Fundamentals
of Care
Guidance for Health
and Social Care Staff
Improving the quality of fundamental
aspects of health and social care for adults
Fundamentals of Care
Guidance for Health and Social Care Staff
Improving the quality of fundamental aspects of health
and social care for adults
This version of the Fundamentals of Care is aimed at staff of all grades who
provide care and the organisations that employ them. These organisations
include all providers of health and social care.
Contents
Foreword
2
1. Aim of Fundamentals of Care
3
2. Using the Guide
4
3. Introduction to the Practice Indicators
6
4. Practice Indicators
7
1. Communication and information
2. Respecting people
3. Ensuring safety
4. Promoting independence
5. Relationships
6. Rest and sleep
7. Ensuring comfort, alleviating pain
8. Personal hygiene, appearance and foot care
9. Eating and drinking
10. Oral health and hygiene
11. Toilet needs
12. Preventing pressure sores
7
14
19
25
30
35
38
42
46
50
55
59
5. Monitoring the use of the Practice Indicators
63
6. Useful contacts
65
Appendices:
66
A1. Steering Group membership
66
A2. Contributors to redrafting
67
Foreword by Jane Hutt AM, Minister
for Health and Social Services
The twelve aspects of care described in the document draw together, for the first time,
guidance on the quality of care service users may expect from health and social care
providers in Wales.
I know, from talking with service users, that they are as much affected by the general
experience of their care as by its outcome. I also recognise that the experience of care is often
variable and dependent on the type of service accessed and geography. These indicators will
help ensure that such inequities are addressed across Wales. They relate to a range of settings,
from a person’s own home, to care homes and hospitals and to all organisations dedicated to
delivering care, in the health, social or independent sectors.
Individuals and organisations providing health and social care within Wales, should use these
indicators to develop and improve the services they deliver. It is only by constant reference
and review that we can raise the quality of care.
So much is being achieved already, but more remains to be done, so that the more vulnerable
members of our society are helped to enjoy a better, healthier and happier future.
I am pleased to commend this document to you.
Jane Hutt AM
Minister for Health & Social Services
1. Aim of Fundamentals of Care
Fundamentals of Care is a Welsh Assembly Government initiative included in the Plan for
Wales as part of “Improving Health and Care Services”.
The initiative grew out of the following:
●
Inconsistency of quality across service settings and areas.
●
Emphasis, until recently, on service efficiency and cost, rather than quality of care.
●
Common themes in complaints and compliments.
●
Increasing expectations of service users.
●
Developing partnerships with service users and between organisations.
●
Lack of clarity for service users on what they should expect.
●
Increasing focus on regulation and performance.
●
Awareness of Essence of Care, DOH, 2001.
Fundamentals of Care therefore aims to improve the quality of aspects of health and social
care for adults.
The indicators will be integrated with educational, commissioning and performance
management frameworks for the NHS, Social Services and the Care Standards Inspectorate, as
appropriate. They therefore reflect an integrated whole systems approach, making them
relevant to multi-disciplinary environments across organisational boundaries.
3
2. Using the Guide
providers respond to and meet the needs of
service-users. Fundamentals of Care is also
designed to enable service-users to assess for
themselves whether the care they receive is
appropriate to their personal circumstances.
For example each section suggests an
indicator to which care providers should
aspire. The indicators are referenced to the
relevant Care Standard Regulations. This
approach will help both the service provider
and the service-user. The service provider can
utilise Fundamentals of Care for self audit
and quality control purposes and establish
how each indicator relates to Care Standard
Regulations. In turn service-users in private,
voluntary and local authority sector provision
are better able to understand how the Care
Standards Act shapes the services they may
receive.
The first reaction to these indicators may be
that they are nothing new. This is true. Indeed
it would be surprising if material did not
already exist on the key subjects addressed,
for example, the Essence of Care in England,
DOH, 2001. What is different is that these
indicators are applicable to the whole of
Wales, across the full range of health and
social care settings. To achieve this, this
document draws together a composite set of
indicators from a range of statutory,
mandatory and professional requirements and
national policies. These include (amongst
others): National Minimum Standards,
National Service Frameworks, National
Institute of Clinical Excellence documents,
Occupational Standards and Professional
Codes of Conduct. Additional indicators have
been included where gaps have been
identified from a literature search and
extensive consultation.
Expectations of service providers in the
private and voluntary sector
Using the Fundamentals of Care
alongside other guidelines and
standards
Fundamentals of Care does not impose any
new requirements, obligations or standards
upon domiciliary, care homes or independent
healthcare providers. Providers of these
services are registered and regulated by the
National Assembly through the Care
Standards Inspectorate for Wales (CSIW).
Fundamentals of Care will supplement but
not replace the Regulations and National
Minimum Standards issued by the National
Assembly and enforced by CSIW. It is
anticipated that all care providers, anxious to
maintain and develop quality personal care
services, will incorporate Fundamentals of
Care within training and staff development
programmes as a basic foundation for the
provision of quality services. Both Health and
Social Services may also incorporate these
indicators into commissioning, contractual or
service-specification requirements.
Fundamentals of Care views the service-user
as the most significant stakeholder in the
development and promotion of best practice
and quality services. On a personal basis the
relationship between the service-user and
care provider is fundamental. The
relationship between the person giving care
and the person receiving care should be a
partnership. Everyone is an individual and
should be treated according to their needs
and wishes. Service-users should receive the
highest quality of care and service providers
have a responsibility to provide this.
At a wider level, practice and services are
governed by legislation and regulations. They
are also influenced by standards and
guidance. In this broader context
Fundamentals of Care seeks to stimulate
improvements in quality and the way care
4
Act Regulations. They are therefore
supplementary to secondary and primary
legislation. It is anticipated, however, that
Fundamentals of Care will play a significant
role in the development of commissioning,
staff training and development programmes.
Social Services may wish to use the
indicators when commissioning from private
sector providers.
Expectations of the National Health
Service
Within the Health Services Fundamentals of
Care will be used to drive up and improve
the consistency, quality and delivery of care.
As a baseline Fundamentals of Care should
be used to establish targets for the consistent
improvement of services and the provision of
care regardless of setting. It is recommended
that individual staff and organisations identify
those indicators from the cross-references that
should already be complied with. For the
other indicators there is a responsibility to
ensure they are integrated into educational
and monitoring systems. All indicators are to
be met and compliance systematically
monitored, whether this be through clinical
supervision, peer review, audit or operational
performance mechanisms.
Putting the indicators into practice
The following need to be considered:
●
the service user and their choices and
wishes
●
the service user’s capacity, capabilities
and need of care
●
the unpaid carer’s capacity,
capabilities and need of training
●
staffing levels and skill mix
●
use of evidence-based professional
assessment tools, practice, and models
of care
●
the type of environment in which the
care is given
●
competency, training and education
of staff
●
supervision of staff
●
the maintenance of buildings and
equipment
●
the provision of suitable facilities and
equipment
●
operational procedures and policies
●
monitoring and evaluation of services
●
links to clinical governance systems.
The NHS may also wish to use the indicators
when commissioning from private sector
providers.
Expectations of Local Authority Social
Service Departments
Social Services may use Fundamentals of
Care as a nationally recognised framework
and where appropriate audit existing
domiciliary and residential care services
against the relevant indicators. In order to
clarify the position fully, Fundamentals of
Care may underpin or support Care Standard
5
3. Introduction to the
Practice Indicators
The document presents a list of indicators
that cover twelve Fundamental Aspects of
Health and Social Care:
●
●
●
●
●
●
●
●
●
●
●
●
Each aspect is described in a separate
section. The sections are layed out as
follows:
Communication and information.
Respecting people.
Ensuring safety.
Promoting independence.
Relationships.
Rest and sleep.
Ensuring comfort, alleviating pain.
Personal hygiene, appearance and
foot care.
Eating and drinking.
Oral health and hygiene.
Toilet needs.
Preventing pressure sores.
●
●
●
●
●
The indicators are research and best practice
based, having been developed in the light of
extensive consultation and a wide range of
reference documents.
●
The indicators are not in priority order. Most
of them relate to the provision of care in any
setting, but some will be less relevant in a
person’s own home.
●
To gain maximum benefit, you will need to
read every section. Issues such as respect,
independence, communication and choice
are important in every situation.
an introduction setting the context;
a Principle quality statement;
Practice Indicators which say in
greater detail how the Principle can be
put into practice;
text in italics under some indicators
providing additional guidance for staff;
some examples of what the indicators
mean in practice to help staff use
them. They are not exhaustive and
therefore do not cover everything.
They are intended to give some clear
compass points. Staff will be able to
add to the list through their own good
and considered practice;
cross references which relate the
principle and supporting indicators to
corresponding existing legal
requirements, professional and
national standards. Where
cross-references are in italics, this
indicates that the document referred to
is in draft form at the time of writing;
selected references.
Two other versions are available. The Flyer
version contains the Principles and the
Booklet has the Principles and Practice
Indicators. These two versions are worded
with the service user in mind. The documents
are also available on the Internet.
6
4. Practice Indicators
People have the right under legislation to see
the information that has been recorded about
them in their medical or care records and, if
necessary, to correct any mistakes. The
requirement for confidentiality and protection
of any information about an individual held
in records however remains an important
principle (Indicator 1.5).
1. Communication and
information
This aspect of care includes written, oral and
non-verbal communication between staff and
service users and their relatives and carers.
Many of the failures or complaints about
health and social care are due to
misunderstandings, inadequate information,
or failures in communication.
There should be clear and accurate information about the type of service provided. It
should be presented in such a way as to take
account of special needs. Information must
be given in a format and language, which is
suitable for the intended use, and reaches the
right balance of every day words, technical
terms, and explanation.
The Patient’s Charter (1990) established that
patients have the right to a clear explanation
of all proposed treatments, including any
risks involved and the alternatives before
giving consent. The provision of information
is one of the driving forces of NHS
philosophy, and communication with users of
health and social care services is a key
principle of a recent Welsh Assembly
Government document The Health and
Social Care Guide for Wales (2002).
The importance of open and honest
communication must be emphasised. People
are entitled to know about their condition,
especially if they request this information.
They should be treated with sensitivity and
understanding and account should be taken
that people under stress or anxious, may not
hear, understand, or remember what has
been said. All service users must feel able to
raise concerns and know how to make a
complaint about a service which has not met
their expectation. They must be able to do so
without fear of being penalised and have the
assistance of independent advice and
advocacy if desired. Special care must be
taken in communicating with those whose
mental capacity may be temporarily or
permanently impaired.
The more people understand their condition
and its treatment, and become involved in
decisions about the care they receive, the
better they are able to make appropriate
choices and manage their own care.
Partnership between health and social care
providers, patients, clients, service users, their
relatives and carers, is the cornerstone of
appropriate person centred care. This is
important at all stages in the care of an
individual, but particularly so during
arrangements for transfer of care to
alternative care settings, and during the
discharge planning process.
Effective communication takes time and
should be considered to be part of workload,
prioritisation and time management.
Except in very special circumstances, which
are specified in law, informed consent must
always be obtained to treatment and care.
Intervention without consent may be an
assault. On the other hand, non-intervention
for people unable to consent may amount to
neglect.
Principle
People must receive full information about
their care in a language and manner sensitive
to their needs.
7
amongst team members and records may be
accessed and used by all. In some
circumstances, information may be shared
with other staff involved in the care of the
individual, if the caring role of the
colleague could not be undertaken effectively
without knowledge or information relating to
the person receiving care. In certain
circumstances there is an additional
requirement to share information i.e. when
information is required by a court order and
when it can be justified as being in the
interests of protecting the public.
Practice Indicators
1.1 Health, personal and social care needs
are assessed and set out in a regularly
reviewed plan of care. This plan is agreed by
the service user and the people caring for
them. The plan is only shared with others
with the service user’s consent.
The plan of care is agreed by the service user
and made available to them. The assessment,
plan of care and its implementation are
recorded and monitored. The plan of care is
reviewed to ensure services remain
appropriate to the service user’s needs.
1.2 Assistance or specialist aids are provided
to those with speaking, sight or hearing
difficulties, special needs or learning
disabilities, enabling them to receive and
respond to information.
1.6 Time is taken to listen and actively
respond to any questions and concerns that
the service user or their relatives may have.
If the person providing care does not have
sufficient knowledge to answer questions
adequately, they refer them to the appropriate
colleague.
1.3 If necessary, people are provided with
access to a translator or a member of staff
with appropriate language skills.
If a translator is needed, they must be
thoroughly briefed on the context of the
information they convey and on the
requirement for confidentiality.
1.7 People are given information explaining
how to comment on their care or make a
complaint. If requested, information is also
given on how to obtain independent advice
and support.
Some examples of what the indicators
mean in practice
1.4 People are consulted about any treatment
and care they are to receive. A suitably
knowledgeable person explains treatment or
care options so that people can make
informed choices. Their consent or refusal is
clearly and accurately recorded.
Some people may have a limited capacity to
understand e.g. people with learning
disabilities or mental illness. In such cases,
every effort is made to help them
comprehend what is being said and to
involve them in the decision making process
with their carer or next of kin.
1.5 People’s personal records are regularly
updated and available to them. To ensure
confidentiality, they are kept secure and
comply with the Data Protection Act 1998.
Where care is delivered by a multi-disciplinary
team, information needs to be shared
8
●
Always ensure that information you
give is accurate.
●
Almost never use jargon; if you need
to, explain what it means.
●
Never assume that your service user is
being given information in an
appropriate format; always ask them.
●
Be clear and unambiguous in what
you say or write.
●
Always check whether people have
any questions.
●
Answer questions openly and as
simply as you can.
●
●
If you are not sure you have correctly
understood what your service user is
asking or requiring of you, ask them.
When you have promised to return to
the person using services at a later
date with information, always ensure
that this is done.
●
Make sure that all of your recording is
undertaken in a way that can be made
accessible to the person using services
and will be easily understood by them.
●
When a person using services voices
dissatisfaction, encourage them to
make a complaint if you are not in a
position to resolve the issue yourself.
●
When you are aware that you have
not delivered any aspect of service as
well as you might have done,
apologise and explain how you will
ensure that the problem is resolved.
●
through the supervision process, with
Fundamentals of Care in mind.
●
If you have a job that involves you in
preparing information for the benefit
of people who use services, check that
your local standards are consistent
with Fundamentals of Care and always
consult service users, carers and other
lay people, elected members of the
Council for example, before
publishing your document.
