Working with patients and colleagues - Open University€¦ · Web viewWorking with patients and colleagues ... You will see what a dialysis machine looks like and how Malcolm’s

Working with patients and colleagues

NNCO_HCA Introducing practical healthcare


Page 2 of 78 27th February 2019

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Contents Introduction Learning outcomes 1 Working in a person-centred way

1.1 Care plans 1.2 Consent 1.3 Your values

2 Communication 2.1 Barriers to good communication

3 Handling information 3.1 Medical records 3.2 Confidentiality

What you have learned in this section Further information (optional) Section 2 quiz Acknowledgements





IntroductionWelcome to Section 2 of the Introducing practical healthcare

course where you will look at how the healthcare assistant role

involves working with other people. Once completed, you will be

given the opportunity to obtain a ‘Working with patients and

colleagues’ badge. This section will take approximately 3.5 hours

to complete.

This section will first consider how a healthcare assistant works in

a person-centred way, and introduce the idea of patient care plans.

You will reflect upon the importance of values when working in a

caring role. It will then consider the need for successful

communication within healthcare settings, and you will be shown a

few examples of barriers to communication. Along with this, you

will learn about the importance of correctly handling information

and obtaining patient consent and confidentiality. Lastly, this

section will explore working as part of a team and the reasons why

situations of conflict may sometimes arise.





Learning outcomesBy completing this section and the associated quiz, you will be

able to:

explain what is involved in delivering a person-centred

approach

describe how to store personal information securely,

and when confidentiality may be breached.





1 Working in a person-centred way A lot of patients finding themselves in hospital meet situations that

involve pain, anxiety and physical indignity with courage and good

humour, but as individuals, their reactions will be varied. Becoming

ill disrupts their normal life, upsets plans, may cause financial loss

and produce a loss of self-esteem. The person-centred approach

to healthcare focuses on the individual’s personal needs, wants,

desires and goals so that they become central to the care and

nursing process. It involves knowing the patient as an individual

and as a person, not just as a patient with a certain condition and,

where appropriate, involving their family and friends. Another way

of being person-centred is to understand that everything you do for

that person requires their consent, so you know they are happy for

you to carry out the action.

Activity 1Allow about 15 minutes

Listen to this next audio podcast about meeting the specific needs

of a person with visual impairment. In it the patient, Jackie, talks

about how she needed support and empowerment from her carers,

particularly as she sought a diagnosis for her recent visual

impairment.





As you listen to it, try to put yourself in the carers role and think

about how you would support a patient with a visual impairment.

What is Jackie feeling? What should the healthcare assistant do?

This audio is provided for use within the course only.

Audio content is not available in this format.

Living with visual impairment: nurse support

View transcript - Living with visual impairment: nurse support

Provide your answer...

View comment - Untitled part

1.1 Care plansAnother vitally important part of working in a person-centred way is

having an individualised care plan. Care plans are usually written

by the qualified nurse with the patient, and tell you what daily care

should be provided. Whether handwritten or electronic, they are

live documents and should be updated by the nurse whenever

anything changes. A care plan is likely to include:

the patient’s relevant medical history

how they want to be cared for

the type of care they want

their specific daily care needsPage 10 of 78 27th February 2019




what works well and doesn’t work well for their care

improvements that can be made to their care.


Next you will hear Gail (a healthcare assistant) speaking about the

importance of care plans, and how useful they are in providing

information for all staff when they come on to the ward at the start

of a new shift as to what care has been given to a patient. Care

plans will also be important for other healthcare assistants working

in clinics and homes. This is an essential part of delivering person-

centred care.

As you listen to the audio clip, write down a couple of things that

you might include in a care plan.


The importance of care plans

View transcript - The importance of care plans



1.2 Consent





Working in a person-centred way requires that everything you do

for a patient is done with their consent. If you are going to take

their temperature or another straightforward observation, usually a

nod or verbal consent is enough to tell you that they are happy for

you to carry out the action.

In the next audio clip you will hear Gail talking about how important

it is to always get the patient’s consent before carrying out any

actions with them, using real examples as to whether this may be

explicit/informed or informal consent.


Obtaining patient consent

View transcript - Obtaining patient consent

1. Explicit (or informed) consent means that the

person giving consent knows exactly what they are

agreeing to. For example, a patient going for surgery

needs to give written consent and, if patient

information is to be shared, they need to understand

what will happen as a result of this.

2. Implied consent: This is when someone has not

explicitly said that their personal information may be

shared but their behaviour suggests that they are

aware that it will be passed on and they are happy





with this. For example, because a patient agreed to go

to the diabetes clinic, his GP reasonably assumed he

also agreed to his information being passed on to the

clinic (The Open University, 2015, p. 60).

3. Mental capacity and consent: There may be

times when your patient lacks the mental capacity to

give consent or make a decision, maybe due to

physical illness or a learning disability or dementia, or

they cannot communicate what they want. In such

instances a family member might be asked to give

consent on their behalf (The Open University, 2015, p.

60).

1.3 Your valuesYour values are a set of principles or beliefs that you believe are

important in the way you live and work, and tend to guide

judgements about what you consider to be right or wrong.

Following the Cavendish review (Cavendish, 2013), NHS England

(2012) described six core values which apply to anyone in a caring

role, including healthcare assistants. They all begin with the letter

C and are known as the ʿ6 Csʾ. You will need to put these six

values into practice throughout your caring role:

The ʿ6 Csʾ:





Care: having someone’s best interests at heart and

doing what you can to maintain or improve their

wellbeing

Compassion: being able to feel for someone, to

understand them and their situation

Competence: understanding what someone needs

and having the knowledge and skills to provide it

Communication: listening carefully but also being

able to speak and act in a way that the person can

understand

Courage: not being afraid to try out new things or to

say if you are concerned about anything

Commitment: being dedicated to providing care

and support but also understanding the responsibility

you have as a healthcare assistant.

