Higher Care -unit 3- Values And Principles

National Qualifications: Values and Principles in Care Higher

Support Material August 2007

Care: Values and Principles, Higher

Acknowledgements SFEU is grateful to the subject specialists in Scotland’s Colleges and other agencies and industry bodies who have been involved in the writing of this and other support materials for the national qualifications in Care. SFEU is also grateful for the contribution of the Scottish Qualifications Authority in the compilation of these materials, specifically for its permission to reproduce extracts from Course and Unit Specifications. © Scottish Further Education Unit 2007

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Care: Values and Principles in Care, Higher F17W 12 Introduction These notes are provided to support teachers and lecturers presenting the Scottish Qualifications Authority Unit F17W 12, Values and Principles in Care. Copyright for this pack is held by the Scottish Further Education Unit (SFEU). However, teachers and lecturers have permission to use the pack and reproduce items from the pack provided that this is to support teaching and learning processes and that no profit is made from such use. If reproduced in part, the source should be acknowledged. Enquiries relating to this Support Pack or issues relating to copyright should be addressed to: Marketing Officer - Communications The Scottish Further Education Unit Argyll Court Castle Business Park Stirling FK9 4TY Website: www.sfeu.ac.uk Further information regarding this Unit including Unit Specification, National Assessment Bank materials, Centre Approval and certification can be obtained from: The Scottish Qualifications Authority Optima Building 58 Robertson Street Glasgow G2 8DQ Website: www.sqa.org.uk Whilst every effort has been made to ensure the accuracy of this Support Pack, teachers and lecturers should satisfy themselves that the information passed to candidates is accurate and in accordance with the current SQA arrangements documents. SFEU will accept no responsibility for any consequences deriving either directly or indirectly from the use of this Pack.

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Contents Reference Section What is the Care Course all about?

7 8

The Course in Care (Higher)

12

Unit Outcomes, PCs and Evidence Requirements

14

Tutor Support Section

17

How to Use This Pack

18

Rationale for teaching/learning approaches

19

Teaching Activities

21

Question Types in Higher Care Assessments

23

Guidance on Unit Delivery

24

Resources

25

Student Support Section

27

Key to Activity Symbols

28

Study Tips

28

OUTCOME 1

29

The Significance of Values in Care

31

Good and Bad Practice in Care

32

Relationship Between Values and Behaviour

35

Types of Service User

36

Discrimination and its Effects

38

Institutional Discrimination

44

Case Study on Discrimination – A Class Divided

45

Effects on Individuals: Worth, Dignity, Social Justice and Social Welfare

46

Values for Professional Carers

47

Codes of Practice and Professional Conduct

50

Care Values and Communication

55

The Role of Effective Communication in the Caring Relationship

57

Verbal Communication

58

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Non-Verbal Communication

62

Barriers to Effective Communication

67

Carl Roger’s Core Conditions

72

Gerard Egan – A Systematic Approach to Helping

74

Reflective Practice as a Tool for Evaluating Personal Practice

80

Formative Assessment – Outcome 1

81

OUTCOME 2

85

An Overview of Legislation

86

The Sex Discrimination Act (1975)

87

The Race Relations Act 1976

89

Disability Discrimination Act 1995 and Disability Discrimination Act 2005

91

The Commission for Equality and Human Rights.

93

NHS and Community Care Act 1990

94

Community Care and Health (Scotland) Act 2002

95

Data Protection Act 1998

96

Adults with Incapacity (Scotland) Act 2000

97

Regulation of Care (Scotland) Act 2001

98

Mental Health: Care and Treatment (Scotland) Act 2003

100

Ways in Which Legislation Acts as a Framework to Promote Positive Care Practice

103

Formative Assessment Outcome 2

104

OUTCOME 3

106

The Care Planning Process

108

Good Practice in Care Planning

109

Care Planning Models

110

The Role of Care Workers in Care Planning and Implementation

112

Goal Setting: Short- and Long-term Goals in Care Planning

115

Assessment of Needs

116

Tools of Assessment

116

Needs Assessment Using a PROCCCESS Model

119

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Holistic Care

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Maslow’s Hierarchy of Needs

122

Implementing the Care Plan

127

Evaluation of Strategies

129

Formative Assessment Outcome 3

131

Answers to Formative Unit Assessment

135

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Reference Section

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What is the Care Course all about? The Course aims to provide the knowledge, understanding, and skills to enable a candidate to recognise the role of sociology in fashioning care priorities and practice. This is entwined with the role of psychology in providing evidence of human behaviour and development. This will have an effect on how the person in need of care responds to change in their life. The application of theories to these clients enables us to account for specific behaviour. The Unit Values and Principles in Care (Higher) examines the care relationship as well as how legislation, values and principles underpin professional care practice and how we plan to meet the care needs of individuals. Summary of Unit content Values and Principles in Care (Higher) This Unit is designed to develop an understanding of the caring relationship and the values and principles that underpin professional care practice. The Unit looks at the role of legislation and care planning in promoting positive outcomes for those in need of care. The final part of the Unit looks at the elements of the care planning process, who is involved, its approaches and tools and how the effectiveness of care interventions can be evaluated. In this Unit candidates study: •

The caring relationship between care professionals and service users

•

The role of legislation in promoting positive care

•

The care planning process

The mandatory content for this Unit is detailed in the Appendix to the Unit Specification. This mandatory content is sampled in both Unit and Course assessment. ASSESSMENT To achieve the Course award the candidate must achieve the Units as well as pass the Course assessment. The candidate’s grade is based on the Course assessment.

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Assessment Objectives At Higher, the key elements of knowledge and understanding, analysis, application and evaluation are assessed in the following ways: •

Knowledge and understanding

Candidates should be able to demonstrate wide-ranging and detailed knowledge and understanding of aspects of care practice and the relevant concepts, theories and methods employed by care professionals in their roles. The range of knowledge should extend to an understanding of key theoretical and practical issues in sociology, psychology and values and principles for care and their application in care practice. •

Analysis

Candidates should be able to select from, interpret and analyse different sociological and psychological theories and models of care planning in the context of care practice. In so doing, candidates should be able to present information in a balanced, logical and coherent manner, which focuses clearly on the issues under review. Candidates should be able to use, with confidence, the language and concepts of care and demonstrate a clear and in-depth understanding of the inter-relationship between evidence and theory. Assessment of issues should be critical and comprehensive and should reflect confidence in dealing with complex arguments. •

Application

Candidates should be able to demonstrate the application of theories, concepts and methods covered in the Units and apply them to a care situation. This will centre on case study and simulated situations from key theoretical and practical issues in sociology and psychology as applied in care practice, and values and principles in care. •

Evaluation

Candidates should demonstrate the ability to make balanced evaluations of care related theories and practical examples and base these upon justified and sustained arguments. Explanations offered and methods used by care professionals should be examined critically and the conclusions drawn should be well developed and reasoned, reflecting clear understanding of the care topic being assessed. The balance of assessment between knowledge and understanding and analysis application and evaluation in Course and Unit specifications will be approximately: • •

Course — 50% knowledge and understanding, 50% analysis, application and evaluation. Units — 60% knowledge and understanding, 40% analysis, application and evaluation

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Values and Principles in Care (Higher): Unit assessment Satisfactory evidence of the achievement of all Outcomes and Performance Criteria for each Unit is in the form of written and/or oral recorded evidence, produced under closed-book, supervised conditions within a time limit of one hour for each Unit. Each assessment samples across the mandatory content for the individual Unit and the nature of sampling is detailed in the Evidence Requirements within the Statement of Standards within each Unit Specification. If reassessment is required, it should sample across a different range of mandatory content. Further details about Unit assessment for this Course can be found in the Unit Specifications and the National Assessment Bank (NAB) materials. An appropriate instrument of assessment would be a case study or case studies accompanied by a series of structured questions. The questions should sample across the mandatory Unit content and allow candidates to generate evidence for all Outcomes and Performance criteria in an integrated way. Course assessment The Course assessment consists of 2 Question Papers. Each Question Paper lasts 1 hour 20 minutes. There is a break of 20 minutes between each paper. Paper 1: •

Section 1 set on content of Psychology for Care (Higher)

•

Section 2 set on content of Sociology for Care (Higher)

•

The mark allocation for this paper is 50

Paper 2: •

Section 3 set on content of Values and Principles in Care

•

Section 4 set on the integrated content of at least two of the three Units in this Course

•

The mark allocation for this paper is 50

Further details of the Course assessment are given in the Course Assessment Specification and in the Specimen Question Paper.

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Link between Unit and Course assessment/added value The Course consists of three Units and an additional 40 hours study. The Course assessment tests the candidates’ knowledge and understanding of the content covered in all three Units and their ability to demonstrate and apply knowledge and skills acquired throughout the Course. In Units at Higher candidates are required to demonstrate knowledge and understanding and the ability to analyse and evaluate a range of related care theories and their practical application. The Course assessment will require candidates to use their knowledge and understanding of psychology, sociology and values and principles and to apply critical and analytical skills to answer questions drawn from the whole Course. Unit and Course assessment complement each other. Unit assessment provides evidence of a specific level of achievement in the psychology, sociology and values and principles sections of the Course. The Course assessment confirms and expands on this, providing sampled evidence of a range of skills exceeding those required for Unit success, such as retention of knowledge. The Course assessment at Higher requires that candidates demonstrate the ability to: •

Retain knowledge and understanding from across all three Units of the Course on a single occasion

•

Analyse and evaluate theories and applications to the care context from all three Units on a single occasion

•

Apply theories and applications in a care context to a range of topics from across the Units on a single occasion

•

Integrate knowledge and understanding of theories and applications in a care context

•

Perform more complex analytical and evaluative tasks than required for Unit assessment.

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The Course in Care (Higher) Course Rationale Issues of health and social care are becoming increasingly important due to an increase in the population of care service users. As a result, there is a growing need for qualified health and social care professionals. The Higher Care Course provides a strong foundation of knowledge and skills for candidates who wish to progress to further or higher education or employment in this area. The Higher Course in Care relates to caring for people in society, other than self or family, in an environment or agency whose codes of practice are dictated to and guided by legislation, policy and professional ethics. This includes formalised personal care in the community or home. It is concerned with the holistic study of the client in context. The Course will form an important part of the menu of provision, not only for those who have identified the field of care as their chosen career path, but also for any candidates who wish to extend their educational experience. The knowledge acquired in the areas of the understanding of human behaviour through applying psychological and sociological approaches and theories to care situations is transferable to other academic or career pathways, particularly those which involve working with people, either individually or as part of a team. This Course can therefore have a number of significant advantages for the candidate. For example it: •

Helps candidates to understand the interrelationship between psychology, sociology and care values and principles which form the basis for care practice

•

Provides an insight into the wide range of factors which might impact upon an individual’s development and behaviour

•

Enables candidates to inform and enhance their understanding of effective service provision

•

Increases candidates’ awareness of the dangers of viewing human behaviour and development purely from their own ethnocentric perspective

•

Raises candidates’ awareness of the psychological factors influencing their perceptions of normal development and behaviour

•

Raises candidates’ awareness of the role of sociology in shaping social policy.

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Aims The Course provides opportunities for candidates to: •

Acquire specialist knowledge and understanding required to care for others

•

Develop the ability to apply knowledge in a range of contexts

•

Develop awareness of their personal value base

•

Develop self-awareness and self-reflective practice

•

Identify people’s needs and develop skills for care planning

•

Develop an understanding of the values and principles that underpin professional care practice

•

Develop awareness of the role of legislation and care planning in promoting positive Outcomes for people requiring care

•

Develop an understanding of the main sociological theories that provide insight into the influences that shape individuals’ lives

•

Develop an understanding of the way in which psychological approaches help to understand aspects of human and behaviour

•

Develop an understanding of why certain individuals or groups in society require care services

•

Acquire awareness of the role of sociology in shaping the values and principles that underpin care practice

•

Learn about some key approaches that can provide insight into understanding human behaviour and development and apply these approaches to a care context

•

Develop an understanding of transition and loss and their relevance to understanding human development and behaviour in a care context.

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Unit Outcomes, PCs and Evidence Requirements Unit Specification: statement of standards SUMMARY This is a mandatory Unit in the Care (Higher) Course but it can also be taken as a free-standing Unit. This Unit is designed to enable candidates to develop an understanding of the caring relationship and the values and principles that underpin professional care practice. Candidates will have an opportunity to examine the role of legislation and the care planning process in promoting positive outcomes for people requiring care. The Unit is suitable for candidates who wish to gain employment in the health and social care sectors at support worker level or to progress to further study. OUTCOMES 1. Analyse the caring relationship between the carer and those requiring care. 2. Explain the role of legislation in promoting positive care. 3. Evaluate the effectiveness of the care planning process. Acceptable performance in this Unit will be the satisfactory achievement of the standards set out in this part of the Unit Specification. All sections of the statement of standards are mandatory and cannot be altered without reference to the Scottish Qualifications Authority. OUTCOME 1 Analyse the caring relationship between the carer and those requiring care. Performance Criteria (a) Explain the significance of values and principles in care. (b) Explain the role of effective communication in the caring relationship. (c) Analyse caring relationships in terms of care values and communication. OUTCOME 2 Explain the role of legislation in promoting positive care. Performance Criteria (a) Describe the main features of relevant legislation. (b) Explain how legislation promotes positive care practice.

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OUTCOME 3 Evaluate the effectiveness of the care planning process. Performance Criteria (a) Explain the care planning process. (b) Analyse approaches to assessing needs of service users. (c) Evaluate strategies for meeting needs of service users. EVIDENCE REQUIREMENTS FOR THIS UNIT The mandatory content for this Unit can be found in the Appendix at the end of this Unit specification. Written and/or oral evidence is required to demonstrate the achievement of all Outcomes and Performance Criteria for the Unit. The evidence must be produced under closed-book, supervised conditions within a time limit of one hour. 60% of the total marks available must be allocated to knowledge and understanding with the remaining 40% of the marks being allocated to analysis, application and evaluation. As candidates will increase their knowledge, understanding and skills throughout their study, assessment should take place towards the end of the Unit. The use of a cut-off score may be appropriate for this assessment. An appropriate instrument of assessment would be a case study or case studies accompanied by a series of structured questions. The questions should sample across the mandatory Unit content and allow candidates to generate evidence for all Outcomes and Performance criteria in an integrated way Each assessment must sample across the mandatory content of the unit and will allow candidates to generate evidence which covers: •

The significance of two values for carers

•

Two communication skills needed by carers

•

The analysis of one caring relationship

•

Two pieces of relevant legislation. This must include at least one of the following Acts: Regulation of Care (Scotland) Act (2001); Data Protection Act 1998; NHS and Community Care Act 1990; Disability and Discrimination Act 1995; Race Relations Act 1976 (Amendment Act 2000); Sex Discrimination Act 1975; Mental Health Care and Treatment (Scotland) Act 2003.Adults with Incapacity Act(Scotland) 2000:Communiyty Care and Health(Scotland)Act 2002

•

The way legislation promotes positive care

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•

The care planning process

•

One approach to assessing needs

•

Two chosen strategies used to meet the needs of specific service users.

If reassessment is required, it should sample a different range of mandatory content. The standard to be applied, the breadth of coverage and an appropriate cutoff score are illustrated in the National Assessment Bank (NAB) items available for this Unit. If a centre wishes to design its own assessments they should be of a comparable standard.

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Tutor Support Section

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How to Use This Pack There are a number of ways to bring Values and Principles for Care to life and so there is a range of material which can be used with different class groups, depending on their ability. Not all the worksheets and activities are intended to be used with every class. For groups taking the external exam Care Higher, more time will need to be spent on helping students to memorise and understand key terms, so more time may be spent on self, peer and formative assessment. For classes who are doing this as a stand-alone unit, then tutors may spend more time investigating some of the websites and discussing some of the real stories that can be found on these sites. A lot of information and exercises have been provided for tutors and students and it would be impossible to use them all within the 40 hours allocated to the unit. It is therefore likely that some of the material will be used when students are revising for the Care Higher external exam. Key points have been summarised to assist candidates to revise for external exams. However, it is important that candidates realise that memorising facts will lead to low marks and they will need to work on analysis, evaluation and application of knowledge to attract higher marks in assessment and external examination. Students should be encouraged to provide stimulus material for class discussion for outcome 1. They can be encouraged to collect media examples that they would like to use in class. This will help raise their awareness of values from everyday examples and to recognise values and principles that exist, or are lacking, in everyday situations. In outcome 2, to illustrate barriers to communication you could pre-arrange interruptions, phones ringing, noise, etc. for the first 10 minutes of your class. Ask students to reflect on the session and identify barriers. For outcome 3, visiting speakers may be able to provide case study material that is useful to an understanding of care planning and some of the issues raised in the unit. Many of the websites mentioned in the pack have sections with personal stories and these are excellent sources of ‘real life’ case studies.

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Rationale for teaching/learning approaches There are a number of policy initiatives which have been considered when developing this pack. They are summarised below.

