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Understand person centred approaches Essay

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 individuals and just because two people might have the same medical condition, for example, dementia, it doesn’t mean that they require the same care or support because they are two different people which means their needs will be different. You need to develop a clear understanding about the individuals that you are working with and their needs, culture, means of communication, likes and dislikes, family and other professional’s involved with them. This means that you can then provide person centred care and support. There are eight person-centred values that support person-centred care and support, these are:

Individuality
Privacy
Choice
Dignity
Respect
Rights
Partnership

2. Explain why person-centred values must influence all aspects of social care work. We work in a way as to embed person centred values because we have to promote individuality, so that the service user can make informed choices and decisions to understand that the choices and decisions they make have consequences which may just as easily have risk as well as having a positive outcome to their own health and wellbeing. By empowering individuals to maintain their own independence, we work to the policies and procedures of not only our organization but the social care sector. Everyone has the right to privacy which allows self-respect and dignity, keeping to the cultural, diversity, equality and values of the individual. It is important that we apply person centred values in all aspect of the work that we do, because this is the basic of the work we do, building everything we do around the person we are caring for. This is not just consulting people, it is also about people taking control of the planning and delivery of their own support and care services.

We also must ensure person centred values influence all aspects of our work because this helps individuals to work out what they want in their lives and makes them feel stronger and more confident. It helps individuals to clarify what support they need to pursue their everyday life. Also brings staff together to support an individual in a joint problem solving and to energise and motivate based upon better understanding of a commitment to the person. To help direct and shape contributions made from service agencies and to ensure that they are based upon what is important to the individual. 3. Explain how person centred values should influence all aspects of social work. Practical and physical support which includes support for the day to day living such as bathing, dressing, persona; hygiene, preparing meals, shopping and general domestic tasks. For example. Providing a service at a time to suit the individual or residents and not you or the system, getting an individual up at a time they have chosen and not just going from room to room getting people up very early in the morning so that day staff have less residents to get up.

Also the way in which we deliver personal care needs to suit the individual, so if they would like a female carer and not a male, if they would like a bath instead of a shower, not just giving them the option of the shower because it’s quicker. The way we deliver the personal care needs of a resident will continue to change, as long as there is enough support available to comply with the risk assessments, then a resident should be able to have their chosen option, i.e. Bath or a shower. Emotional support which is working with residents with mental health issues, or because they are dealing with losing someone close to them.

When providing emotional support, person centred means; Taking an interest in what they have to say, offering empathy and understanding, supporting and encouraging people in the choices they make, listening effectively, giving someone time to express how they feel and respecting their feelings even if you do not understand them, encouraging people to look for positive outcomes, providing support to overcome challenges and barriers. Social support or to maintain contact with family and friends.

In general people are sociable, we will attempt to relate to other people and develop a relationship with them. Sometimes people will need support in relating to others- this can be for a range of reasons such as, illness if social circumstances may of meant that someone has lost contact with other people such as their family and friends, other may have issues in making relationship and some may have had difficult or painful experiences which have made them wary of becoming involved with others.

Outcome 2

Understand how to implement a person centred approach in an adult social care setting. 1. Explain how finding out the history, preferences, wishes, and needs of an individual contributes to their care plan. Finding out the history, preferences, wishes and needs of an individual will contribute to their care plan, you would do this by asking and talking to the person concerned, or if they were unable to tell you this information, you could speak with their family. Ask the individual about their life, and what they used to work as etc, if they are able to tell you all of this, then you will learn a great deal about them and this will help you to offer support to them in the most appropriate ways. Residents can often find it hard to think about what they want especially if they are elderly, as you see them now will be very different to how they were in the past normally. By offering or reminding them such as “remember what you said, you wanted to go to church on Sunday” residents who are religious may often want to go to church on Sunday but can forget if not reminded.

Knowing your residents will help, you can include in their care plan any goals that they want to achieve, what they can do for themselves and the areas that they need support in, any allergies they have, or what activities they would like to take part in or still do. 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/traumatic, threatening or frightening, likely to have serious implications or consequences, of a personal nature, involving complex communications or cognitive needs, for example, death of a close friend or relative, or receiving bad news. Putting person centred values into practice in these situations would be to ensure that the person will retain control and be able to make choices about what they want to do, not to pressure them into discussing more than they want to, give them time to do this. You could also offer them a choice of talking to another member of staff maybe if they would feel more comfortable, or with a relative or a friend if they appear to be unwilling to discuss their worries.