Activity 3 Allow about 5 minutes

In the next audio clip you will hear again from Gail. She refers to

the crucial values of empathy, trust and reassurance which are

needed even before the direct caring for patients begins. As you

listen to it, think about the different feelings that patients will be

experiencing on the operative preparation ward.






Values of empathy, trust and reassurance

View transcript - Values of empathy, trust and reassurance

Nearly everything you do when caring for others will involve the ʿ6

Csʾ, however ill they are, or however short or long their stay in

hospital might be. During your time as a healthcare assistant you

are likely to encounter patients with chronic or long-term

conditions.


In the next video you will be introduced to Malcolm, who talks

about living with a long-term condition. He had a cancerous kidney

removed and is suffering slow failure of the other. You will see

what a dialysis machine looks like and how Malcolm’s treatment is

carried out in hospital. If you haven’t cared for anyone with this

condition or experienced a dialysis department before, this will

provide insight into what it entails.

All ʿ6 Csʾ are required in Malcom’s care. As you watch the video,

use the space below to write down three of the ʿ6 Csʾ you would

need to use if you were supporting him.

This video is provided for use within the course only.

Video content is not available in this format.





End-stage renal failure – a long-term condition: Malcolm's story

View transcript - End-stage renal failure – a long-term condition: Malcolm's story


View comment - Activity 4









Figure 1 Previously active people may suddenly find themselves without

mobility or confined to a wheelchair

View description - Figure 1 Previously active people may suddenly find themselves without mobility or ...

Activity 5 Allow about 5 minutes

In the next podcast video, you will encounter Robert, a motorcyclist

who was severely injured in a road accident. He talks about how

the accident has changed his life irreversibly. He describes how

his behaviour became challenging at times, and how it is important

for those in a caring position to remember that, although he looks

normal, the extensive injuries he suffered brought out difficult

feelings which were reflected in his challenging behaviours.

All 6 Cs will be required in your care for Robert. As you watch the

video, write down three that you would need to use if you were

supporting him.


Motorcycle accident

View transcript - Motorcycle accident






2 Communication Let us now look further at one of the ʿ6 Csʾ in more detail:

communication. Good communication is important, both between

your team and your patients. Only a small proportion of

communication is verbal: when Robert was in pain or frustrated, he

communicated those feelings through his behaviour rather than

expressing how he felt in words. By observing Robert’s body

language during a conversation, you might be able to see visible

signs of his discomfort or pain. His healthcare team had to learn

about his specific needs, however he chose to express them. By

getting to know him as an individual, they would learn how best to

support him, and speak or act in ways that both expressed

empathy and understanding, and explained any treatment or care

plan.

Now you are going to look at an example where there was a lack

of good, basic communication between the patient and the

healthcare assistant, who did not seem to be working in a very

person-centred way.


As a healthcare assistant, one of the roles you might be asked to

carry out is to record a patient’s blood pressure. This will alert you





to any changes from previous readings, such as high blood

pressure (hypertension), which puts extra strain on the heart and

blood vessels.

As you watch the video, write down ways in which the healthcare

assistant could have been more supportive and reassuring with the

patient.

This video is provided for use within the course only.


Measuring blood pressure

View transcript - Measuring blood pressure


The Open University and Unison Partnership website (2015) notes

that ̔'communication is a two-way process and good

communication is about being a good listener as well as a good

speaker. You need to be empathic, so that you can understand

how others will interpret your words and behaviour'.

Communication therefore is an essential part of a caring

relationship and helps to build trusting relationships with the

individuals you care for as well as their families and other workers.

Communication occurs through many different means: verbal,

visual or in written form. It will take up a large part of your day, and





it is important to communicate effectively. Only a small proportion

of communication (7%) is down to actual words. Indeed, in face-to-

face conversations, over a third of communication is made up of

the tone, pitch and speed of your voice (38%), and just over half of

communication is non-verbal, comprising gestures, expressions,

posture and other body language (55%). You are probably already

familiar with a number of features of body language, including the

movement of your body (for eample shrugging, nodding or shaking

your head, waving), facial expressions, eye contact (showing that

you are engaged and listening), and even your muscle tension and

breathing.

The way you look, listen, move, and react to another person tells

them more about how you’re feeling than words alone can. Think

about when you communicate with others over technology and

cannot see their non-verbal communication signs: such

communication can be more difficult and meanings can be more

easily misunderstood.

The following advice has been drawn up by The Open University

and Unison:

Top tips on improving verbal communication skills

Remember to let the other person get their thoughts

across and try to not to interrupt them. Try to listen Page 21 of 78 27th February 2019




more than you speak in a conversation and give the

other person your full attention.

Be open and honest in what you say. If you are not,

your body language may well give you away.

Learn to express yourself well. It is not just what you

say, but how you say it. Your tone of voice can

sometimes change your meaning entirely.

Always make sure the other person has understood

you, or you them, and don’t be afraid to clarify an

instruction or ask them to repeat a phrase.

Alter your style of communication to match your

listener (for example choice of words, tone of voice

and familiarity of gesture). This is a really good way of

building a relationship with them and makes the

information you need to share more relevant and

accessible.

Think before you speak. Once the words have been

said it is impossible for you to take them back so think

about the person you are speaking to and the

outcome you are looking for.

