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Reading: Develop and implement personal care support plan

ContentsDiscuss with client the need to maintain and/or increase their existing relevant skills 2Discussing decisions 4Identify and discuss options with client for personal care support that maintains existing skills and/or increases other skills 5Check that the client (and carer) understand options 7Discuss the worker’s role in personal care support, the client’s role and the carer’s role, and check that details are appropriate 8Role of the worker 8Role of the client 9Role of the carer 10Describe to client (and carer) necessary processes, equipment and aids 10Describe health care requirements and associated support activities within organisation policies, protocols and procedures 16Clarify with clients difficulties in meeting their needs and address with organisation protocols 18Provide people with information to assist them in meeting their personal needs 19Implement personal care support plan and record and analyse outcomes 23Maintain client confidentiality, privacy and dignity within organisation policy and protocols 26

Certificate IV in Disabilities: CHCICS401A: LO 8572 Reading 1© NSW DET 2009

Discuss with client the need to maintain and/or increase their existing relevant skillsWhile most people receiving care in their home or an aged care facility appreciate being cared for, workers must be aware of the need to encourage the person’s independence by balancing providing care with encouraging the person in performing activities independently. It is vital that the person retains and continues to practise skills required for their daily routines. In practice it can be quicker to take over the task rather than encouraging and supporting their efforts, however it is critical that all care is tailored to maximise the person’s abilities.

Therefore it is important that workers assist the client to evaluate their existing skill level and the need to maintain or increase their current level. This is because:

If the person is involved in the process from the beginning, adjustments to skill levels can be designed by the person themselves with assistance from others as needed.

Adjustments to skill levels may require the person to make changes or modifications to routines. Any adjustments need to suit the person’s preferences. People who are involved in these types of adjustments are more likely to be accepting of such adjustments. This has a positive impact upon the effective implementation of goals relating to the adjustments.

It is empowering to the person to be involved in any adjustment to existing skill levels, and increases his or her sense of control over any changes made in response to increasing age and decrease in functional skills.

The process of evaluating and selecting whether to maintain or increase existing skill levels involves summarising information and presenting it in a way that all parties can compare options and arrive at the best decision. Summarising and presenting information includes providing written information and supporting this with descriptive information or explanations about what maintaining or increasing skill levels involves. Group discussions and one-to-one discussions can also be helpful in making sure that all parties have a chance to gain all the information they need, and to have their say.

Deciding whether to maintain or increase skill level

When comparing options, in order to choose, it is helpful to compare them in relation to practical aspects. Considerations such as costs and requirements in terms of staff are only two aspects that strategies may be compared. There are many other aspects that need to be considered.

2 Certificate IV in Disabilities: CHCICS401A: LO 8572 Reading © NSW DET 2009

Decisions need to be selected on the basis that maintaining or increasing existing skill levels:

are safe

will be of positive benefit to the person

will not be of harm or unduly limit the person’s opportunities

are in line with the Disability Service Standards and the Disability Services Act or Aged Care Standards

promote independence

promote extension of skills that may be used to support other areas that are weaker

are possible within existing or potential resources

are achievable

do not reduce the person’s opportunities to participate to the highest possible level in the community

are favoured by the person.

This table can help present information in relation to these points, and outlines the spread of factors to consider.

Table: Skill level table for decision making

Comparison Maintain existing skill level

Increase existing skill level

Is safe

Will be of positive benefit to the person

Will not be of harm or unduly limit the person’s opportunities

Is in line with the Disability Service Standards and Disability Services Act or Aged Care Standards

Promotes independence

Promotes extension of skills that may be used to support other areas that are weaker

Is possible within existing or potential resources

Does not reduce the


person’s opportunities to participate to the highest possible level in the community

Is achievable

Is favoured by the person

Discussing decisionsAttitudes, beliefs and values will impact upon the discussion of strategies. Therefore it is important to maintain certain values when discussing any adjustments. Such values may include:

upholding the value of the person as an individual and rights to choice and self-determination

providing opportunities for increasing the individual’s competence and confidence

meeting the identified need of the person.

The following strategies can help in such discussions:

allowing extra time for the discussion, particularly for people who have complex communication needs, who have hearing difficulties, or who have difficulties concentrating on new information

providing communication supports to help the person to understand the information (eg pictures, diagrams, photographs)

being prepared to rephrase and repeat information as necessary for people who take longer to integrate and understand new information with what they already know

using plain English or simple language to explain options

giving many opportunities for the person to ask questions or to clarify what is being discussed

describing the several options or choices and laying these out in a clear way that promotes discussion without confusion

demonstrating and showing the person through experience what the strategy will involve

giving the person the opportunity to have more information and ask questions

providing reassurance and encouragement to try new things

building small steps into a strategy so as to build competence and confidence

providing a mechanism for review or changing the strategy


building in a ‘trial’ period

giving clear feedback about progress during any trial of a strategy

being prepared to alter the strategy to suit the individual’s needs

starting small and having a long-term vision for later steps.

This would be a good time to attempt Activity 1 before moving on with the remainder of this reading.

Identify and discuss options with client for personal care support that maintains existing skills and/or increases other skillsMaintaining and increasing clients skill levels are not only an ethical obligation but a funding requirement. The following table highlights what some of the service standards say about supporting people’s independence.


