Chapter 6 – Lisa Hanlon (D1SOP6)
Domain 1 Standard of Proficiency 6
Be able to exercise a professional duty of care
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KEY TERMS Duty of care Code of conduct Learning to care Self-care
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Social care is … about the everyday moments. We are there with people, sometimes every day, not just at times of crisis. An activity which may appear mundane to someone else can be a significant piece of work for someone we work with, from preparing a meal to going to a medical appointment or making a phone call. Sometimes just being there and being present when ‘nothing’ is happening is the time when the ‘magic’ happens! |
Defining Duty of Care
In CORU’s Standards of Proficiency for Social Care Workers (SCWRB 2017) there is an expectation, under Professional Autonomy and Accountability, that graduates will exercise a professional duty of care. Legally, this means that you should not harm those to whom you owe a duty of care by your acts or omissions. Failure to do this could mean you are liable due to negligence (Hinds n.d.). As a professional you owe a duty of care to the people you support, your colleagues, your employer, yourself and the public interest. Kline and Khan (2013) describe this as the interconnected duties of care, which include the employer’s duty of care to patients, the employer’s duty of care to staff, the staff duty of care to themselves and to each other and the staff duty of care to patients. The staff duty of care to themselves is expanded on further in the section on self-care below.
One way to ensure quality in how you care for others is to be aware of the standards of your profession. This may involve attending relevant training and keeping your skills open to direction and supervision. According to the Code of Professional Conduct and Ethics, hereinafter referred to as the Code (SCWRB 2019), you must ensure that your knowledge, skills and performance are of a high standard. Your skills must be kept up to date and you should also participate in continuing professional development (CPD). High standards have become the norm in many social care settings as we have become accustomed to HIQA inspections.
Safeguarding is a common element in our work. According to the Code, you must risk assess and ‘take any steps needed to minimise, reduce or eliminate the risks you identify’ (SCWRB 2019: 21). It can be challenging to maintain the balance between, on the one hand, keeping people safe and, on the other, protecting their freedom of choice and opportunities to live a rewarding life. This can be particularly difficult if we feel we know best. We should be aware of paternalistic tendencies, and according to the Code, unless we know otherwise, we must assume that service users have the capacity to make their own decisions, even when we doubt that their decision is the best choice (SCWRB 2019). Gallagher and Edmondson (2015) caution against an overly managerial approach with over-regulation and over-recording, which could impede ‘wise’ social care. Wise social care, rather than best practice, prioritises sustaining warm relationships, flexible judgement and compassion. Standards are upheld, but not at the expense of core values and ethical considerations. A further standpoint to consider is the ‘dignity of risk’. Perscke (1972) coined the phrase in relation to the benefits of risk taking and its consequential learning and development, as opposed to detrimental overprotection. Discussing risk with those you care encourages skilled conversations, shared decisions and the acknowledgment of individual differences (Marsh & Kelly 2018).
Professional experience: I was working with a lady who lived alone. She had severe epilepsy and had also spent long periods of her life in a large mental institution. I worked as part of a community support team and we made twice daily visits to support her with daily tasks. One day, when she was at home alone, she fell during a seizure, causing a head injury when she banged her head off the edge of the washing machine. The injury required staples but she was otherwise okay. My first reaction was to make adjustments to her home to make it safer as I was concerned about hard edges and corners. She was later offered the option to have foam padding added to edges of furniture and surfaces. She declined the padding because, following her years of institutional care, she was very house-proud. She acknowledged that she could have further falls, but she chose to live with a certain amount of risk. We supported her choice to have her home look as she wished.
TASK 1
Reflect on how you would feel if someone you work with chose a course of action that you feel unsure about rather than one you feel is better and safer for them. How would you deal with this?
My response to the task:
Assuming that the person has the capacity to make the decision put before them, support them to understand the options. Be creative in supporting them to view the situation from various perspectives. When their decision is made, respect it and support them. It is our role to support the person to understand the risks and possible consequences rather than remove or limit the choices. There is risk to things we all do every day; sometimes things do not go well and we deal with the consequences. People will not get the chance to learn and develop if they do not get to try new things. What are we protecting them from here? Serious dangers? Or are we trying to protect them from making mistakes, learning from their mistakes, experiencing hurt feelings and having regrets? Should they not feel these things? We are not alone in our work; there are other professionals we can talk to about our concerns. We can share our reservations with a colleague and make sure we are there to support the person if things do go wrong.
