Editorial: Tell me, how do you define person-centredness?

The International Community of Practice for Person-centred Practice (PCP-ICoP) coordinated from Queen Margaret University, Edinburgh, recently wrote about the current state of person-centredness across several countries in the world (McCormack et al. 2015). In that publication, we highlighted a number of concerns, the existence of which are working against the advancement of person-centredness as a coherent theoretically informed and practice-embedded framework for nursing. We believe that a focus on person-centredness provides an opportunity for nursing to rise above particular theoretical ‘fan clubs’ and work within a coherent set of principles that are multivariate, context nonspecific and trans-specialist. To begin with, we, as a profession, should have major concerns connected with how person-centredness is defined across the nursing community and it is surprising to us that there is not more concern about this. We repeatedly observe across the arenas of research, education and policy that person-centredness is not defined or incompletely and poorly defined. There are two dominant features that troublingly, currently pervade descriptions of personcentredness. First, we repeatedly see person-centredness being introduced as hard to define. This has been the case since at least 2004 (Dewing 2004; McCormack 2004). Surely, we need to be moving on from this by now? There are now various definitions that can be used, although some caution is needed as not all of these are underpinned by research evidence or theory. Second, person-centredness seems to be more and more defined according to one or two of its more popular or appealing attributes. The favourites we observe recurring in the literature are that person-centredness is working with what matters to the patient; it is about acknowledging the values, choices and preferences of patients, and it is about a certain type of nurse–patient relationship – always a compassionate one! Indeed, person-centredness does include all of these attributes; however, this is not the totality of person-centredness and, to advocate it, promotes an unhelpful simplification of the concept. There is a paradox here, as the oversimplification also misses the point that, for example, facilitating choices and preferences or developing, maintaining and sustaining a compassionate relationship are probably the most challenging aspects of nursing in the complexity of practice contexts. It is easy to ask the question ‘what matters to you’ but it is quite another to meaningfully and authentically respond to another person’s response. Further, should not we question the dominance of compassion as the ‘only thing that matters in our relationships with persons? Is that what is always wanted? And what about my ability as a nurse to be compassionate even in practice settings that show little compassion to me as a nurse or as a person? These are not simple issues and are not ones that can be fixed with short cycles of change or practice artefacts (badges, symbols, aide-memoires). A related concern is what almost amounts to squabbling between champions of different approaches to person-centredness and positioning these to achieve centre stage for their favoured definition. Definitions are being proposed that are not backed up by empirical research and are severely lacking on theoretical underpinnings. For example, we can perhaps see this in how Karl Rogers is repeatedly proposed as the founder of person-centredness when the etymology of the concept predates Rogers, or Tom Kitwood’s definition of personhood unquestioningly accepted as the underpinning framework in research and development work, without considering the implications of using that definition out of context. Sitting on the periphery, we can see a theoretical knot about concepts related to personcentredness and whether or not they fit under the umbrella of person-centredness. Prominent here are the concepts of women-centred care, child-centred care and family-centred care. The simplification of person-centredness for nursing practice in particular is in the longer term unhelpful for a number of reasons. It encourages a na€ıve understanding of person-centredness which immediately limits the potential to have the impact we know it can. Recent doctoral research (WareingJones 2016) indicates that whilst practitioners have an outline appreciation of person-centredness, they tend not to draw on empirically developed theoretical models, have an incomplete personal understanding of what person-centredness is and generally experience working in contexts and cultures that are inherently unsupportive of person-centredness, meaning they cannot embody or practice in person-centred ways. This leads us to raise the most pressing of concerns: that the majority of definitions of person-centredness completely miss that person-centredness is about a specific type of culture, that incorporates but does not isolate care and one that needs to apply to everyone in an organisation. It is not something that can be technically applied, and certainly, person-centredness cannot thrive