Chapter 7 – Charlotte Burke (D1SOP7)
Domain 1 Standard of Proficiency 7
Understand what is required of them by the Registration Board and be familiar with the provisions of the current Code of Professional Conduct and Ethics for the profession issued by the Registration Board.
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KEY TERMS CORU Registration National Health And Social Care Professions Office Fitness to practise Code of professional conduct and ethics
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Social care … has many facets within our communities. Primarily, social care workers endeavour to support the most vulnerable persons in our society, to be active citizens and seek the right to adequate supports to live a life of their choosing. We need social care workers to build a trusting relationship; to really understand, what it is like to walk in someone else’s shoes and to advocate for the right to a life, not just be satisfied as passive recipients of services. The principle of social justice is fundamental in social care work. |
After many years of striving for professional recognition, we as social care professionals are finally reaching our goal – registration. This is an exciting time for us and more importantly for our service users, as we navigate the journey. The Code of Professional Conduct and Ethics provides a safe framework for our practice, within which we, align our decision-making ability with high standards of service provision. Registration is part of our professional identity as social care workers and it strengthens our status and contributes to professional confidence. Continuing Professional development (CPD) should be embedded in our practice and we need to embrace it and be motivated to learn and upskill as professional social care workers.
CORU
CORU was established by the Health and Social Care Professionals Act 2005 (as amended), (HSCP Act) to protect the vulnerable public – by introducing statutory registration for health and social care professionals. The role of the Health Information and Quality Authority (HIQA), established under the Health Act 2007 – is to monitor the safety and quality of health and social care services. These two pieces of legislation have led to statutory registration and regulation of health and social care professionals and service providers. Both CORU and HIQA have a statutory obligation under each Act and are duty bound to act in line with the legislation.
CORU is Ireland’s multi-profession health and social care regulator. All health and social care professionals who, are subject to registration by CORU, and once registered, you are subject to the Code of Professional Conduct and Ethics, which requires you to include your registration number on any official records.
The HSCP Act 2005 (as amended) established registration boards for the seventeen professions designated in the Act. These professions were originally: clinical biochemist; dietitian; medical scientist; occupational therapist; orthoptist; physiotherapist; podiatrist; psychologist; radiographer; social care worker; social worker; and speech and language therapist. Five professions were added later: optician and optometrist (added when the Optical Regulator was amalgamated into CORU as the Optical Registration Board); counsellor; psychotherapist; and radiation therapist.
TASK 1
Go to the CORU website www.coru.ie and look up the current social care registration board members. Who is the current chair? How many professions are currently registered by the designated board?
The registration boards are overseen by a council, which is responsible for governance and strategy; a representative of each of the seventeen professions sits on the council. The Social Care Workers Registration Board established on 27 March 2015 by the then Minister for Health – Leo Varadkar, is also subject to the HSCP Act 2005 (as amended). It is important to understand that standards set by the Registration Board must be taken into account for Social Care Workers’ future practice. The board sets a threshold for safe practice, although most registrants will be practising well and above this standard.
The Social Care Workers Registration Board (SCWRB) is an autonomous body. CORU’s; Council, the Registration Boards and the Executive, together have the powers to make bye-law’s, which must be legally enforceable and upheld by the High Court. The SCWRB had the final say, after a public consultation process, in the final Code of Professional Conduct and Ethics for Social Care Workers 2018. We will go into this in more detail later on.
What’s In A Name?
The social care profession has evolved over many decades and has various identities, depending on where you work and what service you provide.
As a social care worker for nearly twenty years, this title was retained in the service I worked for, and it is my professional identity, however, this was not the case for everyone. In social work, for example, irrespective of the setting, the professional title of ‘social worker’ does not change. The social care profession began when industrial schools were phased out in the 1970’s. Social care practice was born out of the need to address the serious deficiencies in these large children’s centres (Lalor and Share 2013). The Report on Reformatory and Industrial School’s Systems (1970), chaired by District Justice Eileen Kennedy (the Kennedy Report), recommended that staff engaged in childcare should be professionally trained. There was a shift to smaller, community-based residential settings and increased recognition of the need for training for those providing care and support to children.
As social care practice started to diversify, so did the professional representative body. Noel Howard speaks about a meeting of the Association of Workers with Children in Care (AWCC) in 1976, as a ‘sea of black’, such was the dominance of religious orders in the profession at the time (Howard & Lyons 2014). The AWCC became the Irish Association of Care Workers (IACW) as the field of childcare developed into community childcare throughout the 1970’s. As social care began to emerge as a distinct profession involved in the wider provision of care, for example in the disability services, the IACW became the IASCW (Irish Association of Social Care Workers) (Curam Magazine 2012). In 2011, social care educators, managers and workers came together to form Social Care Ireland, officially launched by Minister Frances Fitzgerald, as the professional representative body for the social care profession in Ireland (Howard et al. 2014).