Adapted from Open University and Unison Partnership (2015)

Here are some further tips that you should consider:





Make sure the person is wearing their hearing aids if

they are hearing impaired, and that they are working

properly with operational batteries.

Ensure where possible that you are facing towards the

light (for example looking towards a window) so that

the other person can see your face and expressions

clearly. This is particularly important if your patient is

hearing-impaired, as they may rely on your lips and

expression for communication.

Communicating effectively can be difficult. In order to get it right, it

is important to be able to tailor communication skills to different

situations: for example you might be using a different tone, pitch

and volume in a formal conversation than you would in an informal

one; and you might convey information differently in a verbal

conversation than in an email. When caring for patients it is best to

avoid using difficult words or abbreviations such as those which

you might use when talking with other health professionals. Your

speech should be respectful and adjusted to suit the individual you

are communicating with.

Working in healthcare means some situations have specific or

specialised needs. Part of your person-centred approach and

knowing your patient as an individual will include finding out their

preferred method of communication. In the UK we use British Sign

Language (BSL) when communicating with hearing-impaired





people. Makaton is another sign language which uses a large

collection of signs and symbols, and is often used with those who

have learning and physical disabilities, or hearing impairment.

Whatever your healthcare setting, as a healthcare assistant you

will be working as part of a team. This will probably include

qualified nurses, students and support workers, but there will also

be a range of other professionals and support staff whom you will

encounter on an everyday basis, including domestic staff and

clerical assistants or receptionists. Whoever you work with, trust

and reliance on others in the team are important ingredients to

good working relationships and will help working partnerships to be

open, honest and successful.

Figure 2 The typical healthcare team has a range of professionals and

support staff

View description - Figure 2 The typical healthcare team has a range of professionals and support st ...





2.1 Barriers to good communication Learning Guide 12 from the OU’s K101 course (Open University,

2015) specifies that ‘Communication between two people often

comes naturally. When communication is difficult, it is often

because of some kind of barriers of one kind or another … Being

aware of barriers, and developing ways of overcoming them are

important in helping you to deliver effective care.’ (The Open

University, 2015, pp. 108–9)

When communication is difficult, it is often because of some kind

of barrier; being aware of barriers, and developing ways of

overcoming them, are important in helping you to deliver effective

care.

There are a number of communication barriers, presented in the

K101 Learning Guide above (Open University, 2015), which you

should consider when working as a healthcare assistant

Physical barriers: ‘sometimes the way a building

is designed makes it difficult to communicate. Noise,

lack of privacy and busy environments where there

are a lot of interruptions are barriers to

communication.’ Consider also the way desks and

chairs are positioned, as this can cause a barrier to

communication; and it is also important to remember





that dimly lit areas might make it more difficult for

hearing-impaired patients to understand you’

Attitude: ‘Some people are apprehensive about

being able to communicate with professionals. This

may be because of the technical language some

professionals use. But it may also be related to the

idea that professionals are busy: they may not have

time or be interested in hearing what you have to say.

Sometimes incorrect assumptions are made about

communicating with people who have a disability.

[This] can mean conversations are directed mainly at

their carers. It is likewise important that staff have a

positive attitude towards patients and don’t become

defensive if a patient complains.’

Emotions: ‘Communicating clearly can be a problem

if we are feeling emotions such as distress or anger.

Fear can prevent someone from making an initial

approach for help. People may be so overwhelmed by

their emotions that they struggle to interact with other

people.’

Cultural and language barriers: these ‘can be

obvious if we are dealing with someone who does not

speak or understand the same language that we do,

but there may also be other hidden cultural

differences about the way we use language.





Language examples might include causing confusion

when terms such as ‘passing water’ or ‘breaking wind’

are directly translated word-for-word because the

meaning does not translate well.’ Cultural norms may

mean, for instance, that many Japanese people have

difficulty saying no, or that women may feel inhibited

discussing personal matters with male medical staff.

Illness, disability or pain: ‘Some people may

have a disability and/or a sensory impairment, such as

a sight, hearing or speech impairment, which makes

communication [harder].’

Memory loss or a learning disability: 'This

[might make] it difficult for a person to understand

information’, particularly that which is being

communicated to them.

Other points to remember:

Body language: it is important to consider how you

are standing or sitting when communicating, as

crossing your arms whilst speaking and listening, or

looking at your mobile phone, will pose a barrier.

Time: always try to make time for listening and

communicating even though you may be very busy.





Confidentiality: when communicating information

that is sensitive or personal, it is important to find a

private place and ensure you will not be interrupted.

Figure 3 The way you communicate with your body language is important

View description - Figure 3 The way you communicate with your body language is important


Look at the following scenarios involving difficulties with

communication. Think about how you might react if you were in

each situation and write the best course of action in the space

provided, before clicking to reveal the solutions. Page 28 of 78 27th February 2019




1. You are helping a patient with written material that they have

received in the post. You are aware that they have severe

problems with their eyesight.


View answer - Untitled part

2. One of your long-term patients has become irritable and is

finding fault with everything you are doing for them.



3. One of your patients has received bad news whilst on the ward,

and is clearly upset and tearful.



4. One of your patients, who does not speak English very well, is

asking you about visiting times.



Occasional disagreement may arise between workers from

different agencies or between the person receiving care and

support and those providing them, and this can lead to conflict. Page 29 of 78 27th February 2019




This can be compounded by different personalities and

temperaments, differences in beliefs and values, or strong feelings

and emotions. Conflict in teams that is not resolved can affect the

quality of care, so must be managed quickly and effectively.





