Health T Level Core Second Edition (A8: Providing Person-Centred Care) PDF

Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 1 of 66 A8: Providing person-centred care Introduction An understa...

Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 1 of 66 A8: Providing person-centred care Introduction An understanding of person-centred care is essential for anyone working in the healthcare sector. This unit provides an introduction to the purpose and key features of person-centred care and planning, and considers how it can be achieved. Relevant legislation such as the Mental Capacity Act and its impact on the provision of person-centred care are considered. The ways that healthcare is regulated to ensure high standards of care are examined by looking at the roles of a range of regulatory bodies within the health sector, such as the Care Quality Commission and the Health & Safety Executive. We also discuss how an individual’s stage of development and long-term conditions and diseases impact care needs and types of service provision required throughout the lifespan and relating to death and bereavement. Promoting independence and self-care can have positive effects on the care and service provision. These are considered with reference to the 6Cs, linked with understanding the need for safeguarding and the importance of managing relationships and boundaries when providing person-centred care. Learning outcomes The core knowledge outcomes that you must understand and learn: A8.1 the purpose of the Mental Capacity (Amendment) Act 2019 in relation to healthcare A8.2 the key principles of the Care Act 2014 A8.3 the role of a range of regulatory bodies within the health sector A8.4 how physical and mental function across the lifespan impacts care needs and informs person- centred care A8.5 the key values of the healthcare sector when providing care and support A8.6 the purpose of the Personalisation Agenda 2012 and the importance of using holistic approaches in order to place individuals, their carers and significant others at the centre of their care and support Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 2 of 66 A8.7 a range of verbal and nonverbal communication techniques, potential communication barriers and how to overcome them to support an individual’s condition A8.8 the application of relevant legislation, including Mental Capacity Act 2005 plus Amendment (2019) and Liberty Protection Safeguards (LPS) on the provision of person-centred care A8.9 the considerations when providing person-centred care to people with pre-existing conditions or living with illness A8.10 how mental health conditions, dementia and learning disabilities can influence a person’s needs in relation to overall care A8.11 how to promote independence and self-care and the positive impact on the healthcare sector A8.12 the range of terms used in the healthcare sector in relation to death and bereavement, including their meaning A8.13 the role of healthcare professionals in providing person-centred care for the individual during the active dying phase A8.14 how to support people with bereavement and how to communicate with families A8.15 what the 6Cs are in relation to person-centred care A8.16 the importance of practising and promoting the 6Cs in relation to demonstrating person-centred care skills, through own actions and promoting the approach with others A8.17 the concept of safeguarding in relation to providing person-centred care A8.18 the importance of managing relationships and boundaries, and how to work within parameters, when providing person-centred care. A8.1 The purpose of the Mental Capacity (Amendment) Act 2019 in relation to healthcare This Act is designed to protect the rights of and to help safeguard and support individuals over the age of 16 who may lack the mental capacity to make choices about their own treatment or care. Key term Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 3 of 66 Mental capacity: the ability to make a decision. It involves being able to understand information and remember it for long enough to make a decision and to be able to communicate it to others. The Mental Capacity (Amendment) Act 2019 protects and supports the rights of individuals, aged 16 or older, who lack the mental capacity to make their own decisions. An individual who has dementia, someone with certain learning difficulties or an individual who has a serious head injury are all examples of people who may lack mental capacity and who would be protected by this Act. The 2019 Amendment to the Act replaced the ‘Deprivation of Liberty Safeguards’ (DoLS) with the ‘Liberty Protection Safeguards’ (LPS). This amendment aims to improve and simplify the process of assessing mental capacity and the care that is required. It also clarifies the Act’s provisions, aiming to ensure that individuals are only deprived of their liberty, or freedom, in order to protect them and keep them safe. The Liberty Protection Safeguards seek to: introduce a simpler process that involves families more and gives swifter access to assessments support carers, families and local authorities allow the NHS, rather than local authorities, to make decisions about patients, allowing a more efficient and clearly accountable process consider restrictions of people’s liberties as part of their overall care package remove repeat assessments and authorisations when someone moves between a care home, hospital and ambulance as part of their treatment. Source: www.gov.uk/government/news/new-law-introduced-to-protect-vulnerable-people-in-care A8.2 The key principles of the Care Act 2014 The six key principles of the Care Act 2014 are as follows. Empowerment Individuals should be supported to make their own decisions based on the best possible information. They should be encouraged to take control of their lives, be confident and make their own independent decisions. Protection Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 4 of 66 This Act gives safeguarding adults a legal framework for the first time and stipulates that service users who are in greatest need of support and protection should be provided with representation. This could be an independent advocate, whose job is to facilitate the involvement of a vulnerable person who is the subject of an assessment or review of a care package. Prevention Since it is better to take action to prevent harm before it occurs, all staff should be trained in safeguarding procedures (see Chapter A11) and how to recognise signs of neglect or abuse. The Act states that local authorities must put in place preventative services that can help reduce or delay the development of care and support needs, including those of carers. Proportionality Actions should be proportionate to the risk: being overprotective can disadvantage service users by preventing them from being able to make their own decisions. Partnership This involves working with a range of professionals, groups and communities to prevent, detect and report neglect or abuse. This includes information sharing, when appropriate and always in line with data protection regulations. Accountability Healthcare and social care professionals are accountable for any activities in relation to safeguarding. They need to be able to justify their actions and decisions. The organisation’s policies, practices and agreed ways of working should be followed. Research Watch this video (or read the transcript) about the Care Act from the Social Care Institute of Excellence (SCIE): www.scie.org.uk/care-act-2014/video.asp Make notes of any additional information you find in addition to the key principles listed above. Produce a factsheet for yourself about the Care Act for future reference. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 5 of 66 A8.3 The role of a range of regulatory bodies within the health sector Regulatory bodies and their role Healthcare services are regulated by official government organisations. The regulations (rules) are set by law and state the standards that have to be met by healthcare settings. Inspections are carried out by the regulators, for example, the CQC and Ofsted, to see whether services are safe, effective and well managed, and whether they meet the needs of their service users. Reports are published as a result of an inspection and healthcare settings may have to make improvements to their services in order to continue providing care. Regulations and inspections enable service users to be informed about the quality and standard of care that is being provided and to have trust in the services they use. Some regulatory bodies are responsible for registering care professionals as ‘fit to practise’, for example, the Nursing and Midwifery Council. A midwife may be ‘struck off’ the register if there are fitness to practise concerns. (See also section A2.11.) Key terms Inspection: the process of observing and carrying out checks to see whether services provided meet the required standards. Regulator: independent organisation that carries out inspections to monitor and rate the quality of services provided. Care Quality Commission (CQC) The CQC is the regulator of health and social care for England. It carries out inspections of care services such as hospitals, GP surgeries, care homes, community care services, mental health services and social service departments to ensure that care standards are being met. The CQC sets out 13 fundamental standards of care. Care should not fall below these standards. You can find the standards using this link: www.cqc.org.uk/about-us/fundamental-standards The role of the CQC includes: Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 6 of 66 registering and licensing care services to ensure essential standards of quality and safety are met carrying out inspections of health and social care settings to monitor that the care provided continues to meet the standards required publishing inspection reports which rate care settings (see Figure 8.1) issuing cautions, warning notices and fines if standards are not met providing recommendations of how the service can improve putting a care provider into special measures – this means informing them of improvements which have to be made within a specified time limit and with re-inspection within six months closing down a service to protect service users if it does not improve and continues to provide inadequate care. Figure 8.1 Care Quality Commission inspection grades Source: Care Quality Commission, www.cqc.org.uk The CQC aims to ensure health and care services provide people with safe, effective, compassionate, high-quality care. The organisation focuses on how services can improve. There are various impacts of regulatory inspections: There is transparency about the standard of services being provided. The public know that independent checks are carried out. They give people confidence in the quality of health and care services. The inspection grade may help individuals to choose whether or not to use that service. The grades enable individuals to compare services and care settings. The strengths of the quality of care provided are identified. They help practitioners do their job effectively, they know what needs to improve. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 7 of 66 Key term Transparency: nothing is concealed, hidden or covered up, the inspections show things exactly as they are, whether good or not. Research Go to the CQC website using the link: www.cqc.org.uk/care-services Refine your search by selecting, from the list on the right-hand side, a type of service. Choose one of care homes, GPs, hospitals or mental health services. Then click on ‘Search for a care home’ (or the type of service you have selected). Scroll down and choose a care setting – try to find one with ‘requires improvement’ or ‘inadequate’ grading. Click on ‘full details’ and then download and read the inspection report. What features of the care setting gained good or outstanding grades? What features of the care setting were considered to require improvement or were inadequate? Health and Safety Executive (HSE) The HSE is the national independent regulator for health and safety in the workplace. This includes public and private healthcare services. The HSE was created by the Health & Safety at Work Act 1974. The HSE’s role is to: enforce health and safety law in the workplace by ensuring health and safety standards and regulations are followed inspect health and care workplaces following health and safety incidents of a non-clinical nature provide advice on health and safety in the workplace improve health and safety in workplaces. The HSE has the right to enter premises to carry out investigations of incidents and accidents, and to check on safety compliance. If there has been an accident it might, for example, collect samples, take photographs and ask questions about safety procedures and risk control as part of the investigation. Following an investigation, the HSE may give advice on how to minimise risk in future and issue instructions that must be carried out by law. It may also issue ‘improvement’ and ‘prohibition’ notices which would detail action that must be taken and the timescale. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 8 of 66 Health and safety Read the following questions. Do you know the answers to these already? What are they? 1 The health and safety concerns in healthcare settings are different from those in other industries or organisations. List three examples of the special needs in healthcare settings. 2 Why are there extra risks for fire evacuations in some healthcare settings? 3 Consider the health and safety policies in your placement organisation. Choose three examples and explain how each addresses risks in your workplace. Then watch this video on YouTube about health and safety in healthcare and compare your answers: www.youtube.com/watch?v=nqf08O7WS-4 The table shows the main health and safety legislation that applies to healthcare services. In the event of a serious incident or accident, the HSE investigation would involve checking evidence that the relevant legislation was being followed by the care service. Regulations What they mean for care settings Manual These regulations relate to ensuring staff are trained in moving and handling Handling activities, including lifting, lowering, pushing, pulling and carrying, so that they are Operations carried out safely. This would include using moving and handling equipment such Regulations as hoists or slide boards to assist with transferring individuals in care settings in and 2002 out of bed, for example. See A3.1, page 53 for details of the Manual Handling Operations Regulations. Lifting Operations and Lifting Equipment Regulations (LOLER) 1998 Reporting of See A3.1, page 51. Injuries, Diseases and Dangerous Occurrences Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 9 of 66 Regulations 2013 (RIDDOR) Management of Risk assessments (see A3.2) have to be carried out and control measures put in Health and place. Care settings must appoint a manager of health safety and security. See A3.1, Safety at Work pages 49–50. Regulations 1999 Food Safety Requires care settings to identify food safety hazards and put procedures in place to (General Food ensure the safe storage, preparation and serving of food. Hygiene) Regulations 1995 Control of See A3.1, page 50. Substances Hazardous to Health Regulations (COSHH) 2002 Key terms Risk assessment: the process of evaluating the likelihood of a hazard actually causing harm. Control measures: actions that can be taken to reduce the risks posed by a hazard or to remove the hazard altogether. General Dental Council (GDC) The GDC is the UK statutory independent regulator for dental care professionals. The GDC was created in 1956 with the role of setting and maintaining standards of dental care practice and so protecting people from unqualified dental practitioners. The GDC maintains a register of qualified dentists and other dental professionals such as dental nurses and hygienists. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 10 of 66 The GDC ensures the quality of dental education and training. It sets the standards of training required for students, for continuing professional development (CPD) and for providers of dental education and training. It monitors whether dental professionals have completed the minimum CPD required to maintain their registration. This ensures knowledge and skills are kept up to date and that practitioners know how to meet and maintain high professional standards. The GDC website provides information for the general public including guidance and advice about topics such as teeth whitening, home aligners and braces. To protect individuals’ safety and maintain public confidence in dental services, the GDC also provides information about how to raise a serious concern about the ability, health or behaviour of a dental professional. The GDC will investigate complaints regarding dental professionals’ fitness to practice, such as: serious or repeated mistakes in patient care failure to respond reasonably to a patient’s needs, including referring for further investigations where necessary violence, discrimination, serious breaches of confidentiality and other inappropriate behaviour. Nursing and Midwifery Council (NMC) The NMC is the professional regulator of nurses and midwives in the UK and nursing associates in England. Anyone practising as a registered nurse or midwife or a nursing associate in England has to be registered with the NMC. The registration has to be revalidated every three years to demonstrate that skills and knowledge are kept up to date and that the practitioner is maintaining safe and effective practice. To revalidate, some of the evidence that is required includes at least 35 hours of CPD and five written reflective accounts. The NMC establishes the expectation that registered professionals will uphold the standards and behaviours set out in the NMC code. Research Use this link to find the NMC code of professional standards of practice and behaviour for nurses, midwives and nursing associates: www.nmc.org.uk/globalassets/sitedocuments/nmc-publications /nmc-code.pdf Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 11 of 66 Use information from the NMC code to make notes about the key aspects of each of the four standards. The standards are: Prioritise people. Practise effectively. Preserve safety. Promote professionalism and trust. The NMC sets the education standards professionals must achieve to practise in the UK, it promotes self- reflection and evaluation of practice to improve services, and it encourages lifelong learning of professionals. It supports professionals to have the knowledge and skills to deliver consistent, quality care that keeps people safe, for example, ‘Caring with Confidence: The Code in Action’ (www.nmc.org. uk/standards/code/code-in-action/person-centred-care/). This gives a series of animated examples of how to follow the standards when providing care. The NMC can investigate reported incidents and take action ranging from providing additional training, allowing time off work, suspension or deregistration, depending on the seriousness of the incident. The NMC website gives examples of different situations, such as theft of medication or concerns about clinical competence, with explanations of how they were investigated and resolved. Health and Care Professions Council (HCPC) This organisation regulates 15 health-related professionals including paramedics, physiotherapists, dieticians, occupational therapists, radiographers, prosthetists, orthotists and speech and language therapists. Key terms Prosthetist: specialist in prosthetics, which are artificial replacements for a missing limb such as a leg, foot, hand or arm. Orthotist: someone who makes splints or braces for weakened limbs for patients who require support due to an accident, injury or disease. This organisation sets standards for professionals’ education, training and practice, providing information about how to ensure training programmes meet the standards required by the HCPC. Some examples of the standards training programmes must meet include: Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 12 of 66 practice-based learning must be integral to the programme the course must be relevant to current practice the delivery of the programme must support and develop evidence-based practice. For in-depth details of the standards visit: www.hcpc-uk.org/standards/standards-relevant-to- education-and-training/set/ The HCPC registers qualified professionals who meet the required standards. It publishes standards of proficiency for each of the 15 specialisms, which all registrants must meet in order to become registered and to remain on the register. The HCPC can take action if professionals on the register do not meet the required standards or if there are concerns about a professional’s conduct, such as: bringing the profession into disrepute, e.g. inappropriate comments on social media failure to maintain adequate records. The HCPC website has a series of case studies that demonstrate the action that can be taken when professional standards are not met. Ofsted This government organisation inspects and regulates social care services that care for children and young people. It has responsibility for regulating children’s homes under the Child Standards Act (CSA) 2000 where regulated activities take place, for example, providing personal care. These organisations must register with the CQC. Ofsted is also responsible for inspecting any services providing education and skills training for learners of all ages. Following an inspection, the setting is given one of the following ratings: ‘Outstanding’, ‘Good’, ‘Requires improvement’ or ‘Inadequate’. The inspection report will identify good practice that the inspectors observed and also indicate what needs to be improved. These areas for improvement will be checked again at the next inspection with the expectation that the issues will have been dealt with and improvements made. Ofsted will put failing settings, rated ‘Inadequate’, into ‘Special measures’, which means they will be re-inspected and checked to monitor progress and improvements to the aspects of service that have been identified as unsatisfactory. Information Commissioners Office (ICO) Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 13 of 66 The ICO is an independent body whose role is to uphold and promote information rights in the public interest, encouraging transparency in terms of data usage and data privacy for individuals. The ICO provides guidance for maintaining data protection in care settings and explanations of data protection legislation, such as GDPR regulations. Its website has ‘At a glance’ summaries, for example, data protection involving children, and checklists organisations can use to review their data protection policies and procedures. The ICO carries out audits and advisory visits across health organisations in relation to personal data. It then produces reports indicating areas of concern, good practice and recommendations for future practice. To see an example of a report on NHS Trusts, visit: https://ico.org.uk/media/action-weve- taken/audits-and-advisory-visits/2618960/health-sector-outcomes-report.pdf Practice points Do you know which regulatory body is responsible for your placement organisation? If not, find out. Using the regulatory body’s website and any information you are given from your placement, find: the standards set for practitioners what the requirements are to become a registered practitioner what action could be taken if a practitioner does not meet the standards. Describe the benefits of a regulatory body for your placement organisation. Test yourself 1 a State one benefit of regulatory inspections for individuals using a service. b State another benefit of regulatory inspections in terms of public trust. 2 Figure 8.2 shows nurses being trained to use equipment to lift a patient from a hospital bed. a Which piece of legislation requires that this training should take place? b Which regulatory body would investigate a care setting if a serious accident occurred when lifting a patient? 3 Give four examples of how the Information Commissioners Office (ICO) provides support for care settings when handling information. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 14 of 66 Figure 8.2 Nurses learning to use equipment for lifting a patient from a hospital bed A8.4 How physical and mental function across the lifespan impacts care needs and informs person- centred care Stages of human development across the lifespan Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 15 of 66 Figure 8.3 Key stages of the human lifespan Development happens throughout life – it does not stop when you reach adulthood (Figure 8.3). There is a generally accepted pattern of development known as ‘norms’ and while not everyone achieves these norms at the same time, they will do so at their own pace; however, the general progression through the stages is similar. Most growth and development occur during infancy, childhood and adolescence; an individual’s skills and abilities become more sophisticated and complex as they progress towards adulthood. But learning and development continue throughout every life stage. Transitions and significant life events occur across the life stages. Transitions mean changes and are a natural part of maturing through life. Some are expected or planned, such as starting school, while others are unexpected, such as illness. Typical care needs The following are typical care needs throughout life: Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 16 of 66 Nutrition and hydration – sufficient food and fluids are essential for good health and wellbeing. Personal care – personal self-care ensures cleanliness and hygiene and supports good health. Personal care may need to be provided by others at certain times of life, for example for babies who cannot bathe themselves or for individuals who have had a stroke or have mobility problems. General health and wellbeing – this is supported by good mental health, life satisfaction and a sense of meaning and purpose. Positive relationships – individuals who have positive and supportive relationships with others are more likely to be happy and healthy. Self-esteem – this means feeling confident about yourself and having a feeling of self-worth. Personal growth – this concerns improvement of skills, knowledge and personal qualities. Personal development enables individuals to reach their full potential. Independence – this develops throughout life and empowers individuals to be self-reliant. Each life stage of human development Birth and infancy 0 to 2 years A baby relies totally on their carers to provide support with hydration, nutrition and personal care needs. A possible significant transition is moving from being home all day to starting at nursery, which means leaving the primary carer for the first time and may cause separation anxiety. Care needs in infancy: food, clothing, shelter love, safety, a carer they can trust activity and sleep immunisations, protection from injury and illness stimulation to learn new skills. Early childhood 3 to 8 years There is an impact on physical and mental function, for example, a child may well need support with self-esteem and independence when starting primary school. Other transitions requiring physical and mental support may include the birth of a sibling or moving house, for example. High self-esteem Low self-esteem Motivated to do something because Lacking motivation because when you have tried new things Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 17 of 66 you have often been successful before, you often did not do very well Confident in social situations because Lacking confidence, especially when meeting new people; new you usually get on well with people people make you feel anxious as you fear you will have nothing to say Generally happy with your life Unhappy a lot of the time Enough self-confidence to cope with Often find life difficult and do not enjoy new challenges as you new challenges and to view them are afraid of failure positively Care needs in early childhood: health – immunisations, personal hygiene, nutrition and balanced diet exercise rest and sleep opportunities to play and learn opportunities to develop social skills. Adolescence 9 to 18 years Children and adolescents will need support with a wide range of expected and unexpected transitions, such as: transferring to secondary school taking exams puberty navigating learning about sex and relationships driving test further education and/or going to university leaving home first job. Adolescents who feel confident, who accept they have strengths and weaknesses and who feel loved and wanted, tend not to undervalue themselves and usually have higher self-esteem. Possible care needs for adolescents: Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 18 of 66 health – problems relating to menstruation, skin problems such as acne or issues such as eating disorders and self-harm, drugs and alcohol abuse social and emotional needs – relating to relationships, feelings and the physical changes of adolescence or peer pressure and exam stress. Early adulthood 19 to 45 years At this time there may be a need for support with general health and wellbeing as this is a life stage that can present many demands, such as changing jobs, promotion or unemployment, causing stress and upheaval. Getting married, having children and going through the menopause are other stages. Divorce and family break-up may occur during this life stage, resulting in physical and mental support needs. Possible care needs in early adulthood: pregnancy/contraception/fertility emotional needs – relating to relationships, work, personal social problems possible injury such as broken bones drug and alcohol problems dietary intolerances, e.g. coeliac disease, IBS unexpected illnesses or accidents affecting physical or mental health. Middle adulthood 46 to 65 years Needs at this life stage could include, for example, support with diagnosis and treatment of conditions and possible loss of parents. Retirement may be a positive or negative transition depending on the physical and mental health of the individual. Possible care needs in middle adulthood: menopause (a woman’s ovaries stop producing eggs) may cause symptoms such as hot flushes, night sweats, mood swings coping with stress due to work, redundancy, unemployment, family responsibilities emotional needs due to, for example, relationship breakdowns or family responsibilities, or bereavement illness may develop – type 2 diabetes, heart disease, arthritis, cancer. Part of the body Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 19 of 66 affected Ageing effects Eyesight Cataracts and glaucoma may develop, if untreated may cause blindness Hair Starts to thin, growth slows, men may go bald. Hair turns grey or white Can deteriorate, losing quiet and high-pitched sounds, and a hearing aid may become Hearing necessary Heart becomes less efficient; blood pressure may increase Heart Blood vessels become less elastic and this can lead to strokes, heart attacks, etc. Lungs become less elastic and the respiratory muscles weaken. Less able to take Lungs and exercise due to reduced lung function respiratory Need to be vaccinated against flu and pneumonia as more susceptible to developing system these Reproductive Menopause means the end of menstruation. This may cause unpleasant side effects such system as hot flushes and disturbed sleep Shrink in height, bone mass reduces, women in particular can develop osteoporosis. Skeleton and This increases the risk of fractures. Knee and hip joints can cause mobility problems. muscles Muscles become less flexible and balance can be affected Skin Loss of elasticity, wrinkles develop Urinary Kidneys become less efficient at filtering waste products; may need to pass urine more system frequently Later adulthood 65 years onwards The effects of aging (outlined in the previous table) may begin to have an impact. Care needs due to illness, for example, support with hydration, nutrition, personal and mobility care, may become necessary. A range of major transitions occurs at this life stage – some may be welcomed, but others may not be wanted or expected. Freedom from work may bring time for hobbies and travel. However, downsizing to a smaller house, moving into a retirement home, bereavement, family illness or disability are all life events that may result in the need for mental health or physical health support. Care needs in late adulthood: Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 20 of 66 chronic health problems may develop, such as heart disease, arthritis, osteoporosis, Alzheimer’s disease, cancer sensory problems – vision and hearing may start to decline loss of mobility – needing care and support in the home emotional needs as a result of social isolation due to loneliness or feeling they are a nuisance or burden for their family to look after. Key terms Chronic: an illness or condition that lasts longer than three months and is ongoing. It can be controlled but not cured. Osteoporosis: causes a loss of bone density which weakens them and as a result they fracture easily. Person-centred care means practitioners working together with an individual to plan their care and support to meet their unique needs at their particular stage in life. This cuts down the risk of inappropriate care or harmful treatment and neglect. The individual is put at the centre, able to choose and control how they want their care and support to be (Figure 8.4). Figure 8.4 The role of the practitioner in person-centred care Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 21 of 66 Active participation describes a way of person-centred working that makes sure an individual can take part in the activities and relationships of everyday life as independently as possible. They are an active partner in their own care and support, which should be provided with the person’s best interests in mind. Reflect Make a list of the transitions and life events that you have experienced. Using your list, describe some short- and long-term impacts you experienced as a result of three of these transitions. A8.5 The key values of the healthcare sector when providing care and support NHS core values (from NHS constitution) The NHS core values were developed by patients, the public and staff. They consist of six statements that all staff, whether consultants, nurses, physiotherapists, paramedics, gardeners, porters or administrators, are expected to demonstrate in their work with patients at all levels in the NHS. They form part of the NHS constitution. Compassion This means providing care that demonstrates kindness, empathy, respect and consideration for the individual receiving treatment or using health services. It means being able to put yourself in the patient’ s shoes and show understanding. Improving lives This involves finding treatments and aids that help individuals have a healthier and better life. It also includes the personalisation agenda (see section A8.6, page 129) where individuals and communities are helped to take responsibility for living healthier lives. Respect and dignity It is important to respect an individual’s views, opinions and choices to show that they matter, that they are valued as an individual. They should never be treated in a harmful or degrading way, for example, Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 22 of 66 curtains round a hospital bed or hospital gowns should always be arranged to preserve someone’s dignity and to not cause any embarrassment. Commitment to quality of care The NHS carries out clinical audits to review standards of care and implements changes where needed. Healthcare staff have to be revalidated every few years (see page 122); this demonstrates that their knowledge and skills are kept up to date. Feedback from patients and their families is used to identify areas where improvements are required. Working together for patients This value means that staff in all parts of the NHS work together to support the care of individuals using health services. Good communication between different care services to provide person-centred care is essential to provide ‘joined-up’ care that meets individual needs. Everyone counts No one should be discriminated against on any grounds of prejudice, including their age, ethnicity or gender, as per the Equality Act 2010 (see page 2). Treatment should be provided based on clinical need, not on prioritising one group of individuals over another, such as older people, and everyone should be valued equally. 6 principles produced by the People and Communities Board The People and Communities Board (PCB) is the NHS England organisation that was commissioned to promote person-centred care between 2015 and 2017. The board developed six principles for engaging people and communities in this: 1 Care and support are person-centred (being personalised, coordinated and empowering). For example, if someone is very unfit and takes no exercise, the local practice nurse may give the individual a voucher for use at the local swimming pool. This may encourage them to take action to improve their poor level of fitness. 2 Services are created in partnership with citizens and communities so that they are relevant to local needs. 3 The focus is on equality and narrowing inequalities in the community. 4 Carers are identified, supported and involved in delivering care. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 23 of 66 5 Voluntary, community and social enterprise and housing sectors are involved as key partners and enablers, focusing on enabling individuals to take an active part in their own care. 6 Volunteering and social action are recognised as key enablers to a healthier future. An NHS report published in September 2020, ‘Rolling out social prescribing: Understanding the experience of the voluntary, community and social enterprise sector’, describes successful projects and identifies areas for improvement. Key term Social prescribing: when individuals are referred to support and help from the community in order to improve their health and wellbeing. Sometimes referred to as ‘community referral’, it involves a range of local, non-clinical services. Examples include local support groups where meeting people with the same problems provides peer support; local activity groups such as for walking, knitting, swimming to improve mental health and general health and wellbeing. (See Chapter A9 for more on promoting health and wellbeing via signposting.) A8.6 The purpose of the Personalisation Agenda 2012 and the importance of using holistic approaches in order to place individuals, their carers and significant others at the centre of their care and support Purpose of the Personalisation Agenda 2012 This Agenda is designed to put the individual first in the process of planning, developing and providing care. Under this, individuals should be able to access support tailored to their individual needs and desires when treated for long-term illnesses and conditions. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 24 of 66 Figure 8.5 What is personalisation? Traditionally, care has been provided using a ‘service-led’ approach. Individuals were treated by services available rather than having care tailored to their individual needs, which was certainly not designed for giving them choice and control. Person-centred care ensures the individual is involved in decision-making by discussing their care needs and then giving them, for example, information about different options that will meet their needs. The individual can then choose care that they prefer. This is enabling and empowering, ensuring the individual is at the centre of their care and has choice and control (Figure 8.5). The introduction of personal budgets supports person-centred care as it is an amount of money the individual is awarded by the local authority to spend on the help they need. This helps them to achieve what is important to them and supports their choice and control. The emphasis is on individuals being able to choose the services they want rather than having a fixed range of standard services, a ‘one size fits all’ approach, which may not meet their needs as successfully. Holistic approaches Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 25 of 66 Using a holistic approach is taking account of the whole person and their life, not just the part that needs treatment or care, for example, mobility difficulties. It takes everything into account, from their social situation and emotional feelings to culture and beliefs, background and family situation, in order to inform and determine the best ways to meet their needs. Case study Person-centred care for Amir Amir is 89 years old; he lives on his own. Amir is thinking of going to live in a care home because his mobility is not what it was. He doesn’t really want to go into a care home but he finds it very difficult to manage the stairs in his house and struggles with food shopping because he cannot walk very far. His daughter, who is his only child, works full time and lives too far away to help him regularly. His daughter is worried about the future for Amir and has contacted social services to discuss the situation. Sundip, a social worker, arranges to visit Amir to have a chat about his possible move. Sundip uses a person-centred approach, ensuring that Amir is supported to make his choices and is involved and in control of his care. As Amir’s key worker, after their chat, Sundip plans the following care package: An occupational therapist to visit Amir’s house to carry out a risk assessment and to see if any adaptations are needed to help with his mobility. A walking frame to be purchased and delivered as soon as possible, to help Amir keep his independence. Help with going shopping to be available from the following week, so Amir will be able to continue shopping himself. A week’s stay is booked, at the end of the month, at a residential home Amir is interested in so that he can try it out and see if