Induction Manual Fitzroy Falls Aged Care Facility

Induction Manual
Fitzroy Falls
Aged Care Facility
© J.N. Bailey 2009
Fitzroy Falls Aged Care Facility – Induction Manual
Version 1.0.0
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Induction Manual
Challenging Behaviour
04 - 07
Incident Debriefing
Behaviour Descriptions
08 - 17
Effective Communication
Verbal and Non Verbal Communication
Maintaining Effective Relationships
Working with Diversity
Cultural Awareness
Cross Cultural Communication
Conflict Resolution
Interpreter Service
18 - 23
Person Centred Approach
Activity Planning/Development
Communication Strategies
Triggers that can Alter Behaviour
24 - 32
Care Plans
Completing Care Plans
Policies and Procedures
Resident Classification Scale
Health Terminology Abbreviations
Completing Documentation
Progress Notes
Commitment to Continuous Improvement
Materials Safety Data Sheets
Health Issues
33 - 45
Food and Fluid Thickeners
Physical Effects of Ageing
Stereotypes of Ageing
Sexuality and Ageing
Grief and Loss
Healthy Lifestyle and Ageing
Swallowing Difficulties/Dysphagia
Case Conferences
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Human Resources
46 - 50
Performance Appraisal
Performance Appraisal Interview
51 - 57
Medication Administration
Medication Effects
Medication Administration Responsibilities
Blister Pack System
Medication Incidents
58 - 59
Mobility Aids
Personal Care
60 -63
Privacy and Dignity
Privacy Guidelines
Reporting Resident/Client Changing Care Needs
Duty of Care
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Challenging Behaviour
Many factors can increase the likelihood of a resident/client behaving
uncharacteristically. This can lead to anger and aggression towards themselves
or others around them. Physical, environmental, medical and interpersonal
factors can provoke any of the following behaviours:
feelings of rejection
intense anxiety.
Care workers need to learn what the factors are for each individual resident/client
and deal with them positively to prevent an aggressive incident.
The following table shows the various triggers that result in challenging
triggers include: triggers include:
altered vision
 slower
reaction time
 need for
toileting or
pad change.
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 noise
 too hot/cold
 discomfort (eg
position or chair)
 overcrowding
 room lighting
 phobias (eg
 odours
 new environment
 rigid routine
 Inconsistency of
Medical triggers
Medical triggers
 urinary tract
 painful conditions
 infections
 dehydration
 medications
 psychiatric
symptoms (eg
 vitamin B 12
 hypothyroidism.
Fitzroy Falls Aged Care Facility - Induction Manual
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triggers include:
 perceived attitude
of carer
 cultural prejudice
 frustration at
having to wait
 lack of
understanding of
what is to happen
 lack of
understanding of
 bossy or
carer/care worker
 feeling they are
being unfairly
 feeling a loss of
 build up of feelings
of rage or anger
© J.N. Bailey 2009
Changes in the resident's/client's physical appearance (ie hostile facial
expression, sustained eye contact, carrying a potential weapon) are all alerts to
the fact that they are feeling aggressive. Indications that the resident/client is
feeling aggressive can also include changes in their activity level and posture (ie
pacing, restlessness, clenching fists and jaw, appearing agitated). The
resident's/client's mood will change and they may show signs of being angry,
anxious, distressed, irritable and short tempered. The resident/client may speak
in a louder voice than normal and may use abusive language or swear.
Options to deal with the challenging behaviour include:
Back off/leave
You should:
respond to your gut feelings
respond positively
don't panic
don't get backed into a corner
look for an escape route
approach the person at a later time.
You should:
 make no sudden movements or try to touch the person (this could be
interpreted as an attack)
 wait until the anger has reduced
 speak in a calm, easy style
 state the facts
 be assertive use "I" messages
 draw up a clear contract of acceptable behaviour
 state that has contract has been drawn up.
Seek back-up
You should:
 use pager, call bell or call out for help
 don't show panic, anger or fear
Use evasive self defence
You should
stay out of their 'firing line'
choose a safe place to stand
allow for an escape route
move to avoid being hit.
Divert attention
You should:
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 use teamwork if possible other (ie another person can step in with a
reassuring message)
 change subject to a favourite topic
 validate feelings and re-direct to another subject/task
Incident Debriefing
Any sudden event which occurs at Fitzroy Falls Aged Care Facility has the potential to
cause distress to residents, staff or visitors. This distress can result in difficulties in
coping, adapting and recovering from the physical and mental upset that the incident may
have caused.
An incident debriefing meeting assists people, particularly staff, to overcome the effects
of the incident by:
 talking about what happened
 expressing how they feel as a result of the incident
 identifying any individual stress reactions (ie physical, emotional, thinking,
 identifying some ways of dealing with stress reactions.
Incident debriefing meetings are designed to reduce the possibility of any physical,
emotional, thinking or behavioural reactions. The meetings provide an important
opportunity for early identification of staff who have had an adverse reaction to an
incident and who may require further professional assistance. The meetings are intended
to be a normal operational procedure for managing challenging/difficult behaviour
incidents and identifying suitable strategies for responding to these incidents. It is
important to note that incident debriefing meetings can be used for any sudden
distressing event at Fitzroy Falls Aged Care Facility.
An incident debriefing meeting is conducted in such a way that, the people attending the
meeting, share their understanding of the following:
the sequence of events leading up to, during and after the incident
the causes of the incident
the effects of the incident on all the people involved, including the resident
other work related issues that had an impact on the incident
previous incidents that occurred
the way each individual has reacted to the incident including the resident
the external professional assistance that can be accessed, if required.
Incident debriefing meetings should always use a systematic approach to gain a
thorough idea of the event and the reactions of everyone involved.
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Behaviour Descriptions
The following is a list of behaviour that you may observe while monitoring your
Abusive: verbal and physical abuse towards staff and other clients
Agitation: general distress, restless, unable to settle
Anger: perceived threat to others, facial expression
Anxiety: a state of uneasiness and uncertainty
Bewilderment: puzzled, perplexed, overwhelmed by a situation
Combative: aggressive behaviour in which physical contact is made (eg hitting,
biting, scratching, hair pulling, kicking, pinching)
Confused: poor memory and recall unable to remember events and tasks asked
of them
Danger to self: history of falls, reduced insight into own safety needs, safety
comprised by confusion, smoker
Disorientation: confused to time, place, person and events
Dependency on family: seeking out family
Depression: feeling of sadness, hopelessness, bouts of crying, this may be a
diagnosed history
Destructive: damaging objects
Frustration: inability to cope and express feelings
Hallucinations: often visual, auditory very real to the client experiencing them
Noisy/verbally disruptive: causing disruption to others (eg yelling, calling out,
screaming, shouting, singing loudly, chanting, banging, dragging furniture, raising
volume of TV or radio)
Pacing: walking faster than normal, usually within a confined space.
Perseveration: repeating same behaviour, action or speech over and over, may
or may not be disruptive
Tearful: shedding tears, weepy, emotional
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Effective Communication
Communication is a two way process involving both listening and talking.
Communication begins with the first face to face contact between residents or
clients and carers. Observation of body language contributes to the total
The aim of effective communication is to correctly interpret the whole
message sent by other people both by listening to the words used (the
verbal) and gaining an overall impression from their body language (the nonverbal).
Active listening is the key to effective communication. Actively use the ears,
the eyes and intuition to understand what the speakers intend, not just what
the speakers say. Listen first and then respond. Check to be sure that you
have received the right message, by providing feedback. When you are
speaking, the same principles apply. Be aware of the total impression you are
creating by choosing your words carefully and using appropriate body
Also be aware of barriers to effective communication. These may be physical
or emotional.
Possible physical barriers:
 noise and interruptions
 sensory loss, for example hearing and vision, or other disabilities such
as difficulty with comprehension
 furniture (a table or desk can easily be perceived as a barrier)
 gender
 age
 height
 tiredness
 pain.
Possible emotional barriers
anger, fear, frustration, anxiety
over-excited state
lack of confidence, low self-esteem
comparison to others
Verbal and Non Verbal Communication
In your job as a care worker, you will be communicating with a variety of people
every day. A lot of this communication will occur face-to-face. For example, you
may chat to the residents or clients in your care, or talk to other staff members.
Effective face-to-face communication requires good verbal and non-verbal
communication skills.
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So, what is verbal and non-verbal communication?
'Verbal' means 'spoken'. So, verbal communication is the messages you send
with words. It's what you actually say.
Non-verbal communication is the messages you send with your body. Some
people call it your body language. For example:
 facial expressions - smiling, frowning, raising eyebrows, eye contact
 gestures - waving your hand, pointing your finger, crossing your arms
 posture - the way you stand or sit.
Non-verbal communication also includes the tone and pitch of your voice. So,
verbal communication is the words. But non-verbal communication is how you
say the words.
Non-verbal communication is an important part of the communication process.
Up to two-thirds of the meaning of a message can come from non-verbal
communication. So, it's very important that you are aware of it. A facial
expression or simple hand gesture can show:
 how we feel
 what we like or dislike
 if we care or not.
Sometimes a person's non-verbal communication may not match their verbal
communication. For example, a person may be saying nice things, but have
crossed arms and a frown on their face. When this happens, the message can be
very confusing. Is the person being friendly, or are they a little bit angry?
Effective communication occurs when your verbal and non-verbal communication
skills send the same message.
Maintaining Effective Relationships
Communication is a process of passing information from one person to another,
or others, to gain understanding.
Principles for building and maintaining relationships
Research has shown that there are three fundamental skills to making effective
relationships. These can best be described under three headings- Respect,
Empathy, and Genuineness.
Try and see it from their point of view
Live in such a way as to make others feel important
Be yourself and share yourself appropriately
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Behaviour which conveys to others that they are worthwhile, unique and
valuable. It involves a commitment to live in such a way as to make other people
feel important. Respect is conveyed by  Giving positive attention
 Active Listening
 Giving your time
 Remembering the person's name
 Introducing yourself-greeting people
 Basic courtesies-offering a chair, saying 'please' and 'thank you'
 Asking questions
 Checking out assumptions you have made about the other person
 Not interrupting or talking over the other person
 Being thoughtful e.g.: remembering concerns a person my have and
inquiring as to how that is going
 Showing concern
 Remembering something they have told you before and reminding them of it
 Asking for assistance or support
 Being complimentary
 Giving positive and correct feedback
 Listening from where a person is speaking
 Asking the other person for their opinion or idea
 Offering rewards
 Expressing appreciation
 Apologising when wrong
 Involving others in decisions
 Showing trust
 Delegating responsibility
 Being assertive rather than aggressive
 Talking in terms of the other persons interests
Behaviour which shows that you understand the other persons world as they are
experiencing it. In other words, "You see it their way", or "put yourself in the other
person's shoes".
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Empathy is conveyed by Reflecting back to the other person feelings you are picking up - "you must have
felt very angry" "you sound very happy".
 Sharing related experiences of your own
 Smiling when the other person smiles, frowning when the other frowns, etcbehavioural mirroring
 Trying to understand why a person 'did what they did', or 'said what they
 Asking questions to gather information-making enquiries, in a genuine
manner, to understand more where the person is coming from
 Recalling what it is like to be in that situation yourself
Behaviour which conveys to others that you are real, trustworthy, not hiding
behind roles or facades, spontaneous and open about yourself in an appropriate
manner. 'Coming across as being real - not phoney.' It involves being yourself
and sharing yourself appropriately.
Working with Diversity
Your skills in developing effective interpersonal relationships in the workplace
needs to incorporate methods that show you have considered the individual and
cultural differences of the people you will have daily interactions with. These
people will include the residents/clients, their relatives, staff, unpaid workers,
your supervisors and managers.