3 Handling informationWithin your healthcare assistant role, you will be asked to handle

various pieces of information given to you regarding patients and

their needs; including confidential information about individuals

and possibly their families or carers. The Data Protection Act

(1984) first introduced rules on how to store information and who

will be given permission to access such data, which are still in

force today (subject to the Data Protection Act, 1998).

If you work for a public authority such as in hospitals or doctors’

surgeries you should be aware that patients have a right to view

anything written about them. They can make a formal request for

this through the Freedom of Information Act (2000). This may

include documents, reports and even emails between healthcare

workers. Patient care plans can become legal documents of

evidence if at any point there is cause for legal action, so if you

add to any of these records you need to remember that what you

write must be accurate and suitable to be viewed by those it

concerns.









Figure 4 You might be asked to handle or contribute to hard data within a

paper filing system

View description - Figure 4 You might be asked to handle or contribute to hard data within a paper filing ...

Problems would be likely to arise if no records are kept. For

example, a patient who is allergic to penicillin could be given

inappropriate care and prescribed penicillin as it wouldn’t be

shown on her medical history.

Another example of why keeping records is important would be to

help care workers remember past actions and future plans,

otherwise details and even major issues might be forgotten, time

would be wasted finding out the same information again, and

repeating some forms of care, such as medical treatments, could

be harmful.

In Activity 8, look at the examples and think of a problem that

might arise if records are not kept. Try to write an example from

your own experiences of healthcare services, click to save it and

then click to reveal the comment.






Why records are needed (1): Signed records prove that

something has happened or been agreed, what might happen

without this?

Problems that might arise if no records are kept: Care could be provided which is not appropriate given my medical history. For example, a prescription for penicillin.


Why records are needed (2): To inform patients of what

has happened to them and what services they are supposed to be

receiving.

Problems that might arise if no records are kept:


Why records are needed (3): So that care can be provided

by more than one person.



Why records are needed (4): To coordinate care between

different agencies.







Why records are needed (5): To provide information which

improves public health.



(Activity adapted from K101 Learning Guide 14, Open University 2015a)

3.1 Medical recordsThe growth in access to computers and the internet has led to

changes in how some personal care records are held. The NHS

plans to introduce integrated digital records across all healthcare

settings in England by 2018, so the use of electronic records is set

to become increasingly common (The Open University, 2015, p.

52).





Figure 5 Medical records are increasingly being filed electronically

View description - Figure 5 Medical records are increasingly being filed electronically

Guidelines published by the Department of Health state that with

electronic records, NHS staff in England must:

not leave a terminal unattended and logged-in

not share logins with other people

not reveal passwords to others

change passwords at regular intervals to prevent

anyone else using them




https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf


avoid using short passwords, or using names or words

that are known to be associated with them (e.g.

children’s or pet’s names or birthdays)

use a password-protected screensaver to prevent

casual viewing of patient information by others

always clear the screen of a previous patient’s

information before seeing another

always logout of any computer system or application

when work on it is finished

(Department of Health, 2003, pg. 19)

The huge increase in social media and mobile technology such as

phones and tablet computers means that it can be easy to share

information with the wrong people, which can breach confidentiality

in the same way as leaving a patient’s records out of the filing

system or remaining logged in to a computer when you have

walked away. As a healthcare assistant, you have a responsibility

to oversee and to protect an individual’s personal information. You

should also treat personal information about other workers that you

have access to in the same way.

3.2 ConfidentialityAs you have seen, patients’ health information and their interests

must be protected through a number of measures. However, there

are some exceptional circumstances when a professional can





share information about a patient without their consent. For

example:

where there is a risk of serious harm to the patient or to others, or a risk of a serious crime being committed. For example,

someone could tell their doctor that they were going to

try to severely hurt themselves or other people. The

doctor could decide to share this information with

someone else who is working closely with that person,

or contact the police.

when a professional has to weigh up the need for confidentiality against ʿpublic interestʾ. This means that, if they feel the

information could be helpful to the public as a whole, it

can be released in certain circumstances. So, if

someone has been diagnosed with a serious

contagious disease such as swine flu, a medical

professional may disclose this information to the

public via the media in order to prevent the spread of

this disease. This would only include information that

is necessary to inform the public and personal details

would not be shared. Likewise, if a court of law

demands that confidentiality should be breached

healthcare staff have no choice but to obey.





It is always difficult to judge when it is justified to breach a

confidence, so healthcare assistants should not decide on their

own. It should always be discussed with a line manager or other

specified colleague.





What you have learned in this section A person-centred approach to healthcare focuses on

the individual’s personal needs, wants, desires and

goals.

Everything you do for a patient requires their consent;

this may be explicit or implied.

Six core values are recognised as applying to anyone

in a caring role: Care, Compassion, Competence,

Communication, Courage and Commitment.

Communication involves both listening and being

heard.

There is a wide range of potential barriers to effective

communication.

Under the Data Protection Act (1984) you must follow

rules on how to store and handle information.

In some circumstances personal information cannot be

kept confidential.





Further information (optional)If you want to find out further information about the Freedom of

Information Act (2000), it is available here: www.gov.uk/make-a-freedom-of-information-request/the-freedom-of-information-act




http://www.gov.uk/make-a-freedom-of-information-request/the-freedom-of-information-act




Section 2 quizWell done, you have now reached the end of Section 2 of

Introducing practical healthcare, and it is time to attempt the

assessment questions. This is designed to be a fun activity to help

consolidate your learning.

