DHS 4: Person-Centred Approaches in Care Settings

DHS 4: Person-Centred Approaches in Care Settings Contents Outcome 1 Understand how to promote application of person-centred approaches in care settings Outcome 2 Be able to work in a person-centred way Outcome 3 Be able to establish consent when providing care or support Outcome 4 Be able to implement and promote active Participation Outcome 5 Be able to support the individual’s right to Make choices Outcome 6 Be able to promote an individual’s well-being Outcome 7 Understand the role of risk assessment in enabling a Person-centred approach Outcome 1 Understand how to promote application of person-centred approaches in care settings Unit DHS 4 1.1 Unit DHS 4 1.1 Unit DHS 4 1.2 Unit DHS 4 1.3 Question 1 Can you explain why person-centred values must influence all aspects of social care work? Person-centred values include individuality, rights, choice, privacy, independence, dignity, respect and partnership – these values must influence all aspects of social care work because as humans we are holistic beings and need to be treated with respect, dignity and individuality and supported to be as independent as we possibly can be to care for ourselves in the best possible way. Tailoring the care to benefit the individual will encourage and enable them to be supported physically, emotionally, socially and cognitively; it promotes a continuity of care; helps build positive relationships between individuals and care workers and provides the holistic approach needed for an individual to thrive. Question 2 Can you explain how person-centres values should influence all aspects of social care work? A person-centred approach means that the service provider fits the care around the individual and not around the service provided, taking person-centred values into consideration. By demonstrating positive body language when dealing with individuals; communicating in ways appropriate to and preferred by individuals and respecting the individual and their uniqueness we promote a sense of value and well-being within individuals. This sense of personal value and well-being can enable an individual to be included in their care decisions and allows them a sense of dignity. Speaking to individuals about their likes and dislikes and finding out about their history will enable care workers to build relationships with individuals, enabling the individuals to feel listened to and a part of their own recovery. Question 3 Can you explain how you evaluate the use of care plans in applying person-centred values? A care plan is the planned processes that need to be put in place to achieve particular outcomes. Each person is an individual, so therefore each care plan is unique to the person it relates to. While some individuals may have similar difficulties or needs, what needs to be done to achieve an outcome will differ depending on the individual. For example – Individuals with anxiety regularly call Crisis Team and need to speak to a care worker to calm their distress. Person A may need reassurance that the physical symptoms he is experiencing is anxiety and not a heart attack. Person B may need to be prompted to remember breathing techniques and distraction techniques to alleviate the anxiety symptoms. Person C may need to talk to someone on the phone about the music they are listening to in order to calm their anxiety. The achieved outcome of calming the anxiety may be the same but the individual outcomes have been reached in different ways. Question 4 Can you explain how to collate and analyse feedback to support the delivery of person-centred care in line with roles and responsibilities? It is important to collate and analyse feedback from several sources to ensure that individual’s needs, wishes and preferences are being provided for, in order to maintain a person-centred approach. Feedback helps to get a broad picture of how the care you are providing is perceived by others and if there are any improvements that can be made to ensure that the individuals that you support remain at the centre of their care. Within my role as a call handler I have a very informal approach to feedback, simply making a note of anything positive or negative and passing this on to my clinical lead or team manager. As a clinical support assistant however, when involved in a person’s care we regularly ask the views of the individual, their carers/family or friends and document their views in a short note about our HBT (home based treatment) visit that day. When a person is discharged from Crisis Team care, they are sent a copy of their discharge summary along with a points of view leaflet – this is optional for people to complete and return and this is monitored by team management to help analyse the level of service Crisis Team are providing and identify any improvements which may be necessary. Any feedback received is also shared with the team during a weekly team meeting. Outcome 2 Be able to work in a person-centred way Unit DHS 4 2.1 Unit DHS 4 2.2 Unit DHS 4 2.3 Question 5 Can you explain how you find the history, preferences, wishes and needs of an individual’s? The history, preferences, wishes and needs of an individual are documented on NTW (Northumberland, Tyne and Wear) NHS database, RiO. Each individual has their own account which documents their history of contact with NTW; their care plans; their WRAP (Wellness, Recovery Action Plan) – which is a plan completed by the individual and their support to list their preferences, likes and dislikes; what they have found helpful and beneficial and what they did not and notes relating to their contact with individual care workers involved in their care. Everything relating to the individuals care – diagnosis, medication, consent to share and limitations, safeguarding alerts and scanned copies of documentation are stored on the database. Question 6 Can you describe ways to put person-centred values into practice in a complex or sensitive situation? Person-centred values such as individuality, rights, choice, privacy, independence, dignity, respect and partnership are put into place whenever we are engaging with an individual who comes into contact with