●
If you have reason to think that some
one may have an impairment of
mental capacity you must consider
what information and to whom you
should communicate. Where
appropriate you should follow the
guidance on consent to treatment.
N.B. The key thing to remember here is that
all people who use health and social care
services have a right to be told what is
happening to them and why, in a way that is
easily intelligible and meets any particular
needs they may have.
If you are a manager, ensure that
communicating and giving information
is something you address regularly
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Code of Ethics and Professional Conduct for Occupational
Therapists Section 2
Creating a Unified and Fair System for Assessing and
Managing Care (Unified Assessment Process)
NAfW NMS Care Homes for Older People standards 1
NAfW NMS Care Homes for Younger Adults standard 1
Framework for best practice: the production and use of the
health information for the public
Health and Social Care Guide sections 1,5,7
Improving Health in Wales chapter 3
Level 2 National Occ. Standards in Care Unit 011
Level 3 National Occ. Standards in Care Unit 022
Level 3 National Occ. Standards in Prom. Ind. Unit 023
NMC Code of Professional Conduct section 3
Social Care Induction Framework Core Areas 1.1,1.2,1.3,4.2
Welsh Risk Management Standard 8
9
Fundamentals Indicator
Corresponding Standards
1.1
NAfW NMS Care Homes for Older People standard 6
NAfW NMS Care Homes for Younger Adults standard 6,18
CSP Core Standards 8,10
Creating a Unified and Fair System for Assessing and
Managing Care
Health and Social Care Guide section 1,5,7
Level 3 National Occ. Standards in Care Units SC8,NC11
Level 3 National Occ. Standards in Prom. Ind. Units
SC3,SC8
NSF for Diabetes Standard 3
NMC Code of Professional Conduct section 2
Tackling Coronary Heart Disease in Wales standard 2
1.2
NAfW NMS Care Homes for Older People standards 36.6
NAfW NMS Care Homes for Younger Adults standard 40
CSP Core Standard 12
Level 2 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Prom. Ind. Unit CL1
1.3
NAfW NMS Care Homes for Older People standards 1.2
NAfW NMS Care Homes for Younger Adults 1.3
Level 2 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Prom. Ind. Units
CL3,CL4
Welsh Health Circular(2002)020 The Health Service and
the Welsh Language
1.4
NAfW NMS Care Homes for Older People standard 8
NAfW NMS Care Homes for Younger Adults standard
7,16,18
CSP Core Standard 2
CSP Service Standard 13
Creating a Unified and Fair System for Assessing and
Managing Care
Good practice in consent
Health and Social Care Guide section 1,5,7
Level 3 National Occ. Standards in Care Units
X12,X13,X19
Level 3 National Occ. Standards in Prom. Ind. Unit X13
NSF for Diabetes Standard 3
NMC Code of Professional Conduct sections 2,3
Welsh Assembly Government Reference Guide for Consent
to Examination or Treatment
Welsh Health Circular (2002) 42
Welsh Risk Management Standard 9
10
1
2
3
Fundamentals Indicator
Corresponding Standards
1.5
Code of Ethics and Professional Conduct for Occupational
Therapists Sections 2.5, 3.4
NAfW NMS Care Homes for Older People standards
7,8,12
NAfW NMS Care Homes for Younger Adults standard 8,10
CSP Core Standard 15
CSP Service Standard 19
Creating a Unified and Fair System for Assessing and
Managing Care
Health and Social Care Guide section 1
Independent Healthcare D.O.H. Standard m 3
Level 2 National Occ. Standards in Care Unit CU5
Level 3 National Occ. Standards in Care Unit CU5
Level 3 National Occ. Standards in Prom. Ind. Unit CU5
NMC Code of Professional Conduct sections 4,5
Welsh Risk Management Standard 7
1.6
NAfW NMS Care Homes for Older People standard 32
NAfW NMS Care Homes for Younger Adults standard 36
CSP Core Standard 12
Health and Social Care Guide section 8
Level 2 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Prom. Ind. Unit CL1
1.7
NAfW NMS Care Homes for Older People standard 31,32
NAfW NMS Care Homes for Younger Adults standard
35,36
CSP Service Standard 5
Health and Social Care Guide section 8
Improving Health in Wales chapter 3
Level 3 National Occ. Standards in Care Unit NC10
Level 3 National Occ. Standards in Prom. Ind. Units
NC10,Z2
Welsh Risk Management Standard 4
All of the references to the National Occupational Standards are guides as to how
meeting the standards contained in Fundamentals of Care can contribute evidence to
part of the units identified. It is dependent on the nature and complexity of the task
undertaken as to how much evidence will be generated.
See footnote above
See footnote above
11
Selected references
Anonymous. (2002) Communication and listening skills, Nursing Times; 98(10) p 7-13.
Audit Commission. (1993) What seems to be the matter? Communication between hospitals
and patients. HMSO.
British Deaf Association. Sign Language Policy. Head Office.
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Chartered Society of Physiotherapy. (2000) Core standards.
Available from: www.csp.org.uk
Chartered Society of Physiotherapy. (2000) Service standards. Available from: www.csp.org.uk
College of Occupational Therapists. (2000) Code of Ethics and Professional Conduct for
Occupational Therapists.
Hallstrom, I. And Elander, G. (2001) Needs during hospitalisation: definitions and descriptions
made by patients, Nursing Ethics; 8(5) p409-18.
Hemsley B. and Sigafoos J. and Balandin S. and Forbes R. and Taylor C. and Green VA. and
Parmenter T. (2001) Nursing the patient with severe communication impairment, Journal of
Advanced Nursing; 35(6) p827-35.
Henderson A. and Zernike W. (2001) A study of the impact of discharge information for
surgical patients, Journal of Advanced Nursing; 35(3) p435-41.
Kutner, JS. And Steiner, JF. and Corbett, KK. and Jahnegen, D. and Barton, PL. (1999)
Information needs in terminal illness, Social Science and Medicine; 48 (10) p1341-52.
Laurent C. and Good Practice Network. (1999) Written for happy endings...how midwives
improved patient education, Nursing Times; 95(48), Dec 1-7, p56-7.
National Assembly for Wales. (2001) Improving health in Wales. Available at:
www.wales.gov.uk/subihealth/content/keypubs/pdf/nhsplan-e.pdf.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
National Assembly for Wales. (2001) Tackling coronary heart disease in Wales: implementing
through evidence. Available from:
www.wales.gov.uk/subihealth/content/keypubs/pdf/coronary-heart-disease-e.pdf
12
National Assembly for Wales. (2001) Ombudsman for Wales Annual Report. Welsh
Administration Ombudsman and Health Service.
Nessa J. and Malterud K. (1998) Tell me what’s wrong with me: a discourse analysis approach
to the concept of patient autonomy, Journal of Medical Ethics; 24(6) p394-400.
Nursing and Midwifery Council. (2002) Code of professional conduct. Available from:
www.nmc-uk.org/cms/content/Publications
Sowden, A. and Forbes, C. (2001) Patient information, Health Service Journal ; 1 Mar 2001,
p.36-7.
Welsh Assembly Government. (2002) Creating a unified and fair system for assessing and
managing care.
Welsh Assembly Government. (2002) Framework for best practice: the production and use of
health information for the public.
Welsh Assembly Government. (2002) Good practice in consent implementation guide:
consent to examination or treatment. Available from:
www.wales.gov.uk/subihealth/content/keypubs/pdf/impguide-e.pdf.
Welsh Assembly Government. (2002) Health and social care guide for Wales.
Welsh Assembly Government. (2002) National service framework for diabetes (Wales).
Available from: www.wales.nhs.uk/sites/documents/334/diabetes-standards-wales.pdf.
Welsh Assembly Government. (2002) Publication of guidance about consent for examination
or treatment for the NHS in Wales.
Welsh Assembly Government. (2002) Reference guide to consent for examination or
treatment. Available from: www.wales.gov.uk/subihealth/content/keypubs/pdf/refguide-e.pdf.
Welsh Assembly Government. (2002) Regulatory and national minimum standards for private
and voluntary healthcare services.
Welsh Assembly Government. (2002) Welsh Health Circular(2002)020. The Health Service
and the Welsh Language.
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh risk management standards.
Available from: http://howis.wales.nhs.uk/wrp
13
2. Respecting people
This aspect should underpin at all times, the
relationship between someone who is
receiving a service and the person or people
delivering that service. Services should
always be provided with compassion and
empathy for the person to whom they are
being delivered.
All human beings – old or young, sick or
well, have a right to dignity, privacy and
informed choice. People also have a right to
expect that these basic human rights will be
respected by others, most especially those
whose role is to provide a caring service.
When people are dependent on others for
any aspect of their care, the individual’s
ability to ensure these basic human rights for
themselves may be compromised. All those
who provide care have a responsibility to
ensure that whatever care they are providing
includes attention to basic human rights.
Where people are unable to ensure these
rights for themselves, when they are unable
to express their needs and wishes as a result
of a sensory impairment, a mental health
problem, learning disability, communication
difficulty or for any other reason, access to
independent advocacy services must be
provided (see Indicator 2.2).
While these rights are common to all human
beings, every person is a unique individual
with unique needs and wishes. Individual
needs and wishes vary with factors such as
age, sex, culture, religion and personal
circumstances; also, people’s individual
needs change over time. These individual
needs may increase vulnerability to the loss
of basic human rights.
It is also important to understand that in
exercising individual rights, people exercising
those rights take responsibility for the choices
they make.
Respecting people as individuals is very
broad and an integral part of all care. It is
particularly important in:
●
●
●
Personal care, including maintaining
personal hygiene, going to the toilet, and
intimate procedures (see Aspects 8 and 11).
Communication and examination by
health and social care staff (see Aspect 1).
Caring for people who are dying or have
died.
Principle
Basic human rights to dignity, privacy and
informed choice must be protected at all
times, and the care provided must take
account of the individual’s needs, abilities
and wishes.
Practice Indicators
2.1 People are treated with respect, courtesy
and politeness.
Staff receive training to support this.
2.2 People are able to access free and
independent advice so that they can make
choices about their care and lifestyle.
This may be provided through advocacy
services or voluntary agencies such as the
Citizen’s Advice Bureau.
2.3 Individuals are addressed by their
preferred name.
2.4 Confidentiality and privacy are respected
as far as possible, especially in hospital
wards, public spaces and reception areas.
2.5 Mail is always given unopened unless
otherwise requested.
Where a person is unable to open their post,
appropriate arrangements are made with their
carers.
2.6 People’s feelings, needs and problems are
actively listened to, acknowledged and
respected.
14
2.7 Information and care are always provided
with compassion and sensitivity.
●
When a service user has asked you to
read their mail, never leave it in a
public place or open to view; always
place back in an envelope and return
to a place of safety, acceptable to the
service user.
●
Never touch the personal belongings
of someone using services, without
asking first, and always treat the
belongings of others with care and
respect.
●
Never judge the appropriateness of the
emotions that service users may
express to you; accept that they are
valid for the individual concerned and
respond appropriately.
●
If people are frightened, offer
reassurance.
●
If people are angry, listen to them and
suggest courses of action that will
resolve angry feelings.
●
If people express sadness, they will
need support in coming to terms with
what they have lost or are about to
lose.
●
Never assume that you know what
religious or cultural requirements a
service user may have, always ask.
●
Never gossip or laugh about people
who use services to your colleagues; a
service user will almost certainly be in
a position of disadvantage when
compared with yourself and should
never become the butt of jokes and
stories.
●
If you are a manager of care providers,
always model behaviour that reflects
respect for others; modelling is a very
powerful vehicle by which others can
learn.
2.8 Spiritual and cultural needs are
acknowledged and respected.
Some examples of what the Indicators
mean in practice
●
Always make clear to your service
user that what they have to say is
important to you.
●
Always demonstrate patience and
understanding.
●
Always knock the door if you are
intending to enter a room occupied by
someone using your service.
●
Never raise your voice when
communicating with your service user,
unless this is in order to be heard by
someone who has a hearing
impairment.
●
If a service user questions your actions
or views on their care, do not take this
personally; be ready to listen and learn
from what they have to say.
●
Always ask a person using services
how they wish to be addressed. Never
assume that it is acceptable to address
a service user by their first name.
●
●
Places such as hospital wards and
office reception areas are very public.
Always ensure that you are able to
maintain confidentiality in such
places, before discussing personal
matters. Always check that a service
user is comfortable discussing issues in
busy environments before you start.
Never open the personal mail of
someone using your services unless
they have requested that you do so.
15
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Code of Ethics and Professional Conduct for Occupational
Therapists Section 2
NAfW NMS Care Homes for Older People standard 14
NAfW NMS Care Homes for Younger Adults standards 16,18
Health and Social Care Guide section 1
Human Rights Act (1998), Articles 2,3,8,9, 14
Level 2 National Occ. Standards in Care Unit 01
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
NMC Code of Professional Conduct section 2
Race Relations Act (1976)
Sex Discrimination Act 1975 (amended 1986)
Social Care Induction Framework Core Areas 1.1,1.2
2.1
CSP Core Standard 1
Independent Healthcare D.O.H. Standard c8 m6
Level 2 National Occ. Standards in Care Unit 01
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
2.2
CSP Core Standard 1
Level 3 National Occ. Standards in Care Unit Y2
Level 3 National Occ. Standards in Prom. Ind. Units
Z2,Y2,NC10,SNH3U3
2.3
NAfW NMS Care Homes for Older People standard 14
NAfW NMS Care Homes for Younger Adults standards
16,18
CSP Core Standard 1
Level 2 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Prom. Ind. Unit CL1
2.4
NAfW NMS Care Homes for Older People standard 12
NAfW NMS Care Homes for Younger Adults standard 10
CSP Core Standards 1,3
Level 2 National Occ. Standards in Care Unit 01
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
2.5
NAfW NMS Care Homes for Younger Adults standard 16
Level 2 National Occ. Standards in Care Units CU5,W2
Level 3 National Occ. Standards in Care Unit CU5
Level 3 National Occ. Standards in Prom. Ind. Unit CU5
16
Fundamentals Indicator
Corresponding Standards
2.6
Independent Healthcare D.O.H.Standard c14
Level 2 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Prom. Ind. Unit CL1
2.7
Level 2 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Care Unit CL1
Level 3 National Occ. Standards in Prom. Ind. Unit CL1
2.8
CSP Core Standard 1
Level 2 National Occ. Standards in Care Unit 01
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
Selected references
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Chartered Society of Physiotherapy. (2000) Core standards.