Table 1: Rights and responsibilities of assisting to maintain independence

NSW Disability Services Standards The NSW Disability Services Standards require people to be supported in a manner which maintains their independence. For example, Standard 2 (Individual need) states, ‘Each person with a disability receives a service which is designed to meet his/her individual needs, in the least restrictive way.’ Standard 6 (Valued status) also states, ‘Each person with a disability has the opportunity to develop and maintain the skills required to participate in activities that enable him/her to achieve valued roles in the community.’

Charter of Residents Rights and Responsibilities

The Charter of Residents Rights and Responsibilities states: ‘Each resident has a right to maintain his or her personal independence, which includes a recognition of personal responsibility for his or her own actions and choices, even though some actions may involve an element of risk which the resident has the right to accept, and that should then not be used to prevent or restrict those actions.’

Aged Care Accreditation Standards Standard 3.5 (Independence) of the Aged Care Accreditation Standards (Residential Lifestyle) states, ‘Residents are assisted to achieve maximum independence, maintain friendships and participate in the life of the community within and outside the residential care service.’

Ageing in place

‘Ageing in place’ is a strategy to enable people with a disability to age in their own home for the longest period possible, as opposed to being placed in institutional care. There are several benefits to adopting a positive strategy to ageing that includes a vision for the person to age in place, and making plans to adapt the home and support provided to suit any changing needs associated with ageing.



Practical issues

In order for people to age successfully and age in place, several factors will need to be considered. Several of these factors relate to the individual in looking at their current skill level and areas where skills may be improved. Other factors may be environmental where modifications and developing the client’s ability to use such modifications will maintain a level of independence.

An example may be where the client needs to develop skills in using technologies such as electronic communication to assist with shopping (internet shopping, or ordering of grocery items). It may be learning to use communication such as telephone or email in order to maintain a social and supportive community network. Other products such as a VitalCall unit in cases of emergencies can aid in independence.

As you undertake the initial observation of the client’s personal hygiene or feeding skills, for example, you will identify areas where the client can improve. As you complete a care plan you may consider what other equipment may be used, such as in a shower situation. You might ask yourself whether a handrail would enable the client to continue to stand in the shower, or whether they need a shower chair because they are unable to stand. These are the types of questions you should be asking as you develop a care plan.

As you build trusting relationships with the client and their carer you may want to set some goals around what they want to do for themselves. This could mean building up their muscle tone so they can stand in the shower. So little by little goals are set.

Check that the client (and carer) understand optionsResearching and using a client’s communication preference is an obvious way of communicating and ensuring they understand options for their personal care needs. Determining they have a demonstrated capacity to make decisions is another way you can gauge the person’s understanding of what is being told to them.

This would be a good time to attempt Activities 3, 4, and 5 before moving on with the remainder of this reading.


Discuss the worker’s role in personal care support, the client’s role and the carer’s role, and check that details are appropriateThe community services industry can be a very stressful area in which to work. We are often working with a high volume of clients with complex issues and within a context of inadequate resources and support. Given this, it is important to be clear and stick within the limits of your roles and responsibilities. This means not working many unpaid hours and taking on tasks which are outside your area of responsibility. In the long run, it is far more effective to advocate for adequate resources than run around trying to do everything and burn yourself out in the process!

Always try to:

Be mindful of your job description and focus your energy on completing tasks that are clearly defined as your responsibility.

Seek advice/clarification with your supervisor where necessary.

Adopt a team approach to completing complex tasks—two hands are better than one!

Work within policies and procedures.

Use supervision as an opportunity to formally clarify your responsibilities and identify your training and support needs.

Role of the worker What is meant by the role of the worker? The worker’s role is the main overall focus of a job. For example:

A distance education teacher’s role is to help students learn.

A doctor’s role is to look after people’s health.

A childcare worker’s role is to care for children.

Each job has a range of responsibilities that must be carried out competently by the worker in order to fulfil the job role. For example, some of the responsibilities of a person in the role of distance education teacher are:

to give support to students while they are learning

to assist in the preparation of learning materials

to mark assessment tasks.


As you can see, the role of a worker is the overall focus or area of responsibility, while the responsibilities are the duties or tasks that you are expected to undertake in the job role.

Now (as an example) let’s look in more depth at the role and responsibilities of a residential care worker. Read through the following description of the role and responsibilities of a residential care worker in a respite care service for children under twelve years of age who have a disability.

The idea behind respite care is to provide both the family and the older person or the person with a disability with a break from each other. The general role of a respite care worker is to ensure the safety and wellbeing of the older person or the person with a disability. Therefore, they must provide an environment that safely assists learning, encourages independence and includes activities that allow for a fulfilling social life. They must ensure that the home is safe and secure, that the residents have access to healthy, nutritious meals, that they have choices in daily living activities, that they are respected as individuals, that hey have opportunities to develop relationships, and that their basic human rights are respected.

Respite care workers can ensure these quality of life issues are met by working with the person and his or her family to determine needs, wants and interests, by providing a consistent and supportive approach. They could work to empower the residents by networking with other appropriate services and/or people, developing and implementing care and support programs and plans that work for the resident and their specific needs, and providing opportunities for growth.


Role of the client The concept of rights cannot be viewed in isolation from the concept of responsibilities. While clients have a right to expect the worker to fulfil the role they should play, they also have responsibilities as a client.


