Healthcare Assistant Induction Programme

Healthcare Assistant

Induction Programme

Workbook

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Document!title:!Healthcare!Assistant!Induction!Programme!

Document!classification:!Restricted!to!Nuffield!Health!

Document!author:!Jay!Morris!(Learning!and!Development!Specialist)!

Approved!by:!Ben!StanfieldFDavies!!!

(Head!of!Professional!Learning,!Education!&!Clinical!Governance)!

Master!document!location:!

Nuffield!Health!Academy!

Issue!date:!!July!2019!

Review!date:!!July!2021!

Version:!1! Page!1!of!82!

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Contents !Introduction! 3!

Healthy!you,!healthy!workplace! 6!

Understanding!your!role! 8!

Code!of!Conduct! 10!

Nuffield!Health!values! 11!

Recognising!our!people! 13!

PatientFcentred!care! 15!

Duty!of!care! 18!

RecordFkeeping! 19!

Safeguarding! 23!

Raising!concerns! 32!

Complaints,!adverse!events,!incidents!and!Datix! 35!

Managing!challenging!situations,!conflict!and!violence! 41!

Keeping!confidentiality! 44!

Consent! 47!

Good!communication! 51!

National!Early!Warning!Scoring!(NEWS2)! 54!

SBAR!tool! 58!

Sepsis! 60!

Skin!integrity!and!Waterflow!assessment!tool! 63!

Hydration!and!nutrition! 68!

Privacy!and!dignity! 73!

Equality,!diversity!and!inclusion! 75!

Next!steps!and!development!of!your!role! 79!

Healthcare!Assistant!New!Employee!Induction!Programme!sign!off! 82!

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Introduction Click the camera icon, to watch a video for an explanation of how to save and use this

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Welcome!to!Nuffield!Health!!We! are!delighted! you!have! joined! us! and!hope!you! will! settle! in! quickly!and! start! to! feel!confident!in!your!new!role.!Starting!a!new!job!can!be!daunting,!but!we!will!do!all!we!can!to!make! your! induction! enjoyable! and! productive.! You! have! joined! a! highly! skilled! and!professional!team!and!will!have!a!vital!role!to!play!in!our!success.!!

We!look!forward!to!working!with!you!and!will!be!happy!to!answer!your!questions!and!provide!any!support!you!may!need!in!your!new!role.!Sometimes!it’s!easy!for!people!to!forget!what!it’s!like!to!be!new,!so!help!us!to!help!you!by!asking!questions!and!checking!your!progress!with!us.!

Your induction programme

Your! line!manager!and!buddy!will!organise!your! induction!programme.!Your!buddy!may!be!somebody!who!is!doing!the!same!or!different!job!to!yourself.!They!will!act!as!a!‘professional!friend’!with!whom!you!can!discuss!things!as!you!learn.!!

You!are!expected!to!complete!your!induction!within!3!months.!!

Drive your own development

We!aim!to!provide!you!with!the!support!that!you!need!to!be!successful!in!your!first!few!weeks!and!months.!As!an!adult!learner,!we!expect!you!to!play!your!part!by!taking!responsibility!for!and!driving!your!own!development.!This!will!involve:!

•! Clarifying!expectations!of!your!role!•! Getting!to!know!people!–!colleagues,!other!parts!of!the!organisation!•! Doing!your!own!research!and!making!notes!as!you!learn!•! Speaking!to!colleagues!and!patients!and!learning!what!they!need!from!you!•! Identifying!your!strengths!and!weaknesses,!as!well!as!gaps!in!your!knowledge!and!skills!

•! Informing!your!line!manager!when!you!need!support!•! Completing!Academy!Online!training!–!mandatory!modules!and!those!specific!for!your!role!

•! Actively!steering!your!induction!so!that!it!meets!your!learning!needs!•! Reviewing!your!progress!and!continuing!to!develop!your!knowledge!and!skill!•! Reading!relevant!policies!and!procedures!and!documents!•! Looking!to!the!future!to!see!how!you!can!further!develop!your!knowledge!and!skills.!

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Mandatory and role-essential training checklist

As!part!of!your!induction!and!ongoing!training,!you!are!required!to!complete!mandatory!and!roleFessential!(jobFspecific)!training,!as!listed!below:!

E3learning!module! Date!completed!

Health,!Safety!and!Welfare! !

Fire!Safety! !

Whistleblowing! !

Managing!Stress! !

Reporting!Incidents!(Datix)! !

Equality,!Diversion!and!Inclusion! !

Safeguarding!Adults! !

Safeguarding!Children!and!Young!People!(Level!1)! !

Infection!Prevention!and!Control! !

Information!Governance! !

Consent!to!Examination!of!Treatment! !

Health!RecordFkeeping! !

Safer!Blood!Transfusions!(Level!1)! !

Mental!Capacity!Act!(2005)!and!Deprivation!of!Liberty!Safeguard! !

VTE!(to!be!confirmed)! !

Cyber!Security! !

Business,!Ethics!and!Modern!Slavery!Act! !

WHO!Checklist!(selfFselect!for!Theatre!Healthcare!Assistants)! !

Practical!module! Date!completed!

Nuffield!Basic!Life!Support! !

Moving!and!Handling! !

Infection!Prevention!! !

Medical!Devices!training!(relevant!to!working!department)! !

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FREQUENTLY ASKED QUESTIONS

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1.! I! feel! nervous!about!completing! this! induction! programme!and! really! don’t! know!where!to!begin…!

First!and!foremost,! the!programme!is!about!helping!you!recognise!the!opportunities!and!boundaries!of!your!role!as!a!healthcare!assistant.!!

It!will!help!you!acquire!the!key!skills!and!competencies!that!enable!you!to!be!a!safe!and!effective!practitioner,!working!as!part!of!a!team!to!deliver!highFquality!care!to!patients.!

Working!with!your!line!manager!and!your!buddy,!spend!some!time!reflecting!and!create!a!plan!of!action!with!small!achievable!goals.!

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2.! How!long!will!it!take!me!to!complete!this!programme?!

This!will!depend!on!you!and!your!buddy.!We!estimate! that! it!should!take!three!months.!However,!people!come!with!different!skills!and!experience!which!may!impact!on!the!length!of!time!it!takes!to!complete!induction.!

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3.!Who!can!support!me!with!answering!the!questions!in!the!induction!programme?!

Your!colleagues!and!your!buddy!will!be!keen!to!can!help!you.!In!addition,!you!can!access!a!variety!of!reliable!and!credible!sources,!both!on!the!Nuffield!Health!intranet!and!online.!Look!out!for!the!suggested!resources!throughout!this!guide.!

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4.!What!if!I!have!a!specific!question!that!isn’t!covered?!

No!problem.!Discuss!with!your!buddy!and!see!if!you!can!resolve!your!question.!Or!speak!to!other!experienced!colleagues!for!help.!

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! Click the useful resources button to access:!The!Royal!Marsden!Manual!of!Clinical!Nursing!Procedures:!Providing!evidencedFbased!guidelines!and!best!practices!on!procedures!and!clinical!tasks.!

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Healthy you, healthy workplace

You!will!be!better!able!to!successfully!play!your!part!in!a!healthcare!team!and!help!people!to!maintain!good!health!if!you!look!after!your!own!health.!!

Healthcare! can! be! a! tiring! and! pressured! occupation,! and! the! best! way! to! manage! the!unwanted!sideFeffects!is!to!keep!yourself!physically!and!mentally!active.!That!means!paying!ongoing!attention!to!the!following.!!

!EAT!WELL!

Aim!to!have!a!balanced!diet!that!provides!the!nutrients!you!need.!As!part!of!a!flexibly!responding!healthcare!team!you!may!find!that!meal!breaks!can!be!at!unusual,!unpredictable!times.!When!a!break!comes,!it!may!prove!a!challenge!to!slow!down!and!relax.!As!a!result,!food!can!be!bolted!down,!practically!unnoticedg!not!good!for!digestion!nor!taste!!

Use!your!breaks!wisely!as!a!chance!to!take!some!time!out!from!whatever!pressures!you!may!be!under.!Allow!yourself!a!few!moments!of!calm.!Eat!food!slowly,!taste!and!enjoy.!

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GET!PHYSICAL!

The!Chief!Medical!Office!Guidelines!(2011)!for!adults!in!the!UK!(see!later)!state!that!we!should!take!a!minimum!of!30!minutes!of!moderate!physical!activity!at!least!five!times!a!week.!!

Moderate!physical!activity!means!that!you!will!probably!feel!warm,!a!little!out!of!breath!and!start!to!break!a!sweat.!But!exercise!doesn’t!have!to!be!intense.!Brisk!walking!is!an!excellent!physical!activity!with!clear!health!benefits.!And!remember!that!the!30!minutes!does!not!have!to!be!taken!in!a!single!session.!You!could!take!two!15Fminute!brisk!walks!or!cycle!rides!during!the!day.!!Perhaps!walk!part!of!your!route!to!work.!

Of!course,!your!work!will!involve!activity,!a!lot!of!walking!and!movement.!Make!sure!that!you!pay!attention!to!your!own!health!and!safety,!as!well!as!that!of!your!patients!and!colleagues.!It’s!important!to!be!physically!fit!and!able!to!undertake!your!duties.!!

