Duty of Care | Skills for Health, Lecture notes of Communication

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THE CARE CERTIFICATE WORKBOOK

Duty of Care

The CARE CERTIFICATE

Standard

What you need to know

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Your duty of care is also to other workers, for example, in a hospital, to doctors, nurses and healthcare support workers but also to caterers, cleaners and maintenance workers. If you are a home care worker you will probably work alone in a variety of homes, but there may well be other people in the premises, as well as whoever you are there to support. Your duty of care is to each individual and to the other workers you come into contact with in the community.

The duty of care is part of the code of conduct for healthcare support workers and adult social care workers in England and will most likely also be in your job description. It is important that you have the knowledge and skills to act on your duty of care in your role but that you don’t work beyond it.

As part of your duty of care you should pass on any concerns you have about wellbeing. Every employer has agreed ways of working to respond to possible harmful situations which will include how to report any concerns. Concerns could be about anything from poor working conditions or equipment to untrained workers, as well as suspected abuse. In any situation, if you do not know what you should do, ask your manager. Providing guidance about how to deal with abuse and violence or substance misuse or how to handle toxic substances or carry out risk assessments are all part of making sure that the duty of care is carried out. Fire drills, agreed ways of handling medication as well as cooking and food storage procedures are some of the routine ways for making sure that everyone knows how to fulfil their duty of care. The agreed ways of working vary from one workplace to another, so you need to check them if you move to a new job in social care or health. Agreed ways of working should be documented, but even if you are told about them only in conversation, you must still work to them.

Duty of care

You have a duty of care

to all those receiving care and

support in your workplace. This

means promoting wellbeing and

making sure that people are kept

safe from harm, abuse and injury.

Wellbeing

Wellbeing could be defined as the positive way in which a person feels and thinks of themselves.

Code of conduct

The code of conduct tells you how you are expected to behave as a care worker.

Duty of care is a legal requirement; you cannot choose whether to accept it. It applies as soon as someone has care or treatment. Breaking this duty, for example through negligence, could result in legal action.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

The Local Authority Social Services and NHS Complaints (England) Regulations 2009 are the legislation for complaints in health and social care. The Department of Health also published the NHS Constitution in 2011, which tells you about guiding principles and patients’ rights. There should be a recorded process to follow which may differ depending on the type of workplace and have a time limit in which the complaint has to be made after the situation happened. If someone wants to make a comment or complaint you should deal with it in line with your organisations agreed ways of working. Depending where you work, that could include:

 arranging to talk in private  making sure the individual knows that you may need to pass on information if there is a risk to the safety of themselves or others  listening calmly and actively, assuring them that you are taking them seriously  not judging or becoming emotional  offering your support but not trying to answer the issue before the agreed way of working has taken place  explaining what will happen next, who the complaint will be passed to and when the person will get some feedback.

Thank them, tell your manager what has been said, and make a record as soon as possible.

Often an organisation has one named person who deals with complaints. Depending on the size of the organisation there may be a complaints section such as the NHS’s Patient Advice and Liaison Service (PALS). You should ask who is the ‘responsible person’ or ‘accountable officer’ for your workplace. Smaller workplaces might not have anything in writing but will still have agreed ways of working for when complaints are made.

Incidents, errors and near misses

Sadly, having the best ways of working, the code of conduct and the duty of care, doesn’t always protect vulnerable adults from harm. All health and social care workplaces involve workers collaborating towards the wellbeing of those needing care or support. Mistakes happen through things like lack of knowledge, poor communication or not sharing information, stress, negligence or being distracted. Mistakes are seen as being one of the following:

Adverse events: action or lack of action that leads to unexpected, unintended and preventable harm.

Incidents: specific negative events. In health and social care serious incidents are described as events which need investigation as they caused severe harm or damage to either the person receiving care or the organisation.

Errors: not doing something as it should have been done, for example through bad planning or being forgetful.

Near misses: situations where an action could have harmed the individual but, either by chance or purpose, was prevented.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

The first thing to do after something has gone wrong is to do what you can to improve the wellbeing and meet the immediate needs of the individuals involved.

Your workplace will have a form which you should complete to record incidents, accidents and near misses. You should record the date, time and facts. This is used to make your manager aware straightaway. Do not blame other workers or suggest to those involved why the incident might have happened, even if you have an idea why it was. If your thoughts turned out to be wrong you could lose the individual’s and family’s trust and respect.

Legislation

For health and social care work a variety of legislation sets standards on how to handle issues to improve services and positive outcomes.

