CARE SUPPORT

5N0758

B & B Nursing Ltd

Excellence in Care, Excellence in Training

Margaret Byrne: 087 686 5034

Email: byrnebrn@[Link]
Web: [Link]
INTRODUCTION

Care support is about learning and understanding the skills needed to provide client care in a variety
of settings from hospital to community care. The purpose of this module is to equip the learner with
the knowledge, skill and competence to work effectively in a care setting. It aims to promote good
practice and respect for diversity in lifestyle, religion and culture in care work. Care support is all
about promoting dignity, privacy, respect, effective communication and confidentiality. This
module is the ideal starting point in learning care support skills as it outlines the various stages and
roles skills needed. Initially it describes how to evaluate carer/client relationships and reflection and
development of themselves working with others (multi-disciplinary teams). The course looks at the
ethical and legal issues encountered in care work and the importance of compliance with same. This
module enables trainees to understand the rationale for their actions and the benefit of performing
their duties to a high quality. The module appeared to increase trainees’ confidence and enhance
their ability to be part of the team.

I. ROLES & RESPONSIBILITIES OF CARER

 To ensure the good name of the Agency and behave in a professional manner while on duty.
 To assist the service user in their day to day living within their own home, promoting
independence and diversity in their lives in accordance with the service user care plan.
 To assist service users with personal care, including getting up /going to bed, washing,
bathing, dressing/undressing and toileting.
 To familiarize with clients and their interests and needs
 To assist service users with mobility problems and other physical disabilities, including
incontinence and help in the use and care of aids and personal equipment.
 To care for service users who are temporarily sick, for example with minor dressings, bed
nursing, help with feeding etc.
 To support families to get used to new caring responsibilities
 To help care for service users who are dying.
 To help the promotion of mental and physical activity of service users through talking to
them, sharing activities such as reading, writing and hobbies, taking them out for
recreational/social, educational and employment activities.
 To do light cleaning tasks such as, changing beds, tidying rooms, laundry (washing &
repairing), and empty commodes.
 To work with other health and social care professionals to provide individual care and
development plans
 Planning, preparing and serving meals, feed service users who need assistance, wash up tidy
away and clean kitchen / dining room.
 Answer the door, telephone and greet visitors.
 To give emotional and practical support to children and young people
 To read and write reports, take part in staff meetings.
 Attend formal and informal training opportunities to enhance understanding of service users’
needs and abilities.
 To adhere to the policies, procedures and guidelines of the Agency.
 To perform other duties as may be reasonably required.
 To report significant changes in the service users health and circumstances, to the duty
manager.
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  To help to organise leisure activities
 To handle finances for the service user as documented in the service users care plan.
 To assist with medication once training has been undertaken and as documented in the
service user care plan.
 To inform the Agency if you are unable to attend an assignment.
 To go with clients to and from a residential home
 To ensure you correctly complete your timesheet, get it signed by the service user and leave
the blue copy with them. The white and green copies are to be returned to the office no later
than mid-day every Wednesday (a list of deadlines will be issued to you every year)

The Professional Carer WILL NOT

 Patronise
 Preach
 Pressure
 Procrastinate
 Punish/Put down
 Pretend/Be pleasure seeking
 Have prejudices

The Professional Carer WILL

 Be proficient in work, lives in the moment
 Praise and encourage clients
 Be client and understanding
 Persevere with clients and help them to attain best results
 Be prepared mentally, emotionally and physically to assist clients
 Be punctual and polite in manner

Effective Carer/Client interaction

Client –carer interaction is made possible through communication, a process where individuals
create meaning. Through communication the carer and client influence one another and the client’s
health can be influenced therapeutically and supportively.

Entitlements of Carer

The entitlement of health care workers to the employment rights include:

 Minimum wage
 Unfair dismissal
 Discrimination
 Maternity leave
 Sick leave
 Holiday time
 Overtime
 Health and safety

National Standards for Residential Care Settings for Older People in Ireland
The Health Information and Quality Authority (HIQA) is an independent organisation. It has the
legal power and responsibility for improving the quality, safety and value of health and social care in
Ireland (excluding mental health services).
HIQA is also responsible for:
 setting standards

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  monitoring and inspecting services
 providing guidance on health information
 carrying out health technology assessments

What do the standards cover?

Each Standard describes an ‘outcome’, or what the nursing home should do to provide a good
quality and safe service for people living there. There are a number of features for each standard to
describe what a nursing home that is meeting the standard is likely to be doing.

Theme Description of theme

Person-centred Care and support This is how the nursing home places
residents at the centre of what they do. This
includes providing person-centred services
and protection of rights.
Effective services How nursing homes deliver best outcomes
for residents, using best available evidence
and information.
Safe services How nursing homes protect residents
through preventing and minimising harm

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 and learning from when things go wrong.
Health and wellbeing How nursing homes identify and promote
optimum health and development for
residents.
Leadership, governance and management The arrangements put in place by the
nursing home for accountability,
decisionmaking, risk management and
meeting its strategic, legal and financial
obligations.
Use of resources Using resources effectively and efficiently
to deliver best achievable outcomes for the
money and resources used.
Responsive Workforce Planning, recruiting, managing and
organising staff with the necessary
numbers, skills and abilities to respond to
the needs of residents.
Use of information Actively using information as a resource for
planning, delivering, monitoring, managing
and improving services.

The standards are grouped into eight sections and cover:

 Person-centred Care and support
 Effective services
 Safe services
 Health and wellbeing
 Leadership, governance and management
 Use of resources
 Responsive Workforce
 Use of information

What Standards mean to you?

The purpose of these standards is to help to ensure that the needs of all people living in residential
care settings are met. The standards cover the following areas:

Person-centred Care and support

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This theme describes how nursing homes place the people living there at the centre of what they do.
This includes providing person-centred services, access to information and protection of rights. It
says:
 The rights and diversity of each resident are respected and safeguarded.
 The privacy and dignity of each resident are respected.
 Each resident exercises choice in their daily lives.
 Each resident develops and maintains relationships with family and community, if they so
wish.
 Nursing homes communicate appropriately with residents and provide information that takes
account of their communication needs.
 Each resident is helped to make informed decisions, gives consent and has access to an
advocate.
 Residents are listened to and their concerns and complaints are acted upon in a timely and
effective manner.

Effective Services
This section describes how nursing homes can deliver effective services to residents using best
available evidence and information. It says:
 Individual care plans detail the assessed needs of residents and the supports required to meet
their needs and to improve their quality of life.
 Each resident enjoys mealtimes and has a regular supply of water and good food.
 The psychological and developmental wellbeing of each resident are promoted.
 Residents receive palliative care that supports and respects their dignity.
 Residents receive care and support at the end of their life that meets their needs and respects
their dignity and independence.
 The nursing home is homely and accessible and promotes the welfare, dignity and safety of
each resident.
 The design and layout of the nursing home promotes the privacy, dignity and wellbeing of
residents.
 Access to nursing home services is fair and open for each resident.

Safe Services
This section describes how nursing homes can deliver safe services for residents using best available
evidence and information. It says:
 Residents are safeguarded from abuse and neglect and their safety and welfare are promoted.
 The nursing home manages risk and keeps residents safe from harm.

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  The nursing home has good infection prevention and control practices to protect residents.
 The health and wellbeing of residents are protected by good medicines management.
 Nursing homes promote a restraint-free environment and residents are not subject to restraint
unless it is needed because of a serious risk to their safety and welfare or the safety and
welfare of others.
 Each resident has their personal property and money managed and protected.

Health and Wellbeing

This section outlines how health, education, social and emotional development and relationships
with family and community are all important factors in a resident’s development. It says:
 The health and wellbeing of residents is promoted through regular assessment, and residents
are given the appropriate support to meet any identified healthcare needs.
 Residents have a choice of interesting activities that meet their needs and preferences.
 Residents experience care that supports their physical, behavioural and psychological
wellbeing.
Leadership, Governance and Management
‘Governance’ describes how a nursing home is organised and run. This section covers the
arrangements put in place by the nursing home in areas such as accountability, decision-making and
risk management. It says:
 There are clear lines of accountability at all levels so that everyone working in the nursing
home is aware of their responsibilities and to whom they are accountable.
 The nursing home has a statement of purpose that states in writing its aims and objectives,
the services it provides, including how and where they are provided.
 Good governance systems are in place to check ongoing practice and monitor performance to
support person-centred, effective and safe services.
 The quality of care and experience of residents in the nursing home are monitored, reviewed
and improved on an ongoing basis.
Use of Resources
This theme describes how the nursing home can use its money and resources to deliver services in
the best possible way. It says:
 The nursing home looks for opportunities to use its resources to provide improved services
and achieve better outcomes for residents.
 Decisions about resources take account of the needs of residents and the levels of demand on
the service.
 Individuals who make decisions on how resources are used are accountable for the decisions
made and ensure these decisions are well-informed.