Remember,!too,!that!as!a!Nuffield!Health!employee,!you!have!free!access!to!our!nationwide!fitness!and!wellbeing!facilities,!so!make!use!of!this!great!perk.!

For!more!information!relating!to!employee!benefits,!access!the!link!provided!at!the!end!of!this!section.!!

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REST!AND!SLEEP!WELL!

Aim!to!have!a!balanced!diet!that!provides!the!nutrients!you!need.!As!part!of!a!flexibly!responding!healthcare!team!you!may!find!that!meal!breaks!can!be!at!unusual,!unpredictable!times.!When!a!break!comes,!it!may!prove!a!challenge!to!slow!down!and!relax.!As!a!result,!food!can!be!bolted!down,!practically!unnoticedg!not!good!for!digestion!nor!taste!!

Use!your!breaks!wisely!as!a!chance!to!take!some!time!out!from!whatever!pressures!you!may!be!under.!Allow!yourself!a!few!moments!of!calm.!Eat!food!slowly,!taste!and!enjoy.!

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!EMOTIONAL!WELLBEING!

To!gain!a!better!awareness!and!enhance!your!knowledge!of!the!importance!of!emotional!wellbeing,!an!eFlearn!module!is!available!on!Nuffield!Health!Academy!Online.!This!eFlearning!module!can!be!selfFselected!for!you!to!complete.!

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Click the useful resources 1 button to access:!information!regarding!UK!physical!activity!guidelines!

Click the useful resources 2 button to access:!further!information!regarding Nuffield!Health!employee!benefits!

Click the useful resources 3 button to access:further!information!relating!to!the importance of sleep

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Useful!resources 1! Useful!resources 2! Useful!resources 3!

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Understanding your role

Whatever!role!or!department!you!work!in,!it’s!important!that!you!are!clear!about!your!job!tasks!and! responsibilities,! role!boundaries!and!Nuffield!Health!expectations.!There!will!be!a! role!profile!that!outlines!your!duties!and!responsibilities.!Ask!your!line!manager!for!a!copy.!!

What we expect of you

Nuffield!Health’s!expectations!will!be!discussed!and!agreed!with!you!during!your! induction!period.!!

Regarding!the!boundaries!of!your!role,!you!need!to!know,!for!example,!that!there!are!tasks!!only!a!registered!nurse!or!clinician!can!carry!out.!These!tasks!should!be!specified!for!both!your!protection!and!the!patient’s.!

Nuffield! Health! regards! patient! and! team! member! safety! as! paramount.! It! is! therefore!important! that!you!act! in!accordance!with!our!policies!and!follow!agreed!ways!of!working.!These!ensure! that!you!are!working!within! the! law,!providing!care!and!support! to!meet! the!needs!of!our!patients!in!line!with!our!values.!!!

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ACTIVITY!

Review!your!role!profile.!Summarise!your!main!duties!and!responsibilities.!What!do!these!mean!to!you?!

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Explain!why!it!is!important!to!work!in!accordance!with!policies!and!agreed!ways!of!working.!

Describe!how!your!previous!experiences,!attitudes!and!beliefs!may!affect!the!way!you!work.!

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Code of Conduct

As!a!healthcare!assistant,!you!make!a!valuable!and!important!contribution!to!the!delivery!of!highFquality!healthcare,!care!and!support.!

Guidance!set!out!in!the!Code!of!Conduct!will!provide!you!with!the!confidence!and!reassurance!that!you!are!providing!safe!and!compassionate!care!of!a!high!standard,!(this!includes!speaking!out!when!you!feel!it!may!be!necessary).!!

The!Code!also!informs!the!public!and!people!who!use!health!and!care!services!exactly!what!they!should!expect!from!the!HCA!workforce.!!

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! Click the useful resources button to access: further!information!regarding!the!Code!of!Conduct!for!healthcare!support!workers!and!adult!social!care!workers!in!England.!

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ACTIVITY!

Look!up!the!Code!of!Conduct!for!healthcare!support!workers!and!adult!social!care!workers!in!England.!List!the!main!standards!as!they!relate!to!

your!role.!What!do!these!mean!to!you?!

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Nuffield Health values

Our! strategic! intent! is! to! champion! the!health!of! the! individual! and! help! our! patients!and!customers!get!the!most!out!of!life.!!

To!this!end!Nuffield!Health!has!embarked!on!a!vital! journey,!bringing!fitness!and!wellbeing!centres,! hospitals! and! clinical! services! closer! together! to! create! an! integrated! health! and!wellbeing!offering!for!our!patients!and!customers.!!

As!the!leading!notFforFprofit!organisation,!success!means!we!can!reinvest!more!for!the!good!of! everyone.! This! means! that! we! put! patients,! customers! and! colleagues! at! the! heart! of!everything!we!do.!!

To!underpin!this!pledge,!Nuffield!Health’s!commitment!towards!our!patients,!customers!and!colleagues!is!driven!by!our!We!CARE!values!framework,!which!consists!of!four!values.!!

Our! values! drive! our! actions,! now! and! in! the! future,! showing! us! the! way! to! deliver! our!organisational!goals!for!our!patients,!our!customers!and!ourselves.!They!act!as!the!enablers!for!our!journey!because!if!we!bring!them!to!life!every!day!at!work,!we!demonstrate!what!we!believe!in.!!

We!know!that!if!we!are!to!provide!this!special!connected!and!caring!service,!every!single!one!of!us!must!share!the!same!goals,!work!cooperatively!and!feel!valued!and!appreciated!for!the!work!we!do.!

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! Value! How!I!will!bring!them!to!life!in!my!new!role!

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ACTIVITY!

Name!the!FOUR!Nuffield!Health!We!Care!values.!Explain!how!you!will!bring!them!to!life!in!your!new!role.!

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Recognising our people

Recognising!our!people!plays!an!important!role!in!motivating!and!engaging!our!colleagues.!Sharing!success!highlights!what!good!looks!like!and!encourages!others!to!do!the!same.!!

The! We! CARE! Values! Recognition! Scheme! celebrates! success! and! creates! a! positive!employee! experience! that! drives! positive! change! and! embeds! our! values.! Employees!nominate!each!other!for!living!our!values!by!filling!in!a!We!CARE!postcard!and!pinning!it!to!the!We!CARE!noticeboard!situated!at!your!hospital.!!

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ACTIVITY!

Explain!why!it!is!important!to!celebrate!success!and!recognise!hard!work!within!a!team!

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•! Additional!information!about!Nuffield!Health!Values!and!Behaviours!is!available!on!the!extranet!along!with!information!regarding!the!We!CARE!Values!Recognition!Scheme.!!

•! Access!the!values!toolkit!by clicking the!useful resources button.!

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Useful!resources!

Discuss!with!your!buddy!where!to!find!your!nearest!nomination!notice!board!and!how!to!nominate!a!colleague.!!!!

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Patient-centred care

Being!personFcentred!is!about!focusing!care!on!the!needs!of!the!patient!rather!than!the!needs!of!the!service.!It!is!important!to!recognise!that!patients!will!have!their!own!views!on!what!is!best!for!them!and!their!own!priorities!in!life.!As!a!healthcare!worker,!you!have!to!be!flexible!to!meet!patients’!needs.!!

It!is!essential!that!you!include!the!patient!as!an!equal!partner!in!the!planning!of!their!care!and!that!their!opinions!are!respected!and!taken!into!consideration!when!planning!and!delivering!care.!!

When! collaborating! with! patients,! use! appropriate! communication! methods! to! actively!encourage!them!to!participate!in!their!own!care!and!be!real!partners!in!any!decisions!made.!!

Try!to!make!sure!that!patients!get!information!in!a!format!acceptable!to!them.!This!in!turn,!will!assist!them!to!make!decisions!about!their!care!and!treatment!and!to!discuss!their!treatment!plan.!

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ACTIVITY!

Describe!what!is!meant!by!‘personalised!values’.!How!would!you!treat!patients!based!on:!individuality,!independence,!privacy,!partnership,!

choice,!dignity,!respect!and!rights?!

Explain!your!understanding!of!the!terms!‘emotional!and!spiritual!well3being’.!How!might!this!influence!the!way!you!care!for!patients?!

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Describe!how!you!will!put!person3centred!values!into!practice!in!your!day3to3day!work.!

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Duty of care

You!know!that!you!have!a!duty!of!care!to!all!those!receiving!care!and!support!in!your!role.!This!means!promoting!wellbeing!and!making!sure!that!patients!are!kept!safe!from!harm,!abuse!and!injury.!!

Duty!of!care!is!a!legal!requirement!and!applies!from!the!start!of!care!or!treatment.!Ignoring!this!duty,!for!example!through!negligent!actions!and!behaviour,!could!result!in!legal!action.!!

Nuffield!Health!provide!guidance!on!matters!such!as!how!to!deal!with!violence,!handling!toxic!substances,!risk!assessments,!fire!drills!and!routine!security.!These!are!all!integral!to!the!care!you!provide.!!

What’s!more,!your!duty!of!care!towards!your!patients! includes!passing!on!(escalating)!any!concerns! you! have! about! the! wellbeing! or! safety! of! your! patients! to! a! colleague! or! line!manager.!Nuffield!Health!has!a!clear!and!detailed!escalation!procedure.!

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ACTIVITY!

