NVQ evidence

Alan was a 69-year-old gentleman with shingles, which required him to be isolated and nursed in a side room. He also had prostatic and bowel cancer. He had been admitted for increasing shortness of breath. His urinary continence was variable and as he was having intermittent melaena, he was sometimes incontinent of faeces. Alan's shingles had affected both eyes and had made him deaf in his right ear. He used a hearing aide to facilitate communication. He was nervous about falling out of bed so he had consented to having bed rails in place.

I was assisted by my Assessor to undertake his morning care. We put latex gloves and plastic aprons before entering the room, I announced to Alan who we were and what we would be doing so that he was aware who we were and what we planned to do. I explained to him what was needed and obtained his consent.

He said that he required having his bowels open. However, due to his melaena, he had been incontinent of faeces. He asked to use a bedpan so we obtained a suitable one and after informing him of what we were going to do we rolled him onto it maximising his dignity as best we could. We ensured he was safe (with the cot sides up) and as comfortable as possible and gave him the bell to ring, after ensuring that he was able to use it.

When we arrived, I asked Alan if he had finished on the bed and before assisting him off it. We did this by rolling him on his side. Whilst he was on his side, it was necessary for me it to wash his bottom.

I then commenced washing Alan. I gave him the choices as to how he wanted this done and what toiletries he used. He chose not to have a shave on this occasion. Before I started washing the rest of his body, I washed out the bowl and change my gloves and apron as well as washing my hands, as I had been dealing with faeces so I did not want to contaminate the rest of Alan's with this.

I asked Alan whether he wished to have sold on his face when I washed it or not. I gave him choice as to which clothing he wore.

Alan then required to be moved up the bed. I followed the following steps with the aid of my assessor: -

Ensure that all parties are all aware of what is going to happen. Agree on a plan of action.

Roll client to one side whilst slide sheet is placed under client ensuring that they head, buttocks and heels are contact with a slide sheet.
Roll client the other way her so at that the other half of the slide sheet can be put into position.

Ensure that brakes are applied on bed and that they are working properly.
Ensure that they are pillows at the top of the bed so that the client does not hurt her/his head to in a move.

Holding slide sheet at client's hips and shoulders, rock from side to side in the direction of the move was counting in the agreed manner and move on the cue word.

Adjust client and bedding to client comfort whilst reducing the effects of pressure on the client as much possible.

Alan expressed that he was very nervous about being rolled from side to side as he felt he was going to fall out the bed. He somewhat distressed by this prospect. I assured him that my assessor and I would be standing at the size of a bed whilst this procedure was being undertaken. I also explained to him that his concerns were not unusual and quite understandable. I made doubly sure that I explained all parts of the move to him prior to any action being taken within the procedure. I found that this explanation process helped to allay Alan's fears. I recorded this in his care plan.

Because Alan was immobile, I encouraged him to change position at least every four hours as described in his care plan. I placed a pillow under his buttock and then put it in the other side four hours later. Alan was also on a pressure-relieving mattress that helped the process. While I was washing Alan, I was inspecting his skin areas to see if there were any abnormalities or signs of pressure he such as redness of the skin and/or broken areas. I found that his skin was intact. I recorded this in his care plan

Unit O2 Promote people’s equality, diversity and rights

Element O2.1 Promote people’s rights and responsibilities

1] The worker’s actions recognise people’s right to make their own decisions in the context of their lives, and acknowledge peoples responsibilities

I offered Alan informed choices throughout the whole interaction and allowed him to make his decisions and then respected them within a framework of safety and appropriateness.

2] The worker’s actions in interpreting the meaning of rights and responsibilities are consistent with existing legislative frameworks and organisational policy

We used the appropriate method of holding the Sliding sheet while moving him up the bed. He wanted up to lift him physically up the bed. I told him that this was not possible as it was both unsafe and without trust policy. I explained that doing this could injure all both him and us. He agreed to let us use the approved method

3] Information provided by the worker is up-to-date and takes account of the complexity of the decisions that people may need to make

We used the latest proved method of holding the slide sheet. We used this method of moving despite Alan wanting at first wanting us to lift him. I have him the cooper consequences of lifting him manually and he consented to us using the slide sheet.

4]

People who are unable to exercise their rights personally are given the appropriate help to do so

5 Tensions between rights and responsibilities are acknowledged and the appropriate support is given towards their solution

When Alan asked to be lifted up the bed, I was empathetic but maintained it was not possible to do it the way he wanted as it was not within trust policy.

6 The necessary records relating to the promotion of rights and responsibilities are accurate, legible and complete

I recorded all care given in the client's care plan. This included the request to be lifted and the use of the slide sheet

7 Information recorded by the worker is consistent with the promotion of rights and distinguishes between facts and opinions

The Language I used when writing was objective and did not use any ambiguous terminology or subjective feelings.

8 People who wish to make a complaint about an infringement of their rights are provided with the necessary information to do so

Alan did not have any complaints at this time

Unit O2 Promote people’s rights and responsibilities

Element O2.2 Promote equality and diversity of people

1 Actions of the worker are consistent with people’s expressed beliefs and views and acknowledge the benefits of diversity

I ascertained Alan's views on how he wanted things to be done and then weighed them up with policy and procedure

2 Anti-discriminatory practice is promoted in ways that are consistent with professional and legislative frameworks and organisational policy

Prior to commencing care, I asked Alan for consent for care to be given by my assessor and me. If he had raised any doubts then I would have sought other arraignments. I did not discriminate against Alan for any reason and gave him the same care he needed as it was prescribed.