Care and compassion

Think clearly and carefully about the potential reasons for someone’s distress. Use your person-centred approach and knowledge of them as an individual, as you may be able to de-escalate a challenging situation by recognising their unmet needs and responding to these with supportive care and/or additional services.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Managing conflict and difficult situations

There are many things that can cause conflict with and between people. Conflict or ‘behaviour that is challenging’ often happens as a result of distress or because needs are not being met. It could be caused by a number of factors including:  biological, for example because an individual is in pain or suffering the side effects of medication or substance misuse  social, for example because of being bored, wanting social contact, having a need to be in control, not being able to communicate or understand what is being said  environmental, for example because of loud noise or bad lighting or barriers to mobility  psychological, for example because of feeling left out or lonely.

Your workplace might have a policy on responding to behaviour that challenges. There will usually be a form to report what happened, who has been involved and where and when the incident took place. You should include whether anyone has been injured and needed medical assistance or whether the police have been called, and sign and date the form. This will then be used to determine any action that is needed to support the individual better.

An open discussion with any individual, where they are treated with respect and dignity, can often find a solution. If possible and safe, when working with a person whose behaviour is challenging:  take them to a quiet place  ask questions and listen carefully to what they say  take their feelings of being upset or angry seriously  try to find a way forward that they understand and can agree to.

It is important that you get to know the individuals you are working with as far as possible, so you can recognise what triggers their distress. It is also important that you don’t get emotionally involved but keep a clear head and look out for body language and reactions. If you feel that a one-to-one situation between yourself and an individual has the potential to become confrontational you should try to leave the scene to give them time to calm down.

When you recognise frustration and aggression in a person’s behaviour you will learn, as you develop in your role, how to use your communication skills and other ways of working to manage a situation before it becomes violent or aggressive. Your manager will provide guidance, explain ways of working and support you to develop your knowledge and skills as you progress in your work.

THE CARE CERTIFICATE WORKBOOK

Duty of Care

The CARE CERTIFICATE

Standard

What do you know now?

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Activity 3.1b

Thinking about your

own work role, complete

the sentences below to

describe how the duty of

care affects you in practice.

The first example has been

completed for you.

Describe - to describe means to create a

picture with words but not simply writing

a list of bullet points.

My job description states that...

I have certain responsibilities to the individuals I provide care and

support to and to my colleagues; this includes working safely and with

the interests and wishes of the individual at heart.

The organisational policies and procedures are there to...

The code of conduct means that...

I must report unsafe or abusive practices because...

THE CARE CERTIFICATE WORKBOOK

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Activity 3.2a

There will be times when your duty to safeguard

the wellbeing of the individual is in conflict with

your duty to promote the individual’s right to take

risks. It is your duty to ensure an individual is kept

safe and does not experience harm but these

situations may cause you a dilemma and you may

not know the right thing to do to keep them safe at

the same time as enabling them to make their own

choices.

Think of two dilemmas that might arise in your

work and describe these in the space below.

Dilemma 1:

Dilemma 2:

THE CARE CERTIFICATE WORKBOOK

Describe - to

describe means

to create a picture

with words but not

simply writing a list

of bullet points.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Activity 3.3b

For each of the three

examples below, describe

who you would ask for

advice and support in

handling comments,

concerns and compliments.

A number of individuals you are supporting believe that someone has been tampering with their medical records

You have read the complaints procedure but you would like to ask for further guidance on one section

An individual you support has told you that they wish to make a complaint about the food served at meal times

Describe - to describe means to create a

picture with words but not simply writing

a list of bullet points.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Activity 3.3c

It is essential to learn from

comments and complaints when

providing care services. Explain

the importance of learning

from comments, concerns and

compliments in order to improve the

quality of service that you provide.

Explain - to explain something

you will need to provide a clear

account of your understanding,

including details like why and how.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Decide whether this is an example of an adverse event, incident, error or near miss

Describe how you recognise this as an example of an adverse event, incident, error or near miss

Explain what you must do and must not do in relation to each example

When serving lunch, an individual who has a nut allergy was given a peanut butter sandwich by mistake. You notice this just in time to change the sandwich.

Adverse event

Incident Must do:

Error Near miss Must not do:

An individual in the bathroom area slips on the wet floor. When investigating you notice that a wet floor sign has not been used.

Adverse event

Incident Must do:

Error Near miss Must not do:

Activity 3.4a & b

continued

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Activity 3.4c

Thinking about the four

scenarios in 3.4a & b, list

the legislation and agreed

ways of working that need

to be taken into account

when reporting adverse

events, incidents, errors

and near misses.

List - this term means to identify the

main points which can be written as

bullet points.

THE CARE CERTIFICATE WORKBOOK STANDARD 3

Activity 3.5b,

c & e

Thinking about the factors

and difficult situations that

may cause confrontation,

select one that relates to

your own role and answer

the questions below.

1. What is the factor or difficult situation that may cause confrontation?
2. How could communication be used to solve problems and reduce the likelihood or impact of confrontation?
3. How would you assess and reduce the risks in this situation?
4. What is the agreed way of working for reporting confrontation in your service?