Explain!what!‘duty!of!care’!means!for!you!in!your!role!as!a!Healthcare!Assistant.!Discuss!with!your!mentor,!buddy!and!/!or!your!colleagues.!

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Record-keeping

Why keep records?

There!are!many!reasons!for!keeping!records!in!healthcare.!The!two!main!ones!are:!

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The importance of good record-keeping

Healthcare!records!need!to!be!clear,!accurate,!honest!and!timely!(this!means!written!as!near!as!possible!to!the!actual!time!of!occurrence!of!the!events!they!describe).!

It! is!essential! that!you!are!aware!of! the!potential! legal! implications!associated!with! recordFkeeping.!!

There!are!two!key!things!you!should!be!aware!of!about!the!legal!aspects!of!recordFkeeping!in!healthcare.!They!are!as!follows:!

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1! To!compile!a!complete!record!of!the!patient’s!journey!through!their!hospital!treatment!

2! To!enable!continuity!of!care!for!the!patient,!within!and!between!services!

1! Individuals!who!work!for!healthcare!organisations!are!responsible!for!what!they!write!

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2! Anything!an!individual!writes!in!relation!to!their!work!as!a!healthcare!employee!becomes!a!public!record.!

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Being transparent

If!you!do!document!in!a!patient’s!record,!you!must!take!care!about!what!you!write.!Not!only!will!you!be!asked!to!formally!explain!your!records! in!the!event!of,! for! instance,!a!complaint!from!a!patient,!but!also!patients!are!able!to!apply!to!see!what!you!have!written!about!them!through!the!Data!Protection!Act!(1998!and!2018).!

The boundaries of record-keeping

One!question!is!whether!healthcare!assistants!are!authorised!to!contribute!to!records!about!patients!and!record!the!care!they!give.!!

Healthcare!assistants!are!permitted!to!write!in!a!patient’s!care!record,!provided!the!registered!nurse!who!delegates!this!responsibility!is!satisfied!that!the!healthcare!assistant!is!competent!to!undertake!the!activity!and!its!documentation.!

Record-keeping: dos and don’ts

Whether!writing!by!hand!or!making!entries!to!electronic!systems,!everything!you!write!or!enter!must!be!honest,!accurate!and!nonFoffensive.!

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Record!events!accurately!and!clearly!–!remember!that!the!patient!may!wish!to!see!the!record!at!some!point,!so!make!sure!you!write!in!language!that!he!or!she!will!understand!

! Focus!on!facts,!not!speculation!

!Record!how!the!patient!is!contributing!to!his!or!her!care,!and!quote!anything!said!that!you!think!might!be!significant!

Don’ts! !

! Avoid!breaching!patient!confidentiality!

! Avoid!unnecessary!abbreviations!

!Do!not!change!or!alter!anything!someone!else!has!written,!or!change!anything!you!have!written!previously.!If!you!do!need!to!amend!something!you!have!written,!draw!a!clear!line!through!it!and!sign!and!date!the!changes!

! Do!not!write!anything!about!a!patient!or!colleague!that!is!insulting!or!derogatory.!

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ACTIVITY!

Summarise!the!importance!of!record3keeping!and!how!this!is!relevant!to!your!role.!

List!the!different!type!of!healthcare!records!you!may!be!expected!to!complete!or!document!in.!

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! •! Click the useful resources button to access: the Royal College of Nursing guide to record keeping

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Useful!resources!

Explain!the!importance!of!updating!a!patients!care!record!in!a!timely!manner!and!the!potential!risks!of!not!doing!so.!

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Safeguarding

Safeguarding!adults,!children!and!young!people! is!about!reducing!or!preventing!the!risk!of!significant!harm!from!abuse!and!exploitation!and!where!appropriate,!supporting!people!to!take!control!of!their!own!lives!by!making!informed!choices.!!

We!all!have!a!part!to!play!in!securing!this!for!the!adults,!children!and!young!people!in!our!care,!particularly!for!those!who!are!vulnerable.!Children!are!considered!vulnerable!by!virtue!of!their!age!and!immaturity,!but!adults!can!also!be!vulnerable,!if!they!are!permanently!or!temporarily!unable!to!care!for!themselves!and!their!interests,!through!a!mental!or!physical!cause.!!

Vulnerable!adults!are!open!to!risks!of!psychological!and!physical!harm!or!being!exploited!for!the!benefit!of!others.!

Safeguarding principles

The!UK!Government!(Department!of!Health!&!Social!Care,!2011)!has!set!out!some!principles!of!safeguarding!in!health!and!social!care!(reference!provided!at!the!end!of!this!section)!that!help!us!to!understand!how!we!can!act!to!protect!people.!!

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People!should!be!supported!to!make!their!own!decisions!based!on!the!best!possible!

information!

It!is!better!to!take!action!before!harm!occurs.!

What!we!do!should!be!proportionate!to!the!risk.!We!do!not!want!to!be!overF

protective!if!the!risk!is!low,!as!this!in!itself!can!disadvantage!people!and!deprive!of!them!of!the!opportunity!to!make!their!own!

decisions.!!

Those!in!greatest!need!require!our!support!and!protection.!

Safeguarding!is!about!different!people,!professions,!groups!and!communities!

working!together!to!cover!all!the!angles!in!preventing,!detecting!and!reporting!

neglect!and!abuse.!

In!all!our!activities!as!healthcare!assistants,!we!need!to!act!with!accountability,!responsible!for!what!we!do!in!safeguarding,!ensuring!appropriate!escalation!to!registered!nurses!and!clinicians.!

Empowerment!

Proportionality!

Partnership!

Prevention!

Protection!

Accountability!

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Support

All! people!who!come! into! contact!with! children!and!young!people!have!a! responsibility! to!safeguard!and!promote!their!welfare!and!should!know!what!to!do!if!they!have!concerns!about!safeguarding!issues,!including!child!protection.!!

As!a!healthcare!assistant,!Nuffield!Health!supports!you!by!providing!suitable!training!that!will!help! you! to! identify! possible! harm! and!who! to! contact! and! seek!advice! from! if! you! have!concerns.!

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! •! As!part!of!your!induction,!you!are!expected!to!read!Gov!25:!Safeguarding!Policy!for!Children,!Young!People!and!Adults.!!

•! Additionally,!you!are!required!to!complete!both!the!Safeguarding!Adults!and!the!

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Safeguarding!Children!and!Young!People!eFLearn!modules!on!Academy!Online.!You!can!access!the!Safeguarding!policy!by clicking the useful resources button above.

Useful!resources!

ACTIVITY!

In!your!own!words,!define!the!term!‘abuse’.!

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Explain!how,!as!a!healthcare!assistant!you!can!deliver!a!‘dignified!care!environment’!to!help!keep!patients!safe!by!minimising!the!risk!of!harm!and!

abuse.!

If!a!patient!tells!you!they!are!being!abused,!what!actions!should!you!take?!

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! Who?! What!makes!them!‘vulnerable’?!

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List!four!types!of!vulnerable!people!you!have!come!across!in!your!role,!identifying!what!makes!them!‘vulnerable’.!

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List!three!signs!of!physical!abuse.!

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List!three!signs!of!sexual!abuse.!

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List!three!signs!of!psychological!abuse.!

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List!three!signs!of!discriminatory!abuse.!

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List!three!signs!of!organisational!!abuse.!

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List!three!signs!of!neglect.!

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Consider!the!people!that!patients!come!into!contact!with!3!who!might!they!be!at!risk!of!abuse!from?!

What!should!you!do!first!if!you!suspect!a!child!or!young!person!is!being!abused?!

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What!should!you!do!first!if!you!suspect!a!child!or!young!person!is!being!abused?!

What!is!the!difference!between!safeguarding!a!child!and!child!protection?!

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! •! Click the useful resources button to access: further information relating to the safeguarding principles.

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Useful!resources!

Describe!where!you!can!get!further!help,!advice!and!information!on!safeguarding!children!and!young!people.!

Highlight!the!key!points!of!Nuffield!Health!policies!and!legislation!relevant!to!safeguarding!adults,!children!and!young!people.!

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Raising concerns

You!may!have!heard!of!raising!concerns!(sometimes!referred!to!as!‘whistleblowing’)!from!highFprofile!cases!of!healthcare!workers!who!have!reported!bad!and!dangerous!practice!to!their!employers,!regulatory!bodies!or!governing!bodies.!!

There! are!many! examples! of! excellent! healthcare! in! the! UK,! but! occasionally! a! situation!comes!to!light!that!exposes!bad!practice.!Reports!have!appeared!in!the!media!in!recent!years!of! instances!of!bad!practice! that!have! led! to!suffering!or!even!death! for!vulnerable!people!receiving!healthcare.!

Incidents!such!as!these!come!to!the!public’s!attention!through!the!action!of!people!who!speak!out!against!the!abuse.!When!incidents!are!investigated,!it!has!been!discovered!that!employees!in!the!organisations!where!the!events!took!place!were!too!frightened!to!speak!out.!!

Speak out, speak up

It!is!important!that,!if!you!suspect!bad!practice!or!abuse,!you!must!feel!free!to!report!it!without!fear!of!recrimination,!intimidation,!or!sanction,!and!in!a!confidential!manner.!!

In! order! to! reinforce! the! duty! and! motivation! of! healthcare! workers! to! protect! vulnerable!people,!the!government!put!in!place!the!Public!Interest!Disclosure!Act!1998,!which!applies!to!almost!all!workers!in!England,!Wales!and!Scotland.!!