our team. In a complex or sensitive situation some of these values become increasingly important – for example privacy, individuality and choice. Case Study While recently call handling I received a call from an individual wishing to speak to a crisis clinician. The individual was in a distressed state, contemplating self-harm by suicide but was refusing to speak to the appropriate crisis team for their area of residence. While speaking to the individual it became apparent their parent worked for the appropriate crisis team, so in order to maintain privacy it was arranged for a clinician from a neighbouring team to speak to the individual on the phone. This enabled the person to discuss their issues with someone who did not know themselves or their parent – ensuring their choice was accommodated, their privacy was maintained and their individuality was honoured (by allowing them to be spoken to as an individual NOT a colleagues family member.) Question 7 Can you describe a situation when you have adapted actions and approaches in response to an individual’s changing needs or preferences? Within mental health care, peoples needs and preferences can change rapidly. A regular caller to crisis team was unwell and had been accepted onto crisis team caseload for a short term of HBT (home based treatment). Her consent to share information and details were all updated accordingly on the records, but after a couple of visits the individual decided to withdraw her consent to share information from her parents. The individual lived with her parents and HBT visits were being carried out at the home address, however to accommodate her change in preference visits were rearranged to take place at her GP surgery. When her parents rang crisis team for an update we had to inform there was no consent to share on the record, advise we could log their call and any concerns they may have but were unable to share information with them. Outcome 3 Be able to establish consent when providing care or support Unit DHS 4 3.1 Unit DHS 4 3.2 Module 3 1.1 Unit DHS 4 3.3 Question 8 Can you analyse factors that influence the capacity of an individual to express consent. In order to provide care or treatment, consent must be obtained from the individual receiving it – it is a legal requirement and respects the individual’s right to refuse care if they wish. Factors which can influence the individual’s capacity to express consent are as follows: intoxication from drugs or alcohol – the ability to understand, retain and process information is greatly reduce when under the influence. mental illness – some mental illness conditions prevent people from being able to demonstrate capacity, e.g. People with schizophrenia may show altered decision-making processes and impairments in their capacity to provide informed consent to medical or psychiatric treatment (https://library.neura.edu.au/schizophrenia/signs-and-symptoms/cognition/decision-making/) physical illness – something as simple as a UTI (urinary tract infection) can adversely affect an individual’s ability to make informed decisions learning difficulties – if a person’s learning difficulty affects their understanding and processing of information they may not demonstrate capacity to make an informed decision. language or communication barriers – any barrier which makes understanding and communicating difficult can impair an individual’s capacity to grant consent not having the information needed –it is important that all of the important and relevant information is provided to an individual to allow a decision to be made Any of these impairments may make the individual incapable of giving their consent, however not all of these impairments will require an assessment of capacity. Capacity is assessed for a particular decision at a particular time and while someone intoxicated may not demonstrate capacity at that time, by the next day they may have capacity to consent to treatment. Question 9 Can you describe different ways of establishing consent for an activity or action and explain why it is important to gain consent, even when it is difficult. There are several different ways to establish consent for an activity or action. You can ask the individual directly; get written consent; use sign language or facial expressions; use an advocate or use a practitioner or carer. It is important that health and social care professionals do their utmost to assist individuals to make their own decisions. This includes giving them all the information they need to make an informed choice and using different communication methods to find out the individual’s decision. Question 10 Can you explain what steps to take if consent cannot be readily established? All individuals have the right to refuse care and support and this must be respected. If consent cannot be readily established then you should not carry out the task; if someone refuses or changes their mind after having said yes, you must stop what you are doing; you should report any refusal or any reservations to your senior staff member, follow their instruction and record in the care / support plan. Outcome 4 Be able to implement and promote active participation Unit DHS 4 4.1 Module 3 1.2 Unit DHS 4 4.2 Unit DHS 4 4.3 Unit DHS 4 4.3 Question 11 Can you describe different ways of applying active participation to meet individual needs? Can you also explain why it is important to encourage people to be actively involved in their own care or treatment and to treat people as valuable and unique? Active participation is a way of working promoting an individual’s right to be included in their care planning and to be allowed to live their lives as independently as possible. This means that the individual is an active participant in deciding how their care is delivered rather than a passive receiver. It is beneficial to the individual because they have more control over their care and their lives, which can make them feel valued and raising their self-confidence and self-esteem. Within Crisis Team we apply active participation from the onset – we are an ‘opt-in’ service so the service user must agree and consent to contact from Crisis Team. At every stage of our