The Kennedy Report’s recommendation to close large institutions in favour of smaller community- based settings, was pivotal in the evolution of the social care profession. The roots of the title ‘social care worker’ as we know it today could be argued to have come about due to the industrial unrest of the 1990’s and the subsequent Labour Court ruling that included new grades for childcare workers/ house parents. People working in the disability services also came to be known as social care workers. The title was coined by Damien McClelland in a Joint Committee and was adopted in 2001 following the Labour Court judgement that fixed pay grades, which led to significant pay increases, in some cases as much as 33% (Lalor et al. 2013).
There was increasing recognition of the value of professional training in delivery of care, and that employment of social care workers has expanded beyond traditional employment settings, such as children’s residential settings, into community-based services. As these roles evolved within communities, so did a plethora of titles. Social Care Ireland conducted a study titled ‘Registration Awareness Study’ available on its website: (www.socialcareireland.ie). A mixed method approach was used with 726 participants completing an online survey, followed up by 16 semi-structured interviews. The report’s findings revealed nearly 80 different titles; other than social care worker; but the only title protected by the HSCP Act is ‘social care worker’.
TASK 2
Go to the Irish Times website (www.irishtimes.com) and find and read this article; ‘Cork women to face criminal charges of falsely claiming to be therapists’, Sunday, 9 February, 2020.
Registration Process
Once the register for social care workers is open, there is a two-year transitional period (known as grandparenting) during which you can apply to register. Only those who are registered may use the title of ‘social care worker’ when this transition period ends. To be eligible to apply to register, you must either hold an approved qualification, or qualify under the grandparenting (transitional) provisions within the Act. This means that you must be able to demonstrate two years’ practice in the previous five years on the date the register opens. You must have a schedule 3 qualification listed in the Act; or a sufficiently relevant qualification; or successfully complete an assessment of professional competence (AOPC). The AOPC is an additional route for social care workers to apply to register during the transitional period allowed for by the Act (Section 91 Subsection 2). The applicant must have two years’ continuous practice on the date of application and must be, in the opinion of their employer, competent in the practice of the profession.
The registration process involves a number of stages and can take some time depending on the volume of applications. New graduates with an approved qualification tend to get on the register between eight and twelve weeks following receipt of all required documentation. Therefore, it is recommended that you start gathering this information and be prepared. You need to complete an online application and submit supporting documents. Then there is an e-vetting process. When all documents have been received and verified, the Board delegates authority to the register to put standard applicants on the register once verification is complete. The Board makes decisions on non-standard applicants. The Board must grant registration if the eligibility criteria set out in legislation are met.
It is your responsibility to apply to the Social Care Workers Registration Board, as the registrant, to engage and demonstrate that you meet the eligibility criteria to register with CORU. Most importantly, you cannot use the title of social care worker after the transitional period, unless you are on the register of the Social Care Workers Registration Board. CORU can take enforcement action where an individual is using a protected title and is not registered with the designated Board. As can be seen from the ‘Irish Times’ Article in the task box above, this is vital for public protection, to ensure that the public are using the services of appropriately qualified and competent health and social care professionals.
National Health and Social Care Profession’s Office
Another important body for all social care professionals is the HSE’s National Health and Social Care Profession’s Office (HSCP’s). This service was established under the 2005 Act to offer support, e-learning modules and access to conferences. It also provides an opportunity for interdisciplinary networking opportunities, where different professionals can share information and learn from each other. As a social care worker, and one of the designated professions in the 2005 Act, you have access to the supports offered.
TASK 3
Who is the current lead of the National Health and Social Care Professional’s Office?
You can access more information on this resource on the HSCP hub on HSELanD (www.hseland.ie)
Why Is Registration Important
Registration of Health and Social Care Professionals (HSCP’s) is important where there is a potential risk to the public that cannot be mitigated by any other action; except statutory regulation. The purpose of statutory registration is to protect the public. Professions that are designated by legislation to register; benefit from the protection of their professional title. Protecting the use of a title, means that when a member of the public uses the services of a registered/regulated professional, they know that a registrant’s qualification has been independently substantiated. Regulated professions are also subject to the Code of Professional Conduct and Ethics applicable to that profession.
Fitness to Practise
The primary aim of CORU is to protect the public. One way of doing this is having a fitness to practice system. This enables CORU to investigate complaints received about a registered professional relating to poor professional performance, misconduct and/or health concerns, which may result in a fitness to practice hearing. During a Fitness to Practice hearing, evidence will be heard from all sides involved. A determination will then be made as to whether a complaint is justified, whether a sanction should be imposed and an agreement to the nature of that sanction. In serious incidents, a professional may be struck from the register and will no longer be entitled to practice, or they may have other sanctions put in place, such as increased supervision or be temporarily suspended. Most importantly, it does not replace the existing complaints procedures that exists with your employer.
That is why it is imperative that you have read and understood the Code of Professional Conduct and Ethics. It formalises the boundaries of your practice as a social care worker. That is why it is so important for you to stay within its remit of accountability, confidentiality, and decision making. Basically, you need to be able to stand over your work and the Code gives you the parameters in which to do that.
