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Marvellous Care – The Warm Up

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Before any exertion it’s important to warm up your muscles, ready your body, fire your heart. Think of Linford Christie or Usain Bolt staring down the track at the start of a race. They call this “getting in the zone”, and it’s about getting focused on being the best they can be. We think the same is true of getting ready to deliver MARVELLOUS care.

The ideal time for your WARM UP is right at the start of your work day. If you’re caring for a person with a learning disability on the ward TODAY, there’ll certainly be opportunities for MARVELLOUS care.

 

The WARM UP consists of two parts:

1. The first is being prepared by getting to KNOW YOUR TEAM.

Who can provide you with guidance and information?

2. The second is getting yourself ready, so CHECK YOUR EQUIPMENT.

What existing skills and experience do you have in your locker?

 

So…

Let’s WARM UP!


KNOW YOUR TEAM

From boy scouts to the world of business there’s a piece of good advice that’s been handed from one generation to the next[1].

“Be prepared.”

It’s good advice because it’s easy, clear and true. The better prepared you are, the better you will be, and you’re pretty good to start with.

Yet on a busy ward, on a busy day, with lots of things demanding your time and attention, it’s easy to overlook. There’s so much to distract you.

So, to be prepared it’s important to take a few minutes to first KNOW YOUR TEAM – the people who can provide guidance and information to support you and your patient.

When it comes to being prepared for giving MARVELLOUS care to a patient with a learning disability, who is your team?

  1. It’s the person themselves
  2. It’s their family and friends
  3. It’s the wisdom of other staff who have tried to help them.

1. Hello…is it me you’re looking for?

No, not the Lionel Richie song. We’re being literal. If a person can tell you what they want, you can always ask them. I know it sounds “duhh”, but it’s pretty easy to overlook. So we suggest you have a set of things you want to know, a kind of “tell me about yourself” list.

And the VERY good news is there are people who have done all the thinking and created tools to help you. How great is that?

So have a look at the Hospital Passport – a resource for people with learning difficulties to explain their personal needs to medical professionals.

Sarah Kennedy also told us about the “One Page Profile” tool from the ace Helen Sanderson website which you may find useful.

Could these be used on your ward? Why not design one yourself! If you do and tell us we’ll share the good news – promise.


Tactic: Update to perfection

If you do use a timetable, hospital passport or “One Page Profile”, consider having “update days”, where you can check with your patient and, if possible, the TEAM that your strategy for the game is still an up-to-date MARVELLOUS, one.


Tactic: Terrific Timetables

A timetable can be really helpful to put on the person’s bedroom wall so they know what to expect throughout the day. If you have a helpful ward OT/activity worker, get them involved in making one if they can (the best one I have ever seen had laminated picture activities you could Velcro onto the timetable but they don’t have to be that sophisticated!)


2. What would mum do?

OK, not just mum, but dad or bro or significant other. If we put it another way, who knows best (apart from you) about what YOU like? It’s your “significant other” – partner, parent or pal. It’s the people you live with, the people who see you eat, get up, come home, go out and get ready for bed. It’s the people you negotiate telly watching with, the people who know that the bright green argyle socks you got for Christmas are EXACTLY what you love, the people who are nauseated when you eat your pizza with chilli sauce.

For a person with learning disabilities, the people who know them best are often family members, but they can be others, like their professional carers if they live in some form of supported living or are supported by a specialist learning disabilities team. These people can head off a lot of potential problems and, more often than not, are DELIGHTED when someone taps into their hidden depths of knowledge on what makes this person tick.

So talk to them, ring them up, text them or get them to write down anything they think will help (they can help you with any of the Hospital Passport or One Page Profile you haven’t been able to get!) It’s what your mum would do!


Those who don’t learn from history are destined to repeat it

Jonny or Jane doesn’t like jelly. Is it better to read about this and not give them jelly or be picking jelly out of your hair and trying to find a way to get it off your white shirt without leaving a stain? Have a quick shufty of any notes from previous care or shifts. During your quick shufty keep a particular eye out for anything from the family or specialist learning disabilities teams we mentioned above. Anything from them is GOLDEN!

So, that’s the TEAM.

…and it’s OK to not be fully prepared to give MARVELLOUS care. Just get as prepared as you can and then think about being better prepared for next time – or even adding your own words of wisdom for the next nurse when you’re back in the DRESSING ROOM.

While we’re helping you get ready for your next few hours, it would be remiss of us not to point out that the TEAM we’ve described is “borrowed” from somewhere else. Oh yes, others (including some excellent carers such as the marvellous Alan Worthington) have already considered how to get this “triangle of care” team playing together.

While we’ll look at this in more detail in the DRESSING ROOM, if you have time, you can check it out here.


Tactic: A familiar face is a welcome face

Many people with learning disabilities respond well to familiarity – so it may be worth thinking about having a core group of people that are usually allocated to work with them on a shift, i.e. don’t allocate them a different bank/agency nurse on a regular basis if you can avoid it


CHECKING YOUR EQUIPMENT

Imagine getting on a football pitch and finding you’ve forgotten to put your boots on. That would leave you at a bit of a disadvantage! So, checking your equipment means a check of the well-crafted implements you have at your disposal.

