Health & Social Care Apprenticeships & Diploma Promote Person Centred Approaches in Health & Social Care 305

2 Objectives 1) Understand the application of person centred approaches in health & social care. 2) Be able to work in a person centred way. 3) Be able to establish consent when providing care or support. 4) Be able to implement & promote active participation. 5) Be able to support the individual’s right to make choices. 6) Be able to promote individuals well-being. 7) Understand the role of risk assessment in enabling a person centred approach.

Person Centred... Write down any knowledge or understanding that you have concerning person-centred approaches in a health and social care setting. 3

3 Imagine Activity; Complete Activity sheet 1 On the sheet, make a list of the 10 things that matter to you most. Think about people, places, hobbies, things that make you ‘you’, likes, personal characteristics…

Key Values that underpin what we do in our job roles... Treating people as i_____________s. Supporting them to access their r______s. Supporting them to exercise c_______e. Ensuring people have p______y if they want it. Supporting people to be as i___________t as possible. Treating them with d______y and r_____t. Recognising that working with people is a p__________p rather than a relationship controlled by professionals. Making sure that individuals have access to e_____l o____________s. 4

4 Person-centred values ? IndividualityIndependencePartnershipRespectRightsChoicePrivacyDignityEqual opportunities

Person centred values activity On the sheet, write in the FIRST BOX, why that value is important and in the SECOND BOX, give an example from work how we might support this value. 5

Person Centred Values ? Value Person CentredNon person centred Individuality Referring to some one by their preferred name Using a label as the main way to describe or relate to an individual Rights Supporting / assisting a person who wishes to raise a complaint to do so Forcing an individual to do something against their wishes Choice Offering a person the opportunity to select from a range of options Providing information or presenting choices at a speed that is too fast for them to understand Privacy Supporting a person to spend uninterrupted time with family Intruding or Interfering with something an individual is doing Independence Letting go of control and assisting an individual to use their abilities and skills Not allowing an individual to use the abilities that they have Dignity Knocking on a door and waiting to be invited in Treating an individual in a patronising manner Respect Valuing an individuals heritage and background Carrying on a conversation or action in the presence of an individual as if they were not there Partnership Consulting and working with an individual In matters that are importance to them Excluding an individual or denying them choice

Watch these short clips... XvxaMhttp:// XvxaM zCsZTOUhttp:// zCsZTOU (up to 1m 20s) 9

10 The Social Care Institute for Excellence (known as SCIE) is an independent charity, funded by the Department of Health to identify and spread knowledge about good practice to the large and diverse social care workforce. SCIE says “there are eight main factors that promote dignity in care. Each of these Dignity Factors contributes to a person's sense of self respect, and they should all be present in care.” These are the eight factors and a brief description:

11 Choice and Control - Enabling people to make choices about the way they live and the care they receive. Communication - Speaking to people respectfully and listening to what they have to say; ensuring clear dialogue between workers and services. Eating and Nutritional Care - Providing a choice of nutritious, appetising meals, that meet the needs and choices of individuals, and support with eating where needed. Pain Management - Ensuring that people living with pain have the right help and medication to reduce suffering and improve their quality of life. Personal Hygiene - Enabling people to maintain their usual standards of personal hygiene. Practical Assistance - Enabling people to maintain their independence by providing ‘that little bit of help’. Social Inclusion - Supporting people to keep in contact with family and friends, and to participate in social activities. Privacy - Respecting people’s personal space, privacy in personal care and confidentiality of personal information.

