UNDERSTAND PERSON-CENTRED APPROACHES IN ADULT SOCIAL CARE SETTINGS
1.1 DESCRIBE PERSON CENTRED APPROACHES
Person-centred is about providing care and support that is centred or focused on the individual and their needs. We are all individual and just because two people might have the same medical condition, for example, Dementia, it doesn’t mean that they require the same care and support. You will need to develop a clear understanding about the individuals you are working with. This includes their needs, their culture, their means of communication, their likes and dislikes, their family and other professionals’ involvement so you can promote and provide person centred care and support. There are eight person centred values that support person-centred care and support. These are:- 1. Individuality
1.2 EXPLAIN WHY PERSON-CENTRED VALUES MUST INFLUENCE ALL ASPECTS OF SOCIAL CARE WORK.
If you ask your family, friends and neighbours, you would get lots of different answers and this will demonstrate how different we all are, even if there are some similarities. This is what gives you your identity and makes you special, unique and different. You have the freedom to make choices every day about how you live your life. Sometimes your choices are restricted because of your financial situation or because you have to work at certain times or work in partnership with your family to make a contribution towards the support of a family unit. The individuals you support may have different circumstances to you but they still have the same rights as you and your friends and family do, to make the same choices, and do the same things. The only difference is that some individuals will need more care and support than others in order to help them to achieve what they want to achieve. The level of care and support will depend on the level of the individual’s ability and the choices they want to make. They should be
given the same freedom as any other human being to make their decision, treated with equal respect and dignity, given the same rights of choice and privacy.
1.3 EXPLAIN HOW PERSON-CENTERED VALUES SHOULD INFLUENCE ALL ASPECTS OF SOCIAL CARE WORK.
On the basis of the eight values of person-centred approach: Individuality: Assumptions should never be made about an individual. They should never have to fit in with you or your employer. Individuals should be allowed and supported to make their own choices. Care and support needs should be tailored to suit each individual. This shows respect by preserving the individual’s dignity and individuality. Their personal beliefs should be respected. Independence: Allow the individuals you support to do things for themselves, however small. Being independent does not necessarily mean being completely alone, but being supported to do things for themselves. Privacy: You will need to understand each individual’s need for privacy and support this in the way you work. The availability of private space will be different in residential care home and home care environments. Choice: Each individual you are supporting should be allowed and supported to make choices. They should be given thorough information in order to make informed choices themselves and you must acknowledge the benefits of their choices. Never take over because you can do things faster or because you think something should be done a particular way. Always involve the individual in decisions about their care and support. Sometimes individuals can be overwhelmed with choice, for example, individuals suffering from Dementia, may respond better if you give them two simple choices but this is much better than giving no choice at all. You will need to be able to communicate and listen well. Dignity: Dignity is what we feel when we are respected and it is what makes us feel important in society and in our lives. Whether individuals are eating, sleeping, washing, shopping or dying, care and support workers must help them to feel dignified. Be aware of the importance of preserving an individual’s dignity, ask them how they wish to be addressed; try not to rush them and take time to listen; use towels or clothing to cover them up when performing intimate care tasks. It is important not to stereotype or make guesses about individuals and their needs. Respect: Is showing an individual you will support them in what they believe is important, whatever their age, culture, disability, gender, belief or sexual orientation.
When working with other people or professionals, never ignore the individuals you are supporting. Always include them in the conversation, irrespective of the subject? Never use a term of endearment, for example, calling an individual “love” or “dear”, without asking them what name they would like to be called. Some people dislike terms of endearment, others will approve as it is part of their everyday language. Either way, we can never assume it is acceptable and it is essential to always check when you first meet. Rights: Individuals you care for and support should continue to have the same rights as when they were living independently. Each individual you support has the right to say no, the right to have a relationship, the right to have a say about how they are supported. They have a right to choose what they eat and when, how they dress and when. They have the right to choose their friends and what they want to do with their time. Partnership: Working in partnership with other professionals, with colleagues, families and carers is an essential part of providing care and support. Person-centred care and support is about a whole range of people working together to improve the lives of individuals. Partnership is all about the individual you are supporting and all of the partners involved will need good communication, sharing appropriate information putting the individual’s best interests at the centre of everything that everyone does.
