I believe that valuing diversity can help you personally, to your advantage, by allowing you to view things from a different perspective. These new qualities you can draw on when dealing with personal changes. Understanding diversity can help you to work more effectively as a team and allow you to build a good rapport with colleagues and clients.
Client’s rights
As discussed above all clients have the right to be different and have freedom of choice and it is their right that they may do this and be free from discrimination.
Dignity and respect are other rights the care value base outlines. I feel that in the care setting these rights are the most important in order to empower the client. It is important to remember that clients have not always been ‘patients’and have in most cases led independent lives. Being in the care setting can make people feel vulnerable and alone and now for whatever reason may be more dependent on others. It is crucial that we raise self-esteem and empower the client and if we cannot offer independence then at least the right to chose how they are aided.
Confidentiality is another right clients are entitled to not only a legal requirement but it can form the main barrier to discrimination. It can also allow a better rapport between clients and staff. This is because trust between the two and respect being shown by confidentiality being upheld.
Summary
The care value base is an all round guideline on how to help improve the quality of clients lives by meeting peoples intellectual, emotional and social needs. It is shown than each point of the care base is important to the next.
I feel the principalities of the care value base do influence the way workers do their job. This is because most of the issues are basic manners and matters of respect. Nursing staff has the basic care values outlined in training and points are closely linked in the UKCC code of conduct. An example of training that includes points of the care value is; when being taught moving and handling of clients the trainees act as the patient and advise on how they felt and ways procedures could be improved.
Q9 Confidentiality
It is implicitly the right of every client and member of staff to expect that any information or confidences relating to their condition or work or to any other nature, which is private to that person, should be dealt with confidentially and staff should respect that as being their right. Confidential information passed to the wrong person can have serious repercussions to the client (more detail is provided in the description of the care value base)
Confidentiality should be seen to include all conversations whether on the telephone or person to person, both within and outside the confines of the hospital. However information relating to the condition of the client, or member of staff in the execution of the care can be reported to a senior member of staff but will remain partly confidential.
So important is this right the Data protection act 1984,Access to personal files act 1987 and the Access to medical records act 1990 were formed to make it a legal requirement that personal information is kept confidential.
Confidential information is used in order to produce statistical information and educational purposes, however before any information is passed on names are removed.
Examples of maintaining confidentiality.
On entering the hospital clients are required to answer a number private questions. This information is required to enable nursing staff to create an individual care plan. This information is written in the client’s notes and only divulged to those who take over care of the client and need to know such information.
Asking the callers identity and requesting a series of details in order to prove their identity screen any phone call received for a client. Even with a relation information about the client can only be discussed with the permission of the particular client.
Any confidential information to be passed to the client is done so in a discreet manner by either discussing it with them in the relatives’ room or by screening their bed area off.
Q5 Code of practice and charters.
A code of practice is a structure to help define the quality of care to be given. A nurse’s code of practice is the UKCC code of conduct. This charter gives guidelines for all areas of nursing practice; it is quite lengthy so I have shown an extract from this piece. Each registered nurse, midwife and health visitor shall act at all times, in such a manner as to;
- Safe guard and promote the interests of individual patients and clients;
- Serve the interests of society;
- Justify public trust and confidence;
- Uphold and enhance the good standing and reputation of the
Professions.
As a registered nurse, midwife or health visitor, you are personally responsible for practice and, in the exercise of your professional accountability, must:
- Act always in such a manner as to promote and safeguard the interests and well being of patients and clients;
- Maintain and improve your professional knowledge and competence;
- Recognise and respect the uniqueness and dignity of each patient and client and respond to their need for care, irrespective of their ethnic origin, religious beliefs, personal attributes, the nature of their health problems or any other factor;
- Protect all confidential information concerning patients and clients obtained in the course of professional conduct and make disclosures only with consent, where required by the order of a court or where you can justify disclosure in the wider public interest;
- Rapport to an appropriate person or authority any circumstances in which safe and appropriate care for the patients and clients cannot be provided.