While working as a care worker you are sure to come across people from the
following diverse backgrounds:
 People from non-English speaking backgrounds (NESB). Migration to
all states and territories of Australia has been predominantly from
Western European Countries such as Italy, Greece, Portugal,
Yugoslavia, Holland and Germany. Towards the last quarter of the
twentieth century migrants have come from India, south-east Asia, Africa
and form South American countries. This has brought a whole new
range of languages and cultures to our predominantly English speaking
communities. People, for whom English is a second language, will be
your residents and team members. It is important that workers at Fitzroy
Falls Aged Care Facility become culturally aware and receive some
education concerning the cultural diversity of the residents and staff.
 Aboriginal and Torres Strait Islanders. The majority of Aboriginal
people today have been born into a westernised culture without the in
depth understanding of how it works and why it works the way it does.
Aboriginal people for a long time were not recognised and have been
excluded from decision making in Australian society. All Aboriginals
deserve to have their culture and traditions understood and respected
just as much as the migrant dominant cultures in Australia.
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 People with disabilities. These may be physical, intellectual or
psychiatric disabilities. These disabilities may effect how a person
functions in society. Whatever the disability a person has, the person
should be recognised as a complete person and not as someone in a
wheelchair or someone with impaired mental function.
 Varying religious/spiritual beliefs and practices. It is not necessary for
you to agree with everyone's beliefs and practices. It is however,
essential that you accept varying beliefs and practices and the
individual's right to hold differing beliefs and practices. You need to do
this if you want to establish and develop an effective working and caring
relationships with someone.
 People who have varying skill levels. Varying skill levels may be
related to varying levels of literacy and numeracy. Low levels of literacy
and numeracy may result from a person being from a non English
speaking background or may result from the person not completing more
than the basic requirements of formal schooling. On the other hand
some residents may have very high levels of literacy and numeracy but
are in Fitzroy Falls Aged Care Facility because of other problems in their
Important points to keep in mind include:
 All staff, relatives and residents/clients are working to achieve the same
goal, the empowerment and maintenance of health of residents.
 Any workplace is made up of individuals with diverse backgrounds, these
individuals will see right and wrong from their own perspective. The
potential for conflict must be recognised and agreeable solutions to
issues be found so that the workplace does not lose its cohesiveness
Cultural Awareness
Successful communication involves both verbal and non-verbal interaction. That is, to get
our message across to others and to understand them, we need to speak and gesture
effectively. As many of our care recipients are born in another country or speak more
than one language, we need to know information about them to ensure their care needs
are met. As people age, it is common for language use to go back to their first learnt
language. It is very important that we recognise this is happening and follow clear steps
to support the person.
The following are some tips to help you communicate effectively across cultures;
Speak slowly and clearly
The care recipient or client needs time to understand your words. Pronounce your words
clearly ? not loudly. We all have an accent ? check to see if your resident or client
understands yours. Take care not to talk down to the person. Clarify by writing down
words. Don't use slang words or jargon (like medical terms and initials).
Explain your role to the care recipient
It is important to explain your role in words that is understood by your resident or client.
Listen and observe
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Words are only one part of communication. The majority of our communication involves
many other cues. The way someone is dressed, their stance, the tone of voice, the pitch,
body gestures, the use of silence. Be aware of your body language and learn about the
body language of your care recipient's culture.
In some cultures it is respectful to maintain eye contact yet in another it is respectful NOT
to have eye contact. Lack of understanding and awareness can lead to misinterpretation
and lack of respect.
Take time to listen
Extra time taken to listen can enable you to clarify what is needed. This will save a lot of
time for all staff later and prevent the care recipient becoming frustrated or withdrawn.
Take care not to approach the resident or client when you know you really haven't got the
time to talk it through thoroughly. Rather, make sure you have the time to discuss any
issue with patience and respect.
People express feelings in many different ways
Emotions and feelings are open to a lot of misunderstanding when translating from one
language to another. Remain respectful of people's different ways. One person may cry
and sob to express their grief and another may not show any signs of emotion at all. Care
workers need to remain non-judgemental. Everyone has their right to express their
feelings their own way. What may be proper behaviour for one group of people may be
disrespectful for another.
Rules of communication
All cultures have unspoken rules of communication. These rules include things like - what
is the right thing to talk about and in what setting. What tone of voice we use, the speed
we speak and the emphasis we place on words, are all factors to be considered when we
speak with people of another culture.
Differences in word meanings
Some words have different meanings in different cultures. "Yes" does not always mean
the person understands, it may be their custom to say "yes" to be polite. It is better to
have the person let you know that they "understand" what you have said rather than
accept a simple "yes" for an answer.
Beliefs and attitudes must be respected
Care recipients have developed certain beliefs about illness and ageing over their
lifetime. We need to ask for more information about what they believe rather than
discount them. It is more respectful to ask them to tell you more about what they believe
and how they would be cared for in their former country. Let the resident or client know
you are interested to know more about them.
Do not assume that a care recipient's level of English will always be correct
As a care recipient translates from one language to another, the structure of their
sentences can become confused. This can occur if a person is distressed or excited.
Another group of people we need to consider in our workplace are our working partners
and colleagues. Many of our co-workers also have a diverse cultural background. To
promote a better workplace, take time to find out about your co-workers ? without being
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too nosy! The more we know about people the easier it is to understand them and work
with them.
Cultural Assessment Tool Understanding Cultural Diversity in Mental Health 2002
Commonwealth Department of Health and Ageing and Multicultural Mental Health
Cross Cultural Communication
Many people are born and live in a variety of countries during the course of their life. To
give the best care possible we need to gather detailed information about our resident or
client. We need to know about their language skills and their culture. One word written on
a document, such as Vietnamese, does not give very true and accurate information about
how that person lives, speaks, thinks and what they believe.
The following may give you some ideas on things we need to know about our resident or
 Family may be extremely important. It may be a specific requirement that family
are involved with all decisions about treatment and care.
 The structure of the family may be very different from what you are familiar with.
 The care recipient may suffer extra stresses related to a change in their role and
financial dependency because of their cultural beliefs.
 Different cultures have different values. Some resident/clients may be proud.
Independence and self-control are important to them. Another culture may value
co-operation. Yet another may be brave. We need to be careful not to be
judgemental about a resident/client's outward personality. It takes a lifetime to
get to truly know a person.
 The care recipient may use other types of healing. They may use folk medicine
methods with or without Western treatments.
 Other cultures may look more at the whole person for healing. Their thoughts,
feelings, spirituality, family, environment, diet and physical self are a key to their
 There may be issues related to the resident or client being male or female. Some
cultures have rules about what gender may treat and care for them.
 The care recipient may have lived through incredible suffering for example if they
have been a refugee or prisoner of war.
 Some cultures feel shame to express their feelings about a trauma or loss.
 Some cultures use terms like "hot", "cold", "wind, "nerves" to describe symptoms.
To assist you to gather useful information about your resident or client consider the
following points:
 Where was the person born and how long have they been in Australia?
 What is the person's first language and other languages spoken?
 What are their reading and writing skills like in each of these languages?
 What is their style of communication non-verbally?
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 What is the person's religion and how important is this to them in their daily life?
 Which ethnic group does the person see themselves linked closest to?
 Who are the resident's or client's main support persons?
A small conversation with your resident/client can find out a lot of information that will be
useful for all care workers and most of all for benefit of that person.
Another group of people we need to consider in our workplace are our working partners
and colleagues. Many of our co-workers also have a diverse cultural background. To
promote a better workplace, take time to find out about your co-workers? without being
too nosy! The more we know about people the easier it is to understand them and work
with them.
Cultural Assessment Tool Understanding Cultural Diversity in Mental Health 2002 West
Commonwealth Department of Health and Ageing and Multicultural Mental Health
Conflict Resolution
The word conflict means different things to different people. What may be a lively
discussion for one person, may be a major conflict for another. Conflict levels can
be looked at in a similar way to stress levels. A certain amount is good for us to
function effectively and to keep us open to new ideas and ways of doing things.
Often, as a result of conflict, an improvement in relationships can take place.
Positive effects of conflict can include:
 A creative approach to problem solving. This can shake you out of lethargy.
 An increase in group and organisational unity. This can help team members
identify and make clear their points of view. Conflict can stimulate team
members to find different methods of approaching situations by exposing
them to new ideas.
Negative effects of conflict can include:
 Violence, particularly where there is inadequate ability to put feelings and
needs into words. This can result in relationship breakdown.
 Breakdown in collaboration, because the purpose or agreement about how
to work together is no longer shared.
 Opposing views from which people can't back down.
 Changes in the work or home environment which produce and reflect anger
and anxiety.
 Emotional devastation, because feelings are ignored, put down or
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There are five main ways of dealing with conflict. These are:
 accommodate (ie to bring harmony to the situation by agreeing with the
other person)
 avoid
 compromise
 collaborate
 compete.
In situations of conflict you will be looking for options which satisfy both sides.
When you are both upset it is difficult to relate to each other. To think, speak and
listen clearly is a challenge and if you are not used to being assertive this will
create added pressure. It is important not to blame the other person for the
situation and aggressively argue the point, equality it is important that one person
doesn't back off and feel like a martyr. These types of behaviour can make things
To be assertive is to deal with your own feelings and avoid blaming others. It can
be wise to:
 Take time out. To do this you can count to ten drop your shoulders,
postpone the situation or go for a walk.
 Check your thoughts, if they are unrealistic or inappropriate change them.
You are the rider as well, not just the horse.
 Reveal your feelings and acknowledge them. This eases the tension and
gives you space to think. You then have a better opportunity to deal with
the situation assertively.
 If it seems too difficult to deal with feelings, it may be of benefit to seek a
third person to act as a mediator.
Interpreter Service
There are a large number of interpreting and translation services, provided by the
Government, private organisations and community networks. Some interpreter
services also provide information on cultural factors and appropriate ways to
communicate with people of culturally and linguistically diverse backgrounds.
Services may include:
 skilled interpreters on site
 professional interpreter service.
Offer the assistance of translating and interpreting to care recipients and/or their
representatives, as appropriate.
The Translating and Interpreting Service (TIS) of the Department of Immigration
and Multicultural and Indigenous Affairs (DIMIA) is a large government interpreter
service. TIS provides a national 24 hour a day, seven days a week telephone
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interpreting service on a national telephone number - 131 450. TIS services are
provided in more than 100 languages and dialects. Each interpreter and
translator is contractually obliged to conform to the Australian Institute of
Interpreters and Translators professional Code of Ethics.
Providing care recipients from non-English speaking backgrounds with
interpreters ensures their care and right of equal access to the full range of public
health care services. Relatives and friends of patients should not be used as
interpreters for medico-legal reasons. In some cultures, gender issues are
particularly relevant and you may need an interpreter who is of the same gender
as your care recipient.
When using the services of an interpreter:
 Brief the interpreter, if possible, about relevant words and concepts prior
to the interview.
 If your care recipient does not understand what you are saying, it is your
responsibility (not the interpreter's) to explain it more simply.
 Speak directly to the care recipient, eg 'How can I help you?'. Do not say
(to the interpreter): 'Ask the client or resident how I can help them?'.
 Sometimes it may take more or fewer words than those you have spoken
to convey the message in another language.
 Do not let the interpreter's presence change your role in the interview.
You need to conduct the interview.
When working with interpreters by phone:
 Describe the telephone equipment you are using (eg conference or single
phone) and where you are (eg residential home or private residence).
 Make allowances for possible clarification by the interpreter because
he/she has no visual cues (eg body language) to assist in interpreting.
 Ensure that all required information is collected from and provided to the
care recipient while the interpreter is on the line there will be no chance
to speak directly to your care recipient after the interpreter hangs up.