2.1 EXPLAIN HOW FINDING OUT THE HISTORY, PREFERENCES, WISHES AND NEEDS OF AN INDIVIDUAL CONTRIBUTES TO THEIR CARE PLAN.
You should always reflect on and celebrate the diversity of the people you are supporting. There are many reasons why individuals think and act the way they do and only by building up comprehensive knowledge about these important things can you help them to fulfil their wishes and needs. The care plan is about the individual and their preferences, needs and wishes. It should be able to give information to others on the individual and their preferences, needs and wishes. It also enables the care plan to be completed accurately and reflect the individual and their preferences, needs and wishes thus making it easier for the carers to give the individual the care accordingly.
2.2 DESCRIBE WAYS TO PUT PERSON CENTRED VALUES INTO PRACTICE IN A COMPLEX OR SENSITIVE SITUATION.
Complex or sensitive situations may include those that are:
distressing or traumatic
threatening or frightening
likely to have serious implications or consequences
of a personal nature
involving complex communication or cognitive needs
In such situations the care plan should mention the needs as to how the individuals should be handled when faced with similar situations or to avoid similar situations in order to prevent them from going through it again. The care plan should also give information on how the individuals can be calmed down and what ways they prefer help from carers in order to calm down and relax. When it involves complex communication or cognitive needs the person’s choice of communication should be discussed and advice should also be taken from their family or social workers regarding the individual’s preference of communication and documented in the care plan so that all the carers could read and follow the communication of choice of the individual.
2.3 EVALUATE THE USE OF CARE PLAN IN APPLYING PERSON CENTRED VALUES.
A Care Plan may be known by other names (eg: support plan, individual plan). It is the document where day to day requirements and preferences for care and support are detailed. A care or support plan sets out what care or support an individual needs. The Individual Needs Assessment will enable the required care and support to be determined. The care plan contains lots of information, for example, medical history, family contacts, risks assessments. In general the care plan gives the carers the guidance and knowledge regarding how the individual in their care prefers or needs to be treated.
2.4 EXPLAIN THE IMPORTANCE OF MONITORING AN INDIVIDUAL’S CHANGING NEEDS OR PREFERENCES.
Our wishes and desires change as we gather more information and change our opinions, for example, I might have a favourite food that I decide to eat every other day but a few weeks later, I could be bored with this food and want something different. Just like how our needs and desires change, so will those of the individuals we support. Changes could be from a whole range of aspects of the individual’s life. It is important to recognise that as needs change, how support is provided will also need to be reviewed regularly to see if any changes or adjustments are required. Carers have a responsibility to listen to individuals, to hear what they are saying, to write down any information about change in the care or support plan and contact their supervisor or manager if this is likely to have an impact on the level or type of care and support that is provided. Changing needs or preferences can relate to:
health needs or preferences i.e. health, abilities, medication, mobility, diet, personal hygiene social needs or preferences i.e. activities, relationships
environmental needs or preferences i.e. aids and adaptations, accommodation changes in family and relationships.
3.1 DESCRIBE FACTORS THAT INFLUENCE THE CAPACITY OF AN INDIVIDUAL TO EXPRESS CONSENT.
The factors are:
mental conditions, i.e. mental capacity
physical conditions i.e. communication abilities
availability, or lack of options
awareness of choices
3.2 EXPLAIN HOW TO ESTABLISH CONSENT FOR AN ACTIVITY OR ACTION
Consent is giving permission to do something. In health and social care settings it usually means that the individual gives consent to take part in an activity or to accept some kind of care or treatment. It is important to remember that:
It is a legal requirement that consent is established before any intervention or care-giving activity takes place Establishing consent is one way care workers can demonstrate they respect the individual and the individual’s personal dignity The process of establishing consent is instrumental to developing trust between care worker and the individual The individual is more likely to want to take part in an activity they have given permission for Consent can be given in a number of ways: verbally, in writing or through actions. The individual might also allow another person to do something with or to them, perhaps by raising an arm to be supported when dressing, and thereby imply consent. Informed consent is given when the individual understands what they are consenting to.
