Earlier
this month I found myself in the honoured position of being a judge for a care
awards event. As judges we had six categories to review, and there were some
amazing testimonies of the care and support dedicated social care staff had given.
Amongst
the many pieces of supporting evidence we reviewed, one short testimony from a
lady who was 101 years-old made me think. She commented on how this particular
care worker was, "Very gentle and caring."
It
struck me instantly that we don't talk anywhere near enough about gentleness as
a quality. It’s perhaps taken for granted, a 'given' that everyone providing
care and support will be gentle, but gentleness has many facets, and can mean
many different things to different people.
My
idea of gentle and yours may be very different. How a sensitive person, who feels
pain easily, might interpret gentleness is going to be different from a person
with a high pain threshold who's always been pretty tough with themselves,
perhaps from doing a hard physical job.
How
health and social care professionals interpret gentleness is also going to vary
immensely. Someone might believe they are being very gentle, when in actual
fact the person in receipt of their care or support may feel very differently.
Sometimes
gentleness is lost when time is short, there are multiple tasks waiting to be
done, our minds are elsewhere, or if a person we are trying to help is verbally
or physically unhappy with us. None of these are excuses, just the facts facing
many professionals.
In
training, gentleness is rarely mentioned. We talk about being person-centred,
about compassion and kindness, but gentleness is mostly just assumed. Can
gentleness be taught? If you mentor someone with the right aptitude and values
closely enough, showing them what a gentle touch and gentle movement is, then
some element of learning can happen, but you cannot physically become someone else’s
hands so there will always be an unknown quantity of how gentle that person is actually
being.
But
of course gentleness isn’t just about the physical, however much it is
associated with our actions and how we utilise our own physical strength.
Gentleness in how we speak, behave and respond emotionally to a person is
absolutely vital, but even less thought about than physical gentleness. A
short, sharp response to someone, perhaps because we’ve answered their question
numerous times already today, or an insincere tone in our voice can hurt
someone who is emotionally sensitive.
Emotional
sensitivity may exist because the person has always been predisposed to it or
because they have an existing mental health condition. It may be a one-off
because they are a having a bad day or it may be as a result of living with
dementia. Whatever the cause, however, the need to be gentle on the mind is
ever-present.
One
of the wonderful things about us as human beings is our ability to feel acute
emotional responses. Granted, it can be a double-edged sword, but it also opens
up a world of feelings that is virtually limitless. When we provide care and
support for a person, it’s crucial to be aware of everything about our
approach, and consider not just what we say, or don’t say, but also how we say
it.
Much
like physical gentleness, we may not see anything wrong in snapping an answer, gesturing
dismissively with our hands, or responding to a request with delaying tactics (for
example, asking the person to sit and wait rather than address their need) –
after all people do it to us and we don’t think anything of it. But these are
not examples of gentleness, and the person on the receiving end may feel hurt,
unwanted or unimportant.
Vitally,
these feelings may not be visible to us, therefore we may not even consider
that we’ve caused them. One of the great problems with the abandonment of
gentleness is that its effects are often completely unseen. They strike at the
heart, but the most sensitive people who experience them will often keep them
locked in their heart. The result is as harmful as a lack of physical
gentleness, just without the bruises to prove it.
I
would urge everyone working in health and social care to consider what
gentleness means to them. When you think you are being physically gentle, try
and go down a notch or two more on the gentleness scale, being even more gentle
than you have previously been, and see how the person responds – they may be
more comfortable, happier and more secure in your company.
To be
gentle on the mind, take a moment to think about your interactions. Draw breath
before you dive in with whatever you were going to say or do. And never assume
it is only women as the ‘fairer sex’ who need physical and mental gentleness. Men
do too, particularly when they are more vulnerable as a result of living with
dementia.
Until next time (which will be my 200th D4Dementia blog!)...
You can follow me on Twitter: @bethyb1886
This morning I spoke at a conference on the importance of
knowing the person. My audience was predominately social care providers. My
remit was to focus on real lives, drawing on my experiences of care in terms of
the importance of knowledge and skills and with a strong message of person-centred-ness in all care.
Since so many of my blog readers are also social care
professionals, I thought it would be worth sharing some of what I spoke about.
But this blog isn’t just for social care professionals, it’s for families too.
