Induction Manual Fitzroy Falls Aged Care Facility
Induction Manual Fitzroy Falls Aged Care Facility © J.N. Bailey 2009 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 1 of 63 Induction Manual Challenging Behaviour 04 - 07 Behaviours Incident Debriefing Behaviour Descriptions Communication 04 06 07 08 - 17 Effective Communication Verbal and Non Verbal Communication Maintaining Effective Relationships Working with Diversity Cultural Awareness Cross Cultural Communication Conflict Resolution Interpreter Service Dementia 08 08 09 11 12 14 15 16 18 - 23 Person Centred Approach Activity Planning/Development Communication Strategies Dementia Triggers that can Alter Behaviour Documentation 18 19 20 22 23 24 - 32 Care Plans Completing Care Plans Policies and Procedures Resident Classification Scale Health Terminology Abbreviations Completing Documentation Progress Notes Commitment to Continuous Improvement Materials Safety Data Sheets Health Issues 24 24 25 26 28 29 30 31 32 33 - 45 Food and Fluid Thickeners Incontinence Physical Effects of Ageing Stereotypes of Ageing Sexuality and Ageing Grief and Loss Diabetes Healthy Lifestyle and Ageing Swallowing Difficulties/Dysphagia Case Conferences Page 2 of 63 Fitzroy Falls Aged Care Facility - Induction Manual 33 33 34 37 38 39 40 41 42 44 Version 1.0.0 © J.N. Bailey 2009 Human Resources 46 - 50 Performance Appraisal Performance Appraisal Interview Harassment Medications 46 47 48 51 - 57 Medication Administration Medication Effects Medication Administration Responsibilities Blister Pack System Medication Incidents Mobility 51 52 53 54 55 58 - 59 Mobility Mobility Aids 58 59 Personal Care 60 -63 Privacy and Dignity Privacy Guidelines Reporting Resident/Client Changing Care Needs Duty of Care © J.N. Bailey 2009 Fitzroy Falls Aged Care Facility – Induction Manual 60 60 61 62 Version 1.0.0 Page 3 of 63 Challenging Behaviour Behaviours Many factors can increase the likelihood of a resident/client behaving uncharacteristically. This can lead to anger and aggression towards themselves or others around them. Physical, environmental, medical and interpersonal factors can provoke any of the following behaviours: frustration fear misunderstanding discomfort/pain feelings of rejection suspicion intense anxiety. Care workers need to learn what the factors are for each individual resident/client and deal with them positively to prevent an aggressive incident. The following table shows the various triggers that result in challenging behaviours Physical triggers Environmental triggers Physical Environmental triggers include: triggers include: pain hunger deafness altered vision altered perception slower reaction time need for toileting or pad change. Page 4 of 63 noise too hot/cold discomfort (eg position or chair) overcrowding room lighting phobias (eg claustrophobia/agor aphobia) odours new environment rigid routine Inconsistency of care. Medical triggers Medical triggers include: urinary tract infection constipation painful conditions infections dehydration medications psychiatric symptoms (eg delusions, hallucinations) vitamin B 12 deficiency hypothyroidism. Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 Interpersonal triggers Interpersonal triggers include: perceived attitude of carer cultural prejudice frustration at having to wait lack of understanding of what is to happen lack of understanding of expectations bossy or domineering carer/care worker feeling they are being unfairly treated feeling a loss of control embarrassment build up of feelings of rage or anger © J.N. Bailey 2009 Changes in the resident's/client's physical appearance (ie hostile facial expression, sustained eye contact, carrying a potential weapon) are all alerts to the fact that they are feeling aggressive. Indications that the resident/client is feeling aggressive can also include changes in their activity level and posture (ie pacing, restlessness, clenching fists and jaw, appearing agitated). The resident's/client's mood will change and they may show signs of being angry, anxious, distressed, irritable and short tempered. The resident/client may speak in a louder voice than normal and may use abusive language or swear. Options to deal with the challenging behaviour include: Back off/leave You should: respond to your gut feelings respond positively don't panic don't get backed into a corner look for an escape route approach the person at a later time. Negotiate You should: make no sudden movements or try to touch the person (this could be interpreted as an attack) wait until the anger has reduced speak in a calm, easy style state the facts be assertive use "I" messages draw up a clear contract of acceptable behaviour state that has contract has been drawn up. Seek back-up You should: use pager, call bell or call out for help don't show panic, anger or fear Use evasive self defence You should stay out of their 'firing line' choose a safe place to stand allow for an escape route move to avoid being hit. Divert attention You should: © J.N. Bailey 2009 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 5 of 63 use teamwork if possible other (ie another person can step in with a reassuring message) change subject to a favourite topic validate feelings and re-direct to another subject/task Incident Debriefing Any sudden event which occurs at Fitzroy Falls Aged Care Facility has the potential to cause distress to residents, staff or visitors. This distress can result in difficulties in coping, adapting and recovering from the physical and mental upset that the incident may have caused. An incident debriefing meeting assists people, particularly staff, to overcome the effects of the incident by: talking about what happened expressing how they feel as a result of the incident identifying any individual stress reactions (ie physical, emotional, thinking, behavioural) identifying some ways of dealing with stress reactions. Incident debriefing meetings are designed to reduce the possibility of any physical, emotional, thinking or behavioural reactions. The meetings provide an important opportunity for early identification of staff who have had an adverse reaction to an incident and who may require further professional assistance. The meetings are intended to be a normal operational procedure for managing challenging/difficult behaviour incidents and identifying suitable strategies for responding to these incidents. It is important to note that incident debriefing meetings can be used for any sudden distressing event at Fitzroy Falls Aged Care Facility. An incident debriefing meeting is conducted in such a way that, the people attending the meeting, share their understanding of the following: the sequence of events leading up to, during and after the incident the causes of the incident the effects of the incident on all the people involved, including the resident other work related issues that had an impact on the incident previous incidents that occurred the way each individual has reacted to the incident including the resident the external professional assistance that can be accessed, if required. Incident debriefing meetings should always use a systematic approach to gain a thorough idea of the event and the reactions of everyone involved. Page 6 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Behaviour Descriptions The following is a list of behaviour that you may observe while monitoring your client: Abusive: verbal and physical abuse towards staff and other clients Agitation: general distress, restless, unable to settle Anger: perceived threat to others, facial expression Anxiety: a state of uneasiness and uncertainty Bewilderment: puzzled, perplexed, overwhelmed by a situation Combative: aggressive behaviour in which physical contact is made (eg hitting, biting, scratching, hair pulling, kicking, pinching) Confused: poor memory and recall unable to remember events and tasks asked of them Danger to self: history of falls, reduced insight into own safety needs, safety comprised by confusion, smoker Disorientation: confused to time, place, person and events Dependency on family: seeking out family Depression: feeling of sadness, hopelessness, bouts of crying, this may be a diagnosed history Destructive: damaging objects Frustration: inability to cope and express feelings Hallucinations: often visual, auditory very real to the client experiencing them Noisy/verbally disruptive: causing disruption to others (eg yelling, calling out, screaming, shouting, singing loudly, chanting, banging, dragging furniture, raising volume of TV or radio) Pacing: walking faster than normal, usually within a confined space. Perseveration: repeating same behaviour, action or speech over and over, may or may not be disruptive Tearful: shedding tears, weepy, emotional © J.N. Bailey 2009 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 7 of 63 Communication Effective Communication Communication is a two way process involving both listening and talking. Communication begins with the first face to face contact between residents or clients and carers. Observation of body language contributes to the total message. The aim of effective communication is to correctly interpret the whole message sent by other people both by listening to the words used (the verbal) and gaining an overall impression from their body language (the nonverbal). Active listening is the key to effective communication. Actively use the ears, the eyes and intuition to understand what the speakers intend, not just what the speakers say. Listen first and then respond. Check to be sure that you have received the right message, by providing feedback. When you are speaking, the same principles apply. Be aware of the total impression you are creating by choosing your words carefully and using appropriate body language. Also be aware of barriers to effective communication. These may be physical or emotional. Possible physical barriers: noise and interruptions sensory loss, for example hearing and vision, or other disabilities such as difficulty with comprehension furniture (a table or desk can easily be perceived as a barrier) gender age height tiredness pain. Possible emotional barriers anger, fear, frustration, anxiety over-excited state lack of confidence, low self-esteem comparison to others culture. Verbal and Non Verbal Communication In your job as a care worker, you will be communicating with a variety of people every day. A lot of this communication will occur face-to-face. For example, you may chat to the residents or clients in your care, or talk to other staff members. Effective face-to-face communication requires good verbal and non-verbal communication skills. Page 8 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 So, what is verbal and non-verbal communication? 'Verbal' means 'spoken'. So, verbal communication is the messages you send with words. It's what you actually say. Non-verbal communication is the messages you send with your body. Some people call it your body language. For example: facial expressions - smiling, frowning, raising eyebrows, eye contact gestures - waving your hand, pointing your finger, crossing your arms posture - the way you stand or sit. Non-verbal communication also includes the tone and pitch of your voice. So, verbal communication is the words. But non-verbal communication is how you say the words. Non-verbal communication is an important part of the communication process. Up to two-thirds of the meaning of a message can come from non-verbal communication. So, it's very important that you are aware of it. A facial expression or simple hand gesture can show: how we feel what we like or dislike if we care or not. Sometimes a person's non-verbal communication may not match their verbal communication. For example, a person may be saying nice things, but have crossed arms and a frown on their face. When this happens, the message can be very confusing. Is the person being friendly, or are they a little bit angry? Effective communication occurs when your verbal and non-verbal communication skills send the same message. Maintaining Effective Relationships Communication is a process of passing information from one person to another, or others, to gain understanding. Principles for building and maintaining relationships Research has shown that there are three fundamental skills to making effective relationships. These can best be described under three headings- Respect, Empathy, and Genuineness. Respect Try and see it from their point of view Empathy Live in such a way as to make others feel important Genuineness Be yourself and share yourself appropriately © J.N. Bailey 2009 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 9 of 63 Respect Behaviour which conveys to others that they are worthwhile, unique and valuable. It involves a commitment to live in such a way as to make other people feel important. Respect is conveyed by Giving positive attention Active Listening Giving your time Remembering the person's name Introducing yourself-greeting people Basic courtesies-offering a chair, saying 'please' and 'thank you' Asking questions Checking out assumptions you have made about the other person Not interrupting or talking over the other person Being thoughtful e.g.: remembering concerns a person my have and inquiring as to how that is going Showing concern Remembering something they have told you before and reminding them of it Asking for assistance or support Being complimentary Giving positive and correct feedback Listening from where a person is speaking Asking the other person for their opinion or idea Offering rewards Expressing appreciation Apologising when wrong Involving others in decisions Showing trust Delegating responsibility Being assertive rather than aggressive Talking in terms of the other persons interests Empathy Behaviour which shows that you understand the other persons world as they are experiencing it. In other words, "You see it their way", or "put yourself in the other person's shoes". Page 10 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Empathy is conveyed by Reflecting back to the other person feelings you are picking up - "you must have felt very angry" "you sound very happy". Sharing related experiences of your own Smiling when the other person smiles, frowning when the other frowns, etcbehavioural mirroring Trying to understand why a person 'did what they did', or 'said what they said' Asking questions to gather information-making enquiries, in a genuine manner, to understand more where the person is coming from Recalling what it is like to be in that situation yourself Genuineness Behaviour which conveys to others that you are real, trustworthy, not hiding behind roles or facades, spontaneous and open about yourself in an appropriate manner. 'Coming across as being real - not phoney.' It involves being yourself and sharing yourself appropriately. Working with Diversity Your skills in developing effective interpersonal relationships in the workplace needs to incorporate methods that show you have considered the individual and cultural differences of the people you will have daily interactions with. These people will include the residents/clients, their relatives, staff, unpaid workers, your supervisors and managers. While working as a care worker you are sure to come across people from the following diverse backgrounds: People from non-English speaking backgrounds (NESB). Migration to all states and territories of Australia has been predominantly from Western European Countries such as Italy, Greece, Portugal, Yugoslavia, Holland and Germany. Towards the last quarter of the twentieth century migrants have come from India, south-east Asia, Africa and form South American countries. This has brought a whole new range of languages and cultures to our predominantly English speaking communities. People, for whom English is a second language, will be your residents and team members. It is important that workers at Fitzroy Falls Aged Care Facility become culturally aware and receive some education concerning the cultural diversity of the residents and staff. Aboriginal and Torres Strait Islanders. The majority of Aboriginal people today have been born into a westernised culture without the in depth understanding of how it works and why it works the way it does. Aboriginal people for a long time were not recognised and have been excluded from decision making in Australian society. All Aboriginals deserve to have their culture and traditions understood and respected just as much as the migrant dominant cultures in Australia. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 11 of People with disabilities. These may be physical, intellectual or psychiatric disabilities. These disabilities may effect how a person functions in society. Whatever the disability a person has, the person should be recognised as a complete person and not as someone in a wheelchair or someone with impaired mental function. Varying religious/spiritual beliefs and practices. It is not necessary for you to agree with everyone's beliefs and practices. It is however, essential that you accept varying beliefs and practices and the individual's right to hold differing beliefs and practices. You need to do this if you want to establish and develop an effective working and caring relationships with someone. People who have varying skill levels. Varying skill levels may be related to varying levels of literacy and numeracy. Low levels of literacy and numeracy may result from a person being from a non English speaking background or may result from the person not completing more than the basic requirements of formal schooling. On the other hand some residents may have very high levels of literacy and numeracy but are in Fitzroy Falls Aged Care Facility because of other problems in their lives. Important points to keep in mind include: All staff, relatives and residents/clients are working to achieve the same goal, the empowerment and maintenance of health of residents. Any workplace is made up of individuals with diverse backgrounds, these individuals will see right and wrong from their own perspective. The potential for conflict must be recognised and agreeable solutions to issues be found so that the workplace does not lose its cohesiveness Cultural Awareness Successful communication involves both verbal and non-verbal interaction. That is, to get our message across to others and to understand them, we need to speak and gesture effectively. As many of our care recipients are born in another country or speak more than one language, we need to know information about them to ensure their care needs are met. As people age, it is common for language use to go back to their first learnt language. It is very important that we recognise this is happening and follow clear steps to support the person. The following are some tips to help you communicate effectively across cultures; Speak slowly and clearly The care recipient or client needs time to understand your words. Pronounce your words clearly ? not loudly. We all have an accent ? check to see if your resident or client understands yours. Take care not to talk down to the person. Clarify by writing down words. Don't use slang words or jargon (like medical terms and initials). Explain your role to the care recipient It is important to explain your role in words that is understood by your resident or client. Listen and observe Page 12 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Words are only one part of communication. The majority of our communication involves many other cues. The way someone is dressed, their stance, the tone of voice, the pitch, body gestures, the use of silence. Be aware of your body language and learn about the body language of your care recipient's culture. In some cultures it is respectful to maintain eye contact yet in another it is respectful NOT to have eye contact. Lack of understanding and awareness can lead to misinterpretation and lack of respect. Take time to listen Extra time taken to listen can enable you to clarify what is needed. This will save a lot of time for all staff later and prevent the care recipient becoming frustrated or withdrawn. Take care not to approach the resident or client when you know you really haven't got the time to talk it through thoroughly. Rather, make sure you have the time to discuss any issue with patience and respect. People express feelings in many different ways Emotions and feelings are open to a lot of misunderstanding when translating from one language to another. Remain respectful of people's different ways. One person may cry and sob to express their grief and another may not show any signs of emotion at all. Care workers need to remain non-judgemental. Everyone has their right to express their feelings their own way. What may be proper behaviour for one group of people may be disrespectful for another. Rules of communication All cultures have unspoken rules of communication. These rules include things like - what is the right thing to talk about and in what setting. What tone of voice we use, the speed we speak and the emphasis we place on words, are all factors to be considered when we speak with people of another culture. Differences in word meanings Some words have different meanings in different cultures. "Yes" does not always mean the person understands, it may be their custom to say "yes" to be polite. It is better to have the person let you know that they "understand" what you have said rather than accept a simple "yes" for an answer. Beliefs and attitudes must be respected Care recipients have developed certain beliefs about illness and ageing over their lifetime. We need to ask for more information about what they believe rather than discount them. It is more respectful to ask them to tell you more about what they believe and how they would be cared for in their former country. Let the resident or client know you are interested to know more about them. Do not assume that a care recipient's level of English will always be correct As a care recipient translates from one language to another, the structure of their sentences can become confused. This can occur if a person is distressed or excited. Co-workers Another group of people we need to consider in our workplace are our working partners and colleagues. Many of our co-workers also have a diverse cultural background. To promote a better workplace, take time to find out about your co-workers ? without being © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 13 of too nosy! The more we know about people the easier it is to understand them and work with them. Acknowledgement: Cultural Assessment Tool Understanding Cultural Diversity in Mental Health 2002 Commonwealth Department of Health and Ageing and Multicultural Mental Health Australia Cross Cultural Communication Many people are born and live in a variety of countries during the course of their life. To give the best care possible we need to gather detailed information about our resident or client. We need to know about their language skills and their culture. One word written on a document, such as Vietnamese, does not give very true and accurate information about how that person lives, speaks, thinks and what they believe. The following may give you some ideas on things we need to know about our resident or client: Family may be extremely important. It may be a specific requirement that family are involved with all decisions about treatment and care. The structure of the family may be very different from what you are familiar with. The care recipient may suffer extra stresses related to a change in their role and financial dependency because of their cultural beliefs. Different cultures have different values. Some resident/clients may be proud. Independence and self-control are important to them. Another culture may value co-operation. Yet another may be brave. We need to be careful not to be judgemental about a resident/client's outward personality. It takes a lifetime to get to truly know a person. The care recipient may use other types of healing. They may use folk medicine methods with or without Western treatments. Other cultures may look more at the whole person for healing. Their thoughts, feelings, spirituality, family, environment, diet and physical self are a key to their health. There may be issues related to the resident or client being male or female. Some cultures have rules about what gender may treat and care for them. The care recipient may have lived through incredible suffering for example if they have been a refugee or prisoner of war. Some cultures feel shame to express their feelings about a trauma or loss. Some cultures use terms like "hot", "cold", "wind, "nerves" to describe symptoms. To assist you to gather useful information about your resident or client consider the following points: Where was the person born and how long have they been in Australia? What is the person's first language and other languages spoken? What are their reading and writing skills like in each of these languages? What is their style of communication non-verbally? Page 14 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 What is the person's religion and how important is this to them in their daily life? Which ethnic group does the person see themselves linked closest to? Who are the resident's or client's main support persons? A small conversation with your resident/client can find out a lot of information that will be useful for all care workers and most of all for benefit of that person. Another group of people we need to consider in our workplace are our working partners and colleagues. Many of our co-workers also have a diverse cultural background. To promote a better workplace, take time to find out about your co-workers? without being too nosy! The more we know about people the easier it is to understand them and work with them. Acknowledgement: Cultural Assessment Tool Understanding Cultural Diversity in Mental Health 2002 West Commonwealth Department of Health and Ageing and Multicultural Mental Health Australia Conflict Resolution The word conflict means different things to different people. What may be a lively discussion for one person, may be a major conflict for another. Conflict levels can be looked at in a similar way to stress levels. A certain amount is good for us to function effectively and to keep us open to new ideas and ways of doing things. Often, as a result of conflict, an improvement in relationships can take place. Positive effects of conflict can include: A creative approach to problem solving. This can shake you out of lethargy. An increase in group and organisational unity. This can help team members identify and make clear their points of view. Conflict can stimulate team members to find different methods of approaching situations by exposing them to new ideas. Negative effects of conflict can include: Violence, particularly where there is inadequate ability to put feelings and needs into words. This can result in relationship breakdown. Breakdown in collaboration, because the purpose or agreement about how to work together is no longer shared. Opposing views from which people can't back down. Changes in the work or home environment which produce and reflect anger and anxiety. Emotional devastation, because feelings are ignored, put down or misdirected. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 15 of There are five main ways of dealing with conflict. These are: accommodate (ie to bring harmony to the situation by agreeing with the other person) avoid compromise collaborate compete. In situations of conflict you will be looking for options which satisfy both sides. When you are both upset it is difficult to relate to each other. To think, speak and listen clearly is a challenge and if you are not used to being assertive this will create added pressure. It is important not to blame the other person for the situation and aggressively argue the point, equality it is important that one person doesn't back off and feel like a martyr. These types of behaviour can make things worse. To be assertive is to deal with your own feelings and avoid blaming others. It can be wise to: Take time out. To do this you can count to ten drop your shoulders, postpone the situation or go for a walk. Check your thoughts, if they are unrealistic or inappropriate change them. You are the rider as well, not just the horse. Reveal your feelings and acknowledge them. This eases the tension and gives you space to think. You then have a better opportunity to deal with the situation assertively. If it seems too difficult to deal with feelings, it may be of benefit to seek a third person to act as a mediator. Interpreter Service There are a large number of interpreting and translation services, provided by the Government, private organisations and community networks. Some interpreter services also provide information on cultural factors and appropriate ways to communicate with people of culturally and linguistically diverse backgrounds. Services may include: skilled interpreters on site professional interpreter service. Offer the assistance of translating and interpreting to care recipients and/or their representatives, as appropriate. The Translating and Interpreting Service (TIS) of the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) is a large government interpreter service. TIS provides a national 24 hour a day, seven days a week telephone Page 16 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 interpreting service on a national telephone number - 131 450. TIS services are provided in more than 100 languages and dialects. Each interpreter and translator is contractually obliged to conform to the Australian Institute of Interpreters and Translators professional Code of Ethics. Providing care recipients from non-English speaking backgrounds with interpreters ensures their care and right of equal access to the full range of public health care services. Relatives and friends of patients should not be used as interpreters for medico-legal reasons. In some cultures, gender issues are particularly relevant and you may need an interpreter who is of the same gender as your care recipient. When using the services of an interpreter: Brief the interpreter, if possible, about relevant words and concepts prior to the interview. If your care recipient does not understand what you are saying, it is your responsibility (not the interpreter's) to explain it more simply. Speak directly to the care recipient, eg 'How can I help you?'. Do not say (to the interpreter): 'Ask the client or resident how I can help them?'. Sometimes it may take more or fewer words than those you have spoken to convey the message in another language. Do not let the interpreter's presence change your role in the interview. You need to conduct the interview. When working with interpreters by phone: Describe the telephone equipment you are using (eg conference or single phone) and where you are (eg residential home or private residence). Make allowances for possible clarification by the interpreter because he/she has no visual cues (eg body language) to assist in interpreting. Ensure that all required information is collected from and provided to the care recipient while the interpreter is on the line there will be no chance to speak directly to your care recipient after the interpreter hangs up. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 17 of Dementia Person Centred Approach A person, whose mental abilities are failing, due to dementia, needs to be treated as a person in their own right. Caring for these residents/clients requires you and other staff to provide a positive social environment that focuses on the person and not on their disease. This type of environment can be provided by using a person centred approach to dementia care. The person centred approach to dementia care is recognised as being a 'best practice' standard. Using this type of approach requires you to take on values and ways of thinking that will promote the residents/clients physical, emotional and intellectual well being. With this type of approach it is also essential to take into account each of the resident's/client's unique desires, tastes, abilities, difficulties and fears. Remember that these things may change as time passes. When using the person centred approach you need to know as much as possible about the person living with dementia. It is important that you have some information about the following: knowledge of their husband/wife, brothers, sisters, children, grandchildren and other family members family background significant people or situations in their lives (past or present) type of work they did likes and dislikes proud moments in their lives values religious beliefs or connection with religious groups past and present interests (eg leisure time activities) involvement in politics major illnesses and hospitalisation recent health problems home situation before you got to know them how they have coped with difficulties in the past how the resident's/client's family is coping with the situation now. To be able to provide a person centred approach to dementia care, you should adapt, as far as possible, your work routine to that of the resident/client so that you can meet their individual needs. To be an effective care worker you will also need to accept and respect each individual resident's/client's reality, rather than putting forward your own views. Page 18 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Activity Planning/Development People with memory failure such as dementia sufferers often can't do many of the things they were able to do before. In planning and developing an activity for a dementia sufferer it is important to recognise and use the abilities that the person does have. In planning an activity for a group it is important to recognise each person's abilities, special interests and physical capabilities. By recognising the abilities these residents/clients do have, the care worker can fill in the bits of the activity the resident/client can't do. When designing an activity it is necessary to consider the following: Will the activity give the resident/client a sense of achievement? Will the activity improve the resident's/client's self-esteem (ie improve their feelings about themselves)? Does the activity provide natural contact with other people? Is it a type of social contact that the resident/client is used to (ie listening to music or playing bingo)? Will the activity increase the resident's/client's trust and ability to cooperate? Does the resident/client see the activity as meaningful? Will the activity promote the resident's/client's sense of physical wellbeing? The table below may be helpful when you are planning an activity. The tablet details the mental abilities of dementia sufferers. The first column gives suggestions for an activity that are related to the abilities of a dementia sufferer. The second column lists the particular memory abilities that are failing in a resident/client living with dementia. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 19 of Residents/clients with dementia can... (suggested activity is listed in brackets) People with dementia find it difficult to... Remember the past (Activity about reminiscing) Remember the present, particularly details Feel emotions (Activity to help the residents/clients express their emotions) Express their emotions verbally or rationally React to a 'threat' and react to their feelings: (Activity to meet resident's/client's needs in a non threatening environment) Make sense of the 'threat' or their feelings Feel secure with Adapt to: • • • • • • familiar faces familiar people familiar routines. new people new places new routines (Activity to meet resident's/client's needs using skills they are familiar with) Know what they don't want (Activity to help residents/clients express their feelings) Know what they want, and tell people what they want Indicate their approval/disapproval of your choice for them (Activity to be meaningful for resident's/clients) Choose or make a decision for themselves Do familiar and simple things (Activity that doesn't have too many unfamiliar steps) Do complicated tasks and learn new ways of doing things Follow your lead or demonstration (Activity to contain specific simple steps that allows the client to follow your lead) Follow instructions Enjoy sociable company (Activity to give the resident/client the opportunity to socialise with residents/clients who have similar interests/backgrounds/cultures) Interpret crowded or busy situations and appreciate satire Do things one step at a time (Activity that is broken down into a series of steps that are easy to follow) Do several things in a hurry Communication Strategies Communicating with a resident/client living with dementia needs you to use good observation and listening skills. When communicating, the most important thing is for you to treat the resident/client as an individual and for you to look at the world from their perspective. The resident's/client's critical physical environment is a one metre circle, with them at the centre. The qualities of being able to negotiate and collaborate with the resident/client in planning their care will help you and others to enter this space. Using these skills will help to improve the resident's/client's well being and care. Observing the resident's/client's reactions to their environment and using active listening skills will also allow a closer relationship to develop. Observation skills Observing the resident/client in their environment and in their interactions with their family, friends and visitors needs more than just looking. You need to observe their: facial expression eye contact and gaze Page 20 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 gestures and movement posture and appearance smell inappropriate use of objects (eg using a pencil to cut paper) sound and tone of voice use of touch signs of physical comfort or discomfort. Listening skills Listening is an active process that requires your participation. To fully understand the meaning of what is being communicated you usually have to ask questions and respond. Then in the give and take of the communication that follows you get a fuller appreciation of what is being said. By using this process you have gone beyond just absorbing the words and now you should then be able to work in partnership with the person in the communication process. Listening is an essential skill for making and keeping relationships. Listening is a commitment to understanding how other people feel and how they see their world. Listening is also a compliment because it says "I care about what's happening to you". Real listening is based on the intention to do one of four things. These are: understand someone enjoy someone learn something give help. Benefits of real listening to a resident/client can include: the resident/client appreciates being heard stops escalating anger and cools down a crisis or reduces tension stops misinterpretations/errors helps you to remember what was said. Effective strategies in talking and listening to a resident/client living with dementia include: Facing the resident/client and not invading their personal space without warning. Having an open posture (ie arms not folded and legs not crossed). Leaning towards the resident/client . Keeping good eye contact (ie looking at the resident/client without staring). Being relaxed. Adopting a running commentary (ie you can say what has happened and what is about to happen). Ask who, what, where, when and how questions. Never ask why? Why questions can make a resident/client anxious, angry or agitated. Avoid should, must, ought to, don't and no. They can make the resident/client feel they are being spoken to as a child and can make them angry or aggressive. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 21 of Never ask "Do you remember?" This can cause distress. Begin your sentences with "May I offer you ...", "I would like to invite you...", "Today, is it going to be... or...?". When you present a choice, always accept the decision and do not argue with the resident/client . Dementia Dementia refers to a group of illnesses that are characterised by changes in the brain that lead to a decline in the person's mental functioning. Dementia brings about changes of personality and can alter relationships within a family. This results in changes in the quality of life of the dementia sufferer and leads to social isolation and loneliness. Dementia is not a part of normal ageing. People with dementia undergo psychological changes and progress through a series of stages that include memory loss, disorientation, verbal communication problems and personality changes. Dementia is a most distressing and serious illness. The causes of dementia are unknown, but can be affected by issues such as poor diet, side-effects of medication, vitamin and hormone deficiencies and depression. The majority of cases, however, fall in to the category of incurable illness. This includes: Alzheimer's Disease vascular dementia (where the brain is damaged from a series of small strokes) mixed dementia which is a combination of Alzheimer's Disease and vascular dementia Parkinson's Disease Huntington's Disease alcohol related dementia (Korsakoff's syndrome). The main symptoms of dementia are: Poor short term memory. The sufferer finds it hard to remember recent events, but can remember incidents from their past, even as far back as their childhood, with complete clarity. Loss of contact with reality. The sufferer begins to lose their hold on reality. They may not know who they are (disorientation in person), who others are, where they are (disorientation in place) or what time of day it is (disorientation in time). This causes them to feel frightened and insecure. If they don't know what time of day it is, the sufferer may get up in the middle of the night believing it is day time. It can increase the sufferers distress if, in the early stages they are aware that something is not quite right but they can't do anything to change it. As time goes by they lose that insight. Changes in behaviour. This is perhaps the most concerning symptom. The sufferer can become quite agitated and restless. Their surroundings, whether at home or in residential care, becomes a place of uncertainty and bewilderment. They no longer feel secure and safe. It becomes more difficult to cope with the varied demands of their life and they reach Page 22 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 a point that they are unable to handle situations at all. They may become more emotional or weepy which may be quite uncharacteristic of their previous behaviour. This is known as a catastrophe reaction where a simple problem such as putting on an article of clothing becomes too much of a challenge. Communication problems. Dementia affects speech as well as behaviour. Sufferers with severe dementia are often unable to communicate, as they would do normally. Their speech becomes incoherent, they may babble like a baby, and the sounds and groups of words they use are without any apparent meaning. In the early stages they may forget common words and use other words to describe what they are talking about. Such as, knowing they are going for a shower and using the word "umbrella..going in the rain " but use the actions of washing their face and body. The association between water falling in the shower and rain is not distinguished. Their actions are not the same as they would use for putting up an umbrella. The name of common objects may be forgotten but they will try to get the message across using other descriptions. Being aware of failing communication in the early stages of dementia can make the sufferer extremely frustrated. Triggers that can Alter Behaviour There are a number of different types of triggers that can alter behaviour in a person living with dementia. These triggers can be divided into the three categories listed in the table below. Triggers that can alter behaviour Client triggers Communication triggers Location triggers (these triggers can be identified from (these triggers can be (these triggers can be identified by the care plan and progress notes) identified in the care plan and observing the client in their own progress notes) environment) Client triggers include: • • • • • • Cultural background/values/language Social history Impact of changes to work roles (eg retired from work) Sleeping problems Feelings such as frustration, sadness, anger, grief Effects of dementia Communication triggers include: • • • • • • • © J.N. Bailey 2009 63 Poor verbal communication (ie speaking too fast, mumbling) Hostile body language Inappropriate nonverbal cues Changes to routine Unfamiliar carers/care workers Preferred language not used Feelings of client not considered Fitzroy Falls Aged Care Facility – Induction Manual Location triggers include: • • • • • • Unfamiliar surroundings Too much noise (eg radio, building sounds) Visual distractions (eg patterned carpet) Decor and fittings confusing (eg can't recognise what room they are in) Too much clutter Visual prompts that cue unwanted behaviour (eg items usually associated with outside activities in immediate inside space) Version 1.0.0 Page 23 of Documentation Care Plans Every resident or client in your care will have a number of documents and records about their care requirements. The most important document you will work with is the 'care plan'. A care plan gives all staff, including yourself, detailed information about the person in your care and their specific care needs. This ensures everybody works together in a consistent way, to provide the best quality care. Care plans are legal documents. You must consult the care plan before completing any task with a resident or client. This ensures the resident or client, your team members and yourself remain safe. So, what information will you find in a care plan? A care plan will include information about the following: Care needs. These are problems or issues that have been determined through formal assessment. For example, a hearing impairment. Goals and outcomes. In other words, what level of support is needed. For example, the goal for a person who is hearing impaired may be to maintain effective two-way communication. Interventions and actions. These are directions on what you need to do to help the resident or client achieve or maintain goals and outcomes. For example, you may be required to clean and check the batteries in a resident's or client's hearing aid every day. The information in a care plan comes from detailed assessments that are carried out from the time of entering care. These assessments are completed by nurses, physiotherapists, occupational therapists, social workers and doctors. Care workers are also involved. A care plan is a 'dynamic' document. This means it is reviewed and updated regularly, to meet changing needs. All staff, including yourself, will be responsible for maintaining the care plans for people in your care. Therefore, it is part of your role to report changes to your supervisor and seek guidance on how to update the care plans in your workplace. Different workplaces will have different ways of presenting information in a care plan. You need to know how to access and read the care plans in your workplace. They will help you plan your daily work with each resident or client. Completing Care Plans To ensure the best possible care is provided it is important to complete the care plan thoroughly. Page 24 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Firstly, ensure the resident's/client's details label is adhered to at the top of each page of the care plan. As this is a legal document every page of the care plan must identify the care recipient. Care alerts must be written clearly in red. This section must include any known allergies or information that could seriously affect the resident's/client's health or well-being. The care needs prompt is where you write a particular care issue that requires attention. The goal (or expected outcome) states what we want to achieve. For example: Care needs - Hearing and visual impairment Goal - To maintain effective two-way communication Each section of the care plan has a box of prompts that you may select as needed. To alert other carers to do this task you highlight the instruction with a highlighter. On a computer the highlighter function is on the formatting toolbar. If the instruction you require is not already listed, write the instruction or information into the space for "Other". There is room at the end of the document for additional comments if needed. The care plan must be evaluated three monthly or before if there is a change in the care recipient's status. The document must be signed and dated when created and each time it is reviewed or changed. Policies and Procedures Policies and procedures are important documents in any workplace. Their purpose is to record, in detail, how a workplace is to operate. Policies and procedures can be categorised into three (3) main areas: 1. Policies and procedures that outline how your workplace will comply with Federal and State/Territory laws, such as Occupational Health and Safety. 2. Policies and procedures that outline the standards your workplace expects. For example, customer service standards. 3. Policies and procedures that outline the day-to-day functioning of the workplace. For example, what staff need to do when applying for leave. So, what are policies and procedures? A policy is a statement of intent. In other words, it's a written aim of the workplace. For example: © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 25 of Residents/clients are assisted to maintain their oral and dental health in accordance with their needs and preferences. A policy may have a number of procedures supporting it. A procedure outlines what staff need to do to achieve the aims of a policy. Following is an example of a procedure for residents/clients who are unable to clean their own teeth. 