Review: iv Fundamentals of Person-Centred Healthcare Practice

Chapter 15 on 'Being sympathetically present' is a timely review of empathy, sympathy and compassion. As students learn and are exposed to experiences in practice and socialised (or not) in how these are practised this is very useful allied with exposure to the 6Cs. Mentioned in post iii: chapter 19 on Person-Centred Rehabilitation would benefit from the addition of reablement and resettlement. Given resort to a single chapter [22] on mental health it is understandable that the extreme form of trauma - physical and psychological experienced (but not necessarily wholly remembered) for people sexually assaulted points to forensic and Criminal Justice Liaison and Diversion Services. The authors here are to be congratulated on a feat of explanatory gymnastics. This just hints at the PSYCHO-dynamic* world that is mental illness, health and well-being (*physical and political).

Perusal of W2tQ reveals how readily Hodges' model can encompass the sciences and the arts (humanities). This is by design (the model's structure). The book stresses art with some (very well-balanced and executed) illustrations and prose. Once again (sorry) though, I thought of veterans, homeless, veterans, prisoners and newly released offenders and their circumstances. Being person-centred is very much attitudinal but this is physical not just cognitive and how we apply knowledge. Where this person is in space that is the centre of gravity. How best to approach, a person living with dementia and impaired senses, a homeless person lying under a bridge - even before we speak. 

 

I'm sure I read 'touch' in here, but it is not indexed. Post-COVID and in nursing as part of person-centredness this is an important part of communications skills, safeguarding and being safe. 

For the newly released prisoner, how prepared are they to be the person they can be, even before we are 'person-centred'?

"For the first time in 25 years the one-off payment given to adult prison leavers in England and Wales is to be raised. The Prison Discharge Grant will increase from £46 to £76, but what difference will that make?"

https://www.bbc.co.uk/sounds/play/m000y5sq

Released On: 24 Jul 2021  Available for over a year

 

The book identifies different interventions and models relevant to the respective practice area, i.e. rehabilitation. Chapter 33 presents a personal challenge in (being a lifelong learner) whether you have a fixed or growth mindset, which of four archetypes of self-awareness applies to you (pp.322-323)? It's worth reading for heutagogy (p.327). I was prompted to consider the ongoing journey here. If anyone would like to test the reflexive credentials of Hodges' model (p.328) please get in touch. Salience is a key concept in Hodges' model. What is important to the patient - person? What is now? Are we only person-centred dealing with conscious persons? Again, perhaps a missed opportunity - care of the unconscious patient? I enjoyed chapter 30 on critical thinking. I was reminded of (verbal) accounts of people applying the Tidal model in forensic care. This proved not exactly straight forward, whereas, once learned Hodges' model can function as an aide-mémoire. If shared then collaboration may be enhanced since as the latter sections of this book show specific concepts need to be identified, articulated, agreed and applied.

The final chapter's title made me laugh a little: A call to action. Sometimes you can't win on the periphery of academia (a privileged position nonetheless?). KISS (Keep it simple stupid) applies to Hodges' model, but whether simple, or deemed complex the model fails to be recognised as a vital tool for all health and social care practitioners. Especially learners taking their seats (in-situ or online) on course 101. I take heart in believing that Hodges' model has a very long tail in relevance and global potential.

Once again model/framework envy creeps in, as I have no evidence (yet). 

Paradoxically (or not) this book will have me try to take note of instances when an interaction calls for a suspension of person-centredness: for me, the patient, client, carer - for us simultaneously.

This is the 'take-away' for me from this book which I also heartily recommend.

I will refer to 'healthful' in another book review.

SPIRITUAL

 

individual - PERSON - patient
|

INTERPERSONAL : SCIENCES

SPIRITUAL  humanistic ---------------------------- mechanistic  SPIRITUAL

SOCIOLOGY : POLITICAL

|

family - group - population

 

SPIRITUAL

Mindset :: Parity - attitude aptitude (My choices*) Hodges' model - disassembly for care	- of esteem :: Touch aptitude attitude Hodges' model assembly of care
Culture Child - Parent - Guardian FAMILY- Social network Be the 'person' the Social Determinants of Health predict/dictate?	prisoner release grants and welfare *(Are you joking - without attending to the politics of health and social care? Diet, green spaces, identity, community (facilities), housing ...)

Many thanks to the publisher Wiley-Blackwell for the review copy.

Review i

Review ii 

Review iii

Fundamentals of Person-Centred Healthcare Practice,  McCormack, B., McCance, T., Bulley, C., Brown, D., McMillan, A, Martin,S. (Eds.). ISBN: 978-1-119-53308-5 February 2021 Wiley-Blackwell.