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Person Centred Approach
A person, whose mental abilities are failing, due to dementia, needs to be treated
as a person in their own right. Caring for these residents/clients requires you and
other staff to provide a positive social environment that focuses on the person
and not on their disease. This type of environment can be provided by using a
person centred approach to dementia care. The person centred approach to
dementia care is recognised as being a 'best practice' standard. Using this type
of approach requires you to take on values and ways of thinking that will promote
the residents/clients physical, emotional and intellectual well being. With this type
of approach it is also essential to take into account each of the resident's/client's
unique desires, tastes, abilities, difficulties and fears. Remember that these
things may change as time passes.
When using the person centred approach you need to know as much as possible
about the person living with dementia. It is important that you have some
information about the following:
 knowledge of their husband/wife, brothers, sisters, children, grandchildren
and other family members
 family background
 significant people or situations in their lives (past or present)
 type of work they did
 likes and dislikes
 proud moments in their lives
 values
 religious beliefs or connection with religious groups
 past and present interests (eg leisure time activities)
 involvement in politics
 major illnesses and hospitalisation
 recent health problems
 home situation before you got to know them
 how they have coped with difficulties in the past
 how the resident's/client's family is coping with the situation now.
To be able to provide a person centred approach to dementia care, you should
adapt, as far as possible, your work routine to that of the resident/client so that
you can meet their individual needs. To be an effective care worker you will also
need to accept and respect each individual resident's/client's reality, rather than
putting forward your own views.
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Activity Planning/Development
People with memory failure such as dementia sufferers often can't do many of
the things they were able to do before. In planning and developing an activity for
a dementia sufferer it is important to recognise and use the abilities that the
person does have.
In planning an activity for a group it is important to recognise each person's
abilities, special interests and physical capabilities. By recognising the abilities
these residents/clients do have, the care worker can fill in the bits of the activity
the resident/client can't do.
When designing an activity it is necessary to consider the following:
 Will the activity give the resident/client a sense of achievement?
 Will the activity improve the resident's/client's self-esteem (ie improve
their feelings about themselves)?
 Does the activity provide natural contact with other people?
 Is it a type of social contact that the resident/client is used to (ie listening
to music or playing bingo)?
 Will the activity increase the resident's/client's trust and ability to
 Does the resident/client see the activity as meaningful?
 Will the activity promote the resident's/client's sense of physical wellbeing?
The table below may be helpful when you are planning an activity. The tablet
details the mental abilities of dementia sufferers. The first column gives
suggestions for an activity that are related to the abilities of a dementia sufferer.
The second column lists the particular memory abilities that are failing in a
resident/client living with dementia.
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Residents/clients with dementia can...
(suggested activity is listed in brackets)
People with dementia find it
difficult to...
Remember the past
(Activity about reminiscing)
Remember the present,
particularly details
Feel emotions
(Activity to help the residents/clients express their emotions)
Express their emotions verbally
or rationally
React to a 'threat' and react to their feelings:
(Activity to meet resident's/client's needs in a non threatening
Make sense of the 'threat' or
their feelings
Feel secure with
Adapt to:
familiar faces
familiar people
familiar routines.
new people
new places
new routines
(Activity to meet resident's/client's needs using skills they are familiar
Know what they don't want
(Activity to help residents/clients express their feelings)
Know what they want, and tell
people what they want
Indicate their approval/disapproval of your choice for them
(Activity to be meaningful for resident's/clients)
Choose or make a decision for
Do familiar and simple things
(Activity that doesn't have too many unfamiliar steps)
Do complicated tasks and learn
new ways of doing things
Follow your lead or demonstration
(Activity to contain specific simple steps that allows the client to follow
your lead)
Follow instructions
Enjoy sociable company
(Activity to give the resident/client the opportunity to socialise with
residents/clients who have similar interests/backgrounds/cultures)
Interpret crowded or busy
situations and appreciate satire
Do things one step at a time
(Activity that is broken down into a series of steps that are easy to
Do several things in a hurry
Communication Strategies
Communicating with a resident/client living with dementia needs you to use good
observation and listening skills. When communicating, the most important thing is for you
to treat the resident/client as an individual and for you to look at the world from their
perspective. The resident's/client's critical physical environment is a one metre circle, with
them at the centre. The qualities of being able to negotiate and collaborate with the
resident/client in planning their care will help you and others to enter this space. Using
these skills will help to improve the resident's/client's well being and care. Observing the
resident's/client's reactions to their environment and using active listening skills will also
allow a closer relationship to develop.
Observation skills
Observing the resident/client in their environment and in their interactions with their
family, friends and visitors needs more than just looking. You need to observe their:
 facial expression
 eye contact and gaze
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 gestures and movement
 posture and appearance
 smell
 inappropriate use of objects (eg using a pencil to cut paper)
 sound and tone of voice
 use of touch
 signs of physical comfort or discomfort.
Listening skills
Listening is an active process that requires your participation. To fully understand the
meaning of what is being communicated you usually have to ask questions and respond.
Then in the give and take of the communication that follows you get a fuller appreciation
of what is being said. By using this process you have gone beyond just absorbing the
words and now you should then be able to work in partnership with the person in the
communication process.
Listening is an essential skill for making and keeping relationships. Listening is a
commitment to understanding how other people feel and how they see their world.
Listening is also a compliment because it says "I care about what's happening to you".
Real listening is based on the intention to do one of four things. These are:
 understand someone
 enjoy someone
 learn something
 give help.
Benefits of real listening to a resident/client can include:
 the resident/client appreciates being heard
 stops escalating anger and cools down a crisis or reduces tension
 stops misinterpretations/errors
 helps you to remember what was said.
Effective strategies in talking and listening to a resident/client living with dementia
 Facing the resident/client and not invading their personal space without warning.
 Having an open posture (ie arms not folded and legs not crossed).
 Leaning towards the resident/client .
 Keeping good eye contact (ie looking at the resident/client without staring).
 Being relaxed.
 Adopting a running commentary (ie you can say what has happened and what is
about to happen).
 Ask who, what, where, when and how questions. Never ask why? Why questions
can make a resident/client anxious, angry or agitated.
 Avoid should, must, ought to, don't and no. They can make the resident/client
feel they are being spoken to as a child and can make them angry or
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 Never ask "Do you remember?" This can cause distress.
 Begin your sentences with "May I offer you ...", "I would like to invite you...",
"Today, is it going to be... or...?". When you present a choice, always accept the
decision and do not argue with the resident/client .
Dementia refers to a group of illnesses that are characterised by changes in the
brain that lead to a decline in the person's mental functioning. Dementia brings
about changes of personality and can alter relationships within a family. This
results in changes in the quality of life of the dementia sufferer and leads to
social isolation and loneliness. Dementia is not a part of normal ageing. People
with dementia undergo psychological changes and progress through a series of
stages that include memory loss, disorientation, verbal communication problems
and personality changes.
Dementia is a most distressing and serious illness. The causes of dementia are
unknown, but can be affected by issues such as poor diet, side-effects of
medication, vitamin and hormone deficiencies and depression. The majority of
cases, however, fall in to the category of incurable illness. This includes:
 Alzheimer's Disease
 vascular dementia (where the brain is damaged from a series of small
 mixed dementia which is a combination of Alzheimer's Disease and
vascular dementia
 Parkinson's Disease
 Huntington's Disease
 alcohol related dementia (Korsakoff's syndrome).
The main symptoms of dementia are:
 Poor short term memory. The sufferer finds it hard to remember recent
events, but can remember incidents from their past, even as far back as
their childhood, with complete clarity.
 Loss of contact with reality. The sufferer begins to lose their hold on
reality. They may not know who they are (disorientation in person), who
others are, where they are (disorientation in place) or what time of day it
is (disorientation in time). This causes them to feel frightened and
insecure. If they don't know what time of day it is, the sufferer may get up
in the middle of the night believing it is day time. It can increase the
sufferers distress if, in the early stages they are aware that something is
not quite right but they can't do anything to change it. As time goes by
they lose that insight.
 Changes in behaviour. This is perhaps the most concerning symptom.
The sufferer can become quite agitated and restless. Their surroundings,
whether at home or in residential care, becomes a place of uncertainty
and bewilderment. They no longer feel secure and safe. It becomes
more difficult to cope with the varied demands of their life and they reach
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a point that they are unable to handle situations at all. They may become
more emotional or weepy which may be quite uncharacteristic of their
previous behaviour. This is known as a catastrophe reaction where a
simple problem such as putting on an article of clothing becomes too
much of a challenge.
 Communication problems. Dementia affects speech as well as
behaviour. Sufferers with severe dementia are often unable to
communicate, as they would do normally. Their speech becomes
incoherent, they may babble like a baby, and the sounds and groups of
words they use are without any apparent meaning. In the early stages
they may forget common words and use other words to describe what
they are talking about. Such as, knowing they are going for a shower
and using the word "umbrella..going in the rain " but use the actions of
washing their face and body. The association between water falling in
the shower and rain is not distinguished. Their actions are not the same
as they would use for putting up an umbrella. The name of common
objects may be forgotten but they will try to get the message across
using other descriptions. Being aware of failing communication in the
early stages of dementia can make the sufferer extremely frustrated.
Triggers that can Alter Behaviour
There are a number of different types of triggers that can alter behaviour in a
person living with dementia. These triggers can be divided into the three
categories listed in the table below.
Triggers that can alter behaviour
Client triggers
Communication triggers
Location triggers
(these triggers can be identified from
(these triggers can be
(these triggers can be identified by
the care plan and progress notes) identified in the care plan and observing the client in their own
progress notes)
Client triggers include:
Social history
Impact of changes to work
roles (eg retired from work)
Sleeping problems
Feelings such as frustration,
sadness, anger, grief
Effects of dementia
Communication triggers
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Poor verbal
communication (ie
speaking too fast,
Hostile body language
Inappropriate nonverbal cues
Changes to routine
Unfamiliar carers/care
Preferred language
not used
Feelings of client not
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Location triggers include:
Unfamiliar surroundings
Too much noise (eg radio,
building sounds)
Visual distractions (eg
patterned carpet)
Decor and fittings
confusing (eg can't
recognise what room they
are in)
Too much clutter
Visual prompts that cue
unwanted behaviour (eg
items usually associated
with outside activities in
immediate inside space)
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Care Plans
Every resident or client in your care will have a number of documents and
records about their care requirements. The most important document you will
work with is the 'care plan'. A care plan gives all staff, including yourself, detailed
information about the person in your care and their specific care needs. This
ensures everybody works together in a consistent way, to provide the best quality
Care plans are legal documents. You must consult the care plan before
completing any task with a resident or client. This ensures the resident or client,
your team members and yourself remain safe.
So, what information will you find in a care plan?
A care plan will include information about the following:
 Care needs. These are problems or issues that have been determined
through formal assessment. For example, a hearing impairment.
 Goals and outcomes. In other words, what level of support is needed. For
example, the goal for a person who is hearing impaired may be to
maintain effective two-way communication.
 Interventions and actions. These are directions on what you need to do to
help the resident or client achieve or maintain goals and outcomes. For
example, you may be required to clean and check the batteries in a
resident's or client's hearing aid every day.
The information in a care plan comes from detailed assessments that are carried
out from the time of entering care. These assessments are completed by nurses,
physiotherapists, occupational therapists, social workers and doctors. Care
workers are also involved.
A care plan is a 'dynamic' document. This means it is reviewed and updated
regularly, to meet changing needs. All staff, including yourself, will be responsible
for maintaining the care plans for people in your care. Therefore, it is part of your
role to report changes to your supervisor and seek guidance on how to update
the care plans in your workplace.
Different workplaces will have different ways of presenting information in a care
plan. You need to know how to access and read the care plans in your
workplace. They will help you plan your daily work with each resident or client.