This code of practice relates directly to the issues raised in the care value base. A code of practice can also enable both members of the public and staff to measure the quality of care given. It can also allow staff to understand what is expected from them; with these definitions of good practice it can help them to think about the quality of their own personal care. A code of practice can also help when clients are not receiving good quality care, these charters and codes can help people to assert their rights and make a complaint.
Stepping Hill Hospital mission statement
This mission statement used outlines the weak points and areas of improvement within Stepping Hill. Although directly linked with the care value base the mission statement is broader in its goals. It is as follows:
Stockport NHS Trust is committed to providing services for our patients and their carers, which improve health, treat disease and promote independence;
To do this well we will:
- Organise and provide services around the needs of their carers;
- Strive for clinical excellence;
- Work in partnership with primary care and other agencies, both statutory and non statutory, to ensure seamless care across the boundaries;
- Value and respect all our staff and establish effective methods of communication and involvement;
- Strive for a culture of lifelong learning and continuous development.
Q12 Evaluation of charters and code of practices.
Both the code of conduct and mission statement can be directly related to the principals in the care value base. Point one in both charters is to foster people’s rights and responsibilities. The need to foster the client’s independence is outlined in the UKCC and also in the mission statements opening paragraph. Fostering clients right to equality and diversity is recognised in point 7 of the code of conduct where it asks for respect and dignity without prejudice.
Code of practices in the work place.
I believe if this code of practice is maintained it would be successful in maintaining the values in the care value base.
I do feel though, from personal experience that issues relating to confidentiality are not adhered to. The reasons for this I believe are partly to do with the lack of understanding of the effects of confidentiality breeches and the personal need to gossip.
One example of this is, when beginning a shift at the hospital within my first moments of being on the ward, another auxiliary made a joke about the ‘she-man’ in bed 5.The so called ‘she –man ‘ was an elderly lady who many years previous had had a sex change operation, however was not in hospital for any reason relating to this. As the lady was on a care of the elderly all female ward, I believe if any of the other patients or relatives were to discover this information this particular lady would be subject to prejudice and discrimination. This is not the first case of breech of confidentiality I have seen.
Q6 Example of a conversation.
A diagram of the communication cycle:
To demonstrate my communication skills I have chosen a conversation I held recently with a patient who I will call Betty.
I was going about my routine duties as an Auxiliary nurse when I noticed Betty had stripped off her sheet and was sitting on the bare plastic mattress. This is how the conversation went;
CHARLOTTE: “ Your not stealing the hospital linen are you Betty (jokingly)?”
BETTY: (Betty smiled)”I’ve had an accident, but I didn’t want to bother you”
Betty’s voice quivered and her eyes began to fill up.
CHARLOTTE; “Oh Betty, that’s what I’m here for. Lets get you sorted out!”
BETTY: “I’m useless. No good to anyone.”
As Betty began she started crying. I stopped stripping the bed and knelt down to Betty’s eye level and held her hand. The curtains around her bed were already drawn.
CHARLOTTE: “Now I know that’s not true.”
BETTY: “I just want to go home”
CHARLOTTE: “ We’ll try our best for you Betty, but for now we need you here, to get well enough to go home.”
BETTY: “Oh I hope it won’t be too long. I don’t like being in here. You girls are all so kind but I don’t like to bother you.”
CHARLOTTE “Oh Betty, you couldn’t bother me, besides it’s my job and I
love my job and the best bit I get to come and chat to lovely people like you!”
Conversation continued.
Betty began to tell me about her garden, her house and her late husband (and how to make her special Christmas pudding!) Betty seemed happier to have some company, although I was very conscious of the time. Once Betty had stopped crying, she became more enthusiastic about getting home. I had to end the conversation then because I had other duties to do.
On analysing this conversation I could tell by Betty’s facial expression, lack of eye contact and posture that there was a problem and she felt uncomfortable. I tried to maintain confidentiality and remove external barriers by drawing the curtain around the bed.
I tried to create emotional safety by showing warmth and sincerity in my responses. By observing Betty’s facial expressions and listening to the tone of her voice it became clear that she was getting upset. I stopped what I was doing in order to give Betty my full attention. I began the conversation with a cheeky joke I felt Betty would not take offence to. I felt this would build rapport.
