Explain why it is important not to assume that an individual with dementia cannot make their own decisions

Under mental capacity act we must assume capacity. We also need to identify ‘unwise decision’ and prove ‘unwise decision’. Therefore, it is a legal requirement to assume an individual has capacity to make own decision. An individual with dementia can make their own decision if appropriate support is provided. An individual with dementia can make decision about their everyday choices which are not complex with or without support. We know different types of dementia affects different types of ability in the different stage. At the primary stage, an individual may make own decision with or without any support. At later stage, they may need more support to make decisions such as advocate, relatives, carer and adaptive technologies.

However, as a professional, we must not work on assumption, notion, beliefs, thoughts and hearsay.

Md Foisal Miah Talukdar

Describe how the ability of an individual with dementia to make decisions may fluctuate

Dementia is a set of symptoms and different types of dementia affects individual’s ability differently. Individual with dementia may be able to make decisions about everyday choices and preferences, but an individual may find very hard to making any complex decision, as they may not be able to understand and retain the information to make right decision. However, ability of an individual depends on types and stages of dementia.

Individuals with vascular dementia may suffer from memory problems (such as recalling recent or past events) and problems concentrating due to slower thought. They may not be able to speak very fluent or not be able to speak at all. Giving consent and taking decision may become very difficult for them. In early onset of the symptoms they may be able to make decisions without any interruption.

Individuals with fronto-temporal dementia can exhibit inappropriate behaviour or ruthless comments to others. Due to their behaviour and lack of empathy to others, decisions taken by them may not be legible for the purpose.

Individuals suffering from dementia with lewy-bodies may have disorganised speech or struggle with planning and decision making.

It is very important to understand that at the beginning of the symptoms of dementia, an individual can make own decisions and plan for their own care ahead even with little help and support. At later stage, it is almost impossible for them to make any decision or contribute to it at all.

Md Foisal Miah Talukdar

Demonstrate that the best interests of an individual with dementia are considered when planning and delivering care and support

One of the legal requirement for delivering care and support is person centred care. Therefore, all providers must create a person centred care plan for each individual they provide care and support. It must meet individual’s choices and preferences and be planned with the individual. However, when we create person centred care plan for an individual with dementia, it is not always possible to determine or establish their choices and preferences due to their memory impairment, poor mobility, medical conditions, poor judgement and inability to retain information and take decision. If choices and preferences of an individual with dementia cannot be readily established then we must take decision considering individual’s best interests. Best interests decisions are usually taken in the presence of various professionals (depending on the specific decision), individual and family members after assessing all the available information.

Example: One of the individual with dementia would like to go out himself for shopping. Due to individual’s forgetfulness and other associate behaviour, it is not suggested to let him go for shopping on his own.

Best interests decision: After reviewing all the available information and taking into account of individual’s and public’s health and safety, it is being decided that we can introduce online shopping to the individual. If it still does not fulfil individual’s preferences then one carer can escort him to do the shopping.

Md Foisal Miah Talukdar

Explain how and when personal information may be shared with carers and others, taking into account legislative frameworks and agreed ways of working

Data protection act 1998 states that individuals’ personal and sensitive information must be kept safe and secure and we must not share personal information without individuals’ consent. Therefore, we must obtain individuals’ consent prior to sharing their personal information. Internal policies and procedures put restrictions on who we can share with and what information we can share which can refer to legislation wording ‘need to know’ and ‘right to know’.

In any emergency situation where individuals’ life is at risk, we can share personal information with the appropriate authority that need to know such information to save individuals lives. An organisation has express powers and obligations to share information with only named organisation for certain purpose. You can share individual’s personal information with carers and other professionals such as GP, hospitals, physiotherapists, nurses, mental health nurse, social service, only to improve the individual’s health and wellbeing. The personal data can be shared only with other agreed professionals in order to improve individual’s health and wellbeing. Data also can be shared to prevent crime and identifying criminals with appropriate authority and we do not need to obtain consent for that.

In order to share individual’s personal data we must follow organisation’s policies and procedures on how to share such information. Few standards are described below –

·         Make sure person seeking information has right to know

·         Determine the purpose (it must be beneficial to the individual)

·         Make sure person seeking information is a real and right person

·         Ask the person to make a written request

·         Use encrypted mail server to exchange personal data    
·         In the event of any doubt, you must contact organisation's information security officer

Md Foisal Miah Talukdar

Explain how the likelihood of abuse may be reduced by supporting individuals with awareness of personal safety ?