1. Explain procedure to resident/client and gain agreement. 2. Assemble equipment - bowl, glass of water, towel, resident's/client's toothbrush and toothpaste. 3. Wash your hands and put on glove. 4. Apply small amount of toothpaste to moistened toothbrush. 5. Clean bottom teeth in upward strokes, starting at the gums. 6. Clean top teeth in downward strokes, starting at the gums. 7. When finished, allow resident/client to thoroughly rinse mouth. 8. Wipe mouth. 9. Clean, dry and store equipment. 10. Remove glove and wash hands. 11. Report and document any changes, such as pain, bleeding gums, mouth ulcers, loose or decaying teeth. Notice how the above procedure outlines, step-by-step, what to do and who is responsible for doing it. It's important that all staff follow workplace policies and procedures. This ensures everybody works together in a consistent way and to the requirements of the workplace. Resident Classification Scale (RCS) The resident classification scale (RCS) is a funding tool used to calculate the subsidy paid by the Commonwealth Department of Health and Aged Care to residential aged care facilities. There is an expectation that all aged care facilities are accountable to their residents, families, communities and the government to meet the accreditation standards for residential aged care services. Providing this standard of care is costly so the Commonwealth Government assists nursing homes by providing various subsidies for differing needs. The RCS is an assessment and funding tool used to determine the level of subsidies that are provided for each resident. The appraisal used for the RCS does not consider all of a resident's care needs. It considers factors that have been identified as contributing the most to differences in the total cost of care. The Director of Nursing or nominated staff responsible for residents' care assesses all the residents using the RCS. This assessment takes place over a three week period. Documentation must be kept to verify the claim that results from the assessment. The assessment covers all of the care needs of the resident. These include: maintaining continence or managing incontinence maintaining, restoring and preventing skin damage Page 26 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 specialised nursing procedures provided by or under the supervision of a registered nurse managing episodes of physical aggression or verbal disruption frequency of staff managing behavioural concerns assisting with vision, hearing, speech and comprehension support required with mobility, toileting, washing, dressing, eating and therapy. When the assessment is complete the aged are facility submits the residents' completed RCS form to the Department of Health and Family Services. The residents are then weight based on their care needs. The total rating determines the classification of the resident in to one of 8 categories (levels 1 - 8). The nursing home receives funding for the resident according to category. Level 1 - 4 is high care and level 5 - 8 is low care. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 27 of Health Terminology Abbreviations When completing documentation at Fitzroy Falls Aged Care Facility you should use the abbreviations in the table below. The left side of the table gives day to day abbreviations, the right side of the table gives medical abbreviations Abbreviation Meaning Medical abbreviation Meaning 1:1 one-to-one BP blood pressure ADL's activities of daily living BSL blood sugar level approx. approximately COAD chronic obstructive airways disease ASAP as soon as possible CVA cerebro vascular accident (stroke) BA/BO bowel action/bowels open b.d. 2 times a day c/o complained of t.d.s 3 times a day DOB date of birth q.i.d. 4 times a day eg for example prn give when necessary etc etcetera IDDM insulin dependant diabetes GP General Practitioner/Doctor NIDDM non insulin dependent diabetes hrs hours DVT deep vein thrombosis (clot) ie that is TIA transient ischaemic attack (mini stroke l left MSU midstream urine r right UTI urinary tract infection N/A not applicable MI myocardial infarction (heart attack) neb. nebuliser IHD ischaemic heart disease (angina) NOK next of kin CCF congestive cardiac failure OT occupational therapist STML short term memory loss OTA occupational therapist assistant mane Morning Physio. physiotherapist nocte nocte PTO please turn over (page) flexion bend/contract ( joint) RAF Resident Administration File extension straighten/stretch (joint) RCF Resident Care File RCS resident classification scale Re with reference to Rehab rehabilitation reqd required s/b seen by temp temperature temperature times (eg repeated times 3) +++++ +++++ Page 28 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Completing Documentation Whenever you write anything, you need to consider the purpose of the writing. The purpose of the writing will determine what you write and how you write it. At Fitzroy Falls Aged Care Facility written documents ensure continuity and consistency in the treatment or management of individuals. They provide a safeguard for the resident/client and the staff caring for them, in that a written document is evidence of care planned and given, actions taken and reviewed or, provide another channel of communication when face-to-face contact is not possible. Written documents are required for a wide variety of work situations and incidents. These include: reports on responses from residents/clients and workers reports on work related issues (eg surveys of safety issues) providing information in flyers or memos incident reports relating to occupational health and safety progress notes/care plans for residents/clients messages for staff and residents/clients maintaining the continuity of care and quality of care to the standards that are required by the organisation and by legislation providing a primary source of assessment information for others who are directly involved with the resident/client reflecting resident/client care in a legal document which can be used to protect the organisation if there is a claim made against them by the resident/client or their family obtaining information about a resident/client from their documented history, this ensures that care workers can obtain a history of past events, services and treatments. Written documents may require a rigid structure (eg when completing an incident/accident report, here questions are asked and blank spaces have to be filled in). Alternatively written documents may be less structured (eg when writing a memo to a colleague). Regardless of the type of written documentation, to ensure that they are of the highest quality to meet legal and organisational standards, it is important to keep the following points in mind: © J.N. Bailey 2009 63 Always use ink. These documents are a permanent record that may be required for legal purposes. If a computer is being used, the document should be saved to a secure folder and have recognised headings and footers. Avoid the use of white out in hand written documents. Draw a line through an error, date and sign. Your writing should be neat, clear and legible. Be objective and use clear and understandable language. Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 29 of Ensure confidentiality. Only use abbreviations approved by Fitzroy Falls Aged Care Facility. Use correct spelling, punctuation and grammar. Don't leave spaces between entries. Particularly in progress notes, as this leaves others the opportunity to add to you notes. If the information they include is wrong, it will still be attributed to you. Be accurate, concise and factual and present the information in a logical order. Use quotation marks when recording a resident's/client's statement. Consider who is going to read the document, why it is being written and what effect it is intended to have. Write events in the order that they happened and as soon as practical after they happened. Be certain the resident's/client's name is written on each page of the progress notes/care plan. Sign your name then print your name and status (ie Care Worker) on any written information. No entry concerning a resident's/client's care or treatment should be made on behalf of another care worker. Progress Notes Progress notes for a resident or client are the most appropriate place to note that the plan of care has been evaluated. The progress notes provide evidence that regular evaluation is taking place. Progress notes are not intended to contain long stories about the day-to-day occurrences for a resident or client. Neither should they contain a Care Worker's subjective response to a situation that has occurred. They should not contain information that is repeated elsewhere such as on the care plan, observation chart or medication chart. Therefore, writing in the progress notes should be by EXCEPTION which means when the resident/client does something differently or responds differently to a situation or treatment that is then recorded. It is exceptional. Progress notes are where new treatments or strategies for managing the resident/client can be recorded and to flag that the care plan needs to be, or has been, altered. Progress notes help in maintaining a record of the continuity of care and quality of care to the standards that are required by the organisation and by legislation. They reflect resident/client care in a legal document which can be used to protect the organisation if there is a claim made against them by the resident or their family When writing in documentation such as progress notes, you will need to ensure that they are of the highest quality to meet legal and organisational standards. It is important to keep the following points in mind: 1. Always use black ink. These documents are permanent records and may be required for legal purposes 2. Avoid 'white ? out'. Draw a line through an error, date and sign Page 30 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 3. Your writing should be neat, clear and legible 4. Only use abbreviations approved by your organisation 5. Use correct spelling, punctuation and grammar 6. Don't leave spaces between entries 7. Be accurate, concise and factual and present the information in a logical order 8. Use quotation marks when recording a resident's statement 9. Consider who is going to read the document, why it is being written and what effect it is intended to have 10. Write events in the order that they happened and as soon as practical after they happened 11. Be certain the resident's/client's name is written on each page of your notes 12. Sign your name then print name and status (ie Care Worker) on any written information 13. No entry concerning a resident's care or treatment given should be made on behalf of another care worker Notes: Progress notes are important methods of communication and as such require some of the same skills used in other methods of passing along information. It is important to remember also, the issues of confidentiality, being objective and using clear and understandable language. Before you start to write; think about who is going to be reading it. Commitment to Continuous Improvement Fitzroy Falls Aged Care Facility encourages all staff to actively strive for excellence and to continually seek to improve the quality and efficiency of services to clients. Fitzroy Falls Aged Care Facility uses a planned and systematic approach to planning and continuous improvement. All stakeholders are encouraged to provide feedback which is analysed and incorporated into strategic, business and continuous improvement plans. Fitzroy Falls Aged Care Facility is committed to Continuous Improvement (CI) and quality of care by identifying opportunities for improvement and solving problems in a way that allows us to work together towards: Aiming for excellence in service delivery in all areas Developing skills and abilities of employees Promoting communication and teamwork between staff and residents/clients Fitzroy Falls Aged Care Facility expects all staff to contribute to continuously improving care and services in line with our Mission, Philosophy of Care, Objectives and Core Values. Teamwork, participation and good communication are essential to achieve consistently high standards. Feedback is actively encouraged. There are procedures in place to gain and respond to comments from residents, relatives, clients and staff about their needs and preferences. Continuous improvement is built into every area of care and service we provide. In addition, residential care facilities must be accredited. What is Continuous Improvement (CI)? Definition - Continuous Improvement (CI) is an ongoing process of gathering information, planning, evaluating and improving care and services to meet changing resident/client and client needs. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 31 of It involves a team-based approach to gathering information, planning, undertaking activities, evaluating the success of activities and making adjustments as necessary. Our residents/clients are changing all the time. Existing residents'/clients' needs change, therefore CI involves being responsive to residents' needs and changing our practices to satisfy those needs. We must maintain high standards at all times. We can do this by getting resident/client feedback about ways to improve the services we offer and be always looking for best practice. That is, finding out if others have better ways of doing things. Accreditation standards provide guidelines about how management systems, staffing and organisational development assist us to provide optimum resident/client health and lifestyle options in a safe and pleasant environment, while respecting mutual rights and responsibilities. Continuous improvement is an integral part of management. It is not an additional task, it is an attitude and way of working. Managers are responsible for identifying, implementing and evaluating continuous improvement activities All employees have a responsibility to identify possible improvements to facility and corporate structures, policies and procedures. We encourage and welcome suggestions for improvement. Materials Safety Data Sheets MSDS stands for Material Safety Data Sheet. A MSDS is a document that contains information on the potential health effects of exposure and how to work safely with chemical products. A MSDS advises you how to use chemical products safely, what safety equipment is required when handling them, how to store them safely and what to do in an emergency. You must make sure you read and understand the MSDS before you work with any chemical or product. You can get an MSDS from your employer before you use a product. A MSDS exists for each chemical product sold in Australia and you can access them through your chemical provider or on the internet. It contains chemical safety information about the product, such as: toxicity, safe-handling procedures, spill response, and first aid procedures. As required by the OHS Act, employers must maintain copies of any Material Safety Data Sheets of chemicals that are stored and used on their premises and ensure that they are readily accessible to employees during each work shift. Page 32 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Health Food and Fluid Thickeners As a care worker it is very important to check the care plan to see if your care recipient's food or drink requires a thickener. A thickener generally consists of vegetable gums, food starches or a combination of both. A specified amount is added and mixed with the drink or food to create a gel-like consistency. Some care recipients require the food or fluid thickener due to swallowing difficulties (dysphagia). A full assessment needs to be carried out by a Speech Pathologist or qualified health practitioner to ascertain if a thickener is required, what type of thickener and the amount that needs to be added. Care recipients on a thickener regime require monitoring to ensure they have adequate fluid intake as thickeners can be dehydrating. Failure to add the thickener can have serious results. Remember, always check the care plan Incontinence Incontinence is the loss of bladder or bowel control. Many sufferers may experience emotional as well as the physical discomfort. It affects people's lifestyle and may result in social isolation. There are several types of incontinence. Stress incontinence - this occurs when pelvic muscles have been damaged. This causes the bladder to leak during coughing, sneezing, laughing, exercise or any movement that puts pressure on the bladder. This commonly affects women and may occur after multiple childbirths or menopause. Urge incontinence, or overactive bladder, involves the urgent need to pass urine and the inability to make it to a toilet on time. It occurs when nerve messages from the bladder to the brain don't connect. The bladder cannot be mindfully controlled. Urge incontinence is experienced in such illness as dementia and Multiple Sclerosis. Mixed incontinence is very common and involves a combination of both stress and urge types of incontinence. Functional incontinence occurs when a person does not recognise the need to go to the toilet. They don't recognise where the toilet is and make it to the toilet on time. This may be caused by dementia, poor eyesight, confusion, difficulty to get out of chairs, and poor lighting. Overflow incontinence relates to leakage that occurs due to the amount of urine is greater than bladders holding capacity. This can result from diabetes, pelvic surgery, polio, spinal cord damage or shingles. Faecal incontinence includes the uncontrolled loss of solid stools. Anal incontinence is the uncontrollable loss of flatus (wind) and liquid stool. Faecal incontinence may be cause by many things including diarrhoea, constipation, nerve damage, or damage of the muscles around the anus from childbirth or surgery. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 33 of What can be done? Ensure the resident/client has had a thorough examination with a medical professional. Encourage the resident/client to self toilet if possible. Check the resident/client is not restricted but his/her mobility. Make sure their mobility aids are reachable eg walking stick, frame. Make sure the distance to the toilet is achievable. Ensure they can easily remove article of clothing. Arthritic fingers struggle with buttons and zippers. Have the resident's/client's medications checked ? they can sometimes be the cause of the incontinence. Discuss the use of absorbent products (pads) to ease the embarrassment of leakage. Have your physiotherapist assess your resident/client and discuss pelvic floor exercises if applicable. Drinking plenty of fluid is important. This assists the kidneys and bladder to function effectively and prevents dehydration. Limiting fluids with caffeine such as tea and coffee to 2 or 3 cups a day will help to prevent over stimulation of the bladder wall and increase urgency. Most importantly make sure you respect your resident's/client's dignity when discussing or assisting them with toileting procedures. If in doubt, treat your resident/client the way you would like to be treated in this situation. The Physical Effects of Ageing A normal part of the ageing process is that our skin and organs cease to function as efficiently as when we were young. As a care worker it is essential to take these factors into consideration to ensure the best level of care for your resident/client. Skin Changes include loss of pain/hot/cold sensation that may result in injury. Skin becomes drier and less elastic increases chances of skin tearing. Sweat glands decrease creating difficulty in maintaining body temperature. Mouth and Teeth Reduced saliva production may create swallowing difficulties or dysphagia. Membranes that line the mouth take longer to repair. Taste buds deteriorate resulting in the lack of taste in foods. Page 34 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Digestion and Elimination Nutrition from food may not be absorbed resulting in malnutrition. Delay of movement of waste can result in constipation. Urinary System Kidney function decline may result in fluid retention, less efficient at storage of essential body salts and less efficient removal of toxic waste. Urinary incontinence may result from muscle weakness or loss of sensation to nerve endings. Heart and Blood Vessels Cardio-vascular system becomes less effective and less blood is pumped. Blood vessels become less elastic and narrower. Blood pressure readings indicate changes related to medications and/or disease. Poor circulation to the hands and feet cause pain, discomfort and less mobility. Lack of blood supply to the skin and tissue may result in ulcers that are difficult to heal. Hardening of the arteries (atherosclerosis) occurs. A block in an artery restricts blood supply and can have terrible results. Lungs Elastic tissue in the lungs does not expand as well and less oxygen is taken in. The chest wall does not expand as much as a younger person. This results in less air entry in to the lungs and less oxygen is absorbed. Reduction in mucous production and the effectiveness of other disease fighting mechanisms make older people more prone to chest infections and pneumonia resulting often in death. Annual flu' injections are a wise precaution. If you have the flu' then it is best not to work with elderly people until your symptoms have gone. Irreversible changes to lung tissue will have occurred in smokers. Reduced ability of the lungs to absorb oxygen affects all of the body's normal functions. Muscles Muscles lose mass, flexibility, strength and durability if they are not exercised regularly in later life. The range of motion at joints declines with ageing and may contribute to reduced participation in exercise. Contractures may occur due to diseases such rheumatoid or osteoarthritis, neurological diseases, strokes or immobility. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 35 of Bones and Joints Bones become more brittle and less dense as a person ages. As a result fractures can occur more easily. Calcification in the joints can cause restricted movements and joint pain. Osteo-arthritis occurs to some degree in most aging bodies. Decreased calcium absorption means possibility of osteoporosis. Nervous System It can take longer to process and respond to messages received. This can result in lowered reactions, responses and reflexes. Poor balance and reflexes mean increased risk of falls. Memory loss may occur. Dementia is mainly an age associated condition with 17 per cent of the population over 75 years suffering with it. Sleep may become an issue for many older people as they need less sleep. Vision Vision deteriorates as a person ages. This means good lighting is always needed to prevent falls or accidents, even in the day time. The lens of the eye can become opaque (cataract) or it can thicken and be less flexible making it more difficult to focus quickly on objects. The lens may also become yellow in colour affecting the way the person perceives colours. Hearing Hearing loss presents mainly through the loss of high frequency sounds. Mobility Safe mobility for older people may become limited by changes in their physical and mental condition. Mobility is necessary for wellbeing. Reproductive System In men, an increased prostrate gland, increased amount of time to urinate and loss of hardness to the penis are possible changes caused by the aging process. In women, decreased vaginal secretions may make sexual intercourse uncomfortable, and thinning vaginal walls are common physical occurrences. Page 36 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Stereotypes of Ageing A stereotype is when an image of, or attitude towards persons or groups is based on superficial observations and experiences. For example, some people stereotype young people as rebellious and loving parties, or stereotype Asian people as being intelligent, or Doberman dogs as being ferocious. These perceptions are formed without us possibly even knowing any Doberman dogs or Asian people. We form the opinions by what others say, or the way these images are shown to us by television, newspapers and magazines. Below are some examples of common stereotypes or myths about elderly people: old people don't have sex most old people are sick old people are set in their ways old people are a burden on society old people have nothing to offer all old people become senile all old people are the same most old people like to be cared for old people prefer to be with people the same age. These beliefs and attitudes are restricting to those who believe them and to the people it concerns. These attitudes don't consider the uniqueness of the individual. The consequence can be the elderly person devaluing themselves and becoming reliant on others. This can result in their self esteem becoming low and thereby reducing their health and fitness levels as they allow others to step in and do everything for them. If the society has a low value on the elderly then this will reflect in the standard of care and services. We must treat each person as a unique individual. Develop care plans that reflect the specific needs of the person. Recognise that each older person has feelings just like us on the inside, only they look different on the outside now. And so will we one day. Most of all remember we are all different. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 37 of Sexuality and Ageing We express our sexuality in many ways. We all have a need for love, touch, holding, cuddling and eye contact. Sexuality is not just sexual intercourse. From the time we are born until the time we die we have an inborn need for affection. This aspect of our sexuality is very distinct from the sexual act. A lot of our judgements and beliefs surrounding sexuality are linked to our values, morals and religious beliefs that have developed over our lifetime. As individuals, we have very different views on sexuality and, in particular, sexuality and ageing. One of the most common attitudes in our society is that old people aren't attractive. This belief creates a major barrier for older people to express themselves sexually. We all like to take pride in our personal appearance. Equally we like to be noticed and communicated to by others. As a care worker it is important to realise how much emotional and psychological value is to be gained by assisting residents and clients to maintain an attractive personal appearance. We also have a need for privacy and discretion. As much as people have different needs and preferences, all adults require respect and an opportunity for privacy. If a resident or client has an issue of a sexual nature it is our role to be discreet about how and who we talk to, and the way we discuss matters with the resident/client and their family. Sometimes a request may be made to purchase items from an adult shop or visit a sex worker. As an adult, the resident/client has the right to do this. As a care worker we need to ensure the safety of the resident/client and discuss methods of protection from sexually transmitted diseases. Some care recipients use masturbation as sexual outlet or masturbate because of a disease process that may have lowered their self-consciousness. Women may need to discuss issues of vaginal dryness with their GP and men may need to discuss problems regarding erections. Their doctor can assist with these issues, as they are normal and treatable. It is not a care worker's responsibility to assist residents/clients achieve or pursue their sexual needs. However it is a care worker's role to respect the care recipient's preferences, maintain the person's dignity and uphold confidentiality at all times. If at any time you are uncomfortable regarding an issue of a sexual nature it is your responsibility to discuss the matter with your supervisor as soon as possible so that the issue may be resolved. Remember sexuality is a wonderful expression of life. Page 38 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Grief and Loss What is Grief and Loss? A loss is the wound. Grief is the healing process. The greater the personal meaning of the loss for a person, the greater the grieving experience may be. A loss could be: a death divorce health changes retirement income independence freedom a body part or bodily function lifestyle role or job memories home security pets relocation to a new area As an aged care worker it is very important to recognise that our residents/clients often are experiencing grief for losses in several parts of their lives. Signs and Symptoms The following signs and symptoms are commonly experienced by people experiencing grief and loss. Not all symptoms would be experienced at the same time, but any combination is normal. Always ensure your resident's/client's signs and symptoms are reported to your supervisor for a thorough medical assessment. Physical signs Emotional signs Psychological signs Chest pains Fatigue Nausea Sleep disturbance Panic Loss of appetite Low resistance to illness Restlessness Sadness Anger Guilt Fear Yearning Numbness - unemotional Hysteria Euphoria Apathy Anguish Loss of self confidence Loneliness Loss of meaning Suicidal thoughts Disbelief Changes in thinking patterns Preoccupation with the loss Confusion Depression Anxiety Loss of interest Aimlessness Concentration poor Memory poor Loss of faith Hopelessness Low self esteem Forgetfulness © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 39 of Stages of Grief Each person is an individual. In our own uniqueness we express thoughts and feelings in many different ways. It can be said that people move through a variety of stages, eg denial, anger, depression, acceptance. However, each person and each loss cannot be so simplified. We cannot put a timeframe onto a person for their grief. It is their experience, not ours. We must remain non-judgemental about how another person is coping with the great changes in their life. The best outcome is when a person has integrated their grief and loss into their present life and can function as best as can be expected. That is, the person doesn't forget their loss. How can someone possibly forget living in a 40 year marriage with another person? Some losses no-one will ever get over. Rather, they will learn how to continue to live with the loss. Communication It is most important to recognise what is acceptable to do as a care worker, when a resident or client is experiencing grief and loss. Spend some time to really listen Acknowledge their feelings Don't discount their feelings - don't say they will get over it If you don't know what to say, say nothing Allow the person to talk about their loss and feelings Tolerate silence. Silence is okay, you don't have to fill the space Reassure the person that it is normal to have a lot of different thoughts, feelings and physical symptoms when they are grieving Recognise that you cannot make them feel better, but you are making a difference by being there Ensure you are aware of any special needs regarding the resident/clients spiritual, religious or cultural beliefs Supervision and Reporting If a resident/client is experiencing identified grief and loss all staff need to be aware of how the person is progressing on a daily basis. Keep your supervisor informed of the resident/client's progress and document it. If the resident/client shows signs that they may be struggling, ensure your Supervisor is aware and that the appropriate agencies are contacted to gain professional support. Diabetes What is diabetes? Diabetes is a long term (chronic) disease characterised by high blood sugar (glucose) levels. This is a result of the body not producing insulin, or using insulin properly. Insulin is a hormone made by the pancreas. Insulin is needed for glucose to enter the cells and be converted to energy. Page 40 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Type 1 diabetes (insulin dependent) • • • • Represents 10 to 15% of all cases of diabetes Occurs when the pancreas gland no longer produces the insulin needed Is one of the most common chronic childhood diseases in developed nations Is not caused by lifestyle factors Type 2 diabetes (non-insulin dependent) • • • • Represents 85 to 90% of all cases of diabetes Occurs when the pancreas is not producing enough insulin and the insulin is not working effectively A genetic predisposition and lifestyle factors contribute to the development of Type 2 diabetes Risk factors include overweight/obesity Diagnosis Diagnosis Usually in childhood or young adulthood, although it can occur at any age. Usually in adults over the age of 45 but it is increasingly occurring at a younger age. Symptoms Symptoms Usually abrupt onset. Symptoms can include excessive thirst and urination, unexplained weight loss, weakness and fatigue, irritability. Sometimes symptoms go unnoticed as the disease develops gradually. Symptoms may include