If!you!see!or!hear!something!at!work,!which!makes!you!feel!uncomfortable,!it!is!important!that!you!are!aware!how!to!raise!it!with!someone.!The!types!of!issues!that!could!be!raised,!include!criminal! offences!or! failure! to! comply!with! legal!obligations.!Specific! guidelines!have!been!developed!relating!to!freedom!to!speak!up!(reference!provided!at!the!end!of!this!section).!

The!Nuffield!Health!policy!(reference!provided!at!the!end!of!this!section)!is!in!place!to!ensure!openness,!freedom!of!speech!and!ethical!practices.!Whilst!we!want!our!team!members!to!feel!comfortable! to! raise! issues! informally,! it! is! important! to! that!employee’s! feel! they!have!the!ability!to!raise!issues!in!a!protected!environment.!

Safecall

In! addition,! 'Safecall',! a! new! whistleblowing! line! provides! a! confidential,! alternative! way!for!people!to!raise!serious!concerns,! if! they!feel!uncomfortable!doing!this!directly!with!their!line!manager!through!our!normal!route.!!

A!link!to!the!extranet!has!been!provided!at!the!end!of!this!section!for!you!to!access!for!more!information.!

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ACTIVITY!

Explain!your!understanding!of!the!term!‘whistleblowing’.!

Who!might!you!turn!to!in!the!hospital!for!further!advice!and!information?!

Explain!your!understanding!of!the!term!‘freedom!to!speak!up’.!

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Click this useful resources button to access: further!information!regarding!Freedom!to!Speak!Up!guidelines!

Click this useful resources button to access: The!Whistleblowing!policy!

Click this useful resources button to access: information!regarding!Safecall!

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Explain!your!understanding!of!the!term!‘Safecall’.!

Useful!resources!

Useful!resources!

!Useful!resources!

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Complaints, adverse events, incidents and Datix

Patients,! their! families!and!carers!have!a!right!to!complain!or!comment!about!their!care!or!support!where!they!feel!it!is!substandard.!It!is!our!duty!to!respond!to!those!concerns.!!

If!there!is!something!wrong!with!our!care,!we!want!to!know!what!it!is!so!we!can!try!to!put!it!right!and!maintain!the!quality!we!are!known!for.!It!is!important!that!this!happens!in!a!timely!manner!and!in!a!positive!way.!!

Complaints!must!be!taken!seriously!and!explored!so!that!any!learning!opportunities!can!be!identified!and!used!constructively!to!make!improvements!and!enhance!the!service!our!patients!and!customers!receive.!!

The!Local!Authority!Social!Services!and!NHS!Complaints!(England)!Regulations!(2009)!is!the!legislation!that!governs!the!handling!and!management!of!complaints!in!healthcare.!!

The! Parliamentary! and! Health! Service! Ombudsman! (2009)! has! subsequently! published!guidance!identifying!six!principles!of!good!complaint!handling!(references!provided!at!the!end!of!this!section),!and!we!have!adopted!these!in!our!own!complaints!handling!policy.!!

SIX PRINCIPLES OF GOOD COMPLAINT HANDLING

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Getting!it!right!

Being!customer!focused!

Seeking!continuous!improvement!

Being!open!and!

accountable!

Acting!fairly!and!proportionately!

Putting!things!right!

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ACTIVITY!

Gov!22!outlines!Nuffield!Health’s!complaints!handling!and!management!processes.!Stage!1!of!this!process!(Local!Resolution)!may!involve!you.!

What!would!you!do!if!you!are!challenged!with!a!complaint?!

Explain!the!importance!of!learning!from!patient!feedback!and!complaints!to!improve!Nuffield!Health’s!quality!of!service.!

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Completing an incident report form

During! your!work!as! a!healthcare!assistant,! you!may!witness! an! incidentg! for! instance.! a!patient! tripping! and! falling,! or! equipment! malfunctioning.! These! types! of! events! must! be!logged!on!an!incident!report!on!Datix,!Nuffield!Health’s!incident!management!platform.!!

Note!that!you!cannot!complete!the!form!on!behalf!of!someone!else.!You!can!only!contribute!to!an!incident!form!if!you!directly!witnessed!the!event!or!were!involved/present!when!it!was!discovered.!!

Nuffield!Health!has!an!Incident!Reporting!policy!(Gov!13:!Reporting!and!Management!of!all!Adverse!Events!and!Serious! Incidents!Policy)! that!will! help! you!understand!how!Datix!works.!

When!completing!an!incident!report,!always!remember!to:!

! Think!very!carefully!about!what!you!are!going!to!write!

! Report!the!facts!and!complete!all!questions!as!best!you!can!

! Follow!the!principles!of!good!recordFkeeping!and!written!communication!

!Seek!advice!from!your!peers!and!senior!members!of!the!team!if!you!require!additional!support.!

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Describe!what!types!of!communication!can!be!used!to!address!problems!and!effectively!respond!to!complaints.!

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A!patient!complains!about!the!inadequate!food!portion!they!have!

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ACTIVITY!

Explain!why!it!is!important!to!be!open!and!honest!and!identify!where!errors!may!have!occurred!and!tell!the!appropriate!person.!

Describe!what!you!would!do!in!the!following!situations:!

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A!patient!slips!in!the!bathroom!and!injures!

themselves.!

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A!patient!on!a!kosher!diet!complains!that!they!were!given!the!wrong!meal.!

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A!patient!informs!you!that!their!details!are!incorrect!on!their!patient!ID!band.!

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! •! Click this useful resources button to access:!further!information!relating!to!the!guidance!and!the!six!principles!of!complaint!handling.!

Click this useful resources button to access: Complaints Management policy

Click this useful resources button to access: Gov 13: Adverse events Datix user manual

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Useful!resources!

Useful!resources!

Useful!resources!

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Managing challenging situations, conflict and violence

Safe!and!healthy!workplaces!provide!patients!with!the!right!environment!in!which!to!recover!and!for!healthcare!workers!to!be!able!to!carry!out!their!work!activities!safely!and!effectively.!!

Healthcare! workplaces! can! also! present! risks! to! health:! faulty! electrical! equipment,! worn!flooring!and!spillages!all!pose!hazards!for!both!patients!and!the!people!who!care!for!them.!!

Keeping! the! workplace! safe! and! secure! requires! a! willingness! to! look! for,! spot,! then!address,!potential!hazards.!!

How!to!keep!your!workplace!safe!and!healthy!

! Make!sure!you!keep!your!working!environment!clean!and!tidy!

!Ensure!equipment!and!furnishings!are!safely!stored!away!when!not!in!use!and!remove!trailing!electric!cables!from!floors!

! Report!damaged!equipment,!floor!coverings!and!lights!immediately!

!Always!follow!Nuffield!Health’s!organisational!infection!prevention!and!waste!disposal!policies,!particularly!with!sharps!(IP!02!Standard!Precautions!Policy)!

!Clean!away!spillages!immediately,!using!approved!procedures!and!personal!protective!equipment!where!necessary!

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Nuffield!Health!have!specific!policies!relating!to!health!and!safety! in!the!workplace!and!for!dealing!with!violence!and!aggression!at!work.!Links!to!these!policies!have!been!provided!at!the!end!of!this!section!for!you!to!access.!

You!are!also! required! to! complete! the!Health,!Safety!and!Welfare!eFlearn!as!part!of! your!induction!programme.!!

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How to handle threatening behaviour

There!are!guidelines!on!how!to!handle!violence!and!threatening!behaviour!(reference!provided!at!the!end!of!this!section).!If!you!recognise!that!a!person!is!exhibiting!threatening!behaviour,!follow!these!guidelines!to!protect!yourself,!your!patients!and!your!colleagues.!!

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Assess!the!situation,!breathe!slowly!and!evenly!

Give!the!individual!plenty!of!space,!physically!and!verbally!

Speak!slowly,!calmly!but!firmly!

!Ask!questions!to!clarify!what!the!aggressor!is!saying,!making!the!aggressor!feel!you!are!listening!and!want!to!help!!

Offer!to!contact!a!senior!colleague!to!assist!you!

Ensure!body!language!is!open!and!relaxed,!make!eye!contact,!but!avoid!staring!!

! Get!onto!the!same!level!as!the!other!person!(for!example,!invite!them!to!sit!down,!or!stand!up!slowly)!!

Avoid!standing!in!a!position!where!their!exit!is!blocked!

Provide!relevant!information,!as!this!may!help!to!reduce!anxiety!or!frustration.!!

Understand,!don’t!antagonise.!

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! •!Click this useful resources button to access: further!information!relating!to!guidelines!for!handling!violence!and!aggression!in!the!workplace.!

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Click this useful resources button to access: Health and Safety policy

Useful!resources!

ACTIVITY!

In!your!own!words,!describe!your!role!in!maintaining!a!safe!and!healthy!working!environment.!

Identify!the!potential!risks!to!patients,!visitors!and!your!colleagues!when!health!and!safety!guidance!is!not!followed.!

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Keeping confidentiality

Confidentiality!is!an!essential!principle!in!healthcare!and!underpins!all!ways!of!working!and!codes!of!practice.!!