Practical examples

The following are some of the roles and responsibilities of a client.


The need to make known any condition that will affect their safety or the safety of the worker. For example, if they have trouble standing in the shower or walking to the shower or they have a swallowing problem they need to inform you of this.

An obligation to cooperate and not be resistive with the worker in undertaking tasks and achieving personal support goals.

Role of the carer Carers do things like feeding, bathing, dressing, administering medications and transporting. They also take on responsibilities such as banking, shopping and bill paying for those they support. Most importantly, carers provide emotional support day in and day out for the person they care for.

This would be a good time to attempt Activity 18before moving on with the remainder of this reading.

Describe to client (and carer) necessary processes, equipment and aidsAn aid is something that helps a person to do something more easily. The aim of any aid is to maximise the abilities and independence of the person. This type of support can mean the difference between the person managing their daily living skills or having to move into a supported accommodation arrangement.

We all have a number of aids in our own homes. It is important that the client is aware of the equipment and aids available to them so they can make informed choices about how best to meet their personal care needs whilst maintaining a level of independence. Below is a brief outline of the various types of equipment and aids that can be used to make life more comfortable for the client and easier for the carer.



Wheelchairs

Man in a wheelchair

A person may experience mobility impairment as a result of accident or injury, chronic medical condition or congenital disability. For example, from paralysis, multiple sclerosis, cerebral palsy, muscular dystrophy, spina bifida, poliomyelitis, spinal cord injury, back injury, arthritis, broken or sprained limbs, loss of limbs, stroke or brain tumour.

Mobility impairments vary—a person may have difficulty with balance, gait and coordination, and experience dizziness, weakness, pain and paralysis. They may use crutches, a walking stick or a wheelchair.

People who use wheelchairs have varying degrees of difficulty with mobility. Some may use their arms to propel the chair, others may use an electric wheelchair, which is usually heavier and cannot be easily folded to be placed in a car.

Source: Interactions

Mobility aids

Mobility aids, commonly walking aids, are tools that are designed to assist walking or enable mobility.

Walking aids vary, from those providing some support for those who can walk independently but need aid in stability, to greater support for those who need help to walk, to those providing maximum support and designed to aid those people who are unable to walk even with help.

Walking aids include walking sticks and canes, crutches; various walking frames such as walkers or Zimmer frames, wheeled (rolling) walkers, wheeled mobility devices such as wheelchairs and power chairs, and scooters. Scooters are a common mobility aid that allows people to access what the community has to offer such as libraries, shops and leisure venues.

Source: Wikipedia

Many businesses that provide mobility aids can be found on the internet. Mobility Aids is one such business, specialising in providing electric scooters, power and manual wheelchairs, lift and recline chairs, nursing beds and a range of other mobility aids. Their website is: < www.mobilityaids.com.au >


http://www.mobilityaids.com.au/

http://en.wikipedia.org/wiki/Mobility_scooter

http://en.wikipedia.org/wiki/Walker_(tool)

http://en.wikipedia.org/wiki/Crutch

http://en.wikipedia.org/wiki/Cane

http://en.wikipedia.org/wiki/Walking_stick

http://en.wikipedia.org/wiki/Mobility

http://en.wikipedia.org/wiki/Walking

http://en.wikipedia.org/wiki/Tool

Lifting and transfer aids

Lifting and transfer aids assist people with some weight-bearing capacity to transfer between one surface and another. This may include standing or seated transfer aids, transfer boards or vehicle transfer aids.

Standing transfer aids

Standing transfer aids assist people who can bear weight to actively participate as they transfer from one seated position to another. This eliminates almost all lifting requirements of the carer and reduces risk of injury. Aids available include:

rotating discs allowing an individual to move into a standing position, and then with assistance turn towards the alternative seat and lower without having to move their feet

standing aid which has rotating discs on which the person stands using a steel frame which includes handles and knee supports, allowing an individual to transfer independently without carer support

walking belts that are worn by the person and allow two carers to hold onto attached handles and support the person as they walk

transfer pads, with handles sewn in on either side, which sit under the persons buttocks and can be used by carers to assist the person to move from sitting to standing.

Lying transfer aids: sliding sheets with handles that when placed under a person lying on

their back allow carers to move them up and down the bed, onto their side or even into a sitting position

air moving elevating lift chairs or cushions to transfer a person lying on the floor that has fallen to a seated position using a pump mechanism.

Vehicle transfer aids can include: mobile battery operated hoists which can be dismantled and

transported

swivel car seat adaptation where a swivel mechanism is attached to the base of the existing vehicle seat and allows it to rotate 90o to assist with transferring (can be either manual or power operated)

swivel discs that rest on the car seat and allow easy turning as the top moveable disc rotates on the base stationary disc (can also be wedge shaped)


transportable steel handles that are used on the ‘V’ shaped door striker plate of most vehicles with grab handle to assist with getting out of a car

adjustable straps that can attach to the vehicle grab rail or door to assist with transferring

sliding pads/sheets to assist with moving, turning and transferring with models available for aircraft transfers

automatic seat lifters which enable a car passenger seat to lift out of a van and swivel 90o

curved transfer boards which accommodate for shape of car doors and allow transfer from mobility aid to/from car.