The situation can be complex because of family pressures, views of the person you are supporting and those of their family may not be the same. The priority is the person that you are supporting, you must make sure that you are working with their choices and preferences, but sometimes it is not always easy to deal with family support workers who believe that they are acting in the best interest of the person concerned. 3. Evaluate the use of care plans in applying person centred values. A Care Plan may be called another name such as support plan, individual plan. The Care Plan is the document where the day to day requirements of individual is detailed, also their previous life history is written here, any likes and dislikes that they have, what they would like to get out of this care service.

Normally a care plan has risks and outcomes at the bottom of each section, the outcome is the section that a care worker should take on board because this is the part of the care plan which is allowing the service user to remain independent and still carry out the activities that they want to. Care Plans are person centred because they are detailed around the individual, what they want, what they like to eat, what time they like to get up, what time they like to go to bed, any hobbies they have, any allergies, what medication that they are on, care workers should always follow the care plan to provide the best person centred care for that individual, because everything that they want is detailed in their care plan. 4. Explain the importance of monitoring an individual’s changing needs or preferences.

Changing needs and preferences can relate to:

Health needs or preferences e.g. health, abilities, mobility, diet, personal hygiene. Social needs or preferences e.g. activities, relationships. Environmental needs or preferences e.g. aids and adaptations, accommodation.

Changes in family or relationships.

Just like our own needs and desires change, so will those of the people we support. It is important to recognise needs as they change, how support is provided will also need to be reviewed regularly to see if any adjustments are required, to ensure that we are providing the correct care for the person we are supporting. You have a responsibility to service users, to hear what they say, to record any information about changes and report it to your manager if it is likely to have an impact on the level or type of care and support that is provided.

It is also important to monitor an individual’s changing because as people get older they will deteriorate, so if an individual has got an infection or a bug, this can bring out changes in them whilst they are ill, for example, an individual who can normally get themselves out of bed and dressed, and walk around with a frame independently, if they get the flu or a bug/infection, they may need help getting out of bed, and they may not be able to walk because the infection would of made them weaker because their immune system is down, in this case you would have to monitor this because they may need hoisting, they may become two carers whilst they are off their feet to help them get in and out of bed, it’s important to observe for situations like this because if left un-helped then this service user could have a fall because they cannot walk on their own, or could lay in bed all day because they didn’t receive help.

Outcome 3
Understand the importance of establishing consent when providing care or support.

1. Describe factors that influence the capacity of an individual to express consent. Factors that influence the capacity of an individual to express consent are, consent- this is demonstrated when the individual either verbally or non-verbally indicates that they are willing to do or allow a third party to do for them. To give valid consent, people need to be able to access, understand and process information relating to the decision that they are making. The mental capacity of an individual is at the centre of the issues relating to consent. Illnesses such as dementia, learning disabilities or long term mental health problems. It is easy to assume that an individual that is suffering from illnesses lack the capacity to make a decision about important issues affecting their own life, but with the right support from care workers, family and friends, specialists and GP’s they can make the decision for themselves.

Age discrimination- health care professionals, solicitors or carers may wrongly assume that older people do not have mental capacity on the basis of their age. Also, people who need to act on the decisions (doctors, GP’s) may wrongly assume that older people do not wish to discuss issues particularly relating to end of life. Communication and information- older people with dementia, for example, may have fluctuating capacity and may be able to understand concepts when explained at the appropriate time and in the appropriate situation. It is important to consider how different approaches to communication can support decision making and maximise people’s ability to make a decision. Finance, property and estate- Adults can indicate that they would like for someone to act on their behalf regarding their finances and estate. This is called a power of attorney. The new LPA in relation to finance will act in a similar way to the current system of enduring power of attorney. LPA will have to be registered with the office of the Public Guardian before it can be used.