The!basis!of!a!good!working!relationship! is!trust.!This! is!dependent!on!the!individual!being!confident! that! personal! information! about! them! is! treated! confidentially.! Information! about!someone!must!only!be!shared!with!others!involved!in!their!care!and!support!on!a!‘need3to3know’!basis.!!

Any!information!should!not!be!disclosed!without!the!person’s!informed!consent.!!

EXCEPTIONS!

Circumstances!when!information!must!be!shared!even!if!the!individual!does!not!give!consent!include!the!following:!!

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There!will!be!times!when!you!face!dilemmas!about!confidentiality,!for!example!not!knowing!what!to!do!or!if!you!should!speak!to!anyone!about!the!information!you!have.!It!is!important!to!seek!support!at!times!such!as!these.!!

It!is!important!to!speak!with!your!line!manager!and!follow!agreed!ways!of!working.!If!your!line!manager!is!unavailable,!speak!to!a!senior!colleague.!

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Someone!seems!likely!to!harm!themselves!

A!person!who!has!been,!or!likely!to!be,!involved!in!a!serious!crime!

A!person!likely!to!harm!others!

Your!safety!is!placed!at!risk!

A!child!or!vulnerable!adult!has!suffered,!or!is!at!risk!of!suffering,!

significant!harm!

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What!happened?!

What!did!you!do?!

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ACTIVITY!

In!your!own!words,!describe!the!meaning!of!confidentiality!in!relation!to!your!role!as!a!healthcare!assistant.!

Have!you!ever!been!in!a!situation!where!you!felt!that!a!patient’s!confidentiality!was!breached?!!

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Can!you!provide!an!example!of!where!a!patient!has!asked!you!to!keep!something!in!confidence!and!you!needed!to!pass!it!on.!What!would!be!

our!policy!here?!

A!neighbour!says!to!you:!

!“I!believe!you!have!a!patient!in!your!hospital!called!John!Brown.!He’s!a!good!friend!of!mine!>!how’s!he!doing?”!!

Describe! the!confidentiality! issues! this!may!pose!and!explain!how!you!would!respond.!

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Consent

What!is!informed!consent?!

It!is!fundamental!that!any!patient!receiving!care!or!treatment!agrees!to!receive!it.!That!is,!that!the!patient!provides!informed!consent!to!receiving!the!care!or!treatment.!

By!‘informed’,!we!mean!that!the!patient!understands!exactly!what!is!going!to!happen!because!either!you,!or!a!colleague!have!explained!it!in!a!way!that!the!patient!can!easily!understand.!

The!absolute!fundamental!underpinning!consent!is!the!need!for!you!to!make!sure!the!patient!is!happy!for!you!to!do!what!you!propose!to!do.!We!must!never!assume!that!because!we!are!part!of!a!healthcare!team,!or!because!we!wear!a!uniform,!that!we!have!the!authority!to!do!things!to,!or!for!people!without!first!seeking!permission.!

When!it!is!needed?!

Obtaining!consent!is!particularly!important!when!it!relates!to!a!patient!undergoing!a!procedure!or!an!operation.!Patients!are!required!to!give!written!informed!consent.!This!evidences!in!writing!that!the!patient!understands!the!need!for!the!procedure/operation,!benefits!and!risks!involved,!alternative!treatment!options!available!and!that!they!are!happy!to!proceed.!

However,!it!is!not!commonly!understood!that!informed!consent!is!needed!for!everything!we!do!with!and!to!patients.!This!includes!even!relatively!minor!care!delivery!activities,!such!as!‘taking!a!temperature’!or!a!‘blood!pressure!reading’.!

Verbal!or!written?!

You!are!not!required!to!obtain!written!consent!for!everything!you!do!with!or!to!patients.!Verbal!consent!will!likely!be!sufficient!for!all!the!procedures!you!are!involved!in!as!a!healthcare!assistant.!

Further!information!

If!you!have!any!questions!relating!to!consent!and!the!differences!between!verbal!and!written!consent,!feel!free!to!discuss!these!with!your!line!manager!or!buddy.!It!is!also!important!to!consider!the!implications!associated!with!patients!not!able!to!provide!consent,!who!are!incapacitated,!or!unconscious.!This!will!be!covered!in!your!eFlearn!module.!!!

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!•! Remember,!there!are!a!variety!of!patient!information!leaflets!and!resources!that!

champion!informed!consent,!these!can!be!found!by clicking the useful resources button above.

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Describe!the!difference!between!implied!and!expressed!consent.!

List!the!different!ways!in!which!a!patient!may!imply!they!have!given!you!consent.!

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How!would!you!feel!if!you!were!a!patient!and!someone!started!doing!something!to!you!without!you!first!agreeing!to!it?!

Explain!what!you!would!do!if!a!patient!refuses!to!consent!or!if!a!patient!was!unable!to!provide!consent.!

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! 50!

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List!the!tasks!you!may!undertake!where!you!would!be!required!to!obtain!informed!consent!from!a!patient.!

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Describe!the!importance!of!ensuring!patients!have!credible!and!accurate!information!before!giving!consent.!

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! 51!

Good communication

Having!good!communication!with!patients!helps!them!in!three!main!ways:!

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•! It! is!common! for!people!who! require!hospital! treatment! to! feel!anxious!about!their!health,!tests!and!treatment!they!might!have!to!undergo!and!what!the!future!holds! for! them.! This! can! sometimes! lead! them! to! speak! out! of! character,!perhaps!seeming!a!bit!rude!or!aggressive.!!

•! Ensuring! you! have! good! communication! with! your! patients! will! reduce! their!anxiety!and!build!their!confidence.!

Good!communication!helps!patients!feel!at!ease!!

1!

Good!communication!helps!patients!to!feel!in!control!22!

•! It!is!easy!for!patients!to!feel!that!they!give!up!all!control!of!their!lives!once!they!enter!the!health!system.!!

•! If!they!are!in!hospital,!for!instance,!even!simple!everyday!things!they!normally!control,!like!when!they!get!out!of!bed,!when!they!wash!and!when!they!eat,!might!be!dictated!by!someone!else.!!

•! Losing! control! can!make!patients! feel!helpless!and! lose!hope,!not! good! for!boosting! their! chances! of! recovery! from! surgery! or! illness.! However,! good!communication!can!avoid!these!feelings!–!it!can!help!patients!to!see!that!they!still!have!a!say!and!are!still!in!charge!of!their!own!lives.!

•! !

Good!communication!makes!patients!feel!valued!3!

•! The!most!precious!thing!we!can!give!to!another!person!is!our!time.!!•! When!we!show!we!are!prepared!to!lay!aside!all!the!other!things!we!need!to!do!to!spend!time!with!someone,!to!listen!to!them,!get!to!know!them!and!understand!how!they!are!feeling,!we!are!showing!that!we!really!value!that!person.!Being!able!to!communicate!well!helps!us!to!achieve!this!with!our!patients,!their!family!and!carers.!

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! 52!

Obstacles to good communication

There!are!a!few!things!that!can!get!in!the!way!of!good!communication,!some!more!obvious!than!others.!When!patients!are!ill,!confused!or!distressed!they!may!not!react!as!they!would!on!a!good!day.!As!patients!are!coming!into!contact!with!you!as!a!result!of!an!illness!or!medical!condition!they!may!find!it!hard!to!listen,!not!take!in!what!you!say!and!misinterpret.!Medication!can!also!affect!a!patient’s!ability!to!communicate.!!

In!addition,!you!may!have!conflicting!demands!upon!your!time,!the!technology!may!fail,!the!schedules!may!change!and!everyone!may!want!you!at! the!same!time.!To!ensure!patients!have!fully!understood!what!has!been!told!to!them,!it!is!important!that!we!not!only!communicate!in!a!clear!way!but!we!also!check!their!understanding!of!what!has!been!discussed.!!

Communication!can!go!wrong!when:!

!Your!patient!or!colleague!is!stressed,!has!limited!time,!or!does!not!have!enough!resources!

!The!technological!aids!that!support!good!communication!are!not!available!when!you!need!them!

!Body!language!is!not!right!for!the!situation!or!the!person,!e.g.!sitting!too!close!or!too!far!away!

! A!person!has!just!received!bad!news!and!they!are!depressed,!angry!or!upset!

! A!person!has!a!disability!or!problem!in!communicating!

! They!do!not!understand!the!medical!explanation!given!to!them!

!Patients!are!not!given!adequate!time!to!communicate!what!they!want!or!have!to!do!

!Body!language!is!negative,!e.g.!crossed!arms,!poor!facial!expressions,!poor!body!positioning!

! There!is!a!lack!of!privacy!

! We!make!judgments!that!are!unfair,!e.g.!generalisations!about!a!group!of!people!

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! 53!

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ACTIVITY!

Describe!what!‘good!and!effective!communication’!means!to!you.!

List!the!different!types!of!communication.!

Explain!why!communication!is!so!important.!

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! 54!

National Early Warning Scoring (NEWS2)

NEWS!is!a!tool!developed!by!the!Royal!College!of!Physicians,!produced!in!2012!and!updated!in! December! 2017! (reference! provided! at! the! end! of! this! section).! It! is! designed! to! help!healthcare!workers!promote!patient!safety!and!good!clinical!outcomes,!assisting!clinical!team!members!to!identify!early!signs!that!a!patient’s!condition!is!worsening!and!that!urgent!attention!may!be!required.!!

