Person-Centred Approaches in Adult Social Care Settings
Person-Centred Approaches in Adult Social Care Settings
1.1. Define person-centred values
-treating people as individuals
-supporting people to access their rights
-supporting people to exercise choice
-making sure people have privacy if they want it
-supporting people to be as independent as possible
-treating people with dignity and respect
-recognising that working with people is a partnership rather than a relationship controlled by professionals
Person-centred care has its focus on the person with an illness and not on the disease in the person. To achieve truly person-centred care we need to understand how the individual experiences his or her situation if we are to understand their behaviours and symptoms. This requires in-depth understanding of the individual’s life circumstances and preferences, combined with up-to-date evidence-based knowledge about individualised medical and social condition and treatment. 1.2. Explain why it is important to work in a way that embeds person-centred values Characterises a person-centred care:
• Has its focus on the person with an illness and not the disease in the person. • Has the person’s own experiences as its point of departure. • Strives to understand behaviours and symptoms from the perspective of the person. • Tailors care and treatment to each individual.
• Promotes both patient empowerment and shared decision making. • Involves the patient as an active, collaborative partner. • Strives to involve the person’s social network in his/her care. We believe that all individuals have the following person centred characteristics
Freedom of Movement
The right of residents to move to an area or place of their preference within legal limitations 2.1 Describe how to find out the history, preferences, wishes and needs of an individual Person-centred working means that the wishes of the person are the basis of planning and delivering support and care services. Therefore, you must find out exactly what people want and expect from the care and support they are planning. Person-centred working means that service provision fits around the person-not the other way around.
If you are going to work with someone, it is important that you know as much about them as possible.To find out about people history, preferences, wishes and needs the best way is always to ask them. They will tell you about their lives, needs and wishes. Some people have problems with communicating so you can always read their care plan, ask your colleagues or just talk to the family. 2.2. Describe how to take into account the history, preferences, wishes and needs of an individual when planning care and support. In my work role I:
• Provide Home Care to individuals, taking into account the history, preferences, wishes and needs of the individual and identified needs
• Provide Care including general counselling, personal hygiene and Meals tailored preferences, wishes and needs of the individual
• Take individuals to appointments and activities
• Assist with exercises, physiotherapy and other medical and care plans
• Monitor wellbeing and other physical conditions, as required
• Follow medical and care instructions carefully and consistently
• Organize time and resources based on the individual needs of clients
• Manage any unanticipated events or unstable situations
• Administer Care Plan in order to ensure that it is delivered in an appropriate, caring and respectful manner
• Ensure that care is provided according to all relevant policies, procedures and regulations
• Monitor supplies and resources
• Identify individual’s requiring more interventions and personal input
• Listen to the individual, take their views into consideration and make recommendations for changes and improvements to their care needs, as required
• Discuss any issues and concerns with individual and then pass on any relevant issues to the appropriate person
• Ensure that all care needs are identified
• Coordinate appropriate care and equipment including appropriate resource, as required
• Conduct and maintain a current, accurate, confidential client reporting system
• Provide information to other health care professionals, as required • Consult with family members and other supports to ensure that care is on-going and that all client needs are identified and met
• Encourage clients and families to be involved in care, if appropriate • Encourage clients and families to take responsibility for care, where and if appropriate • Liaise with all family, medical and other resources, as required • Advocate on behalf of clients for additional service and resources, as required • Establish and maintain current, accurate, confidential files for each client • Inform clients, families on what can be provided and when to access other resources • Perform other related duties as required
2.3. Explain how using an individual’s care plan contributes in a person centred way Care Plans are the primary source of Patient information. Every specialty, PT/OT/Nursing etc. do an evaluation of the individual and formulate a program of goals for the patient to attain, therapies needed, schedule of goal levels, etc. Each person interacting with the patient can refer to the care plan for any information needed. Done properly, the care plan reflects a total person and how to best help them fulfil the goals. A care plan may be known by other names e.g. support plan, individual plan. It is the document where day to day requirements and preferences for care and support are detailed.
Person centred thinking and planning is founded on the premise that genuine listening contains an implied promise to take action. PCP tools can be very powerful methods of focused listening, creative thinking and alliance building that have been shown both by experience and by research to make a significant impact in the lives of people who use human support services, when used imaginatively by people with a commitment to person-centeredness. Used well, with enthusiasm and commitment, these tools can be an excellent way of planning with people who might otherwise find it difficult to plan their lives, or who find that other people and services are planning their lives for them.