Available from: www.csp.org.uk
College of Occupational Therapists. (2000) Code of Ethics and Professional Conduct for
Occupational Therapists
Coyle, J. and Williams B. (2001) Valuing people as individuals: development of an instrument
through a survey of person-centredness in secondary care, Journal of Advanced Nursing; 36(3)
p450-9.
Davies, S. and Brown, J. and Wilson, F. and Nolan, M. (2000) Dignity on the ward; promoting
excellence in care, Nursing Times; 96(33) p 37-9.
Department of Health. (2001) Independent Healthcare. Available from:
www.doh.gov.uk/ncsc/independenthealthcare.pdf.
Department of Health. (2001) National Service Framework for Older People. Available from:
www.doh.gov.uk/nsf/pdfs/nsfolderpeople.pdf (PDF format) or
www.doh.gov.uk/nsf/frameup/contents_.html (HTML format).
Dimond B. (1999) Confidentiality 1: Nurses’ duty to respect patient confidentiality, British
Journal of Nursing; 8(9) May 13-26, p 560,562.
17
G.B. Parliament. (1998) Human Rights Act 1998. HMSO. Available from:
www.hmso.gov.uk/acts/acts1998/19980042.htm.
G.B. Parliament. (1976) Race Relations Act 1976. HMSO. Available from:
www.homeoffice.gov.uk/raceact/racerel1.htm.
G.B. Parliament. (1975) Sex Discrimination Act 1975. HMSO.
Kerish, K. (2000) Individual care: its conceptualisation and practice within a multi-ethnic
society, Journal of Advanced Nursing; 31(1) p91.
Lothian, K. and Philp, I. (2001) Maintaining the dignity and autonomy of older people in the
healthcare setting: care of older people, British Medical Journal; 322(7287) p668-70.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
National Assembly for Wales. (2001) Tackling coronary heart disease in Wales: implementing
through evidence. Available from:
www.wales.gov.uk/subihealth/content/keypubs/pdf/coronary-heart-disease-e.pdf
Nursing and Midwifery Council. (2002) Code of professional conduct. Available from:
www.nmc-uk.org/cms/content/Publications
The orders of St. John’s Trust, Help the Aged. (1999) Dignity on the Ward Promoting
Excellence in Care. University of Sheffield.
van Thiel GJM. and van Delden, JJM. (2001) The principle of respect for autonomy in the care
of nursing home residents, Nursing Ethics: an International Journal for Health Care
Professionals; 8(5) p419-31.
Welsh Assembly Government. (2002) Creating a unified and fair system for assessing and
managing care.
Welsh Assembly Government. (2002) Health and social care guide for Wales.
Welsh Assembly Government. (2002) National service framework for diabetes (Wales).
Available from: www.wales.nhs.uk/sites/documents/334/diabetes-standards-wales.pdf.
Woogara, J. (2001) Human rights and patients’ privacy in UK hospitals, Nursing Ethics: an
International Journal for Health Care Professionals; 8(3) p234-46.
18
3. Ensuring safety
This aspect of care includes the health, safety
and welfare of service users, who have the
right to a safe environment, use of
appropriate and adequately maintained
equipment, and protection against abuse.
The safety of people at work and service
users who come into contact with the
environment in which care is provided, is
governed by the Health and Safety at Work
Act 1974, and its various safety regulations.
Obligations under this legislation include the
requirement for appropriate training,
documentation and investigation of accidents
and untoward incidents.
The way in which these requirements are put
into practice varies greatly and poses
particular challenges for some groups of
patients, clients and service users in their
own homes. This principle applies to all care
settings and all client groups, but the
relevance of the individual indicators will
vary according to location and client group.
Balancing the needs of both staff and service
users can be difficult in individual
circumstances. For example a heavy
immobile person may ask to be moved
without the use of lifting equipment which is
necessary to protect the carer from back
injury. Protection from falls potentially places
unacceptable limits on the person’s freedom
and autonomy. Sometimes the wishes of the
cared-for person conflict with those of his/her
family or other carers. At no time should the
wishes of the person being cared for put at
risk the safety of others.
Health and Safety legislation requires that a
risk assessment is carried out which involves
the careful consideration of what could cause
harm, and what precautions need to be taken
to prevent accident and injury to either the
person receiving care or the care giver.
If a person’s safety is put at risk at any time, a
record must be made and reviewed by the
person or organisation providing care.
This relates to all accidents, injuries, falls,
medication errors, infections, untoward
incidents and near misses.
This aspect of care covers:
●
Maintenance of a safe physical
environment.
●
Protection from physical, verbal,
sexual and financial abuse.
●
Safe working practices.
●
Prevention of falls.
●
Prevention of infection.
●
Prevention from self-harm.
●
Prevention of treatment errors.
Principle
People’s health, safety and welfare must be
actively promoted and protected. Risks must
be identified, monitored and where possible,
reduced or prevented.
Practice Indicators
3.1 People receive support free from abuse,
neglect and inappropriate care.
3.2 People are protected against verbal,
physical, sexual and financial abuse.
3.3 The service user’s environment is clean,
properly maintained, safe and secure. Their
independence and personal choice are
respected.
3.4 Equipment is clean, properly maintained
and stored safely.
3.5 People are assessed for risks to their own
safety and the safety of others. A plan for
managing risk is agreed between the person
being cared for and those caring for them.
3.6 Staff receive appropriate information,
training and supervision to ensure that people
and their carers are safe.
19
This relates to moving skills, use of
equipment, abusive and challenging
behaviour, medication, first aid, infection
control, waste disposal, handling of valuables
and general security.
3.7 People are encouraged to develop or
maintain the level of independence they
wish, striking a responsible balance between
risk and safety.
3.8 People are able to summon help easily at
all times, using a telephone, bell or other
convenient means.
If unable to do so their needs will be checked
regularly.
mentally infirm may become more
confused by change.
●
If, as a provider of services, you use
equipment to do your job, check that
it is properly maintained and in good
working order before embarking on
your day’s tasks.
●
Never leave the flex to appliances in
places where a service user may trip
over it.
●
If you are concerned that a service
user is making a choice related to their
need, which may place them at risk,
ensure that you discuss this with them,
record both their decision and your
view and ensure that your supervisor
or manager is aware of your concerns.
●
If you believe that you are not
adequately trained to undertake
specific tasks safely, you should bring
this to the attention of your supervisor
or manager.
●
Make sure that you are fully aware of
procedures in your organisation to
protect vulnerable adults; if you
believe that a service user is being
abused or neglected, implement your
local procedures immediately.
Some examples of what the indicators
mean in practice
●
Always practise basic personal
hygiene, both for yourself, and the
person for whom you are caring.
●
If you are caring for service users in
their own homes, always ensure that
appliances have been switched off
where appropriate.
●
Always ensure that open fires are left
safely and guarded, with nothing close
to them that may catch alight.
●
Never move a service user’s furniture
without seeking their agreement;
partially sighted people may stumble
as a result of the unexpected and the
20
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Code of Ethics and Professional Conduct for Occupational
Therapists Section 2
Level 2 National Occ. Standards in Care Units
01,CU1,CU4
Level 3 National Occ. Standards in Care Units 02,CU1
Level 3 National Occ. Standards in Prom. Ind. Units
02,CU1
Social Care Induction Framework Core Areas
1.1,2.1,2.2,2.3,2.4,2.5,2.6,4.2
3.1
NAfW NMS Care Homes for Older People standards 30,32
NAfW NMS Care Homes for Younger Adults standard 36
In Safe Hands
Level 2 National Occ. Standards in Care Unit Z1
Level 3 National Occ. Standards in Care Unit Z1
Level 3 National Occ. Standards in Prom. Ind. Units Z1,Z18
NMC Code of Professional Conduct section 8
3.2
NAfW NMS Care Homes for Older People standards 30,32
NAfW NMS Care Homes for Younger Adults standard 36
In Safe Hands
Level 2 National Occ. Standards in Care Unit Z1
Level 3 National Occ. Standards in Care Unit Z1
Level 3 National Occ. Standards in Prom. Ind. Units
Z1,Z18
NMC Code of Professional Conduct section 8
3.3
NAfW NMS Care Homes for Older People standards
18,33,40
NAfW NMS Care Homes for Younger Adults standard
33,37,41
CSP Core Standard 16
CSP Service Standards 2,16
Level 2 National Occ. Standards in Care Units
01,CU3,CU1
Level 3 National Occ. Standards in Care Units O2,CU1
Level 3 National Occ. Standards in Prom. Ind. Units
O2,CU1
NMC Code of Professional Conduct section 8
Patient Safety First
Welsh Risk Management Standards 13,22,27,33,35
21
Fundamentals Indicator
Corresponding Standards
3.4
NAfW NMS Care Homes for Older People standard 18
NAfW NMS Care Homes for Younger Adults standard 33
Independent Healthcare D.O.H. Standard c20
Level 2 National Occ. Standards in Care Units CU1,CU6
Level 3 National Occ. Standards in Care Unit CU1
Level 3 National Occ. Standards in Prom. Ind. Unit CU1
Welsh Risk Management Standards 14,30
3.5
NAfW NMS Care Homes for Older People standard 32
NAfW NMS Care Homes for Younger Adults standard 36
Creating a Unified and Fair System for Assessing and
Managing Care
CSP Core Standard 16
CSP (2001) Effectiveness of falls prevention and
rehabilitation strategies in older people: implementation
for physiotherapy & Falls audit pack
CSP Service Standard 2
Level 2 National Occ. Standards in Care Unit CU1
Level 3 National Occ. Standards in Care Unit CU1
Level 3 National Occ. Standards in Prom. Ind. Unit CU1
Welsh Risk Management Standard 13
3.6
NAfW NMS Care Homes for Older People standards 17,18
NAfW NMS Care Homes for Younger Adults standards
20,33
CSP (2002) Guidance in Manual Handling for Chartered
Physiotherapists
CSP Service Standard 16
Level 3 National Occ. Standards in Care Unit CU7
Level 3 National Occ. Standards in Prom. Ind. Unit CU7
Welsh Risk Management Standard 14
3.7
Independent Healthcare D.O.H. Standard m 12
Creating a Unified and Fair System for Assessing and
Managing Care
Level 3 National Occ. Standards in Care Unit Y5
Level 3 National Occ. Standards in Prom. Ind. Unit Y5
NSF for Diabetes Standard 3
3.8
NAfW NMS Care Homes for Older People standard 36.8
NAfW NMS Care Homes for Younger Adults standard 40
CSP Core Standard 16
22
Selected references
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Chartered Society of Physiotherapy. (2000) Core standards. Available from:
www.blindtiger.co.uk/CSP/uploads/-38c9a362-ed71ce5fa5—7696/SOPPcore.pdf.
Chartered Society of Physiotherapy. (2001) Effectiveness of falls prevention and rehabilitation
strategies in older people: implementation for physiotherapy & Falls audit pack. Available
from: www.blindtiger.co.uk/CSP/uploads/-37e5051b-ed0281cb81—7ffa/fallsEBB.doc.
Chartered Society of Physiotherapy. (2002) Guidance in Manual Handling for Chartered
Physiotherapists. Available from:
www.blindtiger.co.uk/CSP/uploads/-38c9a362-ed71ce5fa5—77d7/GIMH4CP.pdf.
Chartered Society of Physiotherapy. (2000) Service standards.
Available from: www.csp.org.uk
College of Occupational Therapists. (2000) Code of Ethics and Professional Conduct for
Occupational Therapists.
Department of Health. (2001) Independent healthcare. Available from:
www.doh.gov.uk/ncsc/independenthealthcare.pdf.
Department of Health. (2001) National service framework for older people a digest. Pfizer.
H.S.M.E. (2000) Health and safety manual. Health and safety risk assessment policy/procedure.
H.S.M.E. (2000) Health and safety manual. Management of manual handling policy.
Medical Devices Agency. (2001) Equipped to care: the safe use of medical devices in the 21st
century. Available from: www.medical-devices.gov.uk.
Mitchell, P. (2002) Nursing essential to improving patient safety, Journal of Advanced Nursing;
38(2) p109-10.
National Assembly for Wales. (2001). Regulations and national minimum standards for care
home for older people, care homes for younger adults and adult placements.
23
National Institute for Clinical Excellence. (2001) Scope for the development of a clinical
guideline on the assessment and prevention of falls in older people. Available from:
www.nice.org.uk/article.asp?a=30591.
National Patient Safety Agency. (2001) Doing less harm. Available from:
www.npsa.org.uk/admin/publications/docs/draft.pdf.
National Patient Safety Agency. (Forthcoming) Patient Safety First.
Nursing and Midwifery Council. (2002) Code of professional conduct. Available from:
www.nmc-uk.org/cms/content/Publications
Parker, LJ. (1999) Managing and maintaining a safe environment in the hospital setting, British
Journal of Nursing; 8(16) p1053-4, 1056, 1058 passim.
Pennels, C. (2001) Practical ways of putting safety first, Professional Nurse; 16(7 Suppl) pS7.
Sowden A, Dickson R. (1996) Preventing Falls and further injury in older people, Nursing
Standard; vol.10 (47) p32-33.
Welsh Assembly Government. (2002) Creating a unified and fair system for assessing and
managing care.
Welsh Assembly Government. (2000) In safe hands.
Welsh Assembly Government. (2002) National service framework for diabetes (Wales).
Available from: www.wales.nhs.uk/wrp
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh Risk Management
Standards. Available from: http://howis.wales.nhs.uk/wrp
Wilson, P. (1998) Safe patient transportation: nurses can make a difference, Nursing Times;
94(26) p66-7.
Wilson, T. and Smith, F. and Lakhani, M. (2002) Patient safety in primary healthcare – an
overview of current developments in risk mangement and implications for clinical
governance, Journal of Clinical Governance; 10(1) p25-30.
24
4. Promoting independence
4.5 Equipment provided for a specific person
is kept for their own use.
Most people do not want to be dependent on
others and want to optimise their
independence as quickly as possible.
Maintaining independence improves quality
of life and maximises physical and emotional
well being.
4.6 To promote people’s independence
and ability to care for themselves, their
environment is as accessible, comfortable
and safe as possible, in accordance with
their wishes.
