Care Needs of a Confused Client Case Study

Development of a client profile and assessment of individual client need.

Determine the level of assistance required to complete activities of daily living.

INTRODUCTION

 

For the purposes of this assignment the author will endeavour to:

1. Develop a client profile and carry out an assessment of the individual client need.
2. Determine the level of assistance required to complete the activities of daily living.
3. Maintain the clients’ safe environment.
4. Promote the clients’ involvement in social events and therapies.
5. Mobility including falls and pressure area care.
6. Effective verbal and written communication with the client and the healthcare team.
7. Assist the client with the activities of daily living.
8. Promote the rights of the client to dignity, privacy, independence and positive self-image.

 

DEVELOPMENT OF A CLIENT PROFILE AND THE ASSESSMENT OF THE INDIVIDUAL CLIENT NEEDS.

When a client is admitted to a facility such as a nursing home, as in this case, the clients’ confidentiality is of paramount importance and has to be protected. Guided by the data protection act 2003, the author will protect the clients’ anonymity by changing the clients’ name, referring to her as Betty White throughout the assignment.

The methodology used was independent research via the internet, tutor input and class notes.

CLIENT PROFILE

 

Betty is a 79 year old lady. Premorbidly, she lived and active and productive life. Born in Dublin in 1928, was brought up in a working class family; her father worked for Guinness and her mother was a school teacher. She had two brothers (twins) and one sister. As her parents were fanatically secure, Betty and her siblings had the luxury of attending secondary school and had yearly family holidays.

Betty had lived in the family home all her life, even after marriage. She cared for both her parents when they became elderly; both now deceased, dying twenty 20 years ago, only six months apart.

Betty got married when she was twenty two years old; was happily married for fifty three years. She had two boys whom she adored and idolised. Mick was killed in a freak accident by a hit and run driver on his way home from his local pub four years ago!!

By profession, Betty was a Primary school teacher, following in her mums’ footsteps. She eventually was promoted to the Principal of the school. However, Betty always regretted taking this post as her passion was in teaching.

Her favourite subjects were Irish and History. She also loved Music and would conduct the school choir for Communions, Confirmations and Nativity plays.

Betty had a few pastimes, including reading, painting and watching the “Late Late Show “religiously” every Saturday night. She also enjoyed listening to Terry Wogan on the radio.

Betty had two Yorkshire terriers that she absolutely adored. Jack, her eldest son, bought Betty the dogs for her shortly after her husband died to distract her and to keep her company. She regularly groomed them and walked them twice daily. She referred to them as her “babies”.  Unfortunately, Betty was forced to give them away about a year ago. Jack was working abroad for a period of time and was unable to visit her. When he returned, he was shocked to see that Betties’ dogs had become emaciated and matted. Betty was forgetting to feed and groom them which was not like Betty who had always being so particular about her “babies”. Jack had noticed that his mum was becoming forgetful before his trip but had put it down to old age. He couldn’t believe Bettys’ deterioration and immediately contacted her GP. Betty was eventually diagnosed with Alzheimer’s disease.

Betty started smoking shortly after getting married; she had being influenced by some movies she had seen with Mick, her husband. She smoked around twenty cigarettes daily. She particularly enjoyed her first one of the day and especially after meals with a nice cup of tea. Despite numerous efforts from her children encouraging their mum to give up the cigarettes, Betty smokes to this day.

ASSESSMENT

 

The author had and in depth discussion with her mentor in order to gain and insight into how Betty was initially assessed. She explained that Bettys’ assessment began as soon as she entered the ward.

Betty was accompanied by Jack, her eldest son; she walked into the ward with the aid of a Zimmer frame; Jack had to intermittently remind her to keep going straight and explain to her where she was. Betty had to stop on occasion to catch her breath. When she stopped, the authors mentor recalled that she clapped her hands and quite loudly said “look at them over there! They’re nice and clean, so they are!” Jack replied “Yes they are Mam”, Betty clapped her hands again and replied “Yeah, we just need six, six will be plenty!”.

Betty appeared slightly dishevelled, her hair was tossed, her blouse was slightly stained. When she sat down with guidance, the authors mentor noticed a distinct smell of urine. She appeared pleasant and was smiling. On interaction, she spoke loudly and Jack had to prompt her to turn on her hearing aid. Jack privately apologised for her appearance and explained that she had being particularly confused of late and had refused to change that morning.

Although Betty was clearly confused on admission, she had intermittent moments of lucidity. This enabled the authors mentor to gain some of the information she required to carry out her assessment. She also had to rely on Jacks’ input to gain a Holistic insight.

