advice needed on dignity and choice

This is the most challenging area when it comes to dignity practice as well as mca dols, I personally found it helpful to liaise with the clients family and social worker to have a care plan put into place for the need of personal hygiene assistance and challenging behaviour techniques to use when the client is non-compliant. The line between necessity and client recognition of their needs is becoming so blurred that it is becoming harder to care in a dignified way, but at the end of the day to leave a client in soiled clothing for hours on end has to be remedied with their BEST INTERESTS in mind.

Hi Tom

Thanks for your response. That would be my initial route but unfortunately the person does not have any family and the social worker has just said its down to my descretion but is happy to read through the care plan once iv developed one. Not very helpful at all. We have discussed it as a team and although we are all trained in physical intervention, it seems unclear on what a 'reasonable' timeframe is before we take the persons 'best interests' into account. Personally i think any longer than 2hrs is too long to be left sitting around like they have been, i certainly wouldnt want it but there doesnt seem to be any clear guidance

The perception and level of intervention is so clouded within the frame work of care that no matter what you decide to do,it will be wrong in some way, its the industry we're in. but as long as you document your' actions and reasoning why you did what you did , and also whom you've spoken to regarding the client and you are comfortable with how you proceeded then , try having a look at the scie fact-sheets on dealing with challenging behaviour and find a technique that best suits the client you're dealing with. The fact that you are asking for advice is a sure sign that you are dedicated to your role and in My opinion (for what its worth) that puts you in the Dignified carer bracket we all aspire to be.

Thanks for your kind words and advice Tom, they mean alot. It is so difficult sometimes knowing if you are doing the right things but then that is only because we do sincerely care for the well being of the people we support. Im sure everything will be fine and once i have other professionals agreement on my plan, then i know i will be covered. Once again thank you :)

How fortunate for the customer that they are going to be in your care!

if you havent had a lot of joy from the social worker (which IMO is a real shame!) then you might consider asking for some advice and support from your local contacts for the Adult Safeguarding Board - they should be able to advise on what elements to consider in the risk assessments - they arent just there to investigate bad practice, they like to promote good practice too!

from a customer perspective, it is worth looking at what part of the process (manual handling or personal care giving) that brings about the resistance? then you can go about building up a trusting and compassionate relationship with your customer.

I can also remember from a few years back that when I was undertaking training to teach manual handling that there was a specialist course available to teach carers how to complete manual handling tasks with people with cognitive deficits - may be worth doing a bit of research with larger LD organisations to see what they do/ (will try really hard to think of the name of the course........!)

Nickyx

having just read the top post again......................

if the customer has no control over their bodily functions and are not aware that they have become soiled then it becomes a duty of care to put in place a regular regime to ensure health and wellbeing. The risk of skin breakdown and discomfort starts from the moment of incontinence and therefore your risk assessment needs to reflect the customers ability to indicate their needs. Im sure that once you get to know the customer better you will find that you are able to detect small signs and be aware of personal routines which means that you can fine tune your approach to care.

if the reluctance is the personal care intervention, then this is a difficult but common issue. Although I do not condone the practices of leaving someone when they have been incontinent - you can see why the previous care providers may have ended up having minimal intervention. maybe the customer gets distressed at every intervention and therefore they have tried to reduce distress - not a very clever way of addressing the situ, but I can see why it has happened.

I think the only way to feel comfortable and confident in giving personal care in these circumstances is to take the step back and look for meaning.................get to know their personal routines well; involve other health professionals wherever possible (get other perspectives) develop a care plan with the customer and staff that really details from a person centred perspective what their needs are (not what the tasks are!) and if you feel brave enough (!) discuss the care plan and risk assessments with your CQC inspector.

Good luck!

Nickyx

Hi
You have not detailed what the disabilities are but I will try to help. Firstly in order to provide excellent care you need to fully understand the condition of the patient. Contact organisations who deal with the disabilities or do some research on the web. There you will find information which will help you understand how to communicate with the patient. Some suggestions will be verbal or visual prompts, written commands, gestures or a combination of various methods. If one does not work keep trying. Above all keep calm, patient and be pleasant and friendly. Talk in calm soothing tones and be aware of body language as people with disabilities are very perceptive to how they are approached, e.g.if the carer is stressed. It may be the patient dislikes personal care due to bad experiences in the past, being shouted at, held too roughly etc. You say that the patient can stand with support and move, therefore I feel a hoist would be inappropriate, as these can be frightening to a patient with mental disabilities as they do not understand what is going on. In order to administer personal toiletting you may need two people, one to stand at the side of the patient talking, explaining ,reassuring in a friendly manner while the other offers practical support removing clothing and cleaning etc. Of course this will all depend on the abilities of the patient you may even need three people if the patient is heavy. Only you can make that judgement based on the size, weight etc. Make the job as stress free as possible. Prepare in advance to advoid any unnecessary delays which will provide utmost dignity to the patient.If the patient is in a wheelchair take them as near as possible to the toilet/commode. Make sure you have clean garments, wash facilities, clean towels, pads cream etc all nearby. Be as efficient as possible. If you treat people as you would wish to be treated (if the roles were reversed ) you can't go far wrong. It is in the patients best interest to be kept clean and not to sit in soiled clothes which will eventually cause breakdown of the skin and infection. Apart from being unpleasant it will be extremely sore and difficult to prevent reinfection. Once you establish a good rapport with the patient you will create a bond of trust which will enable you provide the care you wish and you will also establish a routine of his personal habits so you can prevent them from soiling themselves. Hope this was helpful, good luck in your caring role.

The issue surrounding "choice" is often a red herring. Tthe recent Capacity Act in England ( get in toch with your local CLDT's) should give you clearer guidance. In Scotland, the Adults With Incapacity Act ( Scotland) 2000, although by no means perfect, goes some way in considering choices, capacity issues and treatments. Anyone now working with people who have an LD, or have dementia or even with limited time capacity e.g stroke etc, should have knowledge of these acts. To not have, is neglectful. So ask your trainers, managers etc to make sure the principles are put into action, icluding treatment plans, risk assessments and the consideration of both legal and welfare gaurdianships, and their equivelants in the country you work in.dstewart2