3.3.d Acknowledging Environmental Norms: A PCDM Key Element

A key element in the PCDM process is to acknowledge environmental norms, in addition to personalizing the care plan. You can facilitate an understanding of which options are available,  what the benefits and risks are of these options, and how to apply these to the person's own context and values.

You learned that person-centred decision making is a collaborative process that enables people to make health care decisions. One part of this process is to explore how environmental factors could impact the available options for care. Environmental factors include: 1) regional resources, 2) social norms, 3) community standards, and 4) institutional routines.  Assessing the available regional resources includes the number and location of family doctors, specialists or midwives; and the type and level of facilities (health centers, community hospitals, tertiary care hospitals, emergency services) that the family can access if necessary.  Even when facilities exist staffing patterns might vary by time of year or day.  There may also be local practice guidelines and/or institutional protocols that are linked to the availability of expertise or comfort level of the providers.

In the PCDM process you should discuss the environment and explore how these factors impact decision making and feasibility of preferred options. It is the responsibility of each team member to remain up-to-date about which environmental factors may impact decision making. This can be challenging when members of a team are unfamiliar with certain aspects of the environment that play a role in the decision making process, or more likely, have different, or conflicting, needs for resources. An example is knowing when the on-call specialist is onsite, when the operating room is booked.

As we are about to see in Florence’s case, her desire to preserve her cultural beliefs at the time of her birth, and to birth in her home, may be affected by what we call 'human resource planning', which means that the limitations of the providers and services that are available on Haida Gwaii may impact her birth options. Such environmental factors that affect people's choices can be anticipated and discussed ahead of time so that the team can explore the feasibility of people's preferred options and make arrangements as necessary.

 Personal Reflection

Reflect on which environmental factors could affect Florence's birth. Can you think of 3 of them?