Review: iii Fundamentals of Person-Centred Healthcare Practice

 

Previously, I recognised the many links throughout the book and on p.54 there are five relating to professional standards. These reflect the book's international scope and multidisciplinary relevance. Those on page 54 do work and support the text. One of them I was presented not with the expected page and missed the outcome of the 'click'. I wasn't going to re-type but found the page through the site's menu. Some links are long, as I found, whether permalinks [usually shorter] or fallback search text might improve link-longevity I'm not sure.

As a reassurance the contrast issue black-text-on-dark-green is limited to one figure.

The book is well referenced with an additional reading list. I've been made aware through plagiarism detectors (one paper) which - it appears - have 'read' an introductory section to Hodges' model as self-plagiarism. I wondered if in comprising a community of practice the references here maybe somewhat insular. I've no analysis to support this and the same no doubt may apply to other to emergent ideas, including threshold concepts. You have to start somewhere. At fear of contradiction there are many theories called upon and referenced.

Students may find the more attention to the position and specificity of references useful p.75 "we cannot not communicate." How times, chapters (8 - Communicating and Relating Effectively), theory, practice and management are challenged. The art of  'sympathetic presencing' working on the phone triaging acute community mental health referrals, 'Being kind and warm'.

For a text on person-centredness the book is imho mental illness-health light, but then as noted what is the book about? Am I suggesting that such books should attend to disciplinary equality? That said if there is a test for parity of esteem here, what do you conclude from one dedicated chapter? I was surprised, but is there a dilemma here? Beside 'Trust in self and others' I made a note, 'intuition'. Is person-centredness and being person-centred taken for granted within mental health practice? Research suggests not. 

Reading the table of contents you will find:

Chapter 18: Being person-centred in the acute hospital setting
Chapter 19: Person-Centred Rehabilitation
Chapter 20: Being person-centred in community and ambulatory services
Chapter 21: Experiencing person-centredness in long-term care
Chapter 22: Being person-centred in mental health services
Chapter 23: Person-centred support for people with learning disabilities
Chapter 24: Being Person-centred in Maternity Services
Chapter 25: Being person-centred in children’s services
Chapter 26: Being person-centred when working with people living with long-term conditions
Chapter 27: Palliative and end of life care services

I had a sense that the chapters were not sufficiently differentiated despite the titles. This may say more about my reading and the (editor's achieved) coherence of the book overall. Perhaps also for me, person-centredness is realised in-situ with personalised details. Not just vignettes (which are used) but the detailed intra- interpersonal, social, physical, political and spiritual choreography that is person-centred care: whether or not there is engagement (a dance).

Dementia is represented but the context appears to be residential care. You will find challenging / courageous conversations, but not challenging behaviour in situations that test interpersonal skills and person-centredness especially for staff, students, carers and families (dementia in general hospitals - despite numerous initiatives). Trauma has its place in the mental health chapter (and in current literature), but again the challenge of psychoses, anorexia are missed opportunities to reveal the potential and delivery of the Person-Centered Practice Framework.

Since the book's publication with its stress on the welfare and well-being of staff and educators too, the need to make explicit the politics in health is even more extreme. The need to protect the title of 'nurse'; mis-information generally and relating to COVID. Person-centred decision making and shared decision making are described as systems. Perhaps this misses the nuances of a health care professional, the team and family working with a person were they are making an unwise decision (pp.83-92). Another chapter indicates the need and utility of disciplinary bridges:

Chapter 17: Socio-political context in Person-centred Practice

 

individual - PERSON - patient
|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

family - group - population

MIND :: Parity -	- of esteem :: BODY
Culture Child - Parent - Guardian FAMILY SOCIO -	Refugees Homeless title of 'nurse'* mis-information Organisational culture? - POLITICAL

One more to follow with many thanks to the publisher for the review copy.

Review i

Review ii

Review iv

Fundamentals of Person-Centred Healthcare Practice,  McCormack, B., McCance, T., Bulley, C., Brown, D., McMillan, A, Martin,S. (Eds.). ISBN: 978-1-119-53308-5 February 2021 Wiley-Blackwell.

* https://twitter.com/hashtag/ProtectNurse?src=hashtag_click

 

Books, Papers and Conferences ...

At present I'm reviewing a paper for a journal on an education topic - nearly complete.

Communication Skills
for Effective Dementia Care

I'm five chapters into the ten chapter book -

Communication Skills for Effective Dementia Care

A Practical Guide to Communication and Interaction Training (CAIT)

- this is for a journal so it will be a 'review'.

