Patient as Person

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Patient as Person

• Wendy Greenstreet
• Nursing and Applied Clinical Studies

2
Setting the context

• use of language
• personhood in health care
• parameters of being a person
• concept of individual
• becoming a person
• ethics and dissolution of person

3
The use of words in healthcare

• determine our expectations of others
• reflect the model of care practiced
• labelling can limit the potential of the person

4
Patient defined

• noun, a person receiving or registered to receive
  medical treatment (Concise Oxford Dictionary
  2001)
• association with medical model of
  healthcare...compliance...in their best
  interests
• subservience of the art of care to the eminence
  of scientific knowledge
• care contractual concerned with task
  accomplishment

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Service User

• attempt to correct imbalance
• a) affirm autonomy
• b) promote participation in significant
  decision making
• however
• a) limited view of caring fails to convey
  mutual sharing
• b) fails to acknowledge what professionals
  offer in averting futile intervention and wasting
  limited resources

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Person in Health Care

• term is levelling- professionals also persons
• whole persons-psycho-socio-spiritual-physical
  beings
• collaborative team working necessary to fulfil
  all dimensions of care
• person centred care not determined by context but
  by professional world view

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Human and Being

• Being Human tissue is human
• Being a Human Being implies
• organised wholeness
• an identity
• individuality-related to, but not synonymous
  independence
• a higher order of being
• (Habgood 1998)

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Parameters of being a person external attributes

• Genetic identity
• Bodily presence
• History -symbolised by treasured possessions

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Parameters of being a person internal attributes

• Entail some kind of communication
• Cultural environment relevant
• Experience shapes who we are
• Language we speak-provides patterns of meaning so
  we can shape our thoughts
• To whom we relate - psychological and social
  belonging
• Consciousness - self awareness

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Individual as singular or distinctive

• each person distinct from other persons
• symbolised in having a name
• relates collectively to all other persons
  constituting humanity
• personal awareness of the self as human and human
  condition as transient (Piedmont 2004)

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Integrated components of individual as
indivisible
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Characteristics and attributes of spirituality in
health care

• every person has a spiritual dimension
• search for meaning and purpose
• hope - sense future
• forgiveness living with our flaws
• spirituality not synonymous with religion
  religion as an example of spirituality
• connectedness
• self - intrapersonal
• others/environment -interpersonal
• transcendence transpersonal

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Becoming a person

• Concerned with potential - comes from -
• Response-ability to choose (Booth 1995)
• Personal agency potential to choose to behave
  differently
• Fate (as inevitable) countered by
• Chance (as uncertainty) presents new choices
  and the possibility of change
• Destiny- purpose in life, unfolding story of
  what becomes of a person (Larner 1998)

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• Freewill
• ..difference between explaining the behaviour of
  individuals in terms of their character, and
  explaining it away as the inevitable consequence
  of impersonal forces, is crucial within ordinary
  relationships
• to claim that one is not responsible for ones
  actions is to contract out of the business of
  being a person
• (Habgood 1998)

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Being myself

• about unity and identity as persons
• an active process
• rooted in biology and culture
• coherent set of responses to experiences
• consistent intentions and dispositions

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Being real

• You BECOME. Thats why it doesnt happen to
  people who break easily or have sharp edges, or
  who have to be carefully kept. Generally, by the
  time you are REAL, most of your hair has been
  loved off, and your eyes drop out and you get
  loose in the joints and very shabby. But these
  things dont matter at all, because once you are
  REAL, you cant be ugly, except to people who
  dont understand
• (Williams 1985 p.12-13)

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Becoming associated with age

• assimilative coping strategies
• accommodative coping
• (Diener et al 1999)

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Person - in summary

• Human being
• Bodily presence
• Entails some kind of communication
• Exist essentially in relationship
• Individual as indivisible and distinctive
• Choice significant in becoming

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Dissolution of a person

• in that becoming a person gradual - then
• a kind of gradualism does also make sense when
  one is watching the slow dissolution of a person
  through illness or old age (Habgood 1998 p.28)

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Technology and Natural Order

• not conscious, life sustained mechanically-control
  natural order - extend life regardless loss of
  person
• self-awareness lost - conscious, life sustained
  without mechanical support - natural order may
  see growth in form different person in same
  physical shell

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Ethics and Quality of Life

• Principles of medical ethics
• Beneficence
• Non-maleficence
• Autonomy
• Justice
• Quality of life
• Patient predominantly physical focus
• Person wider parameters

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Healthy Congruence Balancing Control with
Spirituality

• Control
• planning and deliberate behavioural strategies
• strive to re-establish pre existing conditions
• Spirituality
• intellectual and emotional - transcendence of
  artificial limits
• sharpen perception dependence wider universal
  order cannot control

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Conclusion

• potential linked to becoming - ability to respond
• if becoming unravelled-loss capacity to grow
• no perfect answers
• ethically, best interest determined by focus on
  individual as whole person
• congruence related to choice - control tempered
  by spirituality to avoid futile struggle

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References

• Booth L (1995) A New Understanding of
  Spirituality. Journal of Chemical Dependency 5
  5-17
• Diener E, Fujita F (1999) resources, personal
  strivings, and subjective well-being A
  nomothetic and idiographic approach. Journal of
  Personality and Social Psychology 68 926-935.
• Friedemann ML,Mouch J, Racey T (2002) Nursing the
  Spirit the Framework of Systemic Organization.
  Journal of Advanced Nursing 39(4) 325-332.
• Greenstreet W (ed) (2006) Integrating
  Spirituality in Health and Social Care. Radcliffe
  Medical, Oxford.
• Guenther M (1992) Holy Listening, The Art of
  Spiritual Direction. Darton, Longman Todd,
  London

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References cont.

• Habgood J (1998) Being a Person, where faith and
  science meet. Hodder and Stoughton, London
• Larner G (1998) Through a Glass Darkly, Narrative
  and Destiny. Theory and Psychology 8(4)549-572
• Piedmont R (2004) Spiritual transcendence as a
  predictor of Psychosocial Outcome from an
  Outpatient Substance Abuse Program. Psychology of
  Addictive Behaviours 18(3) 213-222.
• Williams M (1985) The Velveteen Rabbit. Avon
  Books, New York.
• Williams R (2005) Grace and Necessity,
  Reflections on Art and Love. Morehouse