Seated transfer aids and transfer boards:

Transfer boards come in a range of materials, designs and lengths and generally have a non-slip surface on the base, with a slippery top surface which may be moveable. The board is placed between two surfaces such as a bed and wheelchair and the individual slides across the board. Transfer boards are also available which have a toilet opening to allow transfer and use of the toilet without removal of the board.

Source: Jobaccess


Beds

Nursing or hospital beds differ from traditional beds as:

Hospital beds ensure safety as most have side rails to keep the client in the bed. Safety rails or side rails are used for people who may fall out of bed, are prone to confusion or are unsteady on their feet when climbing out of the bed.

Some hospital beds are electronic or have a foot lever to pump the bed manually up and down. When making a bed, bed bathing, rolling a person, performing a dressing or helping a person to dress, it is important to have the bed at the carer’s height to avoid back injury.

Some hospital beds have equipment attached such as IV poles to allow for a bag of fluid or blood products to be hung.

Hospital beds have brakes to ensure safety. The bed is unable to move when the brakes are on and the brakes can be disengaged to move it around the room, to another room or outside.


Breathing devices

Continuous positive airway pressure machines (CPAP machines) give a continuous flow of oxygen or air, usually overnight, for the patient who has sleep apnoea or respiratory disease. There are different devices used for CPAP such as nasal prongs which fit snugly in each nostril and deliver a certain amount of continuous air or oxygen. Another device is a mask which again fits snugly over the nose and mouth.

Nasal prong or mask oxygen is used for patients who have respiratory diseases such as emphysema, chronic obstructive airway disease or asbestosis. People who require oxygen usually have a low flow metre to adjust the amount of oxygen necessary.

Ventilator—some people require a ventilator if they are unable to breathe on their own. These patients may have had a spinal injury and in this case the position of the injury in the spine determines the type of ventilation required.

Continence aids

Incontinence occurs when there is an inability to control the passage of urine or faeces, causing a social or hygienic problem.

For clients who are mobile and continent you may just need to remind them to go to the toilet. These clients should have easy access to a toilet and have facilities to wash their hands afterwards.

Other clients may have continence problems these may include:

stress incontinence—loss of urine when the client sneezes coughs or laughs

urgency incontinence—they experience an urge to go the toilet and must go straight away or they immediately lose the urine

total incontinence—constant loss of control of urine and faeces.

The person’s care plans may include a regular toileting regime to promote continence. For clients who have stress or urgency incontinence there are a range of absorbent pads which are available to insert into underwear to protect skin condition and clothing. You will need to check with clients if they need to be changed on a regular basis. Once again ensure your clients have easy access to the toilet and if they indicate they wish to go to the toilet and you must assist them straight away.

If the client is incontinent, ensure wet clothing is removed straight away and the skin is washed and dried, this is to ensure the skin is cared for and the client’s dignity is maintained.


Clients may also be given exercises by a physiotherapist to perform during the day, to help strengthen their pelvic muscle to help improve their continence. You may need to remind and encourage your clients to do these exercises.

Some clients may be incontinent of urine and faeces. Bowel management plans for clients should be in place. These management plans aim at developing regular bowel habits. Clients with no control may have a regular time in the day where they are given a suppository to help empty the bowel and establish a routine. You would need to discuss this situation with your supervisor and follow policies and procedures.

To prevent constipation a well-balanced diet, high in fibre with an adequate fluid intake, is important. You can help and encourage your clients to choose a well-balanced diet to help prevent bowel problems.

There is a range of products available to protect the client’s skin, clothing and dignity. These include pads, liners, disposable briefs and protective underwear, which need to be changed as required. Ask your supervisor about the range of products your organisation makes available.

Toileting a resident

There are several methods used when toileting a resident:

Commodes—a commode is a portable chair or wheelchair with an opening for a pan. When using a commode chair to transport a resident, use a modesty or dignity gown.

Some can be placed over the toilet. This is used for residents who have difficulty walking to the toilet.

Bedpans and urinals are used when residents cannot get out of bed. Males use a bedpan for bowel movements and use a urinal for urination. A fracture pan has a thinner rim and is only about a centimetre deep at one end. They are used for residents who have limited range of motion in their back.

Personal audio-visual aids

The Independent Living Centre of NSW has a huge range of aids for people with a disability. They are a generalist service in that they display a range of aids for people with any type of disability. They have a great website <www.ilcnsw.asn.au> which provides a listing of the various aids, plus costs, suppliers and so on. You can even see what some of the aids look like—all without leaving home.

Personal audio-visual aids can help a person read, write, and manage daily living tasks.


http://www.ilcnsw.asn.au/

Some examples are:

magnifying aids

audio tapes

electronic reading machines

computers that use large print and speech

Braille

spectacles

hearing aids.

Modified feeding aids

Some care recipients may require feeding due to weakness, paralysis, casts, confusion and behavioural problems. There is a vast range of feeding aids including specialised eating utensils, plate guards, non-slip plates, sip cups, two-handled mugs and rocker knives. Austech have a range of feeding aids that have been modified. Their website is: <www.austechmedical.com.au/dailyliving.htm>.