Overview of Code of Professional Conduct and Ethics
CORU’s Social Care Workers Registration Board Code of Professional Conduct and Ethics for Social Care Workers (SCWRB 2019) specifies the standards of ethics, conduct and performance expected of registered social care workers. It is part of our duty of care to read and understand the Code, which outlines what is expected of us as professionals. Misconduct or poor performance could result in professional misconduct or disciplinary action under a fitness to practice investigation. Breaches of the Code can happen through things you do or things you neglect to do (omissions). This places a greater onus on us as professionals to be aware of professional standards: ignorance is not an acceptable defence. The responsibilities outlined in the code are grouped into three categories: conduct, performance and ethics.
TASK 2
Read the Code of Professional Conduct and Ethics (www.coru.ie/files-codes-of- conduct/scwrb-code-of-professional-conduct-and-ethics-for-social-care-workers. pdf). (NOT WORKING) Pay attention to the twenty-seven responsibilities specific to social care workers under the headings Conduct, Performance, Ethics and Responsibilities.
Learning to Care
We can learn about caring by observing others. It is useful to have positive role models in your place of work. Look for experienced staff who have a good rapport with the people you work with. Try to observe the interactions they have with others and later have conversations with them about why they acted or reacted in a particular way. It helps to be self-aware and take time to examine how you have reacted to situations on placement or in work. It is an advantage to keep an open, questioning mind. This is relevant in terms of duty of care because it benefits the service user, the people with work with and ourselves. No matter how much experience or expertise we gain, we will never know it all, people will always surprise us and will always have something to teach us. We are not, and should not aim to be, all-knowing beings. We need to have a curious mind along with an appetite to keep learning. A mindset that is open to new ideas and ways of working helps us work well with others and avoid getting stuck in a rut.
TASK 3
Think about a time you may have reacted strongly to something while on placement or at work. Why does this situation still come to mind? Thinking ofa colleague you admire, how do you think they might have reacted in that same situation? How does this differ from your reaction? What can you learn fromthis for the future?
TASK 4
Suggest incorporating an exercise into team meetings to promote questioning minds. Every month, ask a different team member to tell the team about an article they read, documentary they came across, podcast they heard about a novel approach relevant to your setting.
Our duty of care can sometimes be evident in the everyday attention to detail in our work. Even though we often spend time on daily tasks that may seem mundane, they present opportunities for purposeful practice. This ensures that there is a therapeutic element to what we are doing. This approach supports positive change for those we are working with. Garfat and Fulcher (2013) identified these everyday moments as opportunities for interventions as we get to observe the ways people can get stuck in ways that perpetuate their struggles. By being there and spending time with people as they live their lives we can support them to discover ways to act differently, which could free them from destructive ways.
Self-care
Our duty of care is not solely about safety. Care can also refer to kindness, to others and to ourselves. Regular self-care routines should become part of your practice and not just something you think of in times of crisis. To take care of other people, you have to take care of yourself; otherwise you start running on empty. As your own wellbeing grows, the more able and likely you are to be patient, supportive, empathetic and loving. This is not just something nice to do; it is expected of us as professionals. The Code states, with respect to addressing health issues related to your fitness to practise, that you must look after your physical, emotional and psychological health.
Taking care of yourself influences others as we impact on each other in our interactions. Helping others helps you; helping yourself helps others. Similarly, harming others harms you; harming yourself harms others. Purposefully invest in self-care practice – take a break, do some exercise, take some time for yourself – and then notice how this affects your relationships. Notice how healthy boundaries in relationships help prevent you getting angry and eventually needing to withdraw. In a way this links to interconnected duties of care (Kline & Khan 2013) referred to earlier, as staff teams that experience workplace violence, which leads to burnout and emotional exhaustion, have reported that these conditions lead to poorer service delivery (Keogh & Byrne 2017).
