Showing Respect Code of Practice 1 and End of Life Knowledge Sets

Showing Respect – Code of Practice 1 and End of Life Knowledge Sets

Standing at Mary’s front door Julie presses the bell and waits to be let in. She is an expected visitor to the house and it’s not long before Mary’s husband Harry opens the door to welcome her. Julie talks with Harry as she follows him into the bedroom where Mary is waiting to greet her. Mary has had a hard night, waking several times with pain but she still manages a smile when Julie sits on her bed and asks how she’s been.

Julie has been a Home Care Worker for over five years now and is happy in her role knowing that she has many opportunities to make a positive difference in the lives of the people she works with. This is particularly true with Mary and Harry, an elderly couple struggling to cope with the shadow that terminal illness has cast across their lives.

Mary was diagnosed with cancer around a year ago and although at first she had a period of treatment in hospital she has now come home to spend the last few months of her life in familiar surroundings with her husband. To allow her to do this Mary has regular visits from her local GP and District Nurse as well as the support of specialist cancer nurses and a team of Homecare Workers.

Julie is part of the team of Home Care Workers and the visits she and her colleagues make here every morning and evening have become invaluable. Today Mary’s son is taking her and Harry out and after a brief chat Julie helps Mary out of bed and into a wheel chair so she can get her ready for the day.

When working Julie visits a number of different people in their homes each day and although she might have the same general approach with all, she always seeks to respect the needs and wishes of every individual she supports. She’s found that Mary often wants to talk about the impact of cancer on her life so when Julie is with her she tries to be ready to offer a sympathetic ear as she works.

Julie pushes Mary to the bathroom where she will help her through a number of tasks to prepare for the day ahead. Julie is always careful not to impose a routine on Mary that best suits her own schedule as a Home Worker. She knows it is important for Mary to be in control of her own care and as a result she respects her right to choose how she wants to get ready. For her own safety Julie needs to be in the bathroom with Mary for much of the time but there are certain aspects of her personal care that Mary can still safely cope with herself. At these times Julie knows it’s important to respect Mary’s privacy and stands near at hand just outside the door until Mary calls her back in.

A little later they’re back in the bedroom and Julie has helped Mary dress, done her hair and put on her coat. Mary has chosen a broach that Julie is pinning on as Harry returns. Seeing his wife dressed and ready for a ride in their son’s car he gives way to inevitable emotion. Julie slips out to the bathroom to check it’s clean and tidy and lets them have a moment together in private.

Being aware of the difference that her support has made to the couple makes Julie feel glad to have shared this part of her day with them and she looks forward to coming back to do it all again soon. Although Mary is nearing the end of her life Julie knows she still has the right to enjoy it when she can and as she prepares to leave for her next call she is happy to think she has helped give Mary the chance to do just that in the day ahead with her husband and son.

...... Questions: 1.What activities does Julie undertake during her time with Mary?

2. How would you list these activities in their order of importance to Julie?

3. How would you list these activities in their order of importance to Mary and

Harry?

Earning trust- Code of Practice 2 Children in a Domiciliary Care Setting

Sandra sits on the sofa in the lounge of Tracey’s home waiting for her to make the coffee and come to join her and as she waits she looks around at the room. The carpet has been vacuumed, the shelves have been cleaned and the children’s toys have been put away neatly into a box under the window. It may seem a common enough scene but to Sandra it represents weeks of patient support and hard work.

Just a few months before, this same home had been in turmoil. Tracey is now 22, the mother of three children under the age of six and a single parent. She had her daughter at 16 and then twin boys at 19. The father of her daughter didn’t really show much interest and was gone before she was born whilst the father of the boys left her a few months after their arrival. Added to this, Tracey’s mother herself a single parent with four other teenage children had moved away from the area and cut off contact with her. Feeling desperate and alone Tracey began to drink heavily.

Her drinking began to impact significantly upon her ability to care for her young family, putting her children at risk and when evidence of what was happening became clear to a Health Visitor from the local surgery action was taken to deal with it. The children were placed with foster carers while Tracey received intensive support from the Family Support Team so that it would be safe for her children to return home. Sandra was the member of the team who worked directly with her.