3.1. Define the term ‘consent’
Consent refers to the provision of approval or agreement, particularly and especially after thoughtful consideration. The question of consent is important in medical law. For example, a surgeon may be liable in trespass (battery) if they do not obtain consent for a procedure. There are exemptions, such as when the patient is unable to give consent. 3.2. Explain the importance of gaining consent when providing care and support the need for consent For one person to touch another without committing a criminal offence, he or she must have lawful justification. Consent is one such justification. This principle applies to medical treatment. Consent to a particular form of treatment allows that treatment to be given lawfully. Consent must usually be obtained before any treatment is given and can only be meaningful if a full explanation of the treatment has been given
Consent can be either expressed or implied. For example, participation in a contact sport usually implies consent to contact by other participants, when contact is permitted by the rules of the sport. Express consent exists when verbal or written contractual agreement occurs. If a person signs a document stating that he or she is aware of the hazards of an activity, and that individual is then injured during that activity, the express consent given in advance may excuse another person who caused an injury to that person.
How much information should I be given about the treatment? You should be given all the information you need to enable you to make a decision about giving consent to be treated. This includes what the treatment is, what it will achieve, any likely side effects, what will happen if the treatment is not given and what alternatives there are. Guidance issued to doctors says they should encourage you to ask questions and they should answer these fully. Can I be treated without giving consent to the treatment?
Whether you are at home or in hospital, if you are an adult (aged 18 or over) and have the mental capacity needed to give consent to a form of medical treatment, you are generally entitled to refuse it and no undue pressure should be placed on you. However, the law does allow treatment to be given to an adult without consent where the adult lacks the mental capacity needed to give consent and where certain sections of the Mental Health Act 1983 (MHA) apply – see Parts 2 and 3 of this guide for details. If you are experiencing mental distress and are offered treatment, you need to be aware of any legal powers that could be used if you refuse. However, the powers must not be used as threats to coerce you into consenting and if you feel this is happening, seek independent legal advice and consider making a complaint.
Discuss any concerns you have about treatment with your doctor, making sure he or she knows what it is about the treatment you object to. You can always ask for a second opinion to discuss the treatment proposed. Your own GP can arrange this, or your consultant psychiatrist if you have one. If you are under 18, the law is complex and it is best to seek specialist legal advice. It may be that you can consent on your own behalf, but this does not necessarily mean you have the same right to refuse. Others, such as your parents, guardian, the local authority or the court, may be able to consent on your behalf. 3.3. Describe how to establish consent for an activity or action Every adult must be presumed to have the mental capacity to consent or refuse treatment, unless they are
• unable to take in or retain information provided about their treatment or care
• unable to understand the information provided
• unable to weigh up the information as part of the decision-making process. The assessment as to whether an adult lacks the capacity to consent or not is primarily down to the clinician providing the treatment or care, but carers have a responsibility to participate in discussions about this assessment.
Carers have three over-riding professional responsibilities with regard to obtaining consent.
• To make the care of people their first concern and ensure they gain consent before they begin any treatment or care.
• Ensure that the process of establishing consent is rigorous, transparent and demonstrates a clear level of professional accountability.
• Accurately record all discussions and decisions relating to obtaining consent Valid consent must be given by a competent person (who may be a person lawfully appointed on behalf of the person) and must be given voluntarily. Another person cannot give consent for an adult who has the capacity to consent. Exceptions to this are detailed below.
An adult who becomes temporarily unable to consent due to, for example, being unconscious, may receive treatment necessary to preserve life. In such cases the law allows treatment to be provided without the person in the care of a nurse or midwife consent, as long as it is in the best interests of that person.
Medical intervention considered being in the persons best interest, but which can be delayed until they can consent, should be carried out when consent can be given. Exceptions to this are where the person has issued an advanced directive detailing refusal of treatment.
Obtaining consent is a process rather than a one-off event. When a person is told about proposed treatment and care, it is important that the information is given in a sensitive and understandable way. The person should be given enough time to consider the information and the opportunity to ask questions if they wish to. Carers should not assume that the person in their care has sufficient knowledge, even about basic treatment, for them to make a choice. Forms of consent A person in the care of a nurse or midwife may demonstrate their consent in a number of ways. If they agree to treatment and care, they may do so verbally, in writing or by implying (by cooperating) that they agree.