Describe health care requirements and associated support activities within organisation policies, protocols and proceduresA policy is a course of action or guidelines to be followed, whereas a procedure is the ‘nitty gritty’ of the policy, outlining what has to be done to implement the policy. For example, a staff recruitment policy could involve the following procedures:

1 All vacant paid positions will be advertised in local and state-wide papers.

2 The advertisements will have details of duties, salary range, closing date and contact details.

3 All interested people will be mailed job descriptions and information about the organisation.

As a result of accreditation, regulatory and funding requirements and best practice standards, most community service organisations have written policies. Policies reflect the philosophy of the service and usually outline a set of general guidelines or rules that tell us what the management of the service expects will be done in particular situations. They may also include


http://www.austechmedical.com.au/dailyliving.htm

a philosophy statement as well as step-by-step procedures that relate to how things should be done in practice.

Policies are usually specific to and developed by individual organisations, are informed by legal obligations and ethical considerations, and are monitored and enforced through service management procedures.

Disability and aged care services will have policies and procedures relating to all areas of their operation. These include clients or service users, staff, community, management, health and safety.

These policies may be written down and kept in a policy manual. But sometimes they are not written down but just understood by everyone that works for the organisation because they have been passed on verbally. In this way, in an organisation that has no written policy regarding developing an individual plan for clients, a worker will know their own limitations in providing a service to each client and will refer to specialist services when appropriate.

From a legal point of view such ‘unwritten’ standard practices and procedures are still considered to be policies.

Most organisations will have both written and unwritten policies. Some policies are written due to regulatory, accreditation or funding requirements. Some are written because they cover important aspects of the service’s operations such as staff recruitment. Others become policies as situations arise and may be relevant only to that organisation.

Written policies provide a clear record which can be referred to by management, workers and clients using the service. Like job descriptions they inform workers about the standard of work required in given situations.

The management of an organisation usually determines policies with input from staff and clients. Staff are often given greater responsibility for determining the procedures detailing how a policy is to be implemented. In community service organisations all people affected by a particular policy or practice should be consulted when the policy is developed or reviewed. This includes staff, clients and the broader community. However, the actual degree to which consultation about policies occurs and who needs to be involved will vary according to the management structure of the organisation. A service managed by a larger organisation such as the local council or a government department, for example, will have more levels of bureaucracy to consider than a sole owner operator or community-managed service.

As with job descriptions, workers should take any opportunity provided to have input into the development and review of policies, practices and procedures within community service organisations. This is one way of making a concrete and useful contribution to the overall operation of the organisation. Workers also have a responsibility and a right to express concerns when the policies and procedures in their workplace are not


working effectively, seem unreasonable or have become out-dated due to change over time.

How to ensure you are always working within policy and procedures

Lack of adherence to policy and procedure can cause embarrassing blunders that damage your own professional reputation and, even worse, cause harm and unnecessary angst for the clients.

Working within organisational policy and procedures is not as simple as reading policy and procedure manuals. Policy is not just the written word. A critical aspect of policy is the way in which it is interpreted by various people and the way it is implemented (‘the way things are done around here’). For example, the organisation may have a written policy that staff meetings occur every second Wednesday. However what you notice is that staff members go to the staff room for an informal catch-up about recent events and team tasks over lunch a couple of times a week instead of at a formal meeting. If you were to go out every day for lunch, you would miss this valuable networking time.


Clarify with clients difficulties in meeting their needs and address with organisation protocolsWhen you have a client who wants something that is not in the scope of that plan, you need to inform them that you are unable to do what they are asking and that they need to talk to your supervisor. It is important that you first offer them the opportunity to discuss this with the supervisor so they can clarify the problem directly. You should never provide services outside the care plan as you may be breaching your duty of care to that person and to the organisation.

During the implementation of a service/care plan, situations may change for the client. These changes may make it difficult for care workers to carry out the tasks outlined in the service/care plan because they may now conflict with the client’s requests. Such changes may occur as a result of improvements or deterioration in a client’s strengths, abilities or conditions. The level of care a client needs may also change from one environment to another.


Here is an example:

Mrs Marini’s assistance with showering is defined on the service/care plan as ‘requires her back washed only’. The assessment of her needs states that she is able to perform the others tasks of showering independently. She now says that she cannot shower herself and needs more care.

In Mrs Marini’s situation you could respond to her immediate needs by assisting in the other procedures involved in showering. This will give you a chance to talk to her and find out the facts behind what she is claiming. You will also be able to observe for yourself her ability and competence in showering. Consulting her will show your respect for her dignity. You could then report the changes in Mrs Marini’s care to your supervisor. As a result of your report, you and your supervisor may review the service/care plan and include some new strategies.

Reporting work requirements unable to be met

When you have monitored your own work performance, received feedback and evaluated your standard of work in relation to workplace expectations, there may be aspects of the work requirements that you do not feel you are able to meet. It is your responsibility to inform your supervisor of any work requirements that you are unable to meet. By doing this, you are being open and honest with your supervisor. You are also being a responsible team member and you are meeting your legal responsibilities and obligations.


Provide people with information to assist them in meeting their personal needsInformation means different things to different people. Some people glean information from attending, observing, and learning by watching others. Others gather more information from listening, doing, and experiencing. Different people might have different preferences for ‘learning’ from information, storing information, and integrating new information with what they already know. Different people will also interpret different information in a variety of ways, depending on their past life experience and knowledge.

The amount of information and the type of information needed for a particular event or outcome might also vary from person to person. This


relates to ‘individual information needs’. Some people have a higher interest and need for information than others to function within a given situation.


