session 1-individuality,role of worker.ppt

Session 1 – Bridging Program

PSW Program FocusCaring for the client

For effective care, you must consider the whole person.

Holism is a concept that considers the whole person.The whole person has physical, social,

psychological, and spiritual parts.These parts are woven together and cannot

be separated.Disability and illness affect the whole person.

Caring for the ClientTwo major concepts:

Client-centred care Wellness

This gives us a model of care giving.

FoundationsEach person has dignity and worth in

their own right and should be treated with respect accordingly.

Each person has a right to self-direction and self-determination.

The ultimate goal of the care-giving team is to improve the quality of life.

“Quality” to mean – as the client perceives it.

Personal support workers work with vulnerable persons and support them in achieving optimal wellness.

Optimal HealthWhat exactly is Optimal Health?

- When you are providing supporting care to a client who lives with an illness or disability, you might be tempted to focus on the medical condition rather than on the holistic person.

- Try to understand what the person may be experiencing so you can provide a better, more compassionate care and support.

Health In the past: health was defined by what it was not. Health was the state of not being sick. Leading causes of diseases in the past was

communicable diseases e.g. TB, Pneumonia, influenza

Any lucky enough to avoid being infected were considered Healthy.

But were they healthy?

Health In modern times: Health is affected by many factors other than

diseases such as lifestyle and environment Emphasis on Holistic healthGiving importance on the 5 dimensions. Physical, emotional, social, intellectual and

spiritual

WHO World Health Organization’s definition of

health is more widely accepted. “ Health is a state of complete physical,

mental and social well-being and not merely the absence of disease or infirmity.”

Nursing trends change, butHolistic nursing care remains the same

True or False?

Dimensions of Health Holism involves considering all dimensions of

health. 1.Physical 2.Emotional 3.Social 4.Spiritual 5.Intellectual

Physical Health - achieved when the body is strong, fit and

free of disease. Influenced by genetics and lifestyleAs a support worker, you play an important

role in maintaining physical health of your client.

Ex: help maintain a clean, safe and comfortable environment, preparing nutritious meals

Factors contribute to Physical health Following a nutritious diet according to

Canada Food Guide Exercise regularly Living in a smoke-free environmentDrinking alcohol moderately or not at all Adequate sleep Safety practices e.g. Safety belts or wearing

helmets Seeking medical attention when needed

Emotional Health Not merely the absence of negative feelings

but the ability to function well in and adapt appropriately to circumstances, whatever they may be.

When people feel good about themselves, they are emotionally healthy.

With strong self – esteem, self control and self – awareness

Emotionally Unhealthy people are often insecureWhen upset – become overwhelmed and

aggressive Emotional health varies throughout one’s life

As a support worker: You will work to both emotionally healthy and not.

Avoid judging them, instead learn to read their emotions so that you can respond in a caring manner.

Social Health Achieved through stable and satisfying

relationships Able to treat others with respect, warmth and

openness. Like and trust others

People with poor social health may show little regard for others and may use others for their own gain

Feeling of isolation and loneliness are common among older people and others who have lost their partners, friends or other social relationships

New immigrants – also at risk for poor social health

- unfamiliar place and not speaking the local language can be very lonely and socially isolating

Social support system- an informal group of people who help each other or others.

As a support worker: You may be a key member of the client’s

support system.

Spiritual Health - Achieved through the belief in a purpose greater

than the self - May or may not involve being a member of a

formal religion or even believing in a higher being - People who are spiritually healthy have a clear

understanding of what they believe to be right and wrong and their behaviors reflect their beliefs

- They feel their life has meaning - More concerned on personal fulfillment than

material things

For some people, spiritual health is closely linked to religion. Being able to attend masses regularly or religious worships.

As a support worker: Respect your client’s expressions of

spirituality E.g. Respecting symbols and icons of

religion, transporting client to attend worships

Intellectual Health Achieved by keeping the mind active and

creative throughout life Intellectually healthy people are able to

maintain curiosity throughout life Open minded and eager to learn People don’t stop learning

As a Support worker; Promote and encourage residents to

participate in activities like reading, doing crossword puzzles, doing crafts and knitting and all other challenging mind games.

WellnessAchievement of the best health possible in

all five dimensions.Physical, emotional, social, intellectual,

and spiritual dimensions

Dimensions of WellnessIt is every person’s responsibility to

practice safe/healthy habitsSelf-responsibility Nutritional awarenessPhysical fitnessStress management Environmental sensitivity

Culture & Health, Wellness, Illness & Disability Culture – influences whether or not a person

will seek out medical treatment, take prescribed medications, take herbal or non medicinal supplements, or even accepts care form someone who is not a family member.