3.3 EXPLAIN WHAT STEPS TO TAKE IF CONSENT CANNOT BE READILY ESTABLISHED
Ensure they understand and act on understanding of the health status or condition of the individual Ensure they understand the individual’s needs and preferences Ensure they understand the individual’s ability to make decisions Ensure they have available the relevant information in a form that the individual can understand3 Ensure they themselves understand the information and options open to the individual Listen to the individual and observe for other responses
4.1 EXPLAIN THE PRINCIPLES OF ACTIVE PARTICIPATION.
Active participation is defined by Edexcel (2010), the body that sets the specifications for the Levels 2 and 3 Health and Social Care Diplomas, as recognising an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is an active partner in their own care or support rather than a passive recipient. This definition accentuates two key principles underpinning care: the rights of the individual and the independence or autonomy of the individual. The individual is regarded as an active partner in their own care or support, rather than a passive recipient.
4.2 EXPLAIN HOW THE HOLISTIC NEEDS OF AN INDIVIDUAL CAN BE ADDRESSED BY ACTIVE PARTICIPATION.
Holistic – covers all aspects of an individual’s well-being. Active participation: Active participation is an approach that enables individuals to be included in their care and have a greater say in how they live their life in ways that matter to them. Therefore when making an individual’s care plan it is necessary to develop it around their needs. When the individuals gets the opportunity to choose the way in which they wish to live their lifestyle and gets to choose the activities they prefer the care plan becomes more effective and easier for the staffs to follow. In this way there is better understanding of the individual in care and on the whole the care becomes more effective.
4.3 EXPLAIN HOW TO WORK WITH AN INDIVIDUAL AND OTHERS TO AGREE HOW ACTIVE PARTICIPATION WILL BE IMPLEMENTED.
Ways of implementing active participation include:
discussion and encouragement with the individual
providing useful information and choice
using friends and family to encourage
ensuring appropriate activities
highlighting the benefits of the activity
recording the outcome
4.4 EXPLAIN HOW TO PROMOTE THE UNDERSTANDING AND USE OF ACTIVE PARTICIPATION
Active Participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient. As a carer it is our duty to inform the individuals in our care the list of activities there are for them to choose from. It is useful if we can support the individual to find out about local social and community networks in the areas where the individuals you support live, particularly if the people we support live in their own homes. Local charities are also likely to run groups, meetings and workshops. We could talk to your friends, family and colleagues to find out what is available locally (without talking about the individuals you work with). We could look in the local paper and use the internet to search local information. The local authority may be able to provide information. After getting the list of activities available it is the duty of the carer to make sure that we explain to them the activities and what they would be doing in each one of them. When all the aspects are explained we have to encourage them to make their own choices and then make a list of the activities they like and plan their support accordingly. If an individual identifies a particular hobby or activity they wish to participate in, it might be worth checking if there are local groups or facilities that would be prepared to support the individual to participate.
5.1 DESCRIBE DIFFERENT APPROACHES TO SUPPORT AN INDIVIDUAL TO MAKE INFORMED CHOICES.
The different approaches to support an individual to make informed choices include: discussion
providing relevant information
guidance from friends or family
using an advocate or support service
5.2 DESCRIBE HOW TO SUPPORT AN INDIVIDUAL TO QUESTION OR CHALLENGE DECISIONS CONCERNING THEM THAT ARE MADE BY OTHERS.
The others include:
Colleagues, Social worker, Occupational Therapist, GP, Speech and Language Therapist, Physiotherapist, Pharmacist, Nurse, Specialist nurse, Psychologist, Psychiatrist, Advocate, Family or carers Every decision made for the individual’s in care may not always be right or preferred by the individual. Therefore it our duty
to encourage questions and comments from the individual.
be prepared to listen
assist the individual to ask for a second opinion
speak to/refer the individual to a senior member of staff
use the complaints procedure.
