Tuesday, April 30, 2013

Person- versus Relationship-centered care

"Personhood: a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect, and trust."
This quote is the definition of personhood given in a book that I've been reading called Dementia Reconsidered: The Person Comes First, by Tom Kitwood. It's about person-centered care in dementia. Person-centered care is a term used often in social work, not exclusively for working with people with dementia, though that is the most common context. It's basically the idea of caring for a person as an individual--bestowing them with personhood, as Tom Kitwood would say--and recognizing their unique needs and perspectives. To me, though, the most important part of this is seeing beyond the condition, and this applies to all of us. A person with dementia is still a person above anything else--they are more than their illness or their circumstances.

We had a lecture recently on person-centered care, which was extremely moving because so much of it was about things I believe or things I've experienced. I don't think I truly realized how much learning I did in my two years volunteering and working at a nursing home until these things have started to come up in discussions. Although the facility that I worked at was not a dementia-specific facility, and we had many residents who did not have dementia, working with individuals with dementia was actually what I was the most anxious about when I began volunteering there. I remember venting to Allison about how stressful it was when I first started there and how nervous I was because I didn't have any formal "training" in how to work with people with dementia, and I was afraid I would do something wrong. It didn't take long, though, for me to realize that the best way to learn was going to be for me to figure out on my own what worked, and I did. And I learned that what these people often needed from me was no different than what my friends, family, or anyone needs in a relationship. They needed their emotions and their experiences to be acknowledged. They needed me to be present, which means listening rather than just hearing, and sometimes means just sitting there holding hands and keeping quiet. And often, the people I worked with clearly needed to feel as though they could give something back to me in our interactions, so that they were a mutual exchange, placing us on the same level. This appeared in different ways, from wanting to teach me things, to wanting to pay me for doing their nails, and offering to share their snacks. When the offers were material, I always made it clear that there were no debts between us for me doing what was my job. But I also tried to let all the residents know, when I could, how much I enjoyed the time I spent with them. I truly did love my job and my work environment and the people I got to work with, and I know how lucky I was to have such a wonderful experience as an undergraduate.

On my last day at work, they hosted a going away party for me. There was a resident with dementia whom I had grown quite close to, and although he did not remember my name and did not necessarily remember all the conversations we'd had, he always recognized me as someone he knew and trusted. I wasn't quite sure he'd understand the finality of my leaving, but when I explained the circumstances and said goodbye to him he surprised me. He told me he would miss me and said, "It's been an honor working with you." I love that he expressed it that way, because it put us on the same level, which is not always the case in any client-professional relationship. But I think that's how it should be. Our lecture on person-centered care ended with a discussion of how the term relationship-centered care is emerging as a potential expansion of the ideas of person-centered care, based on the fact that care should be based on exchanges. Particularly when working with people with dementia, emotional exchanges and having some sort of connection can be critical, and this means focusing on everyone involved in the care, not just the care "recipient". Care should be about more than just meeting physical needs and practical needs--caring for the whole person means caring for their emotional and psychological needs as well, and people need to feel that they are contributing to their community in some way. In these class discussions on issues like this, I find myself time and time again thinking of residents at the nursing home whom I felt particularly connected to, or from whom I learned some very important lessons. Most of these individuals have died, and the issue of "professional grieving" is one I can't even begin to tackle in this post, but I'd like to end this with a quote (of course), as it's the best I can do to remember them here.

"I held him close for only a short time, but after he was gone, I'd see his smile on the face of a perfect stranger & I knew he would be there with me all the rest of my days."


No comments:

Post a Comment