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Responsive Workforce
This theme includes all people that work directly or indirectly with the nursing home. It covers areas
such as planning, recruiting, managing and organising staff. It says:
 Safe recruitment practices are used for staff and staff performance is reviewed regularly to
assure the delivery of person-centred, safe and effective services to residents.
 Each staff member has an important part to play in delivering person-centred, safe and
effective services to residents in nursing homes.
 The nursing home organises and manages its staff to ensure that they have the skills and
experience needed to protect residents and promote their welfare.
 Staff receive the support, training, and supervision they need to enable them to perform their
job to the best of their ability
Use of Information
This theme describes how information is used to plan, deliver, monitor, manage and improve
services for residents in nursing homes. It says:
 All relevant information is used to plan and deliver personcentred, safe and effective services
in nursing homes.
 All information is recorded accurately and stored securely by the nursing home.

II. MULTIDISCIPLINARY HEALTHCARE TEAM

A multidisciplinary team is a group of health care workers who are members of different disciplines
(professions e.g. Psychiatrists, Social Workers, etc.), each providing specific services to the patient.
The team members independently treat various issues a patient may have, focusing on the issues in
which they specialise. The Health Care Assistant works as part of a multidisciplinary team to assist
in the provision of health and social care for patients/residents/clients. He/she supports and assists
clients/residents in all activities of daily living in line with the needs and wishes of the individual
and as outlined in an agreed care plan. The activities of the team are brought together using a care
plan. This co-ordinates their services and gets the team working together towards a specific set of
goals. Sometimes the person has a key worker, who becomes the main point of contact for the
person.

Typical Care Setting

Acute Hospitals, Older Persons Services, Mental Health Services

Typical Duties

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Duties include supporting clients/residents in directing their own lives, acting as an advocate for
clients/residents, promoting participation of clients/residents in the running of the unit, contributing
to the development and implementation of multidisciplinary assessment and care plans, attending to
clients/residents personal care e.g. assisting clients to maintain standards of personal hygiene,
laundry, dietary intake and physical and mental health and any other personal needs, preparing and
serving food.

Work effectively as part of a team:

Remember your position in the multidisciplinary team

 Listen to their ideas

 Respect their point of view
 Understand the role of other team members and the role they play
 If in doubt do not be afraid to ask questions

Teamwork: Healthcare professionals from different disciplines who share common patients and
goals will often collaborate in an effort to improve the overall care-giving experience. Through
coordination, communication and responsibility, teamwork in the healthcare industry has many
benefits. When teamwork is implemented in a healthcare situation, the patient becomes an active
partner in his own treatment. Doctors and nurses listen, monitor and execute based on the patient's
feedback and information. This in turn creates a safer environment for the patient in terms of
medications and unnecessary procedures. When everyone is working together as a team to
accomplish a common goal, results will improve and people will be more satisfied with their
professional life. When working in close proximity and communicating regularly, we are bound to
learn new skills and expand our knowledge

Team building is a philosophy of job design in which employees are viewed as members of
interdependent teams instead of as individual workers. Team building refers to a wide range of
activities, presented to businesses, schools, sports teams, religious or non-profit organizations
designed for improving team performance. Team building is pursued via a variety of practices, and
can range from simple bonding exercises to complex simulations and multi-day team building
retreats designed to develop a team (including group assessment and group-dynamic games), usually
falling somewhere in between. It generally sits within the theory and practice of organizational
development, but can also be applied to sports teams, school groups, and other contexts. Team
building is not to be confused with "team recreation" that consists of activities for teams that are
strictly recreational. Team building can also be seen in day-to-day operations of an organization and
team dynamic can be improved through successful leadership. Team building is said to have benefits
of self-development, positive communication, leadership skills and the ability to work closely
together as a team to solve problems. Work environments tend to focus on individuals and personal
goals, with reward & recognition singling out the achievements of individual employees. Team
building can also refer to the process of selecting or creating a team from scratch.

Team dynamic

When assembling a team it is very important to consider the overall dynamic of the team. According
to Frank LaFasto, when building a team, five dynamics are fundamental to team success

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The team member: Successful teams are made up of a collection of effective individuals. These are
people who are experienced, have problem solving ability, are open to addressing the problem, and
are action oriented.

Team relationships: For a team to be successful the members of the team must be able to give and
receive feedback.

Team problem solving: An effective team depends on how focused and clear the goal of the team
is. A relaxed, comfortable and accepting environment and finally, open and honest communication
are required.

Team leadership: Effective team leadership depends on leadership competencies. A competent

leader is: focused on the goal, ensures a collaborative climate, builds confidence of team members,
sets priorities, demonstrates sufficient “know-how” and manages performance through feedback.

Organizational environment: The climate and culture of the organization must be conductive to
team behaviour. Competitiveness should be discouraged and uniformity should be encouraged - this
will eliminate conflict and discord among team members.

Goals

The overall goals of team building are to increase the teams understanding of team dynamics and
improve how the team works together. Unlike working as a group, working as a team incorporates
group accountability rather than individual accountability and results in a collective work product
Team building encourages the team approach to working on a project. Advantages to this approach
include:

 Increased flexibility in skills and abilities

 More productive than work groups with individual mindset
 More beneficial in times of organizational change
 Encourage both individual and team development and improvement
 Focuses on group goals to accomplish more beneficial tasks
 Improved range of team building objectives such as collaboration, communication and
increased creative or flexible thinking.

Leadership roles

Successful team leaders frequently contain six of the same leadership abilities. A team leader is
usually goal-oriented to keep the team on track.

 They must promote a safe environment where members can openly discuss issues.
 A leader must build confidence amongst members by building and maintaining trust and
offering the members responsibilities.
 A leader should be technically competent in matters relating to team tasks and goals.
 It is important for a team leader to set a manageable list of priorities for the team to keep
members focused.
 Finally, leaders should offer clear performance expectations by recognizing and rewarding
excellent performance, and provide feedback to others.

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Carl Larson and Frank LaFasto conducted a three year study of over 75 diverse teams. By
interviewing key members of each team, Larson & LaFasto identified eight effective strategies a
leader should employ to enhance team building:

 Establish clear and inspiring team goals

 Maintain a results-oriented team structure
 Assemble competent team members
 Strive for unified commitment
 Provide a collaborative climate
 Encourage standards of excellence
 Furnish external support and recognition
 Apply principled leadership

[Link] AND PROVIDING ENHANCED QUALITY CARE

 Respect and understand confidentiality and its limitations in relation to client information
 Identify the effect of dependence on clients and carers
 Describe the importance of client autonomy, involvement and choice
 Safeguard the privacy and dignity of clients
The arrangements to meet each resident’s assessed needs are set out in an individual care plan,
developed and agreed with each resident, or in the case of a resident with cognitive impairment with
his/her representative.

 The resident’s care plan is commenced within 48 hours of admission, or earlier if indicated
by the general risk assessment, from the comprehensive assessment drawn up with the
resident.
 The care plan reflects the assessment findings and sets out in detail the action to be taken by
staff, to ensure that all aspects of the health, personal and social care needs of the resident are
met. Residents, including those with dementia/cognitive impairment, are actively encouraged
to participate in this process.
 The care plan meets clinical guidelines produced by professional bodies concerned with the
care of older people. It is updated regularly to reflect daily changing needs and best practice.
 The resident or his/her representative has access to the care plan and is kept informed of care
changes.
 The care plan is discussed, agreed and drawn up with the involvement of the resident and/or
his/her representative. If the resident is unable or unwilling to participate, this is documented.
 The care plan is formally evaluated by staff in consultation with the resident and/or his/her
representative. It is updated as indicated by the resident’s changing needs and circumstances
and current objectives for health, personal and social care and no less frequently than at
three-monthly intervals.