3 The appropriate action is taken to minimise the impact of discrimination and oppression on people

I asked Alan what he wanted and under took it within the parameters of appropriateness, procedure and policy

4 The worker seeks the appropriate support when they are having difficulty promoting equality and diversity

There was a conflict, as, as an individual, Alan wanted to be physically lifted up the bed. I said to Alan that although I acknowledged that he would like to be lifted physically up the bed, it was not appropriate or safe for him or the others involved in the move to be in this manner. I did not berate him for this choice or for expressing it. I gave him an explanation not-judgmentally and kindly as to why this was not possible and explained the alternative. He agreed to the use of the slide sheet.

5 The necessary records relating to the promotion of equality and diversity are accurate, legible and complete

I recorded in a non-judgemental, objective and as appropriate manner as possible that Alan requested to be lifted physically up the bed. I explained to him that the reason for not using this method was one of safety. I explained the move method of choice was one with a slide sheet.

6 Information recorded by the worker is consistent with the promotion of equality and diversity

I acknowledged that Alan had the right to make the request but also acknowledged that it was not appropriate to move him in the manner requested.

Unit O2 Promote people’s rights and responsibilities

Element O2.3 Promote people’s right to the confidentiality of information

1 Information stored in, and retrieved from, recording systems is consistent with the requirements of legislation and organisational policy

Alan's medical notes were stored in the appropriate notes trolley and were not accessible to him unless he had requested to see them formerly. If he had, then he would have had to written formerly to request to do so. Then, the access is not total. A consultant may, if she/he wishes, hold back certain parts of the notes and there is also a cut off point prior to which one may not see one's notes.

Alan's Nursing Care Plan and Profile are stored along side the Medical Notes in the same trolley. If Alan had wished to see his nursing care plan, then he could have done. However, just because an individual client has access to her/his care plan, then, that does not mean that family/friends/significant others are entitled to do so. It is sometime necessary to guard against nosey visitors looking in care plans and then when challenged them turning to the client and saying "... You don't mind.... do you...?" or "Well, it's my relative!!!!" Despite it being "their" relative, the client has rights as to who sees theirs notes. Also to who visits them. Medical Admission is a very busy place with high numbers of visitors and clients passing thought. Breaches in confidentiality and security are a very high probability without precaution and vigilance being undertaken constantly.

2 Records made by the worker are accurate and legible and contain only the information necessary for the record’s purpose

I am dyslexic so I have to be extra careful about spelling, grammar, syntax and writing that I use. I have to re-check what I write and, if I am concerned, then I seek assistance from others. I am very open about being dyslexic. I feel more comfortable about letting people know as then I do not feel worried about asking for help.

The content need to be unambiguous and as objective as possible as well as only recording what is necessary and relevant. If feelings are allowed to be introduced then this can adversely affect care and can lead to discrimination.

3 Information is disclosed only to those who have the right and need to know, and when proof of identity has been obtained

See O2.3.1If anyone who is not directly looking after Alan tries to access is notes, it is very important to challenge them. The wearing of ID badges ids very important. Both My Assessor and I were wearing our ID badges when we cared for Alan on this occasion.

4 The appropriate precautions are taken when communicating confidential or sensitive information to those who have the right and need to know it

See O2.3.1 and O2.3.3. We did not discuss any thing confidential in the presence of other who was not directly involved in Alan's care. At the start of the shift, my assessor and I received a hand over verbally. It was done away from others.

5 When someone tells the worker something that the worker is required to share with others, the person is told in a clear and appropriate manner that the information may need to be shared with others

When Alan told my Assessor and me that he wanted to be "lifted" rather than "slid" I told him that I would have to record this in the care plan.

6 Confidential records are handled securely and stored in the correct place

See O2.3.1. After I had finished recording Alan's care in his care plan, I returned it to his slot in the notes trolley.

7 The worker seeks support when it appears that information is being misused

Not covered on this occasion.

If information were being misused, then would have challenged the individual in an assertive but polite manner. If the situation were not resolvable, then I would have taken the matter to the Nurse in charge and recorded the matter on an incident form.
Unit CL1 Promote effective communication and relationships.

Element CL1.1 Develop relationships with people which value them as individuals.

1. The worker’s actions contribute to the maintenance of a work environment that promotes the value of individuals and encourages meaningful interactions.

I only conducted conversations with Alan that were pertinent to the situation or that included him rather than talked over him with my Assessor.

2. Interactions with people demonstrate respect for them as individuals and acknowledge their rights to make their own decisions in the context of their lives.

When Alan said that he anted to be lifted up the bed, I did not use a castigating tone but one that was showed I did value his contributions be they, at this juncture, not safe practice.

3 Communication with people is designed to lead to an adequate and accurate exchange of information.

At all stages, I encouraged Alan to make his own decisions and valued his options when he did. I did not rush him and gave him encouraging nods and gestures when he spoke

4 People are encouraged to decide for themselves the actions they wish to take and their right to change their mind is respected.

See CL1.1.3

5 The appropriate action is taken to challenge behaviour that infringes the rights of others.

I challenged Alan over the issue of lifting rather than sliding.

6 Explanations are offered about the worker’s actions whether the individual appears to understand the explanations or not.

Alan, on this occasion, did understand what was said to him. If he had not it is important to still say it because, even at the deepest level, there may have been understanding.

7 Necessary changes to environments or routines are agreed with those concerned before the changes are made.

In the explanation of events I told Alan that what we were planning and that things would be moved. I explained, for example that the table was moved for safety.