NEWS!is!based!on!a!simple!scoring!system!used!in!adults!(aged!16!years!and!above)!in!which!a!score!is!allocated!to!physiological!measurements.!!

SIX PARAMETERS FORM THE SCORE

Six!physiological!parameters!form!the!basis!of!the!scoring!system:!

1! 2! 3! 4! 5! 6!

Respiration!rate!

Oxygen!saturation!

Systolic!blood!pressure!

Pulse!rate!

Level!of!consciousness!

or!new!confusion!

Temperature!

!The!six!NEWS!physiological!parameters!are! recorded!during! clinical! assessment.!Each! is!allocated!a!score!reflecting!the!scale!of!disturbance!for!each!parameter.!!

The!individual!parameter!scores!are!then!added!together!to!generate!the!total!NEWS!for!the!patient.!Below!is!a!table!identifying!the!physiological!measurement!(right!hand!column)!and!the!associated!physiological!measurements!and!scoring.!!

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! 55!

RESPIRATORY!RATE!An!elevated!respiratory!rate!is!a!powerful!sign!of!acute!illness!and!distress,!in!all!patients.!The!respiratory!rate!may!also!be!elevated!because!of!generalised!pain!and!distress.!

OXYGEN!SATURATIONS!(SPO2)!

The!nonFinvasive!measurement!of!oxygen!saturation!by!pulse!oximetry!is!routinely!used!in!clinical!assessment!in!the!acute!setting.!

SYSTOLIC!BLOOD!PRESSURE!

An!elevated!blood!pressure!(hypertension)!is!an!important!risk!factor!for!cardiovascular!disease.!However,!it!is!a!low!or!falling!systolic!blood!pressure!(hypotension)!that!is!most!significant!in!the!context!of!assessing!the!severity!of!acuteFillness.!

PULSE!RATE! The!measurement!of!heart!rate!is!an!important!indicator!of!a!patient's!clinical!condition.!

LEVEL!OF!CONSCIOUSNESS!

A!change!in!the!level!of!consciousness!is!an!important!indicator!of!acuteFillness!severity.!The!assessment!is!done!in!sequence!and!only!one!outcome!is!recorded.!For!example,!if!the!patient!responds!to!voice,!it!is!not!necessary!to!assess!the!response!to!pain.!

TEMPERATURE!

Both!pyrexia!(hyperthermia)!and!hypothermia!are!included!in!the!scoring!system!reflecting!the!fact!that!extremes!of!temperature!are!sensitive!markers!of!acuteFillness!severity!and!physiological!disturbance.!

Clinical response to news

The!NEWS!score!calculation!will! influence!the!appropriate!response!needed!by!the!clinical!team.!!

The!table!on!the!following!page!provides!guidance!on!potential!outcomes,!which!might!include!increased!frequency!of!monitoring!NEWS!or!alerting!a!registered!nurse!or!doctor.!!

Remember,! if! ever! in!doubt,!escalate! your! concerns! to!a! senior!member!of! the! team!and!document!in!the!patient!care!record.!!!

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! 56!

NEWS: EXAMPLE

!MORE INFORMATION

If!as!part!of!your!role,!you!are!required!to!complete!a!patients!NEWS!score,!you!are!required!to! complete! the! NEWS2! eFLearning!module.! This! module! can! be! accessed! on!Academy!Online!

!!

!

! •! Click the useful resources button to access: further information relating to NEWS2, produced by the RCP.

Useful!resources!

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!

To!be!completed!once!you!have!successfully!completed!the!NEWS!EFLearn.!

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! ! ! Action!

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HR! 68! !

BP! 103/62! !

TEMP!(oC)! 37.5! !

SaO2!(%)! 92! !

RR/min! 15! !

CNS! A! !

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HR! 99! !

BP! 101/50! !

TEMP!(oC)! 38.2! !

SaO2!(%)! 91! !

RR/min! 18! !

CNS! V! !

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HR! 108! !

BP! 91/45! !

TEMP!(oC)! 35.9! !

SaO2!(%)! 87! !

RR/min! 20! !

CNS! P! !

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HR! 56! !

BP! 78/45! !

TEMP!(oC)! 35.4! !

SaO2!(%)! 86! !

RR/min! 9! !

CNS! U! !

ACTIVITY!

Here!is!a!patient!and!their!physiological!measurements!taken!on!four!separate!occasions.!Calculate!the!patient’s!NEWS!for!each!episode!and!

state!what!action!you!would!take!

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! 58!

SBAR tool

The!abbreviation!SBAR!stands!for!Situation,!Background,!Assessment!and!Recommendation.!!

SBAR!is!an!easy!to!remember!tool!that!is!useful!for!structuring!and!framing!any!conversation,!particularly!critical!ones,!where!there!is!a!need!for!immediate!attention!and!action.!!

SBAR!provides!a!simple!and!focused!way!to!set!expectations!for!what!will!be!communicated!and!how.!This!tool!is!essential!for!developing!teamwork!and!ensuring!patient!safety.!

! !

•! I!am!a!healthcare!assistant!(Name)!working!on!(area/department)!

•! I!am!calling!/!advising!about!(patient’s!name)!

•! I!am!calling!because!I!am!concerned!that!/!I!am!unsure!about!/!I!need!advice!

! !

•! Their!normal!condition!is!(for!example,!alert,!drowsy,!confused,!self>caring)!–!How!has!this!changed?!!

•! Their!relevant!history!includes!(for!example,!reason!for!admission,!any!subsequent!complications,!asthma,!dementia)!

! !

•! I!have!found!that!the!patient!(for!example,!has!had!an!injury!/!is!struggling!to!breathe!/!is!unable!to!walk!/!is!confused)!

•! Vital!signs!(BP,!temp,!pulse,!blood!sugar)!•! I!think!the!problem!is!/!might!be!•! I!do!not!know!what!is!wrong!but!I!am!really!worried!

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•! I!need!your!assistance!•! I!would!like!you!to!review!the!patient!(when!is!it!urgent!or!routine?)!

•! I!would!like!your!advice!as!to!what!to!do!next!/!in!the!meantime!

!

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! •! Additional!resources!produced!by!NHS!England!(2010)!can!be!found!by clicking the useful resources button.

S! Situation!

B! Background!

A! Assessment!

R! Recommendation!

Useful!resources!

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ACTIVITY!

Now!you!been!introduced!to!SBAR,!have!a!discussion!with!your!buddy!and!your!peers!about!the!different!ways!you!can!use!SBAR!in!your!role!

and!describe!below.!

Create!an!imaginary!scenario!with!your!buddy!or!one!of!your!colleagues!in!which!you!use!SBAR!to!frame!a!conversation.!Use!the!space!below!to!

make!notes.!

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! 60!

Sepsis

Sepsis!is!the!body’s!response!to!infection!causing!injury!to!its!own!tissues!and!organs.!It!is!a!lifeFthreatening! condition! arising! when! the! body’s! abnormal,! or! ‘dysregulated’,! immune!response!to!an!infection!causes!organs!to!start!failing.!!

Sepsis!can!be!triggered!by!any!infection,!but!most!commonly,!it!occurs!in!response!to!bacterial!infections!of!the!lungs,!urinary!tract,!abdominal!organs!or!skin!and!soft!tissues.!!

Caught!early,!outcomes!are!excellent.!Below,!the!diagram!identifies!indicators!of!sepsis.!

SEPSIS RED FLAGS

!Responds!only!to!voice!or!pain/!unresponsive! ! Acute!confusional!state!

!Systolic!B.P!≤!90!mmHg!!(or!drop!>!40!from!normal)! ! Heart!rate!>!130!per!minute!

! Respiratory!rate!≥!25!per!minute! !Needs!oxygen!to!keep!SpO2!≥!92%!

!Non3blanching!rash,!mottled/!ashen/!cyanotic! !

Not!passed!urine!in!last!18h!/!UO!0.5ml/!kg!/!hr!

! Lactate!≥!2mmol!/!l! ! Recent!chemotherapy!

Spotting sepsis

Spotting! sepsis! requires! vigilance,! robust! systems! such! as! NEWS2,! and! excellent!communication,!teamwork!and!response.!!

Sepsis!is!a!serious!condition!that!can!initially!look!like!any!common!infection,!such!as!the!flu,!gastroenteritis!or!a!chest!infection.!If!left!untreated,!sepsis!can!be!fatal.!!

Think!sepsis!if!the!patient:!

! ! !

The!National!Early!Warning!Score!(NEWS)!has!been!shown!by!research!to!identify!patients!at!risk!of!deterioration.!

In! the! context! of! infection,! a! NEWS! above! 5! should! always! prompt! a! screen! for! sepsis,!including!an!immediate!check!for!any!Red!Flags.!

Is!triggering!an!early!warning!score!

Appears!ill!(to!a!health!professional!or!an!unusually!concerned!

relative)!

!

Has!any!signs!of!infection!

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!•! Click the useful resources button to access: for!more!information!and!resources relating to Sepsis.

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Useful!resources!

ACTIVITY!

Now!that!you!been!introduced!to!sepsis!and!its!implications,!have!a!discussion!with!your!buddy!and!/!or!your!peers!about!the!relevance!of!sepsis!in!your!department.!Describe!below!how!you!can!assist!in!your!

role!with!the!management!of!sepsis.!