1) Assessment is for Learning Programme http://www.ltscotland.org.uk/assess/ This programme is based on the principle that ‘good feedback is essential to inform improvements at all levels in the education system’. In it, everyone – the tutor as well as the students – is regarded as a learner. There are 3 parts to the AifL approach: 1) Assessment for learning: day-to-day classroom interactions and feedback that are focused on the learner and sensitive to their individual needs; 2) Assessment as learning: pupil’s participation in assessment and reflecting on their learning helps them to become better learners; 3) Assessment of learning: concerned with enhancing teachers’ confidence in their own judgements so that assessment information is reliable, comparable and dependable. This pack can only deal with points 1 and 2, but tutors will get an opportunity to develop their skills in point 3 through SQA and SFEU workshops. A number of the exercises in this pack will encourage the learner to reflect on their own work and to assess other learners’ work, in order to build them into more independent learners. This will include the use of formative assessment in hopefully preparing learners to produce a more confident performance in summative assessments and external exams. Formative Assessment (process): •

clarifying learning intentions at the planning stage

•

sharing these with pupils

•

involving them in self evaluation

•

focusing oral and written feedback around the learning intention of each lesson or task

•

appropriate questioning

•

organising individual target setting

•

raising children’s self esteem via the language of the classroom

•

(Gardening analogy: feeding and watering the plant).

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Summative Assessment (product): •

baseline testing

•

end of topic tests

•

National Assessment Bank

•

(Gardening analogy: measuring the size of the plant).

Formative Assessment Strategies Formative assessment improves learning. Assessment is used to allow learners to develop an awareness of how THEY can improve their learning. With written work, this can be done with: •

‘Comment Only’ Marking i.e. they don’t get a mark, but do get feedback on how to improve their answer. This is intended to encourage the learner to think about what they can do to improve their work rather than just think: ‘Great. I’ve scraped a pass.’ followed by turning round to ask the mark of the person sitting next to them. This type of feedback ties in to promoting the learner’s intrinsic valuing of their work and taking pride and responsibility for achievement and progress, rather than the extrinsic pass/fail mentality.

•

Peer- or Self-Assessment. These skills help the learner to develop an awareness of what makes a good piece of work. It asks them to independently judge what is strong or weak in an answer, rather than to rely on the tutor. The tutor needs to support learners to achieve the confidence and ability to do this, but it is a very useful technique once developed.

The two techniques could be used together, with the student awarding themselves a mark after considering the comments from the tutor. They can then match this with the mark that the tutor would have awarded them.

2) Curriculum for Excellence (2004) http://www.ltscotland.org.uk/curriculumforexcellence/index.asp The Curriculum for Excellence Report aims to ensure seamless education for children and young people (CYP) in Scotland, aged 3 – 18. The Care Course can contribute to this by directly or indirectly meeting the aspects in bold below. This subject area and the methods of teaching that are used are ideal for meeting these aims. •

All CYP can be successful learners, effective contributors, confident individuals and responsible citizens

•

Every CYP fulfils their potential; attainment will rise across the board

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•

There is a renewed emphasis on equipping CYP with essential skills including literacy, numeracy and creative thinking skills and promoting good health and well being

•

Scotland’s education system continues to meet the challenges of the 21st Century.

Teaching Activities A number of the suggested teaching activities suggested in the Curriculum for Excellence framework are already used widely in care courses: •

Activity based

•

Creative/innovative

•

Direction of travel: do students know where they are going. Do they know how to get there?

•

Narrative: what is the story you want to tell? Not how difficult it is, but how relevant/interesting it is.

3) Citizenship in Scotland’s Colleges (2006) http://www.hmie.gov.uk/documents/publication/cisc.pdf This HMIe report states that the development of skills for citizenship in education is a priority in Scotland and throughout Europe. Citizenship involves the development of skills and attributes to enable young people to participate in the making of decisions, within the political, economic, social and cultural contexts of their lives. Other aspects of citizenship education include the development of knowledge and understanding; a focus on values and citizenship issues; and opportunities for engagement in, and reflection on, citizenship activities. This unit enables students to develop skills for citizenship through course content which encourages awareness of individual difference and understanding of the needs of a range of people. The unit also provides peer and self-assessment activities which help learners develop independence in learning and critical thinking.

4) Changing Lives - Report of the 21st Century Social Work review: Implementation Plan (2006) http://www.scotland.gov.uk/Publications/2006/02/02094408/0 The report notes the need for ‘Programmes of learning that contribute to the continuous development of the social services workforce’ and which ‘Support the establishment of career pathways and career progression, in line with

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emerging policy needs’. This course, based at SCQF level 5 enables learners to enter into the social service workforce at care assistant level, or to develop further underpinning knowledge by advancing to Higher and HNC care Courses.

5) Learning Together (1999) http://www.scotland.gov.uk/learningtogether/ The Scottish Executive produced the publication ‘Learning Together’. This outlines a strategy for education, training and lifelong learning for people working in the National Health Service in Scotland. There is an emphasis on the value of education and lifelong learning in contributing to the delivery of quality services within the NHS. Candidates who study and achieve care units and courses can expect to improve their opportunities for employment within a care sector with this learning ethos. Please note that the materials and activities contained in this pack are not intended to be a mandatory set of teaching notes. They provide centres with a flexible set of materials and activities which can be selected, adapted and used in whatever way suits individual centres and their particular situations.

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Question Types in Higher Care Assessments Students are required to demonstrate Knowledge and Understanding (KU), Application (App), Analysis (A) and Evaluation (E) in the NABs and the external Exam. The external exam now has 25 marks allocated to a section where students are expected to integrate their knowledge from the three units, analysing and evaluating information in a holistic manner. It is important that students are prepared by their tutor to answer these types of question. Question setters use Blooms taxonomy (below) as a guide to the type of question that is asked. This shows how the level of complexity of a question moves from a simple task which asks for Knowledge - ‘Define’ - to a much more complex task such as ‘Assess’ which involves Evaluation.

Source: http://www.officeport.com/edu/blooms.htm

Students should be made aware of the different types of answers they should give, depending on the command word in the question There are a number of sites on the internet which give more information about Bloom’s taxonomy, such as http://www.educationforum.co.uk/HA/bloom.htm.

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Guidance on Unit Delivery Although centres will deliver this unit in a number of ways, a timetable for an 18 week course with 2 hour classes is provided below. As the unit is a nominal 40 hours, this implies that there are at least 4 hours for self-study. Apart from revision of notes, students can be expected to carry out some of the activities in their own time and bring their work back to class for discussion/marking.

7

Unit Content Overview of unit learning outcomes Introduce Outcome 1 Good and bad caring relationships Values for professional care workers Professional codes Effective communication Effective communication Working with different service users Rogers core conditions Egan’s skilled helper model Effects of stereotyping, prejudice and discrimination Revision of outcome 1

8 9 10 11

Investigating Key features of legislation Investigating Key features of legislation Promoting positive care with legislation Revision of Outcome 2

1

2 3 4 5 6

12 Introduction to Outcome 3 The care planning process Models in care planning Care workers and the multi-disciplinary team 13 Assessment of needs and goal setting Using tools of assessment 14 Approaches to assessment PROCCCESS Malsow’s hierarchy 15 Analysis and evaluation of needs Strategies to meet needs 16 Revision of Outcome 3

Opportunity for Formative Assessment and Feedback

Opportunity for Formative Assessment and Feedback

Opportunity for Formative Assessment and Feedback

17 SUMMATIVE ASSESSMENT 18 Feedback on Assessment and Remediation Review of Unit

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Resources Book Miller, J. and Gibb, S. (Eds) (2007) Care In Practice for Higher (2nd Edn) Hodder and Stoughton Magazines and Newspapers Your college or local library might subscribe to these. If not, look them up on the internet. They have up to date information about the ways in which the approaches and theories discussed in this unit are applied in care settings. www.careappointments.co.uk/ Care Appointments is an online resource for people involved in the caring professions. It has relevant news, features and interviews, as well as information about jobs and training courses. Community Care www.communitycare.co.uk www.disabilitynow.org.uk Magazine on disability issues with good info and links Nursing Times www.nursingtimes.net/ The Guardian: They have a special ‘Society’ section on Wednesday which covers relevant issues for this unit. society.guardian.co.uk/societyguardian/ The Herald: They have a special ‘Society’ section on Tuesday which covers relevant issues for this unit. www.theherald.co.uk/heraldsociety/ The Scotsman thescotsman.scotsman.com/health.cfm Click on ‘ Health’, ‘Education’ and ‘Scotland’ topics. Care Organisations on the internet This is a list of some organisations whose services will be based on the psychological approaches and theories discussed in this unit. www.ageconcernscotland.org.uk/index.asp Age Concern site which covers issues relating to older adults. www.barnardos.org.uk Barnardos work with children and young people, families and communities to work towards their vision that the lives of all

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children and young people should be free from poverty, abuse and discrimination. www.carescotland.org.uk Care Scotland This website is produced jointly by the staff of local council social services departments and the Scottish Executive and has up to date information about care in Scotland – policies and practice http://www.nmc-uk.org The Nursing and Midwifery Council is the professional regulatory body for nursing and midwifery. www.nrcemh.nhsscotland.com/ The National Resource Centre for Ethnic Minority Health (NRCEMH) is a unit of NHS Scotland and supports NHS Boards to develop their cultural competence in delivering health services to black and minority ethnic groups, to reduce inequalities and to improve the health of these communities. www.quarriers.org.uk/ Quarriers They provide a range of services in Scotland through more than 100 projects for Adults and children with a disability; Children and families; Young people with housing support needs; People with epilepsy and Carers www.seemescotland.org.uk A website dedicated to mental health issues www.shelter.org.uk Shelter Homelessness campaign and information. www.show.scot.nhs.uk Scottish Executive Health Department site. Information on range of issues including homelessness and disability. www.turning-point.co.uk/ Turning Point provides services for a range of people, including those affected by drug and alcohol misuse, mental health problems and those with a learning disability. National Developments www.scotland.gov.uk is the Scottish Government’s website. Access to legislation and current developments in Health and Community Care policy can be accessed through this link. Film ‘A Class Divided’ is a powerful documentary on discrimination. It can be viewed on the internet at: http://www.pbs.org/wgbh/pages/frontline/shows/divided/etc/view.html

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Student Support Section

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Key to Activity Symbols

Reading

Brainstrorming

Writing

Discussion

Reflection

Case studies

ICT Research

Revision

Group Investigation

Study Tips 1) Highlighting Key Words None of the key words have been put into bold in this unit, as it will be more useful for you to be actively involved in highlighting the keywords on each page. If you don’t already have some, go and buy yourself some highlighter pens! The point of highlighting each keyword is so that when you read over your notes, the main point on each page jumps out at you. Therefore, it is crucial that you only highlight one or two words at a time. If you highlight too much, then nothing will jump out at you and you’ll need to wear sunglasses to read your notes! Occasionally, it is useful to highlight a sentence, if it gives a definition of a key term but even then, it is better to try and highlight only the relevant parts of the sentence. It might also be useful to highlight the key term in one colour, and the definition in another colour, so again you are making the separate things stand out differently. Less is more when highlighting

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OUTCOME 1 There are three learning outcomes for the Values and Principles (Higher) Unit. Each outcome has a list of topics which is the mandatory content. These topics form the structure for these teaching support notes and will provide the basis for national assessment bank and exam questions. The first section of the teaching notes relates to the mandatory content for outcome 1, and is shown below. OUTCOME 1 Analyse the caring relationship between the carer and those requiring care (a) (b) (c)

Explain the significance of values in care. Explain the role of effective communication in the caring relationship. Analyse caring relationships in terms of care values and communication.

Mandatory Content for this Outcome Caring relationships: •

good and bad practice in care

•

relationship between values and behaviour

•

differences between values for informal and professional care workers

•

types of service users.

Respect for individuals: •

recognise and understand the effects of stereotyping, prejudice and discrimination.

Effects on individuals: •

Worth

•

Dignity

•

social justice and social welfare.

Values for professional care workers: •

the value of respect for the worth and dignity of every individual

•

the value of according social justice and promoting the social welfare of every individual.

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Codes of professional conduct: •

registration and professional accountability

•

Nursing and Midwifery Council Code of Professional Conduct: standards for conduct, performance and ethics (2004) Scottish Social Services Council Code of Practice for Social Service Workers: six principles

•

National Care Standards – six principles.

The Role of effective communication: •

verbal and non-verbal communication

•

barriers to effective communication.

Develop a valued relationship: •

Rogers core conditions

•

Egan’s skilled helper model.

Analyse caring relationships in terms of care values and communication: •

good and bad caring relationships should be examined

•

analysis of behaviours to determine the values in evidence or values lacking in the relationship

•

effects of stereotyping, prejudice and discrimination on the individual

•

explanation of the values that the carer should display

•

effects on the individual of professional caring relationship – autonomy, independence, empowering, aspirations supported

•

analysis of the effectiveness of communication in the relationship

•

explanation of the role of communication in the professional caring relationship

•

Reflective practice as a tool for evaluating personal practice in relation to communication.

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The Significance of Values in Care Outcome one of this unit requires you to analyse the caring relationship between the carer and those requiring care. As you work through this section you will find out what is involved in professional caring relationships. You will learn about values and principles in care and how these are applied in care practice. We will start with a look at what a value is:

ACTIVITY/DISCUSSION •

Take a few minutes to think about what you value.

•

List five things that you value.

•

Discuss these values with others in the group and find out if they share similar values or have different values?

You may have discussed values such as education, the right to vote, money, health and relationships. Because we consider these things to be important they are worth something to us; they have value. So, a value can be defined as ‘that which is desirable and worthy for its own sake’. For example the words of the Declaration of Arbroath, 1320, reflect a number of values. ‘It is in truth not for glory, nor riches, nor honours that we are fighting, but for freedom – for that alone which no honest man gives up but with life itself’ Question:

Can you pick out the values in the declaration?

Answer:

The values reflected in the statement are truth, glory, riches, honours, freedom, honesty and life. All of these things are seen to have value here, but what is valued most, and is seen to be worth fighting for, is freedom.

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As you work through this unit you will discover that it is important for all care workers to express agreed care values so that service users will benefit from the care that they receive. Values for care workers are reflected in Codes of Professional Conduct and Care Standards and it is vital that these values are shown in the words and actions of care workers. Care values are significant because they underpin care practice and service users have the right to expect care workers to adhere to these values so that service users can be confident in the standard of care that they will receive.

Good and Bad Practice in Care The values that we hold are reflected when we are in a situation where we care for someone else. In care work there are attitudes and actions that are considered to reflect good practice and attitudes and actions that reflect bad practice. Care workers have an obligation to uphold care values so that good practice is promoted and bad practice is opposed. A relationship where the carer is encouraging and supportive is a good caring relationship whereas by contrast, if the carer is abusive this is a bad caring relationship. A relationship which is ‘good’ is one which allows the person being cared for to develop and thrive whereas a ‘bad’ relationship denies the individual the opportunity to realise their potential. The quality of the caring relationship therefore has an effect on the individual receiving care. We also have to carefully examine (analyse) what we think of as ‘good’ or ‘bad’ as ideas can change over time. For example at one time it was considered ‘good’ practice to force left-handed people to use their right hand to write and use scissors so that they would learn to use their right hand. At one time too, it was considered a ‘good’ thing for people with learning disabilities or mental illness confined to institutions. Attitudes and values change over time and, as a consequence, behaviour and care practice may change too. Values for professional care workers Good practice in care demonstrates agreed care values. The two core values for care are: •

the value of respect for the worth and dignity of every individual

•

the value of according social justice and promoting the social welfare of every individual

(Miller & Gibb 2007)

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These values are reflected in professional codes of conduct. However, there is evidence that some care workers ignore these values in their work. Unfortunately, there are regular news items about people being abused by their carers.

DISCUSSION – Good and Bad Practice in Care

1. Explain why each of the scenarios listed below represents bad practice. 2. Explain the likely effect of the carer’s behaviour on the service user 3. Describe the care that the service users, in each situation, should have received. 4. Explain the difference that good care practice would make to their situation. •

A 35-year-old man strapped to his wheelchair for hours each day so that he almost lost his ability to walk and suffered damage to his feet as he struggled to get free.

•

A man given his daily medication while strapped to the toilet and crying.

•

Improper medication procedures (not recording that medicines have been given) for people in care, risking overdose.

•

Adults left lying in their own excrement for hours during the night.

•

A 76-year-old woman with severe learning disabilities suffered first and second-degree burns after being bathed in scalding water. The carer, who bathed her, failed to check the water temperature, and anti-scald devices fitted to the taps were defective. The woman was only able to communicate making "non-speech" sounds.

•

A nurse ramming a paper towel into a terrified pensioner's mouth, force feeding another so she nearly choked and using abusive language.

•

A carer who stole £1,000 from the 91 year old woman she was looking after (in her own home).

•

A care worker at a nursing home suspended after an alleged sex attack on an 80-year-old woman resident.

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Sadly all of the above incidents are real and all of these incidents have occurred because care workers have failed to: •

respect the worth and dignity of every individual

•

accord social justice and promote the social welfare of every individual.

These examples demonstrate a lack of care values being implemented and represent bad practice. The most serious consequence of the behaviour of these care workers is the harm caused to the service users. This is unacceptable and is regarded as misconduct. The care workers involved will be disciplined and legal action may be taken against them. For more information you may wish to visit the following websites: http://www.learningdisabilities.org.uk www.elderabuse.org.uk

Summary

Key Points 1. Bad practice occurs when core values are neglected or ignored 2. Service users are harmed through bad practice. Bad care practice can be socially, physical, emotionally, cognitively and culturally damaging. 3. Service users should receive care that demonstrates care values. They should be treated with respect and have their dignity maintained. Service users should be treated fairly and be protected from harm. 4. People thrive when they experience good care practice. In good care practice social, physical, emotional, cognitive and cultural needs are acknowledged, respected and supported.