8 When individuals require some form of assistance, this is established with them and given appropriately.

Alan realised that he need assistance with his some of his activities of living, so offering our help here was no problem. We explained beforehand what we were going to do, talked it through as we did it and asked him if there were any problems after each stage of the care delivery session.

9 Opportunities are taken to reflect on own behaviour with, and reactions to, people and this is used to evaluate one’s practice.

After the care delivery, in an appropriate venue away from the client, I asked my Assessor for feed back. I was told that sometimes I work in at a pace that does not allow clients to fully express what they want to. I have reflected on this and have tried to bring this into my future practice.

Unit CL.1 Promote effective communication and relationships.

Element CL1.2 Establish and maintain effective communication with people.

1 The manner, level and pace of communication with people is consistent with their abilities, preferred form of communication, manner of expression and personal beliefs and preferences.

Alan used a hearing aide with headphones that I ensured was set at an appropriate level before commencing care. Shingles had invaded both eyes. However, the right eye was less badly affected and he could open it more readily.

2 The worker’s body language, position, tone of voice and style of active listening encourage people to communicate.

Alan used a hearing aide with headphones that I ensured was set at an appropriate level before commencing care. Shingles had invaded both eyes. However, the right eye was less badly affected and he could open it more readily.

My body language was open and conducive to fostering a therapeutic professional relationship. I worked at a position was at an optimum level that was both professional and therapeutic level. I used a reassuring and at a level that he could hear me but without shouting. I showed that I was listening to Alan with the use of appropriate use of nods and affirmations. I acted upon all concerns in an appropriate level. I gave Alan time to talk and think.

3.

Obstacles to effective communication are minimised as far as possible given the constraints of the situation.

I ensured that the door was shut. I drew the curtains at appropriate times during the interactions. I ensured that Alan had his hearing aide on and set appropriately when required.

4 Information given by individuals is confirmed with them for accuracy.

When necessary, I asked Alan if things were alright post care delivery and if my interpretation of his request were actually what he wanted pre care delivery.

5 Individual’s expression of feelings and needs are responded to in a manner that supports the right to such expression.

During being turned and being moved up the bed, he became distressed. I acknowledged his feelings and tried to allay his fears and made sure he knew what was going to happen

6 People’s behaviour is observed and used to develop an understanding of what it is they are trying to communicate.

Alan's body language was tense when he found out he was about to be moved which helped me to realised he was worried about moving

7 Where there are differences in the ways in which the worker and the people concerned communicate, these are explored and used to improve the effectiveness of the communication.

I do not have a hearing deficit. Alan did. During the interaction, I noted that it was important that spoke at a level that was appropriate. If I had shouted, that would not have been appropriate. If I spoke too quietly, Alan would not have heard.

8 Opportunities are taken to reflect on own behaviour with, and reactions to, different people and this is used to evaluate one’s practice.

After the care delivery, in an appropriate venue away from the client, I asked my Assessor for feed back. I was told that sometimes I work at a pace that does not allow clients to fully express what they want to. I have reflected on this and have tried to bring this into my future practice.

Unit CU1 Promote, monitor and maintain health, safety and security in the workplace.

Element CU1.1 Monitor and maintain the safety and security of the work environment.

1

People entering the environment are identified correctly and their right to entry established.

I already knew Alan and my assessor prior to care delivery. My Assessor and I were both wearing our ID badges in accordance of Trust Policy.

2 The worker’s practice in relation to health, safety and security is consistent with legislation and organisational requirements.

I ensured that

:-) The slide sheet was not effective and safe to use.

:-) I ensured that I was using the correct equipment for moving up the bed as prescribed in Alan's care plan. :

-) I ensured that doors were shut whilst care was being delivered.

:-) Universal precautions were adhered to. Alan was known to have shingles so this was very important.

:-) We had washed our hands and dry them prior to applying gloves (I wore latex and my Assessor wore vinyl) and plastic aprons prior to entering Alan's room. This helped to reduced the spread of infection any further. Alan already had shingles so we did not want that to

3 Prior to starting work activities, the risks involved are identified and the activities are then undertaken in a way that minimises the risks.

Alan had shingles

* Use of universal precautions to reduce risk of Alan getting new infections and my assessor and I contracting infection from him.

* I put Alan's waste in a yellow bag and disposed of it in accordance with trust policy.

* I offered Alan only bed pans/urine bottles that have I knew had been thought the bedpan washer. I ensured that used bed pans/urine bottles were placed into the bedpan washer where they were thoroughly cleaned after use.

* I ensured that Alan only had clean linen that was not contaminated by contact with the floor. All soiled linen was place in a dissolvable red bag then placed in an outer Red bag in this case. (If Alan had not been isolated, then I would have place only soiled linen (that which had a risk of having traces of blood on it - i.e., faeces, vomit etc.)

Alan had been Incontinent of faeces

* See above

Alan had used a urine bottle

* See above

Alan needed to be moved up the bed.

* I ascertained how he was going to be moved up the bed by consulting his care plan. I discovered that he was prescribed the use of a slide sheet!

* I ensured that the slide sheet that we were going to use was clean and not dysfunctional.

* I ensured that the bed was of the correct height. I was taller than my Assessor so I ensured that it was a comfortable height for her.

* I ensured that the brakes were on and that they were functional

* I ensured that Alan was comfortable, safe and know exactly what was going to happen at all times as well as my Assessor.

* After the move, I ensured that the room had been returned to a safe, acceptable state.