Equally they may withdraw or refuse consent in the same way. Verbal consent, or consent by implication, will be enough evidence in most cases. Written consent should be obtained if the treatment or care is risky, lengthy or complex. This written consent stands as a record that discussions have taken place and of the person’s choice. If a person refuses treatment, making a written record of this is just as important. A record of the discussions and decisions should be made.
When consent is refused
Legally, a competent adult can either give or refuse consent to treatment, even if that refusal may result in harm or death to him or herself. Carers must respect their refusal just as much as they would their consent. It is important that the person is fully informed and, when necessary, other members of the health care team are involved. A record of refusal to consent, as with consent itself, must be made.
The law and professional bodies recognise the power of advanced directives or living wills. These are documents made in advance of a particular condition arising and show the persons treatment choices, including the decision not to accept further treatment in certain circumstances. Although not necessarily legally binding, they can provide very useful information about the wishes of a person who is now unable to make a decision.
3.4.Explain what steps to take if consent cannot be readily established As a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions.
You must always act lawfully, whether those laws relate to your professional practice or personal life. 4.1. Define what is meant by active participation Active participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient. 4.2. Describe how active participation benefits an individual
1. Fulfil your desire to connect
When you actively participate in a community, you experience your connection to other human beings. You share your ideas, bond with others who have similar interest, and get a sense that you are supported and accepted. Connecting with others deepens your sense of connection. Actively participating is a way to practice expressing your true Self and recognising that Self in someone else.
2. Build truer, deeper relationships
When involved, are you there to “inform yourself,” or are you there to build relationships, or, foster relationships? As an active participant in an ongoing group, or even a one time event, you give people the opportunity to interact with you. They get to know you and realise that you’re not just there for the contacts. It helps you to build trust. And trust leads to deeper, meaningful understanding of needs and requirements, relationships and friendships.
3. Establish yourself as an expert
As an active participant, means that you are in the conversation. If the opportunity presents itself to share professional information, you are in the loop already. You’ll be involved and be part of or maker decisions that will aid your well-being and motivation to improve your life and your experiences. 4. Take ownership Participating in a group in the surest way to gain ownership. You become a stakeholder, your voice is heard. Better than that, you are in a position to do something to make the changes you want to see.
You own a piece of the pie.
5. Managing life changes
Active participants have involvement which is life changing and frees the individual up from some of the frustrations and angst that beset us all. It helps that others are involved and at the point of decision it is the individual who decides what is going to happen and how, within legal, moral and financial considerations 4.3. and 4.4. Describe ways of reducing barriers to active participation and describe ways of encouraging active participation Always treat people the way you would wish to be treated if you needed the same form of action or advice as you would in that circumstance.
Earn individuals trust and respect by acting in a professional way. Set High standards for yourself and follow the established method and Procedures. Your attitude and actions affect how people feel about themselves. Everything about the carer sends signals and affects the way the individual feel and react to them; the way carers stand and move, their appearance and their demeanour
Taking Steps to Break Down Barriers of Communication
• Point out Discrepancies
• Stay on Subject
• Be Specific / Example
• Key Words / Phrases
• Open Questions
• Treat As You Would
• Friendly Tone
• Body Language
• Convey Warmth
• Respect, Listen, Non Judgemental
• Honesty Trustworthiness Reliability Truthfulness Dependability
GUIDELINES FOR EFFECTIVE COMMUNICATIONS
Communication must take place with employees at their level of understanding, using an appropriate manner, level and pace according to Individual abilities.
• Convey Warmth
• Show Respect with Active Listening and Without Passing Judgement
• Convey Empathy by Reflecting the Employee’s Feelings
• Show Interest
• Take Time to Listen
• Be Aware of Body Language
• Use a Friendly Tone
• Treat the Employee as you Would Wish to be Treated
• Ask Open Questions
• Summarise at Relevant Points in Your Own Words
• Clarify as Required
• Use Key Words or Phrases
• Be Specific, Ask for Specific Examples
• Do not Allow the Conversation to Go Off the Subject
• Stick to the Facts
• Point Out Discrepancies
5.1. Identify ways of supporting an individual to make informed choices Carer ethics concerns itself with activities in the field of care. Carers ethics have the principles of beneficence (The state or quality of being kind, charitable, or beneficial.), non-malfeasance (Not to have misconduct or wrongdoing) and respect for autonomy (The condition or quality of being autonomous; independence). It can be distinguished by its emphasis on relationships, human dignity and collaborative care.