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Relationship Between Values and Behaviour Socialisation is the term used to describe the process of learning to become a member of a particular group or society. Through our interactions with others we develop an understanding of how we are expected to behave in relation to others (our role). For example if, as a result of our socialisation experience, we value education, then we will think, feel and believe that education is something worthwhile and we are likely to demonstrate attitudes and express opinions that reflect this value. So, whether we are aware of it or not, the values that we hold underpin our thoughts, feelings and beliefs and influence our attitudes and behaviour. If I value money more than honesty I might be prepared to keep a wallet that I find, rather than handing it in to the police. Sometimes the values that we hold as individuals are at odds with the values that other people hold. For example pro-life campaigners would seek to protect life from conception to natural death. In contrast, people who value the right to choose would support a woman’s right to choose abortion or may argue that a person with a terminal illness should be able to choose how and when to die. These attitudes and beliefs will therefore, influence behaviour. Differences between values for informal and professional care workers People develop their own personal values based on their socialisation experience. If, as a friend, neighbour or family member, I become involved in caring for someone I know, I may retain all of my attitudes and beliefs and my values might be shared with my friend, neighbour or family member. For example, if my friend Suzanne becomes ill, we might both share the belief that women make better carers than men. This might be based on all kinds of assumptions about women and men. However, we don’t need to question our beliefs and in our discussions and actions we can support each other’s point of view. As a result of our beliefs, we do not value men as carers, and my friend might even refuse care from a man. Informal carers may hold such values and opinions and this may not interfere with their ability to carry out care for the person that they have an established relationship with. However, if I decide that I want to become a formal care worker I will find that I will have to examine my views. I would need to be aware that I have a negative view of male carers, that is, I have a prejudiced attitude towards male carers. If I continued to be unaware of this I might behave differently towards male carers, and view their contribution to care less favourably than that of a female carer. If my prejudiced views persist, and if I am involved in recruiting staff, then I might not appoint men to care jobs; that is, my actions would be discriminatory. This would be unacceptable and would be contrary to core care values. One of the main differences in values, therefore, between an informal carer and a professional care worker is that a professional care worker must examine their attitudes and opinions and be aware of any possible prejudices. The professional carer has to be aware of these issues and address any tendency to treat people either favourably or unfavourably based on any personal prejudices.

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Types of Service User Care workers work with individuals and groups of service users. Service users are sometimes categorised according to characteristics that they share. For example, there are care services for children, older adults, and people with learning disabilities, people with mental health conditions, people with dementia and people with physical disabilities. These distinctions are made so that appropriate support and services can be easily identified and organised, but remember that people are individuals and should be treated as individuals.

GROUP WORK - LOCAL INVESTIGATION Action 1 Work in groups of 3 or 4. Select one of the following service user groups and find out about services that exist in your local area. Older adults with dementia People with addictive behaviours (e.g. drugs/alcohol/gambling) Young people with autism Children with cerebral palsy Adults with learning disabilities Adults with mental health problems People with sensory impairments (e.g. hearing, vision, speech)

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Mind mapping is a useful way to help organise information and help you to remember important points. (for information on mind mapping visit www.imindmap.com)

Example of Mind Maps created using iMindMap™

Action 2 Draw a mind map to describe the services available in your local area.

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Discrimination and its Effects Formal carers may work with a variety of service users. We have already stated that the care worker should be aware of any prejudiced attitudes as these could interfere with their ability to demonstrate respect for the worth and dignity of an individual in their care. A good starting point is to understand what is meant by the terms stereotype, prejudice and discriminatioin.

A STEREOTYPE IS A SET IMAGE

Stereotype means ‘set image’ and is an instantly formed mental image of a person or group, based on assumptions about their characteristics. Stereotyping takes no notice of individual differences and a person or group is thought of in terms of their shared characteristics. For example stereotypes exist about people and their race, religious beliefs, gender, colour, age, marital status, physical or mental status, sexual orientation, economic status and even size.

ACTIVITY Take a few minutes to consider the following groups. What are the stereotypes based on? •

Goths

•

Celtic supporters

•

Teachers

•

Asylum seekers

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PREJUDICE IS A PRE-FORMED OPINION OR JUDGEMENT, OFTEN NEGATIVE

Prejudice is a judgement made about a person or group, based on a stereotyped image. These opinions are often unfavourable or negative and lack any knowledge of the facts; that is to say they are irrational. Prejudices are often formed at a young age, during primary socialisation, and many people are not aware of their own prejudices.

Task 2 Take a few minutes to write down any prejudiced judgements or opinions that might be based on these stereotypes.

Group Goths

Teachers

Stereotype Dress in Black. Evil people. All Roman Catholics. Hate Rangers supporters. Get long holidays

Asylum seekers

Scroungers

Celtic supporters

Prejudice

Discrimination is the unfair treatment of a person or group of people based on stereotyped views and prejudiced opinions. Many people persist with their stereotyped ideas and pay no attention to evidence that would contradict their beliefs. This leads to behaviour based on these beliefs. So, whether intentional or not, they behave differently towards the person or people who display the characteristics associated with the stereotype. This is called discrimination.

NO

People are discriminated against on the basis of race, religious beliefs, gender, colour, age, marital status, physical or mental status, sexual orientation, economic status, size and many other characteristics.

ENTRY

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Task 3 Take a few minutes to write down any discrimination that might be experienced on the basis of existing prejudice. Group Goths Celtic supporters

Stereotype Dress in Black. Evil people. All Roman Catholics. Hate Rangers supporters.

Teachers

Get long holidays

Asylum seekers

Scroungers

Prejudice Won’t make a good carer Can’t invite Jo and Sam to the party – they’ll hate each other Don’t deserve another holiday Send them back

Discrimination

Discrimination is the result of stereotyping and prejudice on the individual.

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The effects of stereotyping, prejudice and discrimination on the individual or group of individuals is real and damaging. •

The Goth who fails to get into care work is unable to reach his or her potential; simply because of the way that they are dressed.

•

The Celtic supporter has been denied the opportunity of getting some free tickets. The Celtic supporter may be the only Celtic supporter in a house full of Rangers supporters!

•

The teacher becomes more and more stressed. If the person who holds the prejudice is the care professional who is supposed to be helping, then their feelings of being unable to cope will be intensified.

•

People seeking asylum will feel rejected and anxious about their future. If care workers and other professionals hold these prejudices then the asylum seeker will struggle to get information about housing, health and welfare benefits.

Group Goths

Stereotype Dress in Black. Evil people.

Prejudice Won’t make a good carer

Discrimination Person dressed as Goth fails to get into a care course or job.

All Roman Celtic supporters Catholics. Hate Rangers supporters.

Would never want Employer gets complimentary tickets to see Rangers to a Rangers game – play but doesn’t offer them to Celtic supporters

Teachers

Get long holidays

Can’t be stressed. Not listened to when complaining about Look at all these work stress holidays!

Asylum seekers

Scroungers

Send them back to their own country

People in host country refuse help, – isolated in society

Remember that the stereotypes and prejudices that these discriminatory actions were based on have no factual basis.

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Take a few minutes to think about the prejudice opinions you have had about people, or groups of people. Set yourself the goal of finding out some facts about the people or groups that you have pre-judged. Challenge your own and other people’s assumptions by finding out the facts. Everyone has prejudices. The importance in care work is understanding this and being aware of when accepting a prejudice arises. We often don’t know we have a prejudice until we are faced with a new situation where our beliefs and values are challenged, or we feel threatened.

ACTIVITY - Discrimination and Mental Health People with mental health problems often experience discrimination. The ‘See Me’ campaign is one strategy that has been developed to combat the prejudice that exists around mental health issues. People with mental health problems may be labelled as ‘psycho’ or ‘schizo’ and as service users they experience stigma and discrimination even by care workers. •

Visit the ‘See Me’ website and read and take notes on some of the personal stories of stigma and discrimination. http://www.seemescotland.org.uk

Using information from the site, write a paragraph to describe the effects of stigma and discrimination on individuals with mental health problems.

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Case Study: John John has just started a job as a support worker in a community mental health team. The team leader has had a meeting with John to discuss some of the important aspects of his role. John now knows that part of his role requires him to: •

Reflect on personal values and attitudes

•

Recognise stigmatising labels and challenge people who use them

•

Show respect for the worth and dignity of every individual service user

•

Accord social justice and promote the social welfare of every individual service user.

Working in groups of 2 – 4 people discuss the following question based on the case study. Summarise your discussion in writing and discuss the main points with the class.

Question: Explain why John should carry out each of the above actions. You should also analyse the contribution that these actions could have in combating discrimination against people with mental health problems, and in promoting good practice in care.

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Institutional Discrimination Discrimination doesn’t only happen at individual level. When an organisation disadvantages a person or group of people either deliberately or unwittingly then this is known as institutional discrimination. The discrimination can be in the form of attitudes, systems, services or behaviour. The McPherson Report, issued following the public inquiry into the murder of Stephen Lawrence, defined institutional racism as follows: "The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people." from: http://www.archive.official-documents.co.uk

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Case Study on Discrimination – A Class Divided View and take notes on ‘A Class Divided’, which is a documentary film about discrimination. Jane Elliot conducted an experiment with her primary school class, and later with adults, to demonstrate to them the effects of discrimination. Individuals describe what it feels like to be stereotyped, and experience prejudice and discrimination. This can be viewed on the internet at: http://www.pbs.org/wgbh/pages/frontline/shows/divided/etc/view.html •

Make a note of the prejudices that are expressed, based on the characteristics of having either blue or brown eyes.

•

Discuss the ways in which the blue and brown eyed children are discriminated against.

•

Describe the effects of the discrimination.

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Effects on Individuals: Worth, Dignity, Social Justice and Social Welfare Examples of discrimination reflect bad care practice and this is damaging to people. It can deny people of opportunities to participate fully in society and is a barrier to fulfilling personal potential. Take a few minutes to look at the following definitions of the terms individual worth; dignity; social justice and social welfare.

Individual worth

Dignity

An individual is a unique human being and this is the basis of their worth. It is not dependent on any other characteristic.

Respect and self-esteem are linked to dignity. An individual’s dignity is maintained when their worth as a human being is recognised.

Social Justice This refers to the fair treatment of an individual and their right to a just share of society’s benefits

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Social Welfare This refers to the provision that exists to support disadvantaged people in society. This can include housing, education, care and financial aid.

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Values for Professional Carers Miller & Gibb (2007) refer to two core values for care practice. •

the value of respect for the worth and dignity of every individual

•

the value of according social justice and promoting the social welfare of every individual.

Respecting the worth and dignity of every individual requires care workers to recognise a person’s importance as a human being with a set of unique characteristics and personality. To show respect is to show regard for the other person by being considerate and courteous. To ensure this, professional carers work from a value base and use caring skills such as empathy to develop an understanding of the individual. One of the first, and perhaps most important, actions that care workers can take is to critically examine themselves for any personally held stereotyped ideas or prejudiced attitudes. This is to raise personal awareness of the possibility that as a care worker the person may act favourably or unfavourably towards others based on their biases. Care workers do not have to ditch individually held beliefs or convictions e.g. about issues of abortion or euthanasia, but these must be recognised and are not permitted to become issues that will harm or discriminate against any individual cared for. So, we can respect individuals by recognising stereotyping, prejudice and discrimination both in our own attitudes and behaviour and in the attitudes and behaviour of other care workers. Stereotyping, prejudice and discrimination should always be challenged so that service users are not unfairly advantaged or disadvantaged for any reason.

Other actions that care workers can take to demonstrate respect for the worth and dignity of every human being, relates to the actions taken to understand the service user’s individual needs. People have specific social, physical, emotional, cognitive and cultural needs. Social, Physical,Emotional, Cognitive and Cultural (SPECC)

S O C I A L

P H Y S I C A L

E M O T I O N A L

C O G N I T V E

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When working with people requiring care, using a value base will maintain and nurture the service user’s identity. They can be themselves. There is a sense of acceptance which will contribute to a positive self-esteem and help people to self-actualise. That is to say, that the service user will feel good about his/herself and can achieve their potential. If needs are not met, or denied, this will also affect a service user’s self-esteem. In this situation selfesteem will be damaged and the person will not reach their potential. The value of according social justice and promoting the social welfare of every individual refers to the idea that everyone in a society has the right to fair and correct treatment. Social justice is the idea of fair treatment for people. It means that service users should have equal access to resources (a resource is something or someone that can help) and that the resources should be fairly shared. Resources should be allocated on the basis of need and not given to people we like or who we think deserve the help. Welfare means wellbeing. People may have a variety of needs depending on their age and stage of development and social circumstances. So, for example, a seven year old who is blind will have different needs from an older person with dementia. To promote social welfare is to promote wellbeing. To do this a care worker will need to have knowledge about the services and benefits available to support a person requiring care. A person should not be disadvantaged because the care worker who is working with them is ignorant about their condition or services available. When care is delivered using a value base this has a positive effect on the service user: Of course, when values are not put into action as principles of practice then the effect or consequence on the service user is negative.

Figure 1. Care Values bring benefits to individuals

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ACTIVITY Visit the websites of the following organisations to investigate, and take notes on, the values and aims of these self-help/voluntary organisations: •

ENABLE

•

Quarriers

•

Downs Syndrome Scotland

•

Age Concern Scotland KEY POINTS Two core values for care practice. •

the value of respect for the worth and dignity of every individual

•

the value of according social justice and promoting the social welfare of every individual.

Stereotype means a ‘set image’ and is an instantly formed mental image of a person or group, based on assumptions about their characteristics. Stereotyping takes no notice of individual differences. Prejudice is a judgement made about a person or group, based on a stereotyped image. These opinions are often unfavourable or negative and lack any knowledge of the facts. Discrimination is the unfair treatment of a person or group of people based on stereotyped views and prejudiced opinions. Institutional discrimination is when an organisation disadvantages a person or group of people either deliberately or unwittingly. Service users are individuals When care is delivered using a value base this has a positive effect on the service user; in other words the service user benefits from the care received.

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Codes of Practice and Professional Conduct A code of practice or professional conduct reflects the values of a profession and is a public statement about the expected behaviour of people who belong to a particular profession. Care workers must maintain standards stated in the code. They are accountable for their actions and legal action may be taken if these standards are not kept.

The Scottish Social Services Council (SSSC) publishes Codes of Practice for Social Service Workers and Employers. These are standards of conduct and practice which all social service workers and their employers must follow.

The SSSC Code states that as a social service worker you must:

1. Protect the rights and promote the interests of service users and carers 2. Strive to establish and maintain the trust and confidence of service users and carers 3. Promote the independence of service users while protecting them as far as possible from danger or harm 4. Respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people 5. Uphold public trust and confidence in social services 6. Be accountable for the quality of your work and take responsibility for maintaining and improving your knowledge and skills

Each of the above main points of the code is broken down into more detail in the publication. http://www.sssc.uk.com

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Codes of Practice and Professional Conduct (Continued) The Nursing and Midwifery Council code of professional conduct details the standards that service users can expect from members of the nursing profession. This code is currently being reviewed and a new publication will be available following a period of consultation.

The code states that as a registered nurse, midwife or specialist community public health nurse you must: A. Respect the patient or client as an individual. B. Obtain consent before you give any treatment or care. C. Co-operate with others in the team. D. Protect confidential information. E. Maintain your professional knowledge and competence. F. Be trustworthy. G. Act to identify and minimise the risks to patients and clients. Each of the above main points of the code is broken down into more detail, in the publication. http://www.nmc-uk.org

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ACTIVITY Visit the Scottish Social Services Council websites and view or download a copy of the code of practice to enable you to carry out the following exercise. http://www.sssc.uk.com Review the SSSC code of practice and select one main point where the carer involved in this incident failed to uphold the standard stated in the code and explain what the carer should have done. INCIDENT

A 76-year-old woman with severe learning disabilities suffered first and second-degree burns after being bathed in scalding water. The carer, who bathed her, failed to check the water temperature, and anti-scald devices fitted to the taps were defective. The woman was only able to communicate making "non-speech" sounds

CODE OF PRACTICE POINT IGNORED

CODE OF PRACTICE WHAT THE CARER SHOULD HAVE DONE

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ACTIVITY Visit the Nursing and Midwifery Council website and view or download a copy of the code of professional conduct to enable you to carry out the following exercise. http://www.nmc-uk.org Review the NMC code of professional conduct and select one main point where the nurse involved in this incident failed to uphold the standard stated in the code and explain what the nurse should have done.

INCIDENT

A nurse ramming a paper towel into a terrified pensioner's mouth, force feeding another so she nearly choked and using abusive language.

CODE OF PRACTICE POINT IGNORED

CODE OF PRACTICE WHAT THE CARER SHOULD HAVE DONE

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Key Points SSSC Code of Practice 1. Protect the rights and promote the interests of service users and carers. 2. Strive to establish and maintain the trust and confidence of service users and carers. 3. Promote the independence of service users while protecting them as far as possible from danger or harm. 4. Respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people. 5. Uphold public trust and confidence in social services. 6. Be accountable for the quality of your work and take responsibility for maintaining and improving your knowledge and skills.

Key Points NMC Code of professional conduct A. Respect the patient or client as an individual. B. Obtain consent before you give any treatment or care. C. Co-operate with others in the team. D. Protect confidential information. E. Maintain your professional knowledge and competence. F. Be trustworthy. G. Act to identify and minimise the risks to patients and clients.

