CHCICS301A Provide support to meet personal care needs Reading 4: Recognise and report changes in client health and/or personal support requirements 1 © NSW DET 2009 Contents Reading 4: Recognise and report changes in client health and/or personal support requirements 3 Introduction 3 Identify variations in personal care support requirements and report to supervisor 3 Work with person and supervisor to identify required changes to processes and aids 4 Identify variations and concerns about client’s health 7 Report variations and concerns about client’s health to the supervisor 9 2 © NSW DET 2009 Reading 4: Recognise and report changes in client health and/or personal support requirements Introduction It is good professional practice to establish an organised way of observing. Assisting clients with personal hygiene is a good opportunity to observe skin integrity, communication skills, orientation to time and date for example, and any changes in behaviour. Transferring clients from one position to another can provide an opportunity to observe mobility. If you are not watchful during all interactions with clients then changes will be missed. Identify variations in personal care support requirements and report to supervisor Reporting changes in a person’s condition Observing clients is a vital part of the aged care and health support worker’s role. To be able to report changes in a client’s condition or needs, the carer must be a good observer. To observe people in your care, you must use ALL your senses. Observing is much more than just looking at the person. Anything unusual or out of the ordinary should be noted and reported to the supervisor. For example, you may smell a strange odour, hear a moan or groan or feel an unusual swelling or lump on the skin. It is important to know your client to be effective in the care you give. ‘Care’ includes being attentive to change and reporting any changes to the relevant person. The worker must first know what is ‘normal’ before they can recognise what is not normal. The age, gender and known medical condition and diagnosis of the client must be kept in mind 3 © NSW DET 2009 Accurate, objective reporting is a skill, which needs practice. The reports made by a worker often affect the type and level of support the person in care will receive. Reports which are inaccurate, and coloured with personal interpretation and perceptions, may result in inappropriate support and assistance to the client. Aged care and health support workers should consult the client about their observations wherever possible, to make sure that what they have seen is accurate and true. Aged care and health support workers should also ask the following questions: What information is relevant to report? What information is not relevant to report? To whom should I report the information? When is it appropriate to report? Have I reported objectively and without value judgement? Have I consulted the client and obtained their consent to pass on the information I think needs to be given? Do I have enough information about the issue? Is it necessary for me to consult or seek advice form anybody and am I clear who that person should be? Work with person and supervisor to identify required changes to processes and aids Contributing to the delivery of a service/care plan There will often be occasions when workers need to seek advice and direction about implementing a service/care plan, for example, aged care and health support workers may be unsure about a decision they are making or concerned about some aspect of the daily care tasks. To know when it is appropriate to seek advice workers should be aware of their role and responsibility in the care of a client. This will be identified in general terms in their job description and more specifically in a service/care plan. Aged care and health support workers should also be familiar with the roles of the care team members who may be included at any one time with a 4 © NSW DET 2009 client. This could include health workers, doctors and immediate supervisors. Workplace policies and procedures may also provide guidelines about when and how to seek advice and direction. For example: a staff information booklet may identify the staff to whom you should report or seek advice in addition to policy guidelines and formal processes, information may be given verbally to indicate what to do in the care of emergencies. Consulting the client Often the person to consult in the first instance is the client. For example: Mrs Avarti has been prescribed tablets for a heart condition. You notice that she has not taken the last two doses and need to find out why. Although you will need to report this situation so that it can be further investigated, it is important that you first seek accurate information from Mrs. Avarti. Consulting her will also show your respect for her dignity. If unsure of the client’s competence, the aged care and health support workers may need to have a discussion with their supervisor or seek advice from a professional worker before consulting the client. Consulting a supervisor There may be many occasions when aged care and health support workers should seek advice from their supervisor about a decision which must be made immediately about a client in their care. This may require a telephone call if the supervisor is not on site. Note: If a supervisor is not accessible and you are faced with an emergency, use a common sense approach. Place the person out of danger and acquire assistance. If you are in an isolated situation you could contact emergency service personnel, eg the police, ambulance or fire services. Often a decision may be difficult to make. For example, when a decision involves the client’s right to choose to take a risk, the aged care and health support workers may wish to seek support as well as advice form their supervisor. Seeking advice and direction from a supervisor is crucial to the role of monitoring the effectiveness of the service/care plan. For example, the service/care plan for Mr. Millthorpe states that he had a hip replacement and should use a walking frame for four weeks, but he tells you