Case Study 1
A panel from CORU’s Professional Conduct Committee heard that a social care worker had posted comments regarding a current case on her Facebook page. These comments had become public and had received significant media attention. The social care worker fully accepted responsibility for her actions; however, she said that she believed these comments to have been private to her Facebook friends and that she had been experiencing a high caseload with a lack of support or supervision, which had impacted on her. The committee found that the facts proved amounted to misconduct in that her actions fell seriously below the standards to be expected of a registered social care worker. While her fitness to practice was remediable, the panel determined that she had not taken actions to address this. Further, the panel concluded that she continued to apportion responsibility to others rather than accept full responsibility herself. The committee issued conditions of work practice, including supervision by a social care worker line manager registered by CORU; and required her to provide details of this supervisor to CORU and to inform the council immediately if leaving this position and/or further disciplinary procedures.
(Adapted from the Health and Care Professions Council, UK (www.hpc-uk.org/).)
Answer
The standard the registrant breached falls under confidentiality and subsequent failure to understand the nature of her action. This registrant did not act in the best interest of theservice user or respect their confidentiality and privacy. Accountability for your decision- making is a fundamental principle that underpins all codes of professional conduct and ethics. You have to be able to stand over your decision-making and rationalise why you made such a decision. In this example the registrant partly accepted the responsibility but produced a number of excuses – her workload, lack of supervision. She did not accept full responsibility for breaching her code of professional conduct and ethics. Her ability to reflect on her poor decision- making is the key message from this example. Reflective learning is a great way of looking at your knowledge, values and assumptions, turning them over in your mind and giving your thought process serious consideration.
Code of Professional Conduct and Ethics
You have a professional responsibility to be familiar with the Code of Professional Conduct and Ethics for Social Care Workers. This document outlines the standards of ethical behaviour and conduct that the public expects from social care workers. When you complete your degree and fundamentally your placements, you will learn to understand how the Code distinguishes your role as a Social Care Worker from other professions. All the Codes will be the same across 17 professions, with only the last section being specific to the profession.
The Code of Professional Conduct and Ethics for Social Care Workers (2018) was set by the Social Care Workers Registration Board and the Council of CORU after a lengthy consultation process. It is tailored by the boards to include any profession specific requirements. Each year registrants will be asked to pledge that they comply with the Code of Professional Conduct and Ethics.
We will now go through the code section by section. The sections are grouped into three categories; Conduct, Performance and Ethics. You will find it useful to have the code open in front of you as you read.
Conduct
You must always maintain a high standard of conduct.
TASK 4
Read CONDUCT, Section 1-5 of the Code of Professional Conduct and Ethics for Social Care Workers (pages 8-12).
Section 1 states that you must act in the best interest of service users. You must treat people with dignity and respect, uphold their right to privacy and autonomy, and respect diversity and different cultures and values. When working in teams it is important to conduct yourself in a professional manner; how you act and the advice you give can have a significant impact on a service user.
Section 2 emphasises the importance of keeping service user information securely and treating it confidentially, including guarding it against accidental disclosure. For best practice, it is advisable to follow confidentiality guidelines and GDPR legislation. Always inform service users (where possible) if you are sharing information about them and obtain their consent before discussing confidential information with their family, carers, friends or other professionals involved in their care.
Section 3 outlines how you must maintain high standards of personal conduct and behaviour. This means that you must uphold the rights and dignity of anyone using the service you work in. You must also, conduct yourself in a professional manner, including when working out in the community. Respecting the roles of other HSCP’s is fundamental; you can use their expertise to enhance the service for the service user, and you will need to work in partnership. Included under this section is to not harm, abuse or neglect service users. Look up Tusla’s Safeguarding Policies along with human resources (HR) policy and practices in your organisation. This is explained in more detail under Section 8.
Section 4 looks at using social media responsibly. You need to be very careful with this section and it reiterates all of the above sections, such as conducting yourself in a professional manner, in the best interest of the service user, and abiding by boundaries of confidentiality. If you use social media,first of all think about what the impact will/might be on the service user if you post something on social media. Ask yourself; if it will be a breach of data, if it will be defamatory or if it will harm them in any way. We will go through this section in more detail in the next case study.
Section 5 explores your responsibility to register and to stay on the register. You must inform CORU, if, for instance, you receive a caution from An Garda Síochána or if you have been involved in a criminal offence. If you are suspended by your employer, you also need to inform CORU. You can only practise under the parameters set out in this code under the title social care worker. Any changes to your circumstances need to be followed up with CORU.
Case Study 2
You are on shift in a residential care home and the young person in your care has come back to the unit appearing – ‘intoxicated’- with slurred speech and with a smell of alcohol off their breath, after visiting their family. They are chatting openly with you and they seem relaxed, but this behaviour is unusual; they are usually much quieter. Eventually they fall asleep at the kitchen table and your colleague thinks it’s funny. They say, ‘This would be hilarious if we took a photo and sent it to all the staff on WhatsApp’
- Do you think this is an issue under the Professional Code of Conduct and Ethics for Social Care Workers?