The expectations of staff, carers and others of
what an individual can achieve are often
clouded by the assumption that dependency
is permanent or inevitable. For example, an
individual may not regain their mobility
because the expectation of other people may
be inappropriately low. This example
highlights the need to work with individual
strengths and potential. It needs to be
recognised, however, that teaching and
supporting individuals in this way may take
more time and greater skill than simply doing
things for them.
4.7 People are encouraged to be active,
through work, taking appropriate exercise
and/or recreation as far as their condition
allows.
Some examples of what the Indicators
mean in practice
●
Always take the time to help
individual service users to do things
for themselves, or with your support, if
they are able.
●
Helping someone to do things for
themselves will often take longer than
if you were to do it for that person;
always exercise patience and
encouragement.
●
If you are aware of aids or equipment
that may help your service user
maintain their independence, discuss
these with them.
●
If you believe access to a property or a
property itself can be modified in a
way that will further promote
independence, bring this to the
attention of your service user, line
manager and the appropriate section
of the Local Authority.
●
Promoting people’s independence is a
national policy; if you believe that the
time allocated to you is insufficient,
raise this with your supervisor or line
manager.
Principle
The care provided must respect the person’s
choices in making the most of their ability
and desire to care for themself.
Practice Indicators
4.1 Time is available to support and
encourage people to care for themselves.
4.2 Ongoing assessment, involving all those
relevant to the person’s care, forms the basis
of the plan of activities and care. This takes
account of the person’s requirements,
strengths, abilities and potential.
4.3 Where possible, people are shown
different ways of doing things to help them to
be independent.
Staff refer to physiotherapists or occupational
therapists for specialist advice.
4.4 If appropriate, people are offered
equipment to help them walk, move, eat, hear
and see. This equipment is well maintained.
25
●
●
For some service users, doing things
for themselves will challenge their
self-confidence; take time to
encourage and reassure; encourage
small steps forward that are
achievable.
●
Always see a desire to be active as a
positive sign; take appropriate steps to
encourage it.
●
If you are a commissioner of care
services, ensure that the likely cost of
working with an individual to
maximise independence is included in
your calculation when costing
packages of care.
Family members of the service user
may be very worried about the taking
of risks. Offer explanation, reassurance
and encouragement to the family.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Code of Ethics and Professional Conduct for Occupational
Therapists Sections 2,3
Level 2 National Occ. Standards in Care Unit 01
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
Social Care Induction Framework Core Areas 1.1,2.1,4.2
4.1
NAfW NMS Care Homes for Younger Adults standard 18
Level 2 National Occ. Standards in Care Unit Z6
Level 3 National Occ. Standards in Care Unit Y4
Level 3 National Occ. Standards in Prom. Ind. Unit Y4
4.2
NAfW NMS Care Homes for Older People standard 2
NAfW NMS Care Homes for Younger Adults standard
2,7,16,18
CSP Core Standard 8
Independent Healthcare D.O.H. Standard a 11
Level 3 National Occ. Standards in Care Unit SC8
Level 3 National Occ. Standards in Prom. Ind. Unit SC8
NMC Code of Professional Conduct section 3
Creating a Unified and Fair System for Assessing and
Managing Care
NSF for Diabetes Standard 3
Tackling Coronary Heart Disease in Wales standard 2
26
Fundamentals Indicator
Corresponding Standards
4.4
NAfW NMS Care Homes for Older People standards 2,36
NAfW NMS Care Homes for Younger Adults standards
2,18,40
CSP Core Standard 18
Health and Social Care Guide section 5
Level 2 National Occ. Standards in Care Units Z6,Z5
Level 3 National Occ. Standards in Care Unit X10
Welsh Risk Management Standards 13,30
4.5
Health and Social Care Guide section 5
4.6
NAfW NMS Care Homes for Older People standards 13,36
NAfW NMS Care Homes for Younger Adults standards
18,40
Level 2 National Occ. Standards in Care Unit CU1
Level 3 National Occ. Standards in Care Unit CU1
Level 3 National Occ. Standards in Prom. Ind. Unit CU1
4.7
NAfW NMS Care Homes for Older People standards
9,15.8
NAfW NMS Care Homes for Younger Adults standard 14
Level 2 National Occ. Standards in Care Units Z6,Z13
Level 3 National Occ. Standards in Care Units X10,X15
Level 3 National Occ. Standards in Prom. Ind. Unit X15
Tackling Coronary Heart Disease in Wales standard 1
Selected references
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Chartered Society of Physiotherapy. (2000) Core standards.
Available from: www.csp.org.uk
Chesson, R. and Duthie, J. (2000) Staff attitudes to physiotherapy and activities in private
nursing homes, Elderly Care; 12(1) p11-3.
College of Occupational Therapists. (2000) Code of Ethics and Professional Conduct for
Occupational Therapists.
27
Davies, S. and Ellis, L. and Laker, S. (2000) Promoting autonomy and independence for older
people within nursing practice: an observational study, Journal of Clinical Nursing; 9(1)
p127-36.
Dent, V. (2002) Promoting independence in dementia care, Nursing & Residential Care; 2(12)
p575-7.
Department of Health. (2001) Independent healthcare. Available from:
www.doh.gov.uk/ncsc/independenthealthcare.pdf.
Eisemann, M. and Richter, J. (1999) Relationships between various attitudes towards selfdetermination in health care with special reference to an advance directive, Journal of
Medical Ethics; 25(1) p37-41.
Evans, G. (2001) Dealing with advance statements (Living Wills). Pembrokeshire & Derwen
NHS Trust.
Faulkner, M. (2001) Empowerment in policy and practice, Nursing Times; 97(22) p40-1.
Gutteridge, T. (2000) Meeting a special need for confidence and independence, Journal of
Dementia Care; 8(5) p24-5.
Kennedy, A. and Rogers, A. (2001) Patient empowerment. Improving self-management skills:
a whole systems approach, British Journal of Nursing; 10(11) p734-7.
Laukkanen, P and Karppi, P and Heikkinen, E and Kauppinen, M. (2001) Coping with
activities of daily living in different care settings, Age & Ageing; 30(6) p489-94.
Lothian, K. and Philip, I. (2001) Maintaining the dignity and autonomy of older people in the
healthcare setting: care of older people, British Medical Journal; 322(7287) p668-70.
Mackenzie, A. (2001) Symposium on improving care of the elderly. Training to engage
residents with dementia in activities, British Journal of Therapy & Rehabilitation; 8(11) p406-9.
National Assembly for Wales. (2002) Consultation on Draft Regulations and Standards for
Domiciliary Care Agencies. Available from:
www.wales.gov.uk/subisocialpolicy/content/consultations/domiciliary/circular-letter-e.htm
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
National Assembly for Wales. (2001) Tackling coronary heart disease in Wales: implementing
through evidence. Available from:
www.wales.gov.uk/subihealth/content/keypubs/pdf/coronary-heart-disease-e.pdf
Nursing and Midwifery Council. (2002) Code of professional conduct. Available from:
www.nmc-uk.org/cms/content/Publications
28
Powell, J. and Bray, J. and Roberts, H. and Goddard, A. and Smith, E. (2000) Goal negotiation
with older people in three day care settings, Health & Social Care in the Community; 8(6)
p380-9.
Rasmussen, BH. and Sandman, PO. (1998) How patients spend their time in a hospice and in
an oncological unit, Journal of Advanced Nursing; 28(4) p818-28.
Ryder, E. and Wiltshire, S. (2001) Understanding empowerment, Nursing Times; 97(32) p39.
Welsh Assembly Government. (2002) Creating a unified and fair system for assessing and
managing care.
Welsh Assembly Government. (2002) Health and social care guide for Wales.
Welsh Assembly Government. (2002) National service framework for diabetes (Wales).
Available from: www.wales.nhs.uk/sites/documents/334/diabetes-standards-wales.pdf.
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh risk management standards.
Available from: http://howis.wales.nhs.uk/gsiteCW/home.cfm?orgid=287
29
5. Relationships
Principle
This principle applies to all care settings and
client groups, but the relevance of the
supporting Indicators may vary.
People must be encouraged to maintain their
involvement with their family and friends and
develop relationships with others, according
to their wishes.
This aspect of care includes arrangements for
people in hospital and in residential settings
to receive visitors, arrangements for
maintaining contacts with families and
friends, and meeting the needs of people who
are at risk of social isolation. This may be
because they are being cared for a long way
from their home, have restrictions placed on
their freedom and movement (e.g. by the
Mental Health Act), or have language/cultural
barriers or sensory impairment. People can
also be socially isolated in their own homes.
The needs and wishes of carers, family,
relatives and friends as advocates are very
important. Staff should help facilitate these
where ever possible. Most carers want to be
as closely involved with their relative or
friend as possible, and their contribution to
care and their role as advocate when the
cared-for person is unable or reluctant to
express their own needs is very important.
Occasionally, however, patients and clients
do not want the same level of involvement
from their family or friends, and in these
circumstances the first responsibility of care
staff is to respect the wishes of the cared-for
person.
Staff also need to respect the boundary
around their relationships with those they
care for. They must not enter into relationships that exploit people sexually, physically,
emotionally, socially or in any other manner.
They must not develop relationships which
compromise their professional judgement and
objectivity and/or give rise to advantageous
or disadvantageous treatment of the person
concerned.4
Practice Indicators
5.1 People are able to receive visitors within
reasonable hours, sensitive to the needs of
others.
Consideration is given to the condition of the
person. Where they are unable to make a
decision for themselves regarding visitors,
those close to that person should be
consulted. Equally if a person wishes to
restrict visiting at any time, staff support their
decision.
5.2 A comfortable area such as a visitors’
room is available for private telephone calls
or for people to spend time with relatives and
friends.
5.3 People are encouraged and enabled to be
part of the community.
5.4 The person decides how much their
family and any informal carers are involved
in their care.
5.5 If someone becomes critically ill,
arrangements are made to ensure that a
relative or friend can stay overnight, either in
the same place or in local accommodation.5
5.6 People are offered support with verbal
and written communication, particularly if
separated from family and friends in their
home culture or country of origin.6
5.7 People are put in touch with relevant
voluntary organisations if they want them to
provide a visiting service.
5.8 People are able to discuss their sexual
health needs and are supported in planning
to meet those needs.
30
Some examples of what the Indicators
mean in practice
●
Make sure that your “house rules” are
as relaxed and open about receiving
guests as they can be, particularly
within the context of shared
accom modation. Make sure these
rules are readily available and easily
understood.
●
Always encourage service users to
maintain their relationships with
family and friends.
●
Make private space available for
private meetings of family and friends.
●
Always be welcoming in your
approach to visitors, showing courtesy
and patience at all times.
●
Encourage the use of the telephone for
keeping in touch, by making it easily
accessible and making any procedure
for the payment of calls, easily
understood.
●
●
Sometimes your service user will want
friends or family to help care for him
or her by feeding or dressing for
example. This sort of help should be
encouraged, unless it would
compromise the health and safety of
your service user. If such help is not
appropriate, you should explain why
to both your service user and the
friend or family member.
●
If you are caring for someone from a
different culture, take the time to find
out from your service user, how links
with their family and/or country of
origin can be maintained. Your service
user may ask you to get in touch with
local community or spiritual leaders
for example. Such contact should be
welcomed and encouraged.
●
Most localities have a range of
voluntary organisations and
community groups who provide
befriending, visiting, good neighbour
schemes and the like. If your service
user asks to be put in touch with such
groups, this should be encouraged.
Most Social Services Departments
have “directories” of such services;
alternatively, the nearest Council for
Voluntary Service should be able to
help.
●
If developing or maintaining
relationships is a problem for your
service user because of
communication difficulties, find out
what local services are available and
get in touch with them. You may have
services for people who are blind,
deaf, dumb, learning disabled or
speech impaired, available locally.
●
People have a right to maintain their
sexual relationships, or develop new
ones so long as behaviour is
appropriate in public and open
spaces. If your service user wishes to
maintain such an existing relationship,
or develop a new relationship with a
consenting partner, private,
comfortable and appropriate space
should be made available. This may
include sharing a room for example.
It may be that your service user
expressly says that they do not wish
family or friends to be involved in any
way in their care; this wish should be
respected. The situation will require
you to deal tactfully but honestly with
friends and family should they raise
the matter with you.
31
●
Where such relationships are being
maintained, or are developing, always
ensure that the privacy and
confidentiality of the relationship is
maintained – it is nobody’s business
apart from the people in the
relationship.
●
If you suspect that your service user is
receiving attention that is upsetting to
them because they are perhaps
showing signs of distress following a
4
Derived from Code of Ethics and Professional Conduct for Occupational Therapists of
the College of Occupational Therapists
Arrangements only (and not reimbursement)
This does not include the cost of postage and phone calls
5
6
visit, you should report this to your
line manager and find gentle and
tactful ways of encouraging your
service user to talk to you about what
is troubling them. Such matters are
extremely sensitive: they cannot be
ignored, but neither can they be
managed in a tactless or aggressive
way. It may be that the use of an
advocate may be necessary in such
circumstances.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Unit 01
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Units
02,W5
Social Care Induction Framework Core Areas
1.1,2.1,3.1,4.2
5.1
NAfW NMS Care Homes for Older People standards 10, 34.2
NAfW NMS Care Homes for Younger Adults standards
13,15,39
Independent Healthcare D.O.H. Standard m 21
5.2
NAfW NMS Care Homes for Older People standards
10,14.3
NAfW NMS Care Homes for Younger Adults standards
13,15,18
Level 2 National Occ. Standards in Care Unit W2
5.3
NAfW NMS Care Homes for Younger Adults standard
13,15
Level 3 National Occ. Standards in Care Units Y3,Y5
Level 3 National Occ. Standards in Prom. Ind. Units Y3,Y5
5.4
NAfW NMS Care Homes for Younger Adults standard 15
Level 2 National Occ. Standards in Care Unit W2
5.5
NAfW NMS Care Homes for Older People standard 19.10
NAfW NMS Care Homes for Younger Adults standard 21
32
Fundamentals Indicator
Corresponding Standards
5.6
Level 2 National Occ. Standards in Care Units W2,W8
Level 3 National Occ. Standards in Prom. Ind. Units
W1,W5,W8
Welsh Risk Management Standards 8
5.7
NAfW NMS Care Homes for Older People standard 10
NAfW NMS Care Homes for Younger Adults standard 13
5.8
NAfW NMS Care Homes for Younger Adults standard 15
Level 3 National Occ. Standards in Prom. Ind. Unit W1
Selected references
Bergbom, I. And Askwall, A. (2000) The nearest and dearest: a lifeline for ICU patients,
Intensive & Critical Care Nursing; 16(6) p384-95.
