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Chapter 2: Literature Review
Patient- or person-centred care (PCC) may be explained as care that is respectful of
and responsive to individual patients’ preferences, needs and values whilst ensuring
that patient values guide all clinical decisions (Institute of Medicine, 2001). Manley
and McCormack (2008) explained that PCC is a term used to describe the
therapeutic relationships between care providers and service users, and between care
providers themselves.
The majority of papers published about person-centred care have focused on
providing frameworks for clinical practice (McCormack, 2008; McCormack and
McCance; 2006; Manley and McCormack, 2001; Nolan et al., 2001; Ford and
McCormack, 2000; Titchen, 2000). Many of these frameworks share similar
recommendations for effective staff/resident communication, staff expertise in
working with older people, a sense of humanity in the care environment, and the
establishment and maintenance of successful staff/resident relationships. The
“positive-person framework” was developed by Kitwood (1990) and has its roots in
social psychology. Kitwood (1990) stated that the approach to communication
influences the type of caregiving and the culture of care. Titchen (2000) then devised
the “skilled companionship” theory, which stated that the nurse must possess a high
level of expertise in knowing the older person in order to deliver PCC. Similarly, the
Burford Nursing Development Unit in Oxfordshire developed a humanistic
framework that facilitated nurses and residents to consider the lived experience.
Furthermore, Nolan et al. (2001) devised the “senses framework”, which focused on
residents’ need for security, belonging, continuity, purpose, achievement and
significance. Nolan et al. (2001) concluded that the senses framework for PCC is
actually dependent upon relationships.
McCormack (2001) then aimed to further develop the PCC theory and stated that
there are four concepts underpinning person-centred nursing: being in relation, being
in a social world, being in place and being with self. Being in relation is about the
relationship between the nurse and the patient. Being in a social world relates to
knowing the person’s social interests and devising life-plans for them. Being in place
relates to the working environment and its systems, which may promote or hinder
person-centred practice, and being with self relates to knowing the patient and their
values. What all of these frameworks have in common is the recognition of the