- What sections of the Code do you think this relates to?
- What do you do next?
- How would you act in the best interest of this young person?
- If you disagreed with your colleague’s conduct, what would you do?
- What attitude do you feel is reflected in this case study?
- How could you use social media responsibly?
Answer
Categorically, pictures of service users do not belong on your phone or on social media. You need to follow the confidentiality policy of your employer and the Code of Professional Conduct and Ethics. Respecting the confidentiality and privacy of the young person in your care is fundamental. You need to speak up and highlight that this action is disrespectful, that it is not a good idea and that it could result in disciplinary action for you both, not just the budding photographer. The young person has not given consent and they are also intoxicated. Your duty of care and your decision-making process should focus on keeping this young person safe from further harm by getting them to bed, putting them in the recovery position, closely monitoring them during the rest of the night in case they vomit, and possibly seeking medical attention. You will also need to establish how they became intoxicated; this information will inform the incident report. It is important to remember that it is illegal to drink alcohol under the age of 18 years. However, since the young person is intoxicated, you may need to judge whether this is something to try resolve right now or at another appropriate time.
Performance
You must always maintain a high standard of performance in your professional practice.
TASK 5
Read PERFORMANCE, Sections 6-21 of the Code of Professional Conduct and Ethics for Social Care Workers (page 13-22).
Section 6 considers ‘wellbeing’. It is your responsibility to look after your own wellbeing. It is also your duty to reveal any health issues/illnesses that may affect your ability to practise. It is worth mentioning that once you reveal this information you cannot be discriminated against. A note of caution, though; if you don’t declare something and you are investigated this will not be taken lightly. You need to take responsibility if you have a health issue. Bear in mind that you also have the flexibility of taking yourself on and off the register. Seek advice from your line manager, GP or occupational health practitioner to avoid the risk of inflicting harm to service users, yourself and others.
You can find more information from your employer under the ‘Dignity at Work’ section in their human resources (HR) policies. The law reflected in this policy comes from the Safety, Health and Welfare at Work Act 2015.
Section 7 signifies the importance of familiarising yourself with relevant legislation that impacts on your practice. In college, you will become familiar with legislation such as the Child Care Act 1991 and its amendments. Tusla (the Child and Family Agency) has welcomed amendments to the 1991 Act; for example the; Early Years Services Amendments Regulations 2016; and Child Care Amendment Act 2015, which has led to a strengthening of the legislative basis for the provision of aftercare services (www.tusla.ie). Depending on who your employer is, changes to legislation will be implemented into polices and procedure documents, which will impact on your practice and service provision.
Section 8 shows the significance of complying with requirements for the protection of children and vulnerable adults. As a mandated person (Children’ First Act 2015) you must report abuse to the appropriate authority (go to the Tusla website for more information). Relevant national guidelines include; Safeguarding Vulnerable Persons at Risk of Abuse (HSE); HIQA National Standards for Adult Safeguarding; Tusla Children First National Guidance for the Protection and Welfare of Children (2017).
Section 9 demonstrates the importance of acting within the limits of your knowledge, skills, competence and experience. This is where accountability for your decision making will be necessary and you will need to stay within your scope of practice. I will clarify this in more detail in the following example.
Case Study 3
- Johnny is a forty-year-old man with an intellectual disability. He lives in a residential care home and enjoys weekends at home with his parents. His parents are friendly and have a good relationship with all the staff in the house. He has just returned home from a few days in his parents’ house. His mother hands you a bottle of antibiotics on her way out and says ‘Johnny needs to take the next one at two p.m.’
- What section of the Code of Professional Conduct and Ethics is relevant in this scenario?
- What do you have to consider?
- It is an hour until the next dose is recommended, what do you do?
- What could you learn from this scenario?
- What could be done differently next time?
Answer
In this case you must consider whether Johnny has the capacity to take this medication independently. What level of support does he need? Johnny has an intellectual disability, so he would be categorised as a vulnerable adult. He needs to understand what he is taking the medication for and it will need to be risk-assessed before he can self-medicate.
(More information is available on HIQA’s website under Medicines Management Guidance).
The next thing to consider is whether the medication, is on the medication administration sheet (MAS). If it is not on the MAS you cannot administer it without permission from Johnny’s GP. If you, did you would be in breach of your employer’s safe administration of medication (SAM) policy and of Section 9 of the code. This is beyond your ‘knowledge, skills and competency’ as you are not a GP.
Ring your manager to seek advice: you cannot give Johnny the medication: neither can you let him go without it. Look in particular at Section 9 (f) you need to be able to justify your decision- making and will be held accountable for it. It is important to understand your duty of care when it comes to medication management.
