Personalised care means empowering people to have greater choice and control over the way their health and care is delivered. Personalised care is both desirable and challenging and NHS England is promoting this approach to caring, which will resonate with many in the workforce.
In the community, nurses work with patients, families and carers to provide care in environments that are not always ideal for clinical procedures, but which enable people to be cared for in a place of their choosing and where they have some control. The personalised care approach accepts that patients help determine their own care pathway and make informed choices, which may not be the preferred option of the healthcare professional.
While attending recently the National District Nurse Network (NDNN) – a network for professional leads of provider organisations - I was fortunate to hear Michelle Mello, National Clinical Lead for Personalised Care at NHSE England, presenting ‘in conversation’ with a Queen’s Nurse, Liz Alderton, a very experienced district nurse and practice teacher in London.
Liz explained that nurses in the District Nurse team use this approach all the time, ensuring that patients have the right to self-determination and are able to make informed decisions, in collaboration with the nursing team. Making plans for end-of-life care was an excellent example, the team working with the patient and the family to ensure that their wishes are respected in the last days and hours leading up to their death.
The approach is also used with people with long term conditions, supporting self-care and creating a supportive relationship where choices are made by the patient. Nurses and healthcare professionals can be challenged by the choices made by patients, which may be at odds with their professional view, based on evidence and experience. The important thing is that the patient understands the risks associated with their choices.
Seeing a patient follow a lifestyle that a professional knows is going to worsen their condition can be hard to accept. As nurses we have been educated to promote health and prevent ill health. However, in the community, nurses have a deep understanding and respect for the way in which people live and the choices they make.
What is unacceptable is seeing the consequences of the lack of choice available for some patients, where this is related to inequalities in health, determined by poor quality housing, unemployment, or insufficient income to provide a healthy diet and secure home environment.
This is why nurses working in the community will continue to be advocates for patients, families and carers and to highlight the impact of inequalities, not just on the health of population served, but in limiting the choices of individuals for personalised care.