Also influence when and how a person will accept care

e.g. First Nations people - interconnectedness is an important part of healing

ReligionReligion relates to spiritual beliefs, needs,

and practices.A person’s religion influences health and

illness practices. A person may not follow all beliefs and

practices of his or her religion. Do not judge the person by your standards.

The nursing process reflects the person’s culture and religion.

The care plan includes the person’s cultural and religious practices.

Determinants of HealthLook at the bigger picture of where we liveIn Canada, the Lalonde Report (1974) first

identified 12 key factors that determine health status.Income and social statusSocial support networksEducation and literacyEmployment and working conditionsSocial supports

Physical environmentsPersonal health practices and coping skillsHealthy child developmentBiology and genetic endowmentHealth servicesGenderCulture

Illness and Disability Distinction between illness and disability:

Illness is the loss of physical or mental health.

Disability is the loss of physical or mental function.

Supporting Clients with Illness and DisabilityNo two clients will experience illness and

disability in the same way.Many factors affect the way clients

experience illness and disability.

Change and Loss Associated with Illness and DisabilityChange in routineChange in work lifeChange in family lifeChange in sexual functionLoss of independenceLoss of dignityChange in self-image

Insight Into the ElderlyBegins with “your” attitude towards illness

and disability and your client’s attitude towards their situation and towards you.

IF YOU ARE GOING TO HELP ME …Please be patient while I decide if I can trust you.

Let me tell my story – the whole story in my own words.

Please accept that whatever I have done, whatever I may do, is the best I have to offer and seemed right at the time.

I am not just a person – I am this unique and special person.

Don’t judge me as right or wrong, bad or good. I am what I am, and that’s all I’ve got.

Don’t assume that your knowledge about me is more accurate than mine. You only know what I have told you – that’s only part of me.

Hear my feelings, not just my words – accept all of them.

Don’t save me – Help me help myself!

(chapter 6)

Caring for the PersonFor effective care, you must consider the

whole person.Holism is a concept that considers the whole

person.The whole person has physical, social,

psychological, and spiritual parts.These parts are woven together and cannot be

separated.Disability and illness affect the whole person.

Psychosocial HealthA holistic approach to health includes both the

client’s physical and psychosocial health.Psychosocial health is well-being in the social,

emotional, intellectual, and spiritual dimensions of one’s life.

Factors that influence psychosocial health include:PersonalityFamily backgroundEnvironmentLife circumstances

Maslow’s Hierarchy of NeedsAbraham Maslow- psychologist who has

influenced ideas about psychosocial health Best known for his theory of Needs Need- is the which necessary or desirable

for maintaining life and psychosocial well- being

Basic needs - must be met first for the person to survive and function

Needs are arranged in Hierarchy or order of importance

Lower – level needs must be met first before higher –level needs are met

Some people will deliberately ignore a particular need for a period of time in order to meet another need.

Basic needs, from the lowest level to the highest level, are:Physical needsSafety and security needsLove and belonging needsSelf-esteem needsThe need for self-actualization

People normally meet their own needs.

Your Relationship with the ClientA relationship is the connection between

two or more people and is shaped by the roles, feelings, and interactions of those involved.Personal relationshipsProfessional relationships

Independence, Dependence, InterdependenceThese are fundamental concepts in the

professional helping relationship.An important goal of most clients is to achieve or

maintain as much independence as possible.As a support worker, you must respect your

client’s choices.Self-esteem can suffer when independence is

limited or lost.People’s roles and identities can suffer when they

are not in control or when they lose their independence.

The Client’s FamilyA family is a biological, legal, or social

network of people who provide support for one another.

Families can take many different forms.Your client will determine who he or she

regards as family members.You may assist the family in many different

ways.

Families in ConflictWhen illness or disability occurs, the stress on

all family members may be great and all have to cope with conflict.

Conflicts may take the form of expressions of irritation, anger, bickering, and arguments.

Conflicts may sometimes be hidden.Sometimes members of the health care team

can help families resolve difficulties by encouraging communication or defusing tense situations.

You must observe and report signs of abuse when necessary.

Chapter 12

Culture and DiversityEthnicity

Refers to groups of people who share a common history, language, geography, religion

CultureRefers to the characteristics of a group of

people – the language, values, beliefs, habits, ways of life, rules of behaviour, and traditions

Everyone has a culture.

