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Caring for the person

patient-care

Caring for the person

The team from Assisi Hospice shares how the Personhood Headboard impacts the way they care for patients as unique individuals.

At every bed in the inpatient ward at Assisi Hospice, you will find a small board with the following sections: “Call Me..”, “I Enjoy…”, “What comforts me…”, “I dislike…”, “I want you to know…” and “Tips to Care”. This is each patient’s Personhood Headboard (PHB). The idea for the Personhood Headboard was first conceptualised in early 2022 by Assisi Hospice Resident Physician Dr Tan Su-Yen, after being inspired by the Clinical Director of Assisi Hospice, Dr Alethea Yee. The first draft of PHB was designed in March 2022 and launched in all wards by the end of May that year.

Dr Tan explained, “Just like pieces of a puzzle, we try to piece together information about the patient we care for from the first day we meet — we try to understand them, their values, and what makes them who they are. Understanding their personhood facilitates care and allows us to care for the patients in ways aligned with their values, thereby allowing them to maintain their dignity and quality of life.”

Examples of patient’s PHB

The PHB is dynamic as patients, family members, caregivers and the Care Team are encouraged to update the board whenever necessary. Dr Tan elaborated, “Different members of the interdisciplinary Care Team have daily encounters with patients and learn more about them in their own way. The PHB allows the team to call patients by their preferred name from the first day of admission, provides a platform for the team to explore their personhood, and to share information about the patients we care for. In this way, we are using PHB to contribute to the effort of creating a person-centred culture in the organisation.“    

For the patient, the PHB reminds them of  their personhood, and the guiding questions serve as a tool for them to share more about themselves. Indicating their personal preferences allows patients and their family to gain a sense of control over their environment and feel empowered. The team directly engages the patient, if they are able and willing to share this information, and creates the PHB together. When it is not possible to engage the patient, the main caregiver steps in to co-create the PHB.

For the Care Team, it is a visual reminder that there is a unique human being behind the symptoms — to remember “who” it is they are caring for, beyond their illness. The team can also use it as a conversation starter to understand each patient’s preferences and provide personalised care. For nurses, the PHB enables them to offer caregivers practical advice that is specific to the patient and allows caregivers to be involved, letting them know what the patient’s preferences are and act accordingly.

Understanding our patients’ personhood allows Assisi Hospice’s Care Team to care for them in ways aligned to their values, and hence allow them to maintain their dignity and quality of life.

Clinical Pastoral Care Manager Joyce Cheah shared an example of how the PHB contributed in an unexpected way. “The patient had a very difficult relationship with her daughter, where any interaction invariably ended up in shouting matches, although they actually cared for each other deeply. The daughter was unsettled about her mother’s preferred place of death, as she felt that her mother would resent her if she let her die in the hospice.”

However, when Joyce managed to get a private moment with the patient the next day, she agreed to fill in her own PHB. The patient wrote: “I want you to know that I want to die simple [sic] with not many people around me….Happy to stay in hospice, new quiet environment. Happy to die here.” This gave her daughter assurance, and whenever she had doubts, the team could direct her to the PHB to remind her of her mother’s wishes.

In spite of its many benefits, filling in the PHB has its challenges. Dr Tan shared, “We learned that not every team member has the tools to discuss the PHB and hence a list of prompters was created to guide staff through the process of creating the PHB. We hope to create a common language for all team members and to increase their confidence in filling in the PHB with patients and families. We also learned that the board is only as good as the effort put into creating it, and catching the right opportunity to do so is very important. For some patients who may be less expressive, engaging their family adds a lot of colours to their PHB and benefits the team immensely.”

A staff survey found that the majority felt that the PHB has improved patient care. Out of the 12 patients and family members surveyed, 11 of them found the PHB helpful. A family member expressed that the process of filling up the PHB “allowed [her] to feel more at ease and comfortable as [her] family was initially worried about the environment and taboo of inpatient hospice”. Another patient expressed that the PHB refreshed her memory on what her interests are.  Even as a patient’s condition deteriorates, the PHB is there to serve as a reminder to always think about the person behind the patient.         

Photo: Assisi Hospice

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