Aspects of Work... Person-centred working affects everything you do. The key areas of practice are... i. Practical/physical support ii. Emotional support iii. Social support iv. Intellectual/cognitive support 8

Practical and Physical Support Give some different examples of the above. 9

How could we ensure that we do these in a person-centred way? 10

Not Person-Centred... “ We don’t have the staff to do it” “It doesn’t fit in with the rotas” “Other residents wouldn’t like it” “The rules say...” 11

How can we offer person- centred emotional support? 12

Taking an interest in what they say Offering empathy and understanding Listening effectively Respecting someone’s feelings – even if you don’t fully understand Providing support to overcome challenges/barriers Giving someone time to express how they feel 13

Make a list of the people you have contact with each week. Include any interaction you have, it doesn’t have to be close. Then try making a similar list with a person who is using your support. Try to see where the key differences are where you might be able to offer support. 14

Person Centred Planning ? The person is at the centre Family and friends are full partners Person-centred planning reflects the person’s capacities, what is important to them (now and for their future) and specifies the support they will require to live their life in the way they wish It is about providing care/support that is centred on the individual and their needs 15

Finding out what people want If you are going to work with someone, it is important that you know as much as possible about them. Try and find time to sit with someone and find out about their life. It is easy to think about people, especially older people, as you see them now and fail to see how their lives used to be. KATE’S POEM 16

What do you see? This film is based on a poem titled “What Do You See?” found by nurses going through the possessions of an old lady who had died in the Geriatric Ward of Ashludie Hospital near Dundee, Scotland. It follows a day in the life of an elderly stroke victim, who makes a silent but heartfelt plea for her caregivers to notice her. YWQ 17

19 Your self-image Think about the number of different ways you could describe yourself: List them all. See how many relate to: Other people (sister, friend...) What you do (care worker, volunteer...) What you believe (Christian, Muslim, loyal, honest...) What you look like (tall, short, blue eyes...) 6

23 Self Esteem In day to day working it is important to think about people’s self-esteem. Complete the ‘self-esteem’ sheet. 25

Identity, self image and self esteem activity 6 Identity is about those things that make people who they are. Values, beliefs, gender, race, religion, sexual orientation all contribute to people’s sense of identity. Self-Image is about how people see themselves, the person they think they are. Self-Esteem is how people value themselves, which is concerned with the worth people attach to that self- image.

21 How are these 3 linked? Identity is linked to well-being. If a person lives in a way that protects their identity and they understand who they are, they are likely to have a good sense of self. This would make them more confident, have good self- esteem and therefore a sense of well-being. Poor self-esteem resulting from depending on others and limited options to choose can result in a person not having a sense of well-being. Effective person-centred care can result in high self- esteem and an overall sense of well-being. 8

Supporting identity and self-esteem ? Recognising and valuing people as individuals. Keeping the person at the centre of their care at all times. Find out people’s beliefs and preferences. Avoid stereotyping people. 26

Factors that affect well being? 7 Well-being is far more than just not being ill - only when someone has their needs met are they likely to feel contented and happy with their lives. Physical needs... Intellectual needs... Emotional needs... Social needs... It means being valued, listened to and respected.

23 How might you ensure that the environment promotes a person’s well-being? ? 10

24 Taking care of personal possessions. Ensuring music or TV suits the needs of the individual. Making sure food and drink meets the needs/wishes of the individual in the way they are prepared/served. Recognise and respect personal boundaries. Providing an environment where people can make contributions (helping out if people want to). 11

The Concept Person centred planning is based on learning through shared action, about finding creative solutions rather than fitting people into boxes and about problem solving and working together, over time to create change in the person’s life, in the community and in organisations ( Sanderson 2000)

Approaches to PCP It is not a single technique but a ‘family’ of approaches that, collectively, seek to give people control over their own lives and ensure that they are respected and valued. (Todd 2002)

One Page Profile A One Page Profile is a short introduction to a person, which captures key information on a single page which gives for example family friends or staff an understanding of the person and how best to support them. It is not a person centred plan more a “beginners guide”. 32

Person-centred approaches; Finding out people’s history, preferences, wishes and needs when creating a care/support plan. Why is this important? 33

37 Person-centred approaches; Finding out people’s history, preferences, wishes and needs when creating a care/support plan. Why is this important? The person’s routines/preferences and way of life is identified/recorded. The person is an active participant rather than a passive recipient. Helps to build a relationship between the person and the care worker. Helps to promote continuity of care. 24

38 Why is it important to review care/support plans with people?

36 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 just a passive recipient.

