105 dem 304 workbook
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Unit 105 (3565) (DEM304 4222-36) Knowledge Workbook
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eor na%e' +E 2124This unit is about developing the learners knowledge, understanding and skill ofenabling the rights and choices of the individual with dementia whilst minimisingrisks.You will also be observed in your workplace environment
You must understand your organisations policies and procedures before attempting
to answer the learning outcomes
Read the guidance on the terms used in this workbook before you start.
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&earner e%ent +e!ord
Unit $%ber' 105 (DEM304)
Unit itle' Enable right and !hoi!e o" indi#id$al with de%entia whilt%ini%iing rikDate Workbook $b%itted' 1t ##########.. 2nd ##########..
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%utcome
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nd (ubmission
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$earning outcomes .1+ .+ !.1+ *.+ *.! must be assessed in a real work
environment and your &ssessor will agree additional methods to cover these,
including observation of your practice
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&ssessor comments to $earner
Target date and action plan for resubmission if applicable-
%utcome of second submission
confirm that this assessment has been completed to the re/uired standard and
meets the re/uirements for validity, currency, authenticity and sufficiency
&ssessor (ignature0 ate0
confirm that the assignment work to which this result relates, is all my own work
$earner (ignature0 ate0
nternal 2erifiers (ignature0 ate0
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dditional g$idan!e
Ke legilation0
3 4uman Rights &ct 1556
3 7ental "apacity &ct 889
3 &dults with ncapacity (cotland- &ct 888
3 7ental 4ealth &ct 88:
3 The isability iscrimination &ct 1559
3 (afeguarding 2ulnerable ;roups &ct 88ample =ric, who is a colleague of 7arieHs, always leaves the door open a bitwhen he takes individuals to the toilet0 anyone passing by can see that he is in there
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http://www.publicguardian.gov.uk/mca/code-of-practice.htmhttp://www.publicguardian.gov.uk/forms/additional-publicationsa-newsletters.htmmailto:[email protected]://alzheimers.org.uk/site/scripts/documents_info.php?documentID=1327http://www.publicguardian.gov.uk/mca/code-of-practice.htmhttp://www.publicguardian.gov.uk/forms/additional-publicationsa-newsletters.htmmailto:[email protected]://alzheimers.org.uk/site/scripts/documents_info.php?documentID=1327 -
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with someone. The staff are now having a discussion about whether it should be shutand, if so, locked or not. =ric says he is Jcovering his back but some people weresaying that =ric is not doing his Iob properly. 4e can reasonably say that he does notknow what Jproperly means until the staff group make up their minds.
Aorkers providing intimate care emphasise the formality of their roles to compensatefor the crossing of boundaries. t is difficult to hold workers to account for intimatecare tasks when no one has spelt out how they want these to be done. &greedprocedures provide one Jbenchmark for good practice which can protect individuals,staff and workers.
(elect one of your Policies that mention that the rights and choices of the individualsmust be respected. Read it through and then e>plain what o$actually do to withthe individual that shows their rights and choices are respected. "omment on howyou think the Policy itself could be improved or how staff could comply with it better.7inimum 198 words-
@ame of Policy0
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&earning $t!o%e 1,3 E:.lain how and when .eronal in"or%ation %a behared with !arer and other; taking into a!!o$nt legilati#e "ra%ework andagreed wa o" working
The ata Protection &ct 1556 is legislation designed to protect the rights of anyone
on whom personal data information- is held and used. This information can be heldin any format, including on paper or P", ""T2 or audio recording.
& variety of organisations, both public and private, hold personal data. The ataProtection &ct is concerned with the way in which these organisations collect, holdand uses this data.
Those involved in (ocial "are rely heavily on the use of personal data and thereforewe need to ensure that all necessary steps are taken to comply with the ataProtection &ct. Ae also hold what is called Jsensitive data, information on areassuch as health, ethnicity and religion. This type of data is subIect to more rigorous
regulation.
&s someone working within (ocial "are you will almost certainly have access topersonal data that is covered by the &ct so that you can help provide services.Ahilst your employer is responsible for ensuring this data is used correctly, as anemployee you are also re/uired to comply with the detail of the &ct.
Personal data is information about a living individual and from which the individualcan be identified. @ormally the data must be held in such a way that it can be readilyaccessible, i.e. in a structured way such as within a filing system or on a P".4owever (ocial "are case records are covered by the &ct no matter how held.
The %ffice of the nformation "ommissioner offers advice and guidance to bothorganisations and the public on the content and meaning of the ata Protection &ctand has a web site at www.informationcommissioner.gov.ukReviewing an individualHs current situation is difficult without access to good records.@o one worker can know everything that has gone on recently.<hough care staff often find time for paperwork is limited, keeping good records isessential. t can form an obIective basis to deciding whether something really is aproblem after all, and to seeing if there are any patterns to difficult situations.
t is also where you e>plain your reasons for taking any restraining action ? animportant legal record. f you are unsure about what to write when recording difficultsituations, discuss this with your manager.