There are only five questions, and if you get at least four correct

answers you will be able to download your badge for the ‘Working

with patients and colleagues’ section (plus you get more than one

try!).

I would like to try the Section 2 quiz to get my badge

If you are studying this course using one of the alternative formats,

please note that you will need to go online to take this quiz.

I’ve finished this section. What next?You can now choose to move on to Section 3, Your healthcare practice, or to one of the other sections so you can continue

collecting your badges.

If you feel that you’ve now got what you need from the course and

don’t wish to attempt the quiz or continue collecting your badges,

please visit the Taking my learning further section, where you




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http://www.open.edu/openlearn/ocw/mod/oucontent/olinkremote.php?website=NNCO_HCA&targetdoc=Your%20healthcare%20practice

http://www.open.edu/openlearn/ocw/mod/oucontent/olinkremote.php?website=NNCO_HCA&targetdoc=Your%20healthcare%20practice

http://www.open.edu/openlearn/ocw/mod/oucontent/olinkremote.php?website=NNCO_HCA&targetdoc=Section%202%20quiz&targetptr=1.6


can reflect on what you have learned and find suggestions of

further learning opportunities.

We would love to know what you thought of the course and how

you plan to use what you have learned. Your feedback is

anonymous and will help us to improve our offer.

Take our Open University end-of-course survey.

Cavendish, C. (2013) An Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings,London, Department of Health [Online]. Available at

www.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf(Accessed 7

December 2015).

Choose Unison and The Open University (2015) Communication Skills [Online]. Available at

www.open.ac.uk/choose/unison/develop/my-skills/communication-skills (Accessed 7 December 2015).

Department of Health (2003) NHS Code of Practice: Confidentiality [Online]. Available at

www.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf







http://www.open.ac.uk/choose/unison/develop/my-skills/communication-skills

http://www.open.ac.uk/choose/unison/develop/my-skills/communication-skills

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf

https://www.surveymonkey.com/r/VBGNFVK


NHS England (2012) Our Culture of Compassionate Care[Online]. Available at

https://www.england.nhs.uk/6cs/wp-content/uploads/sites/25/2015/03/introducing-the-6cs.pdf (Accessed 7 December

2015).

The Open University (2015) K101 Learning Guide 12: Developing skills in communication, Milton Keynes, The Open University.




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https://www.england.nhs.uk/6cs/wp-content/uploads/sites/25/2015/03/introducing-the-6cs.pdf


AcknowledgementsThis free course was written by Joanne Thomas (consultant for the

Open University) and Emma Lipscombe (Learning and Workforce

Development Officer for UNISON), with contributions from Ruth

Beretta (staff tutor for the Open University).

Except for third party materials and otherwise stated (see terms and conditions), this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence.

The material acknowledged below is Proprietary and used under

licence (not subject to Creative Commons Licence). Grateful

acknowledgement is made to the following sources for permission

to reproduce material in this free course:

Every effort has been made to contact copyright owners. If any

have been inadvertently overlooked, the publishers will be pleased

to make the necessary arrangements at the first opportunity.

FiguresFigure 1: Tommi/iStockphoto.com

Figure 2: Rawpixel ltd/iStockphoto.com and sturti/iStockphoto.com

Figure 3: SoumenNath/Istockphoto.comPage 45 of 78 27th February 2019






http://www.open.ac.uk/conditions

http://www.open.ac.uk/conditions


Figure 4: © unknown

Figure 5: Pandpstock001/iStockphoto.com

Audios‘Living with visual impairment: nurse support’ including transcript:

from OU pre-reg nursing programme, © The Open University

‘The importance of care plans’ including transcript: courtesy

Unison (https://www.unison.org.uk/)

‘Values of empathy, trust and reassurance’ including transcript:

courtesy Unison (https://www.unison.org.uk/)

‘Obtaining patient consent ’ including transcript: courtesy Unison

(https://www.unison.org.uk/)

Videos‘End-stage renal failure – a long-term condition: Malcolm's story’

including transcript from SK120 Diabetes Care, © The Open

University

‘Motorcycle accident’ including transcript: from SDK125

Introducing Health Sciences: Trauma, Repair and Recovering, © The Open University




https://www.unison.org.uk/




‘Measuring blood pressure’ including transcript: from SK120

Diabetes Care, © The Open University





Activity 7Untitled partAnswerFind out how the patient usually manages with written material (for

example do they have a magnifying glass or other visual aids?). If

they always rely on someone to read for them, you can do this.

Back to Session 2 Part 2





Activity 7Untitled partAnswerAcknowledge that the patient may be frustrated and upset, and ask

if there is anything you can do to make things better for them right

now. Maintain a positive attitude and do not become defensive

about your actions, as it will probably make the situation worse.






Activity 7Untitled partAnswerTry to ensure some privacy so that you can talk with them about

their situation, listen attentively and allow them to express their

sadness/anger or whatever feelings they have freely, without

feeling hurried or judged at all.






Activity 7Untitled partAnswerTry to assess how much the patient can understand and explain

the visiting hours, writing down the times for them. If you think that

they cannot understand simple language, you might need to ask a

senior member of staff about employing a translator.






Activity 1Untitled partCommentYou may have considered different ways of being understanding

towards Jackie’s situation. Jackie was feeling quite apprehensive

about not having a medical diagnosis and feeling that her

symptoms were not obvious to the healthcare team. As a

healthcare assistant, you would need to remain supportive and

attentive to Jackie, and ask her to reflect on what she was feeling

and what specific support she needed. You would need to

reassure her about a possible future diagnosis and be aware of the

symptoms she is currently experiencing.

