Person-centred approach is a psychological trend which was invented by Carl Rogers (1902-1987). Carl Rogers was an American psychologist and psychotherapist. His hypothesis was that each person owns a reserved potential of self-understanding and the power to change themselves positively. The task of psychotherapy and helping relationship is to help to mobilize those reserved potentials. The person-centred relationship has three main features: 1. Empathic understanding is when the helper is trying to understand the client’s world and the way the client lives his/her life. During my work I keep my behaviour and emotional responses positive. I do not try to influence the client’s decisions and choices. I accept the client’s choices, if that does not cause harm or dangerous to the client, to me or others.
For example follow the client’s bedtime routines. 2. Unconditional acceptance is when the helper does not try to lead the client towards some imagined ideal, but accepts the client just the way he/she is. The helper tries to identify the client’s feelings and gently give them back to the client. The effective communication is very important and the active listening as well. In my work place I am trying to ask questions from the client when I can see something disturb her. For example emotional distress about a broken relationship. 3. Congruence is when the helper does not play a role in the relationship, but participate in it whit his/her whole being. The helper has to be valid while he/she expresses his/her emotions. The helper’s thoughts, emotions and words are also important, not just the client’s.
Abraham Maslow (1908-1970) was an American psychologist who developed the Maslow-pyramid, the hierarchy of needs. His theory was that there is a hierarchy of needs from the basic biological needs to the complex psychological motivations. If the basic needs are being satisfied then the person can reach the next level, and the next… He categorised the basic human needs into five groups:
1. Physiological needs: The physiological needs are the most dominant needs like air, water, food, sleep. If these needs are not being met, or even just one of them unsatisfied, then all the other needs may cease or being downgraded. For example: If someone is hungry, this person’s only purpose is to get some food. In this case he/she will not care with the other motivation needs, such as buy a safer car. He/she will neglect all the other basic needs as well, the sexual desire and the need of sleep. The hunger completely fills out the person’s mind.
-When I am working I cook meals to the client and assist her to eat. The client also has Fortisip (multi-fibre milkshake or nutritional milkshake) five times a day via PEG (Percutaneous endoscopic gastronomy feeding tube). -I take care of the client’s fluid intake. As District Nurse requested, the client has to have two litres fluids per day. -I check the client’s air pressure mattress each day. It has to be on the pressure relieve mode and set to the recommended load. This was specified by the District Nurse.
2. Safety needs: What is safety? I think the knowledge that we are protected from danger, from weather, from crime, from war, from epidemics, etc… It also includes the sense of existential stability that we will be able to ensure to satisfy our basic needs in the future. When I am working I ensure that I read the client’s Care plan with all the risk assessments and I am aware all the possible dangers. The client I am working with has: -Medication risk assessment: Client has visual impairment she is not able to read the medication labels. Client has allergies. Client is using catheter and stoma. -Moving and handling risk assessment: Client is not able to move; carers need to use the ceiling hoist for all transfers.
Carers use slide sheet for positioning. -Pre-assessment-Premises and Environmental Risk/s to staff: no risk found. -Infection Control: Infection in the peg site. Clogging of the tube. Peg tube comes out of the stomach. Client colonised with MRSA at catheter site and is being treated for it. Future infection in the body and stoma site. Keeping the Stoma area clean and caring for the Colostomy. -Health and Safety risk assessment: Client chokes when she is eating or drinking due to her condition. Incorrect diet and supplements will cause choking and health complications. -Heavy Load: Carer pushing the client in a carer controlled wheelchair as client is not able to use electric wheelchair. Carer is at risk of hurting their back when pushing client up gradients. -COSHH: Storage of cleaning goods assessed.
-Bed Rails risk assessment: Client can fall out of bed or hurt herself on the rail when having a spasm. -Pressure sore risk assessment: Client is not mobile and thus needs to ensure the use of pressure relieving equipment. -Nutritional risk assessment: To ensure client maintains a healthy nutritional intake. -Financial risk assessment: Client does not have the capacity or mobility to look after her finances.
3. Social needs: On this level, when the basic and safety needs are being satisfied the individual’s emotional needs come to the forefront. The individual’s desire to be surrounded with friends, family. The point is the affectionate, intimate, honest human relationship. Here the love is not to be confused with the basic sexual desire from Level 1. During my work I am trying to keep the client emotionally content. Although my client has a family which visits her as much as possible, but sometimes they just cannot make it for a week and my client becomes upset, worried and stressed. To avoid this situation I keep her company and try to distract her attention. I speak to her and share my memories with her. I entertain her and keep her positive.
4. Esteem: Individuals need to estimate themselves that is self-esteem. The need for positive self-esteem is common in everybody. An individual’s emotional well-being is based on their own self-image and self-esteem, the way they feels about themselves. Individual does also need the respect of others which should be gained by real capabilities and results and in this way the individual’s self-esteem will further nourish. While I am working I give as much attention as possible for the client. To promote the client’s emotional well-being it is important to show genuine interest in her person and to ask questions to find out more about her and to listening what she wants to say. I ensure that she feels herself listened to, understood and respected.
5. Self-actualisation: It is hard to achieve self-actualisation even for everyday people. When the physiological needs, the safety needs, the social needs and esteem are being met than the individual can start to work to achieve self-actualisation. Maslow thought there is some behaviour whose can lead to self-fulfilment. They can be used well in my work in care. -Try new things do not stick with old, safe methods. For example try a new food it might taste good or try a new activity. -Be honest and real, do not play a role. For example take part in the client’s care with your whole being. (Just as Carl Rogers said in his Person-centred approach-congruence part.) -Be patient and steady to reach your goals. For Example support client to achieve what they wish.
A number of people experience the moments of self-actualisations, Maslow called them peak experiences. The peak experience is an experience characterized by happiness and safety. It is a state of perfection, the cherry on the top. As every people different they experience these moments in different ways, just a few example:
-Affectionate relationship with others, birth of a child.
-Creative activity, an own exhibition.
-Joy of the sport, to win on a competition.
I have worked with my client as a live-in carer for over a year now, I know that she’s cherry on the top would be to see a live Lee Evans show. She adores stand-up comedy and she favours Lee Evans. Hopefully one day she’s wish will come true. I am sure if there will be a chance her family will take her to a show and she will be able to experience the fleeting moment of self-actualisation. (All of us can feel these peak experiences day by day not just in a long waited thing. I preferred to choose this example in my course work.)