Blog - Person-centredness COVID19 and Me
Thursday, 2 July 2020
Blog Omega Xi Chapter Sigma Theta Tau International
In the UK at least, we seem to have arrived at a place where the Covid-19 virus is receding, lockdown is being relaxed and there is less of a sense of ‘crisis’ generally, but especially in health and social care settings. There is a nervousness in the air regarding the search for the so-called new-normal (whatever that might be) – as if we ever had something called normal, or we all agreed on what normal meant! The reality is that normal is only ever individually defined and unique to the perspective of each person. Of course, this issue of normal and defining normality has played out significantly during the Covid-19 pandemic as we shifted from ways of being and doing that fitted with our perspectives of the world and the ways we related to and with each other. As we adjusted from nearness to distancing; openness to masking; connectedness to avoidance, and reality to virtual reality, our sense of who we are as persons also needed some adjusting. As I have written elsewhere:
“We are more than our body-parts held together by connective tissue – we are interacting persons, guided by, whilst also shaping and re-shaping our being in the world through our interior and exterior conditions.” (McCormack & McCance, 2020)
Our personhood (what makes us persons) interconnected with our sense of ‘being’ is shaped by our continuous reflection on our beliefs and values as well as our place in the world and how we come to know that place. Covid-19 has significantly disrupted that sense of place in the world – adjusting how we relate with others in ways that don’t seem ‘natural’ has been a common narrative among many of us as distancing, masking, avoidance and virtual relationships became normalised. As nurses this is particularly challenging given that our being and doing is based on relationships and nursing is often described as a relationship-based practice. Indeed, my writing on person-centredness places relationships (being in relation) at the heart of person-centred practice and the basis for all other practices.
Seeing all of this morph into something that has a sense of ‘other-worldliness’ has been challenging and I have at times struggled to see how person-centredness as I know it would be sustained in such conditions and in our ways of being. I struggled hearing stories of care workers’ personhood being disregarded as expedient decision-making dominated; struggled with stories of older people dying isolated from their loved-ones; struggled with strategic decisions made about how nursing and healthcare students would be ‘employed’ and the expectation to implement such decisions without question; struggled with the language of war and heroes; and struggled with the sheer exhaustion that came with 10-12 hour days engaged in virtual meetings/conversations/events. The balance between being, doing and becoming as a person was destabilised and a recalibration of daily priorities needed to be made.
But have these experiences (that have been experienced in different ways by everyone depending on the nursing role we operated during this time) shifted what we mean by person-centredness and how we engage in person-centred practice? For some time during the pandemic I believed we had lost any sense of person-centredness in our nursing, but I have adjusted that perspective and instead believe that the core tenets of person-centredness (where they did exist) have not been lost, but have been recalibrated! Whilst there is no doubt that the trauma experienced by staff, service users and residents is real and cannot be nor should ever be minimised, I am also aware of the many positive experiences that are being recounted now that we have a chance to be reflective about it. The fact that, for example, many of the interprofessional rivalries that exist among multiprofessional teams seemed to disappear and a person-centred culture of shared decision-making, compassionate leadership and interpersonal wellbeing surfaced, says so much about our commitment to persons at times of crisis – what can we do to make THAT the ‘new normal’? Additionally, the number of new ways of communicating and engaging that have been developed offer new and exciting ways of creating a more connected world that is sympathetically present and authentic. Staff wellbeing strategies have flourished in many organisations and a greater sense of care about persons has surfaced. And of course, the ability of higher education institutions to embrace an online existence has been remarkable.
How we progress from here is still of course not yet known – it is our future to shape and take control of. Otto Sharmer provides us with that challenge:
“The coronavirus situation provides an opportunity for all of us to pause, reset, and step up. COVID-19, like any disruption, essentially confronts each of us with a choice: (1) to freeze, turn away from others, only care for ourselves, or (2) to turn toward others to support and comfort those who need help. That choice between acting from ego or acting from ecosystem awareness is one that we face every day, every hour, every moment. The more the world sinks into chaos, desperation, and confusion, the greater our responsibility to radiate presence, compassion, and grounded action confidence”
Sharmer’s words resonate with me as they connect with what I have previously described as the ’15 properties of person-centred practice’ from an organisational/whole-system perspective (McCormack & McCance 2017). It is my contention that these 15 properties provide us with a route map for continuing to move forward during the Covid-19 pandemic and to a newly constructed post-Covid reality:
1. Place person-centred values at the centre of decision-making
2. Pay attention to all parts of the system that contribute to creating person-centredness
3. Know the boundaries of individuals’ & build a team of complementary persons
4. Provide health-supporting services for everyone’s well-being
5. Create healing environments
6. Develop employment models that reflect individual need but that together strengthen the whole
7. Ensure all care needs are considered significant no matter how small
8. Engage in shared collaborative decision-making at all levels and with all persons
9. Establish feedback processes that hear all voices
10. Facilitate learning in and from practice
11. Pay attention to what matters most and let go of what matters less
12. Provide holistic care
13. Create spaces for stillness and calm for the benefit of personal wellness
14. Strip away things that confuse, are unnecessary & don’t contribute towards a healthful culture
15. Ensure processes are in place to maximise the engagement of staff with their work.
There are many opportunities for us to engage these 15 principles and re-shape nursing and healthcare and create the kind of system that has person-centred values, principles and practices embedded at every level. Doing so will create a new pattern that can be normalised and which has greater potential to achieve healthful cultures for all persons.
McCormack B and McCance T (2020 forthcoming) The Person-centred Practice Framework, in B McCormack, T McCance, C Bulley, D Brown, S Martin and A McMillan (2020) Fundamentals of Person-centred Practice, Wiley-Blackwell, Oxford
McCormack B and McCance (2017) Underpinning Principles of Person-centred Practice, in B McCormack and T McCance (2017) Person-centred Practice in Nursing and Healthcare: Theory and Practice. Wiley Blackwell, Oxford
Professor Brendan McCormack,
Head of the Divisions of Nursing, Occupational Therapy & Arts Therapies
Associate Director Centre for Person-centred Practice Research
School of Health Sciences
Queen Margaret University