It is important that service users are encouraged to make their own choices, for example if a carer chose what activities to involve a service user in, the service user may not enjoy themselves as much, feel bored, and miss out on socialising with others who share the same interests. Intellectual stimulation and socialising are important for maintaining mental well-being; which is very important, as illustrated by the World Health Organisation`s definition of health as:
‘Health is a state of complete physical, social, and mental well-being, not merely the absence of disease or infirmity’.
Care workers can encourage service users to make decisions by:
- asking service users what clothes they wish to wear, if they are helping them to dress
- asking service users what food they would like, rather than just putting food in front of them
- providing clear and up to date information on optional treatments and services available, so that service users can choose from them
- Always listening to what service users have to say, so that they feel their views and ideas are valued, thus helping them to feel comfortable with speaking up
Care workers should involve service users in drawing up their care plans, as this allows them to take further control over their treatment. A care plan states what will be provided for the service user, by whom, when, where and how, and will show what the service user has a right to expect. Care plans must be legible, and are reviewed and updated at set times to reflect any changes in need or preference, (Thomson et al, 2000).
Effective communication is central to encouraging service users to express their preferences and views, and also to help them achieve independence.
Effective verbal communication would involve using ‘open’ questions, such as ‘what do you think?’ Or ‘how do you feel about...?’ These sorts of questions allow for fuller answers. However sometimes ‘closed’ questions are needed to gain basic information such as an individuals’ age, name and marital status. Leading, (otherwise known as biased) questions should be avoided, as they encourage the listener to give the response they think is expected, such as ‘all of the staff have been very nice to you, haven’t they?’ Using multiple questions should also be avoided, as they can confuse the listener, it is better to ask one question at a time and wait for a response before asking another.
Effective non-verbal communication involves using eye contact (so long as it is not over done), facial expressions, such as smiling to convey kindness and leaning forward slightly to show interest in what the other is saying. It can also help to be positioned at the same level as the service user, and to mirror their facial expression (very subtly), which is often done unconsciously by people when they are trying to establish an equal relationship, (Thomson et al, 2000).
Effective communication is important for identifying the needs of service users, and assessing what treatments they could benefit from, giving information, and encouraging them to take control and make choices.
Barriers to communication include:
- An unhelpful environment, such as having too much noise, a lack of privacy or too many people trying to talk at once
- Providing insufficient information, or information with a lot if technical terminology that would be difficult for the service user to understand
- The carer seems uninterested in the conversation
Barriers can lead to miscommunications which can in turn cause problems, such as confusion, upset or anger if the service user feels they are not being listened to, or the service user could miss out on treatments they would have found beneficial.
Empowering service users by encouraging independent choice may help to increase their self-esteem, and individuals with high levels of self-esteem are believed to be less likely to become depressed or anxious in comparison to those with lower self-esteem, (Eysenck, 2002). If service users are constantly having things done ‘for’ them, they may become withdrawn, feel that their input isn`t necessary and in turn have lower self-esteem, therefore it is important for carers to show they are undertaking tasks ‘with’ them instead. For example, when a service user is deciding on what treatments to opt for a carer should provide them with required information, but allow ‘them’ to make the choice, or when getting a service user dressed in the morning a service user should be able to tell the carer what they want to wear, and have the carer help them to put it on. Essentially, a carer should be assisting the service user to maintain their lifestyle (by as much as is possible) by providing the necessary care, rather than the service user altering their lifestyle to fit in with how the care setting is run.
Service users have the right to dignity and privacy
According to the National Health Service ‘dignity is understood as encompassing respect, recognition, autonomy, independence and identity’, (endoflifecare.nhs.uk). To treat someone with dignity is to treat them with a recognition of their rights as a human being, and involves showing respect no matter a person’ age, ethnicity, creed or gender.
Some experiences in later life, such as health problems, bereavement, increased dependence on others and other significant life changes, can pose a threat to older peoples’ sense of dignity, (Bristol.ac.uk). For instance, increasing dependence could make a person feel burdensome, and issues such as losing control of bodily functions could cause a person to feel undignified and embarrassed of themselves, which in turn can have detrimental effects on a person’s self-esteem.
Care workers must adopt the right attitude, and show respect to service users so that they can maintain their sense of dignity. One way that carers can display respect is by showing service users that they are listened to by using the correct body language, such as nodding and using eye contact. It should also be remembered that some individuals prefer to be addressed by their title and surname, rather than their first name. For example, an elderly woman may prefer to be called Mrs Smith, and find being called Emily, her first name, by the carers to be very disrespectful.
Carers can also help to maintain service users’ sense of dignity by providing privacy, particularly when assistance is needed with personal tasks such as bathing and using the toilet, or simply if the service user wants some time alone.
When assisting a service user with using the toilet or bathing:
- The carer must ensure that the door and curtains are closed, so that no one can see in
- Cover the service user’ private parts, so that they do not feel ‘on show’
- Provide a same sex carer to help the service user with personal tasks, if possible
Carers must also remember to be discreet and careful not to embarrass the service user, for example, if a child in a nursery wets himself and the carer noticed and exclaimed “Oh dear, you’ve wet yourself, let`s get you cleaned up”, then the other children would hear and this could cause the child to feel very embarrassed or ashamed, and he may hesitate in telling the carer next time if it happens again. It is important to remember that children value privacy as well, and so service users should be treated with dignity and have privacy no matter their age.