Completing Care Plans
To ensure the best possible care is provided it is important to complete the care
plan thoroughly.
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Firstly, ensure the resident's/client's details label is adhered to at the top of each
page of the care plan. As this is a legal document every page of the care plan
must identify the care recipient.
Care alerts must be written clearly in red. This section must include any known
allergies or information that could seriously affect the resident's/client's health or
The care needs prompt is where you write a particular care issue that requires
attention. The goal (or expected outcome) states what we want to achieve.
For example:
Care needs - Hearing and visual impairment
Goal - To maintain effective two-way communication
Each section of the care plan has a box of prompts that you may select as
needed. To alert other carers to do this task you highlight the instruction with a
highlighter. On a computer the highlighter function is on the formatting toolbar.
If the instruction you require is not already listed, write the instruction or
information into the space for "Other".
There is room at the end of the document for additional comments if needed.
The care plan must be evaluated three monthly or before if there is a change in
the care recipient's status.
The document must be signed and dated when created and each time it is
reviewed or changed.
Policies and Procedures
Policies and procedures are important documents in any workplace. Their
purpose is to record, in detail, how a workplace is to operate.
Policies and procedures can be categorised into three (3) main areas:
1. Policies and procedures that outline how your workplace will comply with
Federal and State/Territory laws, such as Occupational Health and
2. Policies and procedures that outline the standards your workplace
expects. For example, customer service standards.
3. Policies and procedures that outline the day-to-day functioning of the
workplace. For example, what staff need to do when applying for leave.
So, what are policies and procedures?
A policy is a statement of intent. In other words, it's a written aim of the
workplace. For example:
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Residents/clients are assisted to maintain their oral and dental health in
accordance with their needs and preferences.
A policy may have a number of procedures supporting it. A procedure outlines
what staff need to do to achieve the aims of a policy. Following is an example of
a procedure for residents/clients who are unable to clean their own teeth.
1. Explain procedure to resident/client and gain agreement.
2. Assemble equipment - bowl, glass of water, towel, resident's/client's
toothbrush and toothpaste.
3. Wash your hands and put on glove.
4. Apply small amount of toothpaste to moistened toothbrush.
5. Clean bottom teeth in upward strokes, starting at the gums.
6. Clean top teeth in downward strokes, starting at the gums.
7. When finished, allow resident/client to thoroughly rinse mouth.
8. Wipe mouth.
9. Clean, dry and store equipment.
10. Remove glove and wash hands.
11. Report and document any changes, such as pain, bleeding gums, mouth
ulcers, loose or decaying teeth.
Notice how the above procedure outlines, step-by-step, what to do and who is
responsible for doing it.
It's important that all staff follow workplace policies and procedures. This ensures
everybody works together in a consistent way and to the requirements of the
Resident Classification Scale (RCS)
The resident classification scale (RCS) is a funding tool used to calculate the
subsidy paid by the Commonwealth Department of Health and Aged Care to
residential aged care facilities. There is an expectation that all aged care facilities
are accountable to their residents, families, communities and the government to
meet the accreditation standards for residential aged care services.
Providing this standard of care is costly so the Commonwealth Government
assists nursing homes by providing various subsidies for differing needs. The
RCS is an assessment and funding tool used to determine the level of subsidies
that are provided for each resident. The appraisal used for the RCS does not
consider all of a resident's care needs. It considers factors that have been
identified as contributing the most to differences in the total cost of care.
The Director of Nursing or nominated staff responsible for residents' care
assesses all the residents using the RCS. This assessment takes place over a
three week period. Documentation must be kept to verify the claim that results
from the assessment.
The assessment covers all of the care needs of the resident. These include:
 maintaining continence or managing incontinence
 maintaining, restoring and preventing skin damage
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 specialised nursing procedures provided by or under the supervision of a
registered nurse
 managing episodes of physical aggression or verbal disruption
 frequency of staff managing behavioural concerns
 assisting with vision, hearing, speech and comprehension
 support required with mobility, toileting, washing, dressing, eating and
When the assessment is complete the aged are facility submits the residents'
completed RCS form to the Department of Health and Family Services. The
residents are then weight based on their care needs. The total rating determines
the classification of the resident in to one of 8 categories (levels 1 - 8). The
nursing home receives funding for the resident according to category. Level 1 - 4
is high care and level 5 - 8 is low care.
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Health Terminology Abbreviations
When completing documentation at Fitzroy Falls Aged Care Facility you should
use the abbreviations in the table below. The left side of the table gives day to
day abbreviations, the right side of the table gives medical abbreviations
Abbreviation Meaning
blood pressure
activities of daily living
blood sugar level
chronic obstructive airways
as soon as possible
cerebro vascular accident
bowel action/bowels
2 times a day
complained of
3 times a day
date of birth
4 times a day
for example
give when necessary
insulin dependant diabetes
non insulin dependent
deep vein thrombosis (clot)
that is
transient ischaemic attack
(mini stroke
midstream urine
urinary tract infection
not applicable
myocardial infarction (heart
ischaemic heart disease
next of kin
congestive cardiac failure
occupational therapist
short term memory loss
occupational therapist
please turn over (page)
bend/contract ( joint)
Resident Administration
straighten/stretch (joint)
Resident Care File
resident classification
with reference to
seen by
times (eg repeated times
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Completing Documentation
Whenever you write anything, you need to consider the purpose of the writing.
The purpose of the writing will determine what you write and how you write it. At
Fitzroy Falls Aged Care Facility written documents ensure continuity and
consistency in the treatment or management of individuals. They provide a
safeguard for the resident/client and the staff caring for them, in that a written
document is evidence of care planned and given, actions taken and reviewed or,
provide another channel of communication when face-to-face contact is not
Written documents are required for a wide variety of work situations and
incidents. These include:
reports on responses from residents/clients and workers
reports on work related issues (eg surveys of safety issues)
providing information in flyers or memos
incident reports relating to occupational health and safety
progress notes/care plans for residents/clients
messages for staff and residents/clients
maintaining the continuity of care and quality of care to the standards that
are required by the organisation and by legislation
providing a primary source of assessment information for others who are
directly involved with the resident/client
reflecting resident/client care in a legal document which can be used to
protect the organisation if there is a claim made against them by the
resident/client or their family
obtaining information about a resident/client from their documented history,
this ensures that care workers can obtain a history of past events, services
and treatments.
Written documents may require a rigid structure (eg when completing an
incident/accident report, here questions are asked and blank spaces have to be
filled in). Alternatively written documents may be less structured (eg when writing
a memo to a colleague).
Regardless of the type of written documentation, to ensure that they are of the
highest quality to meet legal and organisational standards, it is important to keep
the following points in mind:
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Always use ink. These documents are a permanent record that may be
required for legal purposes. If a computer is being used, the document
should be saved to a secure folder and have recognised headings and
Avoid the use of white out in hand written documents. Draw a line through
an error, date and sign.
Your writing should be neat, clear and legible.
Be objective and use clear and understandable language.
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Ensure confidentiality.
Only use abbreviations approved by Fitzroy Falls Aged Care Facility.
Use correct spelling, punctuation and grammar.
Don't leave spaces between entries. Particularly in progress notes, as this
leaves others the opportunity to add to you notes. If the information they
include is wrong, it will still be attributed to you.
Be accurate, concise and factual and present the information in a logical
Use quotation marks when recording a resident's/client's statement.
Consider who is going to read the document, why it is being written and
what effect it is intended to have.
Write events in the order that they happened and as soon as practical after
they happened.
Be certain the resident's/client's name is written on each page of the
progress notes/care plan.
Sign your name then print your name and status (ie Care Worker) on any
written information.
No entry concerning a resident's/client's care or treatment should be made
on behalf of another care worker.
Progress Notes
Progress notes for a resident or client are the most appropriate place to note that
the plan of care has been evaluated. The progress notes provide evidence that
regular evaluation is taking place.
Progress notes are not intended to contain long stories about the day-to-day
occurrences for a resident or client. Neither should they contain a Care Worker's
subjective response to a situation that has occurred. They should not contain
information that is repeated elsewhere such as on the care plan, observation
chart or medication chart. Therefore, writing in the progress notes should be by
EXCEPTION which means when the resident/client does something differently or
responds differently to a situation or treatment that is then recorded. It is
Progress notes are where new treatments or strategies for managing the
resident/client can be recorded and to flag that the care plan needs to be, or has
been, altered. Progress notes help in maintaining a record of the continuity of
care and quality of care to the standards that are required by the organisation
and by legislation. They reflect resident/client care in a legal document which can
be used to protect the organisation if there is a claim made against them by the
resident or their family
When writing in documentation such as progress notes, you will need to ensure
that they are of the highest quality to meet legal and organisational standards. It
is important to keep the following points in mind:
1. Always use black ink. These documents are permanent records and may be
required for legal purposes
2. Avoid 'white ? out'. Draw a line through an error, date and sign
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3. Your writing should be neat, clear and legible
4. Only use abbreviations approved by your organisation
5. Use correct spelling, punctuation and grammar
6. Don't leave spaces between entries
7. Be accurate, concise and factual and present the information in a logical order
8. Use quotation marks when recording a resident's statement
9. Consider who is going to read the document, why it is being written and what
effect it is intended to have
10. Write events in the order that they happened and as soon as practical after
they happened
11. Be certain the resident's/client's name is written on each page of your notes
12. Sign your name then print name and status (ie Care Worker) on any written
13. No entry concerning a resident's care or treatment given should be made on
behalf of another care worker
Progress notes are important methods of communication and as such require
some of the same skills used in other methods of passing along information. It is
important to remember also, the issues of confidentiality, being objective and
using clear and understandable language. Before you start to write; think about
who is going to be reading it.
Commitment to Continuous Improvement
Fitzroy Falls Aged Care Facility encourages all staff to actively strive for excellence and
to continually seek to improve the quality and efficiency of services to clients. Fitzroy
Falls Aged Care Facility uses a planned and systematic approach to planning and
continuous improvement. All stakeholders are encouraged to provide feedback which is
analysed and incorporated into strategic, business and continuous improvement plans.
Fitzroy Falls Aged Care Facility is committed to Continuous Improvement (CI) and quality
of care by identifying opportunities for improvement and solving problems in a way that
allows us to work together towards:
 Aiming for excellence in service delivery in all areas
 Developing skills and abilities of employees
 Promoting communication and teamwork between staff and
Fitzroy Falls Aged Care Facility expects all staff to contribute to continuously improving
care and services in line with our Mission, Philosophy of Care, Objectives and Core
Values. Teamwork, participation and good communication are essential to achieve
consistently high standards. Feedback is actively encouraged. There are procedures in
place to gain and respond to comments from residents, relatives, clients and staff about
their needs and preferences.
Continuous improvement is built into every area of care and service we provide. In
addition, residential care facilities must be accredited.
What is Continuous Improvement (CI)?
Definition - Continuous Improvement (CI) is an ongoing process of gathering information,
planning, evaluating and improving care and services to meet changing resident/client
and client needs.
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It involves a team-based approach to gathering information, planning, undertaking
activities, evaluating the success of activities and making adjustments as necessary.
Our residents/clients are changing all the time. Existing residents'/clients' needs change,
therefore CI involves being responsive to residents' needs and changing our practices to
satisfy those needs.
We must maintain high standards at all times. We can do this by getting resident/client
feedback about ways to improve the services we offer and be always looking for best
practice. That is, finding out if others have better ways of doing things. Accreditation
standards provide guidelines about how management systems, staffing and
organisational development assist us to provide optimum resident/client health and
lifestyle options in a safe and pleasant environment, while respecting mutual rights and
Continuous improvement is an integral part of management. It is not an additional task, it
is an attitude and way of working. Managers are responsible for identifying, implementing
and evaluating continuous improvement activities All employees have a responsibility to
identify possible improvements to facility and corporate structures, policies and
We encourage and welcome suggestions for improvement.