any of those for Type 1 diabetes plus blurred vision, skin infections, slow healing, tingling and numbness in the feet. Sometimes no symptoms are noticed at all. Treatment Treatment Lifelong insulin injections every day, regular blood glucose level tests, healthy eating plan and regular physical activity. Over time treatment may progress from lifestyle changes only, to lifestyle modification and oral medications. Insulin injections may be necessary in some cases. Complications from diabetes may include eye disease, kidney disease, leg ulcers, feet problems, heart disease, difficulty maintaining penile erections. Warning - It is essential as a care worker that you do not cut nails of clients/residents with diabetes. Refer to your supervisor as a registered nurse or podiatrist will perform this task. Healthy Lifestyle and Ageing Part of maintaining a healthy lifestyle is to consider things we eat and things we do. Everything we do impacts in some way on our health and well-being. Choices of food can result in serious harm to our health if we are not aware of the importance of observing our diet. The best choices for a healthy diet include © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 41 of foods low in saturated fats, as these fats can produce cholesterol which in turn can lead to the blocking of our arteries. Fresh fruit and vegetables ensure we have an adequate supply of dietary fibre, vitamins and minerals. Sound food choices help us to maintain a sensible weight that enables us to remain healthy and prevent diseases such as diabetes, heart disease and high blood pressure. Smoking has been scientifically proven to be unhealthy for us and this habit is linked with certain cancers and heart disease. A much better way of managing stress would be to get 30 minutes of regular exercise each day. Simply walking rather than taking the car or taking the stairs instead of the lift all add up to becoming more healthy. Remaining active has been found to assist in overcoming mental and emotional problems. Don't forget the importance of relationships with family, friends, neighbours and pets as this can be one of the most pleasurable ways for us to stay healthy. Swallowing Difficulties Some warning signs for dysphagia: chest infection specifically regular recurrence shortness of breath following eating/drinking temperature changes febrile resident/client reports changes in swallowing status coughing or choking occurs with foods or liquids fluctuating levels of alertness reclining/lying position. Altered laryngeal function is described as a sensitive indicator for dysphagia: weak, breathy, croaky voice quality wet gurgly voice quality wet spontaneous cough inability to cough abnormal or absent laryngeal elevation on swallowing dysarthria weak slurred speech oral Dyspraxia difficulty coordinating and/or initiating oral movements compensatory head movements holding head back or forward drooling from mouth saliva or food collects in mouth refusal to take food longer time taken to eat meals weight loss Page 42 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 regurgitation/heartburn. Indicators for referral to occupational therapy for mealtime assessment. The following indicators are meant as a guide (use your judgement and knowledge of the person before making a decision) for when to refer a resident/client to occupational therapy for a mealtime assessment: poor posture at the dinner table, eg slouching, leaning on elbows, legs swinging (make sure the resident/client is seated in their correct chair with the correct cushion before referral care recipient is only able to eat a small amount or half their meal without tiring and stopping eating care recipient spills food on the floor, over the table or spreads food around their mouth as unable to direct food to their mouth properly. care recipient is resistant to general assistant given by staff care recipient bring their head to the table to eat rather than their hand to their mouth care recipient regularly drops cutlery, cups or mugs care recipient is unable to hold cutlery, mug or cup or pick these items up due to shape or weight of an item • care recipient looks generally awkward when eating other than normal. Warning signs to report to speech pathologist for residents/clients with dysphagia coughing when eating or drinking - remember if the resident doesn't cough you still need to look for other warning signs weak, hoarse or breathy voice wet gurgly voice during or following meals no attempt to cough and clear the throat when voice is wet/gurgly inability to cough slurring speech drooling saliva pooling of food in the mouth chest infection/temperature changes shortness of breath following eating tiring rapidly refusal to take food/fluid weight loss regurgitation/heartburn. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 43 of Case Conferences Case conferences are an opportunity for a general practitioner (GP) and other health workers/service providers to meet and discuss the care goals of a resident/client using a multidisciplinary approach. The health workers/service providers include: doctor, nurse, social worker, physiotherapist, occupational therapist, care worker, carer, home help, aboriginal health worker, pharmacist, continence adviser, dietitian, podiatrist, speech pathologist, family and friends. Other service providers such as community support groups, psychologists and audiologists may also attend if they are contributing to care provided to that resident. In residential care, the number of people attending the case conference may be limited to the immediate care team plus the resident/client and family. A case conference must include a GP and at least two other contributing team members who each provide a different service to that resident. The roles different participants of the case conference team may include, but is not limited to: Doctor: able to provide medical information regarding the client/resident, including diagnosing medical conditions and prescribing medications. Nurse: able to provide information regarding clinical assessments and complete clinical duties as instructed by the Doctor. Social Worker: able to assess client/residents care level needs and provide information and assistance with their holistic care needs. Physiotherapist: assesses the client/residents mobility requirements and implements exercise and rehabilitation programs. Occupational therapist: assesses the client/residents requirements including developing and implementing programmes to meet their social and emotional needs. therapy activity Pharmacist: provides information to client/residents regarding their medication regime and how medications should best be taken. Client/Resident: are able to discuss their care requirements and needs with those present in the case conference. The family member: assists the client/resident with discussing their care needs and may advocate on their behalf. Care Worker: the care worker is very familiar with the routine and needs of the client/resident they care for, they can provide accurate information regarding to those present in the case conference. The Manager/Supervisor: Coordinates the case conference and ensures that issues discussed are acted upon. The benefits for residents from a case conference are that there is a cooperative approach to improving their health outcomes. This includes quality of life, efficiency of care, use of medications and other care services. At the case conference, goals for care can be created and communicated, with clear responsibility for their actions taken by everyone who attends including the resident. Page 44 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Case conferences can be used as a response to a recent change in a resident's/client's condition such as a stroke, recent hospitalisation or complications from a chronic condition. Residents with chronic conditions and who have multidisciplinary care needs are also eligible for a case conference. Before the case conference, an explanation about why the case conference is being held must be given to the resident/client or their next of kin. This explanation will include medical diagnosis, health problems, health needs and goals. The resident/client must then agree to the case conference being held, this agreement is recorded in their notes. The resident/client must also be asked if, there is any personal information they do not want disclosed. The cost of the case conference will also be discussed with the resident, as fees may be charged by health care providers for their attendance. Discussion at the case conference will be around the resident's/client's problems, identified needs and goals. Additional information may be provided by everyone present. A plan is developed and agreed to, with tasks allocated to each team member, so that the identified care needs and outcomes can be achieved. A time for review, to see if the plan is working, is also agreed upon. Case conferences can be held for any resident/client up to five times per year. For each case conference, a record of who attends, the date, the start time and finishing time must be recorded. After the case conference, a written summary is prepared. This is kept with the resident's/client's records. Every health care provider is given a copy of the summary. The summary includes, the identified goals and the health care provider's tasks that will help the resident/client achieve those goals. The recommendations and any changes to care are then discussed with the resident/client and their next of kin. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 45 of Human Resources Performance Appraisal A performance appraisal is a formal and systematic evaluation of an employee's work performance and current potential. An appraisal must be positive and orientated toward performance improvement. The purpose of a performance appraisal at Fitzroy Falls Aged Care Facility is to provide formal feedback about work performance and for compiling individual staff development plans. The purpose of the development plan is to build the competence of each staff member, in order that their performance in current duties is enhanced and that they are equipped for future developments. The goals of performance appraisal are: to provide a formal opportunity for feedback to staff members on their work performance to provide a formal opportunity for staff members to raise concerns they may have, for example lack understanding of expectations, and have these concerns addressed to provide an opportunity for staff members to reconsider their goals, and the level of performance compared to company expectations to identify training and staff development needs to identify and remove any obstacles to good performance to strengthen the relationship between staff members and their immediate supervisor to assist and encourage staff to take their own initiative to improve job performance to stimulate and motivate growth in staff members where there are performance deficiencies, for the staff member to accept ownership of these for the supervisor and staff member to co-operatively find solutions to address any performance deficiencies. Performance feedback is usually provided informally on a daily basis as employees perform their daily duties. Performance appraisal is a more formal process that will require significant preparation by the staff member as well as their manager/supervisor or team leader. To prepare for a performance appraisal, you will need to review your own performance against a set of criteria. You will also need to consider how you want to develop your role in the future. Page 46 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Performance Appraisal Interview (Self Appraisal) Before attending a performance appraisal interview it would be a good idea to think about your own performance and to reflect on your personal and career goals. You should also think about your future and future of your workplace. It may help to ask yourself the following questions: where do I see my self and this job going. where is this industry going what will the future hold? During a performance appraisal interview you will identify a range of performance issues, some of these will be dealt with immediately, while others may take a longer period of time to resolve. For each issue identified you will be required to develop an action plan to achieve effective resolution. An action plan is a strategy that will enable you make changes to your working life. Some care workers continually repeat the same issue over and over again like a needle stuck in a record. They will turn up at each performance interview with the same unresolved issues. The role of the person conducting the interview is then to help the person to move forward and make the necessary changes to their work situation. To develop an action plan you will firstly, have to identify the goals that need to be reached, this is usually done through the interview process. Secondly, you need to explore the processes used for achieving those goals. Thirdly, you will need to discuss with the person conducting the interview (eg your supervisor/ care manager) the possible consequences of the actions to be taken. An important factor here is to make the most of your achievements. You will then be more likely to continue making positive decisions whilst carrying out the required actions to achieve your goals. Feedback At the time of your performance appraisal interview you will receive feedback about your performance. Sometimes the feedback is not positive and this may be hard to deal with, as we all like to think we are doing our 'best'. Remembering the following points will help you to accept feedback: Listen. Even if you do not like what is being said, let the speaker finish before you give your reply. Defensiveness. Don't try to make excuses and above all avoid getting angry. Everyone has some areas that need improvement and the feedback will help you. Be polite. Thank the person for their feedback even though you may be feeling upset or shaky. Your ability to receive and respond to feedback in a positive way demonstrates to everyone that you are always ready to learn and improve. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 47 of Harassment Harassment is any behaviour which is unwelcome and is based on a person's sex, pregnancy, potential pregnancy, marital status, race, ethnic group, disability, age, career status, family responsibilities, religious or political conviction, trade union membership or activity, sexual preference or any other factor not relevant to their duties. Harassment will usually be repeated behaviour, but can also consist of a single act. Workplace bullying and discrimination against employees on the basis of their workers' compensation history also fall under 'harassment'. Harassment has the effect of offending, humiliating or intimidating the person at whom it is directed. It makes the work environment unpleasant and sometimes even hostile. If a person is being harassed then their ability to do their work is affected. They often become stressed and suffer health problems as a result. Harassment can often be the result of behaviour which is not intended to offend or harm, as jokes or unwanted attention. The fact that harassment is not intended does not mean that it is not unlawful. The differences between people should be acknowledged and respected - never ridiculed. Harassment can involve an abuse of power, for example, a manager may harass a person whom they are supervising, discriminating with allocation of shifts or less popular tasks. Abuse of power can also happen when certain groups are in a minority in the workplace and are therefore in a vulnerable position, for example, people from non-English speaking backgrounds. Reasonable disciplinary action and feedback on performance by a supervisor is legitimate to control how work is done and is not harassment. Types of harassment There are many types of harassment. These can range from direct forms, as abuse, threats, name calling and sexual advances; to less direct forms, as where a hostile work environment is created, but no direct attacks are made on an individual. They can be created by individuals or groups. Examples of verbal harassment: Page 48 of 63 sexual comments, advances or propositions lewd jokes or innuendo racist comments or jokes spreading rumours comments, jokes about a person's disability, pregnancy, sexuality, age, religion, etc repeated questions about personal life belittling someone's work or contribution in a meeting threats, insults, or abuse repeated unwelcome invitations offensive, obscene language obscene telephone calls greater than normal workplace requirements repeated after hours communication unsolicited letters, faxes, emails greater than workplace requirements unexplained rages. Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Examples of non-verbal harassment: leering, eg staring at a woman's breasts putting offensive material on notice boards, computer screen savers, email, etc wolf whistling nude or pornographic posters displaying sexist or racist cartoons or literature demoting, failing to promote, or transferring someone because they refuse requests for sexual favours following someone home from work standing very close to someone or unnecessarily leaning over them mimicking someone with a disability practical jokes which are unwelcome ignoring someone, or being cold or distant with them crude hand or body gestures undermining work performance deliberately withholding work-related information or resources or supplying incorrect information failure to give credit where due unexplained job changes imposing impossible deadlines or targets deliberately not speaking to or shunning a person Examples of physical harassment: unwelcome physical contact, such as kissing, hugging, pinching, patting, brushing up against a person indecent or sexual assault or attempted assault hitting, pushing, shoving, throwing objects at a person unzipping a person's attire threatening gesture such as a raised fist. Sexual Harassment Definition A person sexually harasses another person if the person: makes an "unwelcome sexual advance" towards the other person makes an "unwelcome request for sexual favours" to the other person engages in other "unwelcome conduct of a sexual nature" in relation to the person harassed in circumstances in which a reasonable person, having regard to all the circumstances, would have anticipated that the person harassed would be offended, humiliated or intimidated. "Conduct of a sexual nature" includes the making of a statement (whether oral or in writing) of a sexual nature to the person being harassed or in the presence of the person being harassed. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 49 of Conduct amounting to sexual harassment Sexual harassment is unwelcome, uninvited conduct which is offensive from the view of the person harassed, regardless of any "innocent intent" on the part of the offender. Sexual harassment can involve any physical, visual, verbal or non-verbal conduct of a sexual nature. Sexual harassment can be experienced by both women and men. Sexual harassment may include conduct which occurs in the workplace or in connection with work. Sexual harassment can involve a series of incidents or it can be a one-off occurrence. Whilst single or isolated occurrences of some behaviour may appear relatively minor, when continued over an extended period they can become very wearing and stressful. Examples of sexual harassment Depending on the circumstances, sexual harassment may includes actions as: demands for sexual favours with express or implied threats or promises related to employment status displays of erotic or sexually graphic material including posters, pictures calendars, cartoons or messages left on computer screens, boards or desks unwanted physical contact sexually orientated jokes leering or staring at a person's body offensive comments on physical appearance, dress or private life constant requests for drinks or dates, especially after prior refusal. It is important to recognise that certain behaviour or comments which may not offend one person may be unwelcome or offensive to another person. Some conduct which might be tolerated socially may constitute sexual harassment in the workplace Page 50 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Medications Medication Administration When giving out medications you must always follow these steps: 1. Check the order and the medication prior to popping the tablets out of blister pack. 2. Recheck the order and medication (once popped, if oral tablet) prior to giving to resident/client. 3. Recheck the medication at resident's/client's side. 4. Follow the 5 'R's for safe and correct administration. 5. Sign the appropriate chart (ie medication chart, signing form) for blister pack. You can write on a medication chart, treatment chart or signing form to: complete the front of a medication chart with the resident's/client's details attach stickers (eg same name or drug alert stickers) attach a pharmacy label to the relevant section of a chart or a form sign in appropriate place after you have given the resident/client their medication write in the time you give PRN (as required) medication (e.g. 0810 or 2030 hours). write in number of tablets if giving PRN medication, where the order gives a range of 1-2 tablets (e.g. Panamax 1 or 2 tablets PRN) write 'course completed' on a chart for short term medication (eg a course of antibiotics) enter an approved abbreviation. You cannot (under any circumstances) write on a medication chart, treatment chart or signing form to: transcribe any medication onto any part of a chart or form transcribe any administration instructions (eg cream to left lower leg) write in an alternative name to a medication written up by the doctor (eg the doctor writes up the medication as the generic name of 'Diazepam' and you write in the brand name of 'Valium' next to it) write in a cease order for a medication. If you are unsure or in doubt do not continue to give the medication. STOP and seek assistance or advice from the manager, senior supervisor, registered nurse, pharmacist, or doctor. It is better to query than to guess! © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 51 of Medication Effects When a resident/client has taken their prescribed medications they can develop side effects as a reaction to that medication. This can result in the person having physical changes such as a rash or behavioural changes such as confusion. It is not your responsibility as a care worker to identify the cause of the changes but it is your responsibility to report and record them. It is important that as a care worker you record (document) any physical/behavioural changes in the progress notes and report these changes to the relevant person (eg registered nurse, enrolled nurse, doctor, supervisor, manager). Page 52 of 63 Physical changes Behavioural changes Sweating Change in skin colour (eg rash, red, blue) Change in skin temperature Swelling (eg hands, feet, face, fingers, ankles, legs) Bruising Breaks to the skin Incontinence Constipation Diarrhoea Change in colour of faeces Offensive smelling urine Change in colour of urine Change in frequency of urination Vomiting Nausea Stomach pains Aches and pains Headaches Reduced mobility Alteration to appetite (ie increase, decrease) Changes to sleep pattern Unsteady on their feet Falling Impaired hearing Reduced vision Infection (ie skin, urine, mouth) Reduced ability to meet own needs Changes in speech (eg slurred, tone, volume) Weight changes Breathlessness Reduced physical activity Shaking, tremors (ie involuntary movements) Slow to respond Not conscious or responding Facial expressions (eg showing pain, confusion) Difficulty swallowing Dry mouth Cough Disorientated Confused Anxious Agitated Physically aggressive Verbally aggressive Noisy Demanding Rude Worried Fearful Dependent/reliant Restless Wandering Withdrawn Memory loss Repetitive Refusal to take medications Thoughts of dying and suicide Angry Swearing Hitting out Screaming Calling out Crying Whimpering Tearful Hallucinations (ie hearing and seeing things and hearing voices you are not able to) Paranoid Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 The table above gives examples of changes that you should record (document): Medication Administration Responsibilities A safe and effective medication management system in Fitzroy Falls Aged Care Facility is based on the clear legal responsibilities as outlined in the Poisons Act, Pharmacy Act, Disability Services Act and the Aged Care Act. Health professionals and staff at Fitzroy Falls Aged Care Facility who provide care to residents/clients must be aware of these Acts. Health professionals and staff need to work within the legal requirements of each particular Act as it relates to their role and job responsibilities. The responsibilities of various staff/health professionals/residents/clients are listed in the table below. Health professionals/staff Doctor Responsibilities The doctor is responsible for assessing the resident's/client's health and care needs and prescribing medications if required. The doctor must provide a legible written order and clear instructions for administration of all medications on each resident's/client's medication chart. The doctor is also responsible for sending prescriptions to the pharmacist for dispense on behalf of a resident/client. If a resident/client wishes to self-administer medications, the doctor assesses the resident's/client's ability, documents their findings and conducts reviews when necessary. Pharmacist The pharmacist is responsible for dispensing the medications ordered by the doctor. The pharmacist ensures that instructions and information on the package state who the medication is for, what the medication is and, how and when it is to be given. The pharmacist also provides medications in blister packs. The information on the blister pack label includes: © J.N. Bailey 2009 63 the resident/clients' name the name of medication the dosage of the medication the expiry date and the date prescribed the time and route to be given to the resident/client. Registered nurse/supervisor The registered nurse and the supervisor are responsible for the coordination of the medication system, ensuring that it is safe and effective. They also ensure that care workers are trained in medication management prior to giving out medications. This includes providing support to care workers during medication rounds. Care worker The care worker is responsible for attending the required training in medication administration prior to giving out medications. The care worker must comply with the correct medication administration procedures. The care worker is also responsible for reporting and documenting any medication concerns and Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 53 of incidents. Resident/client The resident/client has a responsibility to inform the responsible health professional if they: self administer non prescribed medications self administer prescribed medication outside the usual medication time have any ill effects from the medication refuse to take the medication. Fitzroy Falls Aged Care Facility Fitzroy Falls Aged Care Facility is responsible for implementing a clear, easily understood Medication Management Policy. The Medication Management Policy must include procedures and processes that comply with the relevant legislative requirements Blister Pack System A blister pack system is based on: The doctor prescribing the required medication by writing up the Medication Profile/Chart. The pharmacist dispensing the medication into the blister packs. The blister pack being refilled on a weekly basis. Any changes to the prescribed medication being attended to by the pharmacist. Information on the blister pack being supplied by the pharmacist. This information includes the colour of each tablet, the name of the tablet, the dose and the times the tablets are ordered. This information is based on the orders given to the pharmacist by the doctor on the prescription and medication profile. The provision of appropriate signing forms. Fitzroy Falls Aged Care Facility uses four standard colour frames to hold the blister packs. This colour coding, assists in identifying the times or type of medication to be distributed to the resident/client. The table below lists the colour coding used: Page 54 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 Colour coding Blister pack usage Blue Regular medications given at standard times White As required medications (PRN) Green Antibiotic medications Blister packs with a blue coloured frame are packed with medications that: Are the residents/clients regular medications. Are given at standard medication times (i.e. breakfast, lunch, dinner and before bedtime). Is packed with one weeks supply of medications. Contains medication that can be given up to 4 times a day. If a resident/client is on more than 8 medications at a time they may be packed into two blister packs. The blister pack also has specific days of the week listed on the side of the pack. This is dependent on which day the pack commences. Blister packs with a white coloured frame are packed with medications that: Are given on a PRN basis (i.e. as required by the resident/client). Requires the doctor will give clear written instructions and the PRN protocols to be followed. Contains medications that are not to be given on a regular basis. Requires the care provider to sign the appropriate signing sheet and to document in the residents/client progress notes when a PRN medication is given. The documentation should include when it was given, why it was given and if the resident obtained the desired effect from the medication (e.g. if Panamax? was given for pain relief, did the resident client obtain pain relief after the medication was given). Requires the resident/client to be reviewed by their doctor if the PRN medication is given regularly as this may indicate that the resident/client needs a change to their medication or other aspects of their care. Blister packs with a green coloured frame are packed with medications that: Contains antibiotic medication. Are ordered for a short time only (usually about a week). May be required to be given at times that differ from the standard times of the residents/clients other medication. Medication Incidents The aim of administering medications or assisting with the administration of medications is to ensure the resident/client receives their medications safely as prescribed. If the medication is not given as prescribed for any reason this is a medication incident. You need to report any medication incident to a supervisor. The table that follows outlines the action to be taken for specific medication incidents. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 55 of Medication incident Action to be taken The blister pack is incorrect. This includes: When the blister pack is incorrect: wrong resident/client name on the label number of tablets does not match the label the pack is damaged the tablets are not packed in the correct time The resident/client refuses to take their medication Explain to the resident/client what has happened and what you need to do. Contact the pharmacist to query the pack and if necessary, send the blister pack back to the pharmacist to repack. Give the medications to the resident/client as soon as possible. If there will be some delay, check with the pharmacist that it is safe for the resident/client to wait. Complete a Medication Incident Form and document in the progress notes. Forward incident form to supervisor. Report to registered nurse or supervisor to follow up incident as required. When the resident/client refuses to take their medication: The resident/client has a right to refuse medication. If the resident/client is confused, gentle persuasion may help or wait a little while and try again. If the resident/client is mentally alert again gentle persuasion may help. If all attempts fail then complete a Medication Incident Form and document in the progress notes. Forward incident form to supervisor. Report to registered nurse or supervisor to follow up incident as required. Care alert Under no circumstances make the resident/client take their medication against their wishes. The resident/client takes some medications and refuses the rest. Follow the actions to be taken in 'The resident/client refused to take their medication'. The resident/client wants you to leave some or all of their medications with them to take at a later time When the resident/client wants to leave some or all of their medication: Explain to the resident/client that it is a Fitzroy Falls Aged Care Facility policy that under no circumstances are you permitted to leave medications with a resident/client. Offer to bring the medications to the resident/client within the next 30 minutes. Do not leave the medication any longer than this because the resident's/client's medication should be evenly given over a 24 hour period. If the resident/client still refuses to take their medication when you return follow the procedure for refused medication. Complete a Medication Incident Form regardless of whether the resident takes the medication when you return after 30 minutes and document in the progress notes. Forward incident form to supervisor. Report to supervisor or registered nurse who can follow-up with the resident's/client's doctor to see if the resident/client can be assessed for self-administration of medications. If the resident/client is unable to self-medicate and still wishes to have the medications left then the supervisor or registered nurse will follow-up with the resident/client and/or their representative. Page 56 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 . Care alert: Under no circumstances leave the medications with the resident/client. This could lead to the potential serious risk of them: forgetting to take the medications another resident/client finding and taking them someone else finding and taking them the medication accumulating and the resident/client taking multiple doses together The resident/client spits out some or all of their medications The medication is given incorrectly. This includes: When the resident spits out their medication: Put on disposable gloves and dispose of medication where possible. Follow 'The resident/client refuses to take medication'. Document in resident's/client's progress notes and complete a Medication Incident Form. Forward incident form to supervisor. Report to the supervisor or registered nurse for follow-up of incident. When the medication is given incorrectly: Report immediately to supervisor, registered nurse and resident/client's doctor. medication given to the wrong resident/client. Follow doctor's advice. medication given from the wrong blister pack Document in resident/client's progress notes and complete a Medication Incident Form. Forward incident form to supervisor. medication given at wrong time It is vitally important that these types of incidents are reported immediately to ensure the resident/clients wellbeing and your own duty of care. You notice the Medication Signing Sheet has not been completed correctly When you notice the medication signing sheet has not been completed correctly: Complete a Medication Incident Form stating why the medication signing sheet is incorrect (e.g. there is a space on the medication signing sheet that does not have signature where there should be a signature). Forward incident form to supervisor. Report to registered nurse or supervisor to follow up as required. You find a loose tablet (eg in a resident's/client's room, on a tray) When you find a loose tablet: Complete a Medication Incident Form and forward to supervisor. Report to registered nurse or supervisor to follow up incident as required. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 57 of Mobility Mobility Mobility is a necessary part of our life. The ability to move allows us to continue living. We can have our freedom, can make choices, and maintain our relationships with others. Restrictions in movements are a normal part of ageing. Depending on the type of restriction, with assistance or an aid, we can generally continue to maintain mobility. In some cases the aid may consist of a change in the style of shoe we wear, or a walking stick, a walking frame, a wheelchair, or a scooter. Whatever the device, it assists us to maintain living. The most important part of mobility is safety. Falls are one of the main disabling conditions of the elderly. A fracture may be the consequence of a fall which may have a significant impact on the resident/client's functioning, independence and quality of life. Fractures also have significant impact to care workers as we need to adjust the personal care routine to protect the injured limb. Appropriate exercise for the resident or client, identification of hazards and use of appropriate walking aids can help prevent falls and improve balance. Stretching and strengthening exercises can prevent muscle weakness and protect the joints. Potential hazards of fall Page 58 of 63 Ways to improve and minimize fall 1. Clutter in rooms and walk areas Always keep the walk areas clear of hazards 2. Spills on the floor Wipe all spills immediately 3. Loose mats Replace with non-slip mats 4. Poor lighting Maintain adequate lighting even during the daytime Leave on a night light or bedside light to avoid falls at night. 5. Accidental fall from bed due to bed height being too high Adjust bed to suitable height to ensure that the resident/client's feet can reach the floor when sitting 6. Wheels on chairs Use stable chairs with suitable seat height Lock wheels Ensure the brake is on (if applicable) 7. Slippery shoes and tripping on loose clothing Wear non-slip shoes Wear clothing with suitable length 8. Slippery floor Use hand rail for support Take special care when walking outdoors Walk near to a wall for support is needed 9. Poor eyesight 10. Use of walking aids without proper instruction Use walking aids correctly and seek professional advice if in doubt Wear appropriate clean glasses Hold handrail Ensure lighting is sufficient Do not carry too many things at once Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 The ability to move ensures a resident or client maintains a healthy fulfilling lifestyle. Safe mobility is the key to allowing people to make choices, go on regular outings, seek out friendships and continue to participate with their interests in the community. Mobility Aids There are many different mobility aids including: The hoist which is a lifting device used by trained staff to transfer non-weight bearing residents or clients. Hoist maintenance includes ensuring: the battery is charged and that spare batteries are on charge wheels are free moving and intact the sling is clean and dry to prevent cross infection there are no sharp metal edges on the hoist - to prevent skin tears. The scooter and wheelchair enable people to remain a part of their community and be independent. They are a crucial part of assisting a person's life to be independent and have personal freedom. By law every public amenity must now be accessible by a wheelchair. Wheelchair maintenance includes checking: the tyre pressure (same as a bicycle tyre) that the chair is safe and intact that any pressure cushions are clean and in the correct positions. Residents or clients with a large variety of health conditions may need to be transported in a wheelchair. The conditions may include: paralysis - from a stroke, or spinal injury back, leg or feet problems dizziness balance problems loss of a leg or foot inability to weight bear. The frame creates a source of stability and balance for a person who is still mobile but requires assistance. The frame can also be used as a tool for the resident or client to assist themselves to stand up and sit down. The frame has non-slip rubber stoppers on the feet of each leg. Ensure each rubber stopper is intact and clean on the bottom. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 59 of Personal Care Privacy and Dignity Privacy is a basic right for all humans. We like to have our privacy, and so do our residents and clients. Each person is different and what might be 'personal' to one person may not be to another. For example a resident or client may be trying to do something they have trouble with, like eating, and prefer to be in a private place so they feel they are not being watched by everyone in the room. Whereas another resident or client may feel encouraged by seeing others struggle with the same tasks, and feel that being with a group makes things more fun. Therefore, it is important to know our individual resident or client's personal needs and wishes. This information should be outlined in their care plan. It is then the care workers role to ensure that dignity is respected by giving them the privacy they require. In a residential facility or a client's home it is important to consider the following: 1. Keep doors closed, draw curtains or screens when the resident or client is undressing, showering/bathing or using the toilet/commode. 2. Maintain the personal dignity of the resident or client. Do not discuss issues that may cause distress and embarrassment in front of other residents/clients or staff. If the person is overcome with emotion, do all you can to retain their privacy and dignity. 3. Do not touch a resident's or client's personal property without permission. Some people may see this breach of their space as touching them without permission. 4. Ask the resident or client for permission before you open their drawers, cupboards or wardrobes. It is easy for carers who have been working with the same person for a period of time to forget these basic 'rules'. Think about how you would feel if your privacy was invaded. The resident or client may not want to be seen as a 'complainer' if care workers forget these basic rights. So, don't assume the resident or client is happy with the ways things are done, always check by asking. As a care worker we need to remember that our workplace is actually another person's home. A trusting and mutually respectful relationship can develop and grow by showing due respect for the privacy needs of your resident or client. Privacy Guidelines for Staff Day to day guidelines: 1. Respect our clients' privacy as you would any person's. Do not gossip about their ailments or personal affairs with people inside, or outside, Fitzroy Falls Aged Care Facility but feel free to talk about these things to your manager or co workers when it may help us to provide better care. Page 60 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 2. Make sure any personal details in files or written records are kept secure and in locked cupboards or filing cabinets. 3. If someone asks for access to their personal information, first see if they are prepared to discuss what it is they want. If it is just to check who we have recorded as their personal contacts, preferred name, doctors details etc, just print out or copy the information we have, give it to them, and if they make any changes make sure that our records are amended. 4. If they want more information or want to look at care notes, refer them to the manager. You can tell them that normally we require requests for access to information to be in writing. 5. If someone is ill and you are asked about them, confine your comments to how they are feeling, whether or not they would like visitors etc and do not discuss their ailment or treatments. 6. If the person is a nominated contact or advocate in some cases we can go further than this, but make sure we have documented this either by recording the resident/client's wishes. 7. If a person unknown to Fitzroy Falls Aged Care Facility phones a facility asking about a current resident and seeking to contact them, we should tell them their postal address (including unit number) unless the resident has given specific instructions for maintaining their privacy. (There is provision on the Admission Form and the Emergency Information Form for people to record their wishes in this area.) With regard to phone numbers, we do not always know when a person has a silent number, so we should not divulge phone numbers, but tell the caller to refer to the telephone directory or directory enquiries. 8. Where people call after residents who have moved out, again we should check whether we have any specific instructions from the person, and if not we should give them a forwarding address, but not a phone number for the same reasons as above. 9. If people ask about a deceased former resident or client, then we should inform them that the resident has passed away. If the caller wants to contact the family/executor we should take the caller's name, address and phone number to pass on (we should always have a contact address for forwarding any mail). Reporting Resident/Client Changing Care Needs Resident/client care and service needs are assessed on admission to the service by their organisation, using procedures and admission documents used by the organisation. Care and service need information is gathered from a variety of different sources including health professionals and through discussing care and service needs with the resident/client or representative. Information is gathered through the initial assessment process, this information is then used to develop the resident/client care and service needs. Care and service needs are recorded on relevant documents including care and service plans. Care needs are reviewed on a regular basis through the process of regular © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 61 of care plan evaluations and through case conference between the care provider and resident/client/representative. Resident/client care and service needs can be subject to change. The changes are most commonly monitored through a regular process of evaluation of care and service plans. Changes in care and service needs can occur at any time though for many varied reasons. It is important as a care worker to report these changes either in written or verbal form to assist in the process of providing accurate care and service to resident/client's. Residents/client's may request a change in their care and service delivery themselves or alternatively you may identify that a change is required through your own observation. As a care worker it is important to remember that resident/client's are able to make individual choices and their choices must be respected. These choices may impact on a change to their care or service need. It is a requirement to provide information to your supervisor regarding changes to your resident/client as this information may impact on a change to their care plan or service and impact on their overall wellbeing. Duty of Care When a resident/client moves into residential or community care services, the intended care to be given is known and agreed to. The law expects that the agreed care will be delivered with the required skill and at a level of competence equal to the needs of the individual. You, as a trainee care worker and Fitzroy Falls Aged Care Facility have a duty of care to the individual entering your care. It is the responsibility of Fitzroy Falls Aged Care Facility to make sure the people they hire to care for the resident/client can carry out the care to the required level. It is also the responsibility of the employee to let Fitzroy Falls Aged Care Facility know if they feel they are unable to effectively and safely carry out that care, for whatever reason. As a staff member who is employed to give care and support to older people, your responsibilities and duty of care to the residents/clients are that you " must do everything reasonable that you can, to ensure that there are as few as possible infringements of any residents'/clients' rights". The key word here is reasonable. Whilst at work you will need to consider your duty of care. In considering your duty of care you should ask yourself the following questions: • • • • Am I in a situation where the resident is relying on me to be careful? Is it reasonable to believe that this resident/client, or other people, could suffer harm or injury if I am not careful? Have I done everything that any reasonable person would/could do in this situation? Am I complying with all laws, regulations and standards that govern this situation and require exercise of a duty of care. Negligence is a failure to take reasonable care to avoid causing injury or loss to another person. There are four steps in proving negligence. These are 1. That there is a duty in the circumstances to take care (duty of care). Page 62 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version 1.0.0 © J.N. Bailey 2009 2. What is the standard of care which a reasonable person would meet in the circumstances (standard of care). 3. That the behaviour or inaction of the defendant in the circumstances did not meet the standard of care (breach of duty). 4. That the plaintiff has, as a result, suffered injury or a loss which a reasonable person in the circumstances could have been expected to foresee (damage). Where a duty of care is not exercised (as a reasonable person may be expected to exercise it) and harm comes to the resident/client, then the resident/client may bring a charge of negligence against the employee and the employer. The resident/client may seek compensation for any loss of quality of life that results. Where the intent has been malicious, a charge under criminal law may be required to be answered in court. © J.N. Bailey 2009 63 Fitzroy Falls Aged Care Facility – Induction Manual Version 1.0.0 Page 63 of
© Copyright 2024