Culture and FamilyCulture affects family structure, roles and

responsibilities.Care of relatives Rebellion of children with cultural issues can

cause a multitude of problems.

Culture and Perceptions of HealthSome cultures believe that supernatural

forces cause illness.People may use charms, rituals, alternative

medicines, or traditional or folk medicine, which may include ancient remedies passed down through many generations.

Some practices may interfere with the client’s medical treatment.Herbal medicines may interact with drugs.

Caring Practice and CultureHow you approach and communicate with

someone may be affected by their cultural background.Touch Personal spaceEye contactFacial expressionsSilence

Culture and CommunicationTouch

Can convey comfort, caring, love, and affectionNot all cultures are comfortable with touch.

Personal spaceIs immediately around one’s bodySome people prefer more personal space than

others.

Eye contactHas different meanings within different

culturesFacial expression

Some expressions are universal.Some cultures use fewer facial expressions.

SilenceThe use of silence varies among cultures.

Culturally Sensitive CareNever use stereotypes to judge your client.Prejudice frequently leads to discrimination.Some clients react negatively or fearfully to

cultural differences.You do not have to agree, but you must be

tolerant and not make judgements.

Legislation:The Client’s Rights and

Your Rights

Foundation Foundation of good client–worker relations is

understanding:Support worker rightsThe client’s rights Legal responsibility

Client Rights and BoundariesEthics is concerned with what you should or

should not do.Legislation is a body of law that governs the

behaviour of a country's residents.Makes sure that all clients receive safe and

skillful careProtects client’s rights

Courts protect the client and the support worker’s rights.

Client Rights and BoundariesA right is something to which a person is

justly entitled.Moral rights are based on a sense of fairness

or ethics and are based on moral principles. Legal rights are based on rules and principles

outlined in the law and enforced by society.

Canadian Charter of Rights and FreedomsFederal legislation that applies to all

Canadians, regardless of where they liveLists the basic rights and freedoms to which

all Canadians are entitledThe right to equality without discrimination

based on race, ethnic origin, colour, religion, sex, age, or mental or physical disability.

Basic Rights of People Receiving Health ServicesThe Human Rights Code of each province and

territory is intended to:Prevent discrimination Promote and advance human rights

Basic Rights of People Receiving Health ServicesLaws governing health care have different

titles across the country.Box 11-1: Examples of Extended, Continuing

Care, and Community Care Legislation (p. 154)An act is another term for a specific law.

Most health care acts consist of general requirements for maintaining health, safety, and well being.

Basic Human Rights in CanadaAll residential facilities in a province or

territory must abide by rules.If they do not, this could result in removal of

their licence. Concern is for the rights and freedom of

people using health care services.

Bills of RightsManitoba and Ontario have created bills of

rights for clients.Some facilities and agencies write their own

bills of rights, based on provincial or territorial laws.

Client Bill of RightsGenerally, all clients have the following

rights:Right to be treated with dignity and respectRight to privacy and confidentialityRight to give or withhold informed consentRight to autonomy Pictographic version of Residents’ Bill of

Rights: Figure 11-1 (p. 141)

Client Bill of Rights (Cont’d)Client Bill of Rights (Cont’d)

Bills of RightsBox 11-3: Ontario’s Residents’ Bill of Rights

(p. 142)Box 11-4: Ontario’s Bill of Rights for

Community Care Clients (p. 143)Being treated with dignity and respect is the

guiding principle of caregiving DIPPS

Dignity and Respect Facility is client’s home and should provide

the same freedoms as the resident’s home. Respecting the person’s dignity and

independence is a basic and important part of support work.

Treating a person with dignity provides emotional support and greatly contributes to quality of life.Box 11-5: Respecting the Client’s Right to

Dignity (p. 145)

ConfidentialityMeans respecting and guarding personal and

private information about another personInformation should only be shared among

team members involved in the client’s care.Information about your employer, your co-

workers, and other clients is private. No matter how well you know a client, do not

discuss personal matters or personal problems.

Use acceptable speech and language.

Privacy and ConfidentialityRight to receive care in private, in a way that

does not expose the body unnecessarily – only those persons involved in the care should see the person’s body.

Information about the client's care, treatment, and condition is confidential.Box 11-6: Respecting the Client’s Right to

Privacy (p. 145)Electronic privacy – do not discuss clients via

computer.

PrivacyClient has the right to privacy at all times –

during bathing, telephone calls, financial advice, toileting, conversations with family.

