Monday 28 November 2016

The art of gentleness

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!)...
Beth x

You can follow me on Twitter: @bethyb1886

Monday 14 November 2016

Is your workforce person-centred?

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.

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.

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...
Beth x

You can follow me on Twitter: @bethyb1886