My understanding of what makes great person-centred care began in the years my dad was living with dementia, and despite
all of the experiences I’ve had through my work since, the education I had from my
dad remains unsurpassed.
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© BETH BRITTON 2016
|
Since my dad’s passing, the rise in prominence of
person-centred care has grown. Virtually every care and support provider
will tell you that their care is person-centred. The danger with person-centred
care being in the mainstream, however, is that huge variations now exist in how
different providers interpret this.
Everyone thinks they deliver great
person-centred care, but do they?
As part of my presentation, I shared three slides taken from
the training that I devised for social care staff, particularly care home staff,
that is based on my personal experiences and designed to help staff understand
more about the practicalities of what person-centred care means. Some of the
examples I use are very obvious but don’t be
fooled by the simplicity. The most person-centred organisations I know realise
that EVERY little detail matters.
To explain the many facets of person-centred care, I like to
begin with the obvious physical differences between individuals, picking up on their
appearance and personal effects. But I also talk about interpretation beyond
the physical characteristics. Think expression, personality and history as just
three examples.
Expanding
more into everyday life, it’s vital to understand the role of a personalised environment and appropriate communication. Beyond that, the key question is how each individual's qualities, interests,
preferences, abilities, needs and aspirations are supported. Maintaining skills, a sense of purpose and the enjoyment
of achievement is vital for all of us, but for this to happen in care environments
staff need to believe in it and make it happen. In dementia care especially we
talk about entering the person’s world, but in reality this is vital to achieving person-centred care for any individual.
I
know from my experiences of delivering my training that staff sometimes wonder
how being person-centred is going to benefit them. Their bosses might argue that
their staff aren’t at work to benefit themselves, they are there to provide
care and support for the people accessing their service. But if we don’t look
at how being person-centred enhances the knowledge and skills of staff to help
them feel a sense of achievement and pride in their work then we are making a
big mistake.
When
staff struggle to support a person who is living with dementia because that
person is experiencing symptoms associated with their dementia like confusion,
anxiety, emotional outbursts or repetition, being person-centred in their whole
approach can not only halt the escalation of these symptoms, it can change the
feelings, perceptions and motivation of staff. They don’t leave work feeling
baffled and as if they’ve failed the person, but instead are able to reflect on
how their response helped the person, and how they might refine that response
further in the future to enable an even more positive outcome.
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| © BETH BRITTON 2016 |
Ultimately, though, it would be wrong to talk about person-centred social care and not address the culture and
leadership of organisations. It’s
no fluke that every CQC ‘Outstanding’ rated adult social care provider is well-led.
Sadly, I’ve
seen too many care homes where Joseph White is supping his morning coffee (that
should be tea), eating a digestive (that should be a custard cream) wearing the
vest belonging to Margaret Ross (but Margaret’s a large lady and she’s got
plenty so it’s fine – it isn’t), while Joan Ellis is listening to Frank Sinatra
(even though he’s her least favourite member of the Rat Pack – she’s a secret
Sammy Davis Jn fan. Oh and by the way, she’s mumbling about being cheated on
and fighting with a man because she is remembering headlines of Sinatra’s
stormy personal life). Meanwhile, Edward Lewis is pacing the corridor, wanting to
fix engines but being told to sit down and have a nice glass of juice (only
Edward hates ‘juice’ because he knows it isn’t real orange juice, just watered
down squash).
The
challenge for every social care provider isn’t just knowing, and by knowing I
mean REALLY knowing, the people they are providing care and support for, but
knowing their workforce too. Joseph, Margaret, Joan and Edward could just as
easily be employees that a social care provider doesn’t treat in a person-centred way as they could be
residents or clients.
Complacency
is the enemy of person-centred care. Recruiting staff with the right values
and ensuring they complete e-learning modules on person-centred care isn’t enough.
Authentic and embedded person-centred care is cultural, organisational, and
comes from the very top and pervades down through every employee no matter what
their role or responsibility.
So,
my challenge to every social care provider reading this blog is:
Embed
observation and responsiveness into your leadership. If you think you already
have, do it again, evaluate and keep evolving the leader you are, and the
expectations you have of everyone in your team. Just as no two days with my dad during his
years with dementia were ever the same, so the knowledge and skills needed to
be a truly person-centred social care provider never stand still either.
Until next time...
You can follow me on Twitter: @bethyb1886