Hearing impairment

For someone who is deaf and who uses Auslan (Australian Sign Language) you may wish to employ an Auslan interpreter to help you to communicate effectively. The Ethnic Affairs Commission and the Deaf Education Network also provide Auslan interpreters.

If you want to telephone someone with a hearing loss you can use a teletypewriter available through:

TTY on 02 9893 8858, or

the National Relay Service on 13 25 44.

The National Relay Service acts as a ‘middle step’ between those who don’t have a TTY and those that do.

Other aids that can assist you to communicate effectively with someone with a hearing impairment include headphones, using either an infra-red or FM system, and hearing (audio) loops.

Cognitive impairments

When communicating with someone with a cognitive impairment it is essential to use plain English and to check that the person understands. If someone has a limited capacity to communicate his or her thoughts and feelings you might consider using:

Compic pictures—pictorial representations of words and actions

Makaton signing—sign language that has been developed for people with an intellectual disability

a communication board—either electronic or handmade

photos

magazines

cue words.


Mental illness

Someone experiencing symptoms of mental illness may not be in a position to communicate effectively or understand what you are trying to tell them. Mental illness symptoms such as hallucinations and delusions, as well as impaired communication and concentration abilities, may necessitate delaying communication until the client is well enough to understand and consent to what is being discussed. Alternatively, the client may have a legal advocate or guardian who can be present at communication events to help clarify issues with the client or respond on the client’s behalf. No matter if an advocate or guardian is involved, it is always better to be able to communicate directly with clients and have them understand what is being discussed.

Physical disability

Some people with, for example, severe cerebral palsy, find it difficult to physically form the words they wish to communicate. While they understand everything you are saying they may have difficulty getting their ideas across. People in this situation will usually have a communication board or an electronic communication system.

If you are communicating with someone who has a disability you should look up this highly useful resource: Go to the website for the Department of Ageing Disability and Home Care at <www.dadhc.nsw.gov.au> and download the Communication Handbook for NSW Government Agencies. You will find it in the publications section of the website.

People from culturally and linguistically diverse backgrounds

Often we find ourselves communicating with people who don’t speak the same language as we do. In order to provide a professional, confidential and effective service to everyone it is essential to use trained interpreters to help communicate effectively with people from backgrounds that are culturally and linguistically different from our own.

Interpreters are people who translate spoken language and they convert information from one language in to another. In Australia the National Accreditation Authority for Translators and Interpreters (NAATI) is the organisation responsible for accrediting and training interpreters and translators. Interpreters accredited by NAATI are bound by a Code of Ethics and have been tested as being qualified to interpret at a particular level. There are five levels of NAATI accreditation ranging from a Language Aide level to senior professional level. In the community services industry we usually recommend that you use the services of a Level 3 interpreter (Professional Interpreter level).


http://www.dadhc.nsw.gov.au/

The agency you work for will usually have policies, procedures and guidelines for accessing interpreters and may use a particular interpreting service. Interpreters can however be provided by the following services:

The Department of Immigration and Multicultural Affairs Translating and Interpreting service (TIS). This is a 24-hours-a-day, seven-days-a-week service which provides both telephone and face-to-face interpreters. They can be contacted on 131 450 or 1300 655 081 (for those who live outside metropolitan Sydney).

The Community Relations Commission for Multicultural NSW—Language Services Division. This is the NSW Government’s interpreter service and also operates 24-hours-a-day, seven-days-a-week. It can be contacted on (02) 9716 2248 or 1300 651 500.

The Department of Health and Centrelink both have their own interpreter services for their own clients or service users.

There are also private interpreting agencies and people who work as freelance interpreters. When using these services or people you should check their qualifications (you want them to be NAATI accredited to at least at Level 3) and there may be a higher fee for these services.

Avoid using jargon

Using plain English is crucial when talking and interacting with clients. Using jargon (words not commonly used or used by workers in a particular industry) tends to disempower people and cause them to feel confused, stupid or frustrated. When we use our own words when paraphrasing, reflecting or summarising, it’s essential that we use words that clients will understand and which will help them either to gain an insight into what is happening for them or to confirm that we are on the right track. The goal of interpersonal communication is to enhance the relationships we have with people and to understand what is happening for them. This will not happen if we try to impress them with our use of the English language or try to show them how knowledgeable we are.

Providing information

Often, workers are required to provide information to colleagues, supervisors, clients and members of the community. How we do this will have an impact on how well we meet the needs of the person asking for the information.



Implement personal care support plan and record and analyse outcomesA care plan consists of the directions that you follow when you look after a resident. Read this care plan (.doc 185 kB) to refresh your memory on what a care plan may look like.

Development of the plan

The individualised care plan is a comprehensive informative document that maps out all areas of care for carers to follow.

A care plan is developed when a client enters the service and when/if their condition changes. They also are reviewed and updated on a regular basis. It is very important that the client’s preferences are documented in the care plan. For example when they like to wash, what type of activities they like to do, what kind of foods they like to eat, what religion they are and even what funeral arrangements that wish for, and so on.

Table: Two residents’ preferences

Mr Benton Ms Higgins

Shower/bath Likes a very quick, daily shower after breakfast

Likes to be first on the shower list every second day. Enjoys a lengthy shower

Clothing Likes to wear loose fitting casual clothing such as a tracksuit and runners.

Likes to wear a dress and stockings, closed in shoes and a handbag. Also wears lipstick every day.