that he does not use it or need it any longer. It would be appropriate for you to respond to Mr. Millthorpe in helpful way, informing him that you need to obtain advice 5 © NSW DET 2009 and direction from your supervisor and that a reassessment may be required. In this way you will be directly working within the service/care plan and contributing to the evaluation and development of ongoing and changing needs of Mr. Millthorpe. Consulting within a team When it is decided that immediate action is required it is necessary to consult with your supervisor. In cases of less urgency, there are formal ways such as regular team meetings where advice and direction can be obtained. Meetings provide the opportunity for members of the team to review the effectiveness of care and to gather information to help implement the client’s service/care plan. Sharing ideas and strategies also provides aged care and health support workers with support. Consulting documentation Workplace policies and procedures provide a form of indirect supervision for workers in their daily implementation of care. They provide guidelines for work as well as help to keep the quality of care consistent. The nature of the forms and requirements will vary from workplace to workplace. However there are several which are commonly found. These are: Incident report forms – where there has been a particular incident, which directly affects you and/or the client. Communication books – which detail each service performed and records the daily status of the client. Progress notes – to record daily status or events. Problem sheet – where specific problems arising for the client are documented and used on a daily basis. Treatment sheets – to indicate specific treatments, which have been carried out for the care of the client. Handover books – in which you report at the end of each work shift to ensure consistent care for the client. Case histories – detailed history of a person’s health status, life history, services given and any other relevant information. Assessment sheets – used to assess the strengths, abilities and identified needs of the person before the planning for care. These documents car vary depending on the service the person is being assessed for. Continence management charts – used to record ways of assisting a person to mange incontinence problems and ensure that there is a consistent monitoring and use of these strategies by the team. 6 © NSW DET 2009 Activity sheets – listing programs and activities that a client may be involved in at a day activity centre or in an aged care facility. Identify variations and concerns about client’s health Areas of personal preference On a day-to-day basis in your work you will come across a variety of different personal preferences. Each individual will have different needs in all aspects of their lives. You may find preferences in their daily living in areas of: communication eating and drinking mobility and transferring attending to personal hygiene dressing and undressing spiritual needs grooming emotional needs expressing sexuality. In dealing with any variations and concerns about a client’s health the responsibilities of an aged care or health support worker include: Clarify what the service/care plan asks aged care and health support workers to do. Speak with your supervisor to get clear advice and direction. Monitor effectiveness of the service/care plan. Be aware of the individual client’s personality and what they need and expect from aged care and health support workers. Constantly make sure the service/care plan is meeting the needs of the client. Report any changes or concerns about the client’s welfare or wellbeing using the appropriate workplace procedures. Carry out care while maintaining the respect and dignity of the client. 7 © NSW DET 2009 How to recognise personal preferences Many of your clients will be quite comfortable discussing directly with you their personal preferences. Others may find this difficult because: They desire to remain independent. It can be very difficult for an older person to ask for help to fulfil simple tasks that they have been capable of doing all their lives. This dependence on someone else can be embarrassing. Cultural differences may make it difficult for an individual to communicate their personal preferences – language difficulties, difficulties in accepting help from a young person or someone of the opposite sex. They do not want to be a bother. Difficulties in communication, especially sensory impairment. Situations may change for the client. These changes may make it more difficult for aged care and health support workers to carry out tasks outlined in the service/care plan. Such changes can occur as a result of improvements or deterioration in a client’s strengths, abilities or conditions. Here is an example: Mrs Martin has always required help in dressing. Lately she has preferred to dress herself, even though she is having difficulties which are obvious to the carers. When approached by a carer as to why she was now dressing herself, she admitted that she would like to continue dressing herself because she recently saw herself in a mirror and was embarrassed by the loose skin hanging from her arms. This example illustrates a number of issues. The level of classification needs to be reviewed in light of Mrs. Martin’s preference because this is going to affect the funding subsidy for her care and the instructions in her service/care plan. There is a conflict of interest between the: duty-of-care to encourage and enable her to be as independent as possible duty-of-care in respecting her own perception and her needs criteria for eligibility for funding subsidy in personal care. Responding to difficulties effectively will require clear communication skills as well as an awareness of your role and responsibility. Aged care and health support workers will need to: be clear about the tasks required by the service/care plan know how to respond to the immediate situation report clearly any issue that is not meeting the service/care plan requirements. 