Dementia-specific Residential Care Units for Older People

Dementia-specific residential care units care exclusively for people with dementia. All the above
standards apply to dementia-specific units; however, they must also meet additional criteria if they

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are to meet the specific needs of people with dementia, which allows them to live the fullest lives
possible. These criteria cover:

• The diagnosis of dementia

• Promoting the understanding of residents and family members of the nature of dementia

• Care planning and assessment for people with dementia

• The provision of person-centred care

• The use of appropriate therapies and techniques

• Facilitating communication

• Staffing arrangements, practice development and staff training,

• The physical design, layout and configuration of dementia specific unit

IV. IDENTIFYING INDIVIDUAL NEEDS OF THE CLIENT

For healthcare professionals, being able to meet patients’ individual needs can be a challenge. A care
needs assessment identifies an individual’s dependencies and care needs to ensure that appropriate
care is provided in the most appropriate setting. A health professional will assess a person’s ability
to look after themselves safely; for example; personal hygiene, movement / mobility, continence
management, preparing meals and essential environmental care/ cleaning and caring for their home.
Following this assessment a Care Plan will be prepared showing the care that will be provided to
meet the identified care needs and all the actions to be undertaken by relevant services and care staff
involved. This may be at home or in a residential home.

Clients should be actively involved in their assessment as well as their family/ caregivers and close
friends. In many organizations a case manager is assigned to support clients during the assessment
process. Leisure and Health staff are responsible for the Social/Spiritual Care Plan that includes
recreation, relaxation, community trips, club affiliation, and other aspects of daily life.

All human needs can be arranged in a hierarchical order of appearance, describing the physical,
emotional, social, psychological and spiritual needs of the person, as identified by Maslow’s
Hierarchy of Needs. Basic physiological or physical needs include food, water, fresh air, sleep,
warmth and sex. The need to feel safe and secure means to have limitations, boundaries, laws and
rules i.e. the need for stability, to be free from chaos and live in harmony. Love, belonging and
affection needs refer to the need to be loved, respected and liked; to be able to form friendships, to
be listened to and feel valued. Self-esteem needs concern the needs to feel confident, competent,
respected and unique or different. The need for self-actualization means achieving one’s full
potential and all one is capable of.

Categories of basic human needs

Physical Needs: These are closely related to body functions and are sometimes referred to as
primary or physiological drives. Physical needs include:

• Food.

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• Water.

• Oxygen.

• Elimination.

• Clothing and shelter for body warmth and protection.

• Activity, or sensory and motor stimulation, including sex, physical exercise, and rest.

Emotional Needs: Emotional needs are closely interwoven with physical needs and are met in
interaction with significant others. They include:

• Love, including approval and esteem.

• Importance, including recognition and respect. NOTE: This applies to the client's perception
of the nurse's/ carers feelings toward him. For example, if your client feels that you do not approve
of or respect him, he may become very demanding, or he may withdraw and not cooperate with your
efforts to make him healthy again.

• Adequacy, including self-sufficiency and the need to be needed and wanted.

• Productivity

• Acceptance

Social Needs: Social needs grow out of the culture and society of which one is a member. They
include:

• Identification or belonging.

• Social interaction

• Education or learning.

• Recreation or play.

• Religion or worship.

Spiritual Needs: It does not necessarily refer to religious issues only, and they are not exclusively
existential, too. They include:

• A need for meaning, purpose, and hope

• A need to transcend circumstances

• A need for continuity

• A need for support in dealing with loss

• A need for validation and support of religious behaviors

• A need to engage in religious behaviors

• A need for personal dignity and sense of worthiness

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• A need for unconditional love

• A need to express anger and doubt

• A need to feel that God in on their side

• A need to love and serve others

• A need to be thankful

• A need to forgive and be forgiven

• A need to prepare for death and dying

Psychological Needs: The following strategies can also make your work more pleasant. Meeting the
psychological needs include:

 Identify signs of stress in the elderly

 Take steps to reduce stress in the elderly
 Identify anger, anxiety and loneliness in the elderly
 Handle angry, rude and disrespectful behaviours of the elderly
 Promote emotional wellness in the elderly

Facilitate diversity of lifestyle, culture and religion for clients.

Ireland has become a multicultural society where people from other cultures are now making it there
home.. Carers need to be aware that there is ethnic diversity in the indigenous Irish population for
example members of the travelling community. It’s vital that as carers we have a basic
understanding of the characteristics of the population that we will encounter.

We need to respect their

 Religions
 Cultures
 Dress
 Beliefs

Clients need to be treated with dignity, respect and non-discrimination in health care settings in line
with current equality legislation.

As healthcare consumers, clients can expect:

 Systematic and accurate investigation of their health concerns

 To be informed about their health status
 To receive healthcare from carers who have current knowledge about their diagnosis and are
competent to provide safe efficient care.
 Feel confident that they will be treated with respect and dignity
 Believe that the carer will show a genuine interest in them
 Receive consistent quality of care from all carers
 Have their confidentiality right respected.

As carers we must aspire to

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  be non-judgemental and open minded
 be sensitive to culture specific issues e.g dress, diet and intimate care.
 seek training for yourself and others, be willing to learn.
 be aware that conflicts are sometimes inevitable, but always seek assistance.

Patience, persistence, effort and real caring are necessary elements if you are to begin the journey of
understanding another’s culture. Learning to understand and respect cultural diversity will give us a
greater insight into how people act and respond in care situations.

Awareness of the individuality of the client

When interacting with clients its vital to remember the difference between hearing and listening.

What is Listening?

Observe and pay attention to the unspoken word

What is one of the biggest barriers to listening?

Mentally Preparing Response.

Be a Bridge, Not a Wall

Listening builds stronger relationships and creates a desire to cooperate among people because they
feel accepted and acknowledged.

Safeguard the privacy and dignity of client

We must remember at all times that it is our responsibility to give maximum privacy to clients when:

 Assisting with food (clients may be embarrassed to be watched being spoon fed, wearing a
bib, using special cutlery such as for stroke clients in order to feed themselves).
 Washing and dressing them (repositioning, toileting, showering and putting on pads).
 Regardless of the setting, home, hospital, nursing home we are obligated to preserve their
dignity ie drawing the surround curtains.
 Politely asking visitors to vacate the area when performing ADL’S.
 Keeping in mind treating your client as you would wish to be treated.
 Safeguard clients dignity at all times and encourage others to do likewise.

Understand the care needs of their clients throughout their life continuum:

The needs of an individual change as he/she progresses through their lifespan. Ensure you
understand the care plan for your client. Never assume you know. A client’s situation can change at
any time. Every client is an individual and not a number.

V. NEED FOR PERSONAL PLANNING AND GROWTH

Planning is the determination of a plan of action to assist the client toward the goal of optimal
wellness. Participants need to be able to identify goals for themselves.

• To set priorities

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• To develop goals and objectives and designate deadlines for their accomplishment

• To formulate a plan of action

• To further their education and gain experience

Personal Planning/Goal Setting

Goal setting is a powerful process for thinking about your ideal future, and for motivating yourself to
turn this vision of the future into reality. The process of setting goals helps you choose where you
want to go in life. By knowing precisely what you want to achieve, you know where you have to
concentrate your efforts. You'll also quickly spot the distractions that would otherwise lure you from
your course. More than this, properly-set goals can be incredibly motivating, and as you get into the
habit of setting and achieving goals, you'll find that your self-confidence builds fast.

Goal setting is an important method of:

 Deciding what is important for you to achieve in your life.

 Separating what is important from what is irrelevant, or a distraction.
 Motivating yourself.
 Building your self-confidence, based on successful achievement of goals.

Believe in Yourself, and Find Success!!

No matter how hard you work or how many brilliant ideas you may have, if you can’t connect with
the people who work around you, your professional life will suffer. The good news is that there are
several concrete things that you can do to improve your social skills and become closer to your
colleagues. All of these tools will ultimately help you succeed in today’s working world.

Smile. Few people want to be around someone who is always down in the dumps. Do your best to be
friendly and upbeat with your co-workers. Maintain a positive, cheerful attitude about work and
about life. Smile often. The positive energy you radiate will draw others to you.

Be appreciative. Find one positive thing about everyone you work with and let them hear it. Be
generous with praise and kind words of encouragement. Say thank you when someone helps you.
Make colleagues feel welcome when they call or stop by your office. If you let others know that they
are appreciated, they’ll want to give you their best.

Pay attention to others. Observe what’s going on in other people’s lives. Acknowledge their happy
milestones, and express concern and sympathy for difficult situations such as an illness or death.
Make eye contact and address people by their first names. Ask others for their opinions.

Practice active listening. To actively listen is to demonstrate that you intend to hear and understand
another’s point of view. It means restating, in your own words, what the other person has said. In
this way, you know that you understood their meaning and they know that your responses are more
than lip service. Your coworkers will appreciate knowing that you really do listen to what they have
to say.