5.3 EXPLAIN THE CONSEQUENCES OF ALLOWING THE PERSONAL VIEWS OF OTHERS TO INFLUENCE AN INDIVIDUAL’S CHOICES.
There are many consequences that could arise when the personal views of others are involved in influencing an individual’s choices. The possible consequences are: individual’s needs not being met
lack of choice
low self esteem
lack of motivation
6.1 EXPLAIN THE LINKS BETWEEN IDENTITY, SELF IMAGE AND SELF ESTEEM.
In general identity is who you are and in social science the term identity describes a person’s conception and expression of their personal individuality or group identity, e.g. national identity or cultural identity. The shaping of someone’s identity depends on the identification with significant others like parents, the peer group or even fictional movie-characters. Furthermore the term Identity describes a unique personality structure in combination with the picture that others have of this structure. The reflection of ourselves and who we want to be determines
our identity. This concept is also described by some as the self image.
In general self-image is what you want or try to be. A person’s self-image is the own mental representation of one’s individual characteristics and qualities like height, weight, hair colour, gender, I.Q. score, etc., as well as the beliefs of that person about himself or herself. The self image is in its importance for the individual relatively resistant to change. A self-image may consist of three types:
1. How I see myself
2. How others see me.
3. How I see others seeing me.
The term self esteem is used to describe the result of this internal self-evaluation. In this process individuals compare their description of themselves as they are, with their description of themselves as they would like to become. Self-esteem depends then on the ability to live up to one’s ideals. Self-esteem:
In general self esteem is how you feel about your self or what you think what others think about you. The term self-esteem is used in psychology to describe a person’s overall emotional evaluation of their own worthiness. The concept of self esteem assumes that the result of this reflection determines further the attitude towards the self, affecting the individual in aspects like motivation, attitudes, confidence and the overall emotional well being.
6.2 EXPLAIN FACTORS THAT CONTRIBUTE TO THE WELL BEING OF AN INIDVIDUAL.
Well being is defined as the state of being comfortable, healthy, or happy. Therefore the factors that contributes to the well being of an individual are: being treated as an individual
getting the dignity and respect like any other human being.
Being able to make choices.
Being able to lead a healthy life.
6.3 EXPLAIN THE IMPORTANCE OF SUPPORTING AN INDIVIDUAL IN A WAY THAT PROMOTES THEIR SENSE OF IDENTITY, SELF IMAGE AND SELF ESTEEM.
Identity is who you are, self image is how you see yourself and self esteem is how you feel about yourself. Therefore all three when combined makes the individual who they are and differentiates them from the others. Being able to identify one self and having a positive self image leads to a good self esteem about oneself therefore leading to a healthy well being. When one works as a carer it is their responsibility to accept that everyone is different and respect the identity of the individual and to treat them as they wish to be treated. When the individual is happy with the way they see themselves as a carer it our duty to make sure that we respect their self image and help them to enhance it. When an individual under our care has a very bad self image about themselves it is our duty to make them understand that they are equally good and provide them with assistance in improving their self image. Self esteem is a very important factor in a person’s well being as it is how the person feels about themselves. Therefore as a carer it our duty to make them feel respected. It is our responsibility to treat them with dignity, give them the freedom of choice in their decision making and respect their privacy. When all these are met the well being of the individual will automatically improve thus fulfilling the most important duty of care which is “supporting the individual in their well being”.