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Clarke, C. and Harrison, D. (2001) The needs of children visiting on adult intensive care
units: a review of the literature and recommendations for practice, Journal of Advanced
Nursing; 34(1) p61-8.
Department of Health. (1997) A service on the edge: inspection report of social services for
deaf and hard of hearing people. HMSO. Available from:
www.doh.gov.uk/pdfs/ontheedge.pdf.
Department of Health. (2001) Independent healthcare. Available from:
www.doh.gov.uk/ncsc/independenthealthcare.pdf.
Garnham, P. (2001) Understanding and dealing with anger, aggression and violence, Nursing
Standard; 16(6) p37-42.
Hupcey, JE. (2001) The meaning of social support for the critically ill patient, Intensive &
Critical Care Nursing; 17(4) p206-12.
Mayers, CA. (2000) Quality of life: priorities for people with enduring mental health
problems, British Journal of Occupational Therapy; 63(12) p591-7.
33
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
NHS Executive. (1999) Doubly disabled: equality for disabled people in the new NHS access
to service. NHS Executive. Available from: www.info.doh.gov.uk/doh/point.nsf
Priestley, M. (1999) How critical care nurses identify and meet the needs of visitors to
intensive care units, Nursing in Critical Care; 4(1) p27-33.
Thomas, R. (2001) Patients’ perceptions of visiting: a phenomenological study in a specialist
palliative care unit, Palliative Medicine; 15(6) p499-504.
Ward, D. (2000) Clinical. Infection control: reducing the psychological effects of isolation,
British Journal of Nursing; 9(3) p162, 164-70.
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh risk management standards.
Available from: http://howis.wales.nhs.uk/gsiteCW/home.cfm?orgid=287
White, E. and Barnitt, R. (2000) Empowered or discouraged? A study of people with learning
disabilities and their experience of engaging in intimate relationships, British Journal of
Occupational Therapy; 63(6) p270-6.
34
6. Rest and sleep
Sleep is essential for good health and
recovery from illness. Most people develop a
personal balance between sleep, rest,
exercise and activity which meets their
individual needs. A change in health or
environment can disturb this balance, and
service users often complain that they are
unable to get enough sleep.
People may be embarrassed about sleeping
surrounded by strangers, or may be disturbed
by the behaviour of others. Inadequate sleep
at night may be reflected in sleeping during
the day, which may in turn exacerbate the
difficulty of sleeping at night.
People have altered sleep patterns for many
reasons. It is important to note that lack of
sleep can cause people to change their
behaviour, in turn affecting their quality of
life. For people in hospital the most common
problem is getting enough sleep as they are
disturbed by the ward activities and routines.
For people in residential care, the emphasis
may be on providing appropriate and
stimulating daytime activity. This aspect
applies to all settings and all client groups,
but the relevance of the Supporting Indicators
will vary according to the care setting and the
client group.
Principle
Consideration is given to people’s
environment and comfort so that they
may rest and sleep.
6.3 Waking, sleeping and resting times are as
flexible as possible to meet people’s needs
and preferences.
6.4 Where beds and bedding are provided,
efforts are made to ensure the person’s
comfort.
6.5 If a person’s sleep is disturbed, they are
made comfortable and offered the support
they need.
This could include sleep management and
relaxation techniques. Care should be taken
to guard against the danger of inappropriate
medication.
Some examples of what the indicators
mean in practice
●
Although organisation is important in
shared care settings such as hospital
wards and care homes, always
remember that the service is being
provided for the benefit of the people
who require the service, not those
providing it.
●
The balance between sleep, rest and
activity will be different for different
people and their ability and
motivation i.e. recovery will to
some extent be dependent upon their
individual needs being met.
●
Private space for TV, conversation and
visits should be made available, radios
should all have earphones attached.
●
Never assume that you know the
conditions that promote sleep; always
ask the person who is using your
services. Sometimes some people may
find shared accommodation
preferable.
●
Never assume that you know what the
“right” balance of sleep, rest and
activity is for people who use your
services; always ask and take what
measures are practical for meeting
Practice Indicators
6.1 Noise is minimised and levels of heat,
light and ventilation are controlled to help
people sleep at night.
6.2 Televisions and radios in shared sleeping
areas have earphones to enable individual
listening.
35
●
●
individual need.
Make sure that beds and bedding are
of appropriate quality and always
clean.
●
If your service user complains of being
uncomfortable, investigate the cause
thoroughly and take appropriate action
to remedy the situation.
Sleeplessness is usually distressing. It
is important that you respond with
patience, tolerance and compassion;
look for appropriate solutions to the
problem and never voice irritation or
annoyance.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Units 01,Z19
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
Social Care Induction Framework Core Areas 1.1,4.2,5.1
6.1
NAfW NMS Care Homes for Older People standard 39
NAfW NMS Care Homes for Younger Adults standard 37
Level 2 National Occ. Standards in Care Unit Z19
6.2
Level 2 National Occ. Standards in Care Unit Z19
6.3
Level 2 National Occ. Standards in Care Unit Z19
6.4
Level 2 National Occ. Standards in Care Unit Z19
6.5
Level 2 National Occ. Standards in Care Unit Z19
NSF for Older People:Medicines and Older People
Selected references
Brostrom, A. and Stromberg, A. and Dahlstrom, U. and Fridland, B. (2001) Patients with congestive heart failure and their conceptions of their sleep situation, Journal of Advanced
Nursing; 34(4) p520-9.
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
36
Church, L. and Davis, P. (1999) Sleep: the gentle healer, Journal of Orthopaedic Nursing;
3(Suppl.1) p53-8.
Department of Health. (2001) National Service Framework for Older People: Medicines and
Older People.
Duxbury, J. (1994) Avoiding disturbing sleep in hospitals, Clinical Night Nursing, Nursing
Standard; 9 (10) p31-4.
Ersser, S. and Wiles, A. and Taylor, H. and Wade, S. and Walsh, R. and Bentley, T. (1999)
The sleep of older people in hospital and nursing homes, Journal of Clinical Nursing; 8(4)
p360-8.
Hogg, G. (1998) Sleep deprivation in a high-dependency unit, Professional Nurse; 13(10)
p693-6.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
National Assembly for Wales. (2001) Tackling coronary heart disease in Wales:
implementing through evidence. Available from:
www.wales.gov.uk/subihealth/content/keypubs/pdf/coronary-heart-disease-e.pdf.
Reid, E. (2001) Clinical. Factors affecting how patients sleep in the hospital environment,
British Journal of Nursing; 10(14) p912-5.
Southwell, M; Wistow, G. (1995) In-patient sleep disturbance; the views of staff and patients,
Nursing Times; 91 (37) p29-31.
37
7. Ensuring comfort,
alleviating pain
This aspect of care includes basic
requirements for being comfortable, such as
being cool or warm enough, being in a
comfortable position and experiencing
appropriate levels of light and noise.
Attention is also necessary to specific
discomforts such as nausea or pain, which
are almost always possible to control to an
acceptable level for the individual service
user. This aspect of care also includes
emotional distress because psychological
well-being is so vital to a person’s overall
health. A person’s psychological state also
affects their perception of pain.
It must be remembered that pain and distress
are what the person says they are and, to this
end, the experience can be made worse by
several factors such as:
partnership with the person, should always
be considered. Helping people to cope with
chronic pain, discomfort and distress is a
particular challenge and requires support
from specialist services. When pain, distress
or other specific symptoms are directly
related to a physiological cause or a specific
treatment process, advice from the
appropriate agencies must be sought.
This Principle applies to all care settings but
the relevance of the supporting indicators will
vary according to whether the person is
receiving healthcare or social care and
whether or not he/she is acutely ill or living
with chronic pain or other symptoms caused
by a particular disease. This aspect of care
and the associated indicators do not include
the specification of particular types of medication or other treatment for which specialist
standards are available.
Principle
●
●
●
●
●
●
past experience;
fear;
anxiety;
stress;
distress;
the environment in which the
individual finds themselves i.e. their
own home or a care setting.
Levels of tolerance of pain and distress are
unique and their expression should never be
ignored, denied or dismissed by people who
are not actually experiencing the feeling or
symptom. Consideration must also be given
to those persons who are unable to
communicate their feelings of pain or
distress.
Those giving care need to be provided with
adequate and appropriate education and
training to allow them to recognise indicators
of discomfort, pain and distress. People who
are unable or unwilling to express themselves
verbally, are also entitled to full assessment.
Assessment with the family and carers, in
People must be helped to be as comfortable
and pain-free as their condition and
circumstances allow.
Practice Indicators
7.1 People are encouraged and given the
opportunity to express pain, discomfort or
emotional distress with support or assistance
offered promptly.
People’s personal environments and abilities
to effectively communicate are also
considered when discussing interventions that
make them feel comfortable.
7.2 If a person needs special aids or
equipment in order to maintain a comfortable
position, these are provided and they are
helped to use them correctly.
7.3 The person’s level of discomfort, pain or
distress is assessed. A plan for controlling or
relieving their pain or distress is agreed,
taking into account their preferences.
38
It may be appropriate to use assessment tools
to provide effective and appropriate
treatment. Results of decisions are recorded
for continuity of care.
●
Always take the situation of your
service user seriously; offer
reassurance and prompt action.
●
Ensure that you have taken all possible
appropriate action to respond to the
discomfort or distress of your service
user. This may require that you call on
specialist expertise e.g. GP, pain clinic
or a specialist nurse.
●
If a service user requests a review of
their treatment regime, do not respond
defensively to this, the fact that they
have asked, reflects a) their confidence
and b) their concern. Ensure that
matters are discussed with them.
●
Never assume that you know what
your service user needs to be
comfortable; always ask.
7.4 People have access to a range of
appropriate pain relieving therapies and
drugs in accordance with an assessment of
their needs.
7.5 Specialist advice is sought if their
symptoms or emotional distress are not
controlled or relieved.
Some examples of what the indicators
mean in practice
●
Make sure that your approach to your
service user is always supportive and
encouraging; if a person is
experiencing pain or distress you need
to know and the person needs to have
the confidence to tell you.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Units 01,Z8,Z19
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
Social Care Induction Framework Core Areas 1.1,4.2
7.1
NAfW NMS Care Homes for Older People standard 19.2
NAfW NMS Care Homes for Younger Adults standard 21
Level 2 National Occ. Standards in Care Unit Z19
Welsh Risk Management Standard 7
7.2
NAfW NMS Care Homes for Older People standard 36
NAfW NMS Care Homes for Younger Adults standard 40
Level 2 National Occ. Standards in Care Unit Z19
7.3
Level 2 National Occ. Standards in Care Units Z8,Z19
Level 3 National Occ. Standards in Care Unit Z8
Level 3 National Occ. Standards in Prom. Ind. Unit Z8
39
Fundamentals Indicator
Corresponding Standards
7.4
Level 2 National Occ. Standards in Care Unit Z19
7.5
Level 2 National Occ. Standards in Care Units Z8,Z19
Level 3 National Occ. Standards in Care Unit Z8
Level 3 National Occ. Standards in Prom. Ind. Unit Z8
Selected references
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Field, L. and Adams, N. (2001) Pain management 2: the use of psychological approaches to
pain, British Journal of Nursing; 10(15) p971-4.
Hodges, C. (1998) Easing children’s pain, Nursing Times; 94(10) p55-6, 58.
Hallström I. and Elander G. (2001) Needs during hospitalization: definitions and descriptions
made by patients, Nursing Ethics: an International Journal for Health Care Professionals;
8(5):409-18.
Howard, V. (2001) A holistic approach to pain, Nursing Times; 97(34) p34-5.
McNair, H. (1999) Let’s put an end to pain, Nursing Times; 95(6) p36-7.
McQuay, H. and Moore, A. and Justins, D. (1997) Fortnightly review: treating acute pain in
hospital, British Medical Journal; 314(7093) p1531-5.
Meeres, C. and McKenna, F. (2001) Dying with dignity, Nursing Times; 97(33) p36-7.
Morrissey, T. (2001) Bereavement Policy. Pembrokeshire and Derwen NHS Trust.
National Assembly for Wales. (2001) A review of palliative care services in Wales. Welsh
Medical Committee.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
Nichols K. (1993) Psychological Care in Physical Illness. Nelson Thornes.
40
O’Neill B. and Fallon M. (1997) ABC of palliative care: principles of palliative care and pain
control, British Medical Journal; 315(7111) p801-4.
Mann E. and Redwood S. (2000) Clinical. Improving pain management: breaking down the
invisible barrier, British Journal of Nursing; 9(19) p2067-72.
Regaard, A. (2000) Palliative care. The principles of pain management in advanced cancer,
British Journal of Community Nursing; 5(8) p382-6, 388.
Welsh Assembly Government. (2002) Adult Mental Health National Service Framework.
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh risk management standards.
Available from: http://howis.wales.nhs.uk/wrp
Yonwin, H. (2000) Self-directed learning…helping the client to be as comfortable as possible,
Nursing & Residential Care; 2(3) p140-3.
41
8. Personal hygiene,
appearance and foot care
Personal hygiene is important for the
maintenance of good physical health e.g. the
prevention of infection, for personal comfort
(e.g. for feeling clean and cool) and for
psychological reasons such as maintaining
confidence and self-esteem. “Looking good“
makes an important contribution to “feeling
good“ and is, therefore, a fundamental aspect
of care and not just a matter of personal
vanity.
When people are able to care for themselves,
personal hygiene habits are largely a matter
of personal preference and choice,
influenced by the individual’s culture and
religion. When people receive this care from
others, sensitivity to these same issues is
important.
The relevance of the supporting indicators
will vary according to the location and
peoples’ individual needs and preferences.
It is important that toiletries are provided for
people to meet their short term needs.
However, it is also important that people are
encouraged to have their own personal
clothing, toiletries and equipment.
Foot health is essential for maintaining good
foot function, which can help to prevent falls
(Principle 3) and is also an important part of
ensuring comfort and alleviating pain
(Principle 7). Neglect of foot health can lead
to lack of independence (Principle 4) lack of
mobility, (Principle 4) and the occurrence of
ulceration and infection (Principle 12). Uncut
toe nails alone are a common cause of
discomfort. Nail cutting is normally part of
personal hygiene.
Disabling foot conditions can cause
immobility and associated consequences –
namely, isolation and its attendant
psychological effects and dependence on
others.
