Course content – PFLEGE-16
6. Module 5 · Person-centred care & life history
6.1. In depth: strengthening personhood, using life history with care
Strengthening personhood and using life history with care
Psychological needs (Kitwood)
| Need | Meaning |
|---|---|
| Love | At the centre – unconditional acceptance |
| Attachment/security | A sense of safety, familiarity |
| Occupation/inclusion | Meaningful activity, participation |
| Identity/belonging | Respected as a person with a life history |
Strengthening personhood instead of undermining it
Kitwood described vividly how the personhood of people with dementia is often (unintentionally) undermined in everyday life – through behaviours he called ‘malignant social psychology’ (not meant maliciously, but harmful): infantilisation/patronising (deciding over the person’s head), ignoring (talking about the person as if they were not there), objectification (treating the person like an object, ‘processing’ them), mockery/accusation (exposing them, blaming them for ‘mistakes’), outpacing (rushing the person, not respecting their pace), disempowerment (not letting them use their abilities), banishment (excluding them), labelling (reducing them to the illness). Such behaviours – often resulting from time pressure, lack of knowledge or routine – undermine dignity and wellbeing and encourage withdrawal, anxiety and challenging behaviour. In contrast, there are the behaviours that strengthen personhood (‘positive person work’): recognition (taking the person seriously, addressing them by name), appreciation, facilitation (letting them use their abilities, supporting rather than taking over), collaboration (involving the person), celebration/sharing joy, holding/comforting (giving emotional security), validation (accepting feelings). For care, this distinction is a valuable tool for reflection: you can check your own behaviour and the team culture against it – do we strengthen personhood, or do we (unintentionally) undermine it? Even small changes (talking with the person instead of about them, respecting their pace, involving them, appreciating them) make a big difference to their wellbeing. This conscious attitude – actively strengthening personhood – is the core of person-centred care and a yardstick for the quality of dementia care. It costs no additional time; it is a question of attitude and awareness.
Kitwood’s concept makes it clear: how we treat people with dementia determines their wellbeing and their dignity. Strengthening personhood is the noblest task of dementia care.
Turning the list into daily practice
A list of eight harmful and seven helpful behaviours is hard to remember in a busy shift. Figure 5.2 therefore pairs each harmful habit with a helpful alternative that you can try at once. The pairs are a teaching aid. They are not a scoring system, and they are not a way to blame colleagues. Kitwood himself stressed that the harmful behaviours are usually not meant badly. They grow from time pressure, habit and fear of doing something wrong.
Look at the example from the start of this module. “Time for our dinner, dear. Let us be a good boy” infantilises Mr Okafor and treats him as a task. A strengthening alternative would be: “Good evening, Mr Okafor. Dinner is ready. You drove buses for many years, did you not? Would you like to sit by the window?” This sentence recognises him, includes a piece of his life and offers a choice. It takes about as long as the first one.
Life-history work: what belongs in it, and what does not
The original text describes life-history work as a treasure. Like every treasure, it needs careful handling. A good life-history sheet is short, practical and alive. It records things that help you to offer familiar, meaningful experiences. Typical sections are: what the person likes to be called; family and important people; home and places; work and role; hobbies and interests; favourite music, food and drink; daily habits (when they wake, how they like their tea); things that calm them; things that frighten or upset them; and what is important to them in their beliefs and customs.
Not everything in a life belongs in a care file. Painful experiences, such as war, flight, violence or loss, may be part of the story. Where they matter, they help you to understand a fear and to avoid triggers. They should be recorded with care, only as far as they help the person, and in neutral words. Some people also have things they never wished to share. Not knowing a part of a person’s life is not a failure, and the sheet is never complete.
There is a second reason for care: the person is more than the sheet. A life history is a starting point for a conversation and not a script. People change, and a person who loved gardening at sixty may not want to garden at eighty-five. Check the offer against the reaction you see today. Does the person smile, join in and relax, or look away? Your observation counts more than the record.
In Germany: dignity, wishes and personal data
- Section 2(1) of the Social Code Book XI (SGB XI), the law on social long-term care insurance, aims at a life that is as independent and self-determined as possible and in keeping with human dignity. Section 2(2) says that the wishes of the person receiving care about how help is given should be met as far as they are reasonable (Bundesministerium der Justiz, n.d.-a). A life-history sheet is one practical way to learn those wishes.
- A life history contains personal data. Under Article 9 of the General Data Protection Regulation (GDPR), the data protection law of the European Union, certain categories of data are treated as especially sensitive. These include data concerning health and data revealing religious or philosophical beliefs, and their processing is prohibited in principle unless an exception in the Article applies (European Union, 2016). In practical terms, a life-history sheet that mentions illness or faith needs a clear legal basis and careful handling. Your organisation sets the procedure: who asks, who may read, where it is kept and how consent is obtained. Ask your data protection officer or manager when in doubt. If the person cannot decide alone, their legal representative or a person they authorised may need to be involved. Module 11 returns to this.
The practical message is simple. Collect only what helps, say why you ask, and keep it where only the people who need it can read it. Photographs, letters and objects that relatives bring can be even more helpful than a form, provided they are handled respectfully and returned.