Social activities

Woodwork and discussion groups only.

Bingo and all outings

Bedtime Likes to be in bed by 9 pm after a cup of hot chocolate

Watches TV between 6 pm and 8.30 pm then retires for the night.

Funeral arrangements

Wishes to be cremated Wishes to be buried

Religious activities

No interest in religion. Will not participate in any religious activities

Devout Catholic. Attends weekly services.

Food Enjoys all food except lamb. Often eats dessert before main meal.

Main meal at lunch. Sandwich and soup for dinner. Fish on Fridays

Exercise Daily afternoon walk around grounds for approximately 15-20 minutes.

10 mins stretching every morning after shower.


Imagine the consequences of providing care to Mr Benton and Ms Higgins without taking into consideration their individual preferences.

How do you find out a person’s preferences? The best person to ask would be the person themself, of course. If the person has a significant level of cognitive impairment, ask the spouse, other family member or friend.


Identifying needs

When identifying needs it is important to note real needs. For example, dementia in itself may be a problem, but how and in what areas does it impact on the client’s ability to carry out activities of daily living and their ability to function independently? That is the client’s real need. Needs can be actual or potential; that is, a client may have an actual problem, or may be ‘at risk’ of developing a problem if certain strategies or interventions are not carried out. An example may be a client who has urinary incontinence. If certain interventions are not put in place, that client is ‘at risk’ or has the ‘potential’ to develop skin problems.

Therefore they may have an identified need of: ‘potential for skin integrity breakdown related to urinary incontinence’ or ‘at risk of skin integrity breakdown related to urinary incontinence’

We do need to know why the client is not able to carry out functions without support or assistance in order to be able to plan strategies. It is difficult to rectify a problem if we do not know what causes it.

For every need or problem there must be a reason. An example of a need/problem and its cause may be: ‘Inability to complete personal hygiene independently related to cognitive impairment’. The problem is ‘inability to complete personal hygiene independently’ and the reason is ‘cognitive impairment’.

From this identified need we would probably require strategies such as:

remind the client to wash hands after going to the toilet

prompt the client with activities during bathing—if the reason was ‘reduced mobility,’ the strategies or interventions required would be entirely different

assist the client to bathroom using a shower chair

encourage the client to stand using hand rails in the shower recess.


Goals/outcomes

If we have identified an area of need and are planning strategies with the client, there must also be a reason or purpose for doing so. The reason is the goal or outcome the client desires and/or needs. A goal or outcome for the need identified above may be: ‘Client will achieve optimum hygiene and maintain current level of independence’.

It is very important that goals be achievable and realistic strategies or interventions are set with that goal in mind. Goals can be changed to suit the client’s changing needs and/or as abilities improve or deteriorate.

Strategies/interventions

Strategies or interventions are the actions we put in place to address the identified need or problem and to achieve the goal. These strategies should be those that have been found to be successful throughout the assessment process.

Strategies should also be individualised for each client. What is appropriate for one client is not necessarily going to be appropriate for another.

Review and evaluation

Care plans must be reviewed and their effectiveness evaluated on a regular and ongoing basis. There is little benefit in putting a plan into place and never reviewing its results and effectiveness.

Reviews are carried out at varying intervals and as needs change. The timing of reviews and evaluations will depend on local policy but they are usually done anywhere between two and six weeks. The effectiveness of a plan should be evaluated in relation to the desired goals or outcomes. That is:

Are goals and outcomes being achieved?

Are strategies still appropriate for achieving the outcome?

Are goals or outcomes still appropriate?

Where it is found that needs have changed significantly, it may be necessary to re-assess a particular area of need.

Changes to a client’s needs and their care plan must be reflected in their progress notes. This way all staff will be alerted to the change and the required care will be consistent. So at all times staff must document the outcome of their care. For example, if staff adapted the lounge area to allow a client better access to view the television, and hence reduce the client’s agitation—was the action successful? If so, staff need to document that the action resulted in less noted agitation by the client. This then provides the


documentation that staff care has impacted and changed the client’s behaviour.

The care plan is a written tool used to document clients’ needs, goals/objectives, care implementation/strategies and evaluation. In an aged care facility it is often called the nursing care plan; however many other facilities adapt the principles to implement and develop their own individual ‘care plan’. Hence it may not always be called the ‘nursing care plan’. It is essential that plans of care be individualised to the clients’ needs. Generic care plans do not address individual needs and are not client specific.

Care plans must be formulated by the care team in consultation with the client and/or his or her representative.

Maintain client confidentiality, privacy and dignity within organisation policy and protocolsWhen caring for clients you are responsible to act in a legal and ethical way. The term ethics means:

an area concerned with making decisions about what is right and what is wrong

involving moral values, including what should or should not be done

you are accountable (responsible) for the care you give.

As a care worker appropriate ethical behaviour will include but not be limited to the following points:

respecting the client as an individual

carrying out your duties to the best of your abilities

asking for help if you are not sure how to perform a certain duty

not performing a duty that you are not competent to do

keeping client information confidential

ensure client’s safety

ensuring client privacy and dignity

advocate for your clients

ensure the client is informed and involved in decision making regarding all care.


Confidentiality

Maintaining confidentiality, privacy and dignity is all about maintaining self-respect and pride for the person. It’s about treating clients the way you would wish to be treated, with respect and decency. It’s about doing what is ethical and moral, that is, what is right, maintaining self-worth and using discretion. As you will soon learn, confidentiality, privacy and dignity are basically tied together.