he likes it. This is to help inform his choice of whether to stay at home or move into residential care. The situation is to be reviewed by Amir and Sundip when Amir returns home from his care home stay. Explain how Sundip has put Amir at the centre of his care plan and supported his choice, control, independence, needs and preferences to deliver person-centred care. Person-centred planning (PCP) Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 26 of 66 This holistic approach to planning places the person at the centre of their care and enables them to have a package of care put in place to support them, as an individual, to live as independently as possible. Steps to person-centred planning are: the person is at the centre of the planning process, which is based on their individual preferences and identified needs family and friends can be partners in the process the plan will identify what is important to the person, both in the present and in the future, helping them to make informed choices the plan helps the person to achieve what they wish for individually and in the community, e.g. continue to work with adjustments to accommodate their needs because of a physical disability the plan is reviewed and adapted over time as required to continue to meet the person’s changing care needs. Person-centred care (PCC) Read the case study on Amir above which gives an example of a person-centred care plan and person- centred planning in practice. Then answer the question. Hierarchy of the individual’s needs (Maslow’s hierarchy of needs theory) Psychologist Abraham Maslow used a humanistic approach, which is person-centred, focused on the individual and their needs and development throughout life. His theory created a hierarchy of human needs, which is a theory of human motivation (Figure 8.6). An individual’s basic, physiological needs that must be met in order to survive, such as food, water and shelter, are shown at the bottom of the pyramid. Maslow’s theory states that only when those basic physical needs have been met will a person have the motivation and capacity to progress to the next level of the pyramid. When safety and security followed by emotional needs are met, a person will have the motivation to progress to trying to fulfil the higher-order needs for their personal development and achievement. Only then will a person ‘self-actualise’, that is, become the person they want to be. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 27 of 66 Figure 8.6 Maslow’s hierarchy of needs Key term Hierarchy: an arrangement of things in order of importance. Case study Maslow’s theory into practice: Joan Joan, who is aged 85, is facing a move into residential care. Joan knows she is no longer able to fully care for herself without help because of her arthritis. She knows that it would make sense to move into a care home, but she has mixed feelings about a possible move. She is worried about losing control over her life and losing all her independence as well as the fact that moving house is one of the most stressful times in life. Following Maslow’s hierarchy of needs, staff at the residential home should first ensure that Joan’s basic needs are met, catering for her food preferences and giving her a comfortable, warm room with her own belongings to arrange as she wishes. This will give her a sense of control and empowerment. However, Joan should also be welcomed and helped to meet other residents so that she feels a sense of acceptance and belonging developing. This will help Joan to feel respected and valued as a resident, Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 28 of 66 and she will be more likely to be mentally, emotionally and physically healthy and comfortable in the new environment as her care needs are being met. Can you think of any other practical things that the residential home staff could do or provide to help meet more of Joan’s higher-level needs? Advanced care planning (for example, end of life care) End of life care, also known as palliative care, is personalised care for individuals who have been given a terminal diagnosis or are towards the end of their life. Specialist teams of professionals such as community nurses and sometimes also volunteers support the person to live as well as possible until they die. Alongside taking care of the individual’s physical needs, a holistic approach is used to help with their emotional, spiritual and social needs. The team support carers, family members and close friends of the individual. This would also include any religious or spiritual figures such as an imam, priest or chaplain. End of life care can be provided by hospices, which are specialist care settings that can provide a range of services to support individuals at this stage of life. Some hospice care is provided by charitable organisations such as Marie Curie Cancer Care and Sue Ryder services. Do Not Resuscitate directive (DNR) DNR stands for ‘do not resuscitate’ and means that the person has requested that they should be allowed a natural death without any attempt at CPR (cardiopulmonary resuscitation) if their heart stops beating. The person will usually have ensured that others – medical staff, social worker, family members – are aware of the DNR. Integrated working This involves different practitioners and service providers, with different skills, working collaboratively to achieve better outcomes by enhancing the care they provide. Team members seek to provide appropriate care while not duplicating or overlapping with others. The importance of using holistic approaches A holistic approach means looking at all the different needs of a patient. These include their medical condition and treatments, and whether they live alone or have any family or friends to look after them or Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 29 of 66 become involved in their care if necessary. The approach considers how well the person understands their condition or illness and how they feel about it – are they feeling upset or depressed or feeling positive, for example. Ensuring that any care provided is in the individual’s best interest ‘Best interest’ relates to taking into account an individual’s circumstances, needs and preferences before a decision or choice is made. Before decisions about care are determined, individuals should be given full and accurate information in a format they can understand. The pros and cons of each option will assist them to actively participate in the decision-making and will facilitate reaching an informed decision. If an individual is assessed as lacking capacity, the Mental Capacity Act 2005 provides five key principles to follow for ‘best interests’ decision-making: 1 A presumption of capacity. 2 Individuals being supported to make their own decisions. 3 Unwise decisions. 4 Best interests. 5 The less restrictive option. See sections A8.1 and A8.8 for details. Complying with autonomous practice Care planning and person-centred care must follow best practice guidelines and be based on professional ethics and practitioner expertise. Practitioners such as community nurses and social workers should support individuals in making autonomous decisions. However, the decisions must be made so that people receive appropriate, safe and effective care. All decisions must be based within the practitioner’s scope of practice, that is, within their level of expertise, and they have a duty of care to manage risks to ensure the health, wellbeing and safety of the individuals in their care. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 30 of 66 Key terms Ethics: concerned with what is morally right or wrong. Autonomous: able to act independently, having control; not being forced to do something. Encouraging engagement with healthcare and social care professionals and organisations Regular contact with healthcare and social care professionals is important for monitoring an individual’s health and wellbeing. Access to relevant services will not only promote individuals’ health but will also develop their self-reliance and reduce their dependency on services they may have required had their needs not been met. Involving people in their own health is an effective way of promoting health and wellbeing. See also ‘Social prescribing’ on page 129 and Figure 8.4, ‘The role of the practitioner in person-centred care’ on page 127. Test yourself 1 Describe what personalisation of care means. 