6.4 DESCRIBE WAYS TO CONTRIBUTE TO AN ENVIRONMENT THAT PROMOTES WELL-BEING.
There are two different kinds of environment:
Physical environment which include bedroom, furniture, the house on the whole, personal belongings. Social environment which include personal boundaries, subjective feelings, relationships, etc. The different ways in which we can contribute to building an environment that promotes well being are: To ensure the physical environment is clean.
The furniture’s are in good condition and are safe to use. Personal belongings are well cared for.
They are treated with respect.
Protected from any form of abuse.
Given their privacy.
Personal boundaries respected and maintained.
Encourage them towards active participation.
Help them to maintain their existing relationships and encourage them in building new ones. Respect their choice
7.1 COMPARE DIFFERENT USES OF RISK ASSESSMENT IN ADULT SOCIAL CARE SETTINGS.
Risk can be defined as ‘the possibility of beneficial and harmful outcomes and the likelihood of their occurrence in a stated timescale’ (Alberg et al in Titterton, 2005). A risk assessment is nothing more than a careful examination of what, in your work or activities, could cause harm to people, so that you can weigh up whether you have taken enough precautions or should do more to prevent harm. The aim is to make sure that no one gets hurt or becomes ill. Risk assessments are done to:
prevention of injury to individuals
prevention of injury to workers and others
description of procedure or steps
to meet legal requirements.
Risk assessment could be used for an individual’s:
Personal habits like for example drinking, smoking, over eating, self mutilation.
7.2 EXPLAIN HOW RISK ASSESSMENT RELATES TO RIGHTS AND RESPONSIBILITIES.
Risk assessment relates to rights and responsibilities in the following ways: Legal requirement: It is legally required by law that the person in charge acknowledges the various risk possibly associated with the individual in care and that the risks are assessed and precautions are taken. Prevention from danger and harm: risk assessments are done to assess the various risks associated with the individual’s mobility, personal hygiene, behaviour, outings and personal habits. Thus preventing the individual from any further harm or damage. Clear guidance or instruction:
the risk assessments underline the risks and give the solutions as to how to handle and prevent the risks from occurring. Thus giving the carers information and instructions on what and how it should be avoided.
7.3 EXPLAIN HOW RISK-TAKING RELATES TO RIGHTS AND RESPONSIBILITIES.
Risk-taking relates to rights and responsibilities in the following ways: Freedom of choice: the individuals in care have the same rights as any other human being does. They have the rights to make their own choices. For example a service user has the right to smoke. Therefore carers cannot make the decision of not allowing them to smoke even though it is not good for their health. Maintaining independence: The individuals in care have the rights to maintain their independence. For example if a service user feels like she is capable of going out on her own and insists on going alone by herself, we the carers have no rights to stop her. But what we could do is go through risk associated and prepare the risk assessment. Maintaining dignity and respect: The individuals in care should be treated equally as any other human being and should be treated with the same dignity and respect. For example if a service user is known to wet their bed at night. It is not right to force them to wear incontinence aids such as sanitary pads as that could make them feel low and lower their self esteem. In such cases risk assessment should be done and other alternative methods should be adopted.
7.4 EXPLAIN WHY RISK ASSESSMENTS NEED TO BE REGULARLY REVISED.
Risk assessments need to be regularly revised to:
ensure they are up-to-date
ensure they prevent risk of injury or harm
take account of changing needs and preferences of the individual take account of changes in equipment.
7.5 EXPLAIN THE IMPORTANCE OF USING AGREED RISK ASSESSMENT PROCESSES TO SUPPORT CHOICE.
Providing choice is your duty and the individual’s right. Risk assessments provide support for individual’s to manage choices in the safest way possible. Where the individual is able to make an informed choice and still wishes to pursue a high risk decision or choice, having a signed risk assessment is one way of showing that they are aware of the risks and are willing to take them. This provides organisations and professionals with a significant degree of protection for their support of the decision should things go wrong.