Bring people together. Create an environment that encourages others to work together. Treat
everyone equally, and don't play favorites. Avoid talking about others behind their backs. Follow up
on other people's suggestions or requests. When you make a statement or announcement, check to

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see that you have been understood. If folks see you as someone solid and fair, they will grow to trust
you.

Resolve conflicts. Take a step beyond simply bringing people together, and become someone who
resolves conflicts when they arise. Learn how to be an effective mediator. If coworkers bicker over
personal or professional disagreements, arrange to sit down with both parties and help sort out their
differences. By taking on such a leadership role, you will garner respect and admiration from those
around you.

Communicate clearly. Pay close attention to both what you say and how you say it. A clear and
effective communicator avoids misunderstandings with coworkers, colleagues, and associates.
Verbal eloquence projects an image of intelligence and maturity, no matter what your age. If you
tend to blurt out anything that comes to mind, people won’t put much weight on your words or
opinions.

Humour. Don’t be afraid to be funny or clever. Most people are drawn to a person that can make
them laugh. Use your sense of humour as an effective tool to lower barriers and gain people’s
affection.

See it from their side. Empathy means being able to put yourself in someone else’s shoes and
understand how they feel. Try to view situations and responses from another person’s perspective.
This can be accomplished through staying in touch with your own emotions; those who are cut off
from their own feelings are often unable to empathize with others.

Don't complain. There is nothing worse than a chronic complainer or whiner. If you simply have to
vent about something, save it for your diary. If you must verbalize your grievances, vent to your
personal friends and family, and keep it short. Spare those around you, or else you’ll get a bad
reputation

VI. STRATEGIES TO IMPROVE OWN PERSONAL DEVELOPMENT

Personal development planning or PDP means creating opportunities to think through, in a structured
way, questions such as:

 What do I really want to achieve from life?

 What kind of person do I want to be?
 Am I clear about my personal goals and ambitions?
 Am I making the right decisions to get me where I really want to be?
 Am I in charge of my life and my studies - or am I just hoping it all will work out somehow?

It has been recognised that students need structured opportunities to think about, and plan towards,
their future. The exact content really depends on you. How much of your time do you want to give
now to planning your future?

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A process of personal development

Development planning can be a very personal process - or it can be a process required by your
employer or tutor. As the word "development" suggests, PDP is something that happens over time. It
isn’t a last minute thing. PDP works best when you:

 Think deeply and in structured ways about your life and ambitions. What does success mean
to you personally?
 Have the right information to make good choices.
 Have people you can trust to share your reflections.
 Have opportunities to experiment and test yourself in new areas so that you have a better
understanding of your abilities and limits.
 Have opportunities to develop the knowledge and skills to achieve your ambitions.

In the work place, the personal development process may be linked to your annual appraisal or
supervision.

Benefits of PDP to personal life

 A better understanding of yourself and how you ‘tick.’

 Being in a better position to make appropriate choices to meet your aspirations.
 Greater awareness of your needs and how to meet these.
 Greater awareness of the unique contribution you can make.
 Developing a positive, forward-looking approach.

Benefits of PDP to professional life

 Clearer ideas about the kind of life and work you want.
 Greater confidence in the choices you make.
 Greater confidence in the skills, qualities and attributes you bring to the career of your
choice.
 Being in a better position to compete for jobs.
 Being better able to discuss your skills, personal qualities and competences with employers.
 Better problem-solving and planning skills.
 Developing the positive attitudes and approaches associated with successful professional life.

Simply put Work Ethic relates specifically to your attitude toward your work. Having a professional
attitude and taking pride in doing your work to the best of your ability go hand in hand with a strong
work ethic. A good work ethic not only allows a person to get on in their career, (because their
employer will be satisfied with their quality of work), it allows them to experience the emotional
rewards of knowing that they have made their best effort.

Adapt to different working environments:

 Conform to the norm of the environment bearing in mind to practice within consistently high
standards
 Ensure the standards of care
 Work within the realms your job description
 Familiarise yourself the regulations, rules and health and safety codes of the
organisation/facility you are working in
 Show initiative
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Verbal and non- verbal communication

Attitude!!! Attitude!!! Attitude!!!

How you present yourself, stance, facial expression, NO HAND ON HIPS!!!

In care settings .good communication skills are a vital part of the carer.

Please remember it’s not just how we speak or listen.

In health care settings, communication breakdowns between patient and caregiver can have dire
consequences: increased patient pain, misdiagnoses, drug treatment errors, and unnecessary
extensions in length of hospital stay, even death. Communication difficulties are all too often
devastating in health care settings. They can, and often do, create huge barriers between patients and
health care staff. Trouble communicating can be attributed to new or chronic speech and/ or
comprehension difficulties, medical interventions and/or language barriers of non-English speakers.
Patients regularly report instances in which communication barriers result in feelings of anxiety,
fear, frustration, unrecognized pain, and overall loss of control.

Communication interventions range from no technology (e.g., gestures and signs, alphabet boards) to
“low” technology (e.g., communication boards and wallets) to high technology (such as voice output
communication aids). Unfortunately, these techniques are most often underused in healthcare setting
because of lack of knowledge. Take the example of people rushed to the hospital without their
glasses or hearing aids, and then expected to answer various questions that they can’t hear, and sign
consent forms they can’t see, on top of the stress of their current condition. In some cases, patients’
communication abilities are weakened due to trauma, decrease in health or discomfort and pain. For
example, people on ventilators cannot speak their requests. Because they are in a weakened state
and have IVs in place, writing becomes difficult and requires too much effort. In such sub-optimal
situations, patients are faced with critical decisions. They need to be able to communicate fully with
their health care providers to ensure receipt of effective care. For elderly patients circumstances may
lead to disorientation and to the administration of medication that may not otherwise be needed.

Getting Communication Access Tools to Patients

 Word boards and picture boards

 A modified call bell (to help people who can’t use a regular call be to get help), and “how
to” instructions with easy to follow pictures
 A magnifying glass for people who don’t have their glasses and need to read consent forms

For individuals who have more complex communication needs in the health care settings, a speech
language pathologist should be called on to help determine what tools may or may not work for a
patient.

Qualities of a person with a strong work ethic:

Punctuality: Being punctual means that you arrive on time or a little bit early. Arriving to work on
time prepared to start your duties is vital in the health care industry. Many people are relying on you.
Organisation is necessary to achieve punctuality, for example if you work a morning shift, plan
ahead the night before by packing your lunch and making sure your uniform is clean. If you are
going to be late , please call your supervisor and your client if working in the community !!!!!

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Reliability: Reliability means that others can count on you to come to work every day and remain
there for the duration of your shift. Reliability is an essential characteristic for a nursing assistant and
frequent absences are a very poor reflection on your work ethic. Reliability also means that others
can count on you to do your job consistently and well, with minimal supervision.

Accountability: Accountability is also an essential characteristic for a nursing assistant. An

accountable person accepts responsibility for their actions and the results of these actions. Being
accountable means that you can accept criticism that is intended to help you improve, admit a
mistake and work to correct the situation. By acknowledging a mistake and taking measures to
correct it you are not only acting in the best interests of your client you are letting others know you
can be trusted to do your job to the best of your ability.

Conscientiousness: Conscientious nursing assistants take their assignments seriously and follow
directions carefully. They demonstrate responsibility by asking for additional explanations where
necessary, seeking help with difficult tasks and admitting that they may not know how to perform a
particular task.

Courtesy and Respectfulness: Always treat both your clients and your co-workers with respect.
Avoid using “baby talk” or “talking down” to clients. Address people as they prefer to be addressed
and always consider other people’s feelings and beliefs.

Honesty: Honesty is a critical quality for health care workers to have. You are expected to
accurately record vital signs and other information about the condition of the people you care for.
You will have access to people’s belongings and will be trusted with information of a very private
nature. If you act in a manner that causes people to lose their trust in you, it will be very difficult to
re-establish.

Co- cooperativeness: Being able to co-operate and work as part of a team is essential. Making an
effort to get along with you co-workers will make your work easier. A good nursing assistant does
not wait for a co-worker to ask for help, he or she sees a need and offers a helping hand.

Empathy: Empathy means that you are able to try and imagine what it feels like to be in another
person’s situation. Empathy gives us another perspective and helps us to be kinder and more
tolerant.

Other qualities that are associated with a strong work ethic are cheerfulness and enthusiasm, a
willingness to volunteer for new assignments and a desire to learn new skills.