2 Describe three features of person-centred planning. 3 List the five types of needs identified by Maslow. Give an example of how three of the needs could be met for a care home resident or a hospital patient. A8.7 A range of verbal and nonverbal communication techniques, potential communication barriers and how to overcome them to support an individual’s condition An important aspect of a person-centred approach to care is to recognise that all individuals have their own particular way of communicating. Eye contact, body language and spoken language skills (where applicable) can all impact how someone communicates. Range of communication techniques Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 31 of 66 Verbal (for example, spoken word and sound) This includes: face-to-face conversations phone calls asking questions recorded messages delivering a training session or presentation interviewing someone. You will probably be familiar with these methods and they are relatively self-explanatory: they involve using spoken words to communicate. However, there is more to communication than this and many of these methods are not a good option (or an option at all) for certain individuals. Nonverbal This includes: gestures facial expression – interest, reassurance, agreement body language – positive/open, no crossed arms. Some special methods used by individuals with sensory impairments are: Makaton – a simplified form of sign language where gestures are used alongside symbols/pictures and speech British Sign Language – using hand signs, facial expressions and gestures PECS – picture exchange communication system, a system that uses pictures that aid communication. The individual points to the picture that shows what they need (Figure 8.7) Braille – involves touching a series of raised dots and symbols that represent letters, punctuation and numbers; used by individuals who have visual impairments. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 32 of 66 Figure 8.7 Using PECS picture communication cards Active listening is a communication technique that a care practitioner will employ to demonstrate an interest in, and responsiveness to, what a person is saying. It promotes good practice by showing respect and building trust with individuals. Active listening skills include: open, relaxed posture eye contact – looking interested nodding agreement showing empathy, reflecting feelings clarifying. Barriers to communication Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 33 of 66 To keep the person at the centre of their care, good communication with them is necessary. An individual’s level of communication skills and how attentive they are, how well they can hear and see what is happening, and whether they are interested or motivated enough to make themselves understood can all be potential negative influences on communication. Communication barriers can be a significant impediment to an individual receiving the care or treatment they need. If appropriate alternative methods of communication are not available to meet the individual’s communication needs, they may not be able to communicate well enough to fully use the services available. Sensory disorder Barriers to communication for visually impaired individuals could include: information not available in different formats, e.g. Braille, large print. Potential barriers for deaf and hearing impaired people: hearing loop not available in the building (Figure 8.8) no staff available who have been trained in sign language/Makaton so the quality of communication is impaired special methods such as PECS are not available the individual can’t lipread and so has difficulties understanding what is being said in a conversation. Speech impairments: an alternative method is not available, e.g. writing responses stroke/dementia patients may not be physically able to speak. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 34 of 66 Figure 8.8 Adapting the environment to overcome barriers to communication – hearing loop Key terms Hearing loop: a special type of sound system to assist people with hearing aids. The hearing loop provides a magnetic wireless signal that is picked up by the hearing aid and can greatly improve the quality of sound while reducing background noise. PECS: stands for ‘picture exchange communication system’; developed for use with children who have autism, it helps them learn to start communicating by exchanging a picture for the item they want. Mental health condition Someone with dementia may not be able to answer questions, they may not remember what has happened or where they are. An individual with a learning disability may not have the ability or vocabulary to communicate effectively and so it can sometimes be difficult for them to explain how they are feeling and for others to establish what the problem is. In these situations, it is still important to give the patient opportunities to communicate, rather than assuming, and to do what we can to facilitate it. Language barriers Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 35 of 66 Not everyone speaks or understands English well or at all, and this can pose significant challenges when discussing health and medical care and treatment with them. This barrier can take the form of: information not available in different languages no interpreter or ‘language line’ (telephone translation service) available, so staff can’t understand and the patient can’t explain their symptoms someone may have a very strong accent or use dialect that is difficult to understand for those not used to it practitioners can find themselves using technical terminology or medical jargon only they understand. Time pressures Some individuals will take longer than others to describe their symptoms or problems. Some may be lonely and just want to talk with someone and so are more demanding in terms of time. Unfortunately, with an appointment system, practitioners may have constraints limiting how long they can spend with each individual; they may keep others waiting if they spend too long with someone. Noisy environment It can be distracting if there is a lot of background noise when trying to have an important conversation and it can cause people to miss important information because they can’t hear the person talking properly. It can be especially problematic when trying to communicate with, for example, someone with autism or who is impaired hearing. Some individuals with autism have sensory sensitivity and cannot ignore or block out background noise. Finding somewhere quiet and private can be difficult in care settings. However, many will have noise-cancelling headphones for certain situations. Positioning of the individual from the healthcare professional (for example, proximity) Free spaces for meetings may be too small so individuals invade each other’s personal space or cannot sit facing each other in the position they would like. Often in offices a large desk is situated between those attending a meeting and so it becomes rather formal, which may not be appropriate for what a patient and a healthcare professional are going to discuss. It is also better for effective communication if people are at the same level as the practitioner, speaking with them to reduce the risk of feeling someone is ‘talking down’ to them. This is particularly important when speaking with children. Tension or conflict Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 36 of 66 There may be tension because the individual is angry or upset following an argument, circumstances in their life or even their health, and this carries through into their responses to a practitioner asking questions. A young adult may be unco-operatively if they feel they are being patronised or not taken seriously, or someone may not understand what is being said but not want to admit it. An individual may be dissatisfied with how long they have had to wait or with the standard of treatment they have received. Overcoming barriers to communication General ways of overcoming barriers to communication include: actively listen to the individual about their communication needs/preferences – show that they are valued active involvement from the individual – ask them how/when/where and in which way they are communicated with to meet their needs access to information that is understandable to the particular individual – correct language, avoiding specialist terminology offer a choice of communication aids or supports that match