The Assessment was guided by a Nursing diagnosis using the Roper, Logan and Thierey model, firmly underpinned by Orem’s self-care model.

There are five steps in the Nursing Process: Assessment, Diagnosis, Planning, Implementing and Evaluation.

Assessment is the first phase; the authors mentor had to gain the information required in a holistic approach, assessing Bettys’ physical, intellectual, emotional and spiritual needs.

PHYSICAL ASSESSMENT:

The nurse collected data in a variety of ways. Initially, she took and recorded Bettys’ general observations, BP, Pulse, Temp., Respirations, height, weight and urinalysis (with difficulty, as Betty required a lot of prompting). All of Bettys’ observations were within the normal range except for her temperature (38 degrees) and the urinalysis, where the nurse noticed that she had protein urea. This discovery explained why Betty had been confused more than normal as Jack had expressed earlier. She then took Bettys’ health history relying heavily on Jacks’ input. After gaining the required information the nurse carried out a pressure area risk assessment using the waterlow scale. This assessment tool was developed by Judy Waterlow, a clinical nurse tutor in 1985. The tool enabled the nurse to make an estimated risk to determine Bettys’ risk of developing pressure sores.

The areas that were assessed included:

• Age and sex: Female (score 2); Age 79 (score 4)
• BMI: Bettys’ BMI was average (score 0);
• Continence: Urinary occasionally incontinent (score 1)
• Mobility: Restless (score 1)
• Neurological deficit: Alzheimer’s disease (score 4)
• Malnutrition screening tool: Weight loss score: unsure (score 2)
• Tissue malnutrition: Smoking (score 1) Peripheral vascular disease (score 5)

The nurse calculated that Bettys’ Waterlow score came in at 20, which puts her in the very high risk category. On completion of the assessment the nurse immediately ordered an air mattress and cushion, and then referred Betty to a tissue viability nurse.

INTELLECTUAL ASSESSMENT:

Betty has been recently diagnosed with Alzheimer’s disease, on interaction she requires a hearing aid to communicate effectively. Although Betty is pleasantly confused at times, when lucid, Betty comes across as a highly intelligent lady and very articulate.

EMOTIONAL ASSESSMENT:

On interaction with Betty and with Jacks input, the nurse was able to determine her emotional awareness. She identified that Betty clearly had deficits in decision making, interpersonal awareness, empathy, commitment, motivation and self-esteem. When Betty is confused she often calls out for Mick, her deceased husband.

SPIRITUAL ASSESSMENT:

The nurse asked Betty questions including whether she found comfort in any particular religion or group. She was confused at that point, so, Jack informed that his mam had been religious in the past but since the death of Mick, Betty has stopped going to mass. However, when confused she would look for her rosary beads.

THE LEVEL OF ASSISTANCE REQUIRED TO COMPLETE THE ACTIVITIES OF DAILY LIVING

 

MAINTAINING A SAFE ENVIRONMENT:

Betty is semi-independent when mobilising with her Zimmer frame.

1. Requires the supervision of one when mobilising to guide her to the toilet, dining room and to the activities room as sometimes she forgets her limitation with her mobility and poses herself more at risk of falls.
2. Betty needs to have her call bell and most frequently used personal items within reach.
3. Betty needs to have verbal reminders to Betty to utilise the call bell when assistance is required.
4. Betty needs to have an uncluttered environment and adequate lighting. She needs to be provided with a night light as Betty may get up at night to use the toilet.
5. Betty needs to have shoes that are well fitting and have non-slip soles.
6. Betty needs to have a chair with arms to assist her with rising.
7. Betty needs to have clothing that she can easily manage when she gets up to the toilet unassisted.
8. Betty needs to be monitored during the night if she gets up she needs to be offered assistance and guidance.

Betty has gout and Arthritic pain.

1. Betty needs to be supervised when mobilising in acute episode of pain due to exacerbation of gouty arthritis. Acute pain will alter Bettys’ mobility and will make her unsteady on her feet.
2. Betty needs to be in a comfortable position, joint pain (leg) rested and given bearing. Rest can reduce local metabolism and reduce joint movement occurs.
3. Betty needs to have a warm or cold compresses applied as it can provide relief from pain and also promote good blood circulation and promote healing.
4.  If joint swelling occurred on her toes specifically on her big toes, she needs to avoid irritations on the site by avoiding the use of a narrow shoe or tripping over a hard object. If irritation persists the site will be more painful.
5. Betty needs the nurse to administer medications such as analgesics/ anti- inflammatory and medications to lower down serum uric acid level and for the nurse to observe Betty for side effects to the drugs.
6. Betty needs the staff to ensure to maintain Bettys’ room clutter free to avoid the risk of tripping.
7. Betty needs her blood urea to be monitored as required by GP.