Many individuals are unaware of the form of abuse and how may they become victim of one. Awareness of personal safety is very important as it can protect individuals from the likelihood of abuse. Awareness of personal safety involves informing individual form of abuse and how they can recognise and protect them. If an individual is aware of all forms of abuse then they can recognise them easily. They will also be aware of how they best can protect them in the event of abuse. Being aware of individuals’ personal safety can increase their self-esteem, which can support them to deal with any kind of potential violence and abuse easily.

·        Individuals are aware of and can recognise all forms of potential abuse

·        Individuals are prepared to deal with this kind of situation prior to any incidence

·        Individuals will know the action they need to take regarding any form abuse or potential    abuse

·        They will also know how they can protect them including techniques to prevention

·        They will also be aware of their legal rights and duties

Md Foisal Miah Talukdar

Evaluate agreed ways of working that relate to rights and choices of an individual with dementia

One of the agreed ways of working is safeguarding adults which relates to rights and choices of an individual with dementia. Every individual has right to be safe from harm and abuse regardless their physical and mental conditions. Therefore, we require to record and report any concern or abuse we observe or come across. Individual with dementia can be subject of abuse or become an abuser very easily as they have lack of mental capacity, poor judgement, poor mobility, disorientation and anger. Therefore, we must take reasonable action according to policies and procedures to promote and maintain rights and choices of an individual with dementia. An example is given below for you to understand better -

Example:

An individual with dementia always choose not to have any personal care. It is the individual’s choice which must be respected. Similarly, you have to consider your duty of care. Your duty of care is what action have you taken or technique you have approached to persuade the individual to maintain personal care. Recording individual’s refusal in provided form is not enough to prevent individual from being self-neglect. You must record what you have done to persuade or to make agree the individual including different time, different person, family meetings or involvement, who did you report and what is the outcome. 

 Md Foisal Miah Talukdar

Explain the meaning of ‘valid consent’

In legal terms, valid consent to care or treatment has three requirements:

·         The individual has the legal capacity and competence to give consent

·         The consent is the free expression of individual’s own accord (not obligated, bounded or pressurised by all means)

·         The consent must be based on sufficient information being provided, and all other advantage and disadvantage are being explained to the individual 

By Md Foisal Miah Talukdar

Explain the impact of key legislation that relates to fulfilment of rights and choices and the minimising of risk of harm for an individual with dementia

Key legislation:

                Human Rights Act 1998 

        Health and Social Care Act 2008 Regulations 2014 

                Mental Capacity Act 2005 

                Adults with Incapacity (Scotland) Act 2000 

                Mental Health Act 2007 

                The Disability Discrimination Act 1995 

                Safeguarding Vulnerable Groups Act 2006 

                Carers (Equal opportunities) Act 2004

An individual with dementia may become deprived of their liberty, rights and choices. They are also at greater risk of harm and abuse. Therefore, government put various legislations in place to protect individual with dementia from harm and abuse and promote their rights. The basic principles of Human rights act 1998 and the disability discrimination act 1995 are no one should be treated unfairly, due to their age, race, gender, disability. belief and sexual orientation. Everyone should be treated equally. These pieces of legislation support the rights of an individual with dementia. The health and social care act 2008 (regulated activity) Regulation 2014 emphasized on ‘Person-centred care’ which promotes rights and choices of individual with dementia. This legislation states that ‘The care and treatment of service users must – be appropriate, meet their needs and reflect their preferences’. Mental capacity act 2005 impose rule about deprivation of liberty for individuals with dementia and other mental illness. It also stated that if it is established any individual does not have mental capacity, then service provider or designated person must act on individual’s best interest. In order to minimise the risks of harm and abuse to individuals with dementia, Safeguarding vulnerable group act 2006 put rules of vigorous screening system for the worker prior to coming in contact with vulnerable adults.

All of these legislations must be maintained in practical work environment by service provider. Violating or non-compliance of these legislations can be heavily consequence such as operation closure, license provoked, reprimand and imprisonment. 