2. Explain how to establish consent for an activity or action. Consent should be obtained before carrying out any kind of activity, for example are you ready to stand/sit? Do you want to go to the shower/bath? By asking questions this is how you can gain consent, for example, I knocked on Mrs Smith’s door before entering and told her who it was, I waited for Mrs Smith to say “come in”, once into the room I asked Mrs Smith if she would like me to open her curtains, I wait for her response before carrying on with the activity. I asked Mrs Smith if she was ready to get up, I again wait for her response after each question before carrying on, if Mrs Smith replies with no, then I would not carry on with the activity as I would not have consent to do so, and I would let Mrs Smith know I would come back later on when she is ready, and ask her what time she would like me to come back at. Informed consent means that the individual has full information about what is to happen, the possible effects both positive and negative.

Implied consent, for example: “you would like to take an individual’s blood pressure, if they present their arm when you arrive, then that is a positive (yes) reply. Written consent which is used in clinical settings where there will be a form for written consent, for example, use of bed rails or cot sides, unless the individual or family have signed the form which allows you to use the bed rails, then you cannot use them. Verbal consent, for example, Mrs Smith asked for painkillers because she is in pain, before giving the painkillers you informed Mrs Smith that the medication will make her sleepy and drowsy, Mrs Smith replied with “yes that’s fine I would still like them”.

3. Explain what steps to take if consent cannot be readily established. Is consent cannot be established then you must not proceed with any care or clinical activity without consent. If someone refuses their agreement or changes their mind after having said yes, you must stop what you are doing as they have the right to change their mind. It is useful to repeat the information again and ensure that any queries and concerns have been answered, you must report any refusal immediately to your manager.

If it starts to become a regular situation where the individual is refusing to change clothes or wash, or take their medication, then sometimes speaking to the family can help, or speaking to their GP to try and work out ways around it, and to help the individual feel more comfortable. We have to find out why they don’t want to give their consent, so why do they not want their medication, have they not been informed of the side effects, is it making them feel ill and maybe the GP needs to be informed so they can review their medication, do they have the capacity to give consent and know what they are consenting to?

Outcome 4
Understand how to implement and promote active participation

1. Explain the principles of active participation.

Active participation- when a person participates in activities and relationships of everyday life as independently as possible, they are an active partner in their own care or support, rather than a passive recipient. The rights of the individual- Individuals with significant needs are marginalised. They are not given the same opportunity to have a say on how they live their lives as most other people in the community, their choices in what they do are severely limited. By active participation they will be given the opportunity to have a say in matters of direct concern to their lives. Individual’s opportunity for learning, development of important skills, knowledge education and employment will increase.

The independence/autonomy of an individual- by active participation, the individual will have increased opportunities for social contact and interpersonal relationships. Encourage the individual with involvement and self-awareness, become more involved in the community and more aware of opportunities about what they can do for themselves. This enhances well-being, increases self-confidence, self-esteem and self-belief, which makes them less prone to exploitation and harm from others. As individuals engage positively by actively participating in an area of their life such as personal care, the scope of abuse by others is reduced.

2. Explain how the holistic needs of an individual can be addressed by an active participation. Holistic needs covers all aspects of an individual’s well-being. 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 individual gets the opportunity to choose the way in which they wish to live their lifestyle and gets to choose the activities that they prefer, the care plan becomes more effective and easier for staff to follow. In this way there is better understanding of the individual in care and on the whole the care becomes more effective.

3. Explain how to work with an individual and others to agree how active participation will be implemented. Active participation will be implemented by supporting an individual’s independence by encouraging and recognising their achievements is one of the best part of providing professional care and support. Spending time to guide and encourage an individual in order to achieve something. By always recognising and celebrating an individual’s achievements, this will encourage them more for the future and give them self-worth. This is active participation. 4. Explain how to promote the understanding and use of active participation. To promote the understanding of active participation, this is done by working closely with work colleagues.

You have to be sensitive with the needs, choices and preferences of every individual. Ask individuals what they want and what they would not be comfortable with, work closely with their families to help them get used to new approaches and see the benefits of active participation to their loved one. For example, Mrs Smith had advanced dementia when she was admitted in to my organisation, sometimes she can manage to feed herself at meal times, and other times she can’t. Care workers had been advised to assess Mrs Smith’s cognitive behaviour from time to time, if she is able to help herself during meal times, Mrs Smith’s independence at meal times had been recognised and that’s part of her active participation in her daily living. Mrs Smith’s family had also been informed to do the same.

