A8- Person centred care

Question 1

What is person centred care?

Answer 1

The action of looking at what makes each pupil unique and then doing everything you can to put their needs first, as it is built on the idea of tailoring care to the individual.

Question 2

How does the NMC code support person centred care?

Answer 2

The NMC code says that all healthcare professionals have a responsibility to ensure the rights of an individual are upheld and that their best interest is at the centre of decision making.

Question 3

How can person centred care be practiced within a healthcare environment?

Answer 3

• Making time for people to understand what is important to them.
• Thinking of wider needs such as social, spiritual, health wellbeing and psychological aspects.
• Communication may need adapting.

Question 4

How can you better your care?

Answer 4

Always reflect on and learn from your interactions with people. This encourages the patient to have trust and confidence in you.

Question 5

What are the 6c’s?

Answer 5

These are values for patient facing staff and clinical staff to uphold, in order to deliver adequate care.

• Care
• Compassion
• Competence
• Courage
• Communication
• Commitment

Question 6

Explain what is meant by care in the 6c’s?

Answer 6

Looking after the health of an individual or a community.

Question 7

Explain what is meant by compassion in the 6c’s?

Answer 7

You must provide care with empathy and respect while maintaining dignity. In order to do this you utilise your intelligent kindness.

Question 8

Explain what is meant by competence in the 6c’s?

Answer 8

Having the ability to understand needs and holding clinical and technical knowledge in order to deliver effective care a treatment.

Question 9

Explain what is meant by courage in the 6c’s?

Answer 9

Having courage enables you to be able to do the right thing by speaking up on your concerns, sharing an innovative vision and embrace new ways of working. This is having personal strength.

Question 10

Explain what is meant by communication in the 6c’s?

Answer 10

This is central to a successful care relationship and teamwork. In addition to this is promotes person centred care as you must listen to an individual to abide by “no decision without me”.

Question 11

Explain what is meant by commitment in the 6c’s?

Answer 11

You must be committed to your patients and populations to improve care and patient experience.

Question 12

What is a boundary?

Answer 12

Rules and limits an individual creates to identify reasonable and safe ways for other to behave towards them.

Question 13

What is patient focus?

Answer 13

Placing the needs of a patient at the centre of care decisions.

Question 14

What is self disclosure?

Answer 14

Information about yourself that should not be discussed with patients.

Question 15

What is a dual relationship?

Answer 15

This is holding more than one type of relationship with a patient, the additional one being different to a patient to professional dynamic.

Question 16

What does it mean to work within your competence?

Answer 16

Having an understanding of your role, capabilities and personal limitations.

Question 17

Why is important to have boundary’s with a patient?

Answer 17

You and the patient may become entwined causing them to view you as friend.
This may cause the patient a level of confusion or you may disclose information to a patient who is considerably dangerous. So creating boundary’s protects both you and the patient. It also allows you to build a good care relationship, communicate effectively and promotes trust and respect.

Question 18

What is maslaws hierarchy of needs?

Answer 18

This is a theory that states humans are most likely to fulfil their needs in a hierarchal order.

1- Physiological needs (air, water, food, shelter, sleep, clothing and reproduction).

2- Safety needs (personal security, employment, resources, health and property).

3- Love & belonging (friendship, intimacy, family and a sense of connection).

4- Esteem (respect, self-esteem, status, recognition, strength and freedom)

5- Self actualisation (desire to become the most that one can be)

Question 19

What is the mental capacity act 2005?

Answer 19

This act protects and empowers those lacking mental capacity, as they may be unable to make decisions regarding their care. This act applies to those 16 or over lacking capacity. It involves decisions on day to day activities and on care and treatment.

This does not apply to unlawful killing, family relationships or voting on behalf of someone lacking capacity.

Question 20

What is mental capacity?

Answer 20

The ability to learn, retain and recite information. This is a major consent issue.
Because of this there must be a record of best interest decisions made for the patient lacking capacity, incase your decisions are challenge so you have an objective record.

Question 21

What are the 5 principles of the mental capacity act 2005?