Materials Safety Data Sheets
MSDS stands for Material Safety Data Sheet. A MSDS is a document that
contains information on the potential health effects of exposure and how to work
safely with chemical products.
A MSDS advises you how to use chemical products safely, what safety
equipment is required when handling them, how to store them safely and what to
do in an emergency.
You must make sure you read and understand the MSDS before you work with
any chemical or product.
You can get an MSDS from your employer before you use a product.
A MSDS exists for each chemical product sold in Australia and you can access
them through your chemical provider or on the internet. It contains chemical
safety information about the product, such as: toxicity, safe-handling procedures,
spill response, and first aid procedures.
As required by the OHS Act, employers must maintain copies of any Material
Safety Data Sheets of chemicals that are stored and used on their premises and
ensure that they are readily accessible to employees during each work shift.
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Food and Fluid Thickeners
As a care worker it is very important to check the care plan to see if your care
recipient's food or drink requires a thickener. A thickener generally consists of
vegetable gums, food starches or a combination of both. A specified amount is
added and mixed with the drink or food to create a gel-like consistency.
Some care recipients require the food or fluid thickener due to swallowing
difficulties (dysphagia). A full assessment needs to be carried out by a Speech
Pathologist or qualified health practitioner to ascertain if a thickener is required,
what type of thickener and the amount that needs to be added.
Care recipients on a thickener regime require monitoring to ensure they have
adequate fluid intake as thickeners can be dehydrating.
Failure to add the thickener can have serious results. Remember, always check
the care plan
Incontinence is the loss of bladder or bowel control. Many sufferers may
experience emotional as well as the physical discomfort. It affects people's
lifestyle and may result in social isolation.
There are several types of incontinence.
 Stress incontinence - this occurs when pelvic muscles have been
damaged. This causes the bladder to leak during coughing, sneezing,
laughing, exercise or any movement that puts pressure on the bladder.
This commonly affects women and may occur after multiple childbirths or
 Urge incontinence, or overactive bladder, involves the urgent need to
pass urine and the inability to make it to a toilet on time. It occurs when
nerve messages from the bladder to the brain don't connect. The
bladder cannot be mindfully controlled. Urge incontinence is experienced
in such illness as dementia and Multiple Sclerosis.
 Mixed incontinence is very common and involves a combination of both
stress and urge types of incontinence.
 Functional incontinence occurs when a person does not recognise the
need to go to the toilet. They don't recognise where the toilet is and
make it to the toilet on time. This may be caused by dementia, poor
eyesight, confusion, difficulty to get out of chairs, and poor lighting.
 Overflow incontinence relates to leakage that occurs due to the amount of
urine is greater than bladders holding capacity. This can result from
diabetes, pelvic surgery, polio, spinal cord damage or shingles.
 Faecal incontinence includes the uncontrolled loss of solid stools. Anal
incontinence is the uncontrollable loss of flatus (wind) and liquid stool.
Faecal incontinence may be cause by many things including diarrhoea,
constipation, nerve damage, or damage of the muscles around the anus
from childbirth or surgery.
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What can be done?
 Ensure the resident/client has had a thorough examination with a medical
 Encourage the resident/client to self toilet if possible.
 Check the resident/client is not restricted but his/her mobility.
 Make sure their mobility aids are reachable eg walking stick, frame.
 Make sure the distance to the toilet is achievable.
 Ensure they can easily remove article of clothing. Arthritic fingers struggle
with buttons and zippers.
 Have the resident's/client's medications checked ? they can sometimes
be the cause of the incontinence.
 Discuss the use of absorbent products (pads) to ease the embarrassment
of leakage.
 Have your physiotherapist assess your resident/client and discuss pelvic
floor exercises if applicable.
 Drinking plenty of fluid is important. This assists the kidneys and bladder
to function effectively and prevents dehydration. Limiting fluids with
caffeine such as tea and coffee to 2 or 3 cups a day will help to prevent
over stimulation of the bladder wall and increase urgency.
 Most importantly make sure you respect your resident's/client's dignity
when discussing or assisting them with toileting procedures. If in doubt,
treat your resident/client the way you would like to be treated in this
The Physical Effects of Ageing
A normal part of the ageing process is that our skin and organs cease to function
as efficiently as when we were young. As a care worker it is essential to take
these factors into consideration to ensure the best level of care for your
 Changes include loss of pain/hot/cold sensation that may result in injury.
 Skin becomes drier and less elastic increases chances of skin tearing.
 Sweat glands decrease creating difficulty in maintaining body
Mouth and Teeth
 Reduced saliva production may create swallowing difficulties or
 Membranes that line the mouth take longer to repair.
 Taste buds deteriorate resulting in the lack of taste in foods.
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Digestion and Elimination
 Nutrition from food may not be absorbed resulting in malnutrition.
 Delay of movement of waste can result in constipation.
Urinary System
 Kidney function decline may result in fluid retention, less efficient at
storage of essential body salts and less efficient removal of toxic waste.
 Urinary incontinence may result from muscle weakness or loss of
sensation to nerve endings.
Heart and Blood Vessels
 Cardio-vascular system becomes less effective and less blood is
 Blood vessels become less elastic and narrower. Blood pressure
readings indicate changes related to medications and/or disease.
 Poor circulation to the hands and feet cause pain, discomfort and less
 Lack of blood supply to the skin and tissue may result in ulcers that are
difficult to heal.
 Hardening of the arteries (atherosclerosis) occurs.
 A block in an artery restricts blood supply and can have terrible results.
 Elastic tissue in the lungs does not expand as well and less oxygen is
taken in.
 The chest wall does not expand as much as a younger person. This
results in less air entry in to the lungs and less oxygen is absorbed.
 Reduction in mucous production and the effectiveness of other disease
fighting mechanisms make older people more prone to chest infections
and pneumonia resulting often in death.
 Annual flu' injections are a wise precaution. If you have the flu' then it is
best not to work with elderly people until your symptoms have gone.
 Irreversible changes to lung tissue will have occurred in smokers.
Reduced ability of the lungs to absorb oxygen affects all of the body's
normal functions.
 Muscles lose mass, flexibility, strength and durability if they are not
exercised regularly in later life. The range of motion at joints declines
with ageing and may contribute to reduced participation in exercise.
 Contractures may occur due to diseases such rheumatoid or osteoarthritis, neurological diseases, strokes or immobility.
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Bones and Joints
 Bones become more brittle and less dense as a person ages. As a result
fractures can occur more easily.
 Calcification in the joints can cause restricted movements and joint pain.
 Osteo-arthritis occurs to some degree in most aging bodies.
 Decreased calcium absorption means possibility of osteoporosis.
Nervous System
 It can take longer to process and respond to messages received. This
can result in lowered reactions, responses and reflexes. Poor balance
and reflexes mean increased risk of falls.
 Memory loss may occur.
 Dementia is mainly an age associated condition with 17 per cent of the
population over 75 years suffering with it.
 Sleep may become an issue for many older people as they need less
 Vision deteriorates as a person ages. This means good lighting is always
needed to prevent falls or accidents, even in the day time.
 The lens of the eye can become opaque (cataract) or it can thicken and
be less flexible making it more difficult to focus quickly on objects.
 The lens may also become yellow in colour affecting the way the person
perceives colours.
 Hearing loss presents mainly through the loss of high frequency sounds.
 Safe mobility for older people may become limited by changes in their
physical and mental condition. Mobility is necessary for wellbeing.
Reproductive System
 In men, an increased prostrate gland, increased amount of time to urinate
and loss of hardness to the penis are possible changes caused by the
aging process.
 In women, decreased vaginal secretions may make sexual intercourse
uncomfortable, and thinning vaginal walls are common physical
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Stereotypes of Ageing
A stereotype is when an image of, or attitude towards persons or groups is based
on superficial observations and experiences. For example, some people
stereotype young people as rebellious and loving parties, or stereotype Asian
people as being intelligent, or Doberman dogs as being ferocious.
These perceptions are formed without us possibly even knowing any Doberman
dogs or Asian people. We form the opinions by what others say, or the way these
images are shown to us by television, newspapers and magazines.
Below are some examples of common stereotypes or myths about elderly
 old people don't have sex
 most old people are sick
 old people are set in their ways
 old people are a burden on society
 old people have nothing to offer
 all old people become senile
 all old people are the same
 most old people like to be cared for
 old people prefer to be with people the same age.
These beliefs and attitudes are restricting to those who believe them and to the
people it concerns. These attitudes don't consider the uniqueness of the
The consequence can be the elderly person devaluing themselves and becoming
reliant on others. This can result in their self esteem becoming low and thereby
reducing their health and fitness levels as they allow others to step in and do
everything for them. If the society has a low value on the elderly then this will
reflect in the standard of care and services.
We must treat each person as a unique individual. Develop care plans that reflect
the specific needs of the person.
Recognise that each older person has feelings just like us on the inside, only
they look different on the outside now. And so will we one day.
Most of all remember we are all different.
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Sexuality and Ageing
We express our sexuality in many ways.
We all have a need for love, touch, holding, cuddling and eye contact. Sexuality
is not just sexual intercourse. From the time we are born until the time we die we
have an inborn need for affection. This aspect of our sexuality is very distinct
from the sexual act.
A lot of our judgements and beliefs surrounding sexuality are linked to our
values, morals and religious beliefs that have developed over our lifetime. As
individuals, we have very different views on sexuality and, in particular, sexuality
and ageing.
One of the most common attitudes in our society is that old people aren't
attractive. This belief creates a major barrier for older people to express
themselves sexually.
We all like to take pride in our personal appearance. Equally we like to be noticed
and communicated to by others. As a care worker it is important to realise how
much emotional and psychological value is to be gained by assisting residents
and clients to maintain an attractive personal appearance.
We also have a need for privacy and discretion. As much as people have
different needs and preferences, all adults require respect and an opportunity for
privacy. If a resident or client has an issue of a sexual nature it is our role to be
discreet about how and who we talk to, and the way we discuss matters with the
resident/client and their family.
Sometimes a request may be made to purchase items from an adult shop or visit
a sex worker. As an adult, the resident/client has the right to do this. As a care
worker we need to ensure the safety of the resident/client and discuss methods
of protection from sexually transmitted diseases. Some care recipients use
masturbation as sexual outlet or masturbate because of a disease process that
may have lowered their self-consciousness.
Women may need to discuss issues of vaginal dryness with their GP and men
may need to discuss problems regarding erections. Their doctor can assist with
these issues, as they are normal and treatable.
It is not a care worker's responsibility to assist residents/clients achieve or pursue
their sexual needs. However it is a care worker's role to respect the care
recipient's preferences, maintain the person's dignity and uphold confidentiality at
all times.
If at any time you are uncomfortable regarding an issue of a sexual nature it is
your responsibility to discuss the matter with your supervisor as soon as possible
so that the issue may be resolved.
Remember sexuality is a wonderful expression of life.
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Grief and Loss
What is Grief and Loss?
A loss is the wound. Grief is the healing process. The greater the personal
meaning of the loss for a person, the greater the grieving experience may be.
A loss could be:
 a death
 divorce
 health changes
 retirement
 income
 independence
 freedom
 a body part or bodily function
 lifestyle
 role or job
 memories
 home
 security
 pets
 relocation to a new area
As an aged care worker it is very important to recognise that our residents/clients
often are experiencing grief for losses in several parts of their lives.
