Elise Brianna, Kirshbaum Marilynne N, Wikander Lolita, Cockshaw Wendell D
Faculty of Health, Charles Darwin University, Ellengowan Drive, Brinkin, NT 0810, Australia.
Charles Darwin University, Ellengowan Drive, Brinkin, NT 0810, Australia.
Nurse Educ Today. 2025 Mar;146:106516. doi: 10.1016/j.nedt.2024.106516. Epub 2024 Nov 26.
Extensive nursing literature exists on the term person-centred care. Nevertheless, there is scant literature defining or explicating the concept. Rather, necessary contextual pre-conditions are often presented under the guise of explicit definitions. Person-centredness appears to be explained as a culture that could allow person-centred care to exist. This raises problems knowing what is being provided and what is being received in a person-centred care experience.
Within a caring space, a nurse providing person-centred care assumes an ontological perspective to provide such care. Specifically, it is typically assumed that the care giver is oriented to a single objective reality and the needs and desires of the care receiver can and should be judged from that perspective. However, when perceived reality noticeably differs between people, this ontological position may not hold. This is particularly apparent when a care receiver is experiencing dementia or other conditions which appear to alter conscious experience. This fundamental problem raises the contemporary issue of the nature of consciousness, as reality is perceived in the context of consciousness.
Some recent evidence such as that presented by Hoffman, suggests that consciousness may be more fundamental than physiology. This may form a basis for connecting with and understanding the experience of another. Consistent with this perspective, we introduce the concept of a Multiple Ego State System (MESSy). This concept may be a starting point for a theory-based person-centred approach to nursing which truly honours the perspective of the care receiver.
An ontological position inclusive of all individual realities as parts of one consciousness is an attractive position for the theoretical placement of person-centred care. Foundational work is therefore needed to explicate this concept.
关于以患者为中心的护理这一术语，护理领域有大量文献。然而，定义或阐释这一概念的文献却很少。相反，必要的背景前提条件常常以明确的定义为幌子呈现出来。以患者为中心似乎被解释为一种能让以患者为中心的护理得以存在的文化。这就产生了一个问题，即在以患者为中心的护理体验中，很难知道提供的是什么以及接受的是什么。
在护理空间中，提供以患者为中心护理的护士会采取一种本体论视角来提供这种护理。具体而言，通常假定护理者面向单一的客观现实，并且可以且应该从这个角度来评判护理接受者的需求和愿望。然而，当人们对现实的认知明显不同时，这种本体论立场可能就不成立了。当护理接受者患有痴呆症或其他似乎会改变意识体验的疾病时，这一点尤为明显。由于现实是在意识的背景下被感知的，这个根本问题引发了关于意识本质的当代问题。
一些近期的证据，比如霍夫曼所提出的证据，表明意识可能比生理机能更为根本。这可能为与他人的体验建立联系并理解这种体验提供一个基础。与此观点一致，我们引入了多重自我状态系统（MESSy）这一概念。这个概念可能是基于理论的以患者为中心的护理方法的一个起点，这种方法真正尊重护理接受者的观点。
将所有个体现实作为一种意识的组成部分纳入其中的本体论立场，对于以患者为中心护理的理论定位来说是一个有吸引力的立场。因此，需要开展基础工作来阐释这一概念。