Foot problems can result from a range of
medical conditions. People with impaired
circulation, who can include Diabetics,
require assessment and/or care to the feet by
State Registered Podiatrists.
Principle
People must be supported to be as
independent as possible in taking care of their
personal hygiene, appearance and feet.
Practice Indicators
8.1 People’s personal hygiene, appearance
and foot care are discussed with them and
any assistance is based on their needs.
8.2 People are helped as necessary to keep
their feet comfortable to enable them to be as
mobile and independent as possible.
8.3 Facilities and equipment for all aspects of
personal hygiene and appearance are
accessible, clean and well maintained.
This includes washing, shaving, bathing,
the use of make-up, care of hair and nails,
dressing and undressing.
8.4 Wash bowls and towels are provided for
personal use as necessary. Toiletries are
provided to meet any short-term needs.
After use, bowls are promptly cleaned, dried
and inverted for storage.
8.5 Care is discreet and sensitive, ensuring
privacy.
8.6 People are referred to a State Registered
Podiatrist / Chiropodist for assessment if they
have a condition or illness which may require
specialist foot care. A plan of care is then
agreed with the person and their carer.
8.7 People are encouraged and helped to
select, purchase and wear their own clothes
and shoes.
8.8 Arrangements can be made for people’s
clothes to be laundered and maintained.
42
Some examples of what the indicators
mean in practice
●
Never fail to recognise the importance
of this aspect to most people; its denial
can lead to poor morale, motivation
and self-confidence.
●
Always have available the basic
requisites to maintain this aspect.
●
Always ensure that items such as
brushes, combs, facecloths etc. are
kept for personal use, and hygienically
maintained.
●
●
Make sure that privacy is available for
people whose personal needs are
being attended to.
Never make assumptions about
personal preferences, always ask your
service user and respect their wishes.
●
The individual preferences of people
using services e.g. the style in which
they wish to wear their hair, or the
way in which they wish make-up to be
applied, are not subjects for informal
chit-chat. Always treat people’s
preferences with respect.
●
Where purchase of clothes is
concerned, wherever possible, your
service user should be encouraged to
choose his or her own clothes and
accessories.
●
Make sure that you always know to
whom items of clothing belong.
●
Your service user wearing someone
else’s clothing is not acceptable.
●
The clothes, accessories and toiletries
of the person using your services
should always be treated with the
same respect as you would afford
your own.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Units 01,Z9
Level 3 National Occ. Standards in Care Units 02,Y5
Level 3 National Occ. Standards in Prom. Ind. Units 02,Y5
Social Care Induction Framework Core Areas 1.1,4.2
8.1
NAfW NMS Care Homes for Older People standard 15
NAfW NMS Care Homes for Younger Adults standard 19
Level 2 National Occ. Standards in Care Unit Z9
NMC Code of Professional Conduct section 2
8.2
NAfW NMS Care Homes for Older People standard 15
NAfW NMS Care Homes for Younger Adults standard 19
8.3
NAfW NMS Care Homes for Older People standards 35,40
NAfW NMS Care Homes for Younger Adults standard 38
Level 2 National Occ. Standards in Care Unit Z9
Welsh Risk Management Standard 14
43
Fundamentals Standard
Corresponding Standards
8.4
Level 2 National Occ. Standards in Care Unit Z9
8.5
NAfW NMS Care Homes for Older People standard 14.2
NAfW NMS Care Homes for Younger Adults standard 18
Level 2 National Occ. Standards in Care Unit Z9
8.6
NAfW NMS Care Homes for Older People standard 15.11
NAfW NMS Care Homes for Younger Adults standard 19.2
8.7
NAfW NMS Care Homes for Older People standard 14.4
NAfW NMS Care Homes for Younger Adults standard 18
Level 2 National Occ. Standards in Care Unit Y1
8.8
NAfW NMS Care Homes for Older People standard 14.4
NAfW NMS Care Homes for Younger Adults standard 18
Level 2 National Occ. Standards in Care Unit Y1
Selected references
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Collins, F. (2001) Choosing bathing, showering and toileting equipment, Nursing & Residential
Care; 3(10) p488-9.
Department of Health. (2000) Care homes for older people, Care Standards Act 2000.
Available from: www.doh.gov.uk/ncsc/carehomesforolderpeople.pdf.
Ford, P. and McCormack, B. and Wills, T. and Dewing, J. (2000) Defining the boundaries:
nursing and personal care, Nursing Standard; 15(3) p43-5.
Jevon, P. and Jevon, M. (2001) Practical procedures for nurses: Face shaving, Nursing Times;
97(11) p43-4.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
Nursing and Midwifery Council. (2002) Code of professional conduct. Available from:
www.nmc-uk.org/cms/content/Publications
44
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh risk management standards.
Available from: http://howis.wales.nhs.uk/wrp
Whiller, J. and Cooper, T. (2000) Clean hands: how to encourage good hygiene by patients,
Nursing Times; 96(46) p37-8.
Whiting, LS. (1999) Maintaining patients’ personal hygiene, Professional Nurse; 14(5)
p338-40.
Yonwin, H. (2000) Self-directed learning…enabling clients to maintain their personal hygiene
and appearance, Nursing & Residential Care; 2(5) p243-7.
45
9. Eating and drinking
This aspect of care includes the choice,
presentation, and availability of food, as well
as helping those who need assistance to eat
and drink.
Proper nutrition, that is food and drink, is
important for recovery from illness, for the
healing of wounds and for good health. Food
also plays an important social role. Missing
meals, being unable to obtain snacks and
drinks, and the lack of help for people who
are unable to feed themselves are concerns
wherever people are cared for.
Some people have problems with chewing
and swallowing food. This can sometimes be
related to oral health (see Aspect 10) or a
stroke. People cannot eat or drink properly if
their mouth is sore, or if they have problems
with their teeth or dentures.
Proper nutrition can depend on food
preferences. Choice of food is influenced by
people’s cultural practices, religious beliefs
and individual tastes.
Staff should ensure that people are clear
about what is achievable.
9.3 Food and drink are served in an
acceptable setting. They are at the right
temperature and attractively presented.
9.4 If a meal is missed, alternative food is
offered and/or snacks and drinks can be
accessed at any time.
9.5 Fresh drinking water is available at all
times, except when restrictions are required
as part of treatment.
9.6 People are provided with special diets in
accordance with their medical needs.
This also includes modified food.
9.7 If eating and/or drinking cause people
difficulties, they receive prompt assistance,
encouragement and appropriate aids or
support.
People with swallowing difficulties are
assessed by a speech and language
therapist and where necessary training in
assisting people to swallow food or drink
safely is given.
Some examples of what the indicators
mean in practice
●
Always provide food of good
nutritional quality, hygienically
prepared and thoroughly cooked.
●
Provide as much variety as is
practicable for your service; always
provide an alternative menu.
●
Allow people time to eat their food
without rushing.
●
If your service user misses a meal or is
not hungry at the mealtime, check
regularly whether refreshment is
required and offer it appropriately.
●
Make sure food looks attractive on the
plate and is of the right temperature;
ensure that pride is taken in the
presentation of the meal.
Principle
People must be offered a choice of food and
drink that meets their nutritional and personal
requirements and provided with any
assistance that they need to eat and drink.
Practice Indicators
9.1 People’s nutritional needs and physical
ability to eat and drink are regularly assessed.
If necessary, they are provided with specialist
advice and support.
9.2 People are encouraged to eat nutritious,
varied, balanced meals, hygienically
prepared and served at regular times.
46
●
Make sure that fresh drinking water is
always available. If you are unsure
about how long water has been in a
glass or jug, change it.
●
Always tell your service user when
you have refreshed their glass or
mug and tell them where you have
placed it.
●
Inappropriate levels of nutrition and
hydration can lead to rapid
deterioration in frail, vulnerable
people. If you have any worrying
observations about your service user,
report these and seek further advice.
●
●
Always provide the direct help that
people need in order to eat and drink.
●
Never leave a drink out of the reach of
your service user.
As people approach the end of their
lives, their willingness to eat and drink
often becomes considerably less; very
sensitive discussions will need to take
place at such times; always report
your concerns to your manager;
always seek advice and call on
specialist expertise whenever
necessary; always ensure that
concerns are discussed with family
and relevant health and care staff in
these circumstances.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Units 01,NC12
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
Social Care Induction Framework Core Areas 2.5,4.2
9.1
NAfW NMS Care Homes for Older People standard 15.9
NAfW NMS Care Homes for Younger Adults standard 19
and supplementary standard 17
Health and Social Care Guide section 5
Level 2 National Occ. Standards in Care Units NC12,NC13
NHS Nutrition and Catering Framework areas 9,10
Nutrition Strategy for Wales action 13
Welsh Risk Management Standard 23
9.2
NAfW NMS Care Homes for Older People standards
16,18.2,34.2
CSIW NMS Care Homes for Younger Adults standards
17,33,39
Health and Social Care Guide section 5
Level 2 National Occ. Standards in Care Unit NC13
NHS Nutrition and Catering Framework areas 3,11,12
Nutrition Strategy for Wales action 24
Tackling Coronary Heart Disease in Wales standard 1
Welsh Risk Management Standard 23
47
Fundamentals Indicator
Corresponding Standards
9.3
NAfW NMS Care Homes for Older People standard 16
NAfW NMS Care Homes for Younger Adults standard 17
Level 2 National Occ. Standards in Care Unit NC12
NHS Nutrition and Catering Framework area 12
9.4
Health and Social Care Guide section 5
NHS Nutrition and Catering Framework area 11
Level 2 National Occ. Standards in Care Unit NC13
9.5
Nutrition Strategy for Wales action 24
9.6
NAfW NMS Care Homes for Older People standards
16.5,16.6
NAfW NMS Care Homes for Younger Adults standard 17
Level 2 National Occ. Standards in Care Units NC12,NC13
NHS Nutrition and catering Framework areas 9,10,11
9.7
NAfW NMS Care Homes for Older People standard 16.9
NAfW NMS Care Homes for Younger Adults standard 17
Health and Social Care Guide section 5
Level 2 National Occ. Standards in Care Unit NC12
NHS Nutrition and catering Framework area 12
Selected references
Anderson, P. (2000) Tickling patients’ taste buds, Nursing Times; 96(50) p24-6.
Barratt, J. (1999) Snacks as nutritional support in dementia care, Nursing Times; 95(32) p46-7.
Bond, S. (1998) Eating matters – improving dietary care in hospitals, Nursing Standard; 12(17)
p41-2.
Brown, J. and Marland, G. (2002) Hydration in older people with mental health problems,
Nursing Times; 98(3) p38-9.
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
48
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Clay M. (2000) Nutritious, enjoyable food in nursing homes, Elderly Care; 12(3) p11-6.
Goldhill, MA. (2000) Clinical guideline: 1. Feeding critically ill patients, Care of the Critically
Ill; 16(1) p20-1.
Hamilton K. and Spalding D. and Steele C. and Waldron S. (2002) An audit of nutritional care
delivered to elderly inpatients in community hospitals; Journal of Human Nutrition &
Dietetics; 15(1) p49-58.
Horan, D. and Coad, J. (2000) Can nurses improve patient feeding?, Nursing Times; 96(50)
p33-4.
Mitchell H. (1999) Nutrition audit at a community hospital, Journal of Human Nutrition &
Dietetics; 12(5) p425-32.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
National Assembly for Wales. (2001) Tackling coronary heart disease in Wales: implementing
through evidence. Available from:
www.wales.gov.uk/subihealth/content/keypubs/pdf/coronary-heart-disease-e.pdf
NHS Estates. (2002) Better hospital food. Part of improving the patient experience. Available
from: www.nhsestates.gov.uk/patient environment/content/food.html
Steele, C. (1998) The links in the food chain…tailoring a menu to suit all patients’ clinical
requirements, Nursing Standard; 12(49) p25-7.
Welsh Assembly Government (2002) Diabetes National Service Framework Standards (Wales).
Welsh Assembly Government. (2002) Health and social care guide for Wales.
Welsh Assembly Government. (2002) Nutrition and catering framework. All-Wales
Catering/Nutrition Group.
Welsh Assembly Government. (2002) Nutrition Strategy for Wales Consultation Document.
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh risk management standards.
Available from: http://howis.wales.nhs.uk/wrp
Wood, S. (1998) Full-service…nutritional aspects of nursing, Nursing Times; 94(32) p24-6.
49
10. Oral health and hygiene
This aspect of care includes care of the
mouth and teeth (including dentures).
Although this is normally part of personal
hygiene (see Principle 8) it is of particular
importance for people who are ill or
receiving long-term care and is therefore
included separately here. Oral health is
necessary for Eating and Drinking (Principle
9), and is also an important part of Ensuring
Comfort, Alleviating Pain (Principle 7);
neglect of oral health can also lead to
infection (Principle 3). People who are
unable to eat and drink normally, who are
severely debilitated or unconscious, or who
are receiving certain therapies e.g.
radiotherapy, or certain drugs are especially
vulnerable.
The care, safety and security of an
individual’s dentures are important to
retaining dignity and maintaining nutrition;
loss of dentures can affect quality of life
(Principle 9: Eating and Drinking), Personal
Appearance (Principle 8), and personal and
social relationships (Principle 5).
10.2 People are encouraged and helped to
care for their mouths with all procedures and
routines explained in advance and support
available when needed.
10.3 A toothbrush and toothpaste or denture
brush and bowl are provided to meet shortterm needs.
10.4 If appropriate, people are able to have
their dentures identified with their name in
case they are lost and they are stored safely
when not in use.
10.5 If someone has no teeth or dentures,
they still receive support to ensure their
mouth is comfortable and healthy.
10.6 If people have any specific problems
with their mouth, teeth, dentures or gums,
arrangements are made for them to see a
dentist, if necessary in their own home.
10.7 People are offered appropriate check-up
appoinments with a dentist in accordance
with their needs.
Some examples of what the indicators
This Principle and most of its indicators apply mean in practice
to all care settings and all client groups, but
some are more relevant for people receiving
long term care, others are especially
important for people who are ill.
Principle
People must be supported to maintain
healthy, comfortable mouths and pain-free
teeth and gums, enabling them to eat well
and prevent related problems.
●
Oral health and hygiene is often not
the most urgent of care needs. Never
overlook it.
●
Make time available to help support
your service user in caring for their
own oral hygiene if this is possible for
them to do.