$ife 4istory work"ase study0 $illian lived in a care home and lately had been spending time with herkey worker, working to pull together her life story. The key worker wrote out $illiansstory in detail and included photos and mementos that were important to her. uringthat time the key worker realised that $illian was finding it very helpful emotionally toshare her feelings about living with dementia. The key worker also found it a veryinteresting process. (he realised that this could be a useful learning e>perience for
others to learn about life story work, but also to learn about how it feels to live withdementia.
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=ffective communication is essential to facilitating meaningful contact with people inthe late stage of dementia. 7any will have lost the ability to communicate verballyand are likely to be e>periencing significant problems understanding what is beingsaid to them and what is going on around them.
;ood communication is a key goal of person centred care. This is an approach todementia care whereby people with dementia are treated as individuals with auni/ue identity and biography and are placed at the centre of all care activitiesKitwood, 155:-.
The 1carer is often a key source of information about the cared for person+ they arean Je>pert in her)his personality and characteristics. 'or e>ample, their taste, likes,dislikes, favourite food, T2 programmes, clothes, past occupation and interests. Thecarer can act as a Jbridge into the cared for persons world and needs.
ts very important to keep carers up to date with information about their loved oneand to make them feel welcomed and supported. 7any carers want to continueproviding some care to their relative and this is to be encouraged. This may behelping them bath, assisting with eating at meals, dressing them or simply talking tothem about shared e>periences and their past life.
'or spouses or couples in particular privacy is essential+ they need an e>clusivespace that is comfortable and free from interruption. <hough lifelong partners maybe obliged to live apart from one another that does not mean the end of what may bea loving and affectionate relationship.
1The Jcarer in this conte>t is not a paid member of staff
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Think about an individual you support who has dementia. Ahat information hasbeen shared with you about them and how has it helped you and the individualC7inimum 88 words-
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&earning $t!o%e 2,3 E:.lain wh it i i%.ortant not to a$%e that anindi#id$al with de%entia !annot %ake their own de!iion
ecisions cannot be made for a person with dementia unless there is evidence thatthey cant make the decision themselves. This is called a mental capacity
assessment.Knowing a person has dementia is not enough to say they cant make a decision.You need to be clear about the reasons why the person cant make the specificdecision under consideration."are staff must have a Jreasonable belief that a person cant make a decision beforedoing anything in their best interests.t is good practice to write down the reasons why a person with dementia cant makea particular decision.
ont assume that people with dementia cant make decisions themselves.
People with dementia should be given all possible support to make their own
decisions.
You need to think about the best time, the best person and the best way to
talk about the decision.
You may need a translator if the persons first language is not =nglish. You
should also check if the person uses a hearing aid.
Pictures can help some people make their own decisions, but they may need
their glasses.
Think about an individual you support who has dementia. Ahat decisions are theystill able to make both on their own and with your supportC Ahat decisions do you
have to take on their behalf and whyC 7inimum 198 words-
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&earning $t!o%e 2,4 /ow the abilit o" an indi#id$al with de%entia to %akede!iion %a "l$!t$ate&earning $t!o%e 3,2 /ow a !on"li!t o" interet !an be addreed between the!arer and an indi#id$al with de%entia whilt balan!ing right; !hoi!e and rik
People have the legal right to make their own decisions about things such as whatmedical treatment to accept or where to live, as long as they have the capacity to doso. This applies to people with dementia too. &s dementia progresses, however, itcan get harder for people to make their own decisions.
The law says that it must always be assumed that someone can make their owndecisions, until it is shown that they no longer have capacity to do so. Aheredecisions are made for people who lack capacity, such decisions must be in thepersons Jbest interests.
Ahen working out Jbest interests it is important to take into account both the pastand present wishes and feelings of the person with dementia, even though they maybe /uite different.
d#an!e de!iionPeople who can still make their own decisions sometimes write Jadvance decisionsalso called Jadvance directives or Jliving wills- to say what kind of care or treatmentthey want in the future when they are no longer able to decide for themselves.&dvance decisions to refuse treatment are legally binding, as long as they have beenproperly made.
(ome people see advance decisions as a good way of making sure their wishes arefollowed in the future. %thers believe that we can never Jsecond?guess what we willwant in the future, and that an advance decision may lead to bad care.
Wel"are attornePeople who are still able to make their own decisions may choose someone theytrust to make decisions for them in the future. The person chosen is known as aJwelfare attorney. The welfare attorney must always act in the best interests of theperson with dementia when making decisions.