service – telephone triage, assessment and HBT (home based treatment) we ask the service user to decide the level of input from the team – we make recommendations to the service user but ultimately the choice if engagement is given to the service user. Question 12 Can you explain how to work with an individual, their carer, families and the wider healthcare team to agree how active participation will be implemented? It is important to maintain people’s independence and record of achievement. Sometimes it may be necessary to spend time guiding and encouraging people in order for them to achieve something. Ways of implementing active participation can include: Open discussion and encouragement with the individual themselves, providing information and choice in order to enable the individual to be an active participant in decisions relating to their care. Using friends and family to encourage the individual as these are the people closest to the individual and will have more in-depth knowledge of an individual’s needs and wants. Ensure appropriate treatment/activities which will encourage the individual and help them to maintain interest in the treatments and activities. Peer-group activities and encouragement as the encouragement of peers and others in similar situations can be of immense benefit in reducing feelings of isolation in an individual. Highlighting benefits of the activity. If an individual is aware of the benefits to be gained from partaking in the activity, they are more likely to want to be an active participant. Recording the outcome as this will allow the individual to feel some achievement and pride as their treatment and recovery continue. They will be able to see how far they have come in their journey and it will encourage continuation. Question 13 Can you explain how the holistic needs of an individual can be addressed by active participation? The definition of holistic states “characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease”. (https://www.bing.com/search?q=holistic+definition&src=IE-SearchBox&FORM=IESR3A) Active participation enables the holistic needs of an individual because the individual is involved in decisions in their care and has a say in how they live their life in ways that are important to them. When an individual is given the opportunity to choose an activity or treatment which is acceptable to how they live their life then the care plan will be more effective, they will feel valued and listened to and their self-esteem and confidence will grow, which in turn will have a positive effect on aiding their recovery. Question 14 Can you explain how to promote the understanding and use of active participation? To promote the understanding and use of active participation, it is important to have knowledge about it. We can promote the understanding and use of it within staff and care providers by ensuring training and qualifications are up-to-date and maintained. To promote the understanding and use of it within service users we can offer activities which appeal to individuals; we can provide information by way of leaflets and case studies which are proven to show the benefits of active participation and we can have discussions with groups of peers to discover the type of things they would be interested in engaging with. Outcome 5 Be able to support the individual’s right to make choices Unit DHS 4 5.1 Unit DHS 4 5.2 Unit DHS 4 5.3 Unit DHS 4 5.4 Question 15 Can you describe the different approaches when supporting an individual to make informed choices? When supporting an individual to make informed choices it is important to avoid letting your own personal beliefs and values influence their decision. Any information provided should be factual and provided in a way that the individual will understand, taking into account their own communication needs and preferences Should the person come to a decision you do not necessarily agree with it is important to remain non-judgemental, people have the right to make their own decisions even if we feel the decision is not the one we would make. To be judgemental of an individual’s choice is unprofessional and displays a lack of respect for the individual’s right to make their own choices. Following a risk assessment process (identifying and evaluating the risks associated with a particular action and their likelihood of occurring) an individual can gain a factual awareness of the risks involved, which can then be assessed in the decision-making process. Documenting a risk assessment that you have created with an individual, provides evidence that you have promoted active participation, respected the individual’s right to make choices and assessed the risks involved. Question 16 Can you explain why it is important to manage relationships and boundaries with service users? It is important to manage relationships and boundaries with service users because we are working with some very vulnerable people. We have a responsibility to them to do things to the best of our ability and to ensure that our help and support does not damage or disenfranchise them – we are there to aid recovery, not become their friend. Working closely with people within their own homes it is important to avoid an individual becoming overly dependent or familiar with you as a worker - if you then move jobs or have to refer them on to another service, any positive work that you have done could be negated as a result of the difficulty they have in separating from you. Working with difficult issues can be very stressful and draining - professional boundaries help us to manage ourselves and our emotions; by maintaining a professional boundary we can be empathetic without becoming emotionally involved. Question 17 Can you explain how you use your own role and authority to support the individual’s rights to make choices? Within my role as a call handler, the individual’s right to make choices is ever present. When registering a new service user I would always need the permission of the individual to create a database record for them. Should someone else be referring the individual into our service I would always ask if the caller has the individual’s consent to refer