Outcome 5
Understand how to support an individual’s right to make choices

1. Describe different approaches to support an individual to make informed choices. Different approaches to support an individual to make informed choices would be discussing it with them, making sure that you provide them with all of the relevant information that they may need to make the decision. Encourage them to get guidance from their family and friends if they need help to make this decision, offering them the support of an advocate or a support service if they feel that this would help them to make their choice. One of the key roles is to provide as much information to the service users and their family about the choices that they need to make. If you expect an individual to attend activities, unless the individual knows the full information of the activity involved, in order for the individual to decide and make the choice on whether they want to attend and whether they think the activity is suitable to them, they would need all of the information for them to be able to make that choice.

For example, Mrs Smith is totally blind and the activity for that day is watching a film, this activity will not suit Mrs Smith as she will not be able to watch the film because of her disability. Mrs Smith would like to attend the music activities or the reminiscing, so you can give Mrs Smith all of the information that she will need, and when these activities are taking place so that she can attend the activities more suited to her. Informed choices require full information, the same principles apply to any choices that people have to make about accommodation, money, medical treatment, support plans, relationships, leisure activities, education and training.

2. Describe how to support an individual to question or challenge decisions concerning them that are made by others. To support an individual to question or challenge decisions concerning them that are made by others, firstly you would have to obtain their permission and then you must get them to express what they would like to challenge and why, what decision has been made on their behalf that they do not like. Then you can offer them the full support and information that they will need, you can offer suggestions, and then make a plan to challenge these decisions. You could offer to be their spokesperson if they were not confident enough to speak out, or you can offer to accompany them to any hearing or appointment. If the person if mentally impaired then you would have to get their signed permission to speak and act on their behalf before any health or social workers would listen to you.

This is because of confidentiality, you either have to be the individual’s next of kin, or obtain power of attorney or guardianship. If the individual wanted to complain, then support them and follow your complaints procedure. You could also arrange for them to speak to the care planner if they felt they had no say in arrangements that had been made for them. 3. Explain the consequences of allowing the personal views of others to influence an individual’s choices. Possible consequences of allowing the personal views of others to influence an individual’s choices would be, the individuals needs not being met, lack of choice, low self-esteem, lack of motivation, stress and abuse.

Individual’s needs not being met such as physical and mental health needs, for example, an individuals hydration and nutrition needs, they don’t need lectures or discussion about their balanced diet. As a care worker our role is to promote good health by encouraging the individual to eat healthy foods and have a good fluid intake, and good activity and exercise is important for good health. Low self-esteem would be an individual being ignored and not being valued, being recognised and valued as an individual is very important for people’s self-esteem. If an individual feels that they are being respected and valued, then they will be more likely to value themselves.

Outcome 6

1. Explain the links between identity, self-image and self-esteem. A person’s identity males them different from everyone else, they may have a specific trait or specific interests, if these are repressed then a person may feel withdrawn or unable to express themselves. Similarly for self-image, if a person if not supported or is somehow not allowed to dress, style their hair the way the want to, or wear the clothes they want to, or if they are not supported properly to look presentable in a way that they feel good, or if they are left looking dirty or untidy, this will affect how they feel and how others react to them, therefore impacting on their self-esteem. All these contribute to the overall wellbeing in how they can express themselves, feel about themselves, and are perceived by others and this will affect if they are content and happy with themselves on a day to day basis. Also if a person is treated with dignity this will give them self-esteem and if they are given their own choices to choose how they want to portray themselves to others, this will also let them create their own image and identity and will help with their self-esteem, because if it’s not their own choice and they are unhappy with it then they will have low confidence and self-esteem.

The links between identity, self-image and self-esteem include spiritual and emotional wellbeing. Spiritual and emotional wellbeing is an integral part of mental, emotional and physical health. It can be associated with a specific region but does not have to be. It is about the individual’s journey to discover things that are important in their lives, enabling them to find purpose and meaning in life. The effects and impact of spiritual wellbeing is determined by each individual and can make a huge impact in their lives. Through spiritual wellbeing, individuals can become empowered and realise that even though they have issues, stresses, challenges, they are not defined by their circumstances. Emotion well-being is based on how the individual feels about themselves.