Aelfare attorneys have many advantages over advance decisions, as they have up?to?date information about the decision to be made. 4owever, there are concerns thatsome people may find it too e>pensive or complicated to nominate a welfareattorney.
http0))www.nuffieldbioethics.org)sites)default)files)files)dementiaDresourceDmakingDdecisionsDbackground.pdf
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http://www.nuffieldbioethics.org/sites/default/files/files/dementia_resource_making_decisions_background.pdfhttp://www.nuffieldbioethics.org/sites/default/files/files/dementia_resource_making_decisions_background.pdfhttp://www.nuffieldbioethics.org/sites/default/files/files/dementia_resource_making_decisions_background.pdfhttp://www.nuffieldbioethics.org/sites/default/files/files/dementia_resource_making_decisions_background.pdf -
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&n ethical framework for dementia=thical decisions can be approached in ! stages0
1. dentify the facts e.g. Ahat is the real problemC 4ow much distress is itcausingC Ahat are the real alternativesC-
. &pply ethical valuese.g. well?being, avoidance of harm, freedom to make owndecisions-,to the facts identified
!. "ompare the situation with other similar situations to find relevant similaritiesor differences
"ase (tudy e>ample0 "onsider a :8?year?old man, 7r P, living with his daughter.Ahen his daughter is cooking, 7r P fre/uently Ioins her in the kitchen and gets in theway of the cooking. 7r Ps daughter is tempted to lock the kitchen door whilst she iscooking to prevent 7r P from entering, but she is not certain whether this is the right
thing to do.
1. dentify the relevant facts
The degree of danger and distress to 7r P when the kitchen door is locked.
The length of time he remains distressed after the cooking is finished.
The danger if 7r P is in the kitchen.
The effect on his daughter of his being in the kitchen during cooking and thee>tent to which this interferes with the cooking.
Ahat 7r P might have thought about this situation had he considered it before
the onset of dementia.
Ahat he is currently able to do.
. &pply ethical values to the facts
&t first it might seem that 7r Ps right to choose would favour allowing him intothe kitchen, since locking the door restricts his freedom and his behavioursuggests that he wants to be in the same room as his daughter.
4owever, 7r Ps previous wishes, at a time when he would have understood
all the relevant issues, might have favoured enabling his daughter to get onwith the cooking unimpeded.
'actors affecting 7r Ps well?being, such as avoiding harm for e>ample
burning himself on the hot stove-, also need careful consideration.
'inally, the interests of 7r Ps daughter must also be considered.
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!. "ompare with similar situations
'or e>ample, 7r Ps daughter might already have had to make a decision
about whether or not to leave her father in the house alone whilst she goes
shopping.
4er deliberation and the decision she made in that situation may be highly
relevant to the issue of whether to lock the kitchen door.
& health professional such as a community nurse might be able to help the
daughter by comparing her situation with that of other families, advising onwhat has worked elsewhere, and perhaps also by identifying a solution whichmay remove the problem altogether.
"arers of people with dementia need more support and advice to tackle the difficultethical dilemmas that they face. The @uffield Lioethics "ouncil has published areport which sets out an ethical approach to dealing with these dilemmas.9ind o$t %orehttp0))www.nuffieldbioethics.org)dementia
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http://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementiahttp://www.nuffieldbioethics.org/dementia -
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"ase (tudy0 avid is :*years old and has had dementia for * years. avid hasalways been very active and independent, and enIoys going for walks or goingshopping by himself. & few times in recent months avid has become confusedwhile on trips to the town centre. 4e has returned home very late several times, andonce his wife 7argaret had to search for him, finding him in a confused and
distressed state. 7argaret is worried about avid going out by himself, and isconsidering stopping him leaving the house on his own
Mse the ethical framework described previously. Aork through the ! stages anddescribe what can be considered to try and support avid and 7argaret, now thathis ability to go out alone safely is fluctuating 7inimum 198 words-
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!Person?centred care has been a guiding principle for good care practice for manyyears. t was included as one of eight key standards in the 18?year governmentprogramme, the @ational (ervice 'ramework for %lder People 881-. n this generalsense, person?centred care means treating people as individuals with dignity andrespect, and enabling people to make choices about their care based on their needs,
preferences, interests and life history.
Person?centred care has been a particularly important concept in dementia care.&ccording to Lrooker 88tensively, person?centred care with people with dementia means0
valuing people with dementia and those who care for them
treating people as individuals
looking at the world from the perspective of the person with dementia
a positive social environment in which the person living with dementia can
e>perience relative wellbeing.
To find out more, look at the following resources0&lBheimers (ociety 886- Ahat standards of care can people e>pect from a care homeC 'actsheet.$ondon0 &lBheimers (ociety.Lrooker, . 88.asp
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Le open and positive.Ahen difficult situations develop ? perhaps an individual is doing something that ishard to respond to, such as repeatedly striking staff ? it can be tempting for staff tothink Hthis individual canHt stay hereH.