them to us. We have had occasions where an individual has declined to access our service and they are assured they have the right to make this choice – alternative care pathways are provided (for example, Samaritans, Shout text service and local mental health helplines). Within my role as a support assistant, the individual is offered factual, relevant information in a way which best meets their needs and preferences in order to allow them to make an informed choice around the next step in their care – they will be offered alternative care pathways depending on their individual circumstances and needs. Question 18 Can you tell me how do you manage risk in a way that maintains the individual’s right to make choices? Within Crisis Team we practice a positive approach to risk management to ensure an individual’s right to make choices is respected. When working with service users within their own home we work in partnership with individuals to manage their own recovery with the support of family, carers and advocates. We aim to help people to access treatment and support while developing trusting working relationships, and by being open and honest about potential risks we help the service user to understand the consequences of their choices and actions. Staff follow NTW (Northumberland, Tyne and Wear) trust guidance, procedures and risk management tools and they are supported and supervised regularly by clinical supervisors, clinical leads and team managers. Service users’ mental capacity is assessed regularly throughout their time on Crisis Team caseload and it is determined whether they are making decisions of their own free will. Question 19 Can you describe how to support an individual to question or challenge decisions concerning them that are made by others? We can support an individual to question or challenge decisions concerning them that are made by others by discussing the decision directly with the individual; by finding out what they do not agree with and how the decision will affect their life we will be better placed to offer appropriate support and services such as advocacy, interpreters if required and enhanced communication techniques such as braille versions of communications. It may be beneficial for the individual to speak directly to the decision maker. There is a complaint procedure or appeal procedure which should be adhered to if the individual chose to make a formal complaint. In my role as call handler/support assistant, should the individual be challenging a decision around their care whilst on Crisis Team caseload I would make a note of their concerns, advise that I would pass this onto a senior member of the team and arrange for a call back at a convenient time to the individual. Should they be disagreeing with treatment or care received from another team or service I would signpost them towards PALS (Patient Advice and Liaison Service). Outcome 6 Be able to promote an individual’s well-being Unit DHS 4 6.1 Unit DHS 4 6.2 Unit DHS 4 6.3 Unit DHS 4 6.4 Question 20 Can you explain the links between identity, self-image and self-esteem? Identity is an individual’s personal view of their own individuality or identity with a group. It encompasses our cultural groups, our roles and our social identity - for example: I am English, I am a mother and I am a biker. Self-image is an individual’s own mental representation of characteristics such as height, weight, hair colour, gender, sexuality etc. It is how an individual sees themselves, how others see them and how they perceive others seeing them. Personal identity can also include intellect, emotions, passions, abilities, behaviour and body image. Self-esteem is a person’s overall emotional evaluation of their own worthiness, it is how a person feels about themselves – for example: I am a caring daughter. Self-esteem affects an individual’s motivation, attitudes, confidence and overall emotional well-being. It affects a person’s behaviour – individual’s with a low self-esteem have more negative thoughts about themselves and can behave in a way that may cause others to reinforce this low opinion of them which in turn increases the individual’s negative feelings. Question 21 Can you analyse factors that contribute to the well-being of an individual? The definition of well-being is “the state of being comfortable, healthy, or happy.” Factors contributing to the well-being of an individual fall into several categories: Physical Health – diet, sleep, exercise etc. Getting regular exercise, having a healthy diet and getting plenty of sleep can make an individual feel better about themselves. It also has ongoing health benefits, reducing the risk of illnesses such as diabetes and heart disease. Exercise releases endorphins, which are chemicals within the brain which give the body a natural high. Social - relationships with friends and family; the opportunity to meet new people etc. As humans we all need emotional support from someone. Having other people to talk to about feelings and emotions is a great reliever of stress. Social networks such as clubs or groups of people with similar interests or beliefs can provide individuals with positive affirmation of their self-worth, which in turn contributes towards their self-esteem. Financial Security – having enough money, avoiding debt etc. Money is not everything, but having enough money to live comfortably and take part in activities of interest to the individual is an important factor to well-being. Most people live with some sort of debt but increasing and overwhelming debt can leave a person feeling trapped and stressed and has a negative impact on a person’s well-being. Work and Education – personal goals and aspirations Work and education can make an individual feel valued. By studying towards a learning goal or qualification; working in a vocational role which gives job satisfaction; or volunteering their time to people or organisations in need, an individual will feel as though they are contributing to society and feel fulfilled. Respect and Dignity – culturally and religiously All individuals should be treated with respect and dignity, regardless of their culture, race or religion. An individual