Care planning Process

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Unit 20- Care planning
Process
SESSION 5
Objectives
Roles and responsibilities in promoting person centered care
Demonstrate the promotion of an individual’s holistic wellbeing
through effective communication when implementing a plan of care
in own workplace
Review the application of risk assessment process in promoting
person-centred planning
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Person Centred Care
Person centred care involves taking a ‘ whole –person’ or holistic approach. Each
individual care needs, wants and preferences. They can be physical , psychological,
emotional, social, spiritual, cultural and religious.
Care approach needs to address all these interconnected needs of the patience hence a
holistic assessment / approach is required.
Holistic approach: Understanding and values the person’s:
1. Strengths and abilities to participate
2. Preferences
3. Feelings
4. Needs for privacy, dignity and control
By addressing all these needs, a person centred care is achieved.
Holistic care
Holistic care is about seeing that people
have a range of needs and that these
needs are not handled in isolation. The
whole persons needs are considered and
attended too
Aspects of holistic care
Physical- warmth , shelter, food and drink
Psychological- wellbeing
Emotional- love, happiness, hope,
security
social- relationship, companionship,
interaction
Spiritual- sense of belonging, being at
peace, purpose
Cultural- customs, languages and
ethnicity, preferences
Religious- Being close to one’s God,
worship, holy book.
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Promoting Holistic wellbeing
Holistic Assessment
• Assessment involve the persons physical, psychological, social ,
spiritual and emotional.
• Holistic assessment involves understanding the relationships
between these elements and although they may be assessed
separately they all contribute towards the whole experience and
person.
Communication
Communication is essential to care, health care professionals need to be
able to demonstrate that they listen and provide information that is clear,
accurate and meaningful at the level at which the patient/client can
understand.
Ensure various types of communication are used appropriately to meet the
clients needs
WOVEN
Written , Oral, Visual, Electronic and Non-Verbal
In groups give examples of how you use types of communication to address
clients needs holistically when making person centred care.
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Communicating effectively both orally and in
writing by ensuring:
The meaning is always clear
It provides guidance
Active listening to clients needs, wants and preferences
It is sensitive
It uses a range of methods and styles
It is comprehensive
It is evidence-based
Records information accurately and clearly
Confirms understanding
Responds appropriately
Appropriate documentation (Recording and Reporting)- Clients health and well being status
Applies to principles of confidentiality and data protection by following local policies, ensuring
disclosure is managed appropriately and safely.
Video Holistic Assessment
https://www.youtube.com/watc
h?v=6WOlzUrWFjY
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Role of effective communication in care
planning process
Involving friends and family, as appropriate
Referral and problem-solving
Use of risk assessment tools
Recognising norms and implications of deviations
Reporting concerns effectively
Checking measurements
Accuracy in recording
Interpreting results to inform care planning
Setting realistic targets to make improvements in conditions
Multidisciplinary team in care planning process
Charlotte Green
Pharmacist Tech Mr Shah
Pharmacist
Liam Short
Staff Nurse
Abe Kamole
Staff Nurse
Ann Lynch
Ward Sister
Helen Roberts
Relief Sister
Jane Hughes
Patient
Jazmin Munroe
Consultant
Fiona Livingstone
Specialist Registrar
Duncan Campbell
New Specialist
Registrar
Joe Robinson
Relief Junior
Doctor
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How to promote holistic wellbeing through
assessment
Types of interventions reflected in care plans:
Medical interventions
Pain Assessment
Social care interventions
Therapeutic interventions
Multidisciplinary approaches
Providing personal care
Hygiene
Meeting dietary needs
Cleanliness of the living and working environment
Supporting daily living activities
SSKIN (surface, skin inspection, keep moving, incontinence/moisture,
Nutrition/hydration) bundles approach to pressure ulcer prevention/care
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Using SSKIN to manage and prevent pressure
damage
These are the five steps that make up SSKIN
Surface: make sure your patients have the right support
Skin inspection: early inspection means early detection – show
patients and carers what to look for
Keep your patients moving
Incontinence/moisture: your patients need to be clean and dry
Nutrition/hydration: help patients have the right diet and plenty of
fluids
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What are the hazards?
Who is doing what, where & when? (WWW)
AND
Who else might be affected by what is done?
What is the degree of risk?
What do we need to, or can we, do to control
(eliminate/minimise) exposure to the risk?
How will we monitor the work/people?
Risk Assessment – the 5 steps
What comes first?
Even before the 5 steps – one question:
What is it we have/want/would like to do?
We can call this: –
The task
The job to do
The procedure
Everything can be covered in this way
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Identifying and Managing a Risk
Identify
the risk
Evaluate the risk
Risk response
(ownership and
priority)
Monitor and
review
Plan / implement
additional actions
Manage
the Risk
Can we work out how high the risk is?