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Care Values and Communication If values are important in the caring relationship then the carer’s ability to demonstrate these values through effective communication is essential. Communication is the way that information is shared between two or more people and reading, writing and speaking are all forms of communication. In the course of their work as the care worker may communicate with service users, families, volunteers, colleagues and other professionals. In this section we will focus on communication with service users but it is important to also apply this knowledge to work effectively as a team member. To communicate effectively carers need to think about the way that they communicate. Carers should reflect on their interactions and evaluate their ability to communicate so that they can learn from their experiences and make plans to improve their effectiveness. Interpersonal communication, communication between people, is a complex process involving listening, questioning, understanding and responding to what is being communicated. Effective communication is achieved when the messages that are given and received are transmitted successfully and interpreted accurately. Message given

Message received

I like working with you.

You like working with me.

In care work, it is the responsibility of the care worker to develop an effective means of communication and to take into consideration a number of factors, when working with a service user. Studies show that there are three components of interpersonal communication: Verbal

in the actual words used in the communication

Non-verbal

by facial expression and other body language signals, gestures and touch paralanguage, that is to say through the vocal tones and the way that the communication is expressed

Non-verbal

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Take a few minutes to consider the relative importance of each of the above components (as a percentage) in transmitting a message. The three parts should add up to 100%

Verbal

%

Non-verbal/facial expression and body language

%

Non-verbal/paralanguage or vocal tones

%

Message

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The Role of Effective Communication in the Caring Relationship You might be surprised to discover that how we say something is far more important that the actual words that we use. So tone of voice and facial expression and body language are vitally important if we want to make sure that we transmit our message effectively.

55%

38%

7% Verbal Non Verbal - facial expression and body language Non Verbal - paralanguage or vocal tones Figure 2

Portions of communicating a message

Non-verbal communication may be transmitted consciously or unconsciously, therefore when working with service users, it is important to think about the non-verbal signals we send. Unless these signals support the verbal message the service user will be less confident about the communication. So, for example if we tell someone that we are listening to them, but don’t look at them, or if we sound irritated when we say the words, the person is unlikely to believe what we say.

I am listening to you.

Well, I think you sound irritated … and you’re not looking at me!

This is an example of when non-verbal communication signals are contradicting the words that are spoken.

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The diagram below shows that interpersonal communication involves sending a message, receiving and interpreting the message and then giving feedback to the sender. This is a cycle of communication and people give and receive messages in this way.

Message

21Receiver

Sender y

Interprets Message

Communicates Message Verbal and Nonverbal signals

Feedback sent to original sender who will receive and interpret the response

Verbal and Nonverbal signals are noted, using all available senses

Interpersonal communication therefore, contains four main elements, the sender, the message, the receiver and feedback. The care worker and the service user are both involved in sending verbal and non-verbal messages and interpreting and receiving verbal and non-verbal feedback.

Verbal Communication Verbal communication is concerned with the actual words used in communicating a message. Verbal communication relates to the actual words and sounds used in the communication. Words and sounds have meaning and the words that we choose to use convey the message we want to send. However, the words a carer uses should be carefully chosen, so that the intended meaning is clear. We will consider three main points in relation to verbal communication. Firstly, words and sounds convey meaning. They are symbolic; this means that they are used to represent ideas. Sometimes the meaning is culturally specific, and the meaning is understood in different ways by different people. Language also evolves over time and meanings change. So, for example the word ‘cool’ has several meanings. If someone says ‘He was rather cool.’ Does this mean icy, detached, calm or trendy? If the receiver has other information about the context or situation they may be able to extract the exact meaning. But without additional information it is impossible to be sure what is meant.

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Secondly, people who belong to particular groups develop specialised language. This includes jargon (technical language) and colloquialisms (slang). Part of a care workers education is to begin to understand specific terminology and use words accurately to convey meaning. For example you may tell a colleague that Jean Brown is complaining of dysuria and should be monitored. But we wouldn’t expect your colleague to ask Jean ‘How is your dysuria?’ Jean might not understand. Instead your colleague may ask, ‘Can you tell me how you feel when you are passing urine?’ or ‘Can you describe how it feels when you go to the toilet?’ Similarly, colloquialisms or slang might not be clearly understood by service users. For example ‘Did I hear you Wallace and Gromit?’ or ‘Were you boking in the toilet? might be unfamiliar terms for vomiting or being sick. If we want to know if someone has been sick or vomited, then we need to make sure that they fully understand what we are asking. Thirdly, language used can also convey prejudice and care workers should think about the meaning, in terms or prejudice that the words that they use might convey. For example greeting an older man as ‘gramps’ or referring to a service user as ‘mental’ conveys stereotypical meanings that are unhelpful when trying to reflect the values of respect and dignity. Language is an important factor in demonstrating respect and is vital to building up a trusting caring relationship. Although we have been speaking about verbal communication as spoken words, there are people who have difficulty with speech and who rely on other forms of communication. British Sign Language and Makaton are two languages that people who have difficulty with speech may use in verbal communication.

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ACTIVITY To find out more about verbal communication using symbols and signs, visit the following websites. http://www.findavoice.org.uk/symbolpages/makaton/mak-1.htm

http://www.british-sign.co.uk/

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Verbal Communication - Questions Asking questions is an important aspect of developing caring relationships. It is part of the carer’s role to find out about the needs of the service user. There are a number of different types of questions but we will look at two types of questions that the carer can use.

Closed questions are used to obtain specific information. They require a specific response. For example, ‘What age are you?’ or ‘Do you have any pain?’ These can be effective to get relevant information quickly, but don’t give the service user an opportunity to provide other details that may be important. Open Questions give the service user an opportunity to provide more detail. This in turn allows the carer to develop a more in depth understanding of the service user’s situation. For example ‘What do you like about going to college? Or ‘What does the pain feel like?’ This gives the service user a chance to talk freely about their experience. If you want to limit the response you can prefix (put at the beginning of) the question with a phrase such as ‘Briefly tell me, what do you like about it?

Work in pairs to decide whether the following questions are open or closed. What time is it? Who left the door open? Why were you late? What kind of day have you had? Did you have a good time today? Have you got a place at college? Do you know how to work the microwave? Could you explain how to work the microwave?

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Non-Verbal Communication Non-verbal communication refers to all the aspects of communication apart from the actual words used. We have already found out that non-verbal communication (NVC) can be divided into two main components; paralanguage or vocal tones (which makes up approximately 38% of the message) and body language and facial expression (which makes up approximately 55% of the message).

Paralanguage or vocal tones Paralanguage or vocal tones add meaning to the verbal message. The volume and speed of speech can offer clues about a person’s emotions. People generally speak faster when they are excited or in a hurry and slow down when concentrating or trying to understand something. Shouting is associated with anger and mumbling with shyness. Putting the emphasis on certain words in a sentence can also change the meaning. Try saying the following with the emphasis on the bold words:

Mandeep is my keyworker but she has never come with me to the cinema. Mandeep is my keyworker but she has never come with me to the cinema. Although both of the sentences contain the same words, the meaning appears to change by emphasising different words in the sentence. Emphasising ‘my keyworker’ sounds as if the speaker is keen to stress a relationship with Mandeep. However, the emphasis on ‘me’ in the second example implies that Mandeep has gone to the cinema, but not with ‘me’. Paralanguage therefore includes, speed, tone, accent and emotional aspects of the message.

Paralanguage in care work involves using the correct pace and tone to communicate with the service user. To motivate a child you may use encouraging tones whereas to calm an anxious or angry service user you would slow down your speech and use soothing tones.

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Body language and facial expression Body language refers to the many signals that we transmit using gestures, posture and touch. The first thing to bear in mind is that body language is culturally specific. For example raising a thumb to an American will be interpreted as a supportive good luck gesture whereas someone from Iran would take offence as it regarded as an obscene gesture, a bit like a two fingered gesture in Britain. In Britain it is considered polite to look at someone when they are speaking to you whereas in Japanese culture direct eye contact is limited and prolonged eye contact can be considered to be disrespectful or even aggressive. We will look at body language and facial expression from a British perspective, but as we live and work in a multicultural society, carers should always be open to learning more about how people from a variety of cultures may express themselves differently using body language. Body language includes eye contact, facial expression, proximity, posture and gesture.

Eye contact can play an important role in establishing a relationship and an unwillingness to make eye contact may even be associated with shifty or dishonest behaviour. If you ‘catch someone’s eye’ then you are indicating to the person, non-verbally, that you want to have a conversation with them. Eye contact demonstrates interest in what is being said and is often accompanied with head nodding and appropriate facial expressions. Facial expression contains a substantial amount of information. A person’s emotions are often revealed by their facial expression. In fact studies show that there are seven universal facial expressions; that is seven facial expressions that are seen all over the world. These expressions are anger, disgust, fear, happiness, sadness, interest and surprise. Do you think that you can read these facial expressions of emotion?

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Picture Exercise – Seven Expressions Test your own ability to recognise emotional expressions. This exercise can be found at the web site below and there is a completion panel for you to decide what the expressions signify. http://www.cultsock.ndirect.co.uk/MUHome/cshtml/nvc/nvc3a.html •

Anger

•

Disgust, contempt

•

Fear

•

Happiness

•

Interest

•

Sadness

•

Surprise

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Proximity refers to the distance between you and the person you are interacting with. Generally speaking the more intimately you know someone then the more comfortable you are with being physically close to them. There are cultural variations but intimate space is thought to be around 15cms. However if a stranger or even your class teacher came to within 15cms of your face to ask you the time, you may think that this person was a bit too close for comfort and is invading what psychologists refer to as a person’s personal space. Psychological studies propose that personal space is around 15cm – 1 metre, and is the distance we like to be able to keep between ourselves and others. So, we may be able to tell something about the relationship between two people by the distance between them. When working with service users we should be aware that being too close can be threatening for the service user whereas if we don’t get close this might suggest that we are disinterested. Posture refers to a person’s stance. Even if we can’t see someone’s face we will sometimes make a judgement based on their posture. If someone is described as overbearing or dominating, this provides a mental image of someone who towers over other people and who probably appears a bit threatening. People may be described in a variety of ways. For example we may interpret that someone is relaxed or anxious from postural signals. When working with service users we should be aware of our own body posture. Facing someone and leaning slightly towards them will suggest that we are interested in them. Gesture refers to body movements that are invested with particular meanings. Gestures can be performed with the hands, head and feet. Nodding the head generally means agreement and shaking it from side to side means disagreement. Care workers can use gestures as a form of communication with service users in situations where communication is otherwise difficult. For example, when my dentist is drilling my teeth, he tells me to raise my hand as a signal that I want him to stop. Touch is a form of non-verbal communication that varies between cultures but which is particularly important in care work. Because carers assist service users with physical care tasks they are allowed to touch service users. Touch can communicate the attitude of the carer to the service user. Touch can be therapeutic, for example massage. Touch can convey gentleness and sensitivity but it can also convey the opposite when carers are rough and insensitive when working with a service user.

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Verbal and Non-verbal Communication

Activity 1 •

Record a television programme (10 minutes) and view it with the sound off.

•

Watch the way that people interact and try to work out what is happening by observing their body language. Note down your understanding of what is happening.

•

View the recording with the sound and evaluate your understanding. How accurate was your understanding? What body language clues did you observe?

Activity 2 •

Work in pairs

•

You should sit facing each other

•

You should both wear blindfolds and sit on your hands

•

Discuss a topic of interest, for example where you like to go on holiday. Try to spend 5 – 10 minutes talking to each other before removing your blindfold.

•

Evaluate this experience. Was it easy or difficult to keep the conversation going? Were you more aware of clues from tone of voice in the absence of visual cues? Did you want to use your hands to express yourself?

•

Explain the insights that this exercise can provide to help you when working with a blind service user?

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Barriers to Effective Communication When carers work with service users it is important to be aware of any possible barriers to effective communication. A barrier is anything that interferes with the message and can be attributed to personal, physical or environmental factors.

Barrier

Message Barrier

Sender y

21 Receiver

Feedback

Personal factors can be attributed to the sender or receiver. A person’s age, stage of development and ability should all be considered when deciding on the best way to communicate. The care worker is often responsible for giving the service user information. If the message contains too much information (information overload) or contains jargon or colloquialisms then these things will prevent the message being effectively communicated. Similarly if the care worker is listening to feedback and isn’t attentive or fails to clarify understanding then this too can interfere with effective communication. A person’s emotional state can be a barrier to communication. For example the message may be poorly communicated if the person is nervous, embarrassed, angry, anxious, or unable to make him or herself understood. It is the role of the care worker to assess the situation and to limit any misunderstandings.

Physical factors can include hearing, speech or visual communication issues. A person with poor or no hearing or someone with limited sight may have difficulty in sending or receiving the message effectively, without assistance. The care worker should consider ways of improving communication with service users who may need the message presented in a way that is more appropriate to their needs. Environmental factors relate to the surroundings where the interaction occurs. Service users will benefit from surroundings where they feel safe and comfortable. Where the interaction involves the transmission of personal information, the environment should be private and free from interruptions.

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Removing barriers To give and receive messages from service users, care workers need to develop effective communication skills. These include: •

Creating an environment that is conducive to people being able to communicate well

•

Recognising the person’s feelings, fears, insecurities and expectations

•

Consider whether the service user has any difficulties with vision, hearing, speaking or understanding

•

Communicating clearly using verbal and non-verbal communication skills

•

Listening effectively.

Effective listening involves paying attention to the speaker. This means that the care worker should demonstrate their attention using appropriate body language. If the service user is unable to see, then using touch and tone of voice should be used to reassure the person that you are paying attention. Gerard Egan suggests the following acronym to remember how to demonstrate attentive listening: S O L E R

square: sit or stand facing the person open posture – don’t fold your arms or cross your legs (barriers) lean forward slightly to show interest eye contact relax your posture

When communicating, carers can use open and closed questions to check the service user’s understanding. The carer can also check their own understanding of what the service user is saying. They can do this by reflecting back what is said, to check the meaning by paraphrasing or summarising

Service User:

I’ve been feeling sick all day

Carer Reflecting Back:

I’m sorry that you’ve been feeling sick all day. When did this feeling start and how is it affecting you now?

Service User:

It started soon after lunch. Now I’ve got pains in my stomach and I want to throw up.

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Effective Verbal and Non-verbal Communication

Brainstorm to identify ways improving communication for people in each of the following service users. •

Older adults with dementia

•

People with addictive behaviours (e.g. drugs/alcohol/gambling)

•

Young people with autism

•

Children with cerebral palsy

•

Adults with learning disabilities

•

Adults with mental health problems

•

People with hearing impairments

•

People with visual impairments

•

People with speech impairments

Select at least five of the above client groups. For each group, write a short paragraph to explain two specific ways that you as a carer, would improve communication for this client group. You should avoid writing very general statements such as ‘I would be aware of body language’. You should be very specific, for example ‘When communicating with an older adult with dementia I would note facial expression, as interest is a characteristic that is evident in a person’s facial expression. This would help me to be aware of topics of interest or items that hold a special significance for this individual and I would be able to develop strategies for holding the person’s attention.’ There are many ways of improving communication between carer and service user. Some suggestions are appropriate for a range of service users. There are a number of possible answers but it is important to try to think of things that may be particularly important for the service user you are working with.

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Older adults with dementia

• • •

Remind the service user of your name Speak slowly and clearly Use short simple sentences.

People with addictive behaviours (e.g. drugs/alcohol/gambling)

• • •

Create a comfortable environment, privacy is important Be attentive – SOLER Check understanding through open questions and reflecting back.

Young people with autism

• • •

Try to achieve eye contact Remove background noise or distractions Use clear and unambiguous language.

Children with cerebral palsy

•

Use simple language as you are speaking to a child Check the child’s understanding by asking open questions Do not rush the child when he or she is speaking.

• •

Adults with learning disabilities

• • •

Adults with mental health problems

• •

•

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Support verbal communication with body language and gestures Use objects and pictures if these help to explain more clearly Let the person know that his/her contribution is valued by giving them him/her to think about their response and then express him/herself. Create an environment where the person feels safe and comfortable Remind the service user that you will maintain confidentiality (the environment, and your non-verbal communication will need to support these words) Check your understanding using open questions and reflecting back.

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People with hearing impairments

• • • •

People with visual impairments

• •

•

People who find speech difficult

• • •

Make sure that the person can see you approaching. (Don’t surprise them suddenly from behind) If the service user can lip read make sure you are sitting in a good light where they can see you. Don’t cover your mouth when you are speaking. If the person uses hearing aids, make sure they are available and working. Don’t shout. Let the person know that you are there and who you are. You can use touch to let the person know how close you are; offer to let the service user touch your face and hair to find out more about you. Describe objects and events in detail to enhance the service user’s experience and understanding Be attentive – SOLER Don’t rush the person. Don’t finish off sentences for the service user but give the person time to express him/herself. Use a picture board if it is appropriate

Advocacy People can have difficulty with communication for a variety of reasons. Advocacy is one way that carers can support people to communicate. It involves finding out what people want to say and helping them to express their point of view. It is a means of empowering people. An advocate is someone who helps someone to express their views, or concerns. Sometimes a carer will fulfil this role. There are many different forms of advocacy, including self – advocacy. To be effective as an advocate a carer must develop an understanding of the service user’s needs and wants. The carer may speak on behalf of the service user or work with the service user to enable them to develop skills to speak up for him or herself (self-advocacy).

Find out about advocacy services – what do they provide?

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Carl Roger’s Core Conditions Communication with people can be more effective if certain conditions are achieved. Carl Rogers developed a Person Centred approach that can help when working with individuals. The person centred approach starts from the basis that an individual knows his or her experiences better than anyone else and that all individuals are capable of change. However sometimes service users may need help to make more sense of their experiences or to make decisions about changing their situation. Rogers suggest that there are three core conditions that are important in creating a relationship to enable growth and therapeutic change. These core conditions are: •

Unconditional Positive Regard

•

Congruence

•

Empathy.