Answer 21

• Assume someone has capacity unless proven otherwise.
• Don’t treat someone as unable to make decisions for themself, unless all practicable steps have to been taken to help them.
• Don’t treat someone as incapable of making decisions just because what they decide seems unwise.
• Always do things in the patients best interest.
• Consider whether something can be achieved in a less restrictive way, can this be done later?

Question 22

What are the additional 8 principles to uphold in the mental capacity act 2005?

Answer 22

• Choice and control
• Strength based approach
• Transparency
• Holistic
• Personal involvement
• Proportionality
• Fluctuating needs
• Accountability

Question 23

What does the mental capacity act 2005 say about advocacy?

Answer 23

You are entitled to an IMCA ‘Independent Mental Capacity Advocate’ if you are 16 or over, lacking mental capacity without someone close to you who can advocate for you, or the local authority are reviewing or planning to revive your accommodation.
IMCA’s are appointed by the local authority and can act and make decisions on behalf of the person lacking capacity.

Question 24

What is holistic care?

Answer 24

An approach to wellness that addresses a patients physical, mental, emotional, social, lifestyle, family and environmental components affecting their health.

Question 25

What is autonomous practice?

Answer 25

This enables all professionals to provide input of organisational decisions, patient care and enables them to act in accordance with their knowledge so they can make solo decisions.

Question 26

What is person centred care planning?

Answer 26

Planning care while focusing on the patients strengths, needs and preferences.

Question 27

What is advanced care planning?

Answer 27

Developing a care plan for ‘far in the future’ to ensure their wishes are respected to reduce the risk of neglect, abuse and a bad patient experience.

Question 28

What is the Personalisations Agenda 2012?

Answer 28

It places the responsibility upon care professionals to put the individual first when planning, developing and providing care to tailor to their needs and desires.

Question 29

What is integrated working?

Answer 29

Multiple organisations working together to improve the overall health of a patient, quality of their care and resource allocation.

Question 30

What is ADRT?

Answer 30

‘Advanced decisions to refuse treatment’ This could be a refusal to receive CPR and more. This can be changed at any time but a doctor can give a patient a DNAR ‘Do Not Attempt To Resuscitate’ even if the patient dosnt agree to one, but the patient can ask for a second opinion to review the decision. This safeguards staff from legal action.

Question 31

What is the Liberty Protection Safeguards 2009?

Answer 31

This piece of legislation comes under the ‘Mental Capacity Act 2005’, as it safeguards those with no mental capacity. This act protects those 16 or over, who are deemed as needing to be deprived of their liberty to enable care and treatment. This use to be called ‘DOLS’ the deprivation of liberty, which is a procedure prescribed by law, when necessary to deprive a patient of their liberty when they lack mental capacity. This is put in place to safeguard them from their own actions. You can come out of this framework.

Question 32

What is liberty?

Answer 32

The state of being free and having the right to choice.

Question 33

What are the 5 steps taken to authorise an LPS?

Answer 33

• The responsible body must have complied with their duty to appoint an IMCA. • The individual lacking capacity or other have been consulted as far as practicable about their wishes. • The 3 assessments and appropriate determinations have been made. • The pre-authorisation review has been done. • The responsible body is satisfied that an authorisation should be made.

Question 34

What are the 8 principles of the LPS?

Answer 34

• Proportionate • Fluctuating needs • Strength based approach • Choice and control • Transparency • Maximise personal involvement • Holistic • Appropriate

Question 35

When should an LPS authorisation request be put in?

Answer 35

If after a mental capacity assessment the following are still true: • Frequent use of medication/sedation to control behaviour. • Frequent use of restraint to control behaviour. • Person, family or friends object verbally or physically to restrictions or restraint. • They’re confined to a particular part of the establishment. • Their placement is potentially unstable. • Possible risk of challenge to restraint or restriction proposed to court of protection, ombudsman, letter of complaint or solicitors letter. • Already subject to LPS authorisation that is about to expire. This is in addition to the two acid test questions.

Question 36

What are the two acid test questions?

Answer 36

• Is the person free to leave? • Is the person subject to continuous supervision and control?

Question 37

What safeguarding support is available under the LPS?