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Access!the!resources!available!on!the!Sepsis!Trust’s!website,!then!complete!the!following!activities!by!selecting the!answer!you!

believe!is!correct, from the drop down lists:

What!causes!sepsis?!

Severe!sepsis!impairs!the!blood!flow!to!which!organs?!

True!or!false?!Children!can!develop!sepsis!

How!many!people!are!estimated!to!die!from!sepsis!every!year?!

True!or!false?!Sepsis!generally!only!affects!the!elderly!

True!or!false?!Delivering!the!Sepsis!6!within!one!hour!is!one!of!the!most!effective!life3saving!treatments!

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! 63!

Skin integrity and Waterflow assessment tool

Healthcare!workers!are!responsible!for!providing!safe!and!effective!care!to!prevent!pressure!ulcers.!!

You!and!your!colleagues!are! ideally!situated!to!monitor!patients’!skin! integrity!as!you!have!frequent!patient!contact!and!your!role!includes!delivering!the!fundamentals!of!patient!care.!!

Maintaining!good!skin!integrity!is!essential!as!pressure!damage!can!have!a!detrimental!impact!on!an!individual’s!wellbeing,!causing!pain,!distress!and!hindering!quality!of!life.!

SSKIN!is!a!fiveFstep!model!for!pressure!ulcer!prevention!(access!http://nhs.stopthepressure.co.uk/index.html!for!further!information).!!

Five skincare steps

The!five!skincare!steps!aim!to!maximise!and!maintain!healthy!skin:!

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Surface!1!

Skin!inspection!2!

Movement!3!

Incontinence/moisture!4!

Nutrition/hydration!5!

Make!sure!your!patients!have!the!correct!support!

Early!inspection!means!early!detection!

Keep!your!patients!moving!and!support!your!patient’s!mobility!needs!!

Your!patients!need!to!be!clean!and!dry!

Help!patients!have!the!right!diet!and!plenty!of!fluids!

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Skin!appearance! What!to!do!

If!you!see!discoloured!skin!that!does!not!turn!white!when!pressure!applied,!the!

person!could!be!stating!to!develop!pressure!damage.!

Seek!further!advice!and!support!

Skin!intact!and!good!colour!No!further!action!required,!follow!skin!care!

guidance!as!stipulated!above!

Skin!is!painful,!swollen,!discoloured!or!sweaty!

Follow!skin!care!guidance!stipulated!above!and!seek!advice!from!the!Registered!Nurse!for!further!support,!monitor!and!document!

Skin!is!red,!blistered!or!broken!Seek!immediate!advice!from!a!registered!

nurse!and!document!

!

Risk of damage

Several!parts!of!the!body!are!at!a!higher!risk!of!developing!pressure!damage,!these!include:!

•! Spine!and!tail!bone!(the!small!bone!at!the!bottom!of!the!spine)!

•! Shoulders!or!should!blades!

•! Buttocks! •! Elbows!

•! The!back!of!arms!and!legs! •! Back!of!the!head!and!the!rims!of!the!ears!

•! The!back!of!the!hip!bone! •! Knees,!ankles,!heels!or!toes!!

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! 65!

What Waterflow does

The! standardised! pressure! ulcer! risk! assessment! and! /prevention! tool! utilised! in! Nuffield!Health!is!Waterlow.!This!recognised!tool!structurally!assesses!the!risk!of!a!patient!developing!a!pressure!ulcer.!!

It! is! important! you! work! within! the! scope! of! your! role! when! using! this! tool.! Equally,! it! is!imperative!to!apply!your!clinical!judgement!and!escalate!any!concerns!to!your!clinical!seniors!and!colleagues.!!

The!Waterflow! tool! consists!of! seven! items:!build/weight,!height,!visual!assessment!of! the!skin,!sex/age,!continence,!mobility,!and!appetite,!and!special!risk!factors,!divided!into!tissue!malnutrition,!neurological!deficit,!major!surgery/trauma,!and!medication.!!

EXAMPLE

See!diagram!below.!You!will!also!find!this!assessment!tool!within!the!patient!care!record.!!

!

RISK CATEGORIES

The!tool!identifies!three!'at!risk'!categories:!

! •! A!score!of!10F14!indicates!'at!risk'!! •! A!score!of!15F19!indicates!'high!risk'!! •! A!score!of!20!and!above!indicates!‘very!high!risk.’!! !

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! 66!

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ACTIVITY!

Define!the!term!‘pressure!ulcer’.!

List!the!ways!you!can!prevent!your!patients!from!developing!a!pressure!ulcer.!

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! 67!

!

Now!you!have!been!introduced!to!skincare!guidance!measures!and!Waterlow!assessment,!discuss!with!your!buddy!and!your!peers!how!you!can!implement!these!tools!in!your!department!as!part!of!your!role!as!a!healthcare!assistant!and!provide!your!

patients!with!safe!and!effective!skincare.!

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! 68!

Hydration and nutrition

You!need!to!be!aware!of!the!signs!and!symptoms!of!malnutrition!and!dehydration!and!take!appropriate!steps,!within!your! level!of! responsibility! to!address! it.!A!patient’s!care!plan!will!detail!the!particulars!of!their!dietary!needs!and!any!problems!they!may!have!drinking!or!eating!properly.!

Tools! such! as! MUST! can! help! you! determine! if! a! patient! is! undernourished!(https://www.bapen.org.uk/pdfs/must/must_full.pdf).!!

MUST! –! the!Malnutrition! Universal! Screening! Tool! used! within! Nuffield! Health,! has! been!developed!by!BAPEN!(2003)!as!a!fiveFstep!screening!tool!to!identify!adults!who!have,!or!are!at!risk!of!developing!malnutrition!or!obesity.!!

THE MUST ASSESSMENT FLOWCHART

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! 69!

Encouraging eating and drinking

!

Provide!help!if!patients!have!trouble!eating.!For!instance!by!providing!appropriate!equipment!such!as!two!handled!mugs!and!cutlery!with!shaped!and!padded!handles!for!people!with!poor!grip,!tremors,!or!weak!wristsg!or!using!clock!alarms!to!remind!patients!when!to!eat/drink!

! Encourage!patients!to!eat!and!drink!regularly!

! Speak!with!them!about!any!problems!they!are!having!eating/drinking!

! Ensure!patients!have!access!to!fluids!at!all!times!

!Notify!a!senior!member!of!the!team!if!you!have!concerns!that!a!patient!is!not!eating!or!drinking!enough!

!

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ACTIVITY!

Explain!the!importance!of!nutrition!and!hydration!in!maintaining!health!and!wellbeing.!

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! 70!

!

!

!Click the useful resources button to access: The Royal College of Nursing page, and read the information relating to hydration and nutrition.

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Useful!resources!

Describe!the!importance!of!monitoring!a!patient’s!fluid!balance.!

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! 71!

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Delirium! Constipation!

Infections! Delayed!healing!

Sleepiness!and!tiredness! Poor!urine!output!

Dry!mouth!and!lip! Light3headedness!and!tiredness!

Loss!of!appetite!Lack!of!ability!to!perform!normal!

tasks!

Tiredness! Poor!concentration!

ACTIVITY!!

What can dehydration!contribute!to? Tick the correct answers

What!are!the!signs!and!symptoms!of!dehydration?!!Tick!the!correct!answers!

What!are!the!signs!and!symptoms!of!undernutrition?!!Tick!the!correct!answers!

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! 72!

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A!patient!with!dementia!forgets!to!eat!and!drink!regularly!

A!patient!with!poor!control!of!their!hands/arms!needs!help!eating!and!

drinking!

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A!patient!who!feels!too!ill!to!take!drinks!regularly!post!operation!

A!patient!with!mental!health!issues!refuses!all!food!and!drink!

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A!patient!tells!you!that!they!are!not!getting!the!food!they!need!for!their!diet!

A!patient!tells!you!that!they!have!a!food!allergy!

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How!would!you!deal!with!the!following!scenarios?!

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Privacy and dignity

Accessing!healthcare!can!be!an!undignified!experience.!For!instance,!patients!are!commonly!prodded,!undressed,!examined!and!assessed.!They!are!routinely!expected!to!reveal!intimate!details!about!themselves!to!complete!strangers!about!their!health!and!their!habits.!!

Being!a!patient!in!a!hospital!can!be!a!very!unusual!and!very!surreal,!experience.!Often!the!only!thing!patients!have!to!hold!on!to!during!their!hospital!stay!experience!is!their!sense!of!dignity.!And!remind!themselves!that!they!are!individuals!with!families,!friends,!jobs,!histories!and!futures.!!

You have the power

Everything!you!do!as!a!healthcare!assistant!with!and!to!the!patients!you!care!for!has!the!power!either!to!strengthen!and!restore!that!sense!of!dignity,!or!diminish!and!undermine!it.!

Privacy!refers!to!freedom!from!intrusion!and!relates!to!all!information!and!

practice!that!is!personal!or!sensitive!in!nature!to!an!individual!

Dignity!is!being!worthy!of!respect.!

!Nuffield!Health! recognises! that!privacy!and!dignity! is!one!of! the!most! important! issues! for!patients!who!come!to!us!for!care!and!treatment.!Patients!want!quality!care,!rest!and!comfort!in!pleasant!hospital!surroundings!and!to!know!that!the!healthcare!team!are!doing!all!they!can!to!protect!their!privacy!and!dignity.!!

