Surrey Skills Academy with support from Health Education Kent Surrey Sussex
The Care Certificate Framework
For
Adult Social Care Workers
Healthcare Support Workers
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The Care Certificate Framework
Privacy and Dignity
Standard 7 Main areas:
Ø I will understand the principals that underpin privacy and dignity in care
Ø I will maintain the privacy and dignity of the individual(s) in my care
Ø I will support an individual’s right to make choices
Ø I will support individuals in making choices about their care
Ø I will understand how to support active participation
Ø I will support the individual in active participation in their own care
Links
Code of Conduct: Standard 2
Compassion in Practice (6 C’s)
Care, Compassion, Competence, Communication, Courage and Commitment
Standard 7
This standard explores respect, privacy and dignity of individuals you support and care for, enabling them to make choices and supporting them to actively participate in their own care / support.
Privacy and dignity are two important values to consider when undertaking any care / support with your clients.
· Privacy for each individual, this has different levels of importance, some like their own company, and some like to socialise, however individuals have the right to be given the level of privacy, they wish for them to live their lives, without undue interference from others.
Within residential establishments individuals share their home with others, and this may be something they are not used to. Many people arrive and depart on a daily basis and individuals may resent the intrusion. It is important that privacy is respected and opportunities for privacy are observed and created, for example: knocking on doors, areas to meet visitors, make and take telephone calls, asking individuals permission to turn on and off televisions, radios or open windows, respecting clients use of their own rooms and being able to entertain visitors in their own room without interruption from workers. Privacy must also be taken into account when you are supporting them with their personal care needs, for example.
For individuals being supported or cared for in their own home, acknowledge the privacy of the person’s own home by announcing your arrival even if you have access to a key.
It is also important to remember, that you should not discuss individuals with anyone, except if it is a specific meeting such as a review meeting / case conference, and where it is the appropriate place for it to be discussed. Information is shared on needs to know basis only.
· Dignity and Respect. In a society where people are living longer, many senior citizens dignity comes from being shown respect, for example: some can remember things from years ago, and some can only remember what they did a few minutes ago, but it does not make them less of a individual, respect is showing someone you value them and that they are important, that you respect their feelings, beliefs and rights, that you see the whole person, their past, their experiences and not just the condition they suffer from.
Social Care Institute for Excellence (SCIE) defines dignity as “a state, quality or manner worthy of esteem or respect. Dignity in care, therefore, means the kind of care, in any setting, which supports and promotes, and does not undermine a person's self respect regardless of any difference. Whilst dignity might be difficult to define, what is clear is that people know when they have not been treated with dignity. Dignity and Respect are key principles of the Human Rights Act.”
Be aware of the importance of preserving a person’s dignity, ask people how they wish to be addressed; try not to rush and take time to listen; use towels or clothing to cover when performing intimate care tasks and not leaving them in a state of undress, closing the bathroom door when they are in the toilet or bathroom for example.
You can show respect by addressing people in their preferred manner, or waiting until they give you permission to call them by their first name, by not using labelling to describe them to other people, or ascribing a term to them like ‘love or dear’
As a care worker, you have a responsibility to ensure your working practices, show people they are valued, that you treat others as you would wish to be treated, that you value individuals’ contributions, planning and reviewing to all areas of their daily life, and that you do not patronise people. When individuals’ rights are taken away they become ‘disempowered’ resulting in low self esteem.
To therefore promote dignity and privacy, you will need to consider the following: -
· Encourage individuals to express their needs and wishes, and to be as self-managing as possible
· If individuals are supported by an advocate, include them in reviews and care planning, where this is in agreement with the clients
· Listen to the wishes and feelings of individuals and act on them
· Enable them to make choices (by whatever means are appropriate)
· Gain consent before undertaking any care / support
· Knock on the door and wait for a reply (if they are able to reply) before entering
· Ensure curtains / doors etc closed before undertaking any care
· Ensure if they need help to go to the toilet, for example that you do not keep them waiting for too long
· Care and support them in a way that you would like to be cared for
· Consider where you have conversations about clients / colleagues etc and also where you complete / leave clients records
Where care or support is given to individuals, where dignity is not embedded in practice, lack of respect for individuals may be evidenced, for example: being addressed in a disrespectful manner, lack of privacy and being rushed to complete tasks instead of being encouraged to be independent, made to feel a nuisance or in the way, the medical model of care instead of the social model of care, not being listened to or consulted on for decisions and choice.
The Dignity Challenge acts as a call to care providers to meet the 10 principles of care in their services to people. In recognising that the concept of "dignity" is interpreted subjectively, the Dignity Challenge attempts to create an understandable and tangible way of explaining what 'Dignity' looks like in the context of treating people with the respect in a care setting.
The 10 points of the dignity challenge state that high quality care services that respect people's dignity should:
1) Have a zero tolerance of all forms of abuse.
2) Support people with the same respect you would want for yourself or a member of your family.
3) Treat each person as an individual by offering a personalised service.