Md Foisal Miah Talukdar

Explain the processes involved in the development, maintenance and breakdown of relationships

Development: After introduction or attraction between participants, a relationship moves onto the development stage. It usually occurs when participants get attracted to one another, show mutual interests and bear same thoughts, dislikes, notion and intellect on various subjects.

Maintenance: Maintenance of relationship requires maintaining basic reciprocity between participants. It may include celebrating something together, exchanging gifts, inviting one another to celebration, providing active support to one another and indulgement. They also build trust by following commitments made to one another in this process.

Breakdown of relationship: This is the process when a relationship ends. A relationship can come to this stage if it is not being properly maintained. There is also a chance of breaking down a relationship at development stage, especially, when participants misinterpret their relationship objectives. Let me give you an example how misinterpretation can occur. Mr. X fell in love with Miss Y at first sight where Miss Y’s approach was to maintain just a professional relationship.

Md Foisal Miah Talukdar

Describe the possible impact of difficult or dysfunctional relationships on an individual’s well-being and self esteem

Let me start with a common quote occasionally I hear “I have nothing to live for”.

Many individuals may feel lonely and low self-esteem because of dysfunctional or difficult relationship. Dysfunctional or difficult relationship can contribute stress and depression on individual’s health and wellbeing. Due to lack of other human contact, social network or any supportive relationship, an individual may suffer emotional and psychological turmoil in their life. It can affect their self esteem, trust and fairness to others. Some individual may not be able to cope with this kind of mental stress or adapt with this change and become violent and aggressive or even can commit suicide.

By Md Foisal Miah Talukdar

Explain the possible consequences of health and social care workers failing to act in the interests of individuals and others

The possible consequences can be as follows-

·         Put an individual at risk or potential danger

·         Put an individual at risk of abuse or harm by others

·         Put surrounding others such as family, carers, other professionals and members of the public at risk or potential danger

·         Carer of support worker may be subject to disciplinary action for breaching duty of care

·         Individual's care need will not be met

·         The service provider’s reputation may be at risk of damage

By Md Foisal Miah Talukdar

Explain why the tissue viability risk assessment should be regularly reviewed and repeated

Tissue viability risk assessment is very important as part of individual’s health and wellbeing. It is also an organisational requirement and our duty of care. Most of the individuals in our service provision are aged and vulnerable to immunity. Some of them are with no mobility and lack of mental capacity. As part of our duty of care, we must carry out duties which concerns to individual’s health and wellbeing.

Individuals with existing skin conditions may exacerbate if we do not regularly monitor or review the tissue viability risk assessment. Individuals may require further treatment which cannot be identified, if we do not review tissue viability risk assessment regularly. Failure to carry out tissue viability risk assessment or review or monitor existing risk assessment can result in safeguarding issue.

By Md Foisal Miah Talukdar

Give an example of an agreed way of working in your workplace and explain why it is important

Confidentiality is one of the agreed ways of working in our workplace. Therefore, we must not disclose any individual's personal or sensitive information to others. In order to work in this particular agreed way, we must keep care plan and other paper work where we record individual's sensitive and personal information in a locked cabinet or designated place. We must shred any unnecessary paper where individual's personal information is recorded.

Why it is important? : It is against law to disclose individual's personal and sensitive information without individual's consent. It also does not support dignity for the individual. Confidentiality is one of the principle care standard and regulator's standard we must follow. Failure to protect individual's personal and sensitive information may result in penalty, disciplinary action, prosecution and even operation closure. 

By Md Foisal Miah Talukdar

Describe what to look for when assessing the skin

Tissue viability risk assessments are mostly carried out by observation. Therefore, a pair of keen eyes with understanding of healthy skin is needed for the procedures. What to look for when assessing skin are described here in below –

·         Intact or freckled

·         Dryness, moist or well hydrated

·         Existing skin condition or skin disease

·         Colour such as redness or normal

·         Any inflammation of skin

·         Existing bruises, blisters and sores

By Md Foisal Miah Talukdar

Describe the changes that occur when damage caused by pressure develops

The changes that occur on skin when damage caused by pressure are described here in below –

Bruise: Skin colour may change into red, dark red, reddish black or black, due to continuous pressure or strong pressure on skin.

Blister: Blister may appear or develop due to constant and vigorous pressure or friction on skin.

Sore: Bruises may turn into a sore or open sore due to further pressure on affected area of skin. Individual may develop bed sore due to constant pressure on their skin.