COMMUNICATION:

Confusion and intermittent Hallucinations:

1. Bettys’ deterioration in her cognitive status needs to be monitored.
2. MMSE is now 10/30 indicating a moderate cognitive impairment.
3. Of late, Bettys’ general condition has deteriorated due to multiple infections and ? a progression in old age illness.
4. Betty needs her GP to continuously review and communicate with Betty and her family to update them regarding her current condition.
5. She now requires A of one for most ADL’s and is now a high risk of falls
6. When having hallucinations, Betty needs to be provided with comfort and reassurance verbally and non-verbally until she settles as this can be a frightening time.
7. Betty needs the staff to use Distraction techniques by making reference to her family, whom Betty is very close to, as this lessens the impact of the hallucinations.
8. Betty needs the staff to liaise with GP as required for treatment and management of infections to reduce the occurrence of the hallucinations.

Betty requires a hearing aid:

1. Betty needs to be encouraged and reminded to wear her hearing aid at all times.
2. Betty needs the staff to reduce the background noise when communicating with Betty.
3. Betty needs the staff to speak clearly and make eye contact with her and observe the devise if it requires battery replacement.

Vision:

1. Betty needs the staff nurse to administer Hyloforte eye drops to Bettys’ eye as prescribed
2. Betty needs to have her most frequently used objects within easy reach.
3. Betty needs the staff to keep Bettys’ furniture in same place and not rearrange her furniture.
4. Betty needs to be prompted to wear her glasses when reading.

BREATHING:

Betty smokes ten cigarettes daily.

1. Betty needs to be encouraged to cut down on the cigarettes.
2. Betty needs the staff to divert her attention when she asks to go out for a cigarette.

EATING AND DRINKING:

Betty is semi-independent in eating and drinking but needs prompting on occasion when in a confused state.

Betty has hypothyroidism.

1. Betty needs the staff nurse to administer levothyroxine 50mg alt days and levothyrosin 100mg alt days as prescribed.
2. Betty needs to be encouraged to take low calorie, low cholesterol diet to avoid increase in weight.
3. Betty needs to be observed for signs of constipation, document when BO. She needs to be encouraged to take a high fibre diet and adequate fluid to prevent constipation.
4. Betty needs to be observed for the “Sick Day Rule” as she requires double dose of hydrocortisone for two to three days when she is unwell (fever) as advised by the Endocrinology team.
5. Bettys’ behaviour needs to be monitored for indications of hypothyroidism i.e. lethargy, agitation, confusion. Any changes need to be reported to her GP.

 

 

 

 

 

ELIMINATION:

Betty is semi-independent in toileting as she needs prompting when confused to go to the toilet and guidance to wipe herself front to back. She is occasionally incontinent and is prone to UTI’s

1. Betty needs to be provided with an adequate supply of continence wear, slip pad.
2. Betty needs the staff to remove wet continence wear from the bin in Bettys’ bathroom every day.
3. Betty needs the staff to offer her cranberry juice regularly with snacks to prevent UTI and avoid further periods of incontinence.
4. Betty needs to be observed for complaint of increasing periods of incontinence which may suspect caused by UTI.
5. Betty needs the staff to initiate bladder training by providing schedule of regular toileting two to three hours with specified time for her to void.
6. Betty needs the staff to remind her discreetly to change continence wear regularly to prevent skin irritation and to ensure she is free from odour of urine.
7. Betty needs to be educated about proper hygiene care and proper disposal of wet continence wear.

PRONE TO UTI’s:

1. Bettys’ urine needs to be observed for appearance, amount, odour and clarity. If infection is indicated, she needs the staff to perform urinalysis and if positive send to lab for C and S testing.
2. Betty needs to be encouraged to take fluids in instances of decreased oral fluid intake.
3. Betty needs the staff to maintain the fluid balance chart.
4. Betty needs to be observed for signs of pain when urinating as well as suprapubic pain; she needs the staff nurse to administer pain relief as prescribed if indicated
5. Betty needs to be encouraged to void every two to three hours to clear bladder and eliminate infection.
6. Betty needs to be educated on proper perineal care, wiping from front to back.
7. Betty needs to be observed for signs and symptoms of UTI such as confusion, urine clarity, smell, fever, urinary frequency.

 

 

 

 

 

WASHING AND DRESSING:

Betty is semi-independent in washing and dressing when in a confused state.