Jackie discussed the importance of the balance between

supporting a patient and allowing them the independence to carry

out everyday tasks. Independence was important to Jackie and so,

as a healthcare assistant, you would need to look for ways which

empower her to feel more independent, such as helping her to

obtain particular aids to carry out tasks on her own, whilst also

being on-hand to support her in case she needed it. It may be that

Jackie would benefit from assistive technology such as a large

keyboard or talking telephone, or books in large print or Braille.





An important element of this is to judge the patient’s limitations,

and provide regular support to push and develop their

independence as they learn to live with or overcome their

condition. Healthcare assistants need to ask their patients what

level of support they would like and what they feel they can

realistically carry out themselves (so as not to take away their

independence, or equally let them feel like they ʿfailedʾ).






Activity 2Untitled partCommentIn order to achieve care that is person-centred, you will need to

understand your patients and their relatives, their background and

ideas, wishes, likes and dislikes. Achieving this can be

challenging, as it requires time to listen and talk. Furthermore, the

organisation of care – particularly in hospital settings – sometimes

means that the focus is on ‘getting the job done’; nevertheless,

staff must remain tactful and not push for information that patients

do not wish to give. What the individual needs and wants should

come first. Remember they are not choosing to be ill and may well

be anxious about what will happen to them. A grown man suddenly

and unexpectedly finding himself in hospital, being washed by a

stranger for the first time since childhood and asked about his

bowel actions may bitterly resent his sudden helplessness and

become irritable and aggressive. Some patients may find fault with

your actions and start to complain, and you will need to be aware

of the emotional impact their situation has had on them. Wherever

you work, you will need to act upon the plan that has been drawn

up with care and compassion.





In addition to a patient’s care plan, you should also consider their

basic comfort. This calls for an awareness of the things that can

cause discomfort, such as feeling too hot or cold, whether they are

thirsty or hungry, in pain or having an itch, or need the toilet or to

change position. All of these require your awareness of their

needs, and to take the appropriate steps meet them.






Activity 4CommentMalcolm has suffered issues with his kidneys for seventeen years.

He describes how he couldn’t exist without his dialysis treatment.

He has accepted the treatment as part of his routine but it is quite

disruptive of his week and limits the other arrangements he can

make. When he is spending such a long period of time in the

hospital, it is important to reduce the delays before treatment as

much as possible and ease his transition onto the machine. The

first ʿCʾ you use will probably be communication, by greeting

Malcolm on arrival and listening carefully to any requirements he

may have before the treatment starts.

Throughout his time on the ward you will be promoting Malcolm’s

physical and emotional comfort, applying the ʿCʾ care. For

example, during the dialysis, it is important to make him feel

comfortable, ensuring his cushions are in the right place and that

the temperature is controlled to suit him.

Malcolm returns regularly for his appointments, and you would

need to understand him and show another ʿCʾ compassion

towards his situation, and try to keep him occupied. Malcolm may

feel more at ease if he is encouraged to bring activities and home

comforts to break up the session.





Malcolm mentioned a couple of complications he might receive as

a result of dialysis. If you were part of his treatment team, you

would need to be aware of these potential issues and monitor his

progress while he is having treatment. This calls for another ʿCʾ: a

level of competence to understand what he needs and have the

knowledge and skills to provide it.

In addition, there are two other ‘C’s which you need to be aware of,

although at first they may not seem directly relevant to Malcolm’s

issues: courage and commitment. You will need to show a

commitment to Malcolm’s treatment: even on days when the

treatment will feel draining, it will still be important to continue in a

positive way. Similarly you will need the courage to act quickly and

correctly if there are any complications with the dialysis, to ensure

that Malcolm’s safety is maintained.

Back to Session 1 Activity 4





Activity 5 CommentRobert’s story illustrates why it is so important to take the time to

understand the context behind a patient’s behaviour and to work in

a person-centred way. This meant having the compassion, or

ability to feel for Robert, to understand him and his life-changing

situation. His needs might not have been obvious from the outset,

but by getting to know him as an individual it was possible for his

nursing team to care for him, placing his best interests at heart and

doing what they could to maintain or improve his wellbeing.

As a healthcare assistant you will need to be competent in

recognising the invisible symptoms causing his discomfort and

behaviour. Robert is clearly in constant pain and has suffered a

brain injury as a result of the accident. Memory loss and extreme

tiredness are both symptoms that affect his life which are hidden to

the outside world. You will also need to demonstrate competence

in how best to alleviate his symptoms, and be knowledgeable

about how to provide appropriate support. You would need to

remember to ensure that he can have regular breaks and support

as required; as well as space when he is feeling more irritable.

Robert describes how his life has completely changed, and he is

now unable to work in his previous job as a result. Healthcare





assistants working with him would need to be compassionate

to his circumstances and recognise all of the symptoms that

Robert faces (including those hidden issues). It is important to

understand how these are driving his behaviour. You would also

need to take a caring attitude in your ongoing work with Robert,

carrying out actions which are best to maintain his wellbeing and

comfort.

As a healthcare assistant, you would need to be aware of how

your communication is affecting him. Any touch should be

carried out in a way to avoid pain, and you would need to convey

empathy and understanding, even when Robert is displaying more

aggravated behaviours.

As a healthcare assistant, you will be required to draw particularly

upon the commitment and courage Cs here: you would need

to be committed to Robert’s continual care, even through difficult

periods, and have the courage to demonstrate empathy even

when he becomes demanding or negative towards his situation.






