Nurturing Personhood; An Essential dimension of Caring for Older Persons

Older people with complex health problems often experience frailty and vulnerability in many aspects of their lives. This experience can be overwhelming, threatening their sense of self and significantly diminishing their quality of life. For those of us who work with older people, it is thus imperative that we approach their care from a holistic perspective of aging and with a firm belief that in addition to their having the potential for functional rehabilitation, they also have the capacity for continuing development of personhood. Alford (1984) refers to holism as encompassing “…the concepts of body, mind, and spirit and interactions with the environment; it promotes respect for human beings, their unique needs, and their right to continue development of personhood across the lifespan.” p.11. Personhood is a complex phenomenon; it defies a reductionist definition and is generally conceptualized as a process happening over a lifetime. Gress and Bahr (1998) state, “Personhood describes the continued development of one’s total being in the physical, psychosocial, sociological and spiritual dimensions toward self-actualization.”p.20 Bahr (1992) also writes, “Attributes of personhood include wholeness, being, peacefulness, joyfulness, contentment, self-worth, self-esteem, social aspects, spiritual dimensions, individualistic, purposefulness, cultural orientation, and reality orientation.” p.5

As providers of health care for older persons, we are privileged. We have the opportunity to promote and support the continuing development of personhood in our clients, while also learning and developing ourselves through the experience of the caring relationship.

“When our personhood is honored we feel comfortable

when it is not taken into account we feel depersonalized.”

M. Buzzell

Following are some helpful approaches to nurture personhood in those older clients for whom we care:

· View those we care for as persons first. This implies a “getting to know” the individual and an obligation to incorporate this “knowing” into the plan of care.

· Explore with clients what their particular health concerns mean to them. This means becoming personally invested with each client and actively hearing and understanding each individual’s perspective. In this regard, Davis (1996) writes about illness as wake-up call…an opportunity for personal growth. She suggests, “Instead of being exclusively focused on doing what we were educated to do to relieve symptoms, we enlarge our role appropriately when we acknowledge that the patient seems to realize that he or she has had a wake-up call and that we can help him or her to discover just what is to be learned from this experience”. p.5 Egan (1982) suggests that we ask ourselves four questions: (a) What is the core of what this person is trying to communicate? (b)What is this person saying about his or her experience? (c)What is this person saying about his or her behaviors? and (d)What is this person saying about his or her behaviors? (Reported in Hickey, 1986).

· Create a physical environment that supports the abilities of older people. Participation in one’s own care enhances feelings of independence and promotes a positive self-concept thereby contributing to preservation of personhood.

· Avoid such language as “waiting for placement”, “social admission” and “not motivated”. While professional jargon is convenient for health care providers, it is distancing for clients. It also has the potential to diminish their feelings of self-worth and curb their continuing development of personhood.

· Ensure clients are not asked to give the same information over and over again. Create processes that facilitate information sharing among providers and organizations. This includes not only critical clinical information, but also equally critical information about the patient as person.

· Involve clients and family members in discharge planning that includes attention to their multi-dimensional needs during transition phases, for example the move from acute care to rehabilitation or from rehabilitation to community care. Involvement in decision-making significantly decreases feelings of helplessness and worthlessness and aids in preservation of the person’s sense of uniqueness and individuality.

· Ensure clients are supported and given the time they need to make difficult decisions, such as giving up independent living and moving to a long-term care facility. This major life transition is one of the most difficult for older persons and requires exquisite sensitivity and compassion on the part of health care providers.