These core conditions are particularly relevant when involved in counselling service users, when there is an opportunity to build up a relationship over a period of time. However these conditions can support effective communication with any service user.

Unconditional positive regard can also be thought of as respect, acceptance, warmth or prizing (valuing the person). The carer demonstrates verbally and non-verbally that they accept the person as a unique individual. The service user doesn’t need to behave in particular ways to gain the carers approval. Unconditional positive regard means that the carer is nonjudgemental about the service user’s situation. This opens up an opportunity for the service user to be able to express thoughts and feelings without fear of rejection or condemnation. Unconditional positive regard does not mean that the carer has to be approving of all of the service user’s behaviour, but the service user knows that they are not judged on the basis of their behaviour. The service user does not have to work hard to earn the approval of the carer. It is the job of the carer to clearly communicate that they accept the service user. This can be done through words of support and encouragement and the creation of a climate where a service user feels safe. In these conditions a service user can build up trust in their carer and is able to relax and begin to reveal their concerns. Congruence is the idea of being ‘in tune’ with the service user. This means that the service user is being genuine with the service user and is open and honest with them. Congruence is about people being real with each other and not pretending to be what the other person wants them to be. Both people in the relationship should be able to be open and transparent but it is the carer who has to work hard to help this happen. If the carer says they will maintain Scottish Further Education Unit

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confidentiality this has to be true. If the carer says that they are not shocked to know that the service user has downloaded pornographic images on their computer, this has to be true. The carer can only achieve congruence by being aware of his or her own personal feelings and thoughts. If the carer is persistently offended by something that the service user says or does, and has strong feelings about this, then the carer should be aware that this is something that may ‘leak out’ to the service user, probably non-verbally, and get in the way of the therapeutic relationship. So, if the carer is shocked that the service user is downloading pornography, this should be voiced so that there is no deception in the relationship. However, although there is shock there is still ‘acceptance’ of the person. Unconditional positive regard, by the carer, is maintained and the service user should find that they are increasingly able to be him or her self rather than pretend in the relationship.

EMPATHY is a characteristic which involves being able to perceive a situation from the service user’s point of view. This is sometimes known as being within a person’s ‘frame of reference’. Support groups bring together people who have had similar experiences, for example bereavement as people in similar circumstances may find it easier to empathise. However, empathy is different from sympathy. Sympathy is imagining how someone must feel, because that is how we would feel in a similar situation. Empathy, on the other hand, requires a lot of hard work to find out from the other person how they see their situation. Because we are all unique, we think and feel differently about similar events. To develop empathy the carer has to get to know the service user’s thoughts and feelings and to try to understand the issues as if they were the service user. This involves the use of open questions, reflecting back and paraphrasing, to check our understanding is accurate. Empathy can be thought of as the ability to enter someone else’s private world and being sensitive to their feelings and experiences. Understanding how another person is experiencing their situation is essential when considering needs, care planning and strategies to meet needs.

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Gerard Egan – A Systematic Approach to Helping Caring relationships are able to develop when Rogers’ core conditions are in evidence. When trying to achieve effective communication it is also useful to have a guideline to follow. Gerard Egan’s Skilled Helper Model, offers a systematic approach to helping using a process of exploring, understanding and acting. Egan further proposes a 3-stage model or framework to guide the helper who is working with a service user to solve problems or develop opportunities. The purpose of the model is to empower the service user by helping them 'to manage their problems in living more effectively and develop unused opportunities more fully', and to 'help people become better at helping themselves in their everyday lives.' The model is not a rigid step-by-step formula but can be used flexibly with the helper moving backwards and forwards between the stages to explore issues, help the service user to develop their understanding and make decisions about future actions. Although the process is dynamic, here, we will describe the stages in order from start to finish. The model has three stages: 1. The current scenario 2. The preferred scenario 3. The action strategies

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1. The current scenario is the stage where the helper (or care worker), enables the service user to explore their situation from their own frame of reference and then to focus on specific concerns. During this stage the carer finds out the service user’s story. There may be parts of the story that the service user brushes over or ignores and the carer is alert to these ‘blind spots’ and helps the service user to explore these areas to expose all aspects of the situation. The carer also helps the service user to focus on issues that are of particular concern to the service user and to decide on priorities; that is, the issues in order of importance. This stage could be summarised as:

Stage a. STORY

1 CURRENT SCENARIO

•

How the helper does this BE AN ACTIVE LISTENER

Demonstrate: b. BLIND SPOTS

c. LEVERAGE

•

UNCONDITIONAL POSITIVE REGARD

•

CONGRUENCE

•

EMPATHY

•

Use open and closed questions

•

Paraphrase (restate the story to check your understanding)

•

Reflect feelings (check you understand how the person feels)

Summarise the story and help the person to focus on specific issues •

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Observe non-verbal communication.

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2. The preferred scenario is the stage where the helper (or care worker), helps the service user to understand and consider all the choices and possibilities available to them. The care worker helps the service user to imagine all the options and to consider the resources that are available to support them to make changes. The service user is empowered through this process and a change agenda or plan is formulated. The care worker helps the service user to work through the implications of these potential changes and to formulate some goals. It is also necessary to check the commitment of the service user to achieving these goals. This stage can be summarised as:

Stage

2 PREFERRED SCENARIO

What happens

a. POSSIBILITIES

How the helper does this Continue to use the skills used in stage one.

b. CHANGE ANGENDA In addition, the helper should: c. COMMITMENT

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•

Communicate a deeper understanding: through increasing empathy and congruence.

•

Help the service user to set SMART goals (specific, measurable, achievable, realistic and time based).

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3. The action strategies formulate the third stage of Egan’s model. At this point the care worker helps the service user to look at ways of achieving the goals that they have set. Possible actions are considered and the advantages and disadvantages of these actions are evaluated. The service user begins to achieve a sense of the most appropriate action to take in their situation; that is to say the actions that are best fitted to achieving the desired goals. Once the service user has made these decisions a specific plan of action is formulated. This is stage can be summarised as:

Stage

3 ACTION

How the helper does this a. POSSIBLE ACTIONS

Continue to use the skills of stage 1 and 2

b. BEST FIT In addition: c. PLAN

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Help the service user to evaluate their actions by considering advantages and disadvantages

•

Decide on actions that will lead to the desired outcomes

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Use

the a

caring

systematic

SOLER

relationship

approach. ACTION LEADING TO VALUED OUTCOMES

Rogers

Remember

using Explore, Understand

and

Positive Regard, Congruence, Empathy.

Establish

Act.

Conditions. Unconditional Scottish Further Education Unit

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Key Points Effective Communication in the caring relationship •

Is used to demonstrate care values

•

Is required to understand individual service users and their needs

•

Involves listening, questioning, understanding and responding

•

Includes verbal messages – the actual words

•

Includes non-verbal signals – paralanguage e.g. pace and tone and facial expression and body language

•

Barriers to communication can be personal, physical and environmental

•

SOLER skills used in effective listening

•

Communication must be appropriate to the needs of the service user

•

Rogers’ core conditions are Unconditional Positive Regard, Congruence and Empathy

•

Egan’s Systematic approach is Explore, Understand and Act

•

Egan’s Skilled Helper Model – 3 stages – Current Scenario, Preferred Scenario and Action Strategies

•

Advocacy is a way of empowering service users, so that their voice can be heard.

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Reflective Practice as a Tool for Evaluating Personal Practice Reflective practice is simply thinking about what you are doing or what you have done. This is known as reflection in action (in the present) or reflection on action (reflecting on a past event). The person who is reflecting can ask themselves questions about their actions. For example: Why did I do that? Why did I say that? How did I feel? How did the service user feel? Did I communicate well? How can I communicate more effectively with this service user? What did I do that was good practice? What did I do that was bad practice? How do I know what is good or bad practice? Am I using any theory in my practice? Could I use any of my current knowledge of theory to improve my practice? Do I need to learn more to be able to improve my practice? Where can I find out more about people with this condition/in this kind of situation? Was that the best I could do for this person? How would I feel if someone did that to me? What could I do differently? A professional care worker will reflect on their actions and the actions of others, to learn from their experiences. Reflective practice lets the professional care worker think about what they do and why they do it. The aim of this reflective practice is to gain a deeper understanding of the service user – carer relationship and to act on what is learned to improve care practice.

Reflective Practice Is a way of improving practice. Means deliberately thinking about what you did. Involves asking lots of why, how, what, or any other questions to gain a deeper understanding about experiences. Is a way of learning from experience and acting on this new knowledge to improve practice.

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Formative Assessment – Outcome 1 Analyse caring relationships in terms of care values and communication

PLEASE READ THESE NOTES Before you do this formative assessment you should review your notes. You should try to make notes of the main points you need to remember. You can highlight main points, use mind-maps, memory cards or mnemonics to help you remember. Sometimes it is useful to work with one or a few other people to revise. You can discuss topics together, take turns in explaining topics to each other and also ask each other questions. When you have completed your revision, try to do the assessment without referring to your notes. You should be aware that in the National Assessment Bank (NAB) instrument of assessment and in external exams you will be asked questions that test both Knowledge and Understanding (KU) as well as your ability to carry out Analysis, Evaluation, and show the Application of theory to practice (AE/App). KU marks are awarded for accurate information given in answers, AE/App marks are awarded for doing something with this information, for example discussing advantages and disadvantages or analysing or applying this information in relation to a particular situation or client group using case study material. In this formative assessment there are no actual marks given but each question indicates whether it requires KU and/or AE/App. If you have difficulty answering the questions, review your notes again and then try again. You may refer to your notes when answering the questions but try to put things into your own words. You should discuss your answers, and any difficulties you have with your class tutor.

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Formative Assessment – Outcome 1 Analyse caring relationships in terms of care values and communication

Read the following case study and answer the questions that follow. You are on placement in a care home for older adults, some of whom have dementia. You are assigned to work with a senior care assistant, Amy. It is 8.30 am and Amy tells you that the first job to be done is to get the residents up for breakfast. You follow Amy to the first room and she enters without knocking. ‘Time to get up Fred, ‘wakey wakey’, she calls and goes over to the window to open the curtains. Fred looks a bit startled and gives you a weary smile. Amy goes into the cupboard and brings out some clothes for Fred to wear and asks you to check that there are towels in the en-suite shower. Amy doesn’t introduce you and you feel a bit awkward as there isn’t an opportunity to introduce yourself as Amy has asked you to check for towels. You find that there are no towels and tell Amy this. Meanwhile Amy has managed to get Fred out of bed and has stripped his pyjamas off. ‘He’s wet himself’ she explains, old people do that. ‘You keep an eye on Fred and I’ll get some towels’. She then rushes out of the room to get the towels but leaves the door open. She returns after a couple of minutes and shuts the door. Fred is helped to shower and dress. He tries to put his own trousers on but Amy hurries him saying that there’s no time to wait as breakfast is on the table. Fred uses a walking frame and you and Amy help him to the table. On the way to the dining room, Amy explains that Fred has dementia. She says that he has one son who lives in the town but his son is an alcoholic and when he visits he just causes trouble. When you get to the dining room Amy says he should sit beside the window, and asks you to get him some porridge. Later in the day you are assigned to Ron who is a care manager. Two people are coming to see Ron, a woman and her son. The woman Jean Anderson, has dementia and she lives with her son and his family. They want to find out about the possibility of a short break at the home. Ron is preparing for their visit. He says it might be possible for you to be present when he speaks to them but he will have to ask for their permission. He asks if you have learned anything about communication skills at college. You discuss the importance of communication skills and are permitted to be present at the meeting. You note that Ron uses verbal and non-verbal communication skills as well as aspects of both Rogers and Egan’s theories. When you are leaving for the day, you meet Amy again. Amy asks how you got on and looks genuinely interested. Amy says that she is on a study day tomorrow. The topic is ‘reflective practice’.

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Formative Assessment – Outcome 1 Analyse caring relationships in terms of care values and communication Note: Main Points from Professional Codes of Practice/Conduct are listed on the following page to help with questions 2 and 3. Questions 1. Outline two advantages, to the service user, of care values underpinning care practice. (KU/AE)

2. Select one main point from the Social Services Council Code of Practice for Care Workers and evaluate Amy’s practice in relation to that point. (KU/AE/App)

3. Select one other main point from a Professional Code of Conduct or Code of practice and explain how this could be put into practice when working with Fred. (KU/AE/App)

4. Explain the meaning of stereotyping. (KU)

5. Explain one reason why care workers should be aware of stereotyping. (KU)

6. Explain one reason why care workers should be aware of their own body language. (KU)

7. Explain two ways of improving communication with someone with dementia. (KU/AE/App)

8. Explain two ways that Ron could demonstrate effective listening at the meeting. (KU/AE/App)

9. Describe what is meant by ‘blind spots’ in Egan’s skilled Helper Model. (KU)

10. Explain the purpose of reflective practice and why this might benefit Amy. (KU/AE/App)

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Formative Assessment – Outcome 1 Main Points from Professional Codes of Practice/Conduct to help with questions 2 and 3.

Key Points SSSC Code of Practice 1. Protect the rights and promote the interests of service users and carers. 2. Strive to establish and maintain the trust and confidence of service users and carers. 3. Promote the independence of service users while protecting them as far as possible from danger or harm. 4. Respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people. 5. Uphold public trust and confidence in social services.

Key Points NMC Code of professional conduct A. Respect the patient or client as an individual. B. Obtain consent before you give any treatment or care. C. Co-operate with others in the team. D. Protect confidential information. E. Maintain your professional knowledge and competence. F. Be trustworthy. G. Act to identify and minimise the risks to patients and clients.

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OUTCOME 2 Explain the role of legislation in promoting positive care.

Performance Criteria (a) Describe the main features of relevant legislation (b) Explain how legislation promotes positive care practice

Mandatory Content Main features of relevant legislation: • •

legislation that is currently in use and that can be seen to have an influence on current care practice. Legislation can be seen to reflect values and the links between legislation, policy, procedures and social or cultural values.

Legislation to be considered: • • • • • • • •

Regulation of Care (Scotland) Act 2001 Data Protection Act 1998; NHS and Community Care Act 1990 Disability Discrimination Act 1995 Race Relations Act 1976 and Amendment Act 2000 Sex Discrimination Act 1975 Mental Health: Care and Treatment (Scotland) Act 2003 Adults with Incapacity Act (Scotland) 2000 Community Care and Health (Scotland) Act 2002.

Ways in which legislation acts as a framework to promote positive care practice: • • • • • • • • • • •

by promoting health and wellbeing social, cultural, mental, physical, emotional and cognitive aspects reflecting values associated with human rights safeguarding human rights and bringing benefit to individual requiring care providing benefits to individuals maintaining quality of life protecting rights and choices maintaining confidentiality promoting equality of opportunity enforcing professional accountability specifying professional care workers responsibilities under legislation (updating, accountability etc.)

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Introduction To be effective, a care worker will need to be familiar with legislation that concerns their work and has an effect on the lives of service users. Care workers have a responsibility to keep up to date with current legislation and to be aware of impending changes. If a care worker is ignorant of their legal obligations when working with others this is detrimental to service users and could also jeopardise their own professional registration. There are also legal consequences for care workers, as for anyone, who breaks the law. Legislation compels people to behave in certain ways and legislation is turned into policy in the workplace. A policy is a course of action and there are a range of policies in place in care settings, for example an equal opportunities policy. When working with a service user or group of service users, carers must work in accordance with legislation and workplace policies. In this section we will consider a number of Acts of Parliament that have been introduced to address issues in society and which have direct relevance to many service users. It is only necessary to know the main features of each piece of legislation and to appreciate the difference that the particular piece of legislation can make.

An Overview of Legislation The key features of each piece of legislation are described and summarised in the following pages. Links between some pieces of legislation are made, where appropriate, to show the way that legislation has been developed and changed. It is important to remember that legislation may change and to keep up to date with these changes. You should work through this information, visiting the websites referred to for further information. The information mainly provides you with knowledge and understanding. Visiting the websites and looking at some of the situations where the legislation is used will give you the scope needed to help you to analyse, evaluate and apply this knowledge and understanding.

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The Sex Discrimination Act (1975) The Sex Discrimination Act was introduced to address inequalities between men and women in response to stereotypes and prejudices that existed (and continue to exist) in relation to sexual identity. For example, the stereotype that men being physically and emotionally strong are suited to work as builders and company directors, whereas women being the opposite aren’t considered for these jobs. Subjects studied at school reflected these stereotypes with girls directed into domestic science and boys into technical programmes. In addition, women and men doing the same jobs were paid different rates with men paid more, as they were seen to be the ‘breadwinner’ for the family. The Sex Discrimination Act made it unlawful to discriminate on the grounds of sex and specifically refers to discrimination in employment, education, advertising or the provision of housing, goods, services or facilities. Discrimination may be direct or indirect. However the individual has to raise a complaint and provide evidence of discrimination.