Client records

As a care worker employed with an organisation, you will, in the course of your duties, become aware of privileged information. Such information that may be gained is strictly confidential and is not to be discussed inappropriately within the organisation or elsewhere. To do so is not only unethical, it is also unlawful. Client information is confidential and is the responsibility of all staff. Only those persons directly involved in the clients’ care will have access to personal information contained in their health record. This information is to be kept strictly confidential, at all times.

Based on the Health Records and Information Privacy Act 2002, it is expected that personal information in regard to residents:

will not be unlawfully or improperly accessed

will not be unlawfully or improperly disclosed

will not be used other than for the purpose that it is intended for

will be treated confidentially and sensitively

will comply with the organisation’s security policy and procedures.

In addition, official information, files, documents and computer files are usually secured and locked so that no unauthorised access can be made. And, staff will not disclose official information or documents gained from their official capacity outside of the organisation.

Confidentiality agreement

All community services facilities take a very serious view of failure to observe confidentiality, as it constitutes a breach of the client’s privacy. This places both the organisation and the individual concerned at risk of legal action and its consequences and may constitute grounds for dismissal. When you begin working in an organisation, regardless of whether it is


residential or community based, you may be required to sign a confidentiality agreement. This statement means that it is absolutely essential to treat any personal details of medical, social or family history of a client and any other information pertaining to the organisation and its operation as strictly confidential.

The main Acts of the NSW Parliament concerned with confidentiality and privacy are:

Freedom of Information Act 1989

Health Records and Information Privacy Act 2002

Privacy and Personal Information Protection Act 1998.

Discussing information

Authorised staff may discuss only matters relevant to their own function and responsibility with other authorised staff or with other entitled persons in the course of client care. Under no circumstances are carers to discuss individual clients or their circumstance with other clients, family members or friends.

In practical terms, this means that information regarding clients may only be discussed at the following times and with the relevant people:

when the client is admitted to the facility or service

at handover time

discussing with relevant others about the client’s care in the normal course of your duties

asking or answering a question about client care with your supervisor

reporting a change you have observed.

Client records are to be read only by staff who are directly involved in the care of the client.

If you have any doubts or are placed in a situation of uncertainty, discuss them with your supervisor. Client confidentiality and privacy are to be maintained at all times.

Some tips to help you maintain confidentiality in the workplace

Never give client information over the phone. If unsure, refer the call to your supervisor.

Keep your voice down when speaking with clients for fear that other clients can hear you.


Be particularly careful when speaking to a client’s family member or friend. Ensure you know who they are and what you are permitted to say and not say.

Keep client charts, computer screens and information out of view.

Persons privileged to access the clients’ record should be specified and procedures developed which include supervised access by clients to their own records.

No information regarding the resident may be disclosed to those who are not directly involved in their care.

Privacy

Take a minute to think about what privacy means to you. Privacy has been described as the right to be left alone, or the right to exercise control over one’s personal information, or protection of individual dignity and autonomy. Privacy can concern physical privacy such as bag searching, or information privacy such as the way in which organisations handle personal information such as our age, address, sexual preference and so on.

One of the main reasons people with a disability or older people are sometimes reluctant to live in residential care is the fear of losing their independence and autonomy. It is therefore very important to encourage people to maintain independence by supporting and assisting them. You can assist them to do this by embracing the person’s right to privacy and dignity. This will help to facilitate trust and confidence and will help to maximise independence, confidence and self-esteem.

Dignity

Privacy and dignity is a basic human right. It is essential as a carer always to ensure that privacy and dignity is maintained. Lack of respect for an individual’s dignity in care can take many forms and the experience may differ from person to person.

Some ways of respecting the person’s dignity are:

Refer to the person respectfully. Refer to a client using their title and surname unless they have another preference. Using other names can be disrespectful and undignified.

When drying the person after a shower, cover their body as much as possible. Leaving a person’s body exposed is undignified and can create feelings of embarrassment or shame.

Shut the bathroom door when the client is using the toilet or shower. If you need to be in attendance for safety, try to make the client feel as comfortable as possible and do not stand over them. If the person


is overly exposed they could feel vulnerable and treated as an object rather than a person.

When a client wishes to talk, ensure you sit at the same level and ensure privacy. Draw the curtains and speak softly. Maintain eye contact and use effective communication skills.

Encourage the client to use a knife and fork by assisting them. Perhaps you need to place the fork into their hand or cut the food up. Eating with fingers can bring feelings of shame and dependence.

Include the client in decision making and problem solving. This will empower the person.

Speak on an adult level with clients; they are not children.

Use a ‘dignity’ gown when transferring an undressed client to the shower.

Try to provide serviettes not bibs for clients.

Provide consistent high standard of care within the policies and procedures of the organisation and in a safe manner.

Never feed a client when they are placed on a commode.


Ways to ensure confidentiality, privacy and dignity

staff training and awareness in such matters

report breaches to your supervisor and ensure the complaint is followed through

lead by good example

recruit appropriately trained staff

follow organisational policies and procedures.

You will come across many issues on a daily basis where you will behave ethically without even thinking about it. If you are unsure of what to do in any situation you should always seek guidance from your supervisor.


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