A short video to accompany Mind The Care Training’s ‘Hanged if you do & hanged if you don’t’ training for health and social care workers. If there’s one thing that unites almost everyone concerned with health and social care services it’s the fear of being sued.
Otherwise rational and courageous workers have been reduced to quivering wrecks at the mere suggestion of litigation or the slightest suggestion that they might have failed in or ‘neglected’ their duty of care.
Duty of care is such a preoccupation for workers that it crops up daily in conversation and in practice whenever we encounter ‘thorny’ issues relating to ‘health and safety’, ‘rights and responsibilities’, ‘freedom of choice’, ‘confidentiality’ and a host of other topics. However not everyone who hears the term understands what it means or indeed where it comes from.
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
Nobody needs 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
‘Don’t panic’.
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.
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?
Last night I had an interesting conversation with a stranger in the car park of my local supermarket. We’d exchanged a few pleasantries in the queue for the checkout – like me he refuses to use automated checkouts because, also like me, he’d much prefer that people keep their jobs.
We happened to have parked our cars next to each other on the way in and so the conversation continued in the car park, this time the subject was cars, driving and the rather nasty bump he’d had to the front of his vehicle. That conversation reminded me of today’s topic on anxiety.
Some time ago, one dark winter morning I found myself driving to work down unlit country roads in the rain. Visibility was poor and so I wasn’t going particularly fast which turned out to be a really good idea.
Also on the road on that dark, wet morning was a cyclist. A cyclist who was dressed in dark clothing with no lights and no helmet. To be honest I don’t even know how this guy might possibly have seen where he was going without lights – it really was that dark. However, presumably he could. I couldn’t see him though.
As I approached this invisible cyclist he pulled out into the middle of the road intending to turn right. You can guess what happened next. That’s why it’s such a good job I wasn’t going very fast. If I’d been driving at the legal speed limit instead of to the actual conditions I’d probably have killed him.
Fortunately, amazingly even he was OK apart from a few bruises. The ambulance came and took him to hospital where he was checked over. The police arrived and took my details, including my negative breath/alcohol test and I called in to work to explain that I wouldn’t be in that day. What happened next was revealing, especially about anxiety, phobias, avoidance and the ease with which normal freeze, flight or fight responses can become pathologies if we’re not careful.
My plan had been to return to work the following day. However within an hour or two of getting back to my accommodation I’d started to think. I actually believe that it would have been much easier to deal with the anxiety that followed if the accident had been my fault. If I’d done something wrong I could just decide to correct the flaw in my driving and make sure that nothing like this happened again. But that’s not what happened.
No matter how hard I tried I couldn’t think of any aspect of my driving that morning that I can change for the better. I hadn’t been drinking, I wasn’t going particularly fast, I was awake and alert, I was certainly concentrating due to the poor conditions, my car was in good condition and roadworthy and I was correctly positioned on the road. There was nothing I could think of to do that might prevent something like this happening again and if it does the next one might be fatal. That’s a really scary prospect.
It’s interesting that even though this is the first such accident I’ve had in over 30 years of driving all across UK, all that evidence of safe driving paled into insignificance against this one event. That’s because of a particular mental shortcut, an heuristic we know as the availability heuristic. I mentioned heuristics in an earlier video as part of my evolutionary psychology series. Click the link at the top of the screen for more information.
The availability heuristic is an evolved mental strategy that gives precedence to recent events. In a changing environment it’s useful – it allowed our ancestors to recall and give weight to the location of food, of predators and a whole host of other, changing environmental and behavioural artefacts. In the modern world it’s still extremely valuable but it has its drawbacks. One such drawback is the over-emphasis we give recent events. Here’s how it can turn useful anxiety into pathological disorders.
My emphasis on this single, recent memory caused me to work hard to find a way to avoid similar problems in the future. So far so good – we can all see the benefit of that. Unfortunately, the only thing I could come up with to avoid a repetition of this awful event is to stop driving. That’s rather less positive – especially in the light of the odds, bearing in mind my years, even decades of driving without hitting anyone, cyclist or not. But recent memories are the thing and that’s why I seriously considered not driving, giving up my job because I’d have no way to get to work without my car and I even spent time trying to rework my finances to allow me to retire early, all because I didn’t want to drive.
Now think about this. If I’d actually stopped driving that day what would my most recent driving memory be? Obviously it would be the traumatic memory of hitting, and initially thinking I’d seriously injured or even killed a cyclist. If that’s the result of the availability heuristic, the result of my most recent memory then my anxiety about driving will never dissipate. Not only that, the sense of fear I’d feel when contemplating driving, coupled with the relief I feel when deciding not to constantly reinforces the heuristic every time I think about getting back into the car.
Even though I know all this it took me three more days to pluck up the courage to drive my car again. I chose a quiet, sunny afternoon in broad daylight and drove around quiet country roads and literally had to force myself to turn the key and start the engine. That gave me a new memory but not enough to overcome the power of the traumatic heuristic. Powerful, traumatic memories take a lot of subsequent memories to take away the fear they generate. And the longer we avoid the issue the harder the trauma is to overcome. And that’s the point of this little video.
If you have an anxiety state that doesn’t seem rational, regardless of the emotion you feel, it’s important to ignore the emotion. Do this as soon as you can to build up new memories that can take advantage of the availability heuristic. That’s what people mean when they tell people to get back on the horse. Don’t let anxiety overcome rationality or you might find that your life choices become governed by fear to such an extent that avoidance shrinks your world, your opportunities and your options over time until there’s almost nothing left.
And it all begins when we give in to traumatic memories because of the availability heuristic.
Most people are surprised to learn that they maintain (and often actually create) the problems they face. Often people will work hard to resist this idea and that can be difficult to overcome but it’s worth the effort. Until people understand their own role in maintaining their difficulties they cannot really take responsibility for solving them. After all – if you don’t think you’re a part of the problem you won’t think that you need to change your behaviour to change it.
Care workers need to learn from past experiences.
The best predictor of future behaviour is past behaviour.
But the people we work with can change too.
The whole point of much of our work is to help them to change.
How can we balance past behaviours and future potential?
How do we promote change without becoming naive and vulnerable?
Complete the contact form below to arrange training for your staff.
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.
Freya Smith is a carer and youth worker. She’s fluent in British sign language and sees all of life as an opportunity for compassion and for helping those in need.
Click the link to see Freya interviewed about her experiences working with homeless children on the streets of Cardiff.
Click the image to play the video
Freya’s enthusiasm is infectious. Her no-nonsense philosophy is practical and effective. To hear her speak about her work with some of the most disadvantaged children in the UK is to catch a small glimpse of what can be possible when we really engage with the task at hand.
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