Answer 37

• Must be appointed a relevant representative as a soon as possible. • Can request authorisation to be reviewed at any time to see if you still meet the criteria/ if anything can change. • Can challenge ur LPS is court. • If you have an unpaid representative you’re entitled to support from an IMCA. • Your home/hospital must explain your rights to appeal and give you support in doing so.

Question 38

What 3 assessments form the basis of an LPS authorisation?

Answer 38

• Mental capacity assessment. • Mental assessment to determine if they have a mental disorder. • ‘Necessary and proportionate’ assessment to determine if arrangements are needed to prevent harm, these are proportionate to the likelihood and seriousness of that harm.

Question 39

Who are the responsible body’s under the LPS and what are they responsible for?

Answer 39

The local authority and NHS body’s are the responsible body’s. They organise assessments and ensure there is sufficient evidence is provided to justify an LPS.

Question 40

What are some communication barriers?

Answer 40

• Sensory impairments • Language barriers • Jargon • PPE • Slang • Non-verbal

Question 41

Why is communication important?

Answer 41

If we can effectively communicate with people we can’t offer them person centred care.

Question 42

How does miscommunication occur?

Answer 42

Your perceptual filters affect and shape what you hear and take in. Your understanding is clouded by your emotions and connotations.

Question 43

What are some non verbal forms of communication?

Answer 43

• Body language • Proximity • Sign language • Gestures • Facial expressions • Brail • Written word • Assistive technology • Apps • Eye contact • Makaton- This is basic sign language, meaning full sentences aren’t signed. This is helpful for people with learning disabilities, doing this may encourage them to talk over time.

Question 44

What are some verbal forms of communication?

Answer 44

• Clarification • Concise speech • Empathy • Paraphrasing • Summarising

Question 45

What is the Care act 2014?

Answer 45

This is a piece of legislation which outlines how adult social care must be provided.

Question 46

What duty’s do the local authority and some other organisations have under the Care Act 2014?

Answer 46

• Prevent care needs from worsening. • Provide a range of high quality and appropriate services. • Give the patients control over how their care is organised. • Promote well-being. • Promote care integration. • Give information and advice. • Promote diversity and equality. • Assess needs and how to meet them. • Set personal budgets and forward direct payments so people can pay for their own social care. • Provide support plans. • Safeguarding adults board.

Question 47

What is a safeguarding adults board?

Answer 47

This is a multi-agency group that ensures the safeguarding of adults who are at risk of abuse. They will co-ordinate agency’s, develop policy’s and procedures in order to prevent abuse, protect individual and promote wellbeing. They will look at past experiences where safeguarding was not up to standard, and reflect on that in order to improve further.

Question 48

How does one obtain a support plan?

Answer 48

You will be referred, have a screening form to assess your needs, have an assessment of eligibility and then it will be given.

Question 49

What is included in a support plan?

Answer 49

• What equipment and care you need. • Personal budget and direct payments. • What services you will be provided with.

Question 50

What are the 6 principles of the Care Act 2014?

Answer 50

• Empowerment • Protection • Prevention • Proportionality • Partnership • Accountability

Question 51

What is a pre-existing condition?

Answer 51

Conditions a person has prior to accessing support.

Question 52

What is a physical health condition?

Answer 52

A medical impairment that affects the body.

Question 53

What is mental health?

Answer 53

The stability of someone’s mental and emotional state.

Question 54

What is a learning disability?

Answer 54

When someone has challenges learning, retaining and reciting knowledge. This can affect how someone communicates as it impacts their ability to use or understand spoken or written language and carry’s out daily activities.

Question 55

What is dementia?

Answer 55

Dementia is an umbrella term for a memory deficit, consequently causing delirium and affecting mental capacity.

Question 56

What does the NMC code say about death and bereavement?

Answer 56

It says in order to uphold the NMC code you must be skilled in death and bereavement care.

Question 57

What is end of life?

Answer 57

When soemone is like to die within the next 12 months or those with imminent death.

Question 58

What is bereavement care?

Answer 58

This is a service offered pre and post loss of a loved one, in order to prepare people for the loss of someone or support them with coping afterwards.

Question 59

What is end of life care?

Answer 59

Care and support for those nearing death by helping them to live as well as possible and die with dignity. This is done with a holistic approach. This is a form of palliative care.

Question 60

What is hospice care?