●
Where this is not possible, ensure a
regular routine for oral hygiene e.g.
always clean away food from around
the mouth when eating is finished.
●
If specific procedures have been
recommended as part of a treatment
plan, always explain what you are
going to do and why.
Practice Indicators
10.1 Following assessment, a plan of care
to keep the person’s mouth healthy and
comfortable is agreed with them.
For guidance on suitable assessment tools,
please see the section Assessment tools
below.
50
●
Make sure toothbrushes, toothpaste
and bowls are available to people who
need them and confined to personal use.
●
Never allow your service user’s
dentures to get mixed up with those of
other people.
●
If your service user complains of
discomfort in their mouth, seek the
advice of a dentist.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Units 01,Z9
Level 3 National Occ. Standards in Care Units 02,Y5
Level 3 National Occ. Standards in Prom. Ind. Units 02,Y5
Social Care Induction Framework Core Areas 1.1,4.2
10.1
NAfW NMS Care Homes for Older People standard 2
NAfW NMS Care Homes for Younger Adults standard 2
Level 2 National Occ. Standards in Care Unit Z9
10.2
NAfW NMS Care Homes for Older People standard 15.2
NAfW NMS Care Homes for Younger Adults standard 19
Level 2 National Occ. Standards in Care Unit Z9
10.3
Level 2 National Occ. Standards in Care Unit Z9
10.5
Level 2 National Occ. Standards in Care Unit Z9
10.6
NAfW NMS Care Homes for Older People standard 15.11
NAfW NMS Care Homes for Younger Adults standard 19.2
Level 2 National Occ. Standards in Care Unit Z9
10.7
NAfW NMS Care Homes for Older People standard 15.11
NAfW NMS Care Homes for Younger Adults standard 19.2
Level 2 National Occ. Standards in Care Unit Z9
51
Assessment tools
Eilers J, Berger A, Peterson M. (1988). Development, testing and application of the oral assessment guide. Oncology Nursing Forum; 15(3) p325-330.
Fiske J, Lewis D. (2001) BSDH Guidelines for the oral management of oncology patients
requiring radiotherapy, chemotherapy and bone marrow transplantation. Journal of Disability
and Oral Health; 2(1) p3-14.
This contains an oral assessment tool and practical nursing oral care guidelines at the
different stages of treatment.
Griffiths J. (2002) Guidelines for oral health care for people with physical disability. Journal of
Disability and Oral Health; 3(2) p51-58.
This contains a simple assessment tool to identify clients who have oral and/or dental problems, are not receiving regular dental care and/or are at risk of poor oral health. Subjective
indicators include the ability to speak, smile or eat without pain or discomfort.
This example of an Oral Health Assessment may be adapted to suit any client group or used
for self assessment.
Griffiths J, Lewis D. (2002) Guidelines for the oral care of patients who are dependent,
dysphagic or critically ill. Journal of Disability and Oral Health; 3(1) p30-33.
This contains an oral assessment guide designed as a flow chart with practical guidance on
techniques and materials.
Rattenbury N, Mooney G, Bowen J. (1999) Oral assessment and care for inpatients. Nursing
Times; 95(49) p52-53.
Griffiths JE. (1996) Working with nurses who care for clients with cognitive impairment.
International Dental Journal; Abstract A96 46(4) Supplement 2 p440.
Griffiths JE, Williams J. (1998) Risk factors for oral health in neuro-psychiatric patients in a
rehabilitation unit. Japanese Society of Dentistry for the Handicapped; Abstracts /
Proceedings. Vol 19; Supplement. September p347.
Selected references
Age Concern. Dental Care and Older People. Factsheet 5. Available from:
www.ageconcern.org.uk
Alzheimer’s Society. (2001) Dental care and dementia.
Arnold, C. and Brookes, V. and Griffiths, J. and Maddock, S. and Theophilou, S. (2000)
Guidelines for oral health care for people with a physical disability. British Society for
Disability and Oral Health. Available from: www.bsdh.org.uk/home/guidelines/physical.pdf.
Blinkhorn, AS. (2002) The scientific basis of dental health education (4th ed). Health
Development Agency.
52
Bowsher, J. and Boyle, S. and Griffiths, JA. (1999) A clinical effectiveness systematic review of
oral care, Nursing Standard; 13(37) p31.
Budtz-Jorgensen E, Mojon P, Rentsch A, Deslauriers N. Effects of an oral health programme on
the occurrence of oral candidosis in a long-term care facility. Community Dental Oral
Epidemiology 2000; 28(2) p141-149.
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Davies, R. and Bedi, R. and Scully, C. (2000) ABC of oral health: oral health care for patients
with special needs, British Medical Journal; 321(7259) p495-8.
Department of Health. (2001) The essence of care. Available from:
www.doh.gov.uk/essenceofcare/index.htm.
Field, D. (1998) Practical procedures for nurses. Mouth care, Nursing Times; 94(7) insert 2p
Fiske, J. and Griffiths, J. and Jamieson, R. and Manger, D. (2000) Guidelines for oral health
care for long-stay patients and residents. British Society for Disability and Oral Health.
Available from: www.bsdh.org.uk/home/guidelines/longstay.pdf.
Fiske K, Lloyd HA. Dental needs of residents and carers in elderly people’s homes and carers’
attitudes to oral health. European Journal of Prosthodontic Restorative Dentistry 1992; 1
p91-95.
Frenkel HF. Behind the screens: care staff observations on delivery of oral health care in nursing homes. Gerodontology 1999; 16(2) p75-80
Frenkel H, Harvey I, Newcombe RG. Oral health care among nursing home residents in
Avon. Gerodontology 2000; 17(1) p33-38.
Griffiths, J. and Jones, V. and Leeman, I. and Lewis, D. and Patel, K. and Wilson, K. (2000)
Guidelines for the development of local standards of oral health care for dependent, dysphagic, critically and terminally ill patients. British Society for Disability and Oral Health.
www.bsdh.org.uk/home/guidelines/depend.pdf.
Griffiths, J. and Jones, V. and Leeman, I. and Lewis, D. and Patel, K. and Wilson, K. and
Blankenstein, R. (2000) Oral health care for people with mental health problems guidelines
and recommendations. British Society for Disability and Oral Health. Available from:
www.bsdh.org.uk/home/guidelines/mental.pdf.
53
Heath R, Muller F, Lewis D, McKerlie R. Standards of dental care in residential homes: a Web
Way Forward. Gerodontology 1999; 16(2) p123-125.
Help the Aged. (2002) Oral health and older people.
Imsand M, J-P Janssens, Auckenthaler R, Mojon P, Budtz-Jorgensen E. Bronchopneumonia and
oral health in hospitalised older patients. Gerodontology 2002; 19(2) p66-72.
Levine, RS. And Stillman, C. (2001) The scientific basis of dental health education: a policy
document. NHS Health Development Agency.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
Royal College of Surgeons of England and British Society for Disability and Oral Health.
(2001) Clinical guidelines and integrated care pathways for the oral health care of people
with learning disabilities. Available from: www.rcseng.ac.uk/dental/fds/pdf/icppld.pdf
Royal College of Surgeons England, Dental Faculty. (2000) Guidelines on the management of
oncology patients.
Sumi Y, Miura H, Sunakawa M, Michiwaki Y, Sakagami N. Colonization of denture plaque by
respiratory pathogens in dependent elderly people. Gerodontology 2002; 19(1) p25-29.
Taylor GW, Loesche WJ, Terpenning MS. Impact of oral disease on systemic health in the elderly: diabetes mellitus and aspiration pneumonia. Journal of Public Health Dentistry 2000;
60(4) p313-320.
Terpenning MS, Bradley SF, Wan JY, Chenoweth CE, Jorgensen KA, Kauffman CA.
Colonozation and infection with antibiotic resistant bacteria in a long term care facility.
Journal American Geriatric Society 1994; 42(10) p1062-1069.
54
11. Toilet needs
This aspect of care is about bladder and
bowel functions, which are a private and
intimate part of people’s lives. Being
dependent on the help of others for managing
them often embarrasses people. This places a
special responsibility on those providing care
to acknowledge and respect these feelings,
and to pay special attention to maintaining
the person’s privacy and dignity (see Aspect 2).
This Aspect of care includes taking people to
the toilet, helping people to use bedpans,
commodes, urinals and other special devices,
helping them to manage their clothing, and
clean and dry their skin. It focuses on the
promotion and maintenance of continence.
Specific procedures such as the management
of catheters, stomas, administering
suppositories, and the management of
incontinence are outside the scope of these
indicators.
This principle and most of the indicators
apply to all care settings and to all client
groups, but the way in which they are put
into practice will vary. For example in old
buildings or in an individual’s own home
some indicators (e.g. 11.1) may be difficult to
achieve. For some people, for example those
who are unable to walk, the problem is not
managing their bladder and bowel functions
but getting to and from the toilet; for others
the problem is communicating or recognising
their need.
Principle
Appropriate, discreet and prompt assistance
must be provided when necessary, taking into
account any specific needs and privacy.
11.2 A person who has difficulty in
controlling their bladder or bowel functions is
offered an assessment by a professional
health worker and a plan of care is agreed.
11.3 Toilet facilities are clean and
appropriately equipped with toilet paper,
soap and fresh hand towels.
11.4 Toilet facilities shared by others have
clear signs and provide privacy.
11.5 If required, people are helped to manage
their bladder and bowel functions with
privacy and dignity, maintaining their
continence and giving them as much
independence as possible.
11.6 If necessary, people are aware of and
have easy access to methods for calling
assistance.
11.7 Body waste is hygienically disposed of
promptly, appropriately and with sensitivity.
11.8 People have access to hand washing
facilities after using the toilet or equivalent
equipment e.g. a commode.
Particular attention is given to infection
control.
Some examples of what the indicators
mean in practice
●
Always respond to people’s need to
toilet promptly.
●
Never show irritation or annoyance
whatever the circumstances.
●
Always approach problems of
incontinence with compassion and
sensitivity; it is often the most
demoralising aspect of frailty.
●
Always ensure that dignity and privacy
is maintained.
●
Always ensure that toilets, commodes,
Practice Indicators
11.1 People’s need of assistance to get to or
use the toilet are assessed and if appropriate
they are enabled to use the toilet (or
commode) independently.
55
towels and the like, are as attractive as
possible to use and never dirty or
poorly maintained.
●
Make sure that your service user has
easy access to a means by which they
can notify you of their needs.
●
Never enter a room e.g. bathroom or
toilet without knocking.
●
●
Always ask your service user how they
wish to be helped in dealing with their
toileting needs – never make
assumptions.
Never leave commodes and the like
either unemptied or on view – such
practices compromise your service
user’s dignity and right to privacy.
●
Never leave bedpans or bottles on
beds, lockers or floors.
●
Always offer assessment where
incontinence is an issue.
●
Always ensure that your service user is
clean and as comfortable as possible
following toileting.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Units 01,Z11
Level 3 National Occ. Standards in Care Units 02,Z12
Level 3 National Occ. Standards in Prom. Ind. Units
02,Z12
Social Care Induction Framework Core Areas 1.1,4.2
11.1
NAfW NMS Care Homes for Older People standard 36
NAfW NMS Care Homes for Younger Adults standard 40
Level 2 National Occ. Standards in Care Unit Z11
Level 3 National Occ. Standards in Care Unit Z12
Level 3 National Occ. Standards in Prom. Ind. Unit Z12
11.2
NAfW NMS Care Homes for Older People standard 15.6
NAfW NMS Care Homes for Younger Adults standard 19
Level 3 National Occ. Standards in Care Unit Z12
Level 3 National Occ. Standards in Prom. Ind. Unit Z12
11.3
NAfW NMS Care Homes for Older People standards
35,36,40.1
NAfW NMS Care Homes for Younger Adults standards
38,40,41
Health and Social Care Guide section 5
Level 2 National Occ. Standards in Care Unit Z11
56
Fundamentals Indicator
Corresponding Standards
11.4
Health and Social Care Guide section 5
Level 2 National Occ. Standards in Care Unit Z11
Level 3 National Occ. Standards in Care Unit Z12
Level 3 National Occ. Standards in Prom. Ind. Unit Z12
11.5
NAfW NMS Care Homes for Older People standard 14.2
NAfW NMS Care Homes for Younger Adults standard 18
Level 2 National Occ. Standards in Care Unit Z11
Level 3 National Occ. Standards in Care Unit Z12
Level 3 National Occ. Standards in Prom. Ind. Unit Z12
11.6
NAfW NMS Care Homes for Older People standard 36.8
NAfW NMS Care Homes for Younger Adults standard 40
Level 2 National Occ. Standards in Care Unit Z11
11.7
Level 2 National Occ. Standards in Care Unit Z11
Level 3 National Occ. Standards in Care Unit Z12
Level 3 National Occ. Standards in Prom. Ind. Unit Z12
Welsh Risk Management Standard 35
11.8
Level 2 National Occ. Standards in Care Unit Z11
Selected references
Anonymous. (2000) Self-directed learning…access and use the appropriate toilet facilities,
Nursing & Residential Care; 2(5) p243-7.
Beresford SA. (1997) Combined toilets and bidets for use by people with a disability, British
Journal of Therapy & Rehabilitation; 4(9) p481-2, 484-6.
Cadd, A. and Keatinge, D. and Henssen, M. and O’Brien, L. and Parker, D. and Rohr, Y. and
Schneider, J. and Thompson, J. (2000) Assessment and documentation of bowel care
management in palliative care: incorporating patient preferences into the care regimen,
Journal of Clinical Nursing; 9(2) p228-35.
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
57
Collins, F. (2001) Choosing bathing, showering and toileting equipment, Nursing &
Residential Care; 3(10) p488-9.
Dean R. (1999) Considerations for bathroom equipment and adaptations, Nursing &
Residential Care; 1(3) p164-6, 190-1.
Department of Health. (1999) Guidance of continence services.
Dowse, J. and Mackender, J. (2000) Back to basics: continence, Nursing Times; 96(30) p7-9.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
Roe, B. and Whattam, M. and Young, H. and Dimond, M. (2001) Elders’ needs and
experiences of receiving formal and informal care for their activities of daily living, Journal of
Clinical Nursing; 10(3) p389-97.
Royal College of Nursing. (1999) Commissioning continence advisory service RCN guide.
Available from: www.rcn.org.uk/rcn_extranet/media/continence1410.pdf.
