Definitions of challenging behaviour that ignore context aren’t just wrong – they’re actually damaging and cause more problems than they solve.
We nurses aren’t perfect. We generally spend our time trying to sort out problems that we didn’t cause. That’s more than most people do. It’s more than the majority of our critics.
But no matter how hard we try, sometimes we fail. Sometimes we don’t fail but people place such unrealistic expectations on our practice, make such unrealistic demands of us that we face criticism, insults, even threats of violence for not living up to the demands of others.
People can disregard our efforts, they can slander us on social media and dismiss us as incompetent, callous fools if they like. That’s their right…
But we don’t have to agree with them!
One of the biggest headaches for health and social care workers is how to make sense of their duty of care. On the one hand we’re told that we must take steps to ensure safety and on the other hand we need to respect people’s rights to make their own decisions, even if they’re risky. This can be a delicate balance to strike.
How not to be hanged
It’s true that the law surrounding duty of care can be complicated but care workers aren’t expected to have the same knowledge as barristers. We’re expected to understand the basic principles of care law, to know what to do if we’re unsure and we have to act reasonably. We don’t even need to be right every time. We only need to be reasonable.
This 90 minute webinar/tutorial is designed for workers who are far too busy delivering care to spend their time reading through long reports of legal precedent. It covers the basic points we all need to be safe ‘at the coal face’ of care delivery in a practical, work-based way that is both engaging and understandable.
Delivered in plain English, the basic message of ‘Hanged if you do – Hanged if you don’t’ is
By taking the mystery and complicated jargon out of the equation, Stuart Sorensen guides workers step by step from basic principles to a solid understanding of duty of care. Real life stories and clear examples are used throughout to make the webinar both absorbing and easy to apply in practice.
The webinar covers:
The duty of care myth
Balancing rights, risks and responsibilities
Common law and necessity
Mental capacity and the right to decide
Acting in best interests
How not to be Hanged
On October 25th 2007 22 year old EG gave birth to twins at the Royal Shrewsbury Hospital. A few hours later she was dead because she refused to accept a blood transfusion. EG was a devout Jehovah’s witness. She suffered a sudden haemorrhage and bled to death following a natural delivery. EG had already signed a form before the birth refusing blood in such an event.
According to newspaper reports staff at the hospital tried to get EG’s husband and wider family to consent to the blood transfusion on her behalf but they would not.
- Is this ‘valid and applicable’ as an advance decision to refuse treatment?
- What about the notion that ‘decision-makers should not be motivated by a desire to bring about the person’s death’?
- What do you make of the staff asking EG’s family to overrule her decision?
- If the family had consented would the transfusion have been legal?
- If not – would the family have been liable or the staff who gave it?
- Who was the legal decision-maker in this situation?
When dealing with people whose behaviours are challenging it’s important to acknowledge that those behaviours may well be based upon some very deep-seated beliefs. Whilst we don’t need to agree with or even support beliefs that cause problems it is vital that we acknowledge the person’s right to hold them – even if we deny their assumed right to act upon them. It’s one thing to object to behaviours – it’s quite another to dismiss the person who holds those beliefs.
Challenging behaviour strategies aren’t necessarily complicated but they are powerful. It’s important then that we use them ethically. This video outlines some of the more basic points about ethics and philosophies of working with people who challenge us.
I’m moving my political commentaries away from this channel and onto my new YouTube channel, ‘Left eye view’. I’d love to see you there. You can visit and subscribe to the channel by clicking the link below…
and also from this video…
Confidentiality can be a real headache for carers. Whether their loved one is being cared for by the NHS or by some other health or social care organisation they often have great difficulty in getting the information they need to care for their relative or friend as the vital part of the care team that they actually are. But does this really need to be the case?
It’s true, of course that people have the right to privacy, including those people who need care services – a fact that few carers would deny or seek to change. But patients and service-users don’t necessarily want to keep EVERYTHING private. Very often the problem arises, not because people have the right to confidentiality but because of the way that workers approach the issue when discussing confidentiality with them in the first place.
It’s important to be nuanced in matters of confidentiality. too often the question is asked…
“Do you want your family to know about your care?”
Really we ought to be far more specific. We need to differentiate more between the types of information we can disclose and that we should not. After all, there can’t be too many young men who would want their mothers to know all about their sex lives or other, equally personal details. Professional care workers need to be much more specific about the types of information to be disclosed and also about which family members or friends it will be disclosed to.
Most carers don’t want the intimate details of personal issues anyway. They do want to understand about medication regimes, care planning, symptoms and side effects, relapse profiles and plans and they need to know who to contact when things go wrong. This requires far more nuanced discussions than typically happen in over-stretched care services. So here’s my solution…
Click here to download a form that you can use to help workers determine just what information can be shared and with whom. It takes all the difficulty out of the equation for care workers by providing them with clear, unambiguous guidance about what they can and cannot disclose.
It is important that the form is completed collaboratively with a representative of the professional care team. The organisation working with the patient or service-user will have legal issues to consider and the worker may need to speak to their management about the form. Don’t ‘ambush’ them with the form. Let them know about it in advance. Ideally give them a copy to discuss with their management first. That way there should be no problems when you do sit down to complete it.
Complete this form at a time when the patient has the mental capacity to make the decision. Staff will not be able to abide by confidentiality decisions made when the patient lacks the capacity to decide.
Please feel free to get in touch, especially let me know of your experiences in using the form. It’d be great to hear from you.
Hanged if you do… hanged if you don’t!
Many people are confused about their duty of care. They think they’re somehow responsible for the actions of other people. This leads them to try and prevent people from doing things that they have a perfect right to do because it might be risky. In truth our duty of care is actually much simpler than most people imagine:
- Do all that you reasonably can;
- Don’t break the law;
- You are not responsible for the actions of other people;
- You are responsible for your own actions in the situation you’re in;
- Care workers are judged upon process, not outcome.
Complete the contact form below to arrange training for your staff.