Part 2 - Person centred care

The experiences of older people and their families highlight why it is essential that we listen to them and work in partnership to achieve the best possible outcomes.

Respect, dignity and partnerships with the older person and their family underpin person centred care.

Luke Graduate nurse
When you are caring for somebody who is acutely unwell, it is hard to sometimes look at them as a person and not just as a bunch of observations.

Susan Clinical Nurse Specialist Continence.
Health care is very task orientated, theres a lot to do and sometimes we get caught up with almost ticking off all the activities we have to do. You know, have you done the medication, have you done the obs? You know, have you, you know, changed this dressing? When often, we dont stop and say well how are you feeling today? You know. Do you want to have a shower, or maybe you just want to have a rest, or would you like me to take you for a walk today?

Marilyn - Multiple hospital stays
You make a transition straight away. The minute you take your outdoor clothes off and put on your bedclothes, you suddenly become the patient.

Ray - patient hospitalised because of stroke
Youre only known as a patient with a name above your bed and the date you came in and the potential date you will be discharged, so, um, they do need to know who you are outside of this confined area.

Hilda - Hospitalised for 9 months
And Id say to the night nurse will you have a look and see how my bags going in two hours? They wouldnt do it, and then the bed would get in a mess, because I havent woke up. I say Im not likely to wake up in a couple of hours, or something, and then theyd come in and oh yes, yes, theyd fixed up the bed and that, but theyd leave me in the cold, trying to fix up, put me bag back on and clean up things like that.

Marilyn - Multiple hospital stays
You hear the doctors round coming down the corridor, and you could see them going into one room, then the next one, and they finally get to you, and the doctor comes in, and so many times, the doctor would come in, and he would lift up, open up the dressing, have a look at the wound, have a bit of a poke at it, then close it up, and then talk to you and go out of the room again, and you sort of think, where has he been before, the gloves are there, the basins beside the bed, the hand wash stuffs there. Whens he going to wash? Is he going to take what Ive got into the next room or have I picked up something from the person before, and particularly when I had a wound that wasnt healing, that scared me a bit and I just sort of felt, well, if he really respected me as a patient, at least he should do what the nurses do and wash and put on the gloves and dispose of them, and it wouldnt really take him that much more time and that became fairly scary.

Ray - patient hospitalised because of stroke
When the doctor came around visiting, hes often come with a team of trainee medical students, and I remember sitting in the chair and he said hello to me, and then he turned his attention to my leg, and particularly my foot, which had a tendency to drop, and he proceeded to talk to the medical students about my foot, and how, you see this, and how the foot drops, and that will never get any better. And here I was, sitting there listening to this and taking this in. Now, itsyou can imagine by my comments, that its impressed in my mind a little bit, but remember, I was very positive at this stage. People who are not so positive about such things might have an adverse reaction to that, and really set them back, instead of encourage them to come forward and get better.

Lyn - Hilda's daughter
With the medication that Mum was on, it, she was seeing things, doing things, pulling out her tubes from her arms, verbally abusing people; she wouldnt kill a fly, let alone doing anything like that. And they just wouldnt believe that it wasnt me Mum. Let them know what youre doing; I think thats a very important thing. Just dont give them an injection, say, well you need that. What is it? What would it do? Hows it going to affect me, or what? Why am I taking all these tablets? Whats this blue one for, whats the red one for?

Ray - patient hospitalised because of stroke
I think that we really need to really, um, understand that theres a lot more to each patient than just what you see in the care of the hospital system.

Marilyn - Multiple hospital stays
The people who do come in and treat you as a person, with a family, with a history, with a, um, a life. You respond to so much better. Theres, um, theres a link, a communication that takes place.

Dora Clinical resource nurse
I find that the families and the carers that come along to us, with the patients, have a wealth of knowledge. When the patients cant tell us what they need, their carers often can. When that family member comes in, and they know that Dad walks better when you do this with him, or Dad can only walk so far, or the next time you do it, if you step him this way, thats what we find that works. Listening and sharing and listening to the patient as well, but when they dont have the words, the carers often do.

Luke - Graduate nurse
Families, um, you know, theyre the patients number one support. Umm. Quite often theyll come to us with questions that, you know, you wouldnt have thought that they would talk about.
Lyn - Hilda's daughter
Theyve got to listen to the family in that situation, and its very hard if they dont, because you do know that person better than what they do, theyve only met that person only just then.

Marilyn - Multiple hospital stays
I think of one doctor in particular who has just been incredible. Hed sit down and get to you an eye to eye, and would ask you one question, a simple question, how are you coping today? and hes give you time to answer. Just speaking to you as if you were a normal person, I could have been in my lounge room, I could have been anywhere, but he showed he cared.

Ray - patient hospitalised because of stroke
You need to dispense with the idea of running to time, and doing all the physical attributes for the patient, and look for the soul and the person inside that body. It only takes that and youve got the whole trigger to the willingness to come forward and recover.

Music and narration

Functional decline is a serious problem for older people in hospital. It can affect a persons ability to perform day to day tasks, and their independence, which can lead to a longer stay in hospital and increase their likelihood of needing admission to residential care. Fortunately, there is much that we can do. We know from the evidence that outcomes for older people in hospital are better when everyone involved in their care takes a person-centred approach, and uses best practice. Often it is the small things that make a difference. Treating older people with respect and dignity, treating them as partners in the health care relationship, listening to them, their families and carers. Letting them know what you are doing and why. Taking the time to get to know them and treating them as an equal. By taking a person-centred approach and using evidence-based practice, as explored in the Best care for older people Toolkit, we can minimise the risks and improve outcomes for older people. To access the toolkit, go to the website.