PSW must respect this right at all times.Should ask permission for everything that

you do to the clientBe proactive – do not wait to be told.

Sharing InformationDiscuss only the information that the person

needs to know in order to give the care – keep all information in the workplace.

Report to RN or RPN your observations – other co-workers may need to know some but not all information.

Avoid gossip – do not discuss a resident’s problems with another resident.

Informed ConsentClient has the right to decide what will and

will not be done to his/her body and who can touch him/her.

Clients need to understand the reason for treatment, what will be done, and how and who will do it.

Clients need to understand the expected outcomes and treatment options.

Informed Consent (Cont’d)All provinces and territories have legislation

that describes when and how consent is to be obtained.

For consent to be valid, it must be informed consent.

Informed Consent (Cont’d)Consent to Treatment Act stipulates that the

client must be informed of the following: The reason for a treatment, procedure, or care

measureWhat will be doneHow it will be doneWho will do itThe expected outcomesOther treatment, procedure, or care optionsThe effects of not having the treatment,

procedure, or care measure

Decision MakerParent or legal guardian gives consent for

client under the age of 18.Responsible party gives consent for mentally

incompetent, unconscious, sedated or confused client.

A consent form may be required – an RN or RPN obtains these.

Support worker is never responsible for obtaining written consent or giving medical information.

Advanced Care Directives Advanced care directive

Legal document that allows clients to convey their decisions about their own end-of-life care.

Living willA document that allows clients to convey their

wishes to accept or refuse medical care to sustain their life.

Substitute decision maker/power of attorneyAllows one to make decisions for one who

cannot give consent due to inability to understand.

Property Will

Legal document that states one’s wishes about where or to whom his/her property should go.

Executor/executrixGuardian of property; carries out instructions

of the will. Estate trustee

A person who acts on behalf of a client with regard to property.

WillsWills

You can ethically and legally witness the signing of a will, as long as your name is not on the will.

You can refuse to witness the signing of a will.Wills should be written while the client is

cognitively intact – usually a lawyer is present.

AutonomyClients have the right to participate in

assessing and planning their own care and treatment.

Personal choice is important for quality of life, dignity, and self-respect.You must allow the client to make choices

whenever possible.

Legal Issues Laws tell you what you can and cannot do.

A law is a rule of conduct made by a government body. Criminal laws are concerned with offenses against

the public and society in general. Civil laws are concerned with relationships between

people. Torts are part of civil law. Liability – if you break the law or violate someone’s

rights, you are legally responsible.

TortsA person who commits such an act can be

sued by the injured person. Torts may be intentional or unintentional.An example of a tort is negligence. Examples of intentional torts are assault,

battery, false imprisonment, invasion of privacy, and defamation of character.

NegligenceMeans the person did not mean or intend to

cause harmThe negligent person failed to act in a

reasonable and careful manner and thereby harmed the person or property.

The negligent person may have to pay damages to the injured person.

Negligence (Cont’d)Not performing a task or procedure correctly Performing a task or procedure that you are

not qualified to do Making a mistake

Box 11-7 (p. 150) lists examples of common negligent acts committed by support workers.

Negligence (Cont’d)A client could be harmed even though you do

your job competently.Accurately record procedures.

Your record may protect you from charges of negligence.

You are responsible for your own actions.Sometimes refusal to follow a nurse’s

directions is your right and duty.

Intentional TortsActs that are meant to be harmfulDefamation is injuring the name and

reputation of a person by making false statements to a third person.

Libel is making false statements in print, writing, pictures, or drawings.

Slander is making false statements orally.Invasion of privacy

AssaultIntentionally attempting or threatening to

touch a person’s body without the person’s consent

The person fears bodily harm.Threatening to tie down an uncooperative

client is an example of assault.

BatteryIs the actual touching of a person’s body

without the person’s consentExample: force-feeding a client

The client must consent to any procedure, treatment, or other act that involves touching the body.

The client has a right to withdraw any consent.

Consent can be verbal or gesture.

Least restrictive vs Non-Intrusive Least restrictive – to choose the method

which allows client to maintain most of the control, freedom of movement or choice when implementing a task in the care plan

Non – intrusive – to choose a procedure or method which allows a client to maintain dignity and does not overly invade the person, before, during and after implementing a task from the care plan

Awareness of Your RoleIf a support worker performs duties beyond

the scope of his/her practice, and these duties were never delegated and taught by the registered staff, the support worker is actually assaulting the client.