In order to uphold service users’ right to privacy:
- Residents in a care setting should have their own private room
- Carers should knock on the door, and wait for an answer, before entering someone’s private room
- Service users should be able to eat in private if they wish
- Service users should be able to be alone if they wish
- Service users should be able to see a doctor in private if they wish
- Confidential information regarding service users should only be disclosed on a ‘need to know’ basis
Tensions in care settings
In care settings sometimes the rights of a service user are in conflict with the responsibilities of the care workers.
Example:
It is morning and a service user, Mr Smith, is awake in bed, feeling quite bored, and wants someone to assist him to get up, washed and dressed straight away. However, several of the residents in the home suffer from incontinence and have awoken in wet beds, and the carers are seeing to them first, and as the home is short staffed it may be a while until they get to Mr Smith.
Mr Smith has a right to get up when he chooses, and leaving him feeling bored in bed may make him feel frustrated, unvalued and that his needs are not being met. However, in a situation like this the staff at the home must allocate their time on the basis of need. Situations such as this cause ethical dilemmas and show that it is not always possible to fully satisfy the rights of every service user. However it could help to explain to Mr Smith why he has had to wait, so that he understands why he had to wait and knows that he was not just being ignored.
Sometimes tensions arise due to a lack of resources, and quite often the demand for particular services or equipment outweighs what the setting is able to provide. This is why organisations must set priorities for the allocation of resources, by weighing out the costs and benefits of doing one thing, versus another, (resource.com).
Care settings are obligated to work within the boundaries of the law. Tensions can arise when a service user seeks a solution to something outside of such boundaries.
Example:
A service user is discovered to have been regularly using cannabis, a class B illegal drug, which his nephew brings to him on visits. When confronted by the carer the service user explains that he uses it to ease his back pain, as he had found the treatments on offer for it to be relatively ineffective, and that the drug is the only thing that gives him relief from the pain. He then asks the carer not to tell anyone about it, and promises to be discreet, and only smoke it privately in his room.
In this situation the service user is asking the carer to keep something confidential, however as it is information regarding illegal activity the carer must report it, and stop it at once. Furthermore smoking the drug may help the service user`s pain, but be causing him other health problems, and in this situation there is also a danger to other residents in the home, as smoking in the building could cause a fire. The requirements of the law must be followed, (Fisher, 2006).
In such a situation it would be very important for the carer to remain objective, and not have their judgement clouded by their feelings, and sympathy, for the service user. As a carer may have to care for the same person for a number of years, and an emotional attachment may form, so that they become subjective rather than objective, which could cause difficulties, (Fisher, 2006).
There may be times when tensions arise within individuals causing them to feel ‘at odds with themselves’, which could possibly be due to mental health issues, or because they are confused, (Fisher, 2006). Such situations could cause a person to become withdrawn, upset or even aggressive, which in turn could cause problematic behaviour. The carer involved must use their communication skills to calm down the service user. The carer will need to respond empathetically to the service user`s point of view, and try to resolve any issues with them. Just telling someone off for unruly behaviour is unlikely to solve the problem, for example if a child is behaving badly in a nursery by yelling at the carers and purposely try to break toys, it is unlikely the behaviour would stop if he was just told off. The underlying issues must be addressed; he could be acting out because he is being bullied by another child, in which case the carers must try to put a stop to it, he could be upset because a pet died or be feeling ‘second best’ since the birth of a sibling, in which case he would need reassurance and comforting.
Tensions may also occur between service users; this could be due to arguments, inappropriate language or irritation at the other`s behaviour. Whatever the case, the care worker must adopt a polite, calm and non-confrontational manner in talking to them, in order to come to a solution or compromise. Using active listening and effective communication skills are essential if a solution is to be found, (Fisher, 2006).
Summary
Caring involves:
- Providing for physical needs (such as dressing and bathing)
- Providing for emotional needs (such as promoting self-esteem)
- Having excellent communication skills
- Remaining objective
- Upholding individuals’ rights (such as the right to dignity)
- Helping people to reach their highest possible level of independence
- Having patience and understanding
Service users have the right to make decisions and everyday choices for themselves; this right can be upheld by providing an advocate to speak on the service user`s behalf if they are unable to speak for themselves, or teaching them the skills needed to speak on their own behalf, providing clear and up to date information on the options available to them, and making sure they understand what they are entitled to expect.
Service users have the right to dignity and privacy; this right can be upheld by showing respect to service users, listening to their wishes, and making them feel valued. Service users should also be able to have time to themselves if and when they wish.
Tensions can arise in care settings for numerous reasons, and depending on what the situation calls for; resources will have to be allocated as fairly as possible and on the basis of need, boundaries of the law must be respected, and tensions between and within individuals must be negotiated to come to amicable solutions.
Bibliography
Eysenck, M (2002) Simply Psychology. East Sussex. Psychology Press Ltd.
Fisher, A (2006) Health, Social Care and Early Years. Oxford. Heinemann.
Thomson, H. Holden, C. Aslangul, S. (2000) Health and Social Care. London. Hodder and Stoughton.
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