Manage health and social care practice to ensure positive outcomes for individuals (M3)

Handout 3: Leading person-centred practice

Learning outcome 2, 4 Assessment criteria 2.1, 2.2, 4.1

Any care planning process must begin with assessment, gathering information to find out ‘where we are now’ and ‘where we want to get to’; this will provide a baseline for the measurement of the plan’s success.

Ideally, the assessment process should be ‘person-centred’, carried out holistically from the perspective of the individual rather than being focused on the ‘abilities’ of the service to provide the plan of care. A familiar starting point may be the use of‘SPICES’; social, physical, intellectual, cultural, emotional and spiritual needs of the individual.

Traditionally, service providers may have made these decisions based on observation and opinion of what the individual requires, or worse, started from a basis ‘what we can afford’. While resource implications will always be a consideration, if they become the primary focus for any care provision, you will not be supporting person-centred care.

To place the individual at the centre of the process, start from their perceptions of what they would like to happen. This can be as wide as a ‘wish list’ of aspirations to a ‘worst nightmares’ – the things they definitely do not want to happen. This approach sets parameters for us to work within.

Bradshaw’s Taxonomy of need (1972) identified four areas to be considered in any planning process:

Normative needsThese could be expressed as an agreed standard such as those expressed in national service standards -- but we have to bear in mind that these may not be the perceived need of the individual.

Felt needsThese are the particular ‘wish lists’ of an individual; but people who have few life experiences to draw upon, or little in the way of aspiration or expectation will take time to develop and express their needs fully.

Expressed needsWhen the ‘wish list’ is turned in to a request for action.

Comparative needsThese would be the perceived needs of a group similar to that of the service user, people who are not in receipt of a service. For instance when developing a care plan for a younger person in care, how much consideration is given to ‘normality’, in terms of the life style and preferences of younger people living in the community?

In his ‘Hierarchy of need’ Maslow suggests stages which must be achieved before anyone can achieve their ‘maximum potential’.

Abraham Maslow maintained that basic physical needs are fundamental, as without food, water, warmth, shelter and clothing, people would not survive. The next stage is safety, everyone needs to know that they are safe from danger and feel safe and secure in their environment. Only when the first two stages are satisfactory, is the individual able to move on towards fulfillment.

The next level social needs looks at the ways in which each one of us need to feel that we ‘belong’, are valued and accepted, loved and cared about. Without this knowledge an individual will have low self-esteem and will not be able to progress. This is a vital part of the care planning process, as some of the individuals receiving services may have issues in their lives which affect their ability to interact with others and form close relationships. It is an area that can be neglected in the day to day need to make sure the practicalities are dealt with. Care workers may feel they have little time to spend involving the individual in social activity and making sure each one feels ‘cared for’ – but this is at the heart of best practice in social care.

Self-esteem needs are simple to understand; it isn’t difficult to see how a lack of friends and people who care about you can lead to an individual having little self-esteem. If you don’t have these relationships, you will subconsciously begin to feel that you are worthless and without self-esteem, we all need to feel loved by others before we can love ourselves. We need to feel valued, that our personal beliefs are respected, that we are equal in the eyes of others and we have some control over our life. If you live in an environment where decisions are made (about you) without anyone even bothering to consult you, or where other people take over your personal care and don’t allow you to be involved, you will soon begin to feel like an ‘object’ rather than a ‘whole person’. Sometimes this can happen ‘with the best intentions’, where care workers are overly protective, ‘know what is best’ for the person or have so much power they forget they are not there to take control!

Michael Smull produced an ‘Overview to Essential Lifestyle Planning’ loosely based on the work of Maslow. He described it as ‘a guided process for learning how someone wants to live and for developing a plan to help make it happen’.

It gives:

  • a snapshot of how someone wants to live today, serving as a blueprint for how to support someone tomorrow
  • a way of organising and communicating what is important to an individual in ‘user friendly’, plain language
  • a flexible process that can be used in combination with other person-centred planning techniques
  • a way of making sure that the person is heard, regardless of the severity of their disability.

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