Support worker must understand the responsibilities within their role and safely act within these boundaries.

False ImprisonmentFalse imprisonment is unlawful restraint or

restriction of a person’s freedom or movement.

Threat of restraint or actual physical restraint is false imprisonment.

Human Rights LegislationProtects workers’ basic human rightsMust treat all workers equallyMust not discriminate on the basis of the

workers’ race, colour, sex, sexual orientation, religion, age, or disability

Workers have the right to be free from harassment.

Occupational Health and SafetySafety is a basic need.In a safe setting, a person has little risk of

illness or injury.Person feels safe and secure.Your employer is also responsible for

providing a safe working environment for you.

Occupational Health and Safety (Cont’d)Outlines the rights and responsibilities of

workers, employers, and supervisors in creating and maintaining a safe environment.

Workers have the right to receive proper training, instruction, and supervision to ensure their safety.

Workers have the right to refuse duties if the work poses a danger to themselves or others.

Employment Standardsand LegislationState minimum acceptable employment

standards within the workplaceCovers basic rules about issues such as:

Minimum wageHow wages are paidHow many hours of work per day and per week

are acceptableFair overtimeHolidays and vacation daysWhat situations qualify worker for a leave of

absence

Labour Relations LegislationAddresses how employers and employees can

resolve workplace issues; ensures that employees have the right to form or join a union

Sets out rules for negotiation – collective bargaining

Identifies unfair labour and employee conduct

Workers’ Compensation LegislationAddresses how workers are financially

compensated for accidental injuries on the job

Discusses workers and employer rights when an injury occurs

Interpersonal Communication

Communication ProcessGood interpersonal communication is needed

to provide safe and effective care.Health care teams need to share information

about what was done for the client, what needs to be done, and the client’s response to care and treatment.

Communication helps you get to know your client and allows you express your thoughts and ideas.

Interpersonal CommunicationThe exchange of information between two

people, usually face-to-faceDuring the exchange, each person acts as both

sender and receiver.If the receiver does not understand the

message or misinterprets it, mistakes can occur.

Interpersonal Communication (Cont’d)

You need to understand and respect the individual.

Accept and respect the client’s culture and religion.

Understand that stresses, problems, and frustrations affect how a message is sent and received.

Communicating with the PersonYou communicate with clients and residents

every time you give care.Your body sends messages all the time.Good work ethics and understanding the

client are needed for good communication.What you say and do is important.

Verbal CommunicationFollow these rules to address the person with

dignity and respect.Call clients and residents by their titles.Do not call clients and residents by their first

names unless they ask you to.Do not call clients and residents by any other

name unless they ask you to.Do not call clients and residents Grandma,

Papa, Sweetheart, Honey, or other names.

For Effective CommunicationUse words that have the same meaning for you

and the person.Avoid medical terms and words that are not

familiar to the client.Communicate in a logical and orderly manner.Give facts and be specific. Be brief and concise.Understand and respect the client or resident as

a person.View the client as a physical, psychological,

social, and spiritual human being.

Verbal CommunicationAppreciate the client’s problems and frustrations.Respect the client’s rights.Respect the client’s religion and culture.Give the client time to process the information

that you give.Repeat information as often as needed.Ask questions to see if the client understood you.Be patient.Include the client in conversations when others

are present.

Nonverbal CommunicationDoes not use words

Messages are sent with gestures, facial expressions, posture, body movements, touch, and smell.

Nonverbal messages more accurately reflect a client’s feelings than words do.

Touch is a very important form of nonverbal communication.

The meaning depends on age, gender, experiences, and culture.

To use touch, follow the client’s care plan. Remember to maintain professional boundaries.

Body LanguageInvolves:

Facial expressionsGesturesPostureHand and body movementsGaitEye contactAppearance (dress, hygiene, etc.)

Body Language (Cont’d)Body language includes posture, gait, facial

expressions, eye contact, hand movement, gestures, body movement, and appearance.

People send messages with their body language.PosturePain

The way you act and move shows interest or disinterest.

Touch Conveys comfort, caring, love, affection,

interest, trust, concern, and reassurance The meaning of touch depends on a person’s

age, gender, life experience, and culture.Some people do not like being touched,Touch should be gentle, not hurried or rough,

not sexual in nature.

SilenceThe use of silence also conveys messages.Silence can convey acceptance, rejection,

fear, or a need to think.During sad times, you may not need to say

anything.It is useful when making difficult decisions

and when a person is upset.Silence can show respect and empathy.