Initiative: It is doing something without being told to do it. All of us get to the place in our work
when we cannot go on. What do we do? No one is around to ask or tell us what to do. We use our
own initiative and look for things that need to be done. Most employers expect their employees to
take some initiative. With more experience, we learn to see things ahead of time and make either a
mental note or a list of small jobs that can be started and completed during that "extra" time.
Maintain your sense of humour, be positive , caring and kind !!!!!

Personal Health & Hygiene: Caring for others is an emotionally demanding job. Often many
facilities are understaffed, which means that employees are sometimes overworked. Not all clients
are happy or grateful that they are receiving care. Many people in need of care do not feel well and
sometimes a person who is ill or worried will become angry and very critical making them hard to
manage. As a health care worker you will have to face the death of some of your clients, this can be
difficult especially in situations where you had a chance to develop a relationship with the client.
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Personal Hygiene and Appearance: Personal hygiene or cleanliness is hugely important as a health
care worker. It promotes a professional image. If you care enough about yourself to keep yourself
clean and neat, the people that you care for will feel that you will do the same for them. Good
personal hygiene helps to prevent the spread of infection, both to your clients and to you and your
family. In a health care setting the potential to come into contact with all types of germs is increased
and practicing good personal hygiene is necessary.

VII. PERSONAL EFFECTIVENESS AS A CARE WORKER TO INCLUDE OWN

STRENGTHS AND WEAKNESSES

People who are personally effective make good use of their skills. They do not squander them. They
use them to achieve their goals in an efficient way. People are personally effective in different ways
because everyone has different goals, values and priorities. It is hard to be efficient if we are not
confident. Our confidence grows when we play to our strengths and weaknesses. It is not how we are
but how we see ourselves.

Personally effective people have two qualities:

 They make good use of their resources

 They are skilled at achieving their goals

To build self-confidence it is important to say positive things to yourself. When you hear your- self
say negative things to your-self stop and say something positive, like recalling your good points,
things you have achieved and done for others. Even if you have not done much good in your life try
and do something nice for others. That makes you a better person and something to be proud of.
Building self-confidence and personal effectiveness is a gradual process of building on past
successes, taking stock of where you are and moving onto bigger things.

Most people want to feel useful in their lives. They want to feel as though they are making a
contribution of some kind. Knowing what you do well, what you can rely on, what qualities you
have are essential to maintaining your personal effectiveness.

 Each individual will identify their own strengths and weaknesses. Where your strength’s are
and further develop them
 We all know our own weaknesses and our goal taking this course is to work on them and
make them strength’s.
 Continuation of ongoing education and taking refresher courses enables us to acquire new
skills needed for effective self-care / care for our clients.

Effective interpersonal communication between health care provider and client is one of the most
important elements for improving client satisfaction, compliance and health outcomes. Patients who
understand the nature of their illness and its treatment, and who believe the provider is concerned
about their well-being, show greater satisfaction with the care received and are more likely to
comply with treatment regimes.

 How do you relate to others

 Actions speak louder than words.
 Do not bring your personal problems into the workplace.
 Do not discusses your financial , emotional or home or family problems with the client
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  Remember this is a professional relationship.
 Give reports accurately and to the point

VIII. RELATIONSHIPS WITH CLIENTS, RELATIVES AND MULTIDISCIPLINARY

TEAM MEMBERS AND INTERPERSONAL ISSUES THAT ARISE IN CARE
WORK

Interactions with Client

Have a clear contract with your client. When working with your clients, make sure they and their
family have a clear understanding of what your businesses responsibilities are. This way they will
know if their needs can be met. As you meet with your client, plan out the services you will provide
for them. Let them know what your expectations are, and have them clarified what they expect from
you. Put it all in writing so you can refer back to it often.

Appropriate interactions with the family of the client:

When building relationships, it’s important to remember that you aren’t just building a relationship
with clients, but their family as well.

 Be aware extent of family involvement

 Be aware extent of prior knowledge
 Be aware of total situation
 Keep lines of communication open with family
 Do not provide medical information
 Do not offer your own diagnosis
 Stay within the realms of your job description

Be a problem solver: Your business was hired to provide quality home care, solving a problem for a
client and their family. Make it your mission to solve the problems you were hired to solve, and
don’t create more problems.

Multidisciplinary Team

A multidisciplinary team (MDT) needs to bring together staff with the necessary knowledge, skills
and experience to ensure high quality diagnosis, treatment and care – core and extended team. An
MDT makes recommendations rather than decisions. These recommendations can only be as good as
the information available to the MDT at the meeting. The final decision on the way forward needs to
be made by the patient in discussion with their clinician.

Effective MDT working should result in:

 Treatment and care being considered by professionals with specialist knowledge and skills in
the relevant aspects of that cancer type.
 Patients being offered the opportunity to be entered into high quality and relevant clinical
trials;
 Patients being assessed and offered the level of information and support they need to cope
with their condition;
 Continuity of care, even when different aspects of care are delivered by different individuals
or providers;
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  Good communication between primary, secondary and tertiary care;
 Good data collection, both for the benefit of the individual patient and for the purposes of
audit and research.
 Improved equality of outcomes as a result of better understanding and awareness of patients’
characteristics and through reflective practice;
 Adherence to national and local clinical guidelines;
 Promotion of good working relationships between staff, thereby enhancing their job
satisfaction and quality of life;
 Opportunities for education/professional development of team members (implicitly through
the inclusion of junior team members and explicitly when meetings are used to devise and
agree new protocols and ways of working);
 Optimisation of resources

The structure and function of the health care Services in Ireland

The HSE is a large organisation of over 100,00 people, whose job is to run all of the public health
services in Ireland. The HSE manages services through a structure designed to put patients and
clients at the centre of the organisation.

The HSE Code of Governance provides an overview of the principles, policies, procedures and
guidelines by which the HSE directs and controls its functions and manages its business, it is
intended to guide the Board, the management team and all those working within the HSE and the
agencies funded by the HSE, in performing their duties to the highest standards of accountability,
integrity and propriety.

The HSE Code of Governance was first approved by the Minister for Health and Children in 2007.
The Code has been reviewed and updated in line with best practice and to ensure it meets the
requirements of the Code of Practice for the Governance of State bodies (2009). The revised Code
was approved by the Minster for Health in August 2011.

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  Integrated Services - including services in the community, hospital services and ambulance
services. All of the services provided by to the public are delivered through four regions -
Dublin Mid Leinster, Dublin North East, West and South
 Clinical Strategy and National Clinical Programmes
 National Cancer Control Programme
 Human Resources
 Finance
 Communications
 Internal Audit
 Information and Communications Technology
 Estates
 Procurement
 Board Affairs
 Consumer Affairs / Advocacy Unit
 Regional Health Offices
 Corporate Planning and Corporate Performance |
 Corporate Pharmaceutical Unit
 Medical Exposure Radiation Unit (MER Unit)

Primary, Secondary and Tertiary health care team

PRIMARY

Primary Health Care

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Primary care is the gateway to most other health services and is the level of care used most often.
This professional care within the community is usually first point of contact for most clients:

Primary health care team:

G.P. This is a family doctor who provides all care for adults and children. The G.P. will see a client
for any illness, for health advice and some health checks.

Practice nurse: This is a registered nurse working with the GP providing health promotion,
immunisation, and disease management advice to clients.

Public Health nurse: This is a registered nurse with special training, advising on preventative care
and early detection of ill health especially in young children and babies. She takes part in child
health clinics, schools immunisation and hearing screening, etc. She works with parents to assess
their child's progress and development" and acts as health educator.

Area Medical Officer: Responsible for child development checks, school health and vaccination
programmes, surveillance and control of infectious diseases, and assessment for entitlement to grants
for disabilities, etc.

Community Welfare Officer: Assesses people for grants, medical cards, special appliances" home
helps.

Home Helps: Home based help for people who need assistance in any of the activities of daily living.

Physiotherapist: Assesses and diagnoses injuries or disease in the skeleto-muscular system and plans
a programme of rehabilitation.

Chiropodist: Treats minor disorders of the foot

Pharmacist: Prescribes over the counter medication for minor disorders that do not require G.P.
intervention and gives advice on the management of minor illnesses. .

Dietician : Nutrition

Dentist

Speech Therapist

*Primary health care members work as a team in the areas of health education, health promotion,
identification of client’s needs, implementation of care programmes for people with illnesses, and
provision of a referral service if specialist advice and treatment is needed

SECONDARY

Secondary Health Care

This is hospital based care for clients who are referred by members of the primary health care team,
usually the GP.

It refers to care in General hospitals and Community hospitals and includes day care, out-client care
and in-client care.

General hospitals

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Day care: Various diagnostic procedures e.g. endoscope, colonoscopy, and Ct scanning can be
carried out without the need for overnight stay.