Personal hygiene:

1. Betty needs the staff to ensure that she is comfortable to do her wash and that she has sufficient face cloth and towels ready for the wash and to promote Bettys’ independence but reassure her that the HCA’s will assist her to meet her hygiene needs when required.
2. Betty requires assistance of one now when showering for Bettys’ safety in the bathroom.
3. Betty needs to be encouraged to carry out her oral hygiene needs daily and after meals.
4. Betty needs to be reminded that she attends the hairdresser of her choice once every two weeks and whenever she would like it done.
5. Bettys’ toe nails need to be observed, if she needs a chiropody referral. Bettys’ chiropody card can be found at the nurses’ station, however, a private chiropodist can also be arranged for Betty if she requires the service immediately.

SKIN:

1. Betty needs the staff to assess extent of bruising on a bi-daily basis.
2. Betty needs the staff to apply arnica to assist in reducing the bruising.
3. Betty needs the staff to administer analgesia if she requires per prescription.
4. Betty needs the staff to give her explanations, support and guidance in relation to the management of same.

ORAL HYGIENE:

1. Betty has been assessed by Mouth Care Assessment Tool, her score is seven. According to this assessment tool she requires Plan A (standard mouth care) mouth care.
2. Betty needs to be reminded to brush her teeth twice daily using toothbrush and fluoride toothpaste.
3. Betty needs to be provided with a small-headed toothbrush with none foaming gel
4. Betty needs to be reminded to remove her dentures both on top and bottom after going to bed and to soak in water with strident overnight.
5. Betty needs to be reminded to rinse in the morning and rinse mouth as well and to apply lip balm regularly.

 

 

CONTROLLING BODY TEMPERATURE:

Betty is semi-independent regarding controlling body temperature.

When lucid Betty is aware of when she is hot/cold and will dress/undress as appropriate. When confused she requires gentle prompting to put on/take of clothes.

Betty needs to be prompted to put on or take off clothes as appropriate, when confused.

MOBILISATION:

Betty mobilises semi-independently with a Zimmer frame.

1. Betty needs supervised when walking, if necessary, as she forgets her limitation with her mobility and poses herself more at risk of falls.
2. Betty needs the staff to ensure that her shoes are well fitting and have non-slip soles.
3. Betty needs to be monitored during the night and if she is getting up, she needs to be offered assistance.

WORK AND PLAY:

Betty is semi-independent regarding work and play.

1. Betty needs to be informed of what activities are on daily. She loves attending daily morning exercises, reading the paper, music and her favourite is dog therapy.
2. Betty needs to be assisted as required by prompting her as to where she has to go.
3. Betty always enjoys reflexology and she gets this regularly. She also enjoys Sing Songs and she needs to be reminded that it is on every Monday and Wednesday.
4. Betty may go out in a tour with the other residents and activity coordinator.
5. Betty needs to be informed when church of Ireland Minister visits for confession and communication.
6. Bettys’ family will continue to assist and support Betty needs to be reminded that she can go out with them whenever she would like to go out for personal and/or family activities.

EXPRESSING SEXUALITY:

Betty has always being very particular about her appearance; following the latest fashion trends appropriate for her age; she wouldn’t leave the house without her makeup on, even if she was only doing the gardening. She is semi-independent expressing her sexuality.

1. Betty needs to be reminded when confused to apply her cream and makeup and provide assistance as required.
2. Betty needs to be encouraged and assisted to wear matching clothes when confused.
3. Betty needs to be given the option as to whether she would like some jewellery and perfume on.

SLEEPING:

Betty can get confused and disoriented in the early hours of the morning, calling out for Mick and her “Babies”. Betty is semi-independent re: sleeping.

1. Betty needs to be given reassurance and to be reoriented her by telling her where she is.
2. Betty needs the staff to ensure the night light is on.
3. Betty needs the staff to keep the background noise to a minimum to avoid disturbing her.

DYING:

ADVANCE CARE PLANNING:

1. Betty needs the staff to keep alert for cues that Betty and her family wants to discuss end of life issues.
2. Betty needs the staff to maintain open communications and initiate end of life care discussion when appropriate or whenever Betty and her family show concern about her medical condition and decline in health.
3. Betty needs the staff to listen actively, giving their full attention and maintaining eye contact.
4. Betty needs the staff to try to be comfortable with silence if Betty cannot find the words to express her feelings.
5. Betty needs the staff to acknowledge concerns and check your understanding by clarifying the meaning.
6. Betty needs the involvement of her family to inform them about her wishes, preferences and choices as appropriate.

 

 

 

 

 

 

MAINTAINING A SAFE ENVIORNMENT

The role of a Health Care Assistant in maintaining a safe environment includes:

Being aware of and adhere to the HAS Health and Safety regulations (2005) and of the facilities’ policies and recommendations when it comes to Health and Safety.