Factors that Influence CommunicationPerceptionsExperiences Physical and mental healthEmotions ValuesBeliefsCulture

Communication TechniquesListening means being attentive to the

client’s verbal and nonverbal communication.Use the senses of sight, hearing, touch, and

smell.Concentrate on what the client is saying.

Observe nonverbal clues.

ListeningListening requires that you care and have

interest.Face the client.Have good eye contact.Lean toward the client.Respond to the client.

ParaphrasingRestating the client’s message in your own

words Paraphrasing serves three purposes.

It shows you are listening.It lets the client see if you understand

the message sent.It promotes further communication.

Empathetic ListeningMeans being open to and trying to

understand the experiences and feelings of othersCan help reduce feelings of lonelinessCan create trust between you and the clientAvoid the pat response, “I know how you feel.”

Asking Closed QuestionsFocus on specific informationSome closed questions have “yes” or “no”

answersMay not obtain complete information

Open-Ended QuestionsLeads or invites the client to share thoughts,

feelings, or ideas.Responses are longer and give more

information than direct questions.Encourage the client to talk.

“Can you describe your pain?”“What can I do to make you more

comfortable?”

ClarifyingLets you make sure that you understand the

message.Ask the client to repeat the message.If possible, list important points.

“Let me see if I understand what you said.”

FocusingLimiting the conversation to a certain topicUseful when a client rambles or wanders in

thought:“Let’s talk about your supper and what you

ate.”

Follow These Rules for Spoken CommunicationFace the client.Position yourself at the client’s eye level.Control the loudness and tone of your voice.Speak clearly, slowly, and distinctly.Do not use slang or vulgar words.Repeat information as needed.Ask one question at a time.Do not shout, whisper, or mumble.Be kind, courteous, and friendly.

Barriers to CommunicationSome barriers, such as vision and hearing

problems, cannot be avoided. You must learn to work around these.

Cultural differences can also interfere.Clients may attach different meanings to

verbal and nonverbal communications.

Barriers to Communication (Cont’d)Environmental

Loud noises, poor lightingInterruptionsAnswering your own questionsGiving adviceMinimizing problemsUsing patronizing languageFailing to listen

Communicating with Angry PeopleAnger is a common response to illness and

disability.It can be communicated verbally or

nonverbally.Raised voices, rapid speech, clenched fist,

refusal to speak or answer questionGood communication is important to prevent

and deal with anger.Box 13-2: Communicating with an Angry Client

(p. 175)

Assertive CommunicationAssertiveness – thoughts and feelings are

expressed positively and directly without offence to others.

Stand up for your rights while respecting the rights of others.

Be confident, calm, and composed.

Expressing DisagreementBe calm and state the problem in a very

straightforward manner. Keep it short and conciseState what you do not agree with, and whyListen to the responseThink before you answerTry to negotiate a solution

Explaining ProceduresClients feel safer and more secure if they

know/understand what is to be done.Explain:

Why the procedure is doneWho will do itHow it will be done What part they will participate in

Explaining Procedures (Cont’d)Give clear, precise explanations, and

instructions.Organize your thoughts before you speak.Give the client a chance to discuss the task.Recognize that people learn in different ways.

Box 13-3: Guidelines for Teaching Tasks to Clients (p. 177)

Verbal Reporting Give reports as often as the client’s condition

requires.Give reports when the nurse asks you to.Report any changes from normal or changes

in the client’s condition.Report these changes at once.

Use your written notes to give a specific, concise, and clear report.Box 8-4: When to Contact Your Supervisor (p.

97)

DocumentationA written account of a client’s condition,

illness, and responses to care.It is a permanent, legal record that provides

communication for health care teams.Legal document

Documentation (Cont’d)Provides currency as the care plans change;

as client’s needs changeProvides accountability – signed/datedEducation – view of client and illness

Documentation (Cont’d)Provides continuity of care because it

provides information about past health problems and may help to detect patterns and changes in the client's health.

Types of ChartsData forms

Details about physical, emotional, social, and intellectual health, plus interests and medication

Assessment formsAssist with identifying a problem area

Care plansContain goals and interventions

Types of Charts (Cont’d)Progress notes

Vary; describe progress of the client ADL checklists and flow sheets

Describe daily careTask sheets (log notes)

Used by agencies in community setting to record provided care and services

Types of Charts (Cont’d)Graphic sheets or flow sheets

Record measurements and observations made every shift or three or four times a day; include measurements for temperature, pulse, respirations, weight

Summary reportsMonthly summary

Incident reportsUnusual occurrences

KardexA card file that summarizes information

ChartingThe record (chart) has many forms.