Out-client care: Here clients' conditions are assessed and reviewed.

Other services include dressing clinics, removal of plaster casts, xrays, blood testing, ante-natal
clinics, etc.

In-client care This is necessary for clients who require on-going care for surgical and medical
conditions.

It also includes obstetric and psychiatric care, palliative care and care of the elderly.

Ambulance service: Clients are monitored and treated by trained ambulance personnel on route to
hospital.

Accident and Emergency Clients are assessed by the triage nurse who decides what level of care is
required and is seen by A&E doctor

Community hospitals

These provide minor injury treatment, rehabilitation and respite care.

TERTIARY

Tertiary Health Care

This is specialist care in regional centres. These centres provide treatment for complex conditions
e.g.

 providing specific cancer therapies,

 rehabilitation after road traffic accidents,
 neo-natal intensive care.
 It also includes obstetric care,
 care of clients with serious disorders of the respiratory system,
 cardiovascular system,
 gastric disorders, etc.

The client is admitted after referral by a hospital consultant.

Tertiary health care team:

These are specialists in a particular urea and include the following:

Consultants-vascular surgeon (veins)

Obstetrician (pregnancy, female disorders)

Paediatrician (children's doctor)

Urologist (kidney, bladder)

Cardiologist, (heart )

Psychiatrist, (mental health)

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Radiographer ( takes x ray) . Radiologist (reads x ray)

Occupational therapist (assists with devices for handicapped clients)

Physiotherapist ( exercise and strengthens the muscle)

Medical social worker (assist with planning / discharge of clients)

Clinical nurse specialists -Breast care, midwife, oncology , diabetes, etc

A Clinical Nurse Specialist is described as an administrator, leader, manager, practitioner,

consultant, educator and researcher.

She provides primary, secondary and tertiary care to people with e.g. diabetes, and provides nursing
interventions which contribute to a healthy lifestyle, and aims to prevent complications associated
with the disease.

The role of clinical nurse specialists

 Client assessment and diagnosis

 Prioritize care based on the assessment
 Nursing interventions based on evidence based practice
 Ongoing assessment, monitoring and evaluation
 Client education, discharge planning and referral to other sources of care within the practice
 Active involvement in research that is relevant to clinical practice.

Interpersonal Skills

Interpersonal skills are the life skills we use every day to communicate and interact with other
people, individually and in groups. Interpersonal skills include not only how we communicate with
others, but also our confidence, and our ability to listen and understand. Problem solving, decision
making and personal stress management are also considered interpersonal skills. People with strong
interpersonal skills are perceived as more calm, confident and charismatic, qualities that are often
endearing or appealing to others. Being more aware of your interpersonal skills can help you
improve and develop them.

You already have interpersonal skills. We all learn how people are likely to react to what we say,
how we say it and what we do, as well as how these actions make others, and us, feel. These skills
are easily further developed with a little time and effort spent working, thinking and practicing them.
Remember it is worth spending time developing these skills as good interpersonal skills can improve
many aspects of your life. There are a variety of skills that will help you to succeed in different areas
of life . However, the foundation for many areas of our lives are good interpersonal skills since these
are relevant to our personal relationships, social affairs and professional lives and are the basis on
which we can develop other life skills. Unlike specialised and technical skills, interpersonal skills
will be used every day and in every area of our lives.

Opening Communication

In many encounters, the first few minutes are extremely important as first impressions have a
significant impact on the success of further communication. Everyone has expectations and norms as
to how initial meetings should proceed and tends to behave according to these expectations. If

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interpersonal expectation is mismatched, communication will not be effective nor run smoothly, and
negotiation will be needed if relations are to continue.

At a first meeting, formalities and appropriate greetings are usually expected: such formalities could
include a handshake, an introduction to yourself, eye contact and discussion around a neutral subject
such as the weather or your journey may be useful. A friendly disposition and smiling face are much
more likely to encourage communication than a blank face, inattention or disinterested reception.

Reinforcement

The use of encouraging words alongside non-verbal gestures such as head nods, a warm facial
expression and maintaining eye contact, are more likely to reinforce openness in others. The use of
encouragement and positive reinforcement can:

 Encourage others to participate in discussion (particularly in group work)

 Signify interest in what other people have to say
 Pave the way for development and/or maintenance of a relationship
 Allay fears and give reassurance
 Show warmth and openness.

Effective Listening

Active listening is a very important listening skill and yet, as communicators, people tend to spend
far more energy considering what they are going to say rather than listening to what the other person
is trying to say.

The following points are essential for effective and active listening:

 Arrange a comfortable environment conducive to the purpose of the communication, for

example a warm and light room with minimal background noise.
 Be prepared to listen.
 Keep an open mind and concentrate on the main direction of the speaker's message.
 Avoid distractions if at all possible.
 Delay judgment until you have heard everything.
 Be objective.
 Do not be trying to think of your next question while the other person is giving information.
 Do not dwell on one or two points at the expense of others.

The speaker should not be stereotyped. Try not to let prejudices associated with, for example,
gender, ethnicity, social class, appearance or dress interfere with what is being said.

Learn to Listen

Listening is not the same as hearing. Take time to listen carefully to what others are saying through
both their verbal and non-verbal communication. Hearing refers to the sounds that you hear, whereas
listening requires more than that: it requires focus. Listening means paying attention not only to the
story, but how it is told, the use of language and voice, and how the other person uses his or her
body. In other words, it means being aware of both verbal and non-verbal messages. Your ability to
listen effectively depends on the degree to which you perceive and understand these messages.

A good listener will listen not only to what is being said, but also to what is left unsaid or only
partially said. Listening involves observing body language and noticing inconsistencies between
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verbal and non-verbal messages. For example, if someone tells you that they are happy with their life
but through gritted teeth or with tears filling their eyes, you should consider that the verbal and non-
verbal messages are in conflict. Listening requires you to concentrate and use your other senses in
addition to simply hearing the words spoken.

Stop Talking: We have two ears but only one mouth. Don't talk, although you may need to clarify
when the other person has finished speaking.

Prepare Yourself to Listen: Focus on the speaker. Put other things out of mind.

Put the Speaker at Ease: Help the speaker to feel free to speak. Remember their needs and
concerns. Nod or use other gestures or words to encourage them to continue.

Remove Distractions: Focus on what is being said: don’t doodle, shuffle papers, look out the
window, or similar. Avoid unnecessary interruptions.

Empathise: Try to understand the other person’s point of view. Look at issues from their
perspective. Let go of preconceived ideas.

Be Patient: A pause, even a long pause, does not necessarily mean that the speaker has finished.
Never finish a sentence for someone.

Avoid Personal Prejudice: Try to be impartial. Don’t become irritated and don’t let the person’s
habits or manner distract you from what they are really saying.

Listen to the Tone: Volume and tone both add to what someone is saying.

Listen for Ideas, Not Just Words: You need to get the whole picture, not just isolated bits and
pieces.

Wait and Watch for Non-Verbal Communication: Gestures, facial expressions, and eye-
movements can all be important.

Choose Your Words: Be aware of the words you are using when talking to others. Could you be
misunderstood or confuse the issue? Practice clarity and learn to seek feedback to ensure your
message has been understood.

Understand Why Communication Fails: By learning about the various barriers to good
communication you can be aware of, and reduce the likelihood of, ineffective interpersonal
communication.

Relax: When we are nervous we tend to talk more quickly and therefore less clearly. Being tense is
also evident in our body language and other non-verbal communication. Instead, try to stay calm,
make eye contact and smile. Let your confidence shine.

Clarify: Show an interest in the people you talk to, ask questions and seek clarification on any
points that could be easily misunderstood.

Be Positive: Try to remain positive and cheerful. People are much more likely to be drawn to you if
you can maintain a positive attitude.

Empathise: Understand that other people may have different points of view. Try to see things from
their perspective. You may learn something while you gain the respect and trust of others.

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Understand Stress: Learn to recognise stress in others and yourself. Although stress is not always
bad, high levels can have a detrimental effect on the communication process.

Learn to be Assertive: You should aim to be neither passive nor aggressive; being assertive is about
expressing your feelings and beliefs in a way that others can understand and respect. Assertiveness
is fundamental to successful negotiation.

Reflect and Improve: Think about previous conversations and other interpersonal interactions;
learn from your mistakes and successes. Always keep a positive attitude but realise that we can all
always improve our communication skills.