Answer 60

This focuses on the quality of life and comfort of an individual with a serious illness. This can be given in the community or in a hospice. They focus on quality over quantity.

Question 61

What is palliative care?

Answer 61

Care for those with incurable diseases. They are made comfortable by managing their symptoms and also given a holistic approach. This is available when you first find out you have a terminal illness and can be received while you’re being treated. End of life care is a form of palliative care.

Question 62

What is an advance care plan?

Answer 62

The process of thinking, talking and recording decisions on their personal and medical issues to ensure their wishes are met. This includes decisions on how you would like to die, what your will will be.

Question 63

What are the principles of advance care planning?

Answer 63

• Think (future) • Talk (family and friends) • Record • Discuss • Share (who needs to know)

Question 64

What professionals can be involved in death and bereavement care?

Answer 64

• Nurses will treat. • Doctors pronounce death. • Occupational therapist will accommodate their home. • Community nurse. • Chaplain will provide spiritual care. • Support worker. • Charity’s like make a wish.

Question 65

How can you support someone with bereavement?

Answer 65

• Listen- Check in, be sensitive and provide emotional support. • Counselling, support groups, give advice, GP will connect to relevant service. • Have empathy, be honest, be compassionate, give clear information and offer support. • Bereavement care- Cruse Bereavement Care, Sue Ryder and Winston’s Wish.

Question 66

What is human physiology?

Answer 66

The science of fluctuating human organs and the cells that compose them. This includes mechanical, physical and biomedical functions that determine the health of an individual.

Question 67

What are the 6 stages of human development?

Answer 67

• Birth & infancy (0-2 years) • Early childhood (3-8 years) • Adolescence (9-18) • Early adulthood (19-45) • Middle adulthood (46-65) • Later adulthood (65+)

Question 68

What happens in birth and infancy (0-2 years)?

Answer 68

They will rely on their carers for basic needs like hydration, nutrition and care. They go from being home all day to being in a nursery, this separation from their primary carer for the first time may result in separation anxiety. During this stage they need food, clothing, love, safety, sleep, immunisations and sensory stimulation.

Question 69

What happens in early childhood (3-8 years)?

Answer 69

They require self esteem support and help with their newfound independence when starting primary school. Care needs include immunisations, hygiene, nutrition, exercise, rest, learning and developing social skills.

Question 70

What happens in adolescence (9-18 years)?

Answer 70

They require support with secondary school, exams, puberty, sex and relationships, driving, further education, leaving home and getting a job. Care needs include menstruation help, skin issues, mental health, drugs, alcohol, feelings, change and peer pressure.

Question 71

What happens in early adulthood (19-45 years)?

Answer 71

They will need support with jobs, promotions, employment, stress and upheaval. Also marriage, children and menopause. Care needs include pregnancy, contraception, fertility, relationships, injury’s, drugs, alcohol, dietary intolerances, illness and accidents.

Question 72

What happens in middle adulthood (46-65 years)?

Answer 72

They require support with diagnosis and treatment, loss of parents and retirement. Care needs include menopause, work stress, responsibilities, bereavement and illness. Ageing effects include: • Eyesight (cataracts, glaucoma or blindness) • Hair (thinning, slow growth, men go bald and hair turns grey and white) • Hearing (deteriorates) • Heart (less efficient, BP increase and their blood vessels are less elastic increasing the risk of strokes and heart attacks) • Lungs (less elastic, muscles weaken, can’t exercise as much, more vaccinations) • Reproductive (menopause) • Musculoskeletal (shrink in height, bone mass reduces casing more fractures and mobility issues) • Skin (loss of elasticity causing wrinkles) • Urinary (kidneys less efficient at filtering waste so you urinate more)

Question 73

What happens in later adulthood (65 onwards)?

Answer 73

It has the same health impacts as middle adulthood (46-65 years). Additionally, the require support with hydration, nutrition and mobility. They have freedom from work and can therefor take up more hobbies and travel. May be in a retirement home, bereavement care or experiencing an illness. Care needs include chronic health conditions, sensory problems, mobility and isolation.

Question 74

What is a regulatory body?