2. Explain the factors that contribute to the well-being of an individual. Physical and mental health- promoting good health is an important part of our support role, encouraging healthy eating and appropriate exercise, activity is valuable in supporting individual’s wellbeing. Mental health can have a major impact on people’s lives and their wellbeing, if someone is suffering from depression, the whole world will seem dark and they will feel hopeless/helpless. Mental health problems can be a result of external factors such as demands and stresses of life but some serious types of psychotic illness are also the result of chemical imbalance that require ongoing medication and treatment. Physical needs are things like food and drink, warmth, shelter, sleep, exercise. The needs will vary from the age of the person and their stage of life. Intellectual needs are about mental stimulation and having varied interests, everyone needs to keep the brain active- individual’s need to have something which holds their interests and makes them think.

Emotional needs are they key to emotional fulfilment, and are about being clear about who you are and liking who you are. All various stages of our lives, individuals needs will be different, individuals need to be loved, feel secure and nurtured. Social needs are about relationships with other people, individuals have always sought to meet their social needs by living in group alongside others. All cultures have a history of people grouping together in villages and towns, or simply in tribes of families. 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 others.

Being able to identify one self and having a positive self-image leads to a good esteem about oneself therefore leading to a healthy wellbeing. When one works as a care worker, it is their responsibility to accept that everyone is different and respect the identity of the individual and to treat them how they want to be treated, when the individual is happy with the way they see themselves, it is our duty as a care worker 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 they are are equally good and provide them with assistance in improving their self-image.

Self-esteem is a very important factor in a person’s wellbeing as it is how the person feels about themselves, therefore it is our duty as a care worker 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 wellbeing of the individual will automatically improve, thus fulfilling the most important duty of care which is ‘supporting the individual in their wellbeing’.

4. Describe ways to contribute to an environment that promotes wellbeing. There are to different kinds of environment, a physical environment which includes bedrooms, furniture, and the house on the whole, personal belonging. A social environment which includes personal boundaries, subjective feelings, relationships, etc. The different ways in which we can contribute to building an environment that promotes wellbeing are to ensure that the physical environment is clean and hygienic to live in.

Ensure the furniture is in good condition and not broken and ensure that the furniture is safe to be used. Making sure personal belongings are well cared for and are treated with respect, for example if providing care in a client’s home and they have a big white rug in the living room which they don’t like anyone to tread on, you would not go in and walk over it with dirty shoes because that wouldn’t be respecting their belongings and would upset the client.

In a social environment you have to protect them from harm or abuse, so not letting strangers in to them that they don’t know, help them to maintain existing relationships with friends and family, so encourage them to phone their family and visit their friends, encourage them to build new relationships. For example, if an individual has just moved in to a residential home, you may have to encourage them to interact with the other service users in order for them to build new relationships and not feel isolated. Encourage them towards active participation and always respect their choice and wishes.

Outcome 7

Understand the role of risk assessment in enabling a person centred approach. 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’. A risk assessment is a careful examination of what in your work, or activities that could cause harm to people, this is done 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: Accident prevention of injury to individuals, prevention of injury to workers and others, description of procedure or steps to meet legal requirements. Risk assessments could be used for an individual’s mobility, personal hygiene, challenge behaviours, outings, personal habits for example having an alcoholic drink because it may interfere with medication, smoking, eating certain foods.

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 the risks are assessed and precautions are taken. Prevention from danger or 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, this giving the care worker information and instructions on what and how it should be avoided.

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 right to make their own choices and take risks, for example, a service user has the right to smoke even through it is a risk to their health. Therefore care workers 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 they are capable of going out on their own and insists on going out alone, the care worker has no right to stop them but what should be done is that you go through the risks 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 be incontinent at night, it is not right to force them to wear incontinence pads as this could make them feel low and lower their self-esteem. In this situation a risk assessment should be done and other alternative methods should be adopted, such as asking them if they would like a mattress protector on their bed, or a Kylie instead of wearing a pad.

4. Explain why risk assessments need to be regularly revised. Risk assessments need to be regularly revised to ensure that they are up to date, to ensure that they prevent risk of injury or harm, they also need to be revised to check that you have taken account of changing needs and preferences of the individual, also to take into account any change in equipment that is needed, for example, an individual who used to walk using a walking frame is not very well at the moment and cannot stand, a review of their needs would need to be done so that this can be changed and for the moment they cannot walk with their frame, so they could be assessed for the hoist.

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 individuals to manage choice 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 that they 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.


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