Wound: Blisters may turn into an open wound due to further constant pressure on the affected skin.

Pressure ulcer: Pressure ulcer may be developed on skin due to prolonged pressure on skin.

By Md Foisal Miah Talukdar

Describe your rights and responsibilities as a worker

Health and safety

My rights are to have a safe working environment. I must have all the equipment or machineries as necessary to perform any tasks safely. I must have access to the required information, guidelines and trainings. My responsibilities are to cooperate with employer by reporting any concerns that can breach the health and safety law. I must use equipment as directed including PPE.

Confidentiality

My rights are to have training on confidentiality or information security. I must have instructions, system and equipment in place to follow such procedures.
My responsibilities are not to share any confidential information without individual's consent. I must keep all the daily care log book locked away. In the event of any confidentiality breach I must report to my manager as soon as possible.

Working time

I am entitled to receive work according to my contract. I am entitled to have a break of at least 15 minutes every 4-6 hours of work. I must opt out of working time regulation if I intend to work more than 48 hours.

Pay and wages

My right is to receive wages according to the contract of employment and must meet NMW. My employer must collect Tax and National insurance contribution and pay to appropriate authority (such as HMRC, DWP) on my behalf. I am entitled to have paid holiday. My responsibilities are to produce correct working hours to the employer including proof of any extra costs incurred due to carry out specific job.

By Md Foisal Miah Talukdar

Think about your previous experiences and the attitudes and beliefs you have, and under the points below explain how they may have affected the way you work.

A positive experience: A positive experience always put a positive impact on work. My positive experiences were receiving feedback from service users and family members which made me more dedicated to my role by setting up myself to achieve further qualifications on this career path.

A negative experience: Reading individual's personal care plan, I established individual's choices of drink and I was serving individual's drink accordingly. But the individual informed me that he no longer likes those drink. I updated the individual's care plan and informed others, that we must ask the individual about the preferences each time, before serving food and drink as they may not like the preferred food and drink all the time.

A positive attitude: Being a good listener, I discovered more about service users needs, preferences, choices and future goal, which help me to provide services according to their current needs. I was also able to identify the skill individual wants to develop and activity which will help them to gain that skill.

My personal beliefs: My moral value lies on 'reciprocity of good deeds' which helped me not only delivering service more effectively but also obtaining feedback from service users for effective service delivery. Acknowledgment of good works always help me to be more dedicated to my role.   

By Md Foisal Miah Talukdar

Thinking about the statements in Part i) that would need to be reported, explain how you would raise your concerns, or whistleblow and why.

I must report to my team leader or supervisor immediately. If team leader is not reachable then I must report to my manager without any delay. I can do that verbally or in writings. If there is any issue with health and safety, I must use 'Do not enter' or 'caution' signpost at first. I must record this issue while ensuring others safety, then report to my team leader or line manager.

I can assist individual to make complaint for the poor delivery of the service.

If my manager is involved in abusive behaviour then I must report it to the Local Safeguarding Authority or follow guidance from policies and procedures.

The reason I should raise my concern or whistleblow is that I have a responsibilities of safeguarding individuals. If I do not raise concerns about health and safety then anyone can cause harm or injuries including myself. If I do not raise concerns on the above scenario, then I would not be following policies and procedures which can be the subject to disciplinary action or prosecution against me.

By Md Foisal Miah Talukdar

Explain how a working relationship is different to a personal relationship

Working Relationship: A working relationship is a relationship where I spend time with my co-worker and service users at work, but I have little or no contact out of working hours. It is strictly professional. In a working relationship, we do not discuss about personal interest and personal life problems.

Example: My relationship with an individual service user is strictly professional. I do not share my personal life's problem with my service user. I have no contact with  service users out of work.

Personal Relationship: A personal relationship is where my personal life, extracurricular activities and social life are involved with other individuals. It can be established with anyone depending on mutual interests. There is no restriction on the subject of discussion.

Example: My relationship with a colleague is very personal. We go out sometimes together. We share our personal life's problems sometimes and provide console, comfort and advice to one-another. We share our opinions and become judgemental. We together bite and fight, but always stay tight.