Direct sex discrimination is where a woman (or man) is treated less favourably than a person of the opposite sex in comparable circumstances is, or would be, because of her (or his) sex. Indirect sex discrimination exists (in employment) where a provision criteria or practice is applied (or would be applied) to both sexes but which puts one sex (or married persons) at a particular disadvantage and cannot be shown to be a proportionate means of meeting a legitimate aim. For example, a requirement to work full-time might be unlawful discrimination against women, who might also have responsibilities as carers. The Equal Opportunities Commission (EOC) was set up to monitor the implementation of this legislation. Current policy issues relate to gender equality and stereotypes that exist in relation to ethnic minority women at work. The Gender Equality Duty (GED) is a new law that came into effect in April 2007 to address ongoing discrimination in the workplace. Thirty years after the introduction of the Sex Discrimination Act, there is still widespread discrimination in society. The amendment introduces a duty that places the legal responsibility on public authorities to promote gender equality in the workplace. Sometimes exemptions are allowed where there is a genuine occupational requirement. For example recruiting a female worker for a women’s refuge.

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You can keep up to date by visiting their website. You can also find an excellent publication giving an overview of 30 years of progress since the Sex Discrimination Act was introduced in 1975. http://www.eoc.org.uk

Key features The Sex Discrimination Act 1975 and Gender Equality Duty 2007 •

The Sex Discrimination Act 1975 prohibits sex discrimination against individuals in the areas of employment, education, and the provision of goods, facilities and services and in the disposal or management of premises.

•

It also prohibits discrimination in employment against married people. Since the Civil Partnership Act 2004 came into force on 5th December 2005, the same protection is afforded to those in a civil partnership as those who are married.

•

The SDA applies to women and men of any age, including children.

•

Genuine Occupational Requirement exemptions

•

The Gender Equality Duty 2007 places the legal responsibility on public authorities to promote gender equality in the workplace.

http://www.eoc.org.uk

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The Race Relations Act 1976 Racial discrimination means treating a person less favourably than others on racial grounds. In the 1976 Act Racial discrimination relates to unequal treatment based on race, colour, nationality or ethnic or national origin. The Act was introduced in response to evidence that people from ethnic minority backgrounds were treated unfairly in society. It put into place protection for individuals from being discriminated against in employment, education, training, housing and the provision of goods, facilities and services. The Race Relations Act (1976) is concerned with actions that discriminate against people and the effects of these actions. It is unable to protect individuals from the negative opinions and beliefs that other people might have, that is to say, racial prejudice. For example, it would be illegal for a health centre to display a sign saying ‘No Asylum Seekers’. This would be an action that would discriminate against this group. However, a person working in the health centre may hold prejudiced views about people seeking asylum. So prejudice still exists but acting on this prejudice to disadvantage asylum seekers, or any other group on the grounds or race, is illegal. The Act defines three different forms of discrimination.

Direct racial discrimination, which is open and obvious. So putting a sign up to exclude people from a certain racial group would be direct discrimination. Indirect racial discrimination is a more subtle form of discrimination. The person or organisation may not be aware that their actions are disadvantaging people in a certain group. For example failing to provide essential information about a service in a language that a person can understand. Victimisation means being singled out for unfavourable treatment. The Act protects people who have complained under the terms of the Act from any hostile repercussions. The Commission for Racial Equality was set up to monitor the implementation of the legislation. Their website can be visited at http://www.cre.gov.uk Under the terms of the 1976 Act the individual has to show that he or she has been treated less favourably than someone from a different racial group in similar circumstances. So, for example a person from an ethnic minority group is constantly having appointments to see a social worker or nurse cancelled and always has to wait a long time for an appointment. However, the same social worker or nurse is always available for local Scottish people, who can always get an immediate appointment.

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The Race Relations Amendment Act 2000 An amendment is a modification or alteration. This amendment widens the scope and strengthens the provision of the 1976 Act. The amendment was introduced in response to widespread racial discrimination in public service provision. This is known as institutional or organisational discrimination. Under the terms of the 1976 Act, the individual has to present evidence of discrimination and this can be difficult to prove. The amendment compels public authorities to be proactive in preventing discrimination and places a duty on them to promote racial equality. The duty extends to all aspects of an organisation’s activity. Public authorities have a duty to eliminate unlawful discrimination, promote equality of opportunity and promote good race relations between people of different racial groups. The Amendment extends the scope of indirect discrimination to include race, ethnic or national origin and also introduces a definition of harassment on the grounds of race or ethnic or national origins. Harassment occurs when the behaviour of a person violates the other person’s dignity or creates an intimidating, hostile, degrading, humiliating or offensive environment for them.

Key Features Race Relations Act 1976 and Amendment 2000 This legislation provides protection from discrimination due to race, colour, nationality or ethnic or national origins. The following forms of discrimination are unlawful: •

Direct discrimination on grounds of race

•

Indirect discrimination on grounds or colour or nationality. Amended to include race, ethnic or national origin.

•

Victimisation

•

Harassment

The Race Relations Amendment Act 2000 Public authorities have a duty to: 1. Eliminate unlawful discrimination 2. Promote equality of opportunity 3. Promote good race relations between people of different racial groups

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Disability Discrimination Act 1995 and Disability Discrimination Act 2005 These pieces of legislation aim to end the discrimination faced by many disabled people. A disability is a long term (chronic), mental or physical impairment that has an adverse effect on an individual’s ability to carry out day to day activities. The 1995 Act establishes rights for disabled people in employment, education, access to goods, facilities and services, and buying and renting land or property. The Act also allows the government to set minimum standards so that disabled people can use public transport easily. The 1995 Act places duties on service providers and requires reasonable adjustments to be made when providing access to goods facilities, services and premises. The Disability Rights Commission was set up by the UK Government to support the Act. You can visit their website at http://www.drc.org.uk and follow the link to Scotland.

The Disability Discrimination Act 1995 has been amended by the Disability Discrimination Act 2005 to place a duty on all public sector authorities to positively promote disability equality. The duty applies in England, Scotland and Wales.

The Disability Equality Duty (DED) requires that a public authority, when carrying out its functions must: •

Promote equality of opportunity between disabled people and other people

•

Eliminate discrimination that is unlawful under the Disability Discrimination Act

•

Eliminate harassment of disabled people that is related to their disability

•

Promote positive attitudes towards disabled people

•

Encourage participation by disabled people in public life

•

Take steps to meet disabled people’s needs, even if this requires more favourable treatment.

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Key Features Disability Discrimination Act 1995 and Disability Discrimination Act 2005 •

Rights for disabled people in employment, education, access to goods, facilities and services, and buying and renting land or property.

•

Minimum standards so that disabled people can use public transport easily.

•

Reasonable adjustments to be made when providing access to goods facilities, services and premises.

•

The Disability Rights Commission was set up.

Disability Discrimination Act 2005 •

Disability Equality Duty (DED) to enforce public authorities to promote equality of opportunity between disabled people and other people and encourage participation by disabled people in public life.

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Keeping up to date

The Commission for Equality and Human Rights. The Equality Act 2006 establishes the Commission for Equality and Human Rights (CEHR) that will come into being in October 2007. The CEHR will bring together the work of the three existing Commissions, the Commission for Racial Equality (CRE), Disability Rights Commission (DRC) and Equal Opportunities Commission (EOC) in this new body. Equality, diversity, and respect for the human rights and dignity of every man, woman and child are defining values of British society. The CEHR will enforce equality legislation on age, disability and health, gender, race, religion or belief, sexual orientation or transgender status, and encourage compliance with the Human Rights Act 1998. This development is aimed at challenging prejudice and discrimination and removing barriers that may prevent individuals from fulfilling their potential, or participating fully in society.

Equality Legislation Promoting Positive Care Practice When working with service users it is vital for care workers to recognise barriers that prevent people from fulfilling their potential. Some of these barriers are based on prejudice and discrimination in relation to age, disability and health, gender, race, religion or belief, sexual orientation or transgender status. Care workers should be prepared to challenge prejudice and discrimination and work towards removing barriers that may prevent individuals from fulfilling their potential, or participating fully in society.

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NHS and Community Care Act 1990 This piece of legislation introduced a number of changes to the way that care is delivered to people with ongoing needs. It makes provision for people who have care and support needs to live independent lives in the community. People with physical and/or mental health needs can be supported in the community, whilst living in their own home or in a residential care home. One of the main changes under the act was the idea of assessing need in the community. Local Authorities were given the responsibility of assessing the needs of people in their area, and to arrange for the provision of care services to meet these needs. Care services can include meals on wheels, home care, respite or short-break schemes, day care and nursing home care. Assessment of needs is carried out at macro level and at micro level. Macro level simply means looking at the big picture. So, local authorities must produce a community care plan every three years. This plan considers the budget, existing service provision and the need that exists in their area. The plan might be for the development of new services, the expansion of existing services or the closure of services that are no longer needed. Micro means small and this refers to the obligation on local authorities to assess an individual’s needs. The aim of an assessment is to find out about a person’s individual needs and the services and support required to meet these needs. A person’s needs are assessed by a member of the community care team. The assessment of needs is ‘person centred’. This means considering need from the service user’s perspective If a person needs a service then there is an obligation to provide the service. This is a move away from people with needs having to fit their lives around available services to one where the services are ‘needs led’ and are provided in a way that best suits the individual’s requirements. A number of other provisions of the Act have been amended or replaced by subsequent government reforms.

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Community Care and Health (Scotland) Act 2002 The Scottish Parliament has the responsibility for Community Care and Health matters in Scotland. This Act extended the role of local authorities and introduced the following reforms. •

Nursing and personal care provided for people over the age of 65 is free of charge.

•

Local joint working between local authorities and NHS Scotland is to be expanded. This has resulted in the formation of Community Health Partnerships or Community Health and Care Partnerships.

•

Direct payments for home care services is to be extended.

•

Informal carers, including young carers have the right to assessment of their own needs. Local authorities have a duty to ensure that carers are aware of this right. This means that a parent who cares for a child with a disability, or a husband who cares for a wife with dementia, can have their needs assessed. The views of carers and the person they care for, have to be considered before deciding which services to provide

To keep up to date with developments you can visit the Health and Community Care section of the Scottish Executive website: http://www.scotland.gov.uk/Topics/Health

Key Features of the NHS and Community Care Act 1990 and Community Care and Health (Scotland) Act 2002 •

Local authorities are responsible for needs assessment

•

Individual needs assessment is person centred and if a service is required it must be provided

•

Nursing and personal care for people over the age of 65 is free

•

Joint working between local authorities and NHS Scotland is to expand

•

Direct payments for home care services is to be made more widely available

•

Informal carers, including young carers have the right to have their needs assessed and local authorities must make carers aware of this right

•

Carers and the person cared for should have their views taken into consideration before deciding which services should be provided

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Data Protection Act 1998 This piece of legislation ensures that personal data is obtained fairly and lawfully, allowing for privacy and protection of the individual. Data is any information recorded in manual or electronic format. Personal data includes names, dates of birth, telephone numbers, bank details, e-mail and home addresses. Data stored has to be kept up to date and accurate and must not be kept for longer than necessary. This means that a carer who is working with a service user can only obtain details that are necessary for the service that is to be provided. Data is recorded in assessment of needs, care planning, letters and paper or electronic files containing personal details. Data must be kept safely to prevent loss or damage or unauthorised access and use of the information. If an organisation holds personal information about an individual, the Act makes provision for the person to access this information. The person can make a ‘subject access request’ to the organisation asking for a copy of information that they hold.

Key Features Data Protection Act 1998 •

Data is any information about a person held in paper or electronic format

•

Data stored has to be kept up to date and accurate

•

Data must be kept safely to prevent loss or damage or unauthorised access and use of the information

•

Subject Access Request can be made for a copy of personal information held by an organisation.

For more information about how one organisation applies this legislation you can visit The NHS Scotland Confidentiality and Data Protection Website: http://www.confidentiality.scot.nhs.uk

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Adults with Incapacity (Scotland) Act 2000 This Act was introduced to safeguard the welfare and manage the finances and property of adults (16 years old or over) who do not have the capacity (ability) to make their own decisions. Adults may lack capacity because of mental disorder or because they are unable to communicate in any way. The legislation permits other people to make decisions on behalf of these adults but safeguards the interests of the person with incapacity. Some of these safeguards include the requirement that decisions taken on behalf of an adult with incapacity must benefit the adult. This helps to protect service users from exploitation by others. Decisions must also recognise and reflect the wishes of the adult, nearest relative or primary caregiver. This promotes the rights of the service user to be treated as an individual and to make the most of their ability. The act also requires that decisions taken on behalf of a service user should achieve desired benefits, so that a person making a decision on behalf of a service user should be able to justify the decision and demonstrate the benefits to the service user. Decisions are required to promote the welfare of the service user by encouraging the use of existing skills. This means that every effort has to be made to empower the service user and to help him/her to reach their full potential.

Key Features Adults with Incapacity (Scotland) Act 2000 Permits people to make decisions on behalf of another adult who lacks capacity Safeguards the welfare and finances and property of adults with incapacity Decisions taken must: •

Benefit the adult

•

Recognise and reflect the wishes of the adult, nearest relative or primary caregiver

•

Achieve desired benefits

•

Promote the welfare of the adult by encouraging the use of existing skills

You can visit the following website to find out how the Highland Council is implementing policy to comply with the legislation. www.highland.gov.uk/socialwork/olderpeopleservices/adultswithincapacity

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Regulation of Care (Scotland) Act 2001 The Regulation of Care (Scotland) Act 2001 is responsible for some major changes that are aimed at giving greater protection to people who use care services in Scotland. The act established a new independent body to regulate care services in Scotland. The Act set up a new organisation called ‘The Scottish Commission for the Regulation of Care’ known as ‘The Commission’. This new organisation is responsible for the registration and inspection of care services. Registration means that a range of care services including hospices and care homes for older people must apply to The Commission to be put on a register to offer a care service. Registered care services must abide by a set of Care Standards which are agreed by the National Care Standards Committee and published by Ministers in the Scottish Parliament. The Care Commission will judge whether the service is able to comply with any legal rules and care standards. If the service is approved it can be registered. Inspection means that The Care Commission has the power to visit care services to make sure that the service is keeping to the agreed legal rules and care standards. The Commission uses the care standards to measure the performance of the care service and will produce a report of their inspection. If the inspectors find that the care given is not acceptable then the Commission has the power to insist on changes and if the service fails to take action, the Commission can close the service down. The Government in Scotland introduced these changes to protect service users by making certain that the quality of care given and received would meet the same standards anywhere in Scotland. Care standards are based on six principles. These are: •

DIGNITY

•

PRIVACY

•

CHOICE

•

SAFETY

•

REALISING POTENTIAL

•

EQUALITY AND DIVERSITY

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You should become familiar with the principles and how care workers put them into practice. You can also visit the Care Commission Website at: http://www.carecommission.com The Regulation of Care (Scotland) Act 2001 also established the Scottish Social Services Council (‘The Council’) to regulate social service workers and to promote and regulate their education and training. The Scottish Social Service Council publishes Codes of Practice for Social Service Workers and Employers. These are standards of conduct and practice which must be followed and which have been discussed in Outcome 1.

Key Features Regulation of Care (Scotland) Act 2001 •

Established a system of care regulation to promote high quality services appropriate to service users’ needs

•

Established the Scottish Commission for the Regulation of Care ‘The Commission’

•

•

Publication of National Care Standards

•

Registration of care services

•

Inspection of care services against required national care standards

•

Able to take action to enforce standards.

Established the Scottish Social Services Council •

Publishes Codes of Practice for Social Service Workers and Employers.

•

Regulation of social service workers

•

Promotes and regulates education and training of social service workers.

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Mental Health: Care and Treatment (Scotland) Act 2003

This law came into effect in April 2005. Its purpose is to make sure that people with mental health disorders can receive effective care and treatment. A mental health disorder refers to mental health problems, personality disorders and learning disabilities.

http://www.scotland.gov.uk/Resource/Doc/26487/0 013533.pdf

Firstly the law is based on a set of ten guiding principles, including the principles of non-discrimination and equality. Anyone who takes any action under the Act has to take account of the ten principles. The Act sets out the circumstances in which a person with a mental disorder may receive treatment and/or be detained on a compulsory basis: which means against their will. When a person refuses the care and treatment being offered to promote their health and wellbeing there are clear procedures that have to be followed. When this help is considered to be essential to the person’s wellbeing the person can be legally required to comply with this care and treatment. The Mental Health Tribunal is a special panel that was set up by the Act to provide an independent and impartial service to decide on the compulsory care and treatment of people with mental health problems. http://www.mhtscot.org The Act also deals with how the criminal justice system should deal with someone with a mental disorder who is accused or convicted of a criminal offence. This includes provision for ongoing treatment and care. The Act sets out a number of rights and safeguards to protect the rights of a person with mental disorder. This includes a new right for service users and carers to request an assessment of the service. Local authorities have new duties to provide ‘care and support services’ and ‘services designed to promote well-being and social development’ for people who have, or have had, a mental disorder. Health Boards will also have to provide services for children and young people (aged under 18) that are appropriate for their particular needs. A person with a mental disorder also has the right to access independent advocacy services. The Mental Welfare Commission has the task of monitoring the implementation of this Act. http://www.mwcscot.org.uk Scottish Further Education Unit

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Key Features Mental Health Care and Treatment (Scotland) Act 2003 •

Guiding principles, including the principles of non-discrimination and equality

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Compulsory powers to require a person with a mental disorder to go into hospital or accept treatment that they may not want

•

The Mental Health Tribunal will decide on cases under the act

•

Deals with how the criminal justice system should deal with someone with a mental disorder who is accused, or convicted, of a criminal offence.

•

Protects the rights of a person with a mental disorder

•

People with a mental disorder have rights to access independent advocacy services

•

Local authorities and Health boards have duties to provide appropriate services

•

The Mental Welfare Commission has the task of monitoring the implementation of this Act.