Signs and Symptoms
The following signs and symptoms are commonly experienced by people
experiencing grief and loss. Not all symptoms would be experienced at the same
time, but any combination is normal. Always ensure your resident's/client's signs
and symptoms are reported to your supervisor for a thorough medical
Physical signs
Emotional signs
Psychological signs
Chest pains
Sleep disturbance
Loss of appetite
Low resistance to illness
Numbness - unemotional
Loss of self confidence
Loss of meaning
Suicidal thoughts
Changes in thinking patterns
Preoccupation with the loss
Loss of interest
Concentration poor
Memory poor
Loss of faith
Low self esteem
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Stages of Grief
Each person is an individual. In our own uniqueness we express thoughts and
feelings in many different ways. It can be said that people move through a variety
of stages, eg denial, anger, depression, acceptance. However, each person and
each loss cannot be so simplified. We cannot put a timeframe onto a person for
their grief. It is their experience, not ours. We must remain non-judgemental
about how another person is coping with the great changes in their life.
The best outcome is when a person has integrated their grief and loss into their
present life and can function as best as can be expected. That is, the person
doesn't forget their loss. How can someone possibly forget living in a 40 year
marriage with another person? Some losses no-one will ever get over. Rather,
they will learn how to continue to live with the loss.
It is most important to recognise what is acceptable to do as a care worker, when
a resident or client is experiencing grief and loss.
 Spend some time to really listen
 Acknowledge their feelings
 Don't discount their feelings - don't say they will get over it
 If you don't know what to say, say nothing
 Allow the person to talk about their loss and feelings
 Tolerate silence. Silence is okay, you don't have to fill the space
 Reassure the person that it is normal to have a lot of different thoughts,
feelings and physical symptoms when they are grieving
 Recognise that you cannot make them feel better, but you are making a
difference by being there
 Ensure you are aware of any special needs regarding the resident/clients
spiritual, religious or cultural beliefs
Supervision and Reporting
If a resident/client is experiencing identified grief and loss all staff need to be
aware of how the person is progressing on a daily basis. Keep your supervisor
informed of the resident/client's progress and document it. If the resident/client
shows signs that they may be struggling, ensure your Supervisor is aware and
that the appropriate agencies are contacted to gain professional support.
What is diabetes?
Diabetes is a long term (chronic) disease characterised by high blood sugar
(glucose) levels. This is a result of the body not producing insulin, or using insulin
properly. Insulin is a hormone made by the pancreas. Insulin is needed for
glucose to enter the cells and be converted to energy.
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Type 1 diabetes (insulin dependent)
Represents 10 to 15% of all cases of
Occurs when the pancreas gland no longer
produces the insulin needed
Is one of the most common chronic
childhood diseases in developed nations
Is not caused by lifestyle factors
Type 2 diabetes (non-insulin dependent)
Represents 85 to 90% of all cases of
Occurs when the pancreas is not producing
enough insulin and the insulin is not working
A genetic predisposition and lifestyle factors
contribute to the development of Type 2
Risk factors include overweight/obesity
Usually in childhood or young adulthood, although
it can occur at any age.
Usually in adults over the age of 45 but it is
increasingly occurring at a younger age.
Usually abrupt onset. Symptoms can include
excessive thirst and urination, unexplained weight
loss, weakness and fatigue, irritability.
Sometimes symptoms go unnoticed as the disease
develops gradually. Symptoms may include any of
those for Type 1 diabetes plus blurred vision, skin
infections, slow healing, tingling and numbness in
the feet. Sometimes no symptoms are noticed at
Lifelong insulin injections every day, regular blood
glucose level tests, healthy eating plan and regular
physical activity.
Over time treatment may progress from lifestyle
changes only, to lifestyle modification and oral
medications. Insulin injections may be necessary in
some cases.
Complications from diabetes may include eye disease, kidney disease, leg
ulcers, feet problems, heart disease, difficulty maintaining penile erections.
Warning - It is essential as a care worker that you do not cut nails of
clients/residents with diabetes. Refer to your supervisor as a registered nurse
or podiatrist will perform this task.
Healthy Lifestyle and Ageing
Part of maintaining a healthy lifestyle is to consider things we eat and things we
Everything we do impacts in some way on our health and well-being.
Choices of food can result in serious harm to our health if we are not aware of
the importance of observing our diet. The best choices for a healthy diet include
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foods low in saturated fats, as these fats can produce cholesterol which in turn
can lead to the blocking of our arteries. Fresh fruit and vegetables ensure we
have an adequate supply of dietary fibre, vitamins and minerals. Sound food
choices help us to maintain a sensible weight that enables us to remain healthy
and prevent diseases such as diabetes, heart disease and high blood pressure.
Smoking has been scientifically proven to be unhealthy for us and this habit is
linked with certain cancers and heart disease. A much better way of managing
stress would be to get 30 minutes of regular exercise each day. Simply walking
rather than taking the car or taking the stairs instead of the lift all add up to
becoming more healthy. Remaining active has been found to assist in
overcoming mental and emotional problems.
Don't forget the importance of relationships with family, friends, neighbours and
pets as this can be one of the most pleasurable ways for us to stay healthy.
Swallowing Difficulties
Some warning signs for dysphagia:
 chest infection specifically regular recurrence
 shortness of breath following eating/drinking
 temperature changes febrile
 resident/client reports changes in swallowing status
 coughing or choking occurs with foods or liquids
 fluctuating levels of alertness
 reclining/lying position.
Altered laryngeal function is described as a sensitive indicator for dysphagia:
 weak, breathy, croaky voice quality
 wet gurgly voice quality
 wet spontaneous cough
 inability to cough
 abnormal or absent laryngeal elevation on swallowing
 dysarthria weak slurred speech
 oral Dyspraxia difficulty coordinating and/or initiating oral movements
 compensatory head movements holding head back or forward
 drooling from mouth
 saliva or food collects in mouth
 refusal to take food
 longer time taken to eat meals
 weight loss
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 regurgitation/heartburn.
Indicators for referral to occupational therapy for mealtime assessment.
The following indicators are meant as a guide (use your judgement and knowledge
of the person before making a decision) for when to refer a resident/client to
occupational therapy for a mealtime assessment:
 poor posture at the dinner table, eg slouching, leaning on elbows, legs
swinging (make sure the resident/client is seated in their correct chair with
the correct cushion before referral
 care recipient is only able to eat a small amount or half their meal without
tiring and stopping eating
 care recipient spills food on the floor, over the table or spreads food around
their mouth as unable to direct food to their mouth properly.
 care recipient is resistant to general assistant given by staff
 care recipient bring their head to the table to eat rather than their hand to
their mouth
 care recipient regularly drops cutlery, cups or mugs
 care recipient is unable to hold cutlery, mug or cup or pick these items up
due to shape or weight of an item
care recipient looks generally awkward when eating other than normal.
Warning signs to report to speech pathologist for residents/clients with dysphagia
 coughing when eating or drinking - remember if the resident doesn't cough
you still need to look for other warning signs
 weak, hoarse or breathy voice
 wet gurgly voice during or following meals
 no attempt to cough and clear the throat when voice is wet/gurgly
 inability to cough
 slurring speech
 drooling saliva
 pooling of food in the mouth
 chest infection/temperature changes
 shortness of breath following eating
 tiring rapidly
 refusal to take food/fluid
 weight loss
 regurgitation/heartburn.
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Case Conferences
Case conferences are an opportunity for a general practitioner (GP) and other
health workers/service providers to meet and discuss the care goals of a
resident/client using a multidisciplinary approach. The health workers/service
providers include: doctor, nurse, social worker, physiotherapist, occupational
therapist, care worker, carer, home help, aboriginal health worker, pharmacist,
continence adviser, dietitian, podiatrist, speech pathologist, family and friends.
Other service providers such as community support groups, psychologists and
audiologists may also attend if they are contributing to care provided to that
resident. In residential care, the number of people attending the case conference
may be limited to the immediate care team plus the resident/client and family. A
case conference must include a GP and at least two other contributing team
members who each provide a different service to that resident.
The roles different participants of the case conference team may include, but is
not limited to:
 Doctor: able to provide medical information regarding the client/resident,
including diagnosing medical conditions and prescribing medications.
 Nurse: able to provide information regarding clinical assessments and
complete clinical duties as instructed by the Doctor.
 Social Worker: able to assess client/residents care level needs and
provide information and assistance with their holistic care needs.
 Physiotherapist: assesses the client/residents mobility requirements and
implements exercise and rehabilitation programs.
 Occupational therapist: assesses the client/residents
requirements including developing and implementing
programmes to meet their social and emotional needs.
 Pharmacist: provides information to client/residents regarding their
medication regime and how medications should best be taken.
 Client/Resident: are able to discuss their care requirements and needs
with those present in the case conference.
 The family member: assists the client/resident with discussing their care
needs and may advocate on their behalf.
 Care Worker: the care worker is very familiar with the routine and needs
of the client/resident they care for, they can provide accurate information
regarding to those present in the case conference.
 The Manager/Supervisor: Coordinates the case conference and ensures
that issues discussed are acted upon.
The benefits for residents from a case conference are that there is a cooperative
approach to improving their health outcomes. This includes quality of life,
efficiency of care, use of medications and other care services. At the case
conference, goals for care can be created and communicated, with clear
responsibility for their actions taken by everyone who attends including the
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Case conferences can be used as a response to a recent change in a
resident's/client's condition such as a stroke, recent hospitalisation or
complications from a chronic condition. Residents with chronic conditions and
who have multidisciplinary care needs are also eligible for a case conference.
Before the case conference, an explanation about why the case conference is
being held must be given to the resident/client or their next of kin. This
explanation will include medical diagnosis, health problems, health needs and
goals. The resident/client must then agree to the case conference being held,
this agreement is recorded in their notes. The resident/client must also be asked
if, there is any personal information they do not want disclosed. The cost of the
case conference will also be discussed with the resident, as fees may be
charged by health care providers for their attendance.
Discussion at the case conference will be around the resident's/client's problems,
identified needs and goals. Additional information may be provided by everyone
present. A plan is developed and agreed to, with tasks allocated to each team
member, so that the identified care needs and outcomes can be achieved. A time
for review, to see if the plan is working, is also agreed upon. Case conferences
can be held for any resident/client up to five times per year.
For each case conference, a record of who attends, the date, the start time and
finishing time must be recorded. After the case conference, a written summary is
prepared. This is kept with the resident's/client's records. Every health care
provider is given a copy of the summary. The summary includes, the identified
goals and the health care provider's tasks that will help the resident/client
achieve those goals. The recommendations and any changes to care are then
discussed with the resident/client and their next of kin.
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Human Resources
Performance Appraisal
A performance appraisal is a formal and systematic evaluation of an employee's
work performance and current potential. An appraisal must be positive and
orientated toward performance improvement.
The purpose of a performance appraisal at Fitzroy Falls Aged Care Facility is to
provide formal feedback about work performance and for compiling individual
staff development plans. The purpose of the development plan is to build the
competence of each staff member, in order that their performance in current
duties is enhanced and that they are equipped for future developments.
The goals of performance appraisal are:
 to provide a formal opportunity for feedback to staff members on their
work performance
 to provide a formal opportunity for staff members to raise concerns they
may have, for example lack understanding of expectations, and have
these concerns addressed
 to provide an opportunity for staff members to reconsider their goals, and
the level of performance compared to company expectations
 to identify training and staff development needs
 to identify and remove any obstacles to good performance
 to strengthen the relationship between staff members and their immediate
 to assist and encourage staff to take their own initiative to improve job
 to stimulate and motivate growth in staff members
 where there are performance deficiencies, for the staff member to accept
ownership of these
 for the supervisor and staff member to co-operatively find solutions to
address any performance deficiencies.
Performance feedback is usually provided informally on a daily basis as
employees perform their daily duties. Performance appraisal is a more formal
process that will require significant preparation by the staff member as well as
their manager/supervisor or team leader.