By Md Foisal Miah Talukdar

Explain how maintaining, regaining or developing skills can benefit individuals

Everybody wants to be as much independent as possible. By maintaining, regaining or developing skills for everyday life can help an individual to be independent. The level of support we provide to an individual depends on their dependency level. If individuals can regain their skills for everyday life, then lesser support they will need and more independent they will become. If individuals can maintain their existing skills for daily life, then they can go ahead and develop new skills, or take on new challenge to fulfil further needs of their lives. By maintaining, regaining or developing skills can benefit individuals physically, psychologically and financially.

By Md Foisal Miah Talukdar

Identify specialist service relating to communication technology and aids

·         Community Optometrist

·         Community Speech Therapy Service

·         Community Audiology Service

·         Community Mental Health Nurse

·         Interpreter Service

·         See Ability

·         Specsaver / Vision Express

By Md Foisal Miah Talukdar

Explain the importance of meeting individual’s communication needs

Communication is very important for an individual’s life as it helps them to understand and to be understood. It helps them to express their needs and preferences. It also helps them to express their pain and discomfort if there is any. If we do not meet an individual’s communication needs, then they will not be able to  establish an effective communication and thus, we will fail to recognise their wishes, needs, pains, discomforts and happiness. An individual’s health and wellbeing can deteriorate due to unawareness of many personal issues if we fail to meet individual’s communication needs.

By Md Foisal Miah Talukdar

Analyse features of the environment that may help or hinder communication

Environment that helps communication –

·         Quiet environment helps to establish an effective communication as it supports individual to listen and to be listened without any interference.

·         Well lit environment helps individual to see and to be seen which is very important prior to communication. It is essential for visual communication.

·         Warm temperature of the room in extreme cold weather condition can help an individual to sit comfortably which is necessary for attentiveness.

·         An airy room in hot or humid weather can help an individual to stay comfortable which is necessary for attentiveness.

·         Dignified environment always help an individual to have their say straightforward.

·         Cooperative environment helps an individual to realise their value of opinions which supports them to communicate well.

Environment that hinder communication –

·         Noisy environment can hinder establishing effective communication due to lacking attention.

·         Dark environment can hinder communication due to lacking visibility of presentation or presenter.

·         Excessive hot or cold weather can hinder communication as it reduces comfort ability and decrease attentiveness.

·         Undignified environment can hinder communication as individual’s values are not respected.

·         Uncooperative environment can hinder communication due to past experience of carelessness and miscommunication.

·         Abusive environment can hinder communication due to lack of self esteem and increased fear.

By Md Foisal Miah Talukdar

Describe how underlying personal issues might be addressed

If we can determine the underlying personal issue, then it can be easily addressed following policies and procedures. The following way we can identify the underlying personal issues -

·         Interacting with the individual

·         Observing the individual

Once personal issues are identified then we can take following steps to address it -

·         Act on person’s best interest

·         Record and report to the manager

·         Prioritise individual’s choice and preferences

·         Follow policies and procedures

·         Seek advice and support from family, friends and other professionals

By Md Foisal Miah Talukdar

Identify underlying personal issues that may be a cause of poor personal hygiene

  

·         Abuse

·         Distress or Melancholy

·         Pain or discomfort

·         Infection

·         Deterioration of existing medical condition

·         Giving up or withdrawing

By Md Foisal Miah Talukdar

Identify risks to own health in supporting an individual with personal hygiene routines

·         Slip, trip and fall

·         Infection

·         Burn or scald

·         Cut or graze

·         Muscle sprain or twist

·         Physical abuse

By Md Foisal Miah Talukdar

Describe how to maintain dignity of an individual when supporting intimate personal hygiene

·         Keep the door and window closed and curtain drawn when supporting with intimate     personal hygiene

·         Hang the ‘Do not enter’ sign in front of the door

·         Wrapped body with towel

·         Work on only one body area at a time

·         Avoid eye contact while providing most intimate personal hygiene

By Md Foisal Miah Talukdar

Describe the effects of poor personal hygiene on health and wellbeing

Effects of poor personal hygiene on health and wellbeing are described here in below –

·         Outbreak of infectious disease such as Diarrhoea, Cold flu, Food poisoning, Tuberculosis around the environment

·         Risk of spreading communicable diseases

·         Feeling weak and poorly

·         Increased chance of developing new symptoms (Physically or Psychologically)

·         Increased chance of contributing bad odour to the environment

·         Low self-esteem

By Md Foisal Miah Talukdar