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REVISION Key features of legislation To develop your knowledge and understanding of key features of legislation and help you to remember them: •

Copy or cut out the Key feature boxes.

•

Work in pairs to either name the piece of legislation from a description of the key features or, if one person names the legislation the other person should try to describe the key features.

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Ways in Which Legislation Acts as a Framework to Promote Positive Care Practice Positive care practice is care practice that brings benefits to the service user. The legislation discussed acts as a framework to promote positive care practice as care workers must adhere to the law when carrying out their work.

Each piece of legislation has specific benefits to particular groups of people. These specific benefits are described in the key features of the legislation. There are general benefits to the service user too. These are shown in the diagram below.

Figure 3. Benefits of legislation to the service user

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Formative Assessment Outcome 2 Explain the role of legislation in promoting positive care Before you do this formative assessment you should review your notes. When you have completed your revision, try to do the assessment without referring to your notes. If you have difficulty answering the questions, review your notes again and then try again. You may refer to your notes when answering the questions but try to put things into your own words. You should discuss your answers with the class tutor.

1. What is the function of the Commission for Equality and Human Rights? (KU)

2. Describe two main features of the NHS and Community Care Act 1990 and Community Care and Health (Scotland) Act 2002. (KU)

3. Explain two ways that the Regulation of Care (Scotland) Act 2001 promotes positive care. (KU)

4. Explain two ways that the Mental Health Care and Treatment (Scotland) Act 2003 supports the rights of people with mental health disorders. (KU)

5. Explain why care workers should know about legislation and suggest one way that a care worker could keep up to date with changes to legislation. (KU)

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Formative Assessment Explain the role of legislation in promoting positive care

Chloe is a 20 year old young woman, who has Down’s syndrome*. Chloe lives at home with her mother and she has completed a catering course at a local college. Chloe wants to work in a restaurant and has applied for a job in the college canteen. At college she has made friends with Dan, who also has Down’s syndrome. Dan is living in supported accommodation, and has a key-worker who helps him with independent living and Dan can do his own shopping, cooking and cleaning. Chloe likes the idea of independent living and has been talking to her mother about this possibility.

1. Describe one key feature of one piece of legislation and explain the relevance of this feature in supporting Chloe. (AE/APP)

2. Describe one key feature of a second piece of legislation and explain the relevance of this feature in supporting Chloe. (AE/APP)

*for information on Down’s Syndrome visit http://www.downs-syndrome.org.uk

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OUTCOME 3 Evaluate the effectiveness of the care planning process

Performance Criteria (a) Explain the care planning process (b) Analyse approaches to assessing needs of service users (c) Evaluate strategies for meeting needs of service users

Mandatory Content for this Outcome Role of care workers in planning and implementation including: •

Social worker

•

Community-based nurse

•

Hospital-based nurse

•

Speech therapist

•

Dietician

•

Occupational therapist

•

Physiotherapist.

Goal setting: •

Short- and long-term goals in care planning

Assessment of needs: This includes preferences and choices •

Tools of assessment e.g. meetings, assessment forms, checklists, observation and asking questions, diaries and scrapbooks and shared activities

•

Needs assessment using:

•

(PROCCCESS) Physical needs

•

Relationship needs

•

Organisational and operational needs

•

Communication needs

•

Cultural needs

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•

Cognitive/intellectual needs

•

Emotional needs

•

Social and spiritual needs

•

Maslow’s hierarchy of needs

•

Involvement of others in assessing needs preferences and choices

•

Values demonstrated in assessing and supporting needs

•

Strategies for meeting the needs of service users.

Evaluation of strategies: •

communication, teamwork and values and principles used.

•

Reflective practice as a tool to evaluate practice.

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The Care Planning Process The care planning process is the system of assessing the needs of service users, devising an individual care plan, implementing the care plan, monitoring and adjusting the care plan where necessary and reviewing and evaluating the relevance and success of the care plan. This evaluation of the care plan should then inform the development of future care plans and lead to service improvement. A care plan is a plan which identifies the most appropriate ways to meet the needs of the service user as agreed in the assessment process. Resources have to be available to meet the needs identified. Priorities have to be set with timescales and action points. Many service users who have a care plan will have a range of different types of need. A care plan may include a combination of support and care, enabling and medical or therapeutic treatment as forms of intervention. For some service users the care plan will be much simpler and identified needs may just be met by the provision of a single service. The whole care planning process of assessment, planning, implementation and evaluation must be carried out in the context of adherence to the core values of care and in accordance with the principles set out in codes of practice and professional conduct.

EVALUATE

ASSESS Values and Principles place the service user at the centre of the process

IMPLEMENT

PLAN

ONGOING MONITORING AND REVIEW

Figure 4. The Care Planning Process

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Good Practice in Care Planning Miller & Gibb (2007) identify ten different points of good practice in assessment and care planning. These are: 1.

Rest upon a firm value base with respect for the dignity of every individual and promotion of choice, rights, empowerment and protection, at the forefront.

2.

Have the service user at the centre; be with, and not of, the service user and be available to him or her. The aim is to empower and optimise the participation of the service user in developing an agreed care plan.

3.

Have good communication, including listening, at the core of the process.

4.

Be part of an on-going process which should never be regarded as complete.

5.

Be needs led and not service led; ‘needs led’ means focusing upon a full examination of needs; ‘service led’ means the way in which, in the past, people were assessed for a particular service for which they had been referred – service came first, needs second.

6.

Be based upon accurate, up to date information. It is important to distinguish clearly what is fact, what is opinion, intuition or something else.

7.

Guard against labelling, stigmatising or making a scapegoat of a person. For example, if Joe is described as ‘difficult’ in an assessment this is a label which can lead to stigma (a negative sign) which can lead to scapegoating (being unjustly blamed for everything which goes wrong).

8.

Be specific about who is responsible for what, and outline the responsibilities, as well as the rights, which the service user has in the process.

9.

Have a built-in evaluation procedure.

10. Emphasise that there is not just one right care plan, there are no absolutes and assessment and care planning should be tailored to individual needs.

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Care Planning Models A model is a pattern or example of how to construct something. Models are used in care planning to as a guide when developing a care plan. There are a number of models that can be used in care planning. We will consider two, the exchange model and person centred planning.

The exchange model emphasises the importance of communication between care workers and the service user. The model makes the most of the knowledge and experience of both the care worker and the service user. The care worker may have expertise in problem solving and knowledge of available resources. The service user also has expertise and is viewed as an equal partner in the process of planning their care, since they know best about their situation. The model recognises the service user’s wider social network and takes this into account when planning care. This social network will include family members, friends, partners as well as formal care workers. The process of producing a plan involves an exchange between the service user, their social network and members of the multi-disciplinary team who may be involved in supporting and caring for the service user. One of the main tasks for the care worker is to facilitate an exchange of information between everyone involved. A named person, a social worker or key worker, has the responsibility of co-ordinating the plan and negotiating agreements about who is to do what for whom and when it will be done. To use this model the care worker uses effective communication skills, including problem-solving skills.

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Person-centred planning aims to empower the service user to take as much control as possible over decision making. This approach emphasises the role of the service user in planning for their future needs. If the service user is unable to understand what is happening or unable express their views it is important that someone is advocating on the service user’s behalf. Some of the features of person centred care planning include: Moving from

Moving towards

clinical descriptions of people

seeing people as human beings

professionals being in charge

Sharing power

professionals inviting people

the person choosing who attends meetings

meetings in offices at times to suit professionals

meetings in a venue chosen by the person, when it suits her/him

meetings being chaired

meetings being facilitated

not asking what person wants

encouraging person to dream

assuming inability

looking for gifts in people

filing plans away

giving the plan to the person

Writing notes of meetings

graphic facilitation of meetings

professionals putting plan into action

all team members having some responsibility for implementing plan

Figure 4. Person Centred Care Planning Adapted from Miller and Gibb 2007

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The Role of Care Workers in Care Planning and Implementation Multi-disciplinary team working involves co-operation and effective communication between everyone involved in the support and care of an individual. Multi-disciplinary teams can include social worker, community based nurse, hospital-based nurse, speech therapist, dietician, occupational therapist and physiotherapist. One person in the team usually takes the lead in managing the care planning process. The Community Care and Health (Scotland) Act 2002 expanded local joint working between local authorities and NHS Scotland. The advantages of multi-disciplinary team working to the service user include a more effective use of resources. Overlap in services should be reduced and gaps in service provision identified and addressed. When planning and implementing care it is decided who will do what, and when they will do it. However this requires increased co-operation between care providers, including sharing of assessments, resources, communication of information and contribution to evaluation. This approach requires everyone in the team to fulfil their role, as failure to co-operate or share information will disadvantage the service user. It can be helpful for the service user to have a named key-worker who will be the main point of contact for any concerns that the service user may have. The principles that all care professionals put into practice are derived from the same values. They also share many of the same skills, for example communication and care planning skills. However each professional group has a particular set of skills that may be more significantly used in relation to meeting specific needs of particular service users.

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ICT ACTIVITY Work in groups to research careers in care work. You should use a range of websites to research these careers, and complete the table below. Careers Scotland and NHS Careers may be a useful starting point for your search. http://www.careers-scotland.org.uk http://www.nhscareers.nhs.uk

Professional Carer

Role description

•

Describe service users these professionals work with

•

Explain reasons why these service users might benefit from their particular professional skills

Community based nurse

Dietician

Hospital-based nurse

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Occupational therapist

Physiotherapist

Social worker

Speech therapist

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Goal Setting: Short- and Long-term Goals in Care Planning Care planning is the part of the process where the decisions about what is to happen are agreed and written down. The care plan sets out the strategies for providing the help that the service user requires to meet their needs by setting goals. Goals are targets that the service user is aiming to achieve and planning is about discussing options and deciding on the best way to support the service user. When deciding on goals care workers should support the service user to set SMART goals. They should be: Specific, Measurable, Achievable, Realistic and Time framed. If the goals set are specific, measurable and achievable it is more likely that the service user will be motivated to keep working to succeed. If the goals are unrealistic with no real way to measure success then people involved won’t be able to tell if they are making any progress towards the goals. A short-term goal is a step towards a long-term goal.

You may have learned about goal setting and completed exercises in the Psychology for Care Higher Unit or the Intermediate 2 Values and Principles Unit.

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Assessment of Needs People who use care services have rights that are supported in law and when needs are assessed this must be in accordance with the requirements of relevant legislation. When needs are assessed it is the service user who is given control over decision making and in the case of someone with incapacity a named person will advocate on their behalf. The NHS and Community Care Act (1990) introduced the concept of a ‘needs led’ assessment. This means that it is the individual’s needs that determine the services required to meet these needs. This is unlike a service led assessment where the services are provided and a person has to try to fit into existing services to have their needs met. Services that can be drawn upon to meet an individual’s need may be sought in the statutory or independent sectors, including voluntary and private care providers. Informal care providers may also be involved in meeting need. Sometimes it is difficult to know exactly what is needed, especially when needs are complex. Tools of assessment are helpful in providing some objective evidence of individual need.

Tools of Assessment A person’s needs may be expressed subjectively, that is the person can tell you how they feel, and also objectively by considering evidence of their situation through observation or information from a range of sources. Tools of assessment can be used to draw attention to a service user’s needs or changes in their needs. These tools can take the form of meetings, assessment forms, checklists, observation and asking questions, diaries and scrapbooks and shared activities. A number of these tools can be used together so that a clear picture of an individual’s needs may emerge.

A meeting is useful in bringing people together. Using person centred planning it is the service user who decides where and when to meet and who should attend the meeting. A meeting is useful for facilitating a discussion about the service user’s needs and possible strategies for meeting those needs. There may be a series of meetings to enable the service user to consider all the information and possible options. Ultimately, it is the service user who selects the strategy that they believe is best suited to meeting their individual needs.

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Assessment forms are used to gather essential information about the needs of the service user. The form usually poses a number of questions for the service user to answer. The answers give the care provider an overview of the service user’s general needs. There may be questions relating to mobility for example, ‘Do you walk without any help?’ ‘Do you use a walking stick or other walking aid?’ ‘Are you unsteady on your feet?’ Checklists have a number of questions, usually in boxes, and the box is ticked to indicate the service user’s situation. This kind of assessment is usually a starting point for a more in depth assessment of need. Observation and asking questions is a way of assessing a person’s ability or mood. For example, you may observe an older adult bending down to pick up a paper from the floor. You can observe if they have any difficulty in bending, if they appear unsteady or if their hand shakes. Or someone who has a mental health problem may be observed to see whether their mood is improving, for example if someone has been depressed you may observe whether they smile or appear interested in activities or interacting with others. Asking open or closed questions can help to support your observations. For example, ‘You seem quite fit, but it looked as if your back was a bit sore when you bent down. Was it?’ Or, ‘you seem happier today, are you?’ Remember to use your knowledge of communication theory when asking questions. Diaries and scrapbooks are built up over a time to record significant feelings or events in the life of the service user. This helps to build up a picture of the individual’s experience over time and provides insights into the unique life experience of the person and enables carers to identify particular areas of need. Shared activities A person’s needs may also become more apparent when a carer is doing something with the person. You may be shopping with someone, helping prepare a meal or playing bingo. The service user may discuss likes and dislikes, wants, dreams and nightmares on such occasions. This information may make an important contribution to care planning and shouldn’t be ignored.

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Case Study: Andy and Assessment Tools Read the case study and discuss answers to the questions which follow. For the last two years Andy has been drinking at weekends with his friends. It began as a bit of a laugh but now Andy’s drinking is getting out of control. He began adding vodka to cola in a bottle and drinking this every day, even at school. There is now more vodka than cola in the bottle. He looks tired in class and lacks interest in schoolwork and sport. Andy’s guidance teacher has been meeting with Andy to try to get him to talk about the reasons for the changes in his behaviour. Andy gets on well with the guidance teacher but is ashamed to admit that he is abusing alcohol. He has started to steal money from his mother’s purse and is dodging school. Andy’s mother has had several rows with him but he denies that he has stolen any money and says he doesn’t have a problem. Things came to a head last night when Andy came home drunk. He fell on the floor and began vomiting. His mother became alarmed as he was unconscious and he nearly choked on his vomit and died. Andy was taken to hospital where his condition was monitored. Andy has been frightened by this experience and he has asked one of the nurses what he should do.

1. What are the advantages of having a meeting? e.g. The issue can be discussed.

2. Are there any possible disadvantages? e.g. Andy might find it difficult to express his feelings.

3. Suggest the kind of questions that might be asked on an assessment form or checklist. e.g. How much vodka do you drink in a week? 4. Discuss how Andy’s guidance teacher could use observation and asking questions to assess Andy’s situation.

5. How could Andy use a diary to help him assess the extent of the problem?

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Needs Assessment Using a PROCCCESS Model PROCCCESS When a care worker is working with a service user to assess needs it is important to do this in a logical and organised way to achieve a holistic assessment. A holistic assessment considers the different needs that a person has and recognises the inter-relationship of needs. There is a recognition that if one area of need is not met then another area of need might also be negatively affected. For example if someone is unable to get out because they have poor mobility (physical need) then they may be unable to maintain friendships and attend social events (social need). One way of carrying out a holistic assessment of needs is to use the PROCCCESS approach. PROCCCESS, reminds the assessor to consider, Physical needs, Relationship needs, Organisational and operational needs, Communication needs, Cultural needs, Cognitive/intellectual needs, Emotional needs, Social and Spiritual needs.

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Holistic Care Holistic care is care that considers the needs of the whole person. This is because there is an inter-relationship between the different needs that a person has. For example: Brian is an adult man who is depressed. •

The word depression tells us how Brian is feeling but we don’t know why he is feeling this way. So as well as finding out that emotionally we want to plan to help him to feel happier we need to consider other needs too.

•

Assessing social needs would tell us something about employment and relationships which can be an important factor in a condition like depression. Social support may or may not be available, so these needs should be considered as part of an assessment.

•

Physical needs should also be assessed. Brian may look healthy but we know from research and health promoting strategies that exercise can improve mood. If Brian isn’t taking any exercise this might be included in the care plan.

•

Cognitive assessment would tell us about what this man knows about depression. He may need to be given new information to help him to make future choices.

•

Assessing cultural needs will provide an insight into his attitudes and beliefs. As an adult male he may feel cultural pressure to have a heterosexual relationship (with a woman) but he himself may not want this. If carers are to be able to provide holistic care all of these factors are important in assessing Brian’s need for care and support.

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Case Study: Ali Read the case study and then carry out the activity that follows

Ali is eleven years old. He has cerebral palsy*. He needs some help to wash and dress and has difficulty with speech. He lives at home with his mother, Fatimah, who has been unusually tired and short tempered over the last few months. She has now been told that she has a heart condition and will need a major operation. She will need to rest for a few months following the operation. Fatimah’s husband died three years ago and she has no family support

Use the PROCCCESS approach and write short notes explaining the possible needs that could be considered using this model. •

You should consider both Ali’s needs and Fatimah’s needs.

Discuss the usefulness of this approach in pairs or small groups and summarise your discussion to help when you revise this topic.

Summary

*for more information on cerebral palsy you can visit http://www.scope.org.uk

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Maslow’s Hierarchy of Needs In professional care work it is considered important that the actions that care workers take are based on evidence that has been well researched and that gives us powerful reasons for doing the things we do. If we want to provide the best care to meet someone’s needs we need to know something about how to work out (assess) what needs a person might have. The name of the psychologist Abraham Maslow is strongly linked to ideas we have about needs. Maslow (1954) proposed that all human beings have a number of needs. From his investigation of human needs he found that we are all motivated to try to fulfil these needs. It became evident that some needs are more important than others so Maslow put these needs into a hierarchy. Because unmet needs can be a cause of stress this theoretical model can be used as a way of assessing the needs that a person may have.