4 Work areas are maintained as safe and as free from hazards as is possible during work activities.

* I ensured that Alan's table was moved out the way at appropriate times during the moving process but was in an appropriate position when we washed Alan. After finishing procedures, I made sure that Alan's table was returned to a position that was both comfortable for him as well as being safe.

* Before commencing, I ensured that the area was clear of obstacles and the floor was not wet

* I attempted to be as tidy as possible when I was undertaking procedures.

5 Equipment and materials are used in a correct, safe manner that is consistent with current legal and organisational requirements.

Bed Pan

* Of a suitable shape for Alan

* Sterilized before hand

* Inserted correctly

* Removed correctly

* Covered once used

* Sterilized once used

Urine bottle

* Of a suitable shape for Alan

* Sterilized before hand

* Inserted correctly

* Removed correctly

* Covered once used

* Sterilized once used

Wipes

* They were taken from a packet that was only being used on Alan.

* They were clean and unused prior to use

* They were disposed of in a yellow bag once used.

Linen

* Clean linen was not allowed to touch dirty

* Used linen was put in a dissolvable red bag then in an outer red bag once used. (There was the issue that Alan had shingles so was isolated. This meant that all his linen was dealt with in the above manner. However, if Alan had not been isolated, only contaminated or soiled linen would have been soiled in that way. Non-soiled and non-contaminated linen would have been placed in a Colourless plastic bag and place in the appropriate linen skip.)

Rubbish

* Placed in a yellow bag and tied with a bag tie then placed in the clinical waist bin in a locked cupboard. (Again, due to Alan's isolation, this was so. If he had not been isolated, then just the clinical waist [body product contaminated or the possibility of such] would have been treated like this. Non-clinical waste would have been placed in a black bag then placed in the non-clinical waist bin in a locked cupboard

6 Equipment and materials are stored safely and securely when not in use.

Bed Pan

* In sluice differentiated from dirty ones post sterilization

Urine bottle

* In sluice differentiated from dirty ones post sterilization

Wipes

*In a packet. There was a pack in Alan's room specifically for him as he was isolated. This would have been discarded on his discharge.

Linen

* In linen room where it was not able to come in contact with the floor or dirty linen

Rubbish

* See above

7 Waste and spillage are disposed of without delay in a safe manner and place.

No spillages occurred on this occasion.

If there had been spillages of: -

Dry substance.

* The floor would be swept and then the sweepings thrown in a bin.

* The floor would then be washed using detergent and hot water using non-isolation mop, the head of which would be washed post use, being placed in a colourless linen bag.

Non-body contaminated fluids

* The Excess would be absorbed with paper towels that would then be discarded in a non-clinical waist black bag.

* The floor would then be washed using detergent and hot water using non-isolation mop, the head of which would be washed post use, being placed in a colourless linen bag.

Contaminated spillages

* Paper towels would be used to absorb excess.

* Neat Milton liquid would be poured on top of the towels.

* Towels then disposed on in Clinical Waist yellow bag.

* The floor would then be washed using detergent and hot water using a clinical area mop, the head of which would be washed post use, being placed in a red dissolvable bag then in a red outer bag.

8 The appropriate action is taken to minimise health, safety and security risks that arise during work.

Health risks

* Used appropriate procedure for moving and handling, disposal of waste.

* Use of Universal Precautions helped to decrease risk of infection from spreading

Safety risks

* Ensured that cot sides where appropriately in place when Alan was left.

* Used appropriate procedure for moving and handling, disposal of waste.

* Use of Universal Precautions helped to decrease risk of infection from spreading

Security risks

* Appropriate use of Care Plan and Medical notes.

* Verification of staff by use id badges.

9 The appropriate safety procedures are put into effect without delay in an emergency.

There were no emergency situations in this instance.

10 Health, safety and security records made by the worker are accurate, legible and complete.

Unit CU.1 Promote, monitor and maintain health, safety and security in the workplace.

Element CU1.2 Promote standards of health and safety in working practice.

1 The risks to self and others when undertaking work activities are identified and appropriate actions are taken to minimise risk.

There was a potential risk to Alan of nosocomial infection from us and a risk to us of catching shingles.

* Alan was nursed in Isolation

* We used Universal Precautions

* Used linen was disposed of in dissolvable red bag then in an outer red bag

* Clean linen was not allow contacting the floor or used linen

Alan and I could have been injured during the move up the bed

* We used a slide sheet as prescribe in his care plan

* I explained to Alan what was going to happen and gained his consent as this assisted with his co-operation

2 Approved safe methods and systems are used when undertaking potentially hazardous work activities.

* Universal precautions were used

* Approved method of manual handling

* Approved method of waste disposal were used

3 Others with whom the individual is working are encouraged and supported to promote their own health and safety during work activities.

* Before commencing, I ensured that my assessor and I used the above methods.

4 Work activity is stopped immediately if there is the likelihood of an accident or injury, and the appropriate action is taken to remedy the problem.

* Alan requested to be lifted up the bed so I stopped and ensured that we found a safer, approved way of moving him up the bed was found.

5 Accurate information regarding own whereabouts is maintained so that immediate contact can be made should this be necessary.

* I had informed the Ward Clerk that we would be in with Alan for approximately 30 minutes, in case we were required.

6 Health and safety records made by the worker are accurate, legible and complete.

See above.

Unit CU.1 Promote, monitor and maintain health, safety and security in the workplace.

Element CU1.3 Minimise the risks arising from health emergencies.