Minding yourself and being actively aware of how and when you participate in acts of self-care can be overlooked or dismissed. We need to prioritise ourselves and get into a routine of taking care of ourselves all the time, not just when we are feeling stressed. As trained professionals, we possess many skills but sometimes we can feel stuck, unsure of what to do next or as if things are just getting on top of us. It is important to know our own limits and to recognise when we need help. According to the Code of Professional Conduct you must ‘act within the limits of your knowledge, skills, competence and experience’ (SCWRB 2019). We often encourage help-seeking behaviour in those we work with, but do we practise this ourselves? Asking for help and advice should be viewed as a strength no matter what stage of your career you are at.
As well as incorporating useful exercises such as relaxation techniques into your life, it is important to look after yourself physically in terms of sleep, diet and exercise. Prevention of burnout is important enough that you need to take active steps to prevent it. Burnout is ‘continuous and repetitive emotional pressure that takes place while workers try to maintain close relationships with people for long periods’ (Choi & Kim 2015: 583). Burnout can be prevented and mitigated against when you do things such as acknowledge the emotional toll of your work, have self-awareness in relation to your emotional reactions, take responsibility for your wellbeing and develop protective strategies such as setting boundaries between the self and the professional role (Molloy 2019; Keogh & Byrne 2017).
A friend of mine who worked in quite a challenging environment would find it hard to get work out of her head when she got home. She decided to do something to clearly ‘switch off work mode’. She began a new routine of changing out of her work clothes and having a shower while singing loudly to music. She sees this routine as shaking off work and becoming herself again, and she then finds it easier to push thoughts of work from her head. For other people it might be walking the dog, going for a swim or just sitting with a cup of tea. It should be something that you can do or access easily so that you can slot it into your routine easily. It also needs to be done with the intention of self-care and de-stressing.
- Become aware of what your mind is saying, in other words of your thoughts at this moment.
- Breathe in through your nose while silently counting to four.
- Hold your breath for another count of four which imagining it is filling your head with calm and smoothing out any physical tension.
- Breathe out to a count of four while imagining the calm flowing through your body.
Self-care Tips
- Know your limits and know when to ask for help.
- Look after yourself physically, get enough sleep, eat as healthily as you can and do some physical activity at least three times a week.
- Find a relaxation exercise that suits you the best. They can all work equally well. Walking, petting or just spending time with your pets can be calming.
- Develop a routine to fit at least one technique into your day (at whatever time you prefer) to practise it.
- Use something in your environment as a reminder to fit relaxation into your day (e.g., when you wake up, after you finish shift handover, when you arrive home, before you go to sleep).
- Get outdoors: getting outside is great for exercise and fresh air. You can explore the idea of ‘mindful walking’. Leave your phone on mute and go for a walk where you really take in and notice the sights, sounds and smells around you, focus on these things and keep pushing thoughts of work or negative thoughts out of your head.
- Stimulate your senses: different things work for different people. Maybe your way to relax is to light a nice candle and just sit for a few minutes taking in the aroma and watching itflicker. Try to do this, just concentrating on the candle. Avoid making to-do lists in your head.
These activities will not remove the problems from your life/work, but they do teach you to calm your thoughts and practice moments of relaxation or mindfulness, which can help with the anxiety caused by stressful experiences. Over time, as you use a relaxation exercise (e.g., breathing exercise, gentle stretching, mindfulness) every day, you can expect to get better at the skill.
TASK 5
Complete a self-care plan. You can design one yourself (or use the sample one at the end of this chapter). Try using headings to see where you need to focus most attention. Note down what stressors may be making you feel anxious or burnt out. Then look at the wellbeing activities you incorporate into your life.For example, under the heading Physical, you might list Eat healthily most of the time; Get enough sleep; and Take regular exercise. Next, what do you do to take care of yourself emotionally? Do you write a diary, paint, take time to be alone and think, use breathing techniques, spend time with your pet, practise mindfulness, have someone to talk to? What do you do socially? It is important to do things with other people and to nurture our relationships. Do you regularly phone or video chat with a friend, have date nights with your partner, visit family, be part of a club or group? If you are already doing these things, make sure that you prioritise them and recognise them as self-care. If you are not doing anything like this, ask yourself what is standing in your way and what you can do to make it happen. Be patient and kind with yourself, start off small and build up. If your self-care practice falls by the wayside a bit, just pick it backup again – don’t abandon it.