What are these implements? Well they’re your SKILLS and EXPERIENCE. You’re a mental health professional and have trained and been honed to perfection on the finishing school of the ward.

 

 


The key equipment (skills and experience) for you to check are:

COMMUNICATION:

Being able to communicate with someone is a key skill. Although the advice here is about communicating with people with a learning disability, it’s also applicable to other patients.

Key Skills:

Communication is about two people and getting clear understanding between them. To communicate effectively with a person with learning disabilities, it’s good to have the ‘Communication Coach’ inside your head. They’ll remind you of some key principles of good communication to help you.

Communication Coach Checklist:

  1. Use short clear sentences.
  2. Ask one question at a time.
  3. Offer one choice at a time.
  4. Use your body as well as your words to communicate.
  5. Listen carefully.
  6. Check you have been understood – ASK!
  7. Respond instantly to feedback.
  8. Smile and use a warm tone of voice.

 

If you have a bit of time, Wardipedia’s section on communication will help get your coach up to speed…

…and when it comes to really top notch specialist advice, have a look at this by Nicola Grove of City University in collaboration with Barbara McIntosh of Foundation for People with Learning Disabilities.

(If you don’t have time, worry not – we’ll put it in a locker in the dressing room for you!)


ASSISTING CHOICE

This has to be carefully written, so please read it carefully:

People with a learning disability know what they want but they may become confused if offered too much.

To best understand this, consider the following example:

Have you ever been in a hotel that offers a buffet breakfast? You know the ones – a variety of drinks, toast, butter/marg, jam, marmalade, croissants, French bread, Danish pastries, cornflakes, bran flakes, rice crispies, porridge, sausage, bacon, tomato, mushroom, hash browns, beans, egg (boiled, fried, scrambled), cold ham, cheese, pineapple, melon, grapefruit, apples, oranges, bananas, fruit salad, yoghurt, milk and both tea and coffee. And beside it all is a sign saying ‘our chef would be happy to cater for any special needs required’.

It takes you half an hour to decide! Chances are you drink all the juices, have three slices of toast, a cooked breakfast with porridge and take three bananas ‘in case you get hungry’.  It’s not what you actually want or need and you see someone else’s breakfast and wish you’d chosen that.

For SOME people with a learning disability multiple choices like this are a recipe for unhappiness. The best way to help people is to keep it easy and clear. Offer a choice between two things, or better still, know their preferences and make them available (what did YOUR TEAM say they liked?)

So when it comes to multiple choices, always be on the look out for confusion and find ways around it.

But also remember:

“All people with a learning disability have the right to make their own decisions. Some may need support to make decisions. Choice is very important to an individual’s well-being. It gives them control over their lives, from making small day-to-day decisions such as what to eat, to life-changing choices such as moving home. Not being able to make choices or having choices ignored has a detrimental effect on mental health.”

(From Supporting Complex Needs which you’ll find later in Locker 3 in the DRESSING ROOM)


EMOTIONAL CONTROL (yours)

When you’re on top of your game you’re a FANTASTIC resource to all your clients – in fact you’re probably the BEST resource they have while they’re on the ward.

But the job can also take its toll, grind you down, wear you thin and put you on edge. Not the stuff with patients – we know you love this part – but a ward isn’t just about that. There’s the paperwork, the meetings, the politics, the responsibility – and the fact there are many demands on your time and energies. It can get to you. It gets to everyone sometimes.

But here’s the rub. Many people with a learning disability are incredibly good at picking up the moods of others. They often have to be. And it can affect them if you’re anxious, or edgy, or more abrupt than you meant to be.

So one of the great secrets of providing MARVELLOUS care is to make the decision to be as emotionally calm as possible  –  in other words, to CONTROL YOUR OWN EMOTIONS.

And it’s not just because it’s the right thing to do. If you’d like a nice safe ward, the evidence would suggest controlling your emotions can be a big part of that. Look at this from the wonderful Safewards research project www.safewards.net.

 

Safewards tells us that “Staff on peaceful wards were able to remain calm and help patients manage their own behaviour (emotional regulation).”

 

And this is where Nello can help us. One of the biggest single factors in controlling your own emotions is simply this. You make the decision to. That’s what he did.


CHECKLIST

✓  Equipment all in place?

✓  Communication Coach on board?

✓  Multiple choice detector functioning?

✓  Decision to be calm made?

Time to move on to THE (GAME) PLAN – What opportunities will you have to provide MARVELLOUS care TODAY?

[1]As advice goes, it’s better than “wear clean underwear in case you get knocked over” but not as good as Oscar Wilde’s “be yourself as everyone else is already taken”.

[2] “shufty” is a technical term that translates as; “to read with the quick, but focused intensity of a hungry person with a menu – taking everything in but looking for the tasty bits.”

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