THERE WAS NO HEALTH EMMERGENCY THAT OCCURED

However, the following account is what would happen if one had occurred

1 Assistance is immediately summoned for any health emergency and action appropriate to the condition is begun.

* If a health emergency had occurred, the emergency bell should be pulled. However, it is very important that panic does not ensue. It is very important for workers to stay calm. It is very important that a Registered Nurse of other practitioner is in attendance as they are accountable for what happens.

* According to the type of Health emergency determine if other action is required for summoning other help: -

- In the case of Cardiac Arrest, then 2222 needs to be called on the telephone as this summons the CRASH team.

- In other medical emergency, the Fast bleep must be rung which will summon help quickly

2 The individual with the health emergency is provided with support, both verbally and by physical presence.

* It is very important that individuals involved are supported as they can become very anxious. It is very frightening to see a relative collapse so calm is very important to maintain as best as possible. If the client is conscious too, panic can make any adverse condition worse. If the client is unconscious, treating them as if they are conscious is very important, as it is not possible to ascertain if they can hear or not.

3 When someone with more competence to deal with the emergency is available, appropriate support is given to assist in the ongoing care of the individual with the health emergency.

* When Registered or specialist help arrives, a verbal report of what happened allows them to find out what is happening.

* This needs to be brief and concise but be as objective as possible.

4 The immediate vicinity is made as private and safe as possible once the intervention has been taken over by an appropriate person.

* Ensure that the surrounding area is clear of obstacles as this may cause other injuries to be incurred by aiders.

* If, for example, a client is being electrocuted and they power is still in contact, either isolate the power, if possible and if it is not, arrange for it to shut off. DO NOT TOUCH THE CLIENT UNTIL THE POWER IS OFF or the worker will become a victim too.

* Others, such as visitors and relatives, should be removed or, if they wish, be moved to a safe area where they can observe. (Some prefer to remain with their relatives/friend while they are being attended to in an emergency as they can find it more stressful to leave the scene. Others prefer to get out the way.) Choice must be exercised with discretion and kindness. Saying things such as "would you like to come with me?" give them the choice whether they go or stay. If they choose to leave the scene, then they may appreciate a drink. Ask if they need you to stay with them or whether they need you to leave.

5

Any others involved in the incident are offered appropriate support once any initial danger is passed.

* See above

6

Records of incidents are accurate, legible and complete.

* It is not always the role of a support worker to make accounts of medical emergencies in care plans. As registered practitioners, Qualified Nurses are accountable for such situations so it is more appropriate for them to make reports. The role of the support worker is reporting what happened as clearly and objectively as possible so an accurate report can be made.

Unit Z1 Contribute to the protection of individuals from abuse.

Element Z1.1 Contribute to minimising the level of abuse in care environments.

1 Knowledge of individuals’ whereabouts is maintained consistent with their plan of care and organisational policy.

* Alan was bed bound

2 Those within the environment are offered appropriate advice and support on how to minimise the possibility of abuse.

* Alan would have been at risk of abuse if he had been lifted up the bed. I counselled him as to this was not possible and that he would have been at risk of abuse if this had happened.

* My Assessor and I would have been at risk of abuse if we had lifted Alan up the bed

3 Immediate action appropriate to the situation is taken when there are any indications of abuse.

*Actions were stopped so I could explain to Alan that there was an abuse issue arising from his request to be lifted.

4 Information on abuse is reported to an appropriate person.

* My assessor was there and so she heard the situation first hand.

5. Records of abuse that are made by the worker are accurate, legible and complete.

See above

6. Appropriate advice, guidance and support is sought when the worker is unsure about the boundaries and effects of their relationship with individuals.

* As Alan consented to the use of the slide sheet without any duress or any problems, I was able to deal with the situation without the need to involve my Assessor directly although she was there.

7. Where the care team has agreed this, individuals who behave in an inappropriate manner are assisted to examine ways in which their behaviour may be seen as abusive.

* Alan made a simple request to be lifted. He did not become aggressive ore verbally abusive; he merely made a request that could have resulted in abuse to him and us. I was able to counsel him to give him an informed choice so he could make his mind up to use the slide sheet.

8. Where there are restrictions on access, caller’s rights of entry are confirmed prior to allowing access.

* Alan's door was shut and the curtains were cross. If anyone had knocked on the door, we could have said that we were busy and that could they please mind waiting until we were at a more appropriate point of proceedings.

9 Ways in which the organisation’s policies, procedures and routines could be improved to minimise the level of abuse are suggested to appropriate people.

* Alan was under the impression that it would have been easier and quicker to lift him up the bed rather than use the slide sheet. There were no issues of procedure/policy/routine inappropriateness or any changes that could have been made here.

Unit Z1 Contribute to the protection of individuals from abuse.

Element Z1.2 Minimise the effects of abusive behaviour.

1. Individuals who display abusive behaviour are responded to in a manner which respects the individual whilst at the same time clearly shows that the behaviour is unacceptable.

* Alan's behaviour was not abusive in this case: he just made a request, the consequences of which could have resulted in abuse occurring. I was able to counsel him rationally and without duress. He was allowed to make his own choice as to use the slide sheet.

2. Appropriate action is taken to divert any abusive behaviour whilst promoting the rights of those involved.

* See Z1.2.1

3. Risks and disturbances to others and their activities are minimised.

* See Z1.2.1

4. In all cases where the worker requires further assistance, this is sought without delay.

* See Z1.2.1

5. Records of any abusive incident completed by the worker are accurate, legible and complete.

* See above

6. Records are submitted to an appropriate person without delay in a manner that maintains their confidentiality.

* My Assessor saw what I had written in the care plan

7. The worker’s own feelings aroused by the abusive behaviour are managed in a way that supports the right to such feelings whilst minimising any undue effects on the individuals and the setting.