To prepare for a performance appraisal, you will need to review your own
performance against a set of criteria. You will also need to consider how you
want to develop your role in the future.
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Performance Appraisal Interview (Self Appraisal)
Before attending a performance appraisal interview it would be a good idea to
think about your own performance and to reflect on your personal and career
goals. You should also think about your future and future of your workplace.
It may help to ask yourself the following questions:
 where do I see my self and this job going.
 where is this industry going
 what will the future hold?
During a performance appraisal interview you will identify a range of performance
issues, some of these will be dealt with immediately, while others may take a
longer period of time to resolve. For each issue identified you will be required to
develop an action plan to achieve effective resolution.
An action plan is a strategy that will enable you make changes to your working
life. Some care workers continually repeat the same issue over and over again
like a needle stuck in a record. They will turn up at each performance interview
with the same unresolved issues. The role of the person conducting the interview
is then to help the person to move forward and make the necessary changes to
their work situation.
To develop an action plan you will firstly, have to identify the goals that need to
be reached, this is usually done through the interview process. Secondly, you
need to explore the processes used for achieving those goals. Thirdly, you will
need to discuss with the person conducting the interview (eg your supervisor/
care manager) the possible consequences of the actions to be taken. An
important factor here is to make the most of your achievements. You will then be
more likely to continue making positive decisions whilst carrying out the required
actions to achieve your goals.
At the time of your performance appraisal interview you will receive feedback
about your performance. Sometimes the feedback is not positive and this may be
hard to deal with, as we all like to think we are doing our 'best'.
Remembering the following points will help you to accept feedback:
 Listen. Even if you do not like what is being said, let the speaker finish
before you give your reply.
 Defensiveness. Don't try to make excuses and above all avoid getting
angry. Everyone has some areas that need improvement and the
feedback will help you.
 Be polite. Thank the person for their feedback even though you may be
feeling upset or shaky. Your ability to receive and respond to feedback in
a positive way demonstrates to everyone that you are always ready to
learn and improve.
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Harassment is any behaviour which is unwelcome and is based on a person's sex,
pregnancy, potential pregnancy, marital status, race, ethnic group, disability, age, career
status, family responsibilities, religious or political conviction, trade union membership or
activity, sexual preference or any other factor not relevant to their duties.
 Harassment will usually be repeated behaviour, but can also consist of a single
 Workplace bullying and discrimination against employees on the basis of their
workers' compensation history also fall under 'harassment'.
 Harassment has the effect of offending, humiliating or intimidating the person at
whom it is directed. It makes the work environment unpleasant and sometimes
even hostile. If a person is being harassed then their ability to do their work is
affected. They often become stressed and suffer health problems as a result.
 Harassment can often be the result of behaviour which is not intended to offend
or harm, as jokes or unwanted attention. The fact that harassment is not
intended does not mean that it is not unlawful. The differences between people
should be acknowledged and respected - never ridiculed.
 Harassment can involve an abuse of power, for example, a manager may harass
a person whom they are supervising, discriminating with allocation of shifts or
less popular tasks. Abuse of power can also happen when certain groups are in
a minority in the workplace and are therefore in a vulnerable position, for
example, people from non-English speaking backgrounds.
 Reasonable disciplinary action and feedback on performance by a supervisor is
legitimate to control how work is done and is not harassment.
Types of harassment
There are many types of harassment. These can range from direct forms, as abuse,
threats, name calling and sexual advances; to less direct forms, as where a hostile work
environment is created, but no direct attacks are made on an individual. They can be
created by individuals or groups.
Examples of verbal harassment:
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sexual comments, advances or propositions
lewd jokes or innuendo
racist comments or jokes
spreading rumours
comments, jokes about a person's disability, pregnancy, sexuality, age, religion, etc
repeated questions about personal life
belittling someone's work or contribution in a meeting
threats, insults, or abuse
repeated unwelcome invitations
offensive, obscene language
obscene telephone calls
greater than normal workplace requirements
repeated after hours communication
unsolicited letters, faxes, emails greater than workplace requirements
unexplained rages.
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Examples of non-verbal harassment:
leering, eg staring at a woman's breasts
putting offensive material on notice boards, computer screen savers, email, etc
wolf whistling
nude or pornographic posters
displaying sexist or racist cartoons or literature
demoting, failing to promote, or transferring someone because they refuse requests
for sexual favours
following someone home from work
standing very close to someone or unnecessarily leaning over them
mimicking someone with a disability
practical jokes which are unwelcome
ignoring someone, or being cold or distant with them
crude hand or body gestures
undermining work performance
deliberately withholding work-related information or resources or supplying incorrect
failure to give credit where due
unexplained job changes
imposing impossible deadlines or targets
deliberately not speaking to or shunning a person
Examples of physical harassment:
 unwelcome physical contact, such as kissing, hugging, pinching, patting, brushing
up against a person
 indecent or sexual assault or attempted assault
 hitting, pushing, shoving, throwing objects at a person
 unzipping a person's attire
 threatening gesture such as a raised fist.
Sexual Harassment
A person sexually harasses another person if the person:
 makes an "unwelcome sexual advance" towards the other person
 makes an "unwelcome request for sexual favours" to the other person
 engages in other "unwelcome conduct of a sexual nature" in relation to the person
in circumstances in which a reasonable person, having regard to all the circumstances,
would have anticipated that the person harassed would be offended, humiliated or
"Conduct of a sexual nature" includes the making of a statement (whether oral or in
writing) of a sexual nature to the person being harassed or in the presence of the person
being harassed.
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Conduct amounting to sexual harassment
 Sexual harassment is unwelcome, uninvited conduct which is offensive from the
view of the person harassed, regardless of any "innocent intent" on the part of
the offender.
 Sexual harassment can involve any physical, visual, verbal or non-verbal conduct
of a sexual nature.
 Sexual harassment can be experienced by both women and men.
 Sexual harassment may include conduct which occurs in the workplace or in
connection with work.
 Sexual harassment can involve a series of incidents or it can be a one-off
occurrence. Whilst single or isolated occurrences of some behaviour may
appear relatively minor, when continued over an extended period they can
become very wearing and stressful.
Examples of sexual harassment
Depending on the circumstances, sexual harassment may includes actions as:
 demands for sexual favours with express or implied threats or promises related
to employment status
 displays of erotic or sexually graphic material including posters, pictures
calendars, cartoons or messages left on computer screens, boards or desks
 unwanted physical contact
 sexually orientated jokes
 leering or staring at a person's body
 offensive comments on physical appearance, dress or private life
 constant requests for drinks or dates, especially after prior refusal.
It is important to recognise that certain behaviour or comments which may not offend
one person may be unwelcome or offensive to another person. Some conduct which
might be tolerated socially may constitute sexual harassment in the workplace
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Medication Administration
When giving out medications you must always follow these steps:
1. Check the order and the medication prior to popping the tablets out of
blister pack.
2. Recheck the order and medication (once popped, if oral tablet) prior
to giving to resident/client.
3. Recheck the medication at resident's/client's side.
4. Follow the 5 'R's for safe and correct administration.
5. Sign the appropriate chart (ie medication chart, signing form) for
blister pack.
You can write on a medication chart, treatment chart or signing form to:
 complete the front of a medication chart with the resident's/client's
 attach stickers (eg same name or drug alert stickers)
 attach a pharmacy label to the relevant section of a chart or a form
 sign in appropriate place after you have given the resident/client their
 write in the time you give PRN (as required) medication (e.g. 0810 or
2030 hours).
 write in number of tablets if giving PRN medication, where the order
gives a range of 1-2 tablets (e.g. Panamax 1 or 2 tablets PRN)
 write 'course completed' on a chart for short term medication (eg a
course of antibiotics)
 enter an approved abbreviation.
You cannot (under any circumstances) write on a medication chart, treatment
chart or signing form to:
 transcribe any medication onto any part of a chart or form
 transcribe any administration instructions (eg cream to left lower leg)
 write in an alternative name to a medication written up by the doctor
(eg the doctor writes up the medication as the generic name of
'Diazepam' and you write in the brand name of 'Valium' next to it)
 write in a cease order for a medication.
If you are unsure or in doubt do not continue to give the medication. STOP
and seek assistance or advice from the manager, senior supervisor,
registered nurse, pharmacist, or doctor. It is better to query than to guess!
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Medication Effects
When a resident/client has taken their prescribed medications they can develop
side effects as a reaction to that medication. This can result in the person having
physical changes such as a rash or behavioural changes such as confusion. It is
not your responsibility as a care worker to identify the cause of the changes but it
is your responsibility to report and record them.
It is important that as a care worker you record (document) any
physical/behavioural changes in the progress notes and report these changes to
the relevant person (eg registered nurse, enrolled nurse, doctor, supervisor,
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Physical changes
Behavioural changes
Change in skin colour (eg rash, red,
Change in skin temperature
Swelling (eg hands, feet, face, fingers,
ankles, legs)
Breaks to the skin
Change in colour of faeces
Offensive smelling urine
Change in colour of urine
Change in frequency of urination
Stomach pains
Aches and pains
Reduced mobility
Alteration to appetite (ie increase,
Changes to sleep pattern
Unsteady on their feet
Impaired hearing
Reduced vision
Infection (ie skin, urine, mouth)
Reduced ability to meet own needs
Changes in speech (eg slurred, tone,
Weight changes
Reduced physical activity
Shaking, tremors (ie involuntary
Slow to respond
Not conscious or responding
Facial expressions (eg showing pain,
Difficulty swallowing
Dry mouth
Physically aggressive
Verbally aggressive
Memory loss
Refusal to take medications
Thoughts of dying and suicide
Hitting out
Calling out
Hallucinations (ie hearing and seeing things and
hearing voices you are not able to)
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The table above gives examples of changes that you should record (document):
Medication Administration Responsibilities
A safe and effective medication management system in Fitzroy Falls Aged Care
Facility is based on the clear legal responsibilities as outlined in the Poisons Act,
Pharmacy Act, Disability Services Act and the Aged Care Act. Health
professionals and staff at Fitzroy Falls Aged Care Facility who provide care to
residents/clients must be aware of these Acts. Health professionals and staff
need to work within the legal requirements of each particular Act as it relates to
their role and job responsibilities.
The responsibilities of various staff/health professionals/residents/clients are
listed in the table below.
The doctor is responsible for assessing the resident's/client's
health and care needs and prescribing medications if required. The
doctor must provide a legible written order and clear instructions
for administration of all medications on each resident's/client's
medication chart. The doctor is also responsible for sending
prescriptions to the pharmacist for dispense on behalf of a
If a resident/client wishes to self-administer medications, the
doctor assesses the resident's/client's ability, documents their
findings and conducts reviews when necessary.
The pharmacist is responsible for dispensing the medications
ordered by the doctor. The pharmacist ensures that instructions
and information on the package state who the medication is for,
what the medication is and, how and when it is to be given.
The pharmacist also provides medications in blister packs. The
information on the blister pack label includes:
© J.N. Bailey 2009
the resident/clients' name
the name of medication
the dosage of the medication
the expiry date and the date prescribed
the time and route to be given to the resident/client.
The registered nurse and the supervisor are responsible for the
coordination of the medication system, ensuring that it is safe and
effective. They also ensure that care workers are trained in
medication management prior to giving out medications. This
includes providing support to care workers during medication
Care worker
The care worker is responsible for attending the required training
in medication administration prior to giving out medications. The
care worker must comply with the correct medication
administration procedures. The care worker is also responsible for
reporting and documenting any medication concerns and
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The resident/client has a responsibility to inform the responsible
health professional if they:
 self administer non prescribed medications
 self administer prescribed medication outside the usual
medication time
 have any ill effects from the medication
 refuse to take the medication.