Section 10 Continuing Professional Development (CPD)
This is an important section, so we shall give it a special focus here. The theory of lifelong learning underpins CPD, along with the concept of being open-minded and self-aware; prepared to learn new things, no matter how experienced you are, so you can identify any gaps in your knowledge and address them. Social care workers need to take responsibility for keeping their skills, competencies and knowledge up to date. Keeping yourself informed of any changes to practice, and most important, what you base your decisions on. You need to be aware of all relevant legislation, regulations, policies and guidelines that influence and guide your practice. Furthermore, social care workers need to act within the limits of their skills (as highlighted in the above case study).
Engaging in CPD can be completed in two ways; formally or informally. Informally, it can be practical ‘on the job’ learning from the people you support, from colleagues or other health and social care professionals, or anything that you feel might enhance your skills and knowledge in some way. Examples could be the chats we have with a more experienced colleague, the sharing of thoughts, being honest with our feelings and challenging ourselves as to why we think a certain way. Or, you can go down the more formal route and attend a course or take some training. Implementing anything new into your practice; that you learned from a course; can bring its own challenges. It all depends on the situation you are trying to apply it to. Changing the way people think or a work culture can be complex; for example, if your colleagues/team feel ‘Sure that’s the way we always do it around here’, how do you overcome that? Reflective practice can be a way to explore these barriers to change. Exploring your practice; through the lens of reflection; can be either a positive or a negative experience. It will depend on you, your experience, how much support you seek, how self- aware you are and what is going on in your own life at the time. Furthermore, not all new skills and knowledge have to be practice-based; you need to get the balance right. When you work in the caring professions, having a good work/life balance is paramount. Getting this balance is vital to prevent ‘burnout’; and this should be one of your core principles when working in social care. You give so much of yourself to supporting others, building relationships that can often be complex and challenging, that you need to be mindful of yourself. For example, completing a course or workshop in mindfulness can still be considered CPD, as long as you can reflect on how the learning has enhanced your practice and benefited the people you support.
Social Care Ireland (SCI) is the professional representative body for the social care profession in Ireland. SCI has a designated CPD co-ordinator, whose role is to complete a training needs analysis with SCI members. This can take into account what new practices or models of care are being developed or implemented in practice. SCI works in conjunction with the HSCP’s office, which partially funds the facilitation of a number of training events and workshops. The advantage; of not only being called a social care worker, but also being under the umbrella of the HSCP’s office means you can also avail of interdisciplinary events and training. For example: you work in the disability services with an aging population. You are supporting someone that over time becomes a falls risk. An assessment is required for this person to live safely within their home. Do you think this is outside your ‘knowledge, skills or competence’? The benefit of coming under the HSCP umbrella, is that you can avail of interdisciplinary education provided by occupational therapy or physiotherapy; so, for example, you can upskill in falls risk management. You can then mitigate risk better by understanding what you need to be looking out for to prevent a fall. Having access to this kind of training enhances people’s ability to make more informed professional judgements backed up by interdisciplinary learning.
To demonstrate that you are compliant with CPD requirements as a registered social care worker you must show evidence of and record the CPD you have undertaken. So; what does this entail? Thirty CPD credits must be accrued over a twelve-month period. To put this into context, one hour of learning equates to one CPD credit. Remember, this is not the supermarket, where we collect points just for turning up and spending money! You need to be able to reflect on your learning and record any evidence that supports how it has enhanced your work. You should be able to answer questions like; How did you implement your learning into your practice? What does that look like? How have you applied this new skill or knowledge into your practice? What was the benefit to the people you support? What was the benefit for your colleagues? The Social Care Workers Registration Board in CORU, has put together a CPD Guidance Document and supporting documentation, which provides direction and tools for registrants on how to build and demonstrate reflective learning. SCI has a CPD portfolio that you can also use with some good practice examples.
A registrant can be audited by CORU to ensure that they have a system and process in place to maintain their knowledge, skills and proficiencies. A worker, if called upon, must submit the recorded evidence of their CPD. Just to recap, the main reason we engage in CPD is to upskill. As a registrant, you also need to record your involvement. What CORU are interested in is reflective learning and you can use any model of reflection for this. CORU have adapted the Kolbs cycle of experiential learning to inform their CPD process.
CPD Process
The table below lists some examples of the types of learning activities in which you might engage. As mentioned above, it is not as clear-cut or as easy as collecting points in the supermarket; you need to reflect on what new or enhanced learning you achieved and how it made a difference to your practice, on a professional or personal level, as seen through the lens of a reflective model. Planning your CPD for the year ahead makes this much easier to navigate and it can help to link in with your supervisor and colleagues. Being able to identify what the gaps are in your skills and knowledge will also help with planning. Ask yourself questions like; Who will I be key working for the next year? What skills can I develop to support this person more effectively? What training can I attend that will enhance my contribution to the team? Are there any personal learning goals I have set for myself? As a member of your professional body, SCI, there are a number of advisory groups and special interest groups you can join.