Steps to Managing Conflict at Work

Conflict arises when one or more person tries to ensure their preferred outcome is achieved to the
exclusion of the preferred outcome of others. In examining the area of conflict more closely, the
issues causing the conflict need to be examined as well as the behaviour of both parties and then
finally the feelings which result based on how people feel they have been dealt with. Often it is the
behaviour and consequent feelings which cause the longer term and deeper damage to the
relationship than the actual issue itself. Therefore, in managing conflict, these aspects need to be
understood and resolved as well as dealing with the issue that may have caused the original conflict.

Reactions to Conflict

The ways in which we deal with conflict are based on the following.

The situation arises when there is a clash between differing priorities and preferred outcomes. The
outcome that then results can lead to how each party feels following the interaction. Often the person
does not have control over the situation or issue causing conflict, but the key area they can influence
is their own behaviour. By focusing on behaviour, each person can affect the outcome of an
interaction and the feelings which then result. Typically there are 3 broad approaches to dealing with
conflict some of which were outlined by Thomas Kilman. These include:

Fight: Achieving personal goals becomes the driving force when interacting with others at work or
in a particular situation. The person in this case will not concede any of their own preferred
outcomes. This style can be used when the individual needs of the person are too important to
compromise on. There are also people who use this style predominantly regardless of how important
the issue is as they see each conflict as a threat and a potential power struggle.

Avoid: This behaviour can result from a fear of confrontation which the person using the style may
have. They may use this approach as a way also of maintaining the relationship as they may not be
confident enough to confront the cause of the conflict. This style can also be used when one person
feels there is nothing to gain by dealing with the cause of the conflict and they therefore choose to
avoid any confrontation. Also it can be used when emotions are running high and the timing may be
better to wait before confronting the other person.

Resolve: In using this approach when dealing with the conflict, both parties try to resolve the
disagreement in a way that is mutually beneficial. In this instance, both sets of needs are deemed to
be equally important and dealt with accordingly. Resolution can be achieved when both people
involved agree to compromise as a way of moving forward. Alternatively, it may also be possible to
reach agreement by collaborating. This approach ensures both sets of needs are met without
compromise through joint problem solving.
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Causes of Conflict

There are many causes of conflict within the organisation and these include.

 Poor organisation structures

 Poor communication
 Personality conflicts
 Change
 Lack of teamwork /poor performance

Effects of Conflict

Conflict can potentially result where two or more people interact with each other and because of
their behaviour or due to a clash of interests, conflict or tension can arise. There are also positive
aspects associated with conflict as it enables feelings to be expressed whilst recognising there are
often different views or perspectives. Conflict becomes a more serious problem when it is not dealt
with effectively or at all and where the feelings which result are not expressed or resolved. The
negative effects of conflict are that communication breaks down, individual needs are not heard or
met, creativity is stagnated and relationships with others usually deteriorate.

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TIPS FOR CARING FOR A PERSON WITH ALZHEIMER'S DISEASE

Caring for a person with Alzheimer's disease at home is a challenging task that can become
overwhelming at times. Each day brings new demands and opportunities as the caregiver copes with
changing levels of ability and new patterns of behaviour. In any demanding situation, the better you
care for yourself, the better you will be able to care for your loved one.

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Setting up home care

Soon after a diagnosis of Alzheimer’s, it will be necessary to get started on making changes that help
provide a sense of wellbeing and physical safety for the affected person. Things that were taken for
granted before, such as home safety and socializing, will now require some planning. There will be a
need to communicate in new ways and make changes to the home environment. These changes
include:

 Adjusting your communication style to the client’s changing needs as the disease progresses.
Talking to the early-stage Alzheimer’s client who is in denial, to handling aggressive or
paranoid behaviour in the middle stage, then relating to the dying client.
 Scheduling visitors to avoid surprises and have something to look forward to. Even if the
elder with dementia does not recognize those who visit, the contact is nonetheless valuable
for them.
 Establishing routines in activities of daily living
 Maintaining social contacts and fun
 Setting up a safe home environment

Promoting comfort and safety

As the symptoms of Alzheimer’s progress, the person becomes more emotionally fragile. At first,
there may be the sense of grief and dread that accompanies the awareness of having a progressive
terminal illness. During this early stage of the disease, caregivers can promote the client’s sense of
wellbeing by providing emotional support and by helping to maintain familiar activities and social
contacts. Eventually though, the diagnosis of Alzheimer’s is forgotten and the ability to be rational
fades. Logical thinking can no longer be used to help alleviate fear and confusion. As problems with
memory and judgment increase, the client becomes more vulnerable to accidents and injuries.
Problem behaviours develop that place the person at increased risk of getting lost or getting hurt.
Caregivers must hone communication skills and make changes to the home environment in
anticipation of the problems of mid-stage Alzheimer’s disease. Following are some tips for
promoting physical safety and emotional comfort.

Be sensitive and gentle about informing the client of the diagnosis.

There will be times when you’ll want to remind the person that they have Alzheimer’s. At other
times it might be better to refer to a “memory problem.” Even

if you repeatedly tell the elder that they have Alzheimer's disease, they may not remember that you
told them. Be prepared to repeat the information at times when you’re trying to help the person
understand why they can’t do something or why you are taking over a task the person used to do.

Develop a positive attitude.

Many people look on their care-giving responsibility as a way of being involved with their loved
one. Their caring is based on unconditional love, and they do not consider it a burden. Dementia
clients are able to read body language and to respond to the positive attitudes of the caregiver. Where
client and caregiver have had problems in their past relationship, it can be especially challenging to
empathize and be kind, so a support system for the caregiver is most important.

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Learn to communicate with an Alzheimer’s client

Acknowledge requests and respond to them. Don’t argue or try to change the person’s mind, even if
you believe the request is irrational. Be affectionate with the client, if this feels natural.

Try not to set up a cycle of paying attention only when the person displays problem behaviours.
Break this negative cycle by being supportive of positive behaviour.

Remember the worth of the person as a human being.

Even if they don’t seem to respond, the person deserves to be loved and cared for, touched, and
spoken to. Much like an infant, the dementia client thrives on human contact. If treated poorly, the
person feels rejection, loneliness, grief, and pain. Your warm, supportive care is essential to the
dementia client’s well-being.

Managing behaviour problems

Be accepting of the increasingly limited capabilities of the person with dementia and implement care
strategies accordingly. Do your best to be client, kind, flexible, supportive, and calm. This disease is
no one’s fault, although it is very aggravating and disappointing.

By the same token, don’t take problem behaviours (like aggressiveness or wandering) personally.
Accept the symptoms of the disease and proceed from there. Remember that the person is not
behaving this way on purpose. For some of these problems, medications may be helpful

Expect the client to totally lose their memory.

Be ready with boundless patience. Many Alzheimer's sufferers have no awareness of their loss of
memory. You may feel aggravated at repetitive behaviours or with having to repeat what you just
said, time and time again. The positive side of this is that the person is not as upset as you are; they
don’t realize what is happening to them or how it affects you

Get emotional support for yourself.

The above suggestions can be hard to implement. You have your own sense of grief and loss about
the diagnosis--feelings that may be compounded as you see the person you’ve known and loved
gradually lose their familiar personality and abilities. Your lifestyle may be radically changed,
especially if you are the lone caregiver. Besides, some caregivers may have responsibility for a
person who they weren’t very close to, or who treated them badly in the past, making it particularly
hard to stay positive or to empathize with the client. Remember there is plenty of support for you in
this journey if only you reach out for it.

Fun and active ideas for engaging an Alzheimer’s client

Gear activities to the client’s ability to participate Plan activities that the client is interested in,
such as art, cooking, walking, swimming, or gardening. Focus on enjoyment, not achievement.

If the person is lucid enough, involve them in making music, doing puzzles or crosswords, or
playing memory games, card or board games. Or, the client may passively enjoy hearing music,
contact with pets, or sitting outside in the garden.

Use humour: Even when Alzheimer's clients no longer have the cognitive ability to understand your
humour, they can still appreciate it. They may still smile or laugh and sharing that laughter can be a
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relief to both you and your charge. Use the same modes of humour as you always have: teasing,
nonsense, clowning. Be even more silly than usual!

As symptoms progress, unfamiliar people, places and activities can be upsetting or confusing.
Routines are reassuring to Alzheimer's clients. Here are some recommendations as mid-stage
Alzheimer’s begins:

 Structure the day.