As Betty began to cry her body language altered so I also changed my body language by kneeling down, giving eye-to-eye contact and holding her hand to offer support.
We had silences throughout our conversation but I felt these were not awkward but appropriate pauses.
I encouraged Betty by asking her open questions and let her know I was listening by gesturing with facial expressions and verbally checking understanding.
Q10 Evaluation of my communication skills
I felt I communicated effectively with Betty although I could not offer any resolution. I tried not to rush her but found it difficult not to due to the circumstances, on reflection I feel I may not have listened properly. I think I made Betty feel at ease and allowed her to feel comfortable talking about her problems. I did this by initially building rapport with a joke and later by comforting her by holding her hand and retaining eye contact. Later in the conversation I feel I began to presume things about Betty and tried to finish her sentences for her, as I was very aware of the time.
Q12 Possible improvements to my communication skills
Due to the nature of the work it is very difficult to spend time with clients, however where possible the execution of better time management could allow me to spend a little social time with clients.
Because time is limited I perhaps seem disinterested in what the client has to say; I could try to record the reaction of people I speak to, to gauge whether or not I appear to be rushing them. I could also take note of their non-verbal messages to see whether or not they feel understood. With the use of reflective practices by showing the person I have understood their ideas by reflecting them back in my own words.
I also feel I should be aware of my own non verbal messages and facial expressions, this would involve being aware of my posture, tone of voice, angle of my head and gestures I make. In order to improve this skill I could video conversation work with my friends and make notes on ideas for changing the expression in my face and eyes so that I look more interested, this exercise could also allow me to see my friend’s non-verbal communication to see if I appear to be a good listener.
I could try and evaluate conversations I hold. This would ensure I have listened properly and replied with the appropriate non-verbal messages. These exercises would ensure I have listened to the topic of conversation and not just presumed it.
Q7 Barriers to communication
On a hospital ward there can be a wide variety of barriers when trying to communicate with a client. Again I will refer to the care value base in which it states that we as workers should value people’s equality and diversity as well as their rights.
Good communication skills are vital in order for a client to be listened to and thus understood, both of which empowers the client by allowing them to feel valued and respected.
Barriers to communication can be, Visual disabilities. In order to overcome this there are several things a carer can do to aid the client, such as using conversation to describe things, remembering detail sighted people take for granted could be important. Allow the client to touch your hands or face so they can recognise you. It may also be that some clients with visual disabilities have some sight so checking with the client would be important in establishing limitations of the individual, thus aiding in their personal care plan.
Hearing disabilities. In order to aid a client with hearing difficulties it is important not to shout at them, if they have some hearing a hearing aid would probably be worn and should be checked that it is in working order. If possible face-to-face contact in good light would help the client to lip read. Writing notes and using pictures could also prove helpful. If the client can uses sign language it may be necessary to seek help from a professional interpreter or family member who can communicate in sign.
Barriers to communication cont’d
Physical and intellectual disabilities could be overcome by the use of pictures and signs. The use of simple and clear speech in short sentence could also be effective.
Language differences and the use of slang and jargon can be overcome with good non-verbal signs and expressions. Again the use of diagrams and pictures may be effective, however the use of an interpreter/translator would the most effective form of communication.
With such a broad scope of people in a care setting a barrier to communication can be misunderstanding. Different cultural interpretations or the type of language used i.e., regional dialects, phrases and jargon can cause this. Using good listening skills to check understanding and different ways of saying things in short, clear sentences could help overcome this barrier.
A client with a learning dysfunction or a physical dysfunction such as dementia may not be able to make sense of what is said; in order to overcome this barrier an advocate for the client is required.
On a hospital ward enormous environmental barriers are presented as it is never silent even in the dead of night there will always be noise; other clients, equipment and machines or workers carrying out their duty i.e., the porter clanging around moving oxygen cylinders, or visiting time with the sound of everybody talking. Where possible, to try and reduce background noise, moving to a quieter room and to remember to check the clients understanding.