Support for CPD for social care workers types of learning activity
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Discussions with colleagues |
Gaining and learning from experience |
Active engagement in research |
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Active engagement in supervision or mentoring |
Keeping up to date with research evidence in support of best practice |
Maintaining records of your CPD engagement |
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Peer review |
Active involvement in multidisciplinary groups, support groups, development or peer learning groups or voluntary work |
Active participation in a CORU board, committee or assessors’ panel |
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Active participation in professional body |
Publication of an opinion piece, a clinical audit, a case study or research article |
Subject-specific conferences |
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Learning through the use of online resources |
Membership of professional networks |
Work shadowing |
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Writing clinical protocols, policies or procedures manuals |
Undertaking postgraduate education such as postgraduate certificate, diploma, masters or doctorate |
Specialist lecture, workshop or demonstrations |
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Professional reading and study (for example, CORU website and publications, professional publications, journal articles, webinar, online libraries or educational videos) |
Professional or Clinical supervision |
Sharing information/ learning from CPD activities with work colleagues |
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Reading and reflecting on literature, case studies, discussion topics either individually or in a group (for example, journal club) |
Reflection on critical incidents or complex cases, or review of critical incident and development of action plans in response |
Visit to another department or area of organisation |
(Table available from https://www.coru.ie/files-education/cpd/scwrb-support-for-continuing-professional-development.pdf (CORU nd:14).
Section 11 signifies your responsibility to obtain consent from the service user before any intervention or assessment commences. Ensure, as far as possible, that consent is acquired voluntarily. You will need to provide the service user with the relevant information in a format they understand and in a timeframe that suits them. They will need to understand the information and the decision they will have to make. All of this needs to be in place in order to get informed consent.
Case Study 4
You are working with a person with an acquired brain injury. It is dinner time and you need to assist them to physically eat their dinner.
- What section of your Code of Professional Conduct and Ethics is relevant to this case study?
- How would you go about doing this?
- What do you have to think about before carrying out the above task?
- What could you do to build trust with the person?
Answer
You have a personal responsibility to make sure the person understands what you are going to assist them with. Consent is important. It is fundamental that you ask the person is it okay to support them to complete the task before initiating assistance.You need to understand how this person usually gives consent. The key principle here is to consider that there are many other methods of communication other than verbal, that people need to be active participants in decision-making, and the social care worker needs to be aware of individual responses. If a person has limited verbal communication, you could consult another worker or read through the care plan to see how they like to be supported. Building trusting relationships is vital within social care. This is how we pick up on non-verbal cues to know someone is comfortable with you coming into their personal space. Sometimes this takes time and patience.
Practitioners must always assume that all service users in their care have the capacity to make their own decisions, even ones they may disagree with. If there are any doubts around capacity, it is up to the practitioner to demonstrate otherwise. Depending on the impact of the decision being considered, it may have to be assessed by a multidisciplinary team. It should not be automatically assumed that, a person who has mental health challenges or a disability, cannot make decisions for themselves.
Ireland will have a new office Decision-Making Support Services that will promote the rights of people who may need support with their decision-making capacity. This was due to commence in 2020, but has been delayed for financial reasons.
TASK 6
Look up the webpage https://decisionsupportservice.ie/1. Does Ireland still use the title Ward of Court?Read this Irish Times article: ‘Replacement wards of court system to be delayed without budget funding’ (Kitty Holland, Irish Times). https://www.irishtimes.com/ opinion/letters/decision-support-service-must-be-funded-1.4351825
As a social care worker, it is paramount that you support a person’s ability to make decisions and adhere to the guiding principles under this ADM Act. There has also been a change in the language used, especially around recording this information. For example, where previously the wording might have been, ‘In Robbie’s best interest he will get the No. 17 bus to his day centre’ it would now be, ‘It is Robbie’s will and preference to get the No. 17 bus to his day centre’.
TASK 7
For some useful resources on the Assisted Decision-Making (Capacity) Act (2015) and the Guiding Principles, look up; National Quality Improvement team within the HSE Legal Capacity; Josephine Mc Loughlin www.legalcapacity.ie
Section 13 is all about effective communication. For instance, the service user and/or young person must understand what is being asked of them. There are many ways to communicate and; if anyone you support is challenged in this area, they should have a care plan in place to support this need. Keeping your files up to date is important, for continuity of care and to ensure that you pass on any relevant information to your colleagues and the team. One of the standards of proficiency a social care student must achieve is to be able to recognise all behaviour, including behaviours of concern, as a form of communication. This means that you may need to understand what was the antecedent before the behaviour occurred and if there was a trigger. The challenge in social care is to reduce these mitigating factors.
Communicating with service users and/or young people can be complex and perplexing; for instance, they may, due to their circumstances, have a lack of trust in adults. Being able to explain to a young person and/or service user what is going on in a way they will understand is a core skill as a social care worker. You may have to adapt your communication style or technique to fit the situation and person you are communicating with. Written communication is another area that can be difficult to master. Social care workers practice is primarily relationally based, but due consideration needs to be given to factual, accurate and non-emotive records. All records kept on service users and/or young people are maintained, and care needs to be taken with them as they are legal documents. Please note that Freedom of Information Act 2014 allows individuals to access this information.
