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The Role of the Nurse in a Person-Centred Care Model
A few months ago, the Spanish Society of Geriatric and Gerontological Nursing (SEEGG) invited us to form part of a technical team in which we could reflect on the implications of nursing care from the perspective of the Quality of Life and Rights model, a model that is currently called Person-Centred Care (PCC). As a result of this call, we decided to join this working team whose work has been reflected in a technical document called "Person-Centred Care", available for reading and downloading from the website of our Scientific Society.
Given the interest and topicality of the subject, we have prepared below a brief summary of the reflections contained in this new material.
Definition and role of professionals
The concept of Person-Centred Care, (ACP), is an approach that, for some of the most advanced countries in social policies (Nordic countries, United Kingdom, Australia, Canada,...), has figured for years as one of the key elements in the improvement of the quality of care for the elderly.
The aim of this approach to improving care is to allow and facilitate each person to continue doing what they like, offering them the necessary support to be able to develop those activities, tasks and roles that allow them to improve their personal and emotional well-being. The development of this approach has been possible thanks to the contribution of many authors and trends from different disciplines (psychology, nursing, occupational therapy, education, social work, physiotherapy...).
The objectives set by the SEEGG for this work were
- To identify the role of the nurse in the Person-Centred Care model.
- To provide geriatric nurses with points of reflection on the role of the nurse in Person-Centred Care in supporting the development of the elderly person's life project, in cooperation with other professionals.
We start from the fact that, in the view of the ACP, the organisation of care systems for the elderly must be based on the recognition of capabilities and respect for the dignity, autonomy, culture, values and preferences of the individual. In any of these systems, interdisciplinarity will play a fundamental role. Thus, within the interdisciplinary team, the role of the nurse will be particularly important, both in terms of comprehensive assessment and in the development of the care plan together with the person.
Health professionals represent resources that accompany the elderly person and their family with the intention of helping them to find those elements that respond to and satisfy their needs both in the area of health and, from respect for their values, their expectations of personal development.
In these contexts, geriatric nurses, who are responsible for planning care, have been incorporating a model of care that leaves behind disease-based interventions, to focus on a more comprehensive perspective of care for older people and their families. This approach covers the entire spectrum of care, from promotion and prevention to care for people in the final stage of their lives, and seeks to promote the well-being of each individual, enhancing their capabilities and decision-making autonomy from a holistic and personalised perspective, in which respect for their values prevails, and in which each person is a participant and protagonist in their care.
Nurses' care only makes sense from the point of view of the person, of who they are, of what they represent within their social environment. In this way, care acquires meaning by taking into account their reality and their way of life.
The nurse must accompany the person in the decision making process, ensuring that decisions are made consciously, with adequate information and in an autonomous manner. Amongst her tasks, she must carry out a comprehensive assessment of the person to identify their needs, abilities, limitations, resources and possibilities for independent living. In other words, the nursing professional is the one who will determine the person's capabilities, always taking into account their functional autonomy and decision-making capacity. This will help to prioritise the intervention situations, and to plan jointly (person - professional team) the activities to be developed to maintain and/or recover a greater degree of independence in accordance with the expectations of each individual, subsequently evaluating the results of these interventions.
The nurse is responsible for providing tangible and intangible care, from the point of view of the person she accompanies in her health experience, based on the content of the relationship established in the care, even when she delegates tasks of daily living activity to other professionals.
Caring means accepting the autonomy of people in the field of decision making. Verbal and non-verbal communication, observation and life history, together with respect for the independence and free will of the individual, will help us to ensure that the elderly person develops their life project in the best possible way.
Nursing professionals must maintain a critical and reflective attitude towards the reality of people and their rights, guaranteeing the enjoyment of quality care and trying to generate, together with the rest of the interdisciplinary team involved in care, the necessary impact to promote the change of model in the provision of care for the elderly.
It is a figure that acts as a training and information provider for the people who care for them, whether they are non-professional carers or direct care professionals. Because of this, her responsibility in leadership, teaching, motivation, supervision, etc., is essential.
Today, nursing practice must be based on evidence-driven health care. Nurses are constantly challenged to identify new and better ways to deliver optimal care for each person. Since the process of nursing care involves a deliberate approach to problem solving or prevention, the success of its implementation will depend on the knowledge, skills, and attitudes of the professional, which must be integrated into an ethical and theoretical framework of reference for nursing practice.
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