Effective Housekeeping by the healthcare assistant can remove some workplace hazards by getting the job done safely and properly they can eliminate the hazards that can cause injuries. They are also responsible for keeping the floors, halls and fire exits free of trip and slip hazards by removing rubbish/objects thereby, keeping the clients environment safe. The healthcare assistant is responsible for ensuring that the bed is at correct height and that the breaks are on.

Good housekeeping is an on-going process; it is not a trial and error clean up done only occasionally; occasional panic clean ups are ineffective and costly in reducing accidents! Principals and Procedure are more than just policy. The Control procedures of Good Housekeeping include:

• Keep entrances and exits clear.

• Follow safe work procedures required by law.

• Keep entrances and exits clear.

• Follow safe work procedures required by law.

• Report or fix damaged or broken equipment etc.

• Clean up leaks or spills quickly and properly.

INFECTION CONTROL:

Correct hand washing and the use of PPE, the correct disposal of clinical waste including sharps; segregation of laundry; correct use of manual handling equipment is of paramount importance when it comes to infection control.

EATING AND DRINKING:

A healthcare assistant is also responsible for making sure that the client has the correct cup/beaker for the individual and be aware of any client that may require assistance in drinking in order to prevent the hazard of burning. The healthcare assistant should be acutely aware if a client requires thickener in their drink and what level. If unsure, they should ask the nurse in charge for verification. When feeding a client they should follow the correct procedure and if they observe a client unable to tolerate a normal diet they should report this to the nurse in charge. Doing so, they are eliminating the hazard of choking.

MOBILISING:

The Healthcare assistant is responsible for ensuring that the environment is safe for the clients to mobilise. They have to assess the area in which the client is mobilising or being transferred. They have to remove any objects that may obstruct the client from mobilising safely. They have to use the correct equipment required as indicated by the occupational therapist and notify the staff nurse if they have any concerns that the equipment is no longer appropriate. They have to check the equipment is in good working order, for example, the hoist is charged, the correct sling is used, the wheels on the wheelchair are inflated and the breaks are working. If there are any concerns, they have to report and document it.

They should ensure that there is adequate lighting for the clients’ to mobilise; ensure the clients’ have easy access to the call bell in order for the client to be able to communicate to them that they require assistance for toileting, for example. This eliminates the risk of a client attempting to go to the bathroom on their own and potentially falling in the process.

In the case of a confused client, the healthcare assistant should ensure that the client has all of their most frequently used items within easy reach.

PROMOTE CLIENT INVOLVEMENT IN SOCIAL EVENTS AND THERAPIES

The social events and therapies in Bettys’ nursing home include:

Cognitive Stimulation Therapy: this therapy is available to clients that have mild to moderate confusion. The aim of the sessions is to actively engage and stimulate the confused clients, providing a learning environment for the clients while they benefit socially by participating in group activities. The focus of the group is to stimulate the individuals’ five senses; it focuses on communication; it uses repetition and structure; it focuses on the clients’ current abilities and not on their disabilities in a failure free environment.  www.cstdementia.com

The author promotes this social event and therapy with Betty by explaining to her what the therapy involves and asking her if she would like to attend; remind and encourage her to attend. Guide her to the room and observe how the therapists stimulate Bettys’ memory in order to know how to reinforce the therapy.

Bettys’ favourite day is Tuesday: Dog therapy. Having had to give up her”babies” due to her confusion, she really enjoys dog therapy. The author will promote this therapy by reminding Betty that the therapy is starting; Guide her to the room; encourage Jack, her son to bring in her dogs for a visit when he can.

Betty enjoys attending the Sing Songs on Mondays and Wednesday. The author will promote this social and therapeutic event by yet again reminding her to attend and to guide her to the location. The author could also access the music Betty likes to sing along to and play the music for her when she is in her room.

The clients regularly go out in a tour with the activity coordinator. The author will find out where and what Betty will be going and doing. If Betty has said in the past that she had enjoyed that particular tour, the author will promote the social event by encouraging Betty in an enthusiastic manner for her to go.

Betty enjoys reflexology. The author will promote this therapy by encouraging Betty to attend and to guide her to the therapy.

MOBILITY INCLUDING FALLS AND PRESSURE AREA CARE

According to the HSA 2008, risk assessment, has an impact on how an organisation can achieve its’ objectives it has outlined. It adopts the Impact, Cause and Context approach. The HSA has set out guidelines where healthcare professionals should identify potential risks and the impact on an individual if that were to happen. If an incident does occur, i.e. a client falling or a client developing a pressure sore, they should determine any short comings on their initial assessment; determine the cause and how this happened. Control measures should be put in place in order to reduce or eliminate these risks, these include: training, procedures, engineering controls, policies and team working.