Section 14 looks at acting in accordance with the principles of ‘open disclosure’. Another name for this is ‘open communication’. This means being honest and open with people if they have experienced an adverse event that may have caused them harm. It needs to be completed by a responsible person in a timely manner. This needs to be carefully balanced in terms of disclosing something to a service user that may cause greater harm, and should be done in consultation with the line manager and/or team depending on the situation. It is not about blame but all about integrity and professionalism. An adverse event could, for example, be a service user being given the wrong medication and having to seek medical attention. On 12 November 2013, Health Minister Dr James Reilly launched a national policy and guidelines on ‘open disclosure’ with three supporting documents, staff support booklet, a patient information leaflet and a staff briefing guide. The National Quality and Improvement Team in the HSE is responsible for this.
Section 15 highlights the significant role placements have for students in obtaining their practical skills. It is important to role-model best practice when supervising students or new colleagues so that you can assist, advise and support them. This will support the development of the professional skills, values and attributes they will need to perform their duties when dealing with services users and/or young people and families. For example, you would be expected to assist a colleague who is encountering difficulties and provide advice/support as appropriate. Take an active role in providing assistance, advice or support where you can.
Section 16 goes into more detail. If you take on the role of teacher or supervisor (practice educator), you will need to meet the standard expected of someone in that position; for example, you should have a train the trainer qualification or have completed a supervision course. You need to plan ahead and set goals that are agreed by all parties involved, setting the parameters for the role; for instance, one of the starting points before having a supervision session is writing up a contract between the two parties. Being a reflective practitioner is an important skill here, so that you can support someone going through the reflective cycle and help them see how it might be useful to apply it to their practice as a social care worker. In order to teach someone else the skills they require, you will need to have those skills yourself.
Section 17 looks at accountability for your decision-making, especially if you delegate tasks to others; for example, if you assign a task to a new graduate they will need to be supervised correctly, so as not to put the service user at risk when carrying out the task. Again, you need to be working within your skill and knowledge base when doing this. For example, if a student was on placement in the disability services and a staff member asked them to go to the shop with a service user and the student was not made aware that the service user likes to run away. The social care worker in the unit is accountable for this decision, as the student was not informed of this. If this service user was known to abscond it would be recorded within a risk assessment, outlining what controls are in place to mitigate against this potentially dangerous situation. One control that may be in place is to use a walking belt with the person and this would have to be passed by multidisciplinary team, as it is seen as a restrictive practice. The idea of the belt is so that the service user can feel you beside them and if they run you can go with them. It can also act as a deterrent. The important consideration here is that if you ask someone to do something you need to give them all the information before doing the task, in order to complete the task safely and it is imperative that the service user is never be put at unnecessary risk.
Section 18 outlines that, record-keeping has become more stringent under GDPR legislation, which has added another layer of regulation to all citizens’ personal information. Everything you record about a person in your care should be seen as a legal document and written down clearly and factually. You must adhere to any policies and procedures in your organisation, in writing clear, accurate, up-to-date reports. In general, service users have the right to access any information that is held about them.
Section 19 is an important section of the code that addresses health, safety and welfare risks. This states how you must follow risk assessment policies and procedures; to assess potential risks in the workplace and your areas of practice, and it is your responsibility to try to minimise, reduce or eliminate any risks identified. Oversight of risk assessments should be regularly reviewed by the team to make sure that the same mitigating factors are still relevant and to review whether all the controls in place are sufficient or if they need to be adapted. Any time a change is made, it is important that the whole team is informed. There will also be a Safety Statement which you will need to familiarise yourself with and sign off on.
Sometimes; in your practice you will come across a service user and/or young person who poses a risk to your safety. You need to know what the risks involved are, so that you can take appropriate measures to protect yourself and others. This can be a challenging environment to work in, but; if possible, try to make reasonable efforts, if appropriate, to go ahead with your interactions with them. Try to visualise a weighing scale with the risk on one side and safety on the other, and trying to strike a balance. Another way of looking at this is positive risk-taking or positive risk enablement; this links in with Section 12 and consent and is underpinned by autonomy and making independent decisions. For example, if you are supporting a service user and/or young person to build capacity to make their own decisions, even ones that might be disagreeable, and if the impact of their decision causes an imbalance to the scale, you will have to devise a risk assessment and may have to inform a multidisciplinary team.
Section 20 states that you are duty-bound to report any concerns about the care and support a service user and/or young person is receiving. This is your number one priority at all times; not what the team thinks or any loyalties that you may feel towards a colleague. When I started practice, we used to do full body lifts to transfer service users; however, we have now learned that this is unsafe practice, which puts service users, yourself and/or others at risk. We now have ceiling hoists and bespoke slings to avoid these unsafe practices. Using a hoist/sling as a control measure lowers the risk and brings the risk/safety scales back into balance.
