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Chapter 18 Implementing person-centred care
want to talk with visitors or watch TV). If visitors are in
the room, check with the person to see if they want the
visitor(s) to stay during the procedure. If the person’s
carer needs to learn new skills so that care can be contin-
ued at home, a teaching session should be scheduled at a
time both appropriate for the person and convenient for
the carer. These interventions reflect the person-centred
approach because the person is being involved in the
decision making throughout the implementation process.
Equipment
Anticipate all the equipment you will need to successfully
carry out the intervention and arrange it so that it is easily
accessible. Be sure to order sufficient supplies at the begin-
ning of the shift for the care you expect to provide, and be
considerate of colleagues who will follow you by leaving
adequate supplies; for example, medication and intravenous
therapy orders. Follow the healthcare facility policy when
ordering supplies. It is also important to ensure your equip-
ment is in working order and therefore safe to use. Nurses
and midwives also have a responsibility for the care of the
environment after a procedure. Equipment that is not put
away properly not only may become a hazard but also
detracts from the person’s environment.
Environment
Think through the proper environment for each intervention.
Pay special attention to respecting the person’s dignity,
privacy and safety needs. Privacy is routinely violated in
some care settings when measures as simple as closing a
door or pulling curtains are neglected. These considerations
are of special importance when people share rooms. For
example, if an enema is being administered, it can be embar-
rassing for the person and unpleasant for the person’s
roommate. With some planning, the intervention can be
scheduled in a private bathroom or at a time when the room-
mate is absent.
Personnel
Prior to implementing care, identify if you are able to carry
out the planned intervention independently or if you are
likely to need assistance. In Chapter 13, the issue of self-
awareness is discussed and this includes an appreciation of
one’s own expertise. Harm can occur either to the person or
to you when interventions are attempted by an insufficient
number of personnel or someone who is not competent in
the procedure. For example, it is easy for a student to under-
estimate the strength it takes to support a large person or the
expertise that is required in changing a central venous
catheter. Until experienced, it is always safer to err on the
side of having too much help rather than not enough. One
helpful tip for student nurses and midwives is to begin each
rotation by asking ‘Who thinks they might need help
today?’ The team can then plan to coordinate care so that
help is available when needed.
Anticipate unexpected outcomes/
situations
When you learn about new procedures and interventions,
you often see a description of possible adverse effects
listed. While everyone hopes never to encounter these
complications, they do occur with some frequency. The
skilled nurse or midwife knows what might happen if an
intervention ‘goes wrong’ and is prepared to deal with the
new challenge. This may be as simple as accurately assess-
ing how much support a patient will need to avoid a fall
when ambulating for the first time after surgery, or being
prepared to respond to complaints of burning at a new
intravenous site.
Promoting self-care: Teaching,
counselling and advocacy
Although most people can independently meet their basic
human needs, illness and the stress of diagnostic and thera-
peutic measures may interfere with a person’s usual practice
of self-care. The person’s abilities to independently meet
their human needs must be fully assessed. You can fail
people by doing too much for them and by encouraging
negative, sick-role behaviours, such as inappropriate
dependence. Conversely, there is a time and a place for the
‘tender loving care’ that says to a person ‘I know you may
be able to do this for yourself, but just this once, how about
if I do it and we’ll talk’. Balancing the need to encourage a
person’s best self-care effort with the effort to make each
person feel cared for and loved is an important component
of the art of caring.
The plan of care should include specific instructions for
any assistance the person requires to meet their basic human
needs, including the need for significant encouragement to
promote greater independence in functioning. When routines
of self-care (or assisted self-care) are included (e.g. colostomy
management), instructions should include the time of the pro-
cedure, the equipment used, the process and the level of
personal involvement. Continuity of care is essential to the
person’s development of a comfortable routine.
If the person and family want to participate actively in
seeking wellness, preventing disease and illness, recover-
ing health and learning to cope with altered functioning,
they need to possess effective self-care behaviours. You
need to be aware of the importance of people learning to
direct and manage their own care, and use interactions with
them for both planned and spontaneous teaching, coun-
selling and advocacy. (These nursing and midwifery roles
are described in Chapters 8 and 11.) For example, while
caring for a child recently diagnosed as having cystic fibro-
sis, the nurse works continuously with the parents and
siblings, helping them to develop the knowledge and skills
that will enable them to care for the child after discharge.
Referring families such as this to a community support
group or other resources further enhances the development
of self-care behaviours.