* I was not affronted in anyway by Alan's request. I did not berate him at all and did not make him feel bad for making the request. If I had had any issues, my Assessor was at hand, in this instance, to help me, if I had needed help. I am in a very lucky position to be able to go to any of the other staff if I have any concerns with abuse.

8. The effect of the abusive incident on others in the setting is minimised.

* See above

Unit Z1 Contribute to the protection of individuals from abuse.

1 Monitoring of individuals that is specified in the plan of care is carried out in a manner and at the time intervals required.

By prescribing the use of the slide sheet, Alan was being protected from abuse, as we were. Updates were preformed by qualified nurses on a daily basis due to the nature of the ward. Alan was an unusual case as he was on the ward longer than average as the finding of a bed for him was more challenging as he required isolating.

Alan was protected against abuse by having his care prescribed in the care plan and any changes documented.

2 Any changes in individual’s condition and behaviour are reported to the appropriate person without delay.

Alan made the request to be lifted and this was dealt with professionally and kindly and then recorded in the care plan.

3. Any signs of possible abuse are reported to the appropriate person without delay.

See above

4. Information received from others is confirmed with them for accuracy and authenticity.

Not appropriate here.

5. Information reported by the worker is consistent with all available evidence and observation.

See Z1.3.1

6. Contact with appropriate members of the care team is maintained as part of the monitoring process.

My assessor was there so she saw me deal with the situation.

7. Records made by the worker of information gained are accurate, legible and complete.

See above

8. Where the worker has concerns over individuals who are at risk or is unsure of the action to take, advice is sought from an appropriate person without delay.

The situation was within my remit so I was able to deal with it. However, if this situation were not within my remit, I would have informed a qualified nurse and recorded the fact in the client's care plan.

Unit Z7 Contribute to the movement and handling of individuals to maximise their physical comfort

Element Z7.1 Prepare individuals and environments for moving and handling

1 The personal risks to the individual, and to those assisting the individual, are assessed and the results of the assessment are used to plan the move

* Alan was able to roll but needed to be slid up the bed rather than lifted. He was able to put his hand on his hest and tuck his chin down. He found holing onto a pillow more comfortable and more secure. Especially as he was anxious about being rolled, the explanation had to be more intense and more understanding of this.

2 Where the worker’s own assessment indicates that there is a risk to the personal health and safety of the individual client or those assisting the individual, advice is sought promptly from an appropriate member of the care team before any move is carried out

*As my assessor was in attendance, I was able to liase with her re my plan for the move.

3 The level of support required is agreed with individuals and they are supported in being as self-managing as possible

See above

4 Actions and support provided to individuals are consistent with the plan of care and the outcome of the worker’s own assessment

* We undertook the move in accordance to the clients care plan and I agreed with what it said in the care plan and my assessor was happy with my assessment of this.

5 Before starting the move, the reasons are explained clearly to the individuals in a manner that encourages their understanding and co-operation

* Because Alan had asked to be lifted up the bed and this was not possible, it was very important to obtain consent from Alan as to a more appropriate way of moving him up the bed. I explained that the method used was the safest for him and the movers. I gave Alan time to listen to this explanation. I then gave him time to answer or put him under duress to make him use the slide sheet.

6 The immediate environment is appropriately prepared for the proposed move in agreement with those concerned and potential hazards are removed

7 Individuals are assisted to reach a safe, comfortable position consistent with their plan of care

8 The worker’s clothing and footwear is consistent with safe moving and handling procedures

9 The hoisting or other equipment which is selected is suitable for the individual and confirmed as safe before use

10 Appropriate assistance that is required to enable the worker to move and handle the individual safely is sought without delay

Unit Z7 Contribute to the movement and handling of individuals to maximise their physical comfort

Element Z7.2 Assist individuals to move from one position to another

1 Individuals are encouraged to contribute to the moving process consistent with any limiting abilities that they have

* Alan was able to participate by holding the pillow to his chest and tucking his chin on his chest when required.

2 Moves and changes of position are carried out in a manner that takes into account the individual’s advice on the most appropriate method and equipment

* Alan's metastases in he bone caused Alan a great deal of pain so it was very important that this was considered when moving him.

3 Where the individual’s advice and wishes conflict with safe practice, this is referred to the appropriate person without delay

* See above

4 Moving and handling methods used are appropriate to the individual, their condition, the worker’s personal handling limits and the equipment available

* See above

5 Moves and changes of position are carried out in a manner that minimises the individual’s pain, discomfort and friction and maximises their independence, self-respect and dignity

* See Above

6 Where the worker is moving or changing the position of the individual with another’s help, the appropriate explanations are given to co-ordinate their actions

* See above

7 Individuals are supported throughout by verbal and non-verbal means in a manner, and at a level and pace appropriate to them

* See Above

8 Full and accurate details are recorded in the plan of care when the worker and the individual find a method of moving and handling which is acceptable to both of them and is consistent with organisational and legal requirements

* See above

9 Changes in the individual’s condition are recorded and reported accurately, completely and without delay to the appropriate person

* There were no changes in Alan's condition, before, during and after the move

10 Following changes of position, furniture and fittings are returned to their correct location

Unit Z7 Contribute to the movement and handling of individuals to maximise their physical comfort

Element Z7.3 Assist individual’s to prevent and minimise the adverse effects of pressure

1 As agreed with the care team, the individual and their carers are encouraged to be as self-managing as possible, to participate actively in the prevention of pressure sores and are informed of factors which cause them

Alan was at risk of developing pressure sores as he could not turn unaided. To help to reduce the risk of him developing any the following measures had been prescribed in his care plan.