 Provide consistent environmental cues about time of day.
 Help the person to look forward to milestones of the day, such as bathing, dressing, meal
preparation and eating, going outdoors, having visitors, getting ready for bed. Talk about the
upcoming markers of the day.
 Enlist the client in accomplishing small tasks around the house or yard.
 Keep the environment familiar. Put things in expected places. Novelty and surprise are not
helpful to most Alzheimer's clients.
 Be near the person. Many dementia clients feel most comfortable if their caregiver is nearby.
You do not have to talk or entertain them.
 Create a routine around regular toilet visits, to avoid embarrassment, discomfort, or medical
complications. The caregiver may have to help with hygiene. In late-stage Alzheimer’s, adult
diapers are often needed.

Keeping the Alzheimer's client safe

At some point, you will need to determine that it is no longer safe to leave the Alzheimer's client
alone in the house for more than a few minutes. Some warning signs that this time has arrived are
when the client:

 forgets to turn off the stove when done cooking, or the faucet when they are done using the
water
 forgets to close the front door
 forgets to turn off is no longer able to use the telephone to call for assistance from neighbours
or emergency personnel (e.g., to call 112 or 999)
 does not notice dangerous situations such as fire, or spilled water on the floor
 is unpredictable or confused under stressful conditions
 is no longer happy when left alone at home: is agitated, depressed, or withdrawn
 wanders or becomes disoriented
 does not realize that some activities he/she engages in are ones that now require supervision,
such as cooking, ironing, or bathing.

Keep evaluating whether the person can be left alone, until you finally determine that it is time to
supervise or be with the Alzheimer's client at all times. This may be when you first seek outside
helpers to be with the client while you sleep, go grocery shopping, or have some respite.

Keeping the Alzheimer's client safe in the house

If necessary, have a friend, family member or hired caregiver in the house with the client when you
go out.

Purchase safety latches or locks for cabinets that contain medications and cleaning products. Large
drug stores, large children’s stores, and large toy stores sell child safety equipment that may be
suitable.
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Child safety gates may be used to block stairwells and rooms you don’t want the person to enter.

Get plastic covers for the corners of furniture to protect against injury.

Indoors, place furniture against the walls and keep the walking areas clear of electrical cords and
other hindrances to movement.

Management of Wandering

Wandering around the house may be irritating to the caregiver, but not necessarily unsafe for the
client. In this case, you may need to adjust your anxiety level about wandering. On the other hand,
some wandering can be dangerous and must be prevented: going into areas of the house that are off-
limits, especially stairwells, leaving the house alone via a window or door to go outside; or leaving
your yard or property.

Two characteristic precursors to wandering are restlessness and disorientation. Redirecting

behaviours, distracting, orienting, and encouraging physical exercise therefore, serve to reduce the
incidence of wandering. Some suggestions are:

 Immediately redirect pacing or restless behaviour into productive activity or purposeful

exercise.
 Make sure the Alzheimer's client gets plenty of exercise and movement. Even consider
singing and dancing! If you walk outdoors, make sure that you and the client have clothing
that shelters from cold, rain, and sun.
 Make sure the person is involved in many productive daily activities, such as the simple
chores of folding laundry or washing vegetables for dinner.
 Reassure the person if they appear disoriented.
 If wandering tends to occur at a particular time of day, distract the person at that time.
 Reduce noise levels and confusion. These can disorient the person.

Disorientation can be a result of medication side-effects, drug interactions, or over-medicating. If

disorientation is becoming a problem, consult the doctor.

If you are moving the client to a new environment, reduce disorientation by acclimating them ahead
of time with several visits.

Where to look for a lost Alzheimer's client

Check dangerous areas near the home, such as bodies of water, open stairwells, dense foliage,
tunnels, bus stops, high balconies, and heavily travelled roads.

Look within a one-mile radius of where the client was before they wandered.

Look within one hundred feet of a road, as most wanderers start out on roads and remain close by.
Especially look carefully into bushes and ditches, as the person may have fallen or gotten caught.

Search in the direction of the wanderer’s dominant hand. People usually travel first in their dominant
direction.

Management of belligerence, anger or aggressive behaviour

Following are some ideas about caring for an aggressive Alzheimer's client. Consider each idea
independently of the others.
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  Don’t confront the person or try to discuss the angry behaviour. The person with dementia
cannot reflect on their unacceptable behaviour and cannot learn to control it.
 Do not initiate physical contact during the angry outburst. Often, physical contact triggers
physical violence in the client.
 Provide the person with a “time-out” away from you. Let them have space to be angry by
themselves. Withdraw in the direction of a safe exit.
 Distract the person to a more pleasurable topic or activity.

Look for patterns in the aggression. Consider factors such as privacy, independence, boredom, pain,
or fatigue. Avoid those activities or topics that anger the person. To help find any patterns, you
might keep a log of when the aggressive episodes occur.

If the person gets angry when tasks are too difficult for them, break down tasks into smaller pieces.

 Minimize stress and novelty.

 Maintain calm within yourself. Getting anxious or upset in response may escalate the
aggressiveness.
 Let the person play out the aggression. Just be sure that you are safe and that they are safe
themselves.
 Get help from others during the activities that anger the client.
 Don’t take the aggressiveness personally.

Management of hallucinations, illusions or paranoia

Hallucinations can be the result of failing senses. Unidentifiable sounds, shadows, and highly
contrasting colours all can become the basis for fantasy. Decrease the number of things in the
environment that can be misinterpreted as something else, such as patterned wallpaper or bright,
contrasting surfaces or objects. Management of night-time wakefulness and other sleep problems

Brain disease often disrupts the sleep-wake cycle. Alzheimer's clients may have wakefulness,
disorientation, and confusion beginning at dusk and continuing throughout the night. This is called
“sundowning.” There are two aspects to sundowning. First, confusion, over-stimulation, and fatigue
during the day may result in increased confusion, restlessness, and insecurity at night. And second,
some Alzheimer's clients have fear of the dark, perhaps because of the lack of familiar daytime
noises and activity. The client may seek out security and protection at night to alleviate their
discomfort.

Following are some strategies to reduce night-time restlessness:

Improve sleep

Physical activities will help the person feel more tired at bedtime. Walk with the person during the
day. If the person seems very fatigued during the day, give them a short rest in the afternoon to
regain their composure. This can lead to a better night’s sleep. But don’t let them sleep too long –
too much daytime napping can increase night-time wakefulness. Also, limit the client’s caffeine
intake.

Be consistent with the time for sleeping, and keep a routine for getting ready for bed.

Approach from the front and retain eye contact. When assisting someone physically, do not approach
him/her from behind or from the side. This can startle and confuse the person in your care, leading to

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increased levels of agitation and/or paranoia. Instead, approach from the front. Touch the care
recipient on the shoulder, upper arm or hand, and tell them what’s going on. Use a calm voice to
walk him/her through the whole process. Retain eye contact throughout the duration of the activity

It is not unusual for a person with dementia to go through the motions of the activity they may
previously have carried out at work. This can indicate a need to be occupied and to feel there is a
purpose and structure to their life. Specific types of repetitive behaviour may include:

 Asking the same question over and over again − As well as memory loss, this can be due to
the person's feelings of insecurity or anxiety about their ability to cope. Try to be tactful and
client, and encourage them to find the answer for themselves. For example, if they keep
asking the time, suggest that they look at the clock themselves. It may help if you to move
the clock to a position that is more visible. People with dementia may become anxious about
future events such as a visitor arriving, which can lead to repeated questioning. It may help if
you don't mention the event until just before it takes place.
 Repetitive actions − Actions such as repeatedly packing and unpacking a bag, or rearranging
the chairs in a room, may relate to a former activity such as travelling or entertaining friends.
If so, this may serve as a basis for conversation. Alternatively, it could signify boredom or a
need for more contact with people.
 Repeatedly asking to go home − This may take place in residential care, or when the person
is already at home. It can be a sign of anxiety, insecurity, fear or depression. The concept of
'home' might evoke memories of a time or place where the person felt comfortable or safe, or
of a home, family and friends that no longer exist. If the person doesn't recognise their
present environment as 'home', then it isn't home for them. Try to understand and
acknowledge the person's feelings and reassure them that they are safe and loved.

Suspicion

Some people with dementia can become suspicious. If they have mislaid an object they may accuse
someone of stealing it, or they may imagine that a friendly neighbour is plotting against them. These
ideas may be due to failing memory, an inability to recognise people, and the need to make sense of
what is happening around them.

 If this happens, state calmly what you know to be true, if appropriate, and then reassure and
distract the person.
 Try to remember that although the person's interpretation may be wrong, the way the person
feels is real.
 Explain to others that they should not take unfounded accusations seriously.
 Don't automatically dismiss the person's suspicions if there is any possibility that they may
be true.

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