These are organized into sections for easy use.Each page is stamped with the client’s name, room and

bed number, and other identifying information.Health team members record information on the forms

for their departments.

Agency policies about medical records address:Who records, when to recordTerminology, abbreviations, correcting errorsInk colour, signing entriesBox 8-6: Guidelines for Recording (p. 107)

RecordingChart all observations in relation to

behaviour, skin, pressure areas, etc. Chart all vital signs, weight.A data sheet can be made up to make it

easier to collect information (e.g., leg size).

24-Hour ClockUses four-digit number for time

First two digits are for the hourLast two digits are the minutes

For am: add 0 in front of the timeFor pm: add 12 to the first two digits of the

clock

24-Hour Clock (Cont’d) Recording time

Figure 8-9: The 24-hour clock

Next to each of the following, write the times using the 24-hour clock.11:00 AM _____ 8:00 AM _____ 4.00 PM _____ 7:30 AM _____ 6:45 PM ______ 12 NOON ______

3:00 AM ______4:50 AM ______5:30 PM ______10:45 PM ______ 11:55 PM ______ 9:15 PM ______

Managing Stress, Time, and Problems

StressStress is a normal part of life.Stress is the emotional, behavioural, or

physical response to an event or situation.The event or situation that causes stress is

called a stressor.New situations or illness can cause stress.Some stress can be good (it can make you

work more effectively to accomplish tasks).

Coping with StressLong-term stress can lead to burnout − a

state of physical, emotional and mental exhaustion.

Stress affects the whole person and can have positive or negative effects on all dimensions.Box 9-1: Physical Signs of Stress (p. 115)

Responses to StressA person’s response to stressors is influenced

by several factors – health, personality, past experiences with the same or similar stressor, number of other stressors, and nature, severity, and duration of stressors.Box 9-2: Emotional and Behavioural Signs of

Stress (p. 115)

Defense MechanismsAn unconscious reaction that blocks

unpleasant or threatening feelingsMost people use defense mechanisms

occasionally, because these can help to relieve stress.

Defense Mechanisms (Cont’d)Conversion

Changing an emotion into a physical complaint

DenialRefusing to accept an unpleasant or threatening reality

DisplacementDirecting emotions toward a person or thing that seems

safe, instead of the source of emotions

ProjectionAssigning one’s feelings to someone or something else

Defense Mechanisms (Cont’d)Regression

Reverting or moving back to earlier behavioursRepression

Keeping unpleasant or painful thoughts or experiences from the conscious mind

Defense Mechanisms (Cont’d)Rationalization

Making excuses for one’s behaviour or situation, while ignoring the real reason

Reaction formationActing in a way that is opposite to what one

feels

Managing StressDon’t ignore signs of stress – this can result

in illness.Strategies:

Develop self-awareness.Identify priorities.Set goals.Plan your life and your work.Be assertive; make decisions that work for you.

Managing StressDealing with stress is important.Stress affects:

YouThe care you giveYour client’s quality of lifeHow you relate to co-workers

Job BurnoutBurnout is common among health care

workers.Burnout can have negative consequences for

your health.Do not ignore the signs.Long-term effects can lead to physical,

emotional, and mental exhaustion.

Time ManagementValues are standards that influence

behaviour.Values vary from person to person, developing

and changing as a person grows and matures.Values have a strong motivational component

that directs conduct.No two individuals give equal importance to

the same value.

Setting Smart GoalsYour goals should be SMART

S – specific goalsM – measurableA – achievableR – realisticT – timely

Planning Your Life and Your WorkQuestions to guide your decisions include:

What are the client’s needs and priorities?How much time will each task or activity

require?When will I do each task or activity?Have I allowed time for the unexpected?Is there anyone with whom I should co-

ordinate these activities?Give each task a time limit.

Decision MakingSkills that you need to make a decision:

Focus: on the client and the task to make the right decision.

Flexibility: you need to be flexible and responsive to your clients’ needs.

Decisiveness: stick to your decisions unless they are not working; indecisiveness can upset clients.

