we work with may be experiencing pain, discomfort and distress and may be unable to take action to reduce these feelings themselves. As care workers, we should be observant and responsive to the wellbeing of the individuals that we care for and try to minimise pain, discomfort and distress as much as we can.

The table below lists several causes of pain, comfort and distress and how they may be minimised.

CauseRemedy
Individual is uncomfortable and has restricted mobility so is unable to move themselvesSupport the individual to reposition themselves
Light is too brightDim or turn off lighting, close curtains
Exterior noise levels are loudClose window
Temperature is too coldTurn up heating or provide an extra blanket
Temperature is too hotTurn down heating or remove a blanket
Prosthetics are rubbingAdjust prosthetic, apply cream
Experiencing high levels of painAdminister prescribed pain relief (if trained to do so)
Bed is wet/soiled, unpleasant odoursSupport individual to wash, change clothes and replace bedding
Examples of causes and remedies for pain, discomfort and distress

Some individuals may not be able to communicate their pain, discomfort or distress, so you may need to make decisions based on your observations. For example, an individual’s facial expressions or behaviours could indicate that they are in pain. However, it is still necessary to obtain their consent before carrying out a health or care activity.

There may be times when you need to address the causes of pain, discomfort or distress with others. For example, if a co-worker is carrying out a healthcare activity in a way that is causing an individual distress, you should speak to your colleague about it and suggest an alternative way of doing things. If the staff member does not take any notice, you may need to escalate your concern to a manager or supervisor. Team meetings are another forum where you are able to discuss ways that you can work better as a team to reduce the pain discomfort and distress of the individuals that you care for.

CARE CERTIFICATE – STANDARD 5: WORK IN A PERSON-CENTRED WAY

  • 5.1 Understand person centred values
    • 5.1a Describe how to put person-centred values into practice in their day-to-day work
    • 5.1b Describe why it is important to work in a way that promotes person centred values when providing support to individuals
    • 5.1c Identify ways to promote dignity in their day-to-day work
  • 5.2 Understand working in a person centred way
    • 5.2a Describe the importance of finding out the history, preferences, wishes and needs of the individual
    • 5.2b Explain why the changing needs of an individual must be reflected in their care and/or support plan
    • 5.2c Explain the importance of supporting individuals to plan for their future wellbeing and fulfilment, including end-of-life care
  • 5.3 Demonstrate awareness of the individuals immediate environment and make changes to address factors that may be causing discomfort or distress
    • 5.3a Take appropriate steps to remove or minimise the environmental factors causing the discomfort or distress. This could include: Lighting, Noise, Temperature, Unpleasant odours
    • 5.3b Report any concerns they have to the relevant person. This could include: Senior member of staff, Carer, Family member
  • 5.4 Make others aware of any actions they may be undertaking that are causing discomfort or distress to individuals
    • 5.4a Raise any concerns directly with the individual concerned
    • 5.4b Raise any concern with their supervisor/ manager
    • 5.4c Raise any concerns via other channels or systems e.g. at team meetings
  • 5.5 Support individuals to minimise pain or discomfort
    • 5.5a Ensure that where individuals have restricted movement or mobility that they are comfortable.
    • 5.5b Recognise the signs that an individual is in pain or discomfort. This could include: Verbal reporting from the individual, Non-verbal communication, Changes in behaviour
    • 5.5c Take appropriate action where there is pain or discomfort. This could include: Re-positioning, Reporting to a more senior member of staff, Giving prescribed pain relief medication, Ensure equipment or medical devices are working properly or in the correct position e.g. wheelchairs, prosthetics, catheter tubes
    • 5.5d Remove or minimise any environmental factors causing pain or discomfort. These could include: Wet or soiled clothing or bed linen, Poorly positioned lighting, Noise
  • 5.6 Support the individual to maintain their identity and self esteem
    • 5.6a Explain how individual identity and self-esteem are linked to emotional and spiritual wellbeing
    • 5.6b Demonstrate that their own attitudes and behaviours promote emotional and spiritual wellbeing
    • 5.6c Support and encourage individuals own sense of identity and self-esteem
    • 5.6d Report any concerns about the individual’s emotional and spiritual wellbeing to the appropriate person. This could include: Senior member of staff, Carer, Family member
  • 5.7 Support the individual using person centred values
    • 5.7a Demonstrate that their actions promote person centred values including: individuality , independence, privacy, partnership, choice, dignity, respect, rights

