Person-centered approach to care (PCA): a philosophy of care and management for carers.

Current literature increasingly recognises the need for person-centred rather than task-centred approaches to meeting the health care needs of clients. In the aged care sector this can be broadly interpreted to mean a focussed consideration of residents' and clients' emotional (as well as their physical) needs and preferences in their care and lifestyle planning. Recently developed and implemented strategic challenges for Uniting Care Ageing NSW-ACT affirm that the organisation 'will have a unique person-centred model of care supported by a small number of staffing models which are efficient and managed to support quality of life for clients and carers'.Although the term person-centred approach or PCA is being more readily adopted as part of the healthcare 'lingo', many people struggle to understand its meaning. UnitingCare Ageing Hunter, Central Coast & New England Region has adopted the interpretation derived from Professor Tom Kitwood's work (1997) on the broader concept of personhood. In this context, PCA includes and supports the consideration of each person's needs and preferences from a holistic perspective that includes associated relationships and the impact that other people, practices and/or the physical environment may have on the individual. More recently, Brooker (2004) has elaborated on a definition that characterises PCA as:* Respecting and valuing the individual as a full member of society;* Providing individualised places of care that are in tune with people's changing needs;* Understanding the perspective of the person;* Providing a supportive social psychology in order to help people live a life where they can experience relative well-being.The works of both Kitwood and Brooker build on the 1950s research of the psychotherapist Carl R. Rogers, who developed the personcentered approach as a method of facilitating psychological growth (Natiello 2001). Rogers' approach was a radical departure from the authoritarian assumption that professional experts could and should help by solving others' problems for them, with the expectation that clients would then somehow be better able to solve their own problems (Rogers 1977). Tom Kitwood applied this approach to clients experiencing dementia and developed responses that contrasted starkly with the more 'technical' versions determined by the medical model at that time. Kitwood believed that a focus on dementia from the perspective of an organic mental disorder ignored the larger human issues and he therefore strove to create a new paradigmatic view of dementia in which 'the person comes first' (Kitwood 1997: 2). His research sought to provide a better understanding of the different ways in which personhood (that is the way in which one person views the status of another) was undermined for those people who were living with a diagnosis of dementia.One of the common theories upon which Kitwood built his research protocols was the assumption that all human beings have the five following fundamental psychological needs:* Comfort, the provision of warmth and strength;* Attachment, the forming of specific bonds or attachments;* Inclusion, being part of a group;* Occupation, being involved in the process of life;* Identity, having a sense and feeling of who one is. …