A healthcare professional is part of a multi-disciplinary team, and should report any concerns regarding their clients’ risk of falling or developing a pressure sore to the nurse in charge. Thereby, an action plan can be implemented: a referral to the OP and/or the tissue viability nurse.

Although, a client, such as Betty, is holistically assessed on admission, this process is ongoing. She is constantly being reassessed in all aspects of her individual care. Due to Bettys’ reduced mobility, age and cognitive status with a waterlow score of 20, she is in the high risk category of developing pressure sores.

The healthcare assistant has to be alert at all times of any risks to their clients’ in relation to the prevention of falls and pressure area care. Re: Mobility, they should follow the OT’s guidelines in moving and handling, however, constantly assessing on a personal level the clients’ ability and communicating any deterioration in mobility to the staff nurse.

Re: Pressure area care, the healthcare assistant has to be vigilant at all times when caring for clients’; knowing what the waterlow score of their client is and implementing any recommendations and equipment that have being advised;  however, being constantly aware of their pressure points and if any redness is identified immediately report to the staff nurse for reassessment. Promotion of continence by regular prompting to go to the toilet giving gentle guidance and assistance, especially in the case of a confused client(like Betty), and educating the individual in proper peritoneal care is vital in maintaining skin integrity.

EFFECTIVE VERBAL AND WRITTEN COMMUNICATION WITH CLIENT AND THE HEALTHCARE

Multidisciplinary Teams have a Common Purpose:

• Leadership is needed to keep focus on achieving the outcomes.
• Resources are needed to be able to achieve the outcome.
• Communication is needed to understand what needs to be done; how much we have left to do on any issues/problems which may stop us achieving the outcome.

Teams tend to make better decisions than individuals.   As individuals they have complimentary capabilities, and by working in synergy productivity is higher.  By playing to their strengths each team member can focus on whatever aspect of the project that they feel comfortable with.

COMMUNICATION:

Communication is a two way process which involves transferring information. It is of vital importance that when preparing any important communication:

• PURPOSE: The Objective
• AUDIENCE: Who you are communicating with
• STRUCTURE: Material
• STYLE: Vocabulary, Tone of voice; information from one person to another

The sender turns an idea into a message using words/pictures. The message is sent through a medium to the receiver. The receiver interprets the message and acts upon it. Communication is essential within an organisation because without it a team will struggle to function and to co-ordinate the activities within the organisation.

INTERNAL COMMUNICATION:

This is communication between two or more people within a business such as a nursing home. The methods of internal communication include:

VERBAL	WRITTEN	VISUAL
Formal meetings	Letters	Posters
Handover	E-mails	Graphs/Charts
Telephone	Memos	Website
Intercom	Eipicare	Pictures

Epicare, is a useful tool used in Bettys’ nursing home. It is a computerised system whereby healthcare assistants communicate the care that has been given to each individual client. It helps monitor, for example, nutrition, fluid intake, hygiene and elimination.

NON-VERBAL CUES THAT SHOWED UNDERSTANDING:

• I noticed that during meetings with the team/ interacting with clients gave good eye contact.
• Nodded and on occasion.
• Leaned forward, showing interest.

VERBAL CUES THAT SHOWED UNDERSTANDING:

• I noticed members’ saying things like “I see”, “I know”, “I understand”, “Thank you”
• Asked opened questions.
• Asked specific questions to seek clarification.
• Waited to disclose their opinions.
• Asked opened questions.
• Asked specific questions to seek clarification.
• Waited to disclose their opinions.
• Disclosed similar experiences to show understanding/
• Demonstrated concern.
• Paraphrased to show understanding.
• Building trust and establishing rapport.

BARRIERS TO EFFECTIVE COMMUNICATION:

LANDGUAGE:

The sender of the message should not use language that is too technical or difficult for the audience to understand. It may also frustrate and confuse the audience. The message should be targeted correctly at the ability of the receiver. The sender should avoid using technical jargon, use simple concise sentenced and use visual support to enhancethe communication.

INFORMATION OVERLOAD:

Message containing too much information can make it difficult for the receiver to absorb all the information. The receiver can become confused and may not understand the message. This can lead to tasks being completed to an insufficient standard or not being completed at all.

TIMING:

The receiver may not be given sufficient time to read, listen, understand and respond to the message. This makes the communication useless. The sender should not expect an immediate response. They need to give adequate time to fully understand the message and give an appropriate response.