who is respected and treated in a dignified manner will feel more self-worth. (https://dsdweb.co.uk/2019/01/31/analyse-factors-that-contribute-to-the-well-being-of-individuals/) Question 22 Can you explain the importance of supporting an individual in a way that promotes their sense of identity, self-image and self-esteem? Can you give an example of how you do this in your practice? It is important to support an individual in a way to promote their identity, self-image and self-esteem because by providing a positive reinforcement of these we can ensure an individual that it is OK to be who they are. By learning about the individual and their background we can encourage them in activities to aid recovery that they will find stimulating and interesting in order to promote engagement. Within crisis team I provide this support by building rapport and engaging with individuals both on the telephone and face to face on HBT (home based treatment) visits. We are encouraged to take responsibility for visits with patients we have already either spoken to or previously met. Each individual’s care is tailored to meet their needs and preferences. Question 23 Can you describe ways to contribute to an environment that promotes well-being? Environment can mean both the physical environment and the social environment. Physical environment can include the property the service user is residing in, their personal room, furniture and belongings. By ensuring the physical environment is clean, well-lit and pleasant to be in; furniture is safe to use and appealing and personal belongings are well cared for we create a pleasant environment to promote well-being. Social environment includes personal boundaries, relationships and subjective feelings. In order to maintain a social environment conducive to promoting well-being we can respect an individual’s privacy; ensure they are safe from abuse; respect and maintain personal boundaries and choices; encourage and help them to maintain existing and build new relationships and keep communication channels open and honest. Outcome 7 Understand the role of risk assessment in enabling a Person-centred approach Unit DHS 4 7.1 Unit DHS 4 7.2 Unit DHS 4 7.3 Module 3 1.3 Question 24 Can you explain how to undertake risk assessment in enabling a person centred approach, then compare different uses of risk assessment in adult social care settings? In enabling a person centred approach, risk assessments should include evidence of working with the service user to identify what is likely to work and what is not; taking the views of carers and others involved with the service user into account when forming a plan; and considering the pros and cons of choosing one action over another. They should also develop plans and actions which will support positive potentials and priorities expressed by service user whilst minimizing risk to service user and others; and ensure the service user, carers and everyone affected or involved are fully informed of the decision, the reasoning behind it and the associated plans (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/478595/best-practice-managing-risk-cover-webtagged.pdf) Within social care settings risk assessments can be used to prevent accidents; prevent injury to individuals, workers and others; provide description of procedures and to meet legal requirements. They can also be used to assess risk around individual’s mobility; behaviour and habits such as self-harm, smoking and alcohol use and personal hygiene. Risk assessments are also carried out around outings and excursions. Question 25 Can you explain how risk assessment relates to rights and responsibilities? Risk assessment relates to rights and responsibilities in several ways. It is legally required by law that the person in charge acknowledges possible risk associated with the individual in care and they must ensure that precautions are taken. Risk assessments are used to prevent danger and harm associated with an individual’s mobility, hygiene, behaviour, outings and personal habits; and they provide guidance and instruction for carers on what the underlying risk is and solutions on how to handle and prevent the risks occurring. Question 26 Can you explain why risk assessments need to be regularly revised? Risk assessments need to be regularly revised in order to take account of the changing needs and preferences of the individual. By revising them regularly we can ensure they are up to date, relevant and that they prevent the risk of injury or harm. Question 27 Can you explain why safety and clinical effectiveness are important? Clinical Effectiveness is a seen as a key part of quality in the NHS, along with patient safety and patient experience and is defined as “the extent to which clinical interventions do what they are intended to do – which is to maintain and improve the health of service users, securing the greatest possible health gain from the available resources.” (https://www.ntw.nhs.uk/content/uploads/2017/10/Agenda-item-9-ii-Clinical-Effectiveness-Strategy-Draft-v1.2-for-Board-Oct17.pdf) Question 28 Can you describe how you would promote clinical effectiveness, safety and a good experience for the individual? To promote clinical effectiveness, safety and a good experience for the individual we need to ensure we have staff and carers carrying out good practice, using appropriate skills and competence to provide treatment or services when the patient needs them in an appropriate location to achieve clinical effectiveness to maximise health gain. This means that in everyday practice we need to think critically about what we do, questioning whether it is having the desired result and make changes to our practice based on evidence of what is effective in order to improve patient care and experience. (NTW (Northumberland Tyne and Wear NHS trust clinical effectiveness presentation for staff) Feedback Unit DHS 4 Learner Declaration: I confirm that the answers in this unit are my own work. Learners signature…………………………………………………………………………………… Date……………………………… Tutors signature………………………………………………………… …………………………….Date……………………………… IQA signature…………………………………………………………………………………………….Date………………………………. 11