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Person-centredness, relationships       and meaning making         Dr Trevor Adams        University of Surrey
‘After six months in certain hospitals, there areways in which psychiatric nurses are no longerlike ordinary people. Their...
Diagnosed
DiagnosedMarginalised
DiagnosedMarginalisedInstitutionalised
Person-centred care
Person-centred carePerson with DEMENTIA
Person-centred carePerson with DEMENTIAPERSON with dementia
Person-centred carePerson with DEMENTIAPERSON with dementia
Dementia =[biomedical factors]+[social/psychological factors]
Dementia =Physical Health +Neurological Impairment +Personality +Biography +Social Psychology
“Personhood” is the central idea inperson-centred care.
“a standing or a status that is bestowed onone human being, by another in the contextof relationship and social being”    ...
malignant social psychologies•   Disempowerment    •   Withholding•   Imposition        •   Outpacing•   Disruption       ...
positive person work•   Warmth            •   Celebration•   Holding           •   Acknowledgement•   Relaxed pace      • ...
problems with person-centred care
problems with person-centred caredoes not fully represent:family carers and dementia care workers
problems with person-centred caredoes not fully represent:family carers and dementia care workersthe embodied and bodily n...
problems with person-centred caredoes not fully represent :family carers and dementia care workersthe embodied and bodily ...
Relationship centred careRecognition that there is often three people oragencies involved in the provision of dementia car...
the senses framework –       mike nolan and colleagues• A sense of purpose - opportunities to engage  in purposeful activi...
the senses framework –        mike nolan and colleagues• A sense of security - of feeling safe and  receiving or deliverin...
Humanistic: putting humanity and the interestsof the person first‘Dementia Reconsidered: the person comes first’
Humanistic: putting humanity and the interestsof the person firstExistentialist: highlighting questions of existencerather...
Humanistic: putting humanity and the interestsof the person firstExistentialist: highlighting questions of existencerather...
Humanistic: putting humanity and the interests ofthe person firstExistentialist: highlighting questions of existencerather...
Recently various people at Bournemouth Universityhave identified various areas in which health careprovision needs to be ‘...
insiderness    living in a personal world               that carries a sense of how               things are perceivedagen...
sense-making       care for the ???, of things,                   events and experiences for                   personal li...
creativity helps people with dementia affirmtheir selfhood
creativity helps people with dementia makesense what is happening to them
Person centredness, relationships
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Person centredness, relationships

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dementia relationships

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Transcript of "Person centredness, relationships"

  1. 1. Person-centredness, relationships and meaning making Dr Trevor Adams University of Surrey
  2. 2. ‘After six months in certain hospitals, there areways in which psychiatric nurses are no longerlike ordinary people. Their attitude to mentalillness changes - as it does to old age, to cruelty,to people’s needs, and to dying. It is as if theybecome numbed to these things.’ (Sans Everything 1967)
  3. 3. Diagnosed
  4. 4. DiagnosedMarginalised
  5. 5. DiagnosedMarginalisedInstitutionalised
  6. 6. Person-centred care
  7. 7. Person-centred carePerson with DEMENTIA
  8. 8. Person-centred carePerson with DEMENTIAPERSON with dementia
  9. 9. Person-centred carePerson with DEMENTIAPERSON with dementia
  10. 10. Dementia =[biomedical factors]+[social/psychological factors]
  11. 11. Dementia =Physical Health +Neurological Impairment +Personality +Biography +Social Psychology
  12. 12. “Personhood” is the central idea inperson-centred care.
  13. 13. “a standing or a status that is bestowed onone human being, by another in the contextof relationship and social being” ‘Dementia Reconsidered’ Tom Kitwood
  14. 14. malignant social psychologies• Disempowerment • Withholding• Imposition • Outpacing• Disruption • Infantilisation• Objectification • Labelling• Stigmatisation • Disparagement• Ignoring • Accusation• Banishment • Treachery• Mockery • Invalidation
  15. 15. positive person work• Warmth • Celebration• Holding • Acknowledgement• Relaxed pace • Genuineness• Respect • Validation• Acceptance • Empowerment• Facilitation • Enabling• Collaboration • Including• Recognition • Belonging
  16. 16. problems with person-centred care
  17. 17. problems with person-centred caredoes not fully represent:family carers and dementia care workers
  18. 18. problems with person-centred caredoes not fully represent:family carers and dementia care workersthe embodied and bodily nature of dementia
  19. 19. problems with person-centred caredoes not fully represent :family carers and dementia care workersthe embodied and bodily nature of dementiathe two-way nature of communication in dementia care
  20. 20. Relationship centred careRecognition that there is often three people oragencies involved in the provision of dementia care:the person with dementia, their family carer(s) andtheir paid-for carer(s) – the dementia care triad.Sensitivity to how communication between eachparticipant constructs personal experience, identityand meaning to each member of the dementia caretriad.
  21. 21. the senses framework – mike nolan and colleagues• A sense of purpose - opportunities to engage in purposeful activities or to have a clear set of goals to aspire to;• A sense of fulfilment - achieving meaningful or valued goals and feeling satisfied with one’s efforts;• A sense of significance - to feel that you matter, and that you are valued as a person
  22. 22. the senses framework – mike nolan and colleagues• A sense of security - of feeling safe and receiving or delivering competent and sensitive care;• A sense of continuity - the recognition of biography, using the past to contextualise the present;• A sense of belonging - opportunities to form meaningful relationships or feel part of a team.
  23. 23. Humanistic: putting humanity and the interestsof the person first‘Dementia Reconsidered: the person comes first’
  24. 24. Humanistic: putting humanity and the interestsof the person firstExistentialist: highlighting questions of existencerather than essence and the personal struggle togain a meaning to one’s life
  25. 25. Humanistic: putting humanity and the interestsof the person firstExistentialist: highlighting questions of existencerather than essence and the personal struggle togain a meaning to one’s life‘In day to day interplay with persons with dementia it isinescapable to address existential struggles and innateIssues.’ Holly Queen-Daugherty 2002
  26. 26. Humanistic: putting humanity and the interests ofthe person firstExistentialist: highlighting questions of existencerather than essence and the personal struggle togain a meaning to one’s lifeChristian: people are created in the image of God,imago Dei and are relational and thus there is a deepvein of co-creativity in people through which they relateto others and identity is displayed and gained
  27. 27. Recently various people at Bournemouth Universityhave identified various areas in which health careprovision needs to be ‘humanized’.Todres, L. Galvin, K. and Holloway, I. 2009 Thehumanization of healthcare: A value framework forInternational Journal of Qualitative Studies onHealth and Well-being. 1-10,
  28. 28. insiderness living in a personal world that carries a sense of how things are perceivedagency experience yourself as making choices and being generally held accountable for one’s actionsuniqueness actualizing a self that is unique which can never be reduced to a list of general characteristicstogetherness in community
  29. 29. sense-making care for the ???, of things, events and experiences for personal lifepersonal journey on a journeysense of place Come from a particular place where the feeling of at-homeness becomes realityembodiment live within the fragile limits of human embodiment
  30. 30. creativity helps people with dementia affirmtheir selfhood
  31. 31. creativity helps people with dementia makesense what is happening to them
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