Taylor-Cookson, J. and Mitchell, J. (2001) Toileting equipment for children with special needs,
British Journal of Therapy & Rehabilitation; 8(9) p352-6.
Welsh Assembly Government. (2002) Health and social care guide for Wales.
Welsh Assembly Government. (2002) Nutrition and catering framework. All-Wales
Catering/Nutrition Group.
Welsh Assembly Government and Welsh Risk Pool. (2002) Welsh risk management standards.
Available from: http://howis.wales.nhs.uk/wrp
Willis, J. (2000) Bowel management and consent, Nursing Times; 96(6 Ntplus) p7-8.
58
12. Preventing pressure sores
Current literature refers to pressure “ulcers”.
However for the purpose of this document
the term “sore” has been used, following
extensive public consultation.
A pressure sore is a breakdown of the skin
and underlying tissue, which occurs, usually
over bony areas such as the sacrum,
buttocks, heels, shoulders, and elbows, as a
result of unrelieved pressure, shear or friction.
Anyone whose mobility is limited by being
confined to a bed or chair because of injury,
illness or frailty, including those with mental
health needs or a learning disability, is
vulnerable. There is even a risk to those who
spend a relatively short time on an operating
theatre table or patient trolley. This risk
increases with prolonged immobility, poor
nutrition, obesity, excessive thinness,
debilitating illness, lowered mental
awareness, (or loss of consciousness), moist
skin due to sweating or incontinence,
over-hydration, or dehydration.
Pressure sores are serious, and may become a
life-threatening problem for individuals
receiving care in any setting. If individuals at
risk are identified and the appropriate skin
care and attention is received, giving all due
regard to all the specific factors which may
increase the risk, the likelihood of pressure
sores can be limited. It is therefore a
fundamental aspect of care, and, part of the
responsibility of the care team. This aspect of
care does not include the treatment of
established pressure sores, for which
specialist clinical guidelines are available.
Where any of the risk factors mentioned
above are present, people receiving care in
their own homes or residential settings should
be assessed by a district nurse.
of the indicators will vary with the location
and the client group.
Principle
People must be helped to look after their skin
and every effort made to prevent them
developing pressure sores.
Practice Indicators
12.1 People are assessed for risk of pressure
sores and if considered at risk, they receive
further assessment by a registered nurse and a
plan of care is drawn up.
12.2 People are made aware of the risks of
pressure sores and shown ways of preventing
them. They and those caring for them are
encouraged and advised on appropriate care
procedures.
12.3 Appropriate beds, chairs and other
equipment are made available to reduce the
risks of pressure sores. More specialist
preventative equipment such as special
mattresses and cushions are also available if
necessary. All equipment is clean and
properly maintained.
12.4 Correct moving techniques are
encouraged, including regular turning and
appropriate self-care, helping people to avoid
pressure sores, increasing their well-being,
independence and dignity.
12.5 If a person is at risk, their skin is
checked at least once daily, preferably when
their personal hygiene is attended to.
12.6 A person who is at risk or who has a
pressure sore has access to advice from a
registered nurse. This includes assessment
and a plan of care based on recognised best
practice.
This Principle is relevant to all care settings
and client groups, but the relevance of some
59
Some examples of what the indicators
mean in practice
●
Prevention is better than cure. Nearly
all pressure sores can be prevented.
●
Listen carefully to what the person
says about how their skin feels e.g.
itching, burning. Teach them what
they can do for themselves to keep
their skin in good condition.
●
Teach the person to change their
position frequently.
●
Check every day for any changes in
condition or colour of the skin e.g.
redness, dryness or soreness.
●
If you are in any doubt, get advice.
●
If you are a commissioner of services,
make sure that you have a clear policy
about the responsibility for provision
of appropriate equipment to prevent or
relieve pressure sores.
Cross references
Fundamentals Indicator
Corresponding Standards
Principle
Level 2 National Occ. Standards in Care Unit 01
Level 3 National Occ. Standards in Care Unit 02
Level 3 National Occ. Standards in Prom. Ind. Unit 02
Social Care Induction Framework Core Areas 1.1,4.2
12.1
NAfW NMS Care Homes for Older People standard 15.3
NAfW NMS Care Homes for Younger Adults standard 19
Level 2 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Prom. Ind. Unit Z7
NICE Pressure ulcer risk assessment and prevention
12.2
Level 2 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Prom. Ind. Unit Z7
NICE Pressure ulcer risk assessment and prevention
12.3
Level 2 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Prom. Ind. Unit Z7
NICE Pressure ulcer risk assessment and prevention
12.4
Level 2 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Prom. Ind. Unit Z7
NICE Pressure ulcer risk assessment and prevention
60
Fundamentals Indicator
Corresponding Standards
12.5
Level 2 National Occ. Standards in Care Units Z7,Z9
Level 3 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Prom. Ind. Unit Z7
NICE Pressure ulcer risk assessment and prevention
12.6
Level 2 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Care Unit Z7
Level 3 National Occ. Standards in Prom. Ind. Unit Z7
NICE Pressure ulcer risk assessment and prevention
Selected references
Adcock, L. (2001) Preventing pressure ulcers: the work of the residential homes nursing team,
Nursing Older People; 13(1) p14-6.
Care Council. (2002) Codes of Practice for Social Care Workers. Available from:
www.ccwales.org.uk
Care Council. (2002) Induction Framework for Social Care. Available from:
www.ccwales.org.uk
Care Council. (1998) National Occupational Standards in Care Level 2 and 3 and Promoting
Independence Level 3. Available from: www.ccwales.org.uk
Clay, M. (2000) Pressure sore prevention in nursing homes, Nursing Standard; 14(44) p45-50,
52, 54, Available from: www.nursing-standard.co.uk/archives/vol14-44/pdfs/4550w44.pdf.
Gebhardt, K. (2002) Pressure ulcer prevention: part 1. Causes of pressure ulcers, Nursing
Times; 98(11) p41-4.
Gould, D. and James, T. and Tarpey, A. and Kelly, D. and Pattison, D. and Fox, C. (2000)
Intervention studies to reduce the prevalence and incidence of pressure sores: a literature
review, Journal of Clinical Nursing; 9(2) p163-77.
McCafferty, E. and Watret, L. and Brown, C. (2000) A multidisciplinary audit of patients’ seating needs, Professional Nurse; 15(11) p715-8.
National Assembly for Wales. (2001) Regulations and national minimum standards for care
homes for older people, care homes for younger adults and adult placements.
NHS. (2001) Policy for the prevention and treatment of pressure ulcers.
National Institute for Clinical Excellence. (2001) Working together to prevent pressure ulcers.
Available from: www.nice.org.uk/pdf/clinicalguidelinepressuresorespatleafletenglish.pdf.
61
North West Wales NHS Trust. (2001) Pressure ulcer policy and guidelines.
Ogonovsky, M. (2001) Draft policy for pressure ulcer prevention and management. North
Glamorgan NHS Trust.
RCN Guidelines. (1999) Pressure ulcer risk assessment and prevention. Department of Health.
Available from: www.nice.org.uk/Docref.asp?d=16423.
Reed, S. and Hambridge, K. and Land, L. (2001) Ntplus. Implementing best practice in
pressure ulcer prevention, Nursing Times; 97(24) p69-71.
Russell, L. (1998) Wound care management. Physiology of the skin and prevention of
pressure sores, British Journal of Nursing; 7(18) p1084, 1088, 1090-2 passim.
Shipperley, T. (2000) Guidelines for pressure ulcer prevention and management, Nursing
Times; 96(14 Ntplus) p11-2.
Stanton, J. (2001) Literature review. A nurse’s aid to clinical selection of pressure-reducing
equipment, British Journal of Nursing; 10(15) pS16, S18, S21-4 passim.
The Tissue Viability Society webpage. Available from: www.tvs.org.uk.
62
5. Monitoring the use of the indicators
Performance monitoring will take place at all levels, as illustrated below.
Service Users and Carers
Service Providers
Community Health
Councils
Local Health Boards
Commissioners
Social Services
Local Authorities
Regional Offices
NHSD
CSIW
Welsh Assembly Government
63
SSIW
NHS
Social Services
Within the NHS, monitoring of the standards
is included within the Service and Financial
Frameworks process. Organisations will need
to provide evidence that they are
implementing the standards.
Social Services Inspectorate Wales (SSIW)
inspects how local authorities carry out their
social services responsibilities. In doing so,
SSIW checks how authorities meet the
requirements of legislation and guidance,
including good practice guidelines, and how
local authorities themselves ensure quality
through their management and monitoring
arrangements. These will include the
Fundamentals of Care.
As NHS performance management develops,
it will increasingly focus on continuous
improvement. Organisations’ performance
will be assessed against a set of criteria
within a balanced scorecard, which brings
together a number of different elements.
These might include existing capacity and
organisation and processes, as well as
outcomes.
Within this context, application of the
Fundamentals of Care standards will need to
be assessed along with other elements of
performance, such as meeting financial
requirements and implementation of National
Service Frameworks. The aim will be to
support organisations in making a single and
joined up assessment of their performance, as
the basis for consolidation of good practice
and improvement where necessary, rather
than working through piecemeal and partial
audits.
Care Standards Inspectorate
Wales
The National Assembly for Wales has a range
of regulations and national minimum
standards that cover services that people
receive at home, in care homes or in private
and voluntary health care settings. CSIW is
responsible for ensuring that providers in the
independent, voluntary and local authority
sectors deliver services in accordance with
these regulations and national minimum
standards. The Fundamentals of Care will be
referred to by CSIW in addition to other
national guidance, where it is helpful to
provide guidance on practice.
As the new continuous improvement
approach is introduced, application of these
standards will be absorbed into a national
process of setting requirements, assessing
performance, creating action plans for
improvement, putting these into action and
monitoring change.
It is also envisaged that Community Health
Councils will be able to use the standards
during their visits to healthcare settings.
In terms of planning, the new Health and
Wellbeing Strategies will take account of
these standards.
64
6. Useful Contacts
For an electronic version of this document,
access the Welsh Assembly Government
website at:
www.wales.gov.uk/subihealth/content/booklet-e.pdf
Association of Welsh Community
Health Councils
Park House
Greyfriars Road
Cardiff
CF10 3AF
Tel. 029 2023 5558
Care Standards Inspectorate Wales
National Assembly for Wales
4-5 Charnwood Court
Heol Billingsley
Nantgarw
CF15 7QZ
Tel. 01443 848451
NHS Wales Clinical Governance Support
and Development
NHS Quality Division
Welsh Assembly Goverment
Cathays Park
Cardiff
CF10 3NQ
Tel. 029 2082 3319
Maggie Parker (Chair of Steering Group)
Office of the Chief Nursing Officer
Welsh Assembly Goverment
Cathays Park
Cardiff
CF10 3NQ
Tel. 029 2082 3915
NHS Direct Wales
Tel. 0845 46 47
www.nhsdirect.wales.nhs.uk
Patients Association
PO Box 935
Harrow
Middlesex
HA1 3YJ
Tel. 020 8423 9111
Care Council of Wales
Tel. 029 2022 6257
Welsh Risk Pool
(01745) 589799
Carers National Association
Tel. 029 2081 1370
Crossroads Wales
Tel. 029 2022 2282
Contact-a-Family Wales
Tel. 029 2049 8001
Princess Royal Trust for Carers
Tel. 020 7480 7788
Carer’s Assessment Leaflet available from:
www.wales.gov.uk/subisocialcarers/
65
Appendices
Appendix 1 Steering Group membership
A steering group consisting of the following individuals guided the project.
Name
Representing
Mandy Arthur
Vanessa Bourne
David Boyland
Professor Dame June Clark
Natalie Cooper
Maggie Crawford
Vernesta Cyril
Dr Brynley Davies
Margaret Ellis
Sue Gregory
Janet Griffiths
Florinda Hall
Judith Hill
Linda Hopkins(Researcher)
Gillian Hughes
Yvonne Hurcombe
Jonathan Isaac
PMD, Welsh Assembly Government
Patients Association
PMD, Welsh Assembly Government
(Researcher) University of Wales Swansea and CYNGOR
SSIW, Welsh Assembly Government
Independent Healthcare Sector
Southeast Wales Racial Equality Council
Independent Medical Advisors
Directors of Social Services
Nurse Executives Wales
Chair All Wales Special Interest Group (Dental)
Southeast Wales Racial Equality Council
Iechyd Morgannwg Health
Association of Welsh Community Health Councils
CSIW, Welsh Assembly Government
Campaign for Care (Service Users)
Project Manager, Office of the Chief Nursing Officer,
Welsh Assembly Government
Association of Welsh Community Health Councils
(Researcher) University of Wales Swansea
(Chair) Office of the Chief Nursing Officer,
Welsh Assembly Government
All Wales Committee for Health Care Professions
Office of the Chief Medical Officer,
Welsh Assembly Government
Welsh Council for Voluntary Action
Health Professional Group, Welsh Assembly Government
SSIW, Welsh Assembly Government
CSIW, Welsh Assembly Government
CSIW, Welsh Assembly Government
PMD, Welsh Assembly Government
Care Forum Wales
Jane Jeffs
Janet Jones
Maggie Parker
Sue Rees
Dr David Salter
Daisy Seabourne
Jan Smith
Howard Teague
Sue Whitson
Angela Williams
Gaynor Williams
Cheryl Wilsom-Carter
66
Appendix 2 Contributors to redrafting
The Steering Group acknowledges the contribution of the following people who helped to
redraft the documents:
Sue Acreman, Therapy Services Manager, Velindre NHS Trust
Mair Allinson, Senior Nurse, North Glamorgan NHS Trust
Victoria Deakins, Occupational Therapist, Powys Healthcare NHS Trust
Ruth Derrick, Team Manager, Torfaen Social Services
Iolo Eilian, Planning and Development Officer, Wrexham Social Services
Cerri Evans and Andrew Critten, Plas Penmon Nursing Home
John Greer, Chief Podiatrist, Pembrokeshire and Derwen NHS Trust
Helen Jones, Social Worker, Wrexham Social Services
Tracy Livingstone, Assistant Matron, Nightingale Home Hospices and Cancer Support Centre
Dr Charles Twining, Clinical Psychology Advisory Subcommittee, Welsh Medical Committee
Jackie Wilding, Parkinsons Disease Specialist, Powys Healthcare NHS Trust
67
ISBN: 0 7504 3102 4
© Crown copyright 2003
Welsh Assembly Government, Cathays Park, Cardiff CF10 3NQ
03/03