TRUST:

The receiver may not trust the sender of the message and will not listen to the message. They may not believe the message or take necessary action once the message has being received.

NO FEEDBACK:

The sender may be looking for feedback in order to take further action. For example: the staff nurse may require information from the healthcare assistant before referring a client to OT, Physio. Tissue Viability Nurse etc. A feedback mechanism needs to be built into the communication process to ensure the correct action is taken. For example: a specific time slot for feedback/questionnaire.

ASSIST CLIENTS WITH ACTIVITIES OF DAILY LIVING

MAINTAINING A SAFE ENVIRONMENT:

Betty is semi-independent when mobilising with her Zimmer frame.

• When mobilising Betty you need to guide her to the toilet, dining room and to the activities room as sometimes she forgets her limitation with her mobility and poses herself more at risk of falls.
• Provide Betty has her call bell and most frequently used personal items within reach.
• Give verbal reminders to Betty to use the call bell when assistance is require Betty needs to have shoes that are well fitting and have non-slip soles.
• Provide Betty with clothing that she can easily manage when she gets up to the toilet unassisted.
• Ensure that Betty has an uncluttered environment and adequate lighting. You should provide her with a night light as Betty may get up at night to use the toilet.

COMMUNICATION:

Confusion and intermittent Hallucinations:

• Monitor Bettys’ deterioration in her cognitive status.
• Ensure that Bettys’ GP to continuously review her and communicate with Betty and her family to update them regarding her current condition.
• Give Betty comfort and reassurance verbally and non-verbally when she is having hallucinations, until she settles as this can be a frightening time.
• Try distraction techniques by making reference to Bettys’ family, to whom she is very close to, to try to lessen the impact of the hallucinations.

BREATHING:

• Encourage Betty to cut down on smoking.
• Use distraction techniques when Betty asks to have a cigarette.

EATING AND DRINKING:

• Remind and encourage Betty gently that she has her food and drink in front of her when she is in a confused state.
• Monitor Betty, when confused, in case she may spill her hot/or cold drink to prevent injury.

ELIMINATION:

• Provide Betty with an adequate supply of continence wear, slip pad.
• Ensure wet continence wear are removed from the bin in Bettys’ bathroom every day.
•  Offer Betty cranberry juice regularly with snacks to prevent UTI and avoid any further periods of incontinence.
• Observe Betty for complaint of increasing periods of incontinence which may suspect cause of UTI.
• Initiate bladder training by providing schedule of regular toileting two to three hourly with specified time for Betty to void.
• Staff to remind Betty discreetly to change continence wear regularly to prevent skin irritation and to ensure she is free from the odour of urine.
• Educate Betty about proper hygiene and disposal of wet continence wear.

WASHING AND DRESSING:

 

• Assist and Guide Betty when necessary to maintain a high standard re: Hygiene needs.
• Give Betty a choice whether she would like a shower etc. on a daily basis, giving constant gentle encouragement and reassurance.

CONTROLLING BODY TEMPERATURE:

 

• Observe and interact with Betty to determine whether she may need assistance or guidance putting on/taking off clothing due to changes in temperature.

MOBILISATION:

 

• Betty is a high risk of falls when confused. Supervision of one on mobilisation is required at all times.
• Encourage Betty to use her walking frame as indicated by the OT dept.
• Gently guide Betty to her destination as she can often get aggressive when approached in an abrupt manner.

 

 

WORK AND PLAY:

 

• Inform Betty what activities are on daily. She loves attending dog therapy and others as documented earlier.
• Encourage, assist (when necessary) and guide Betty to the activities and social events she wants to attend. This can change daily, depending on her mood. Never force her to attend, even if she may have enjoyed it in the past, it will only agitate Betty more and increase her risk of mobilising unattended/ falls.

             EXPRESSING SEXUALITY:

• Gently prompt and encourage Betty to use her creams, make-up and jewellery as she has always used before diagnosis and admission.

              SLEEPING:

• Provide a night light for Betty in case she wakes up and is disorientated/needs to mobilise to the toilet with guidance.
• Give reassurance to Betty when she calls out for Mick and her “babies” in the early hours of the morning, as she is confused and disorientated and this is very distressing for Betty.
• Offer Betty a hot milky chocolate and stay with Betty and try to reorient her as to where she is etc. until she settles back to sleep.