Tracey brings the coffee and sits with Sandra and they begin to chat about how Tracey has been coping over the last week. When Sandra started working with Tracey the home in which she now sits was a very different place. Her drinking had spiralled out of control and everything around her became affected as a result.

Having been let down by two partners and feeling abandoned by her mother Tracey found it very hard to have confidence in anyone who tried to help her so when Sandra came to work with her the first thing she had to do was to earn her trust.

From the very start Sandra sought to be open and honest with Tracey about her situation and what she needed to do if the children were to be allowed back. By making her aware of the Care Council for Wales Code of Practice that sets the standards for her role Sandra helped Tracey understand what she could expect from the support she would receive. Sandra was careful to ensure that, in her relationship with Tracey, she carried through everything she promised to do as well as assuring her that she would not talk with anyone about their time together except those who needed to know in order to help her.

Slowly, Sandra’s relationship with Tracey developed and her consistent support and help has been a crucial factor in helping Tracey face the issues behind her drinking and begin to deal with them. As a result the children have returned and with continued support Tracey is growing in confidence as a mother seeking to create a stable home for her young family.

Over their coffee Sandra explains to Tracey that because of the progress she’s made the level of support she receives will now change to become a little less intensive although she makes it clear that it can change back again if needed. Sandra enjoys her visits to Tracey’s home but she is glad to be reducing her time there for she knows that if less support is needed more success has been achieved.

......

Questions: 1.Why do you think Tracey grew to trust Sandra as she did?

2.What are the main threats to Tracey’s continued progress?

3.How can Sandra help her to deal with those threats?

Ensuring Safety- Code of practice 3 and Knowledge Set Dementia. Day Service setting for the elderly

It’s a warm summer day and David has taken George into the garden to pick some flowers to brighten up the lounge. George walks slowly but David is careful to walk at his pace and let him lead the way to the flower bed at the far side of the lawn. It takes a few minutes to get there but when they do George is confused. He is looking at the flowers they have come to pick but he doesn’t seem to know why they are standing together in the garden.

David is a Support Worker in Day Services working with elderly people struggling with dementia. George is one of them and has been coming to the centre for the last year to give his family a break and during that time David has played a very important part in his care and support.

Having worked with people with dementia for over five years David is very aware that they are amongst the most vulnerable of all those who use Day Services. He has learned that one of his main roles in the support he provides is to ensure that people like George feel safe during their visits to the centre. He has found that this is particularly important for those suffering with dementia as they can often struggle to speak up for themselves when needing help.

George is an excellent example of this. When he first came to the centre he was very disorientated and thought he was back in the barracks where he had done his basic training during the Second World War seventy years before. This meant that for the first few weeks he was constantly looking for the men he had trained with asking everyone around him if they had seen Bobby and Fred.

It was during this initial period that George faced issues with his safety that affected his well being and progress at the centre. A casual member of staff frustrated at George’s persistent questioning had been verbally aggressive towards him. He pretended to be an officer from George’s old barracks and gave him orders to sit in the corner of the room and keep quiet.

David is often busy working with people in the garden or greenhouse and as a result doesn’t get much time to spend with new arrivals but when, one day in George’s second week at the centre, he noticed him sitting agitated and alone in the corner of the lounge he knew something wasn’t quite right. So he sat with the old soldier and gently sought to understand why he seemed so upset.

George told him that Captain Roberts had told him to sit down and shut up until he was given further orders. Then as they continued to talk George suddenly sat to attention and saluted. When David asked what he was doing George pointed to a member of staff on the other side of the lounge who had just entered the room and simply said ‘Captain Roberts’.

David guessed what had happened and immediately took George to the Centre Manager to tell him what George couldn’t. George seemed to settle after that and although he often talked about his war time friends he never went looking for them again.

