RESEARCH TO PRACTICE
Three Factors Impacting the Care of Older Adults
Nolan, M R., Davies, S., Brown, J., Keady, J. & Nolan, J. (2003). “Beyond ‘person-centered’ care”: a new vision for gerontological nursing. International Journal of Older People Nursing, 13 (3a), 45-53.
This article discusses older adults’ health care in the United Kingdom (UK) from the perspective of the reformed health care system for older people. The new geriatric health care model was introduced by the British government in 2000. This was the first time that national standards of care for this segment of the population had been established in the UK. The British researchers consider the impact of adding new dimensions to the person-center model to make it more realistic and effective. American experience with person-centered care is included in their discussions. The core principles of the new health system in the UK are:
* The promotion of ‘person-centered’ care
* The elimination of age discrimination in health careThe researchers argued that person-centered care did not pass the exam in real life and they suggested replacing it with a model based on relationship-control care. Person-centered care requires that a caregiver has knowledge of each resident as an individual, and care is organized around his/her needs. It is tied to increasing elders’ independence and autonomy. However, when researchers have analyzed people’s care in the person-centered model, they have concluded that there are three factors that impact the care of elders more than the person-centered care model. These three factors are:
(1) Respecting personhood
Personhood is defined as “status bestowed upon one human being by others in the context of a relationship (p.47).” Respect for personhood is fundamental. A person’s autonomy is critical, but it also needs to be considered in the context of a person’s relationships. People need to be seen in terms of “belonging to a network of social relationships within which they are deeply interconnected and interdependent. “(p.47). A person can only be understood within his/her network of relationships and socio-cultural beliefs that in turn helps staff understand an individual’s unique aging experience. It also helps staff provide more meaningful care to this person, as staff can see the person interacting in their natural social network. This helps staff identify a resident’s unique needs and which can be met by a caregiver.
(2) Valuing interdependenceThis dimension focuses on a person’s web of relationships and his/her reciprocity. The best relationships are mutual, where everyone involved works on maintaining the appropriate balance between interdependence, dependence, and independence. These kinds of relationships facilitate people’s growth. Researchers claim that nurses need to be more attentive to their external relationships, including those with other disciplines. Another claim is that person-centered nursing is less likely to promote symmetrical relationships. For this to happen, all participants need to be meaningfully involved and incorporate their experience in health care.
(3) Investing in caregiving as a choice
The highest quality of care can be provided only when caregivers “have a positive predisposition toward such care” (p. 48). Positive attitude and passion is a major concern for gerontological nursing. The long-term care industry is afflicted by a high staff turnover rate, poor recruitment and weak retention. Working with older adults is often seen as having low value and less challenging than work in other health fields. Researchers have found that nurses, other health employees and social workers believe that working with older adults will not improve their clinical skills, and as a result will not advance their career. Often, poorly organized internships in older adult care fields for nurses produce a negative experience for them. Consequently, when a nurse does not believe that his/her work makes a difference, it results in meaningless care. Relationship centered care has the potential to provide a high level of care because it is understood as a relationship between those giving and those receiving. The reciprocity of such a relationship is likely to build a bond that is meaningful for both sides.
Implications: Nursing homes’ orientation trainings need to be designed in such a way that a newly hired nurse or any other employee sees the value of his/her work. Consistent staff assignment enhances staff’s esteem, as staff members can see the fruits of their work and helps them see its meaning. Consistent staff assignment helps staff get to know people under their care and build the relationships that are meaningful to residents. Teamwork and cross training enhance interdisciplinary reciprocal relationships.