The most important thing is to try to be open and positive about the potential you andyour staff team have to improve the situation.(o often, with reflection and teamwork, staff can work together to develop an actionplan to respond differently and ensure the placement continues smoothly. (taffbenefit from this approach too in many ways.
You are not aloneYou may find yourself alone with an individual when a difficult situation arises, but ina care home another staff member should be nearby and able to help. &lways call onteam support in these urgent situations. 4aving another person witness the eventcould be vital too. n the community you may have support from a loved one who
lives with the individual.To make plans about using restraint in the longer?term, remember that good decisionmaking involves consulting with all relevant parties, including the individual, familymembers, friends, the manager, other involved professionals say a ;P-, and, insome particularly difficult cases, the inspection services.
Aorking with people with dementia can be very rewarding. Lut situations can arisethat are difficult for the person with dementia or those supporting them O or bothparties.
&earning $t!o%e 3,3 De!ribe how to en$re an indi#id$al with de%entia;!arer and other "eel able to !o%.lain witho$t "ear o" retrib$tion
The "are uality "ommissions =ssential (tandards of uality and (afety %utcome1: state0
Ahat should people who use services e>perienceCPeople who use services or others acting on their behalf0
&re sure that their comments and complaints are listened to and acted on effectively.
Know that they will not be discriminated against for making a complaint.
This is because providers who comply with the regulations will04ave systems in place to deal with comments and complaints, including providing
people who use services with information about that system.
(upport people who use services or others acting on their behalf to make comments
and complaints.
"onsider fully, respond appropriately and resolve, where possible, any comments
and complaints.
&lways remember, clients are your customers and as such have the right to e>pect acertain standard of service from you and your organisation.
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*Aorkers have to work within constraints imposed by their employers. 4owever,within these constraints there are choices. epending on the choices you makeindividuals will feel you are on their side, indifferent or wanting to control them byabusing the power you have over them. You can contribute towards their feelings ofwell?being or their hopelessness and powerlessness.
Ahen people feel empowered they are more confident to say when things are not
right for them. This includes their carers and anyone else involved in decision
making for the individual who has dementia.
@ot every care provider will live up to every aspect of person?centred care all thetime. (taff may adopt a patronising or degrading attitude, and in some services,people with dementia may even be vulnerable to physical or psychological abuse orgeneral neglect.
n these situations, the person with dementia may not be willing or able to complain ?either because it is difficult for them to Hmake a fussH or because they are afraid ofbeing victimised.
Relatives or friends of the person with dementia may have general or specificconcerns about the level of care provided. &ny care provider that is doing its best toprovide good /uality care has nothing to fear from a complaint. nstead, it should seeit as a positive opportunity to improve.
& good complaints process will not only investigate what happened on a particularoccasion but will also identify weaknesses in the overall processes of care and make
sure that the same situations or mistakes do not keep occurring
*=>tracted from http0))www.workingtogetherforrecovery.co.uk
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"ase (tudy0 You support Nohn who has dementia. 4e lives in a care home where
they have many group social activities and encourage everyone to Ioin in. Nohn gets
very an>ious in groups of people and his behaviour shows that he does not want to
be in situations like this. Nohns wife mentioned this when he was admitted but has
noticed when she visits he is often sat in a group and looking very an>ious. (he hastold you that she is worried about this but does not want to cause trouble as
everyone seems very caring.
=>plain how you would support her to raise her concern formally in line with your
workplace policy and procedures and how you would reassure her it was %K to do
so. 7inimum 188 words-
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&earning $t!o%e 4,1 /ow to %aintain .ri#a! and dignit when .ro#iding.eronal $..ort "or inti%ate !are to an indi#id$al with de%entia
5<hough it may be undesirable to cut across the informality of care relationships bymaking unnecessary rules or regulations, intimate care is clearly one site where
things can go wrong. There is a narrow margin of error. The usual social rules andinhibitions have already been broken and it is not always easy to arrive at new oneswhich are appropriate to the particular conte>t within which you are caring or beingcared for. 7oreover, receiving or giving care arouses strong feelings which peoplerarely put into words.
magine that you need help to go to the toilet. You have dementia. Arite down threethings which your helper could do to ease any embarrassment or discomfort youmight feel, and three things which would make the whole situation even worse. Thinkabout who could be helping you in this situation, their gender, their relationship toyou, their manner, what they say, their facial e>pression, and so on. 7inimum 88words-
9http0))openlearn.open.ac.uk)mod)oucontent)view.phpCidF!568!EsectionFcare
%>fordshire $earning and (kills (erviceMnipart 4ouse
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