As they stand by the flowers George turns to David for help. David says nothing but smiles, holds up his basket and points to the flowers. They’ve done this same thing together many times and seeing the basket George’s confusion seems to clear and is replaced by a smile of his own as he points David to some red poppies they’d planted some months before. There is a tear in his eye. ‘For Bobby and Fred’ he says.

......

Questions: 1.What was the difference between the approach David took with George and that of the casual member?

2.Do you think that David handled the situation in the right way?

3. If you were faced with a similar situation involving a service user and a colleague what would

you do?

Promoting Independence- Code of Practice 4 Day Service setting / Mental Health

Matthew walks down towards the main doors of a busy shopping centre carrying a bag containing what he’s bought during his visit. He’s only been here for half an hour but as he navigates his way through the other shoppers he is feeling very pleased with what he’s done. For Matthew, half an hour in town on his own is quite a big achievement and as he reaches the main entrance of the shopping arcade he is greeted by Phillip, his Support Worker, who is as delighted as Matthew at what he’s done.

A few years ago Matthew had been walking alone through the town centre on his way home after a very similar shopping trip to the one he’s doing today but on that occasion he was confronted by a group of teenagers who took his bags and his wallet and left him on his back, bruised and bloodied in a side street. He recovered from the injuries to his face and body relatively quickly but the emotional scars inflicted that day have taken longer to heal.

Since the incident he has not been able to leave his house alone and even when someone is with him outside he often suffers flashbacks and panic attacks for seemingly no reason at all. He can’t work, finds it difficult to sleep and needs calming medication to get him through each day.

When it became apparent that the effect of the assault on Matthew was greater than his family had first thought he was taken to his GP who referred him to a hospital psychiatrist as an outpatient. After a number of sessions it was felt that he would benefit from the support of the Community Mental Health Team, a group made up of a range of mental health professionals such as Social Workers, Doctors and Psychiatric Nurses. It was then, through this team, that he was given the opportunity to attend a centre run by Day Services where he could get daily support to help him return to the independence he had enjoyed before the attack.

Matthew has been attending the centre for over six months with Phillip as his Key Support Worker and they have begun to make significant progress. Today’s visit to the shopping centre is the conclusion to several weeks planning that they have done together at the centre and its success is due in no small part to Phillip’s help and support.

Phillip’s work with Matthew has sought as far as possible to respect his right to be independent and to help him recover some of the independence he’d lost Phillip began to reintroduce him to the everyday risks that come with living an independent life. This has been a slow process but in recent weeks they have been focused on the shopping trip, listing the acceptable risks that anyone would have to face on such a trip as well as looking at aspects of his behaviour when under pressure that he would have to be careful to control.

Phillip made sure Matthew had his phone to use in case he faced problems but he had also asked another Support Worker who was known to Matthew to follow him at a distance to make sure he was safe at all times and only to assist if absolutely necessary. Matthew didn’t need assistance in person or by phone and as he returns to where Phillip waits, he feels that every step he’s taken in the last half an hour has been a step forward.

Phillip knows that Matthew still has quite a way to go but as he sees the sense of achievement that is so obvious on Matthew’s face he is glad to be doing the work he does.

......

Questions: 1. Do you think the way Phillip supported Matthew was effective? Why?

2. If you were asked to support Matthew how would you do it?

3. How would you use the Code of Practice in Matthew’s support?

Accepting accountability- Code of Practice 5, end of Life Knowledge Sets. Residential Services for the elderly

Anna helps Sam to move from his bed to the seat by the window in his room. She would be happy to take him outside in his wheelchair or down to the lounge to sit with some of the other residents but usually he prefers to sit and look out into the garden and watch the birds coming to a bird table on the lawn.

Sam is in his late eighties and for most of his life he’d been a relatively fit and healthy man, living at home with his wife. Six months ago however, he lost his wife through a sudden heart attack which was quickly followed a month later by a serious stroke that almost took his life too. Although he survived the stroke it left him weak and frail, unable to talk clearly or walk unaided. The home life he had known with his wife for over sixty years was abruptly brought to an end and after a brief time living with his daughter and her husband it became clear that he would need the more intensive support a residential home could provide.