My self-care plan
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Stressors in my life: |
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Things I do/will do to care for myself physically |
Things I do/will do to care for myself emotionally |
Things I do/will do to care for myself socially |
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What is preventing me from doing more self-care activities? |
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What will I do to overcome these barriers? |
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Tips for Practice Educators
A main requirement for achieving this proficiency is the student’s understanding of their responsibilities in terms of their duty of care. Knowledge of the Code is important. Students need to be aware how and where to access this information and should be conversant with the contents.
Risk and risk assessment usually features in discussions on duty of care. Although this is a vital piece of work to cover, it should be balanced with the needs and rights of the person we are working with. We strive to keep people safe but also support people to develop and live as independently as possible. Interesting conversations could be had on duty of care versus dignity of risk/therapeutic risk.
Caring for others involves respecting them and this begins with the care and self-respect we show ourselves. We must not merely pay lip service to the notion of self-care but actively encourage it. Students should be self-aware and able to identify the stressors in their lives and the steps they routinely take to counteract them. Personal self-care plans are a useful tool for students to identify their own personal wellbeing story. This is an important step to have in place before students start on placement and should be something we check in with them about, perhaps as part of a checklist for preparedness for placement. Incorporating self-care into our practice is a good way to model for the people we work with. We are showing them how we actively care for ourselves even when we feel well and healthy, not as just a reaction to crisis or illness.
References
Choi, Y. and Kim, K. (2015) ‘The influence of emotional labour on burnout: Centered on the stress coping strategy and moderating effect of social support’, International Journal of Social Science and Humanity 5(7): 583-8.
Gallagher, C. and Edmondson, R. (2015) ‘Identifying key elements of social care practice in successful care settings for older people in Ireland: Steps towards ‘wise’ social care’, Irish Journal of Applied Social Studies, 15(1). Available at: <https://arrow.tudublin.ie/ijass/vol15/iss1/6/> [Accessed 11 November 2020].
Garfat, T. and Fulcher, L. (2013) ‘The therapeutic use of daily life events with families’, Relational Child and Youth Care Practice 26(4): 50-2.
Hinds, A. (n.d.) ‘The Duty of Care in Irish Tort Law’. Ireland: CPA. Available at: <https://www.cpaireland. ie/CPAIreland/media/Education-Training/Study%20Support%20Resources/F1%20Bus%20Laws/ Relevant%20Articles/the-duty-of-care-in-irish-tort-law.pdf> [accessed 13 November 2020].
Keogh, P. and Byrne, C. (2017) Crisis, Concern and Complacency: A Study on the Extent, Impact and Management of Workplace Violence and Assault on Social Care Workers. Social Care Ireland. Available at: <https://www.researchgate.net/publication/312211150_Crisis_Concern_and_Complacency_A_Report_on_the_Extent_Impact_and_Management_of_Workplace_Violence_experienced_by_Social_Care_ Workers [accessed 11 November 2020].
Kline, R. and Khan, S. (2013) The Duty of Care of Healthcare Professionals. London: Public World. Available at: <http://www.publicworld.org/files/Duty_of_Care_handbook_April_2013.pdf> [accessed 13 November 2020].
Marsh, P. and Kelly, L. (2018) ‘Dignity of risk in the community: a review of and reflections on the literature’, Health, Risk and Society 20(5-6): 297-311.
Molloy, E. (2019) ‘An exploration of social care workers’ experiences of emotional labour and professional burnout in domestic violence refuges’, Journal of Social Care 2(2). Available at: <https://arrow.tudublin.ie/cgi/viewcontent.cgi?article=1043&context=jsoc> [accessed 13 November 2020].
Perscke, R. (1972) ‘The dignity of risk and the mentally retarded’, Mental Retardation, 10(1): 24-7. Social Care Workers Registration Board (2017) Standards of proficiency for social care work. Dublin:
CORU Health and Social Care Regulator. Available at <https://coru.ie/files-education/scwrb-standards- of-proficiency-for-socialcare-workers.pdf>
Social Care Workers Registration Board (2019) Social Care Workers Registration Board code of professional conduct and ethics. Dublin: CORU Health and Social Care Regulator. Available at https://coru.ie/files-codes-of-conduct/scwrb-code-of-professional-conduct-and-ethics-for-social- care-workers.pdf.