41 What is Active Participation? yEiFNMhttps:// yEiFNM This short film shows how one elderly care provider in Australia encourages active participation for all its residents. 41

Active participation Service users should be; Involved Assist in planning Assist in reviewing service “nothing for us without us” 20

Positive ways of encouraging Active Participation You may need to steady someone’s hand while they write something, but it is far better than you writing it for them. You could accompany someone on many trips to the supermarket, and eventually wait in the car park while they go in alone. Recognise and celebrate people’s achievements, no matter how small. 41

Promoting Active Participation Think about someone with whom you work regularly, and identify a task(s) that is carried out for them. Why are they unable to do the task themselves? Could the situation be improved so that they are more actively involved? 42

Supporting People to make choices Always ask people about their needs, wishes and preferences – whether this is what they want and if this is the way they want to receive it. Offer alternatives wherever possible. Look for ways of actively supporting people in achieving the choice they want. 43

Watch the video about Emily’s Safety. Identify the instances where Emily was or wasn’t put at the centre of her care. player.asp?guid=039a7f83-c e- b38b ad2e2http:// player.asp?guid=039a7f83-c e- b38b ad2e2 44

45 Why is it important? The individual is fully ENGAGED with all stages of their care. ENSURES that their preferences are made known and acted upon. 28

46 Making sure everyone understands how to apply it! Give them information that... Explains how to use specific equipment that an individual relies upon. Explain how an individual prefers to communicate. Provide specific details about how an individual will actually participate. 29

Risk assessments and PCP How can risk assessments be used to support person centred planning? Why must they be kept up to date? 22

Risk assessments and PCP How can risk assessments be used to support person centred planning? Everyone is entitled to take risks. Taking risks is part of being able to choose and take control over your life. Concern about risk should not get in the way of people living their lives in the way they want to. 46

Risk assessments and PCP Why must they be kept up to date? People’s circumstances do not remain the same – things change. Changes mean that people’s risk assessments need to be revised regularly and updated. 47

48 Risk Assessments... Balances benefits against possible harm Identifies ways of minimising harm Might show others that some choices may be safer than first thought Demonstrates to an individual the possibility of harm in a way they can understand 31

Case Studies Read through the case studies and complete the questions. 52

Informed / Implied consent ? Informed: when an individual is aware of all the facts, have the relevant information and can make decisions in their own best interests and can give consent verbally or non verbally. Implied: which is not expressively granted by a person, but rather inferred from a person’s actions and the facts & circumstances of a particular situation.

Why consent is important ? It protects care providers against legal challenge. Recognises and understands the rights of the person and the importance of recognising that people should determine what happens to them. 51

Mental Capacity Act 2005 ? You have a duty of care for the people you support, but they also have the right to make their own choices and to reach decisions about actions they want to take. It is easy to make the assumption that because some has dementia for example, they lack the capacity to make decisions about important issues affecting their own life. 47

50 Factors that might affect a person’s ability to express their view - Not being used to ‘speaking out’. Not being able to understand. Not having the information to support their choice. Mental Capacity. Communication difficulties. 33

52 Gaining consent Consent should be obtained before carrying out any kind of activity. This may be verbal or written. Use an advocate. Obvious implicit consent. Use of professionals or carers who have a legal responsibility to make decisions on behalf of a person. 35

53 If consent cannot be given... ? Stop what you are doing. Repeat the information again for clarity but don’t put pressure on the person to agree. Follow any legal/procedural requirements. Report to line manager/clinical practitioner responsible. No care/treatment should be given without clear consent. 36

Summary... zCsZTOUhttp:// zCsZTOU (From 1m 20s) 59

57 How Can I adopt a more Person Centred Approach? When talking with clients? When carrying out personal care? When supporting clients to pursue leisure activities/interests? At meal-times? 63