Nuffield!Health!expects!our!people!to!respect!patients'!rights!to!privacy!and!dignity!and!we!continue!to!work!hard! to!ensure! that! there! is!a!culture,! in!both!our!hospitals,!which!values!them.!

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Describe!what!is!meant!by!privacy!and!dignity!in!your!work!setting.!

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Describe!how!you!can!enable!patients!to!make!informed!choices!about!their!care!and!their!life.!

Explain!how!you!can!ensure!patients!individual!belief,!values!and!choices!are!respected!and!adhered!to.!

Can!you!explain!the!role!of!a!chaperone,!when!one!may!be!needed,!your!responsibilities!and!the!process!involved.!

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Equality, diversity and inclusion

Patients!have!rights!

!! The!right!to!be!treated!fairly!and!with!respect.!!

!! The!right!to!be!protected!from!harm!or!insult!!

!! To!have!their!needs!met!when!they!are!unable!to!meet!them!themselves!through!illness!or!disability.!!

!! To!be!involved!in!their!care!

!! To!make!their!own!decisions!based!on!the!best!information!we!can!provide.!

!! To!accept!or!decline!the!care!and!treatment!we!offer!them.!!

Treating!someone!fairly!can!sometimes!mean!having!to!treat!them!differently,! for!example,!you!may!need!to!give!our! information! in!different!formats!(eg!Braille)!or!make!sure!there! is!easy!access!for!a!patient! in!a!wheelchair,!so!that!patients!with!different!needs!all!have!the!same!opportunity!to!access!our!services!

Respecting those rights

We!want!our!patients!to!feel!that!they!are!important!and!that!their!values,!beliefs!and!personal!relationships!will!be!fully!respected!at!all!times.!This!applies!to!all!of!our!patients,!regardless!of!their!age,!gender,!ethnic!origin,!sexual!orientation,!economic!status,!disability!or!religious!beliefs!(or!nonFbeliefs),!or!their!psychological!or!physical!requirements!deemed!by!the!Equality!Act!(2010)!as!protected!characteristics.!!

Inclusion!refers!to!a!person!‘being!included!within!either!a!group!or!society!as!a!whole’.!It!is!important! to!understand!an! individual’s!differences!so! that!you!can! include! them!and! treat!them! equally! and! fairly.! Excluding! people! because! of! their! differences! is! known! as!‘discrimination’.!Some!discrimination!is!on!purpose!and!can!be!easily!noticed.!This!is!known!as!direct!or!deliberate!discrimination.!Examples!include!treating!a!person!differently!because!of! their! religion! or! sexual! orientation,! and! ‘excluding’! people! who! use! wheelchairs! by! not!providing!easy!access.!!!

Other!forms!of!discrimination!can!be!unintentional!or!accidental!and!are!not!as!easy!to!see.!There!may!be!ways!of!working!in!place!that!apply!to!everyone!but!may!disadvantage!certain!individuals! or! groupsg! for! example,! providing! food! at! times! that! do! not! take! into! account!religious!fasting!periods.!

When! the! CQC! inspect! services,! they! take! into! account! how! services! implement! the!characteristics!stipulated!in!the!Equality!Act.!The!CQC’s!human!rights!approach!to!regulation!helps!make!sure!that!service!users!receive!safe!and!good!quality!care.!

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Useful information

Nuffield!Health!has!clear!policies!and!guidance!on! issues! related! to!equality,!diversity!and!rights.!Nuffield!Health’s!position!is!specified!in!HR!16:!Equality,!Diversity!and!Inclusion!Policy!(reference!provided!at!the!end!of!this!section).!Furthermore,!the!Care!&!Quality!Commission!are!dedicated!to!equality!and!human!rights!throughout!the!work!undertaken!by!the!CQC.!It!underpins!how!the!CQC!monitor!and!inspect!services!and!is!embedded!into!the!way!the!CQC!perform!as!a!regulator.!!

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ACTIVITY!

List!the!legislation!and!codes!of!practice!relating!to!equality,!diversity!and!discrimination!that!apply!to!you!role.!This!information!will!be!

covered!in!your!e3learn.!!!

Explain!what!is!meant!by!‘equality’,!‘diversity’,!‘discrimination’,!and!‘inclusion.!

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Describe!how!you!can!access!information,!advice!and!support!about!diversity,!equality!and!inclusion.!

Describe!how!you!would!challenge!discrimination!in!a!way!that!encourages!positive!change.!

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Useful!resources!

Describe!how!you!would!challenge!discrimination!in!a!way!that!encourages!positive!change.!

!Useful!resources!

Access!the!Nuffield!Health!Equality,!Diversity!and!Inclusion!policy!by clicking this useful resources button.

Access!the!Equality!Act!2010 for further information by clicking this useful resources button. !

Access!the!CQC’s!website for!more!information!about!equality!and!human!rights, by clicking this useful resources button.!

Useful!resources!

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Next steps and development of your role

Personal!development!occurs!throughout!our! lifetime.!As!we!progress!though!life,!we!grow!and!develop!both!personally!and!professionally.!!

In! order! to! structure! your! professional! growth! and! development.! Nuffield! Health! uses! an!annual!performance!review!tool!known!as!Performance!Excellence.!!

This!starts!with!agreeing!a!set!of!aims!and!objectives!for!the!workplace!and!acknowledging!your!strengths!and!development!needs.!Once!your!aims,!objectives!and!development!needs!have!been!agreed,!you!can!set!goals!that!enable!successful!completion.!!

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Further!information!relating!to!the!Performance!Excellence!process, click this useful resources button.

A!personal!development!plan!will!assist!you!to!organise!and!identify!learning!and!

Getting support

The!most!important!person!involved!in!your!personal!development!plan!is!you.!However,!your!line!manager,!your!colleagues!and!the!patients!you!provide!care!and!support!to!will!all!play!a!part.!!!

In!order!to!create!and!agree!your!personal!development!plan,!we!suggest!that!you!ask!yourself!questions!such!as:!!!!!

•! What!are!my!ambitions!and!goals!and!what!do!I!want!to!achieve?!

•! What!are!the!standards,!skills!and!knowledge!needed!by!my!current!role!and!do!I!have!any!gaps?!!

•! What!are!the!learning!and!development!opportunities!in!my!current!role?!

•! Am!I!making!the!right!choices!to!get!me!there?!! !

Useful!resources!

development!needs!to!help!you!do!your!job!better!or!progress!in!your!career.!You!will! ! review!your!aims!and!objectives!during!the!year!with!your!line!manager.!

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Further training

Upon!completion!of!this!induction!programme!(and!depending!on!your!currently!qualifications)!you!will!be!expected!to!undertake!further!training!to!enhance!your!knowledge!and!skill.!

If!you!do!not!currently!hold!a!Level!2!Healthcare!Support!Worker!qualification,!it!is!mandatory!that! you! enrol! on! this! apprenticeship! programme! following! completion! of! this! induction!programme.!!

More!information!can!be!found!on!the!Nuffield!Health!Apprenticeships!homepage!at!the!following!site:!!!!!!!!!!!!!!!!!!!!!!!!https://mynuffieldhealth.sharepoint.com/sites/academy/SitePages/Apprenticeships.aspx!!

The!following!clinical!apprenticeships!available!to!healthcare!assistants!include:!

Level!2!Healthcare!Support!Worker!

Level!3!Senior!Healthcare!Support!Worker!

Level!5!Nursing!Associate!and!Assistant!Practitioner!

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•! Further!information!is!available!on!the!apprenticeships!homepage!or!by!contacting!the!apprenticeship!team!at!apprenticeships@nuffieldhealth.com.!

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ACTIVITY!

Now!you!have!completed!your!induction!booklet!jot!down!below!your!future!ambitions!and!goals!in!readiness!for!your!final!sign!off!by!your!

buddy!and!line!manager.!

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Healthcare Assistant New Employee Induction Programme sign off

Name!of!healthcare!assistant! !

Name!of!buddy/assessor! !!

I!have!completed!the!Healthcare!Assistant!New!Employee!Induction!Programme!to!the!best!of!my!ability!and!completed!all!agreed!topics!and!activities!in!the!workbook.!!

Signature!of!healthcare!assistant! !

Date! !!

I! have!supported! the!above!named!HCA! through! the! induction!programme!and! they!have!successfully!completed!each!activity.!

Signature!of!buddy/assessor! !

Date! !!I! can! confirm! that! that! the! above! named! HCA! has! successfully! completed! this! induction!programme!and!this!can!be!recorded!on!their!AOL!training!record.!Tick!the!relevant!box!that!applies!to!further!training!(if!applicable).!!

Please!note,!you!must!submit!an!apprenticeship!application!form!for!the!‘Level!2!Healthcare!Support!Worker’!for!all!HCA’s!without!a!Level!2!qualification!(or!equivalent).!!

Further! information! is! available! on! the! Apprenticeships! home! page! or! by! [email protected].!All!applications!must! be!submitted!by! the! relevant!line!manager.!

Signature!of!line!manager!!

Date!!

Level!2!Healthcare!Support!Worker! Date:!

Level!3!Senior!Healthcare!Support!Worker! Date:!

*!A!copy!of!this!form!must!be!uploaded!onto!Academy!Online!to!mark!completion!

Click the video camera icon, to watch a video explanation of how to sign this PDF document.