Putting the person in the centre (not in the middle) as a necessary condition for proper care and good and efficient healthcare services. This is the basic theoretical assumption of the PhD program as well as for healthcare policies and healthcare services in many nations. The definition of healthcare is widely defined and can be studied from multi professional perspectives.
The second basic assumption of the program is a person-centred approach to research aiming at improving care services, stresses the necessity of synthesis and integration of both theoretical knowledge, professional skills and moral judgment.
The PhD program provides in-depth knowledge in contemporary approaches to person-centredness in healthcare research, practice and different lines of traditions. Also implications for choice of method and innovation of new methodological approaches are central issues.
Furthermore, different approaches to person-centred healthcare research are informed by different, partly overlapping traditions of philosophy and psychology of personhood, like
- the tradition of patient-centred care, running from Hippocrates to Kierkegaard (Kierkegaard 1859), Buber (Buber 1923/62) and Ricoeur (Ricoeur 1976) to recent theories of person-centred nursing (McCormack & McCance 2006; McCance, McCormack & Dewing 2011; Morgan & Yoder 2012),
- the tradition of person-centred therapy, running from Kierkegaard to Carl Rogers’ humanistic psychology (Rogers 1961) and further to today’s acceptance and commitment therapy (e.g. Hayes 2006; Hayes, Strosahl & Wilson 2011), and
- the tradition of human motivation and mindfulness, running from Antiquity and the teleological ethics of Aristotle to recent theories of mindfulness (Kabat-Zinn 1990) and self determination (e.g.Deci & Ryan 2008).
Three levels of healthcare
According to the International Alliance of Patients’ Organizations, patients and carers have a fundamental right to patient-centred healthcare that respects their unique needs, preferences and values, as well as their autonomy and independence; the essence of patient-centred healthcare is that the healthcare system is designed and delivered to address the healthcare needs and preferences of patients so that healthcare is appropriate and cost-effective (IAPO 2006).
In line with this definition, person-centred research may focus on one of three different levels of healthcare, the individual level, the inter-disciplinary level, and the organization or system level (Figure 1).
Figure 1: Areas of Person-Centred Research
Research concerning the individual level focuses on understanding the unique person and the unique living circumstances of the person/user/patient. In addition, the aim of producing new knowledge to support person-centred care highlights the importance of person-centred principles being applied also to the work-life circumstances of healthcare practitioners. Therefore, at the level of the individual, the PhD program focuses on theory and methods researching and stimulating user values and involvement, helpful communication and quality of the care services, one the one hand, and the practitioners’ experience of care intensity, cooperation and competence on the other.
Research at an interdisciplinary level focus on coordination, communication and interaction to improve efficiency of services, mutual knowledge among professionals and user participation across disciplines and services, including the experiential knowledge of the family, friends, and other members of the person’s community and local context. The PhD program particularly focuses on theory and methods for researching and stimulating interdisciplinary cooperation, clinical health promotion, shared decision making involving the user, and new models of practice to the benefit of persons with long term and complex health needs.
Research at an organizational and system level focuses on organizational culture and ways in which health and welfare institutional systems, both private and public, laws and financial regulations, set the agenda for health services. The PhD program focuses also on this level at theory and methods aiming at researching development of supportive organizational systems, ethical leadership, cooperation, innovation and change processes, with the aim of improving person-centeredness of health care services (e.g. the Coordination Reform).
References
Buber, Martin (1923/62). Ich und Du (Werke, Erster Band Schriften zur Philosophie, 1962).
Deci, Edward L. & Richard M. Ryan (2008). Self-determination theory: A macrotheory of human motivation, development and health. Canadian Psychology 49 (3): 182-185.
IAPO (2006). Declaration on Patient-Centred Healthcare: International Alliance of Patients' Organizations. Kierkegaard, Søren (1859). Synspunktet for min Forfattervirksomhed.
Hayes, Steven C. (2006). Acceptance and mindfulness at work: applying acceptance and commitment therapy and relational frame theory to organizational behaviour management. New York: Haworth Press.
Hayes, Steven C., Strosahl, Kirk D. & Wilson, Kelly G. (2011). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change: Guilford Press.
Kabat-Zinn, Jon (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, N.Y.: Delacorte Press.
McCance, Tanya, McCormack, Brendan & Dewing, Jan (2011). An Exploration of Person-Centredness in Practice. The online journal of issues in nursing 16 (2).
McCormack, Brendan (2001). Negotiating partnerships with older people : a person centred approach. Aldershot, Hampshire, England ; Burlington, VT, USA: Ashgate.
McCormack, Brendan, Karlsson, Bengt; Dewing, Jan & Lerdal, Anners (2010). Exploring person-centredness: a qualitative meta-synthesis of four studies. Scandinavian Journal of Caring sciences 24: 620-643.
McCormack, Brendan & McCance, Tanya (2006). Development of a framework for person-centred nursing. Journal of Advanced Nursing 55 (5): 472–479.
McCormack, Brendan & McCance, Tanya (2010). Person-centred nursing : theory and practice. Chichester, West Sussex: Blackwell.
Ricoeur, Paul (1976). Interpretation Theory: Discourse and the Surplus of Meaning. Texas: Christian University Press.
Rogers, Carl R. (1961). On becoming a person. Boston: Houghton Mifflin.
Steiger, Nancy .J. & Agnes Balog (2010). Realizing patient-centered care: putting patients in the center, not the middle. Frontiers of Health Services Management 26 (4): 15-25.