The concept of caring means that it tends to examine individual needs rather than ‘curing’ by exploring the relationship between the carer and the individual. The progression of care has also shifted more towards the carer’s obligation to respect the human rights of the individual and this is reflected in the code of practice devised by the general social care council.
Generally, the focus of care is more on developing a relationship than concerns about broader principles, such as beneficence and justice. Carer’s seek a collaborative relationship with the individual in care. Themes that emphasises respect for the autonomy and dignity of the individual by promoting choice and control over their environment are commonly seen. This is in contrast to paternalistic practice where the health professional chooses what is in the best interests of the person from a perspective of wishing to cure them.
Carers seek to defend the dignity of those in their care. It is because carers having a respect for people and their autonomous choices. People are then enabled to make decisions about their own treatment. Amongst other things this grounds the practice of informed choice that should be respected by the carer. The Principles of informed choice • Services should be person centred in that they are flexible and responsive to need. • Individuals continue to make a contribution to society and should be viewed as assets to society. • Individuals want to live independently in their own homes or in a homely environment in their chosen community.
• Individuals want services that help them to help themselves. • Individuals want local services to help them maintain their independence and safety in the community and promote good health. • Services need to provided in a timely fashion as soon as possible once the need has been identified. • Services will support informal care networks in terms of family, friends, and community. • Individuals should be protected from harm, abuse, neglect and isolation. • When they require treatment in an acute hospital setting they want: o the best quality treatment as close to home as possible
a smooth transition of care between community services and hospital and between hospital and community services.
to return home as soon as possible with appropriate support when required o access to rehabilitation services to maximise their level of independence • Individuals want access to good quality information to enable them to make informed decisions about services they may need.
• Individuals want to retain control of decisions concerning their life and lifestyle. • Admission to residential care will be made on the basis of positive and informed choice. These principles are consistent with the focus on Independence, Participation, Care, Self-fulfilment and Dignity.
5.3. Explain how agreed risk assessment processes are used to support the right to make choices Risk assessments are used in several different ways in order to deliver safe and effective services that have people at the centre. e.g.
As you can see from the table above , risk assessments are carried out for various reasons, but they are always used in order to protect either the person using the services or the support worker, or both. Risk assessments should never be used as a reason to prevent people from making choices; they are there to protect and to ensure that risks are reduced. A good risk assessment allows people to make choices that are based on facts and on having the right information. It helps people to understand the consequences so that they are making informed choices. Managing risks and safeguarding
‘Giving people more choice and control inevitably raises questions about risk, both for individuals exercising choice over their care and support, and for public sector organisations who may have concerns about financial, legal or reputational risk.’ (‘Personalisation and support planning’, DH, 2010, para 133) ‘Personalisation and support planning’ indicates two aspects of risk that need to be addressed in practice: 1. Safeguarding, where staff will need to:
• implement the organisation’s procedures for safeguarding, including joint working agreements with partner agencies; • work with other professionals and agencies to reduce risk and safeguard adults and carers; • respond using the organisation’s procedures to signs and symptoms of possible harm, abuse and neglect;
• take appropriate action when there are serious safeguarding concerns, seeking advice from line managers and accessing specialist expertise;
• work with services when there is any indication of child safeguarding concerns.
2. Risk assessment and management, where staff will need to: • implement the organisation’s procedures for risk assessment and management, including joint working agreements with partner agencies; • use agreed approaches to the assessment and management of risks when working in situations of uncertainty and unpredictability;
• seek support when risks to be managed are outside own expertise; • when necessary, work within the organisation’s procedures for managing media interest in risk and safeguarding situations.
5.4. Explain why a worker’s personal views should not influence an individual’s choices Personal Beliefs and Care Practice
1. In good care practice, carers are advised that:
2. • You must make the care of your individual client is your first concern you must treat your individual clients with respect, whatever their life choices and beliefs (paragraph 7).
• You must not unfairly discriminate against individual clients by allowing your personal views to affect adversely your professional relationship with them or the treatment you provide or arrange.
University/College: University of California
Type of paper: Thesis/Dissertation Chapter
Date: 4 October 2016
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