Activity 6CommentIf this was the patient’s first blood pressure test, the healthcare

assistant would normally describe to the patient how the blood

pressure check would be carried out and why the blood pressure

needed to be measured. She gave no reassurance to help the

patient feel more relaxed, and should have explained that the cuff

was going to tighten and there might be a bit of pressure. She

could have checked that he was comfortable and his arm

supported, though she did ask him to try and relax his arm. If a

patient is particularly nervous it helps to suggest they visualise

being in a nice place, to help them relax. Afterwards she just said

the blood pressure was ok, with no explanation of what the figures

meant and how they related to the ʿhealthyʾ scale.






Activity 8Untitled partCommentService users and agencies couldn’t prove what was agreed or

provided with consent. Without this record, agencies may be sued.






Activity 8Untitled partCommentPatients might not be able to remember everything they need to

know. If there were no written record, they might find it more

difficult to complain about a lack of services.






Activity 8Untitled partCommentA lot of care is provided by teams. Unsafe kinds of care would be

much more likely if there were only verbal handovers.






Activity 8Untitled partCommentTime and resources would be wasted. Essential services would

not be provided. In cases of abuse, connections would not be

made between concerns raised by people from different agencies.






Activity 8Untitled partCommentNational data wouldn’t be collected to help design prevention

programmes.






Figure 1 Previously active people may suddenly find themselves without mobility or confined to a wheelchair DescriptionThe picture shows a female healthcare worker notifying the handler of a wheelchair in which a male patient is seated in a wheelchair. Both are looking out of a window. Another woman, not in uniform, is standing alongside.

Back to Session 1 Figure 1





Figure 2 The typical healthcare team has a range of professionals and support staffDescriptionThere are two photos showing a range of professionals and support staff working in the healthcare sector. The first shows a hospital cleaner, the second shows a surgical team with (from left) operating theatre technician, consultant surgeon, ward nurse, theatre sister, theatre staff nurse and surgical registrar.






Figure 3 The way you communicate with your body language is importantDescriptionThe photo shows a male healthcare worker holding a packet of orange tablets in his left hand and pointing firmly with his right index finger at his patient. The patient sitting next to him is not making eye contact






Figure 4 You might be asked to handle or contribute to hard data within a paper filing system DescriptionThe photo shows a female healthcare worker looking through a

shelf containing numerous paper files.






Figure 5 Medical records are increasingly being filed electronicallyDescriptionThe picture shows a computer screen displaying an Electronic Medical Record System.






Living with visual impairment: nurse supportTranscriptJackieI needed the nurses to comfort me, which sounds quite a strange term to use. I wanted sympathy which again is not a term that you would often use with anybody with an impairment or disability but because I was so, I’ll say ill at that time, I just needed somebody to look after me. I also needed the nurses to believe in me because sometimes with this type of impairment it is not visible to the other person. I can only describe and explain what I’m seeing or feeling or hearing etc and when you haven’t got a diagnosis as such, as I hadn’t at that time, you haven’t got anything to hang it on so I needed the nurses to believe what I was saying and to comfort me and to calm me. Independence to anybody with any type of impairment is extremely important but the road to independence is quite long and arduous. At the beginning you are mostly dependent on people and you do need that sympathy, you do need that support and you do need that help to get through the initial symptoms of what you are experiencing. As you learn to live with the impairment, then you need to be able to take control of your life and this is where nurses can play a big role, by being able to give the power to the person with the impairment. It’s very easy to want to do things for people but that's not actually helping anybody in the long run, you need to enable that person to do things for themselves. You talk to them, you ask them what they want to do, you ask them what they think they can do for themselves and you try and just push them a little bit more each time. But again you have to be very clever here and you need to note when that person needs to stop, they need to just pull back a bit and they need some support. So for a nurse it is very difficult here because you don’t know how a person is going to be. You don’t know how much dependence and independence he or she might need at any particular time so you have to read that person on not only a day to day basis but perhaps an hourly basis at some times when there are certain things going on but promoting independence is one of the main roles that a nurse can provide for somebody with impairment.

Back to Session 1 MediaContent 1





The importance of care plansTranscriptGail:Um a care plan is used for every patient, and it’s one of the most important pieces of documentation that you will ever have and it’s as it suggests, it is a care plan for that particular patient. Everything will be documented in there and it’s really important that anything you do for that patient is documented in there, because at changeovers of staff, another staff member coming in can have a look and see what’s been done, what’s been happening, what needs to be done um so that it can be given as a whole holistic care.






Obtaining patient consentTranscriptGail:You must always get consent from a patient and this can be in um different ways.If a patient is having an operation or an intervention, normally they would have to sign a Formal Consent Form, and a Formal Consent Form can come in lots of guises – it could be that the patient consents for themselves; it can be that the patient has an advocate that will sign for them. If it’s a patient that is under an age or doesn’t understand, then a parent can sign for that patient, so there are lots of different Consent Forms and you have to make sure that you use the appropriate Consent Form - that is really important! Consent on a formal form is usually taken by the doctor that is going to do the procedure or the operation, and when the consent’s done, you will talk to the patient and tell them what the risks, complications, side effects could be, what they are going to do um and what may happen afterwards so this is what they call an Informed Consent. So the patient then knows everything about that procedure or that operation, and he then can sign that consent if he agrees with it. So that is Informed Consent. The other consent that there is, is a Verbal Consent. I would use this as a healthcare [assistant] um, all the time. Every time you go to a patient to do anything with them you must gain an Informal Consent from them. This can be ‘Mrs Jones I’m just coming to do your blood pressure, is that alright?’ and the patient would say yes or no. If the patient says no, then we don’t do that blood pressure! We would then maybe go and speak to a member of staff to pass that on and maybe go in from a different angle and actually explain why we need to do the blood pressure. So everything that you do for a patient, you must gain consent. If you are actually saying to them ‘shall we put your nightie on’, that they say ‘yes’, that is a consent. You must gain consent!