4) Enable people to maintain the maximum possible level of independence, choice and control.
5) Listen and support people to express their needs and wants.
6) Respect people's right to privacy.
7) Ensure people feel able to complain without fear of retribution.
8) Engage with family members and carers as care partners.
9) Assist people to maintain confidence and a positive self-esteem.
10) Act to alleviate people's loneliness and isolation.
Personal information disclosed to you during the course of your work is to be treated as confidential and should only be disclosed with the consent of the person concerned unless an emergency makes it impossible to obtain their consent. You may only disclose information to those with direct need for information (such as health care professionals, care managers and your manager). Relatives, neighbours and family friends are not necessarily entitled to receive confidential information. Sharing information from individual’s care / health records must be on a “needs to know” basis only, so for example you may need to discuss with the GP about a health complaint, but if they started to ask re their financial situation, then this would be totally inappropriate and should not be shared with them. Depending on the environment you work in will dictate to some degree what might need to be shared. Take for example you are in a hospital, and are looking at discharge, then it may be very appropriate for the doctor to be asking about the home that the client lives in, to establish whether discharge back there is appropriate or not.
However, there may be times, when it will be necessary to breach client confidentiality, and these could include if: -
· It can be justified to protect the client or another from a significant risk or harm.
· If there is suspected abuse
· It is required by law or by the order of the court.
To maintain confidentiality, you need to consider where and when you discuss clients – i.e. not when you are on the train going home or in the pub in the evening or in a public place. Within a residential care setting (e.g. care home, nursing home, hospice, hospital), it is also important what you do with the client’s records, so that they are not left in a public place for all to read, you will need to check your own individual organisations policy on the management of this.
Within the client’s own home, do not leave their documentation in a place where an unauthorised person could gain access to it and also if you need to talk to the office or other health professional, consideration needs to be taken as to where you make that phone call. Likewise, if you are in the client’s garden with them, be aware of neighbours, who may be able to hear that conversation.
If you have any concerns re confidentiality, and whether you should pass information on or not, this should be discussed with your line manager who will advise you as to the best course of action. You will also have a policy and procedure relating to this within your workplace, which would be helpful for you to read.
To ensure that the clients self – esteem is maintained, it is important for them to make choices, where ever they are able to and be as fully involved in any decision as possible. This can range from what to eat or wear, when to have personal care, where they want to live in the future, activities they want to participate in or what their wishes are for their end of life care.
To enable the clients to make decisions, it is important that we give them the information and support that they need to do this. For some clients, they will very easily be able to make decisions, but for others they may struggle for any number of reasons, including having reduced or fluctuating capacity, lack of confidence and self esteem in their own ability to make these decisions or inability to express themselves. It is therefore part of your role to enable that person to make their decisions where possible and within this acknowledge that for some people they will be able to answer your questions and others we may need to do more visually – for example, if you are asking them what to wear, it may be that you show them some options. If someone is having difficulty expressing what they want, ask them to write it down, or nod / use thumbs up / down to the appropriate answer. The key to this is getting to know your clients and their needs and adapting your skills / techniques to meet their needs. Each person is unique and are shaped not only by their background but also their life history.
There is also the option of using a risk assessment approach to support clients to make decisions, and through this you can ensure that you support them to remain safe and prevent accidents from occurring and it empowers them to be in control of their own life. Taking risks, is part of everyday life and is something that you do every day; it is just that you don’t document it. For clients, we need to formally record risk assessments within their support / care plan.
The Health and Safety Executive looks at the 5-step approach to risk assessment: -
1) Identify the hazard
2) Decide on who may be harmed and how
3) Evaluate the risks and decide on the precautions
4) Record your findings and implement them
5) Review and update your risk assessment
Clients will have risk assessments in their notes, and it is important that you check these and read them before you support them with their care, as that way you have a better understanding of that persons needs. If you find, that they don’t correlate with that person, or the individual is telling you something different, it is important that you either update the risk assessment (if you are in a position to do this) or if not you advise someone who can do this.
As an individual, you can support the client to make that decision, but their decision should not be influenced by your own choices or decisions. For example, if you are supporting the client to go out, it is important that they choose where to go and are not influenced on this by your preference to go to a certain place. This could also apply if you were supporting a person to go to bed and they wanted to know what time was convenient to you as they felt as if they should “fit in with your schedule”.
However, sometimes, people may have made “well-meaning” decisions for individuals and they may not be happy with these decisions, so you may either need to support them to address the decision that was made or support them to complain (this will depend on the individual situation). It is important that you don’t ignore it, as you are their advocate to support them with this.
One of the important tasks of your role is how you empower individuals to make choices and have as much control of their life as possible. It is important to empower those you care for and support, so that decisions are not taken for them, and control over their life reduced, for example ensuring that those you care for or support are able to access a range of information and resources so that informed choice and decisions can be made, such as how they wish services to be provided, what level of support they would like, as well as when and how it will be delivered.