I also feel there are silent barriers when trying to communicate. If a client is afraid, shy, upset, angry, depressed or embarrassed they may not feel comfortable talking about certain issues. People are often afraid to know what is wrong with them. It is in this kind of situation as with the others that referring to points in the care value base need to be addressed. To overcome these psychological barriers careful explanations and reassurance should be offered.
Q8 How a ward administrator puts the care value base into practice. (Based on information given in an interview)
Ann is a ward clerk; she is a key member of the ward staff. Her job consists of answering the telephone, speaking to relatives and colleagues alike. It is often the case where she is first contact clients and relatives meet on arriving at the ward as she will process all details (personal and diagnostic) onto the hospital files, it is also her responsibility to ensure all orders for supplies are requested and delivered. Although Ann does not undertake direct daily care chores, indirect care is carried out such as organisation of patient transport, processing valuables and the respective paperwork, organising admission and discharge papers, social work contact and any other clerical tasks required for the client
The main principle of the care value base in Ann’s job is maintaining confidentiality understanding and enforcing the following.
- The security of recording systems
- The need and right ‘to know’,
- Confidentiality can value and protect a client,
- Policies, procedures and guidelines,
- Boundaries and tensions in maintaining confidentiality
Ann values diversity in a client and understands the possible repercussions of failing to maintain confidentiality. As a result of failure to maintain confidentiality a client could be discriminated against or put at risk e.g., if the clients home address was to become public knowledge and known to be empty it is at risk from burglary.
It is Ann’s’ responsibility to screen all calls received to the ward maintaining client confidentiality at all times. Ann explained to me that it could be difficult dealing with relatives and close friends on the telephone when she is unable to divulge information for various reasons, especially, she says, when she has built a rapport with those people.
Fostering equality and diversity is also important in Ann’s job. Ann deals with a wide scope of people and must be aware and sensitive to individuals needs, especially, she explains, as people are often worried impatient and sometimes unreasonable. Ann deals with anxious relatives by being patient, understanding and offering as much information and support as she can. Ann is also aware of the benefits of valuing diversity, she believes she has learnt a lot from meeting such a variety of people and although she tries not to Ann does find herself stereotyping clients, but was keen to point out this was just her personal thoughts and was not discussed with colleagues.
Although Ann admitted stereotyping people she said she did respect peoples rights and tried to maintain each right in the care value base in her day-to-day work.
The key point in her job is communication. The way Ann delivers her non verbal messages, tone of voice, facial expressions and gestures are all key in her effective communication with clients and relatives.
I did not totally realise how adaptable the values of the care base are in all areas of care work but they evidently are important.
Q8 How a Nursery nurse puts the care value base into practice (based on information given during an interview)
I interviewed Helen who currently works as a nursery nurse at a small private nursery where the children’s ages range from 3 months to 5 years. As a nursery nurse Helen is involved in many care tasks – for instance feeding, washing and toileting. Educational activities set out in the Early learning goals are planned and employed by Helen and her colleagues. It is Helens responsibility for the overall care of the children in the nursery.
Valuing diversity is an important key in Helens job as her children come from all sorts of backgrounds and from different ethnic and religious groups. Helen therefore fosters people’s rights and responsibilities by respecting the right to be different and to be free from discrimination.
Effective communication throughout her work is vital not only with the children but with parents and colleagues. As Helen works in the private sector and parents are paying for this service they have expectations that they require to be met such as reports on how their child is performing or dealing with individual tasks.
Helen believes that it is easier to respect diversity in her job because her clients are children and are willing themselves to accept people the way they are, Helen further added that she has learnt a lot from observing different children interact and therefore understanding the benefits of valuing diversity.
Confidentiality is a point in the care value base which Helen must adhere to, she explains the of issue confidentiality is vital in the protection of individual rights for example Helen has a child who’s father is in prison, If confidentiality was breeched the other parents could react in a way that could cause problems with prejudice towards the child and its family by not wanting their child to play with the child concerned. Again Helen described that she has a child who’s mother has HIV and although the child does not, she defends what she believes would be a similar but natural reaction by other parents, and firmly believes prejudice would be an automatic reaction. Here Helen would enforce the three key points of the care value base by fostering people’s rights and responsibilities, fostering equality and diversity and maintaining the confidentiality of information.