If you felt there was a serious risk to a service user you would need to consult with your line manager and/or team depending on the situation. You could also raise concerns outside your organisation if you felt the issue was unresolved and that there was a serious breach of behaviour or malpractice. Go to the HIQA website for more information.
Case Study 5
You have been working a few weeks in a children’s residential care unit for young people. You are told one particular young person in your care is a risk of absconding; they have absconded from the unit in the past. You have to go to the supermarket with this young person. They run off and you have tried to follow, but you are concerned that the situation is getting dangerous they are dodging back and forth across the road and you are afraid they may be injured by passing cars. However, you are also concerned about letting them out of your sight as they have engaged in very risky behaviours in the past.
- What section of the Code of Professional Conduct and Ethics does this relate to?
- What would you do?
- What are the key factors you need to consider?
- How could you involve the team to discuss what happened?
- Where would you record this information?
Answer
This is a tricky and potentially dangerous situation and the first thing you would do is call for help. Your number one priority is to try and follow the young person if it is safe to do so. Sometimes in social care you have to make on-the-spot decisions. Therefore, understanding the potential risk factors before an intervention commences means you are informing your practice. Furthermore, this will support your decision-making competencies. Being able to follow the risk assessment for this young person is paramount. Risk assessments are there to bring balance to risk and safety, especially in this particular situation. This incident should be explored further in supervision using a reflective model. This will support and enhance your practice if this situation happens again. It should also be brought to the team to review the risk assessment to see if more supports could be brought in to support this young person’s needs. You would be responsible to write up an incident report that is factual, accurate and non-emotive.
Section 21 discusses professional indemnity and this will be important when you are registered. This is similar to having insurance for your car and it is the law in Ireland. SCI the professional representative body for the social care profession, will offer this as part of their annual membership fee or alternatively, you could source this independently.
Ethics
You must always maintain a high standard of ethics.
TASK 8
Read ETHICS, Sections 22-26 of the Code of Professional Conduct and Ethics for Social Care Workers (page 23-26)
Section 22 acknowledges that, as a student you will be aware of the ethical obligation that you have, if you carry out any research. You will need to be mindful of the data that you collect and how you use that data. As a social care worker, ethical obligation is a similar concept but delves deeper into your competencies as a practitioner. You will need to comply with this section, the attributes of ethical behaviour, behaving with integrity and being honest, and as a practitioner your obligation is to this code first and foremost. Please ensure that you always conduct yourself in a manner that respects the rights and dignity of others.
Section 23 specifies the need for the rights and dignity of people using the service to be upheld. Follow the legislation on discrimination under the Equal Status Acts 2000-2018, and be conscientious of the nine grounds that discrimination can be founded on; similarly, you must not condone discrimination by others.
TASK 9
Think about a time when you felt a member of your team disrespected a person in your care. If you don’t have much practice experience, can you think of a time you or someone in your group of friends was disrespected?
- What might be considered disrespectful behaviour towards a service user, by a staff member or another person?
- What do you think you might do if you encountered a situation in which a staff or other person was being disrespectful to a service user?
Answer
One role of the social care worker is to challenge negative discrimination and/or unjust policies and practices. Fundamentally, social care work practice is underpinned by social justice. You need to advocate for the people in your care. Having a non-judgemental attitude is vital. If you encounter a staff being disrespectful towards a service user, you are duty bound to report it. Your obligation under this code is to the service user.
Section 24 stipulates how to avoid conflicts of interests. For instance, you cannot accept financial contributions from parents or service users, as this may be perceived to affect your professional judgement. You should also avoid entering into any contracts that might cause conflict with this code.
Section 25 outlines how to undertake research in an ethical way. You must seek approval from an ethics committee before undertaking any research, especially if you are working with vulnerable service users. You must always follow the legislation around conducting research, for instance; the Data Protection Act 2018 (Section 36 Subsection 2) (Health Research) Regulations 2018.
Section 26 covers how to advertise truthful, accurate, lawful information that is not misleading. If you recommend a product to a service user, the recommendation must be based on your professional opinion.
Section 27 Responsibility specific to social care workers This code is specific to social care workers and it is something that can be overlooked in service provision. The role of supervision. There are some great resources available on HSELanD; for example, there is an e-learning module on supervision, which provides a good introduction to the theory and framework behind effective supervision.
Conclusion
The aim of this document was to go through each part of the Code and provide some insight into how to apply the Code to your practice. As a student on placement, you can use the Code to evidence best practice and see how you can replicate that in your future practice.
References:
Lalor, K., Share P. (2013) 3rd Ed. Applied Social Care. An introduction for Students in Ireland. Gill & Mac Millan. Dublin.
Howard, N., Lyons, D. (2014) Social Care Learning from Practice. Gill & Macmillan. Dublin Curam Magazine (2012) Summer issue no. 45 (p.2)