6 Major Steps in Critical Thinking to Solve a Problem Identify and define a problem Generate possible solutions Choose the best solution Make a plan Implement the plan Evaluate the outcome

The Role of the Support Worker

Role of the Support WorkerTo assist clients to accomplish the tasks of

everyday living so that they can get on with their lives

A variety of assistance may be required for some, and very little for others

Includes personal care, home management, family responsibilities, and social and recreational activities

Role of the Support Worker (Cont’d)Ultimate goal of support work: to improve the

client’s quality of lifeProvide care in a kind, sensitive and

understanding manner.Use discretion (responsible judgement).Honour the client’s right to confidentiality.Display empathy (having an understanding of

another person’s emotions).

Support Work Across CanadaThe client is always the focus of care.There are differences in educational

programs, work settings, job responsibilities, and terms used to describe support workers across Canada.All work to meet the client’s needs.

Settings for Support Work Facility-based setting – HospitalsRehabilitation and subacute care agenciesComplex, chronic or long-term care centres

(nursing homes, nursing facilities, nursing centres, 24-hour care)

Community-based settingMental health centresHome care agenciesHospicesHealth care systems

PSW ResponsibilitiesPersonal care – assisting with ADL (activities

of daily living)Eating, bathing, grooming, dressing, toileting,

moving and positioning, ambulatingProvide for the client’s safety and physical

comfortNot responsible for deciding what should or

should not be done; must observe and report changes in client’s behaviour

ResponsibilitiesSupport nurses and other health care

professionals by following the established care plan and implementing the care.

Consult with other health care professionals in order to provide care.

Variety of housekeeping tasks

People You SupportPatient – person receiving care in a hospitalResident – person living in a residential

facilityClient – general term for all people receiving

health care or support servicesRemember – every person is unique

Caring for IndividualsOlder adultsPeople with disabilitiesPeople with medical problemsPeople having surgeryPeople with mental health problemsPeople needing rehabilitationMothers, newborns, childrenPeople requiring special care

The Health Care Team Group of people working together to meet

the client’s needsIncludes professionals with a variety of skills

and knowledgeThe support worker is an important member

of the health care team.

Regulated WorkersA regulated profession is self-governing. It has a professional organization called a

college, which sets education and licence requirements. It establishes the scope of practice, codes of ethics, and standards of conduct for its members.

Unregulated WorkersAn unregulated profession does not have a

professional college.There are no official requirements for

educational programs.No code of ethics Support workers are unregulated workers.

Scope of PracticeTo protect the client from harm, you must

know what you can do, what you cannot do, and the legal limits of your role.

Never perform a function or task that you have not been trained to do or that is beyond legal limits.

Sources of Information about Scope of PracticeYour educational programYour employer’s policiesYour supervisor

An RN (registered nurse) is licensed and regulated by the province to maintain overall responsibility for planning and provision of care.

Scope of PracticeRN (registered nurse):

Assesses, develops nursing plans, implements and evaluates care, and carries out physician’s orders

An RN is usually a team leader of health care team consisting of the: RPN (Registered Practical Nurse)/LPN

(Licensed Practical Nurse) Support workerAssistive personnel – other health care

professionals

Support Worker SupervisorSupport workers my be supervised by RN or

RPN/LPNOr may be hired directly by clients You must be aware of the tasks and

procedures you can perform as a support worker.

Being a ProfessionalDemonstrate respect for others, commitment,

competence and appropriate behaviour, professional appearance.

Be cheerful, friendly, work when scheduled, perform tasks competently, and help others.

Show enthusiasm, consideration, honesty.Box 1-1: Statements that Show Negative Attitude (p. 14)Box 1-2: Practices for Professional Appearance (p. 14)

ConfidentialityRespect and guard personal and private

information about another person.Only share information to the health care

team member involved in the client’s care.Never talk with a client about another client.Avoid talking about co-workers.Do not discuss work issues/client care

outside the work area.

Compassionate CareCompassion – caring about another person’s

misfortune/sufferingCaring – having concern for the dignity,

independence, preference, privacy and safety of client and their families

Treating people with respect, kindness and understanding

DIPPSDignity – state of feeling worthy or valuedIndependence – allow client to do what they

want or canPreference – allow client to make choicesPrivacy – client’s body and affairs are private

from viewing by othersSafe – to be free from hazards and feel secure

about care provided

Decision MakingSupport workers make many decisions during

their day.Consider priorities – DIPPSConsider the client’s viewpointConsider your scope of practice – your limitsConsider your supervisor’s viewpoint and

guidance

session 1-individuality,role of worker.ppt

Documents

aggressive emotional

dimensions of health

holistic person

foundationseach person

model of care

compassionate care

supporting care

state of complete physical