Person-centred care is an important approach towards people with dememtia and their care. It developed in the late 1980s by Tom Kitwood at the University of Bradford, United Kingdom. Person-centred care challenged archaic institutional approaches towards people with dementia and redirected attention away from bio-medical aspects of dementia and to people’s subjective experience of having dementia. This enabled people with dementia to be seen as able to make sense of their situation, as having feelings and possessing value, worth and dignity.
Kitwood’s initial argument was that professional practice towards people with dementia had been underpinned by the bio-medical approach. Kitwood argues that within the medical profession there existed a “hypothesis of exclusive neurological causation” which claimed that the behaviour of people with dementia was entirely due to neuropathological processes. Kitwood challenges this view and argues that people’s experience of dementia arises out of a the (dialectical – sorry Kitwood uses technical words at times, but continue reading anyway) relationship between physical health/neurological impairment and social/psychological factors.
“Personhood” is a central idea in person-centred care and Kitwood defines it as “a standing or a status that is bestowed on one human being, by another in the context of relationship and social being” (Kitwood 1997, p. 8). In addition, Kitwood sees personhood as transcendent, sacred, and unique; and that it accords people who have dementia with an ethical status that offers them absolute value resulting in an obligation “to treat each other with deep respect” (Kitwood, 1997; p. 8).
Kitwood links personhood with the provision of care to people with dementia and describes different types of interactive processes that often occur in dementia care settings that impair the personhood of people with dementia. These processes are called ‘malignant social psychology’ and are seen to have a malign effect on personhood and contribute to the development of dementia. Kitwood describes seventeen of these processes as “malignant social psychology”. One type of malignant social psychology is “treachery”. This happens when different forms of deception are used to manipulate or gain control over a person with dementia. Regrettably, this sometimes happens when a nurse says something that is untrue to a person with dementia so that they can get them to do something they would not otherwise do. When this occurs, the person with dementia feels betrayed and humiliated (just like you would!) and contributes towards their downward decline into dementia.
Another malignant social psychology Kitwood identified is “objectification”. This occurs when a person with dementia is treated as if they had no opinions and feelings, as if they were just a lump of dead matter. This occurs in many situations such as when a nurse changes someone’s clothes without realising that they can be seen other people or when a nurse is talking to another nurse about what they were doing the previous night without any consideration that the person with dementia is beside them. All these forms of interaction would have a malignant effect on anyone’s sense of self, but even more so someone with dementia.
Kitwood agues that the progression of dementia is not necessarily downward and that through good communication which he calls “positive person work”, a person’s condition may improve and lead to “rementia”. Kitwood (1997) outlines ten different forms of “positive person work”. One form of positive person work is recognition. This occurs when a person acknowledges that a person with dementia is a person. Nurses may do this by speaking to someone with dementia by their preferred name, by affirming the views of the person with dementia or by simply thanking a person with dementia. Another form of positive person work is play. This occurs when people with dementia are enjoying themselves as they undertake activities that engender spontaneity, self-expression and fun.