Values of empathy, trust and reassuranceTranscriptGail:Patients come in because they come in for an operation onto my ward, um, so you are there to get them ready for… for theatre and make sure that they get up to theatre and that everything is alright. But before you even start that, the care starts. As they are coming onto the ward, we may get patients that are upset, they’ve never been into hospital before. You may get a person with a needle phobia. So your job starts - before the caring, your job starts with the empathy, the reassurance that everything is going to be alright, “I’ll be looking after you ... You can ask me anything”. You’ve got to get the trust – and once they trust you and you can calm things down they feel better and we can do our job better so then the caring starts – but things start before then!






End-stage renal failure – a long-term condition: Malcolm's storyTranscriptMalcolmMy name is Malcolm Lawrence. I’m a dialysis patient. I’ve been on dialysis for four-and-a half years. I’m on dialysis because both my kidneys failed. My first kidney had a benign tumour called an oncocytoma 17 years ago and had to be removed. The second kidney, over a period of 12 years, gradually failed, which meant that at the end of those 17 years, I really couldn’t really exist without going on to dialysis. Dialysis is a way of filtering the blood externally, doing the things that the kidney should be doing, but isn’t doing. If you’ve not been a dialysis patient, you don’t really know what it’s like. There are plenty of other illnesses around but I can’t think of anything where you have to have this regime on a regular and very necessary basis. Malcolm’s wifeYou’ve obviously got used to the dialysis and accept it, and don’t want it to rule our lives, but essentially it does, um to a certain extent, it rules our timetable because Mondays, Wednesdays and Fridays, obviously we can’t make any major plans on those days and, in fact, when Malcolm goes to dialysis, I choose those days to do my own things. MalcolmI have dialysis. I have what’s called a fistula. This is when a vein is joined to an artery in your forearm which gives a good site for needling. I put anaesthetic cream on it and tape it down, and then I have some lunch, and then I get to the unit about quarter to one. So here I am on the dialysis unit. I’ve been here about an hour today and my whole session will be four hours, not including putting me on the machine and putting me off the machine. This is the great dialysis machine here next to me, and this is the filter which is red as my blood is passing through it. The blood goes through the machine and back into me, and out again, and here you can see the two needles that have been put in. Being on the machine is perfectly fine normally, but one or two things that occasionally happen – sometimes blood pressure drops, and sometimes one gets cramps – but these are very infrequent. Most of the time it’s really quite nice sitting here. They keep the temperature well controlled and the seat’s quite comfortable, now that I’ve brought my cushions in, and it’s really just a matter of whiling the time away. The main problem of being on dialysis would be perhaps the next day you might feel rather tired and a little bit strange as well, but actually being on the machine, as far as I’m concerned, is quite a passive thing. I feel very fortunate I’m here. It’s only a 20 minute journey by car when I drive here, the unit is very, very





efficient, I’m always seen within half an hour of arriving, so one must count one’s blessings.






Motorcycle accidentTranscriptRobert:If people come up to me and tap me on the back, you know it really hurts and it, you know, it feels like they’ve stabbed me. Sitting in a chair or laying on my back is not so much painful because I’ve got used to it now but I can always feel it, and it’s just a bit of a nightmare to be quite honest. There are times when you’re thinking like oh, do I have to be like this every day for the rest of my life, then there are other times when you just completely forget about it because I’ve got so used to it. What’s still affecting me now is apart from the sore back and the no skin on my knees it’s the mental things that are affecting me, which are really terrible memory and fatigue, because a lot of people think tiredness is physical, but it needn’t be. Now, for example after we’ve, you know, talked now I’ll probably have to have a lay down this afternoon, just simply because my brain is completely worn out, or might not be, but that’s by far the worst thing and that’s the reason why after three years on I’m not back to work because I was originally thinking, my old boss came to see me in hospital, you know a couple of months after the accident, and I was saying oh don’t worry, I’ll be back to work by Christmas, you know, I set myself, you know, January the first I’ll be back to work and whatever, that was you know two-and-a-half years ago, and the way that things are going at the moment I certainly won’t be able to go back to doing the job that I was doing. If you look at me physically, well if I’m standing there with my shorts on, you wouldn’t know that I’d got any sort of injury at all, and I say it often but 50 per cent of the time talking to me you wouldn’t think that there’s anything wrong with me, but a lot of people when you go out they don’t see the time when you’re at home, and the time when you’re sitting there and oh god, can hardly move, and of course you know I get tired and irritable, and completely zombified, and that’s one of the worst things about having a head injury, or it’s a brain injury, is that it’s a hidden injury, completely hidden. So life I think has changed, I mean it’s changed massively financially because I was a salesman in the past, I used to earn a lot of my wages as commission so, but now I don’t so that’s changed an awful lot. But I think you get used to, well I’m used to now… what I’ve got and rather than what I had, so it puts things into perspective a lot.






Measuring blood pressureTranscriptKerriRight, let's just do your blood pressure. If you just want to roll up your sleeve.Lovely, pop your arm in there for me.OK if you just want to relax your arm. Try not to move or talk.OK lovely, that's not too bad at all.





Documents

Working with patients and colleagues - Open University€¦ · Web viewWorking with patients and colleagues ... You will see what a dialysis machine looks like and how Malcolm’s