* Four hourly turns with a pillow placed under his thigh to reduce pressure from his sacrum.

* He was laying on an airflow metastases.

* He was washed and dried after each incidence of incontinence.

I discussed with Alan that as he was not able to move himself with ease, that we would need to help him to do so. He agreed with this.

2

Factors which contribute to the occurrence of pressure sores, and the ways that the individual and care team can minimise their effects, are discussed with the individual in a manner, and at a level and pace, appropriate to them

* See Z7.3.1

3 The individual is dressed, positioned and supported in a manner which minimises the adverse effects of pressure and maximises their self-esteem

* See above

4 The individual is encouraged, and supported, to change position regularly in accordance with their plan of care

See Above

5 Any changes in the individual’s condition are reported without delay to the appropriate person

* No changes to report

6 Activities to prevent and minimise pressure sores are carried out as specified in the plan of care

* See Above

7 Pressure relieving equipment is used correctly, cleaned, maintained and stored in accordance with the manufacturer’s instructions

Slide sheet.

* Inspected for signs of wear

* Inspected for cleanliness

* If soiled, placed in a green bag and sent to mini-laundry. As Alan was isolated, then it would have had to be placed in a red dissolvable bag first.

Pressure matrices

* Inspected that all attachments were in place and that it was plugged into the mains.

* Inspected to see if there were any warning lights on - if there were, then the correct agency contacted and the matrices changed for one without fault.

* Ensure that the mattress was clean after instances of incontinence using Hospec and water, then rinsed and dried.

8 The individual is left in a position that is as comfortable as possible given their plan of care

See above

Unit Z8 Support individuals when they are distressed.

Element Z8.1 Contribute to the prevention of individuals’ distress.

1 Support is offered to individuals and they are not pressured to discuss or disclose more than they want, need or are able to.

It was observed that Alan became distressed when I mentioned that he needed turning. I questioned him as to why he was so distressed about being turned. He said that he was worried about falling out of bed when he was turned. I said to him that my Assessor and I would be standing at the side of the bed preventing this from happening and that there was nothing to worry about.

2 Immediate support is given to individuals consistent with their personal beliefs and preferences when they appear to be becoming distressed.

I did not berate Alan for the expression of his concerns. I let him express himself in his own manner.

3 Responses are made to the individual’s expressed feelings, needs or problems in a supportive manner that accepts the individual’s right to express them whilst taking account of personal safety.

* See Z8.1.1

4 Where the individual’s condition has changed and they behave in a way that has previously indicated distress, the appropriate action is taken without delay.

* There were not any changes in Alan before, during or after the care delivery. I would have reported any changes to a registered nurse and recorded them in the care plan.

5 Interactions with individuals are in a manner, expression and tone that are supportive of them and are likely to promote their confidence in the care team.

* I responded to Alan in a caring calming manner and offered support to him in a manner that was suitable to him.

6 Individuals who indicate that they are likely to harm themselves are advised in an appropriate manner what action the worker may have to take.

* Alan made no mention of harming himself. If he had, even if he sounded as if he was joking, referred the matter to a qualified nurse and recorded the fact in the care plan. Individuals can sometime harm themselves, even if they joke about it. It is ESSENTIAL that any mentioning of self-harming is reported to a qualified nurse and recorded in the care plan.

7 Appropriate assistance from others is requested without delay when the worker is unsure of their ability to deal with the individual’s distress or the effect that it may have on their condition.

* I was able to deal with the situation as it fell within my role. Anyway, my assessor was there in any case if there had been any problem that was outside my role.

8 Records completed by the worker are accurate, legible and complete.

* See Above

Unit Z8 Support individuals when they are distressed.

Element Z8.2 Support individuals in times of distress.

1 Support is offered to individuals and they are not pressured to discuss or disclose more than they wish.

It was noticeable that Alan was distressed by the tone of his voice and that fact that he tensed up at the thought of being moved! I offered him time to express his feelings and did not hurry him.

2 When they wish to do so, the options open to the individual are discussed and reviewed with them.

I told Alan that it was very important that we moved him, as he required to be changed as well as the benefits of altered position on his pressure areas. I also told him that he need not have any worries as we would not drop him and that we would explain all steps prior to them happening. I also reassured him throughout the procedure,

3 Individuals are encouraged and supported in considering the best option for them and the possible ways of carrying this out.

See above

4 The worker’s records of the individual’s choices of action are accurate, legible and complete.

See above

5 Specific information and resources requested by the individual are clarified with them and obtained.

Alan asked exactly what we wanted to do and I gave him the information he needed.

6 Individuals are offered appropriate support given their choice of action, particular needs and plan of care.

See above.

7 The appropriate action is taken without delay when the individual’s behaviour gives cause for concern.

In this case, Allen's behaviour did not cause any cause for concern. Thus no action was necessary.

8 Where the individual raises issues which are beyond the worker’s role and the individual is in agreement, they are supported in contacting another appropriate person for help

Alan's behaviour did not raise issues that were beyond my role thus no help was required from an outside source.

9 Others who are disturbed by the individual’s expression of distress are offered appropriate support.

Alan disturbed no others in this instance.

10

The worker’s own feelings aroused by an individual’s distress are managed in a way that supports the right to such feelings whilst minimising any undue effects on the care setting:

Alan's feelings did not distress me excessively so I did not need to seek support.

