Block 5: Whole Block

Block 5: Whole Block

1. Unit 17 - Unacceptable care

   • Good Quality care
     • PPE
     • Good eye contact
     • Time to explain
     • Good attitude staff and management
     • Well trained
     • Knows history
     • Protects modesty
     • Listens
     • Protects rights to 5 principles of care.
   • Poor Quality Care
     • Little or no training
       • Marie O'Brien - Fakhra - eating , choking - lack of training.
     • Discriminatory
     • Rushed
     • No PPE
     • Dangerous
     • No eye Contact
       • Elsbeth Jones - Broken wrists P14, care agency - Fiona
     • Abusive Care
       • Treated as a non person
       • depersonalisation - treated as an object
       • Humiliation
       • Locking in toilet
         • Alan Harris - Victor. Cedar Court. Frustrated, confused
           • Lauren - Whistleblower
       • Ignore spacial rights - touch
       • Types of abuse.
         • Neglect
           • Moving bed from wall
         • Racism
         • Emotional
         • Physical
           • Hitting, over use of restraint, causing pain.
         • Psycological
         • Sexual
       • Often more about Bad care environments, inappropriate attitudes, beliefs and practices that develop over time.
     • Institutional bad practice - always done that way!
   • Intimate care
     • Washing - crossing gender lines.
     • Hidden aspects of care
     • Toileting - Crossing intimate boundaries
       • Richard - Marie O'Brien, Toileting Lack of training.
     • Requires careful supervision
   • Attitudes to behaviour
     • Communication
       • Talk and listen
     • What does the person get from behaviour?
       • What training/counselling could be given?
         • Rosalie Williams - Hearing problems/Learning Dis - Aggression-Violence. Some staff wanted discussion, some wanted moved.
     • Can they control behaviour?
       • i.e ticks, fits, etc
     • What does it achieve?
       • Does it get them out of something they do not want to do?
     • Lowe and Felce 1995, Moves to use respectful terms - i.e. challenging behaviour.
   • Preventing abuse and aggressive behaviour
     • Maintain environment
     • Maintain calmness
     • Protect potential victims
     • Prevent/manage triggers to behaviour
     • Communicate
       • In a way which is:
         • Appropriate
         • Encouraging open exchanges.
         • Minimising constraints.
         • Free from discrimination and oppression
         • Acknowledging of rights.
     • National Occupational Standards for Health and Social Care - Skills for Care 2005
   • Safe Care
     • Proper training and supervision.
     • Thorough recruitment and selection.
     • Written policies and procedures
       • Assist in promoting independence and give a "standard" care.
       • Jocelyn Lawler Ch17 - not prep for intimate care/embarrassment/emotions.
     • Procedures for reporting abuse/ unacceptable care.
     • Effectively manage/train staff. Give development opportunities.
     • Codes of care for Employers of social care workers.

2. Unit 18 - Handling personal info

   • Confidentiality
     • Record keeping
       • Accurate
         • Amy, Brian and Zac - wrong info on form
       • Up to date
       • Comprehensive
       • Reduces risks of mis-treatment or incorrect diagnosis.
       • Provides history of illness/allergy.
       • Assist diagnosis
       • Reduces waste - repeated tests
       • Skilled and integral part of care work
     • Vital to trust.
       • Dan Morgan - Mum saw GP re his drug use, notes on file - Mum may be at risk of harm if disclosed by doc.
       • Patel Ch23 - HIV status of relatives - consent negotiated to talk about in group support.
     • Electronic records.
       • Breeches in security
       • Easily shared
   • Records
     • Those at risk easy to identify
     • Can be shared between multiple people/care settings
     • History not forgotten
     • Reduce wasteful repeats of test/procedures.
     • Helps protect against incorrect or misinformed diagnosis
   • Data Protection Act 1998
   • Mental Capacity Act 2005

3. Unit 19 Getting care right.

   • Formal accountability?
     • Must be prepared to defend and justify what done/why did.
     • Not just about keeping records but most easily recognisable form of it.
     • Increases safety.
     • Can be accountable to many people, i.e. service users/ HSE/public/managers
       • Conflicts of accountability - what works for one body of people may not work for another.
     • Responsible for what you do or say/choose not to do or say
     • Review/ Meetings. PDR or service user meetings.
     • Complaints procedures/ grievance procedure.
     • Explicit statements of responsibility: Contract/Job role
     • Procedures to measure performance - Care records/ surveys.
     • Penalties/ Rewards. +Bonuses + Promotion - Prosecution - Fired -Sued.
     • General Social Care Council 2002. Codes of practice.
       • Apply GSCC guidelines: Marie O'Brien - Accountable as contract states she should ask for training in any area she feels she requires. Manager accountable as didn't arrange suitable induction as stated in their job role.
   • Informal accountability
     • Conversation
     • General talking
     • Even the question "What have you been doing? classes as informal accountability if you feel the need to justify the answer.
   • Protocols and guidelines
     • Standardise care
     • Protect management
     • Assist in training
     • Please insurers
     • Provide a formal set of instructions
     • Define correct/best practice
     • Allow unskilled staff to be used to support skilled workers.
     • Service users not involved in planning
       • Can focus on what is convenient for the organisation.
     • Maybe considered to deskill the workforce.
     • Do not allow for an individual approach.
     • Help get "older" workers up to scratch.
   • Evidenced based care. Based on evidence available at that time. Problems.
     • What is best in general may not suit everyone.
     • Must be acceptable
     • Undervalues the skills and experience of the worker.
     • Missing evidence - if not tested for exactly that group etc.
     • Rarely empowers the service user.
       • Could hinder case as may not have clear evidence a treatment will work.
     • If not evidence based care.
       • Waste of resources.
         • Glasziou et al 2003 - antibiotics in ear infections... can clear up spontaneously without.
       • Unnecessary interventions. i.e enema in labour to reduce risk of infection... now proven no benefit.
       • Harm. i.e. belief that bed rest after operations... now proven causes DVT if inactive for too long.
   • Knowledge based care
     • Research knowledge.
     • Organisational knowledge
     • User knowledge/ first hand knowledge.
     • Community knowledge.
     • Good research balanced with evidence and a personal approach.
   • Internet
     • Accountability - more info available on web - performance. i.e. Ofsted/ Hospital league tables.
     • Can change relationships between care recip and care giver.
       • Empowered + more likely to stand up for themselves.
     • More likely to be younger patient searching web.
     • Disadvantaged groups more likely to search web.
       • Poss due to disjointed relationships with care professionals.
       • Zeibland et al 2004
     • Instant information.
     • Research evidence online.
       • The Cochrane Collection
       • The Campbell Collaboration.