Growth Needs

Deficiency Needs

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Fig 5. Maslow’s Hierarchy of Needs adapted from Wikipedia.org From this diagram you can see that five levels of need are identified. Physiological, safety, love and belonging, esteem needs and at the top is selfactualisation. Needs at the bottom of the hierarchy are absolutely essential for life e.g. food and water. To move up the hierarchy a person has to satisfy needs at the lower levels first. You can also see that there are two main types of needs: deficiency needs and growth needs. Maslow believed that the lower levels were deficiency needs because when they aren’t satisfied people are motivated to try to do something to fulfil these needs. Higher level needs are known as growth needs. Activity that relates to these is more concerned about making efforts to fulfil abilities and talents. This leads to personal growth and is what Maslow called selfactualisation or working towards reaching our full potential. You should be aware that if you carry out more detailed study of Maslow’s work that the original model illustrated in Figure 5 has been adapted and later models (1970) and (1990) have additional levels for growth and development, including cognitive and aesthetic needs.

Involvement of others in assessing needs preferences and choices A more comprehensive assessment of needs, and a greater understanding of preferences and choices can be achieved by involving others in the assessment process. A range of people can contribute by sharing their point of view. This provides the opportunity to see things from a variety of perspectives. The service user is central to the process but significant others (family and friends) as well as care workers can also contribute to help the service user and those contributing to his/her care, to develop a clearer picture of needs preferences and choices.

Values demonstrated in assessing and supporting needs It is important to remember that to achieve good practice in assessing and supporting care needs, the agreed core values for care must be maintained. •

the value of respect for the worth and dignity of every individual

•

the value of according social justice and promoting the social welfare of every individual.

For example, questions asked in forms and checklists or discussion at meetings should be free from prejudice. People should be treated as individuals and provided with equality of opportunity.

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Revision of Knowledge and Understanding of Needs 1. What is a need? 2. Give an example of a need. 3. What is a want? 4. Give an example a want. 5. Describe three circumstances that can affect needs. 6. Draw a diagram of Maslow’s hierarchy and name the five main levels. 7. Put the following needs into the correct level of the hierarchy. • • • • • • • • • • • • • • •

Morality Food Confidence Access to employment Friendship Breathing Security Problem solving Sleep Family Respect of others Creativity Intimacy Protection from abuse Achievement

8. Explain what is meant by the term ‘deficiency’ needs. 9. Explain what is meant by the term ‘growth’ needs. 10. Why is it a good idea to involve others when considering needs, preferences and choices?

Peer assessment – get someone else to mark your answers and discuss any points on which you differ.

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CASE STUDY Read the following case study and then answer the questions that follow. Joe is seventy three and lives alone. He has lived in his present house for over 50 years and is surrounded by pictures and souvenirs that have precious memories for him. He is a well-known and popular person in the town. Joe has one daughter. She and her family live in the north of England. Joe also has two younger brothers who live in a nearby town. Although they only see each other three or four times a year they consider themselves a close family. They phone each week and never forget Joe’s birthday. Over the past year his neighbours have noticed that he has been more and more confused. He has been forgetting names and sometimes doesn’t seem to know what day of the week it is. This week one of Joe’s neighbours, Shamira saw him wandering late at night and nearly being run over by a car. She went to help Joe and saw that he was dressed in his pyjamas and a jacket. Joe said that he was going to work. Joe had a career as a musician and he is particularly fulfilled when he is playing and singing, especially jazz. Shamira took Joe back home. She found that the house was cold and there was a smell of gas. She saw that the gas fire had been left on but not lit. Shamira made this safe and went to the kitchen to make him some warm tea. She found that there was nothing in the cupboards and that the food in the fridge was mouldy and out of date. Shamira phoned Joe’s daughter who is very concerned about her father’s changing circumstances. She contacted social services and Joe is to have an assessment of needs. Using Maslow’s hierarchy of needs as a model (guide) write about some of Joe’s circumstances that would help you to understand his needs at each of the levels. Needs Joe’s circumstances Physiological

Safety

Love and belonging Esteem

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You might have noted some of the following points about Joe’s circumstances.

Needs Physiological

Joe’s circumstances Joe has no food in the house Joe’s house is cold

Safety

Joe was nearly run over Joe left gas on but not lit Joe’s food is mouldy Joe’s family live at a distance but are emotionally close Joe has lived in his home for over 50 years

Love and belonging

Esteem

Joe is respected in his local community Joe is a talented musician

Selfactualisation

Finds fulfilment in singing and playing jazz

Continue to use Maslow’s hierarchy to note down some of Joe’s needs.

Needs Physiological

Safety

Love and belonging

Esteem

Selfactualisation

Joe’s circumstances Joe has no food in the house

Needs

Joe’s house is cold Joe was nearly run over Joe left gas on but not lit Joe’s food is mouldy Joe’s family live at a distance but are emotionally close Joe has lived in his home for over 50 years Joe is respected in his local community

Joe is a talented musician Finds fulfilment in singing and playing jazz

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You might have noted the following needs

Needs Physiological

Safety

Love and belonging

Esteem

Joe’s circumstances Joe has no food in the house

Needs Joe needs food

Joe’s house is cold Joe was nearly run over Joe left gas on but not lit Joe’s food is mouldy Joe’s family live at a distance but are emotionally close

Joe needs warmth Joe needs to be safe from dangers of traffic, unlit gas and mouldy food Joe needs to know his family care for him

Joe has lived in his home for over 50 years

Joe needs his pictures and souvenirs as they have important memories Joe needs to maintain links with his local community where he is respected

Joe is respected in his local community

Joe is a talented musician Selfactualisation

Finds fulfilment in singing and playing jazz

Joe’s needs to maintain his musical abilities Joe needs opportunities to sing and play and listen to music, especially jazz

Implementing the Care Plan The next question is how are these needs to be met? Deciding on the best way to meet these needs is the planning part of the process. Remember that at the start of this outcome we stated that: “A care plan is a plan which identifies the most appropriate ways to meet the needs of the service user as agreed in the assessment process. Resources have to be available to meet the needs identified. Priorities have to be set with timescales and action points. Many service users who have a care plan will have a range of different types of need. For many service users the care plan will comprise a combination of support and care, enabling and treatment forms of intervention. For other service users the care plan will be much simpler and identified needs may just be met by the provision of a single service.”

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The implementation of the plan simply means putting the plan into action and following the agreed decisions. The arrangements made to meet needs are the various strategies that have been developed to meet the goals. For example if X needs to sit up to avoid a chest infection and if X needs a hoist to move from bed to chair then this should be done. If this is not done then there could be serious consequences for the service user e.g. chest infection develops if left in bed or dislocated shoulder if moved without the help of a hoist. There can also be consequences for the care worker, e.g. back injury, as well as legal implications. Effective planning and implementation involves relevant care provision and appropriate strategies to meet needs.

Care provision refers to the actions that are taken to meet a person’s needs. There is therefore a relationship between recognising needs and providing services to meet these needs. There are many different types of care provision. Care can be provided in many different settings including hospitals, day centres residential homes and a person’s own home. There are also different care workers who provide care services including social workers, community-based nurses, hospital-based nurses, speech therapists, dietician, occupational therapists and physiotherapists. Strategies are actions that are taken to meet needs. A variety of potential strategies for developing a caring relationship are contained throughout this unit. For example the following may be considered to be strategies: •

Anti-discriminatory practice

•

Rogers’s core conditions

•

Egan’s skilled helper

•

Advocacy.

There are also a number of strategies used to meet identified needs. In care planning, the service user may have a range of options to choose from. A strategy is usually always implemented with the expectation that it will successfully meet the aim and allow the service user to achieve their desired goals. However there may be a number of reasons why a strategy doesn’t work, for example the person’s health or circumstances may change. To analyse something you have to carefully examine it in detail and to evaluate something you have to weigh up advantages and disadvantages, positives and negatives, and consider different points of view. In the previous exercises you have analysed some of Joe’s potential needs. These needs could be met in a number of ways.

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Evaluation of Strategies It is important to evaluate whether a care plan is meeting the desired aims. Evaluation is built into the care plan so that a date is set for a formal evaluation of the plan. This may involve a meeting but may equally involve completing a checklist. However, rather than waiting for a formal review, strategies used to meet goals should be continuously monitored and reviewed. If they aren’t working for any reason then consideration should be given to changing the care plan before the formal review takes place. If goals are being met, then new goals may be discussed and agreed. When you evaluate the effectiveness of strategies used in the care planning process you need to analyse the particular reasons why the plan is or isn’t working. It is useful to consider the effectiveness of communication with the service user and with other members of the care team. It is also useful to consider whether care values and principles were evident in the process. You should recognise any barriers to progress, e.g. failure to communicate effectively or prejudiced attitudes that exist. Reflective practice, discussed in Outcome 1 is one way that care workers can evaluate their own personal practice.

One possible strategy for meeting some or all of Joe’s needs would be for him to move into a care home in the same town. Evaluate this strategy by discussing two advantages and two disadvantages of Joe moving into a care home.

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ACTIVITY - Analysing approaches to assessing needs and evaluating strategies for meeting Joe’s needs To analyse something you have to carefully examine it in detail. To evaluate something you have to weigh up advantages and disadvantages, positives and negatives, and consider different points of view. •

Suggest two care professionals that could contribute to planning Joe’s care and explain the contribution they could make.

•

Suggest two goals for Joe.

•

Suggest two different ways (strategies) that these goals could be met (remember it is important to offer service users’ choices).

•

Evaluate each of the strategies, outlining potential advantages and disadvantages for Joe, his family and the community.

•

Consider the needs of a variety of different service users and suggest strategies for helping to meet these needs. Evaluate strategies by considering advantages and disadvantages.

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Formative Assessment Outcome 3 Evaluate the effectiveness of the care planning process Before you do this formative assessment you should review your notes. When you have completed your revision, try to do the assessment without referring to your notes. If you have difficulty answering the questions, review your notes again and then try again. You may refer to your notes when answering the questions but try to put things into your own words. You should discuss your answers with the class tutor.

1. Explain what is meant by a ‘needs led’ assessment? (KU)

2. Explain why the involvement of significant others can be beneficial when care planning. (KU)

3. Describe one level of Maslow’s hierarchy and explain how one assessment tool could be used to assess need at this level. (KU/AE App)

4. Explain two advantages of multi-disciplinary team working (KU)

5. Describe two ways that an elderly person who has had a stroke that has affected mobility and speech could be helped by a particular care professional. (KU/AE App)

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Formative Assessment Read the case study and then answer the questions that follow.

Case Study Sally is 43 years old. She is married with four children. She qualified as an accountant and had a senior job with an organisation before choosing to leave work when she had her children. She planned to return to work when her youngest child started school. However at this time she became unwell and was diagnosed as having multiple sclerosis. The main symptoms that Sally has are fatigue and muscle spasms. Sometimes she uses a wheelchair to minimise these symptoms and to improve her mobility. This makes travel on public transport difficult and she was unable to go to a school meeting because, although there is a lift in the school, the classroom was upstairs in an area of the school without a lift. Sally has applied for several jobs but has never had an interview when she has disclosed her condition on the application form. When she omitted this information on one form she got a job interview. At interview she discussed her situation but didn’t get the job. She was told that she lacked recent experience but she believes that discrimination exists. Her daughter Annie is 14. Annie is overweight and her three brothers sometimes tease her about her weight. Annie has been quite withdrawn, not wanting to go out with her family and friends and spending a lot of time in her bedroom. Today Sally saw some cuts on Annie’s arms and she has found out that Annie is being bullied at school. Annie started crying, she says that people call her a ‘freak’ and that she hates herself. Several weeks have passed and a care plan is in place for Annie. A multidisciplinary team is working with the family. The team includes Kim, a community psychiatric nurse. Kim is working with Annie to raise her selfesteem and to help her work towards her goals, including the goal of becoming more assertive. This involves her being able to speak up for herself. Things seem to be settling and so Sally is considering another job application.

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Question Paper Formative Assessment

1. Explain two possible effects of using labels such as ‘freak’

(KU 4)

2. Describe one professional care value and explain how this will influence the care that Kim will offer Annie. (KU 3 AE/App 3) 3. Describe the three core conditions of the person centred approach to helping and evaluate the contribution that this approach could make, in facilitating change for Annie. (KU 6 AE/App 6)

4. Explain what is meant by using a multi-disciplinary approach to care planning and explain one advantage of this approach for Annie. (KU 4 AE/App 2) 5. Describe two key features of legislation relating to disability and explain their relevance to Sally’s situation. (KU 4 AE/App 4)

6. Explain the importance of evaluating a care plan.

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Care: Values and Principles, Higher

Glossary of Terms Advocacy

Speaking on a person’s own behalf or on behalf of another person

Analyse

Examine carefully

Assertive

Saying what you thinks or feels, without being aggressive

Chronic

Long term

Cognitive

Thinking and problem solving skills

Concept

Idea or thought

Culture

The way of life of people in society

Discrimination

Treating people differently often unfairly due to a particular characteristic e.g. age or sexual orientation

Discrimination

Unfair treatment based on prejudice

Domiciliary care

Care in a person’s own home

Empathy

Developing a sense of what it is like to be in another person’s situation

Empowerment

Transferring power to others

Evaluate

Weigh up / consider advantages and disadvantages

Interaction

Communication between people (includes verbal and non-verbal)

Need

Something necessary for maintaining life and wellbeing

Norm

Accepted way of doing things

Prejudice

A bias towards others based on stereotyped ideas

Principle

Standard

Psychologist

Someone who studies the human mind

Reflective practice

Thinking about what you do and why you do it

Research

Study or investigation

Residential care

Care home where people live and receive care

Respite

Relief

Socialisation

The process of learning to become a member of a society

Stereotyping

Ideas about people based on characteristics or membership of a particular group.

Value

Something considered as having worth

Want

Something we would like to have but is not essential

Students should be encouraged to add to this Glossary as they go through the Unit.

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Answers to Formative Unit Assessment There are a range of possible answers for these questions. The following is for guidance only.

1. Explain two possible effects of using labels such as ‘freak’ (KU 4) 2 marks are available for explaining 2 effects. For example 2 marks could be given for an answer similar to the following: Labels reflect stereotyping and prejudiced attitudes. They do not demonstrate their respect for the individual and they are damaging to the person’s selfesteem. 2. Describe one professional care value and explain how this will influence the care that Kim will offer Annie. (KU 3 AE/App 3) 3 KU marks are available for a full description of a professional care value. A brief description should only be given one or two marks. For example 3 marks could be given for an answer similar to the following: One care value is to respect the worth and dignity of every individual. This means recognising that an individual is a unique human being and this is the basis of their worth. It is not dependent on any other characteristic. Respect and self-esteem are linked to dignity and an individual’s dignity is maintained when their worth as a human being is recognised. 3 AE/App marks are available for explaining how this will influence the care that Kim will offer Annie. This requires candidates to apply their knowledge and a range of answers are possible. 3 marks could be given for an answer similar to the following: Respecting Annie’s worth and dignity will mean that Kim will treat Annie as an individual. Kim will not judge Annie on the basis of her age or weight. Kim will listen to Annie and recognise her right to be in control of her own life. Kim will discuss options with Annie and respect her preferences and choices.

3. Describe the three core conditions of the person centred approach to helping and evaluate the contribution that this approach could make, in facilitating change for Annie. (KU 6 AE/App 6) 2 KU marks are available for the description of each of the 3 characteristics i.e. 2 marks for describing unconditional positive regard; 2 marks for describing congruence and 2 marks for describing empathy.

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If these are simply listed with no description then a total of one mark only can be awarded. 6 AE/App marks are awarded for developing the above knowledge and linking each of these core conditions to points such as: • • • • •

helping Annie to feel valued as an individual helping Annie to feel safe in disclosing her feelings reassuring Annie that Kim understands her situation building up trust in Kim raising Annie’s self-esteem

4. Explain what is meant by using a multi-disciplinary approach to care planning and explain one advantage of this approach for Annie. (KU 4 AE/App 2) 4 KU marks can be awarded for knowledge contained in the answer such as: Multi-disciplinary team working means that care professionals work together to assess, plan, implement and evaluate care. A range of professionals are involved and this can avoid overlap or gaps in services as well as a more effective use of resources. 2 AE/App marks can be awarded for explaining one advantage such as: One benefit to Annie would be sharing of assessment information. This would help Annie because members of the team could share information and she would not have to repeat distressing events to different care workers at different times for different assessments.

5. Describe two key features of legislation relating to disability and explain their relevance to Sally’s situation. (KU 4 AE/App 4) 2 KU marks can be awarded for each of 2 features from the Disability Discrimination Act 1995 or Disability Discrimination Act 2005 or the Disability Equality Duty (DED)

4 AE/App marks can be awarded for explaining how each of the points is relevant to Sally’s situation. The points may be related to access to public transport, involvement in school life or equality of opportunity in employment.

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6. Explain the importance of evaluating a care plan.

(KU 4)

4 KU points are available for an explanation that should make two main points. For example these points might include: • • • •

it is important to find out if goals are being met to find out if there are difficulties in meeting goals and what these difficulties are to discuss with the service user alternative strategies that could be implemented to set new goals.

(KU 25 AE/App 15)

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