Answer 74

An organisation people have to be in to remain a professional within their field. The body will establish national standards for qualifications, education, training, conduct and practice and endure consistent compliance with them. Its main aim is to ensure that standards are met and act accordingly when they’re not by investigating.

Question 75

What is the NMC?

Answer 75

The ‘Nursing And Midwifery Council’ regulate and set standards for the training, education and conduct of nurses and midwife’s. If these standards aren’t met they will investigate, hold hearings to address concerns and take action. To maintain your registration you must maintain your knowledge, skills, adherence to to the code of conduct, ethics, performance, pay to renew it, reflect, get feedback, do CPD and get a third party confirmation to say that you are fit to practice.

Question 76

What is fitness to practice?

Answer 76

When someone has the appropriate skills, knowledge, character and health to practice their profession safely and effectively.

Question 77

What is the GMC?

Answer 77

The ‘General Medical Council’ regulates and sets standards for the education, training and conduct of doctors and medical practitioners. If standards aren’t met they may receive warnings, conditions may be imposed upon their practice and they may lose their registration. To maintain their registration they must do CPD, uphold values, revalidate and demonstrate their fitness to practice.

Question 78

What is the GDC?

Answer 78

The ‘General Dental Council’ regulates and sets standards for the training, education and conduct of dental practitioners. To renew their registration they must do CPD, adhere to standards and pay the renewal fee.

Question 79

What is the GPhC?

Answer 79

The ‘General Pharmaceutical Council’ regulates and sets standards for the training, education and conduct of pharmacists, pharmacy technicians and premisses. To maintain their registration they must do CPD, adhere to standards and pay the fee.

Question 80

What is the Health and Care Professionals Council?

Answer 80

They regulate and set standards for the training, education and conduct of health and care professionals like paramedics, SALTS, therapists and radiographers. To maintain their registration they must do CPD, adhere to standards and pay the fee.

Question 81

What are the 3 types of regulators?

Answer 81

• Professional • Service • Commissioning groups

Question 82

What organisations are influenced by regulators?

Answer 82

• Royal colleges • Professional associations • Advisory groups • Peer review/quality improvement • Standards

Question 83

Who are the care quality commission?

Answer 83

An independent regulatory body for quality and safety of care.

Question 84

What is a ‘HSE’ health and safety executive?

Answer 84

A national independent regulator for health and safety in the workplace. They work in partnership with co-regulators to inspect, investigate and take action. They investigate where incidents are RIDDOR reportable.

Question 85

What is OFSTED?

Answer 85

A regulatory body for social care that look after young people like schools and care homes. They regulate under the CQC and rank organisations outstanding, good, requires improvement and special measures.

Question 86

What is the information commissioners office?

Answer 86

An independent body that is responsible for proving information on rights. They provide guidance for maintaining data protection in a care setting. They do audits, review data protection policy’s and deal with reports regarding areas of concern.

Question 87

What are the 6 NHS core values?

Answer 87

These reflect the shared values of all NHS organisations and underpin what they do. • Compassion • Improving lives • Respect and dignity • Commitment to quality of care • Working together for patients • Everyone counts

Question 88

What is meant by compassion in the NHS core values?

Answer 88

This means to respond with humanity and kindness to each persons pain, distress or needs.

Question 89

What is meant by improving lives in the NHS core values?

Answer 89

Striving to improve the health, well-being and experiences of everyone.

Question 90

What is meant by respect and dignity in the NHS core values?

Answer 90

Value every person as an individual, respect their aspirations and strive to understand their priorities and abilities.

Question 91

What is meant by commitment to quality of care in the NHS core values?

Answer 91

Earn trust by striving to abide by standards of care and quality. This can be done by receiving feedback from patients.

Question 92

What is meant by working together for patients in the NHS core values?

Answer 92

Patients come first and should be fully involved in their care. Other professionals should also be involved in their care.

Question 93

What is meant by everyone counts in the NHS core values?

Answer 93

Maximising resources for the benefit of everyone while ensuring no one is excluded.

Question 94

What is the assessment for mental capacity?

Answer 94

When assessing someone’s mental capacity, the first step is to determine if the individual has a cognitive impairment due to an illness or alcohol/drug use. Then determine if this interferes with their decision making.