LEVEL 2 DIPLOMA IN CARE – IMPLEMENT PERSON-CENTRED APPROACHES IN CARE SETTINGS

  • 1 Understand person centred approaches for care and support
    • 1.1 Define person centred values
    • 1.2 Explain why it is important to work in a way that embeds person-centred values
    • 1.3 Explain why risk taking can be part of a person-centred approach
    • 1.4 Explain how using an individual’s care plan contributes to working in a person-centred way
  • 2 Be able to work in a person-centred way
    • 2.1 Find out the history, preferences, wishes and needs of the individual
    • 2.2 Apply person-centred values in day to day work taking into account the history, preferences, wishes and needs of the individual
  • 3 Be able to establish consent when providing care or support
    • 3.1 Explain the importance of establishing consent when providing care or support
    • 3.2 Establish consent for an activity or action
    • 3.3 Explain what steps to take if consent cannot be readily established
  • 4 Be able to encourage active participation
    • 4.1 Describe how active participation benefits an individual
    • 4.2 Identify possible barriers to active participation
    • 4.3 Demonstrate ways to reduce the barriers and encourage active participation
  • 5 Be able to support the individual’s right to make choices
    • 5.1 Support an individual to make informed choices
    • 5.2 Use agreed risk assessment processes to support the right to make choices
    • 5.3 Explain why a worker’s personal views should not influence an individual’s choices
    • 5.4 Describe how to support an individual to question or challenge decisions concerning them that are made by others
  • 6 Be able to promote individuals’ well-being
    • 6.1 Explain how individual identity and self esteem are linked with well-being
    • 6.2 Describe attitudes and approaches that are likely to promote an individual’s well-being
    • 6.3 Support an individual in a way that promotes a sense of identity and self esteem
    • 6.4 Demonstrate ways to contribute to an environment that promotes well-being
    • 6.5 Recognise and respond to changes in physical and mental health
    • 6.6 Explain the importance of good nutrition and hydration

LEVEL 3 DIPLOMA IN ADULT CARE – PROMOTE PERSON-CENTRED APPROACHES IN CARE SETTINGS

  • 1 Understand how to promote the application of person-centred approaches in care settings
    • 1.1 Explain how and why person-centred values must influence all aspects of health and adult care work
    • 1.2 Evaluate the use of care plans in applying person-centred values
    • 1.3 Explain how to collate and analyse feedback to support the delivery of person-centred care in line with roles and responsibilities
  • 2 Be able to work in a person-centred way
    • 2.1 Work with an individual and others to find out the individual’s history, preferences, wishes and needs
    • 2.2 Demonstrate ways to put person-centred values into practice in a complex or sensitive situation
    • 2.3 Adapt actions and approaches in response to an individual’s changing needs or preferences
  • 3 Be able to establish consent when providing care or support
    • 3.1 Analyse factors that influence the capacity of an individual to express consent
    • 3.2 Establish consent for an activity or action
    • 3.3 Explain what steps to take if consent cannot be readily established
  • 4 Be able to implement and promote active participation
    • 4.1 Describe different ways of applying active participation to meet individual needs
    • 4.2 Work with an individual and others to agree how active participation will be implemented
    • 4.3 Demonstrate how active participation can address the holistic needs of an individual
    • 4.4 Demonstrate ways to promote understanding and use of active participation
  • 5 Be able to support the individual’s right to make choices
    • 5.1 Support an individual to make informed choices
    • 5.2 Use own role and authority to support the individual’s right to make choices
    • 5.3 Manage risk in a way that maintains the individual’s right to make choices
    • 5.4 Describe how to support an individual to question or challenge decisions concerning them that are made by others
  • 6 Be able to promote individuals’ well-being
    • 6.1 Explain the links between identity, self-image and self esteem
    • 6.2 Analyse factors that contribute to the well-being of individuals
    • 6.3 Support an individual in a way that promotes their sense of identity, self-image and self-esteem
    • 6.4 Demonstrate ways to contribute to an environment that promotes well-being
  • 7 Understand the role of risk assessment in enabling a person-centred approach
    • 7.1 Compare different uses of risk assessment in care settings
    • 7.2 Explain how risk-taking and risk assessment relate to rights and responsibilities
    • 7.3 Explain why risk assessments need to be regularly revised