the needs and preferences of the individual offer the individual access to a range of support options and choices. It is important that health and social care practitioners work to find a way to communicate despite difficulties, and that they do not create communication barriers themselves. They should ensure that they use their communication skills effectively to avoid creating barriers to care. The list above of general principles and the table below show some specific ways they can do this. Ways of communicating effectively Avoid jargon Explain any specialist terminology Use age-appropriate vocabulary Using vocabulary that can be understood by all Use simplified language, especially with, for example, young children, individuals with learning disabilities or patients with dementia Use interpreters or translators Use positive body language, such as nodding agreement and making eye contact Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 37 of 66 Avoid sarcasm and do not talk down to the person Use communication that is Be polite appropriate to the individual Make the service user feel they are being taken seriously Be patient, especially when listening to repetition Do not ignore the person’s views or beliefs just because they are different from yours Use active listening by demonstrating interest in response to what a person is saying, using body language to show a positive reaction Ask the person rather than assuming you know what they want, need Listen to individuals’ needs or prefer Concentrate on what the person is saying – this can encourage them to communicate their needs Emphasise important words Slow the pace of conversation if necessary Increase the volume of your speaking voice but do not shout Adapt communication to meet Use repetition where appropriate individuals’ needs or the Use gestures or flash cards/pictures if appropriate situation Make use of aids to communication such as a hearing loop system Use specialist communication methods such as Braille or signing Use technological aids, such as Dynavox or a Lightwriter Key terms Dynavox: speech-generating software. A person touches a screen that contains text, pictures and symbols, then the software converts those symbols into speech. Lightwriter: a text-to-speech device. A message is typed on a keyboard, displayed on a screen and then converted into speech. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 38 of 66 A8.8 The application of relevant legislation, including Mental Capacity Act 2005 plus Amendment (2019) and Liberty Protection Safeguards (LPS) on the provision of person-centred care See also section A8.1. Mental Capacity Act 2005 plus Amendment (2019), including the five principles ‘Capacity’ is the ability to make a decision, including understanding information and remembering it for long enough to make a decision, and to be able to communicate it to others. This Act is in place to provide a legal framework setting out key principles, procedures and safeguards to protect and empower those who are unable to make some of their own decisions. This could include people with learning difficulties, dementia, mental health problems, strokes or head injuries. The Mental Capacity (Amendment) Act 2019 has five statutory principles: 1 A presumption of capacity – every adult has the right to make their own decisions and must be assumed to have capacity to do so unless it is proved otherwise. So, a care worker must not assume someone cannot make a decision for themselves just because they have a particular condition or disability. 2 Support individuals to make their own decisions – a person must be given all practicable help before anyone treats them as not being able to make their own decisions. This might include presenting information in a different format for those with physical or learning disabilities, for example. 3 Recognise that unwise decisions do not mean lack of capacity – just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking the capacity to make that decision. People have the right to make what others may regard as an unwise or eccentric decision. Everyone has their own preferences, values and beliefs which may not be the same as those of others – they cannot be treated as lacking capacity for thinking differently. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 39 of 66 4 Best interests – action taken or decisions made under the Act on behalf of a person who lacks capacity must be done in their best interests. So, care workers should provide reasons showing the decision they are making is in the individual’s best interests. They should try to involve the person, or consider whether the decision could be put off until the person regains capacity. 5 Less restrictive option – anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms. A care practitioner must always consider whether a decision can be made in a way that is less restrictive of an individual’s freedom. So, while it would be reasonable for a care worker to accompany an individual with learning disabilities who lacks capacity on a visit to the shops or to see friends, it would not be reasonable to lock them in their room to prevent them from going out. This would be an unacceptable deprivation of liberty. Principles 1 to 3 are concerned with the process of determining capacity; principles 4 and 5 concern the decision on whether or not action is needed, depending on the best interests of the individual. This is sometimes referred to as the ‘best interests’ decision-making process. Research 1 Use the link to view a video clip about each of the five ‘best interests’ decision-making principles: www.scie.org.uk/mca/introduction/mental-capacity-act-2005-at-a-glance#principles 2 In your own words, write an explanation, with examples, of each of the five ‘best interests’ decision- making principles. Liberty Protection Safeguards (LPS) The 2019 Amendment to the Mental Capacity Act replaces the Deprivation of Liberty Safeguards (DoLS) with the Liberty Protection Safeguards (LPS). This amendment aims to improve and simplify the process of assessing mental capacity and the care that is required, and to increase the individual’s protection against losing their freedom unnecessarily or inappropriate decisions being made for them. The LPS ensure that individuals are only deprived of their liberty or freedom in extreme situations, in order to protect them and keep them safe. The safeguards would apply when: the person lacks the capacity to consent to care arrangements the person has a serious mental disorder the arrangements are necessary to prevent harm for the individual the arrangements must be proportionate to the likelihood and severity of harm. Hoare, Stephen, et al. Health T Level: Core Second Edition, Hodder Education Group, 2024. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/oaklandscoll-ebooks/detail.action?docID=31291299. Created from oaklandscoll-ebooks on 2024-09-01 21:12:49. Copyright © 2024. Hodder Education Group. All rights reserved. Ebook pages 172-214 | Printed page 40 of 66 They seek to make the process simpler and more efficient, and to reduce the burden on individuals, their families, carers and local authorities. They also remove the requirement for repeat assessments when moving between healthcare settings, e.g. between hospital and a care home. Test yourself 1 ‘A presumption of capacity’ is one of the key aspects of the Mental Capacity Act. What is the meaning of ‘capacity’ here? 2 Describe two situations when the Liberty Protection Safeguards would apply. 3 What is the aim of the Liberty Protection Safeguards? A8.9 The considerations when providing person- centred care to people with pre-existing conditions or living with illness Conditions or illnesses Serious illness (for example, cancer) The term ‘cancer’ is a general description of a condition that can affect most parts of the body. Cells in a particular place reproduce uncontrollably to form a growth called a tumour. This can then invade healthy tissue, organs, blood cells or bones. Metastasis is when the cancer spreads from one part of the body to another. There are many different signs and symptoms of cancer depending on the type. Treatments include surgery, radiotherapy and drug therapy called chemotherapy. The Macmillan cancer support website explains the types of cancer and the treatments available (www.macmillan.org.uk/cancer-information- and-support/cancer-types). Neurological conditions (for example, dementia)