 

 

800 words, or thereabouts are needed on Hodges' model and its utility in reflecting, deliberating and comprehending the environment and climate change. I have some notes already. 

Mathematics and Art: A Cultural History

Yesterday I had to visit a neighbour. A card for an undelivered item: a parcel. 

What could this be? 

It was quite a big box. 576 pages worth to be exact and a larger format book 9.5 x 12 in that instantly shouted 'quality'.

The book is not new, but is lovely to discover ... 

In my message to the publisher I highlighted my non-mathematical status, but great interest in topics within mathematics and the disciplinary bridges from maths - physics; sciences and humanities and of course mathematics and art.

I'm really grateful (especially to Princeton University Press) to receive both these books.

The dementia care title will also help me complete the two-part paper on Hodges' model, deprivation of liberty and threshold concepts. There are so many strategies and techniques outlined for carers both formal and informal. In July reading this book will also assist with a presentation at the Threshold Concepts conference.

Now well into the new year - the revisions to the paper on the SDGs and Hodges' model is also a priority.

To manage time I've put twitter down, but clearly with the above some tweets will follow in due course.

Then finally it will also be time to leave this blog alone for a time - well fewer posts at least ...

 

Dementia & Sleep: What the Papers Say

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

Sleep disturbance
Sleep disturbance 2

Just recently I came across a gentleman who in living with dementia and supported by his wife at home has been struggling with his sleep. Waking in the early hours 0330, 0400 in the summer is not too bad accompanied by the dawn chorus, but if it happens most days? And then in Winter: that is another matter.

Also fairly recently there are increasing instances of this man not being sure that the lady-  who is in their / his house and is taking him shopping - is his wife. She looks like my wife...? She knows what to buy and then she pays for the shopping.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

Who are you?	Have the doctor consider  prescribing a sleeping tablet
"Oh OK! Hello Sandra."	Arrange a medical review

This gent is up early anyway as there is a newspaper to collect which involves a walk. The problem is he leaves too early and is then outside waiting. His wife was struggling with all this so we discussed the need for a care review by the community mental health team. A sleep diary was provided to obtain some data upon which to base decisions. While I was in the garden with Mr. my student (thanks Katie) suggested to Mrs Y that this 'imposter' be passed as a friend. This has since proved very effective at reducing anxiety, social tension and distress.

Whilst we constantly strive for truth, honesty and respecting autonomy and dignity, sometimes sadly, 'truth' is compromised. It becomes less clear when it is being cognitively undermined.

We also want to maximise independence and support what are the usual daily activities of living: collecting the newspaper included. Risks were becoming evident however. So, Mrs Y came up with a strategic decision which has seen this gentleman adjust very quickly. Sleeping in until 8 o'clock is quite a surprise for the rest of the family to hear. And for us too. It is as if the (subscription) token for the newspaper was not only sitting waiting in a pocket or wallet. It also had slot in memory, where it had to be kept on constant refresh, whirring away; of such importance that it was proving quite disruptive introducing new risks, disturbing sleep. There are still many other activities and walks to be enjoyed. Nice call Mrs Y:

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

	Cancel the newspaper

"Welcome (nursing) home?"

Sometimes people residing in nursing and residential care facilities become so ill they need to go into hospital. In community mental health terms this can mean that an individual's behaviour can be so disturbed they need specialist assessment and care. It is essential to ensure they can have the best quality of life that their circumstances can provide, without resort to 'care by medication'.

The job means listening to people in care asking to go home. Staff need to be skilled and sensitive in how they respond to such requests, especially when they are repeated time after time. Family members can really struggle with this; should they visit? It is amazing how things can change though...

Quite a while ago I visited a care home and had arrived a bit early. As I turned-up the lady I'd called to see had just returned back from a stay in hospital. It was remarkable to see her recognise the home as home. She responded warmly to the nurse in charge, the many greetings and reassurances offered plus the familiar surroundings. As we accompanied this lady through to her room, it made our day (my week) to hear the deep sigh of relief when the door to her room was opened.

She said, "Oh, it's good to be back."

Walking over to the side of her bed, this highly trained life-trooper stopped.

Sometimes when a tree falls in the forest and someone IS there, there is no sound - just emotion.

Suddenly this lady made like a falling pine in Grizedale forest. In slow motion she fell sideways to greet her bed with another sigh - satisfaction and rest. The home manager and I just looked at each other....

Close call that - just missing the wall - but so good to be 'home' at last.

Image source: http://www.english-lakes.com/grizedale_forest.html