What could go wrong?
What is the worst that could happen?
Consequence – severity
Likelihood
How often must it be done?
How many people do it?
Is everyone doing it competent and trained?
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Evaluating the risk
1. Highly unlikely
2. Possibly
3. Quite likely
4. Very likely
1. Slight harm
2. Injury affecting work
3. Serious injury
4. Possible fatality
Risk Assessment in care planning
Use of risk assessment tools
Recognising norms and implications of deviations
Reporting concerns effectively
Checking measurements
Accuracy in recording
Interpreting results to inform care planning
Setting realistic targets to make improvements in conditions
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Why focus on risk now?
Policy drive to give ‘choice and control’
Support for self-directed care
Enabling people to take risks they choose
DH framework for risk management
Concerns about increasing risk
Concerns about risk-averse services
Vision for adult social care seven principles
1. Prevention: empowered people and strong communities
will work together to maintain independence. Where the
state is needed, it supports communities and helps
people to retain and regain independence
2. Personalisation
3. Partnership
4. Plurality
5. Protection: there are sensible safeguards against the
risk of abuse or neglect. Risk is no longer an excuse to
limit people’s freedom
6. Productivity
7. People
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Think local act personal
Risk management and protection/ safeguarding
should be addressed in a balanced way across all
sections of the community, avoiding an approach
that views people in receipt of social care funding
as most at risk.
Assessing risk
How serious?
Vulnerability
Mental
capacity
Consent
Risk to the
person and
others
Intent
Legal Impact
framework
Frequency
Duration
Wishes of
individual
Wider context
Adapted from Hughes J (2006)
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Ensuring best practice
Ensure:
All reasonable steps have been taken
Reliable assessment methods have been used
Information has been collated and thoroughly evaluated
Decisions are recorded, communicated and thoroughly evaluated
Policies and procedures have been followed
Practitioners and their managers adopt an investigative approach and are proactive
Risk guidance for people with dementia (DH 2010)
Sharing power
Do you know what good practice looks like?
How do you involve people who use your service in running it?
You want to be innovative and cost-effective – what steps do you take to engage
the practitioner workforce in judging the risks?
Do you have a whistle-blowing policy?
What is the role of managers in setting and maintaining professional standards?
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Tool to audit power
(Braye and Preston-Shoot, Empowering practice in social care, OUP 1995)
Personcentred
services
Difference
and
diversi
ty
celebrated
People
treate
d with
respect
and dignity
Negotiation
and
fairness
about
decisions
Staff are
trustw
orthy
and
suppor
tive
Staff are
honest
and reliable
There is
involv
ement
in decisionmakin
g
Access to
inform
ation
and advice
is
given
People’s
strengths
are
recognised
Human
rights
are
upheld
Person-centred approach to risk
Smull and Sanderson, Essential Lifestyle Planning, 2005
Differences in power and status affect the context
in which people influence risk decision-making
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Six personalised safeguarding responses
Personcentred
services
Alert
Referral and
decision
Strategy
discussi
ons
Assessment
and
investigation
Outcomes
Monitor and
review
Person-centred risk assessment
Who is the person?
Where are we now?
Where do we want to be?
What have we tried and learned already?
What shall we do next?
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Employers should be alert to:
Professional standards
Inspectorate standards
Better ways of organising work
Blame
Value conflicts
Retention
Consistency and continuity
Morale and satisfaction
Dangerous people
Continuing professional development
Celebrating good practice
Developing a model risk-taking policy
Values and principles
A ‘statement of purpose’
Beneficial outcomes anticipated
Professional standards
Identified constraints
Position on controversial issues
Associated procedure
Endorsements
Acknowledgements
Consultation
Review arrangements
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Benefits of Risk Management
• Supports strategic and business planning
• Promotes continuous improvement and identification of new opportunities
• Encourages innovation and creativity
• Engenders a proactive outlook
• Ensures robust contingency planning
• Improves our ability to meet objectives and achieve opportunities
• Reduces shocks and unwelcome surprises
• Advocates transparency
• Furthers compliance with governance agenda
• Stimulates regular review and monitoring of business processes
• Enforces ownership
• Provides for effective use and prioritisation of resources
• Reassures staff, stakeholders and governing bodies
• Enhances communications internally and with external stakeholders
• More informed decision-making.
Reference
Brooker, D. and Lillyman, S. (2013). Nursing & health survival guide.
Abingdon: Routledge, p.56.
Torres, C. E. (2017). Risk benefit assessment. Maryland: UP-NIH
Faculty
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Useful links
Vision for social care
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPoli
cyAndGuidance/DH_121508http
Person-centred assessment
http://www.thinklocalactpersonal.org.uk/Browse/safeg
uarding/?parent=8625&child=3681
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