What matters?

This is a guest post from Dr Michelle Howarth, senior lecturer in nursing at the School of Health and Society, University of Salford

In an era where the cost of living is rising, and more people are facing hardship, the question of ‘what matters to a person’ is fundamental to ensure our appreciation of the wider determinants that influence wellbeing. Personalised conversations that ask ‘what matters’, are gradually becoming part of our natural discourse, in our ambition to understand how we can support individuals. However, not all conversations reflect a personalised philosophy and inherent tensions predicated on cultural and professional paradigms have influenced our ambition to ‘fix’ and ‘heal’ rather than understand. This was highlighted in Dr Aimee Doweks insightful blog. This pathogenic model can restrict our ability to ask ‘what matters to you’ and shift our attention to ‘what’s the matter with’. Evidence of this position resonates in our clinical assessment methods and our approaches to meet targets, increase throughput, and improve efficiency. 

But what about the question ‘what matters to you’? How can asking ‘what matters to you’ help overcome the increasing inequality and disparity that we now face? What steps can we take to enable us to ask what matters and how do we truly engage in a conversation that empowers resilient individuals and communities? How can we shift the paradigm of ‘what’s the matter with someone’ to ‘what matters to them’?

Educating our workforce is fundamental. As a qualified nurse, and senior lecturer, I have been taught, and taught students to listen, engage and ‘see the person’, not just the patient. However, whilst our education practices reflect the notion of person-centred care in theory, in practice, they rely on a traditional, pathogenic model. For example, student nursing placements represent 50% of a BSc Nursing programme, yet we rarely allocate students to placements that can offer insight into the wider determinants, such as those services in the Voluntary, Community & Social Enterprise Sector (VCSE) or social prescribing schemes that regularly work with people through personalised approaches to enhance wellbeing. The focus on traditional, clinical placements could potentially restricting the students’ vision of the person and potentially ‘what matters to them’ and the wider determinants that can affect people’s wellbeing.  

Arguably, we need to expose our students to more diverse placement opportunities within our local neighbourhoods to enable enriched learning experience outside of the clinical paradigm to enable them to, as Lord Crisp notes, ‘remove our NHS specs’. Achieving this means adopting innovative practices that encourage our students see beyond the bedside, and work & learn in communities where what matters to someone takes precedence over what’s the matter with someone using personalised approaches.

This paradigm shift is starting to manifest across a number of universities that provide health care education. For example, a group of educationalist colleagues from the PerCIe have been collaborating with colleagues, Practice Education Facilitators (PEFs), students and third sector orgs to understand how we can develop placement opportunities that within nonclinical settings to enable students to learn about what matters to someone. PerCIEs vision is to enabled students to adopt personalised approaches through learning with and from communities, statutory and voluntary organisations that support diverse groups. PerCIE, is helping to remove the boundaries between HEIs’, to enable them to ask the question ‘what matters’ and challenge existing paradigms, to empower our students to enable the person, not just the patient to have a voice. 

Alongside this, the Personalised Care Institute offers a range of e-learning courses, webinars and podcasts which explain more about personalised care approaches. These resources provide valuable CPD for qualified health and care professionals, but there is also an argument that these resources should be incorporated into pre-registration curricular for all health and care professionals too, embedding personalised care as ‘business as usual’.  

There is a long way to go, not least the need to convince our students, manage expectations and secure support from professional regulatory bodies, but the change is happening. In the not-too-distant future, all students could be offered an opportunity to develop a greater understanding of personalised care through innovative placement growth.  

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