Block 5: Whole Block

Unit 17 - Unacceptable care
1. Good Quality care
  1. PPE
  2. Good eye contact
  3. Time to explain
  4. Good attitude staff and management
  5. Well trained
  6. Knows history
  7. Protects modesty
  8. Listens
  9. Protects rights to 5 principles of care.
2. Poor Quality Care
  1. Little or no training
    1. Marie O'Brien - Fakhra - eating , choking - lack of training.
  2. Discriminatory
  3. Rushed
  4. No PPE
  5. Dangerous
  6. No eye Contact
    1. Elsbeth Jones - Broken wrists P14, care agency - Fiona
  7. Abusive Care
    1. Treated as a non person
    2. depersonalisation - treated as an object
    3. Humiliation
    4. Locking in toilet
      1. Alan Harris - Victor. Cedar Court. Frustrated, confused
        Lauren - Whistleblower
    5. Ignore spacial rights - touch
    6. Types of abuse.
      1. Neglect
        Moving bed from wall
      2. Racism
      3. Emotional
      4. Physical
        Hitting, over use of restraint, causing pain.
      5. Psycological
      6. Sexual
    7. Often more about Bad care environments, inappropriate attitudes, beliefs and practices that develop over time.
  8. Institutional bad practice - always done that way!
3. Intimate care
  1. Washing - crossing gender lines.
  2. Hidden aspects of care
  3. Toileting - Crossing intimate boundaries
    1. Richard - Marie O'Brien, Toileting Lack of training.
  4. Requires careful supervision
4. Attitudes to behaviour
  1. Communication
    1. Talk and listen
  2. What does the person get from behaviour?
    1. What training/counselling could be given?
      1. Rosalie Williams - Hearing problems/Learning Dis - Aggression-Violence. Some staff wanted discussion, some wanted moved.
  3. Can they control behaviour?
    1. i.e ticks, fits, etc
  4. What does it achieve?
    1. Does it get them out of something they do not want to do?
  5. Lowe and Felce 1995, Moves to use respectful terms - i.e. challenging behaviour.
5. Preventing abuse and aggressive behaviour
  1. Maintain environment
  2. Maintain calmness
  3. Protect potential victims
  4. Prevent/manage triggers to behaviour
  5. Communicate
    1. In a way which is:
      1. Appropriate
      2. Encouraging open exchanges.
      3. Minimising constraints.
      4. Free from discrimination and oppression
      5. Acknowledging of rights.
  6. National Occupational Standards for Health and Social Care - Skills for Care 2005
6. Safe Care
  1. Proper training and supervision.
  2. Thorough recruitment and selection.
  3. Written policies and procedures
    1. Assist in promoting independence and give a "standard" care.
    2. Jocelyn Lawler Ch17 - not prep for intimate care/embarrassment/emotions.
  4. Procedures for reporting abuse/ unacceptable care.
  5. Effectively manage/train staff. Give development opportunities.
  6. Codes of care for Employers of social care workers.
Unit 18 - Handling personal info
1. Confidentiality
  1. Record keeping
    1. Accurate
      1. Amy, Brian and Zac - wrong info on form
    2. Up to date
    3. Comprehensive
    4. Reduces risks of mis-treatment or incorrect diagnosis.
    5. Provides history of illness/allergy.
    6. Assist diagnosis
    7. Reduces waste - repeated tests
    8. Skilled and integral part of care work
  2. Vital to trust.
    1. Dan Morgan - Mum saw GP re his drug use, notes on file - Mum may be at risk of harm if disclosed by doc.
    2. Patel Ch23 - HIV status of relatives - consent negotiated to talk about in group support.
  3. Electronic records.
    1. Breeches in security
    2. Easily shared
2. Records
  1. Those at risk easy to identify
  2. Can be shared between multiple people/care settings
  3. History not forgotten
  4. Reduce wasteful repeats of test/procedures.
  5. Helps protect against incorrect or misinformed diagnosis
3. Data Protection Act 1998
4. Mental Capacity Act 2005
Unit 19 Getting care right.
1. Formal accountability?
  1. Must be prepared to defend and justify what done/why did.
  2. Not just about keeping records but most easily recognisable form of it.
  3. Increases safety.
  4. Can be accountable to many people, i.e. service users/ HSE/public/managers
    1. Conflicts of accountability - what works for one body of people may not work for another.
  5. Responsible for what you do or say/choose not to do or say
  6. Review/ Meetings. PDR or service user meetings.
  7. Complaints procedures/ grievance procedure.
  8. Explicit statements of responsibility: Contract/Job role
  9. Procedures to measure performance - Care records/ surveys.
  10. Penalties/ Rewards. +Bonuses + Promotion - Prosecution - Fired -Sued.
  11. General Social Care Council 2002. Codes of practice.
    1. Apply GSCC guidelines: Marie O'Brien - Accountable as contract states she should ask for training in any area she feels she requires. Manager accountable as didn't arrange suitable induction as stated in their job role.
2. Informal accountability
  1. Conversation
  2. General talking
  3. Even the question "What have you been doing? classes as informal accountability if you feel the need to justify the answer.
3. Protocols and guidelines
  1. Standardise care
  2. Protect management
  3. Assist in training
  4. Please insurers
  5. Provide a formal set of instructions
  6. Define correct/best practice
  7. Allow unskilled staff to be used to support skilled workers.
  8. Service users not involved in planning
    1. Can focus on what is convenient for the organisation.
  9. Maybe considered to deskill the workforce.
  10. Do not allow for an individual approach.
  11. Help get "older" workers up to scratch.
4. Evidenced based care. Based on evidence available at that time. Problems.
  1. What is best in general may not suit everyone.
  2. Must be acceptable
  3. Undervalues the skills and experience of the worker.
  4. Missing evidence - if not tested for exactly that group etc.
  5. Rarely empowers the service user.
    1. Could hinder case as may not have clear evidence a treatment will work.
  6. If not evidence based care.
    1. Waste of resources.
      1. Glasziou et al 2003 - antibiotics in ear infections... can clear up spontaneously without.
    2. Unnecessary interventions. i.e enema in labour to reduce risk of infection... now proven no benefit.
    3. Harm. i.e. belief that bed rest after operations... now proven causes DVT if inactive for too long.
5. Knowledge based care
  1. Research knowledge.
  2. Organisational knowledge
  3. User knowledge/ first hand knowledge.
  4. Community knowledge.
  5. Good research balanced with evidence and a personal approach.
6. Internet
  1. Accountability - more info available on web - performance. i.e. Ofsted/ Hospital league tables.
  2. Can change relationships between care recip and care giver.
    1. Empowered + more likely to stand up for themselves.
  3. More likely to be younger patient searching web.
  4. Disadvantaged groups more likely to search web.
    1. Poss due to disjointed relationships with care professionals.
    2. Zeibland et al 2004
  5. Instant information.
  6. Research evidence online.
    1. The Cochrane Collection
    2. The Campbell Collaboration.

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Block 5: Whole Block

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