Person Centred Care:
Being Generous
Person-centred care is generous with time and energy.
We all want to be seen as generous rather than stingy. Kindness to others is one of the hallmarks of families, teams, and even societies.
Being kind and generous with our skills and time is not unique to a person-centred care approach, but it is an important part of this perspective on dementia care.
Miriam’s Story
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 went and talked about the words 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.
What Do We See in Miriam’s Story?
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 the link was that 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’.
Tip 1: Be in the Moment With People
It’s not just about giving time to “do things”; it’s about 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 look at the next task to be done and the next place we need 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 being 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).
Tip 2: Being Generous With Time and Energy Is Important When Working With Tangata Whenua
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 the deeper meaning of “Tēnā koe”. It is often used as a greeting; however, it is about who the person being greeted is, not only as an individual, but also as part of the whakapapa of those who have informed who they are. “Tēnā koe. I truly see who you are, and I sit with who you are”.
In our current crazy, busy lives, there are more and more constraints on our time. These external factors impact 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 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 understand what they need, to support tāngata whaiora in achieving their wellbeing goals. “Tēnā koe, I have seen you and your whakapapa. Kia ora ai, I will support you with your wellbeing“.
Wait, Does Being Generous Mean I Have No Boundaries to My Role?
We still need professional boundaries. Professional boundaries help us avoid blurring the lines of our role.
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?”
Tip 3: Care for the Carer
Sometimes we don’t feel we have time to give. It can be hard to hear this message about being generous with time when you are feeling overwhelmed. Being short-staffed has a huge impact.
It is important to realise that sometimes taking this approach can help to make things go more smoothly and actually save time! Tom’s staff were already spending a lot of time with him in Miriam’s story. Miriam chose to spend some of that time differently.
Sometimes we feel that we don’t have any empathy left to give. Compassion fatigue is a specific type of stress that we, as caring professionals, can experience. It has been described as “the emotional, physical, social and spiritual exhaustion that overtakes a person and causes a pervasive decline in his or her desire, ability, and energy to feel and care for others” (McHolm, 2006).
Here are some tips to help combat compassion fatigue:
– Work on the way you talk to yourself
– Celebrate that you make a difference in the work you do (you really do, thank you!). At the end of the day, take a moment to reflect on this and the good things that happened.
– Realise you can’t solve everyone’s problems or fix everything.
– Remember that your client’s suffering is not yours to own; let it go.
Look after yourself:
– Take your breaks.
– Take care of your physical health.
– Talk to people in your life about what a better work/life balance might look like.
– Learn to say no.
– Make time to do things that you enjoy outside of work to help you recharge. Pick one thing that you are going to do just for you, and schedule it in your diary.
– Take opportunities to learn.
– Maybe taking time to enjoy just being with the people you are supporting may help recharge your batteries and remind you of why you started this work in the first place!
Expand your resources:
– Make connections with colleagues you can trust.
– Consider learning a mindfulness technique.
– Check out whether your organisation has an employee counselling scheme available.
Would You Like To Find Out More About Being Generous With Time and Energy?
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.
What Might This Look Like?
How do we know that we are working in a way that tries to be in the moment with people? Some of the things we might see are:
1) Always taking a moment to pay attention and connect with the person before starting tasks for the day. For example, smiling and greeting the person by name.
2) Offering a calm presence, rather than seeming rushed or stressed – even if you have to fake it!
3) Trying not to interrupt or talk over the person.
4) Using body language and getting down to the person’s level to make eye contact.
5) Using touch, as appropriate, to help connect and gain attention. This might be a hand on their arm, shoulder, or holding their hand.
6) Trying not to multitask, particularly not holding a conversation with someone else at the same time that we are helping the person.