 

DYING/ ADVANCE PLANNING:

• Keep alert for cues that Betty and her family want to discuss end of life issues.
• Maintain open communications and initiate end of life care discussion when appropriate or whenever Betty and he family showed concern about Bettys’ medical decline in health.
• Listen actively, giving your full attention and maintaining eye contact.
• Try to be comfortable with silence if Betty cannot find the words to express her feelings.
• Acknowledge any concerns and check your understanding by clarifying the meaning.
• Involve Bettys’ family to learn about her wishes, preferences and choices.

 

 

PROMOTE THE RIGHTS OF THE CLIENT TO DIGNITY, PRIVACY, INDEPENDENCE AND POSITIVE SELF-IMAGE.

A Healthcare assistant has a Duty of Care to Protect Each Individual Clients’ Dignity, Privacy, Independence and a Really Positive Self-Image.

DIGNITY AND PRIVACY:

When caring for any client, the healthcare assistant has to be acutely aware that the dignity, privacy and respect of every client is of paramount importance and has to be protected at all times. They, including the author, have very intimate knowledge about their past history and their current condition. This is privileged information and is highly confidential. Under any circumstances should any of the clients’ information be discussed outside the multi-disciplinary team. Any written communication e.g. handouts at handover, should be shredded when the shift is completed.

When caring for an individual, doors and windows should be closed to protect the clients’ privacy and dignity. If, for example, an individual requires a hoist transfer/bed bath or chosen to wash at their sink, the carer should protect their privacy and dignity to the best of their ability; always conscious of the individuals’ feelings and if they were in that position, how would they feel/cared for.

INDEPENDENCE:

Individual clients’ independence should be promoted at all times. Clients’ are being cared for over a 24 hour period; there is no rush!. A true example that happened the author today:

The author offered to assist a client with his/her breakfast this morning. Earlier it was communicated that a client appeared to consume very little as their family was ordering the exact same food for the client every day. On interaction, the author approached the client in a friendly and gentle manner.The Authorapproached the subject in a sensitive manner, encouraging the client, to order his own food; without being disrespectful to family members. Told the client that they can clearly express what they would like to have and to stand up for them. The client said it was refreshing to hear that they had options and had being going along with everything just to keep the peace!! Said that things were going to change from now on!

The client took their time eating, we a little chat when half of the food was consumed, when I was making the clients’ tea. A senior individual storms into the room and said “shower time”, I explained that the client hadn’t had their tea and toast yet! She replied: “it’s nine o’clock, everyone has to be finished now!! You have been in here ages!!”. I felt so bad for my client and somehow got the courage to say” that if he/she wants to take time over their breakfast, that’s their choice”!

When she left, I apologised for her behaviour and reassured the client that they can take as long as they want to eat their breakfast and not to worry; there is plenty of time in the day!! When I met the staff member a few mins later, she confronted me again about the length of time. Then she said when you’re not here we feed the client. I was dumbfounded! The client had been obviously been assessed by OT as there was adapted utensils available. Surprised myself for the second time in one day and replied “why would you feed the client when they can feed themselves with minimum assistance?  Her reply was she didn’t like my approach, ever heard of time!

POSITIVE SELF IMAGE:

A healthcare assistant has the ability to promote a positive self-image in their clients’ in a number of ways including:

• Continually reassuring the clients re: how well that they are doing/completing tasks, such as transferring; caring for their own hygiene needs, to the best of their ability.
• Complementing the clients on their appearance, saying how good they look, that you their style, hair, make-up or how lovely they appear to smell.
• Toilet regularly, in the promotion and education of continence care.

 

 

 

 

 

 

 

 

 

 

 

 

 

   

ACTIVITIES OF DAILY LIVING.

MAINTAINING A SAFE ENVIRONMENT

PROMOTE CLIENT INVOLVEMENT IN SOCIAL EVENTS AND THERAPIES

MOBILITY INCLUDING FALLS AND PRESSURE AREA CARE

EFFECTIVE VERBAL AND WRITTEN COMMUNICATION WITH CLIENT AND HEALTHCARE TEAM.

ASSIST CLIENTS WITH ACTIVITIES OF DAILY LIVING

PROMOTE THE RIGHTS OF THE CLIENT TO DIGNITY, PRIVACY, INDEPENDENCE, POSITIVE SELF-IMAGE.

 

 

 

CONCLUSION

 

In this assignment I have:

1. Developed a client profile and assessed the individual client needs.
2. Determined the level of assistance required to complete the activities of daily living.
3. Maintained a safe environment
4. Promoted the client involvement in social events and therapies.
5. Assessed mobility and falls and pressure area care.
6. Communicated effectively both written and verbally with the client and the healthcare team.
7. Assisted the client with the activities of daily living.
8. Promoted the rights of the client to dignity, privacy, independence and positive self-image.