Unit Z12 Contribute to the management of client continence

Element Z12.1 Encourage clients to maintain continence

1. The client’s pattern of body waste and functioning is monitored in a manner that is sensitive to the client and their needs.

It was recorded that Alan had had a problem with melaena thus it was important that any instances were recorded. Alan's body language showed that he was quite embarrassed about being incontinent. He verbalise that he was very embarrassed about needing help with maintaining his continence but also said he was pleased for us to help him with this. I asked Alan if he did not mind us helping to wash him, as he was unable to do this without help. He said he did not. He said that he wanted to use the bedpan however; he had had some incontinence both of urine and faeces.

2. Clients are encouraged to communicate the need to use toilet facilities in a manner appropriate to them.

Alan knew that if he required using the toilet, he could ring the bell. I reiterated this and told him that, although it was not what we would have liked the, that sometimes we could take a long time in coming, due to the nature of the ward. I did say that we were trying our hardest to come to him as soon as we could.

3. Communication with clients about body waste and function is consistent with the language the client uses.

I discovered that Alan liked to use the words "have his bowels open" and "pass water". As this is the case, these are the expressions that I used when I was discussing matters with him.

4. Clients are assisted and encouraged to make regular use of the most accessible and appropriate toilet facilities to achieve a pattern of elimination consistent with the plan of care.

The incident of care took place after breakfast. Further to Alan knowing that he could ring the Bell, I ask Alan before his dinner and his supper if he required having his bowels open or pass water so needed enjoy his meals.

5. Clients are assisted and encouraged to choose and maintain a suitable food and drink intake to facilitate bowel and bladder action as agreed with the care team.

Alan was encouraged to have beverages and food actually the appointed times. I also ensured that his jug was full when I entered the room. I insured that Alan knew that it was better to have squashed and tea or coffees as the latter two have a diuretic effect as well as a dehydrating one.

I also encouraged Alan to have a high-fibre diet, Weetabix, vegetables etc as this would have a regulatory effect on his bowels.

6. Any change in pattern and type of elimination is discussed with the client and reported accurately, completely and promptly to the appropriate care team member.

Alan was having a problem with melaena. The members of the care team knew this. However, this was indicative of abnormality in that this was evidence of bleeding gastro-intestinal tract. It is very important to continue to report to other members of the care team that alone was experiencing this problem.

7.

Support to the client is given in a manner that promotes self-respect, maximises privacy and is consistent with the plan of care.

• I ensured that when we were dealing with Allen's incontinence that we did not denigrate him or make fun of him
• I ensured that the curtains were drawn in the room whilst we were undertaking the care

Unit Z12 Contribute to the management of client continence

Element Z12.2 Support clients in the management of incontinence

1. Clients are supported in a manner that promotes their dignity, self-respect and privacy.

See above

2. The client is given time and opportunity to express concerns and practical difficulties arising from incontinence.

I gave Alan time to discuss any of his problems. I did this by direct questioning him a sensitive manner as well as so allowing some therapeutic spaces in conversations.

3. The client is encouraged to choose continence equipment and management techniques and clothing that is recommended by the care team for the management of incontinence.

Alan was offered a choice of sitting on an incontinence pad for incontinence sheets. He chose to sit on an incontinence sheet. I also offered Alan the choice of wearing a convene. This could have been very useful to him, however he chose to sit on the incontinence sheet and have a bottle in situ. I did not denigrate him for this choice.

4. The client is given an appropriate level of support to develop the skills necessary to use the equipment or to undertake exercises correctly.

At this time come Alan was becoming fairly frail to an extent where he required assistance to change a used bottle with a clean one. I made sure that Alan knew that it was not a problem for me to come and change bottles for him. I also told him, if he felt he had had his bowels open, he should drink and ask for assistance to change.

5. Equipment provided is in a convenient place where the client can reach it.

I let alone know that I would come and changes bottles for him if he required me to a. However, I placed the table in reaching distance so, if you chose to, he could place the bottle on it. I ensured that the call bell was to hand the

6 Where the equipment in use appears to be inappropriate or unsuitable, the client is referred to an appropriate person for a re-assessment of their needs.

The equipment used was appropriate, thus no referral to outside persons was required at this point. If a referral had been required, then I could have called upon the Qualified Nurses on the ward, or the Continence Advisory Service or the occupation therapists. Before I did this, I would have had to discuss it with the qualified nurse in charge and record the fact in the care plan.

7. Clients are given the opportunity to dispose of their own used equipment or soiled linen using their preferred method when they are able to do this.

Alan was not able to dispose of his own waste or waste products so we had to help him with this.

8. Waste is disposed of safely in a manner consistent with the client's personal beliefs and preferences and legal and organisational requirements.

The bedpan and urine bottle were placed in a bedpan washer and washed thus.

Other waste products, such as used to wet wipes, where disposed of in a yellow bag according to trust policy.

9. Offensive odour is reduced as far a possible.

I discreetly used an air freshener to disguise the smell that was produced. I did is Alan's request.

10. The client is assisted and encouraged to take medication to promote a regular patter of elimination when it has been prescribed.

Alan was on Lactuose for his bowels as he was on oromorph (which was constipating). He was also not mobile which compounded this too. As a Registered Nurse, it was part of my Assessor’s accountability that Alan took the tablets that she had dispensed. This had happened. If Alan had not taken his medication, I would have informed my Assessor or the Registered Nurse on duty that this was the case.

Candidate Signature: …………………………………………………………

Assessors Signature: …………………………………………………………

Date: ………………………………

posted by alanpjack  # 11:17 AM