8 © NSW DET 2009 Any conflict felt about obligations and responsibilities should be discussed with your supervisor. Reporting objectively To observe objectively, aged care and health support workers should: report or record only what they see and hear, not what they think and feel about a situation. report without making a value judgement from their perspective. always check the behaviour to validate that the behaviour is different to their normal behaviour always communicate your observation to the individual concerned to get more information about their behaviour and to show compassion and respect. Report variations and concerns about client’s health to the supervisor There is a plethora of expected physical health changes due to the ageing process. All older people will experience these physical changes, some to a lesser and others to a greater, degree. The major ones include: Sensory: decline in eyesight, hearing, smell, taste (especially for smokers) and sometimes touch. Skin becomes thinner, fatty tissue thins and skin wrinkles and sags, sweat glands reduce. Fat distribution: muscle is replaced with fatty tissue, middle aged spread appears and is difficult to shift. Brain and nervous system: long term memory remains in tact, intelligence is generally unchanged, but there may be slight impairment to short-term memory, new learning and the ability to focus and concentrate, reaction time slows, body temperature is less regulated. Heart and blood vessels: blood flow reduces from thickening arteries, heart responds slower to increased demands for blood when reacting to stress or exercise. Bones/skeleton: discs in spine become thinner, bone density decreases, may shrink in height. Posture: some develop a stoop over time as muscle contract more slowly. 9 © NSW DET 2009 Mobility: less endurance for sustained exercise and activity, combined with a loss of strength. Joints: cartilage is worn away, tendons are less elastic, restricted movement in joints, muscles, ligaments and tendons deteriorate. Dental health: teeth need constant maintenance or will decay, destabilize, discolour, gums recede. Lungs: less air moves through the lungs, therefore less oxygen gets into bloodstream. Immune system: more susceptible to infection because defence mechanisms are reduced. Kidneys become less efficient (may need to urinate during night). Genitals: testicles may drop, prostate enlarges, may cause difficulty urinating, sperm reproduction may also reduce. Hormonal changes, menopause in women. Hair becomes grey and thins. Sexual function: may take longer to stimulate and slower to reach orgasm, but is still encouraged. Common risks to a client’s safety A risk is a situation, which has the potential to create a hazard to a person’s health, safety or wellbeing. Risks which occur, because of the process of ageing can be physiological, psychological, emotional or environmental. Risks are found in all environments. However the amount of actual risk to a person will vary, depending on the particular environment and on the number of personnel and checks in place to monitor and minimise risk. Risks which may result, from the ageing process include: falling injury poor nutrition infection getting lost or disoriented rejection and loneliness financial abuse neglect by aged care and health support workers elder abuse. 10 © NSW DET 2009 Factors that lead to increased risks for older people Some older people need to depend on others in order to fulfil daily tasks. The level of their dependence is directly related to how their body ages. When you consider the potential risks to an individual’s health and safety it is important that you understand the ageing process and the effects it has on the body. As people age they may have physical limitations in performing daily activities and are less able to cope with hazards in their living environment. As we have seen, the ageing process can increase risk of injury due to changes in body systems. Balancing personal preferences, rights and safety of your clients Clients have the right to make decisions that may include the acceptance of personal risk. Aged care and health support workers have a responsibility to ensure that safety hazards and situations of risk are minimised for clients, however, it is not possible to protect them from all potential hazards. It is important that you understand the difference between the client’s rights to live with risk and staff neglect. It is important that you carefully consider all of the implications when considering preventing clients from fulfilling personal preferences or independence because of possible risk situations. The freedom that an individual is given should be balanced with stability and security. Whilst allowing clients to maintain their independence and fulfil personal preferences it is essential that their own safety and the safety of others are taken into consideration. The perfect example to illustrate this is that of smoking. A client who lives in a residential care facility will have the right to smoke. However they will only have the right to smoke in designated areas. This means they may not be allowed to smoke in public areas, their bedroom of in their bed. This rule will have been introduced in order to protect the safety of all residents and all staff rather that just to limit the freedom of the individual. It is not easy to respect the person’s needs and personal preferences while trying to ensure that they are safe. You will be faced with many situations where you have to weigh up the person’s rights and individual preferences against safety factors. There may also be times when the individual places not only themselves at risk but others at risk as well. It may be that a client is happy to receive assistance. It may also be possible through discussion to provide clients with alternative approaches to fulfilling their level of independence and personal preferences. It may be that only a small change in routine or the way in which a person performs a task is all that is required to eliminate the risk. 11 © NSW DET 2009 Observation, of any of the above, report immediately, to the Registered Nurse or supervisor and document the situation in the notes. 12 © NSW DET 2009