Person-centred care: Being generous

I was working with Tom, a young man with dementia who was often quite unsettled.  

One day I spent some time sitting with Tom. I found out that he didn’t know anything about his parents who had both died, and this was on his mind.  

I asked Tom if he would like to visit his father’s grave, so we visited it and talked about the words that were written on the headstone.  He cried and grieved.  We took a photo of his father’s resting place and I printed it off for him to keep.  

After we had gone through all this, Tom was really settled and much happier.

• In Miriam’s story you can see how things changed when she took the time to find out about Tom’s story, and made the effort to help him connect with his father’s graveside memorial.
• From the perspective of the care team, there may have been no particular reason to think that Tom’s parents’ deaths would have anything to do with his unsettled state.  The only reason Miriam discovered that there was a link was because she was being generous with her time in this respectful way.
• Miriam’s generosity didn’t depend on Tom reacting in a certain way – it was just offered as a kindness.  But look what good came out of it!
• What effect do you think this kindness had on the whole team, and on other people in Tom’s life?  Some writers have referred to this as 'ripples of celebration spreading through a community'.

It’s not just giving time to “do things”, it’s giving time to “be with”. One person who has written and spoken a lot about this is Dr John Swinton.

• It is very easy for us to be driven by time. We can be looking to the next task that has to be done, and the next place we have to be.
• We can miss the person in all of this busyness.
• Being intentionally present is about putting the person first. It is about recognising someone for who they are and really trying to be in the moment with them (not thinking about other things).
• Being present in the moment with someone is a way to say “It’s good you exist. I’m glad that you’re here”. It is an expression of love and validation (see last month’s topic).

Being in the moment with a person and generous with our time and energy, rather than being dominated by ’clock time’, is a way for us to communicate “Ka kite au i a koe. I see you”.  This is a message Te Ao Marama Apiata (Ngati Hine, Ngati Rahiri, Ngati Kawa) shared with us: 

• Reflect back on key moments of interaction with other people that really helped you at times when you felt very vulnerable. What can you recall that made this so special? I would guess that you have been seen and felt heard .
• I have had the privilege to sit with a kuia who explained to me a deeper meaning of "Tēnā koe". It is often used as a greeting, however, it is about who the person is that is being greeted - not only as an individual, but all of those that have informed who they are, their whakapapa. "Tēnā koe. I truly see who you are and I sit with who you are".
• In our current crazy busyness of life, there are more and more constraints on our time. These external factors impact on our ability to sit with people. We focus on our needs and wants. We just don't get to see the bigger picture.
• Whakawhanaungatanga (developing relationships) can help us realign our priorities. From a Māori world view, we have tikanga (customary practices) that  help us keep these external factors in check - if we choose to apply them. By putting these tikanga into practice we can start meeting people at the point of time when they need someone to understand them. "Tēnā koe. This is you and I want to get to know you more".
• Dr Susanne Pitama and her colleagues have developed a model, the Meihana Model, that builds on Tā Mason Durie’s 'Te Whare Tapa Wha' to support health practitioners to better engage with whānau who require support with their wellbeing. Through utilising the hui process her ākonga (students) are able to engage with tāngata whaiora (people with a disability) in a meaningful and mana enhancing way. They are able to spend the time required to see who they are sitting with and to understand what they need, to support tāngata whaiora to achieve their wellbeing goals. "Tēnā koe, I have seen you and your whakapapa. Kia ora ai, I will support you with your wellbeing".

• We still need professional boundaries.
• Professional boundaries help us to stop the lines being blurred about what our role is.
• This can be particularly tricky when working with people living with dementia who may not understand how your role is different from a family member.
• We are talking about being generous with time and energy within your role. 
• When you are not sure about whether doing something is appropriate in your role, it can be really useful to talk it over with people you work with or to ask yourself “what would they think?”.

• You can listen to Professor John Swinton talk about being present and creating connection  here
• You can read more about the Meihana and hui ideas here
• You can find a list of resources about compassion fatigue here
• You can find some tips about how to communicate to help make a connection here
• New Zealander Robyn Youngsen has written a book TIME to CARE: How to love your patients and your job.