Fitzroy Falls Aged
Care Facility
Fitzroy Falls Aged Care Facility is responsible for implementing a
clear, easily understood Medication Management Policy. The
Medication Management Policy must include procedures and
processes that comply with the relevant legislative requirements
Blister Pack System
A blister pack system is based on:
 The doctor prescribing the required medication by writing up the Medication
 The pharmacist dispensing the medication into the blister packs.
 The blister pack being refilled on a weekly basis.
 Any changes to the prescribed medication being attended to by the pharmacist.
 Information on the blister pack being supplied by the pharmacist. This information
includes the colour of each tablet, the name of the tablet, the dose and the times the
tablets are ordered. This information is based on the orders given to the pharmacist
by the doctor on the prescription and medication profile.
 The provision of appropriate signing forms.
Fitzroy Falls Aged Care Facility uses four standard colour frames to hold the blister packs.
This colour coding, assists in identifying the times or type of medication to be distributed to
the resident/client. The table below lists the colour coding used:
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Colour coding
Blister pack usage
Regular medications
given at standard times
As required medications
Antibiotic medications
Blister packs with a blue coloured frame are packed with medications that:
Are the residents/clients regular medications.
Are given at standard medication times (i.e. breakfast, lunch, dinner
and before bedtime).
Is packed with one weeks supply of medications.
Contains medication that can be given up to 4 times a day.
If a resident/client is on more than 8 medications at a time they may
be packed into two blister packs.
The blister pack also has specific days of the week listed on the side
of the pack. This is dependent on which day the pack commences.
Blister packs with a white coloured frame are packed with medications that:
Are given on a PRN basis (i.e. as required by the resident/client).
Requires the doctor will give clear written instructions and the PRN
protocols to be followed.
Contains medications that are not to be given on a regular basis.
Requires the care provider to sign the appropriate signing sheet and
to document in the residents/client progress notes when a PRN
medication is given. The documentation should include when it was
given, why it was given and if the resident obtained the desired effect
from the medication (e.g. if Panamax? was given for pain relief, did
the resident client obtain pain relief after the medication was given).
Requires the resident/client to be reviewed by their doctor if the PRN
medication is given regularly as this may indicate that the
resident/client needs a change to their medication or other aspects of
their care.
Blister packs with a green coloured frame are packed with medications that:
Contains antibiotic medication.
Are ordered for a short time only (usually about a week).
May be required to be given at times that differ from the standard
times of the residents/clients other medication.
Medication Incidents
The aim of administering medications or assisting with the administration of
medications is to ensure the resident/client receives their medications safely as
prescribed. If the medication is not given as prescribed for any reason this is a
medication incident.
You need to report any medication incident to a supervisor. The table that follows
outlines the action to be taken for specific medication incidents.
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Medication incident
Action to be taken
The blister pack is incorrect. This
When the blister pack is incorrect:
 wrong resident/client name on
the label
 number of tablets does not
match the label
 the pack is damaged
 the tablets are not packed in
the correct time
The resident/client refuses to take their
 Explain to the resident/client what has happened and what you
need to do.
 Contact the pharmacist to query the pack and if necessary, send
the blister pack back to the pharmacist to repack.
 Give the medications to the resident/client as soon as possible.
 If there will be some delay, check with the pharmacist that it is
safe for the resident/client to wait.
 Complete a Medication Incident Form and document in the
progress notes. Forward incident form to supervisor.
 Report to registered nurse or supervisor to follow up incident as
When the resident/client refuses to take their medication:
 The resident/client has a right to refuse medication.
 If the resident/client is confused, gentle persuasion may help or
wait a little while and try again.
 If the resident/client is mentally alert again gentle persuasion may
 If all attempts fail then complete a Medication Incident Form and
document in the progress notes. Forward incident form to
 Report to registered nurse or supervisor to follow up incident as
Care alert
Under no circumstances make the resident/client take their medication
against their wishes.
The resident/client takes some
medications and refuses the rest.
Follow the actions to be taken in 'The resident/client refused to take their
The resident/client wants you to leave
some or all of their medications with
them to take at a later time
When the resident/client wants to leave some or all of their medication:
 Explain to the resident/client that it is a Fitzroy Falls Aged Care
Facility policy that under no circumstances are you permitted
to leave medications with a resident/client.
 Offer to bring the medications to the resident/client within the next
30 minutes. Do not leave the medication any longer than this
because the resident's/client's medication should be evenly
given over a 24 hour period.
 If the resident/client still refuses to take their medication when you
return follow the procedure for refused medication.
 Complete a Medication Incident Form regardless of whether the
resident takes the medication when you return after 30 minutes
and document in the progress notes. Forward incident form to
 Report to supervisor or registered nurse who can follow-up with
the resident's/client's doctor to see if the resident/client can be
assessed for self-administration of medications.
 If the resident/client is unable to self-medicate and still wishes to
have the medications left then the supervisor or registered nurse
will follow-up with the resident/client and/or their representative.
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Care alert:
Under no circumstances leave the medications with the resident/client. This could
lead to the potential serious risk of them:
forgetting to take the medications
another resident/client finding and taking them
someone else finding and taking them
the medication accumulating and the resident/client taking multiple doses together
The resident/client spits out
some or all of their medications
The medication is given
incorrectly. This includes:
When the resident spits out their medication:
Put on disposable gloves and dispose of medication where possible.
Follow 'The resident/client refuses to take medication'.
Document in resident's/client's progress notes and complete a Medication
Incident Form. Forward incident form to supervisor.
Report to the supervisor or registered nurse for follow-up of incident.
When the medication is given incorrectly:
 Report immediately to supervisor, registered nurse and resident/client's
medication given to
the wrong resident/client.
 Follow doctor's advice.
medication given from
the wrong blister pack
 Document in resident/client's progress notes and complete a Medication
Incident Form. Forward incident form to supervisor.
medication given at
wrong time
 It is vitally important that these types of incidents are reported
immediately to ensure the resident/clients wellbeing and your own duty of
You notice the Medication
Signing Sheet has not been
completed correctly
When you notice the medication signing sheet has not been completed correctly:
 Complete a Medication Incident Form stating why the medication signing
sheet is incorrect (e.g. there is a space on the medication signing sheet
that does not have signature where there should be a signature).
Forward incident form to supervisor.
 Report to registered nurse or supervisor to follow up as required.
You find a loose tablet (eg in a
resident's/client's room, on a
When you find a loose tablet:
 Complete a Medication Incident Form and forward to supervisor.
 Report to registered nurse or supervisor to follow up incident as required.
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Mobility is a necessary part of our life. The ability to move allows us to continue
living. We can have our freedom, can make choices, and maintain our
relationships with others.
Restrictions in movements are a normal part of ageing. Depending on the type of
restriction, with assistance or an aid, we can generally continue to maintain
In some cases the aid may consist of a change in the style of shoe we wear, or a
walking stick, a walking frame, a wheelchair, or a scooter. Whatever the device, it
assists us to maintain living.
The most important part of mobility is safety. Falls are one of the main disabling
conditions of the elderly. A fracture may be the consequence of a fall which may
have a significant impact on the resident/client's functioning, independence and
quality of life. Fractures also have significant impact to care workers as we need
to adjust the personal care routine to protect the injured limb.
Appropriate exercise for the resident or client, identification of hazards and use of
appropriate walking aids can help prevent falls and improve balance. Stretching
and strengthening exercises can prevent muscle weakness and protect the
Potential hazards of fall
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Ways to improve and minimize fall
1. Clutter in rooms and walk areas
Always keep the walk areas clear of hazards
2. Spills on the floor
Wipe all spills immediately
3. Loose mats
Replace with non-slip mats
4. Poor lighting
 Maintain adequate lighting even during the
 Leave on a night light or bedside light to avoid
falls at night.
5. Accidental fall from bed due to bed
height being too high
 Adjust bed to suitable height to ensure that the
resident/client's feet can reach the floor when
6. Wheels on chairs
 Use stable chairs with suitable seat height
 Lock wheels
 Ensure the brake is on (if applicable)
7. Slippery shoes and tripping on loose
 Wear non-slip shoes
 Wear clothing with suitable length
8. Slippery floor
 Use hand rail for support
 Take special care when walking outdoors
 Walk near to a wall for support is needed
9. Poor eyesight
10. Use of walking aids without proper
Use walking aids correctly and seek professional
advice if in doubt
Wear appropriate clean glasses
Hold handrail
Ensure lighting is sufficient
Do not carry too many things at once
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The ability to move ensures a resident or client maintains a healthy fulfilling lifestyle. Safe
mobility is the key to allowing people to make choices, go on regular outings, seek out
friendships and continue to participate with their interests in the community.
Mobility Aids
There are many different mobility aids including:
The hoist which is a lifting device used by trained staff to transfer non-weight
bearing residents or clients. Hoist maintenance includes ensuring:
 the battery is charged and that spare batteries are on charge
 wheels are free moving and intact
 the sling is clean and dry to prevent cross infection
 there are no sharp metal edges on the hoist - to prevent skin tears.
The scooter and wheelchair enable people to remain a part of their community
and be independent. They are a crucial part of assisting a person's life to be
independent and have personal freedom. By law every public amenity must now
be accessible by a wheelchair. Wheelchair maintenance includes checking:
 the tyre pressure (same as a bicycle tyre)
 that the chair is safe and intact
 that any pressure cushions are clean and in the correct positions.
Residents or clients with a large variety of health conditions may need to be
transported in a wheelchair. The conditions may include:
 paralysis - from a stroke, or spinal injury
 back, leg or feet problems
 dizziness
 balance problems
 loss of a leg or foot
 inability to weight bear.
The frame creates a source of stability and balance for a person who is still
mobile but requires assistance. The frame can also be used as a tool for the
resident or client to assist themselves to stand up and sit down. The frame has
non-slip rubber stoppers on the feet of each leg. Ensure each rubber stopper is
intact and clean on the bottom.
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Personal Care
Privacy and Dignity
Privacy is a basic right for all humans.
We like to have our privacy, and so do our residents and clients. Each person is
different and what might be 'personal' to one person may not be to another.
For example a resident or client may be trying to do something they have trouble
with, like eating, and prefer to be in a private place so they feel they are not being
watched by everyone in the room. Whereas another resident or client may feel
encouraged by seeing others struggle with the same tasks, and feel that being
with a group makes things more fun.
Therefore, it is important to know our individual resident or client's personal
needs and wishes. This information should be outlined in their care plan. It is
then the care workers role to ensure that dignity is respected by giving them the
privacy they require.
In a residential facility or a client's home it is important to consider the following:
1. Keep doors closed, draw curtains or screens when the resident or client is
undressing, showering/bathing or using the toilet/commode.
2. Maintain the personal dignity of the resident or client. Do not discuss
issues that may cause distress and embarrassment in front of other
residents/clients or staff. If the person is overcome with emotion, do all
you can to retain their privacy and dignity.
3. Do not touch a resident's or client's personal property without permission.
Some people may see this breach of their space as touching them
without permission.
4. Ask the resident or client for permission before you open their drawers,
cupboards or wardrobes.
It is easy for carers who have been working with the same person for a period of
time to forget these basic 'rules'. Think about how you would feel if your privacy
was invaded. The resident or client may not want to be seen as a 'complainer' if
care workers forget these basic rights. So, don't assume the resident or client is
happy with the ways things are done, always check by asking.
As a care worker we need to remember that our workplace is actually another
person's home. A trusting and mutually respectful relationship can develop and
grow by showing due respect for the privacy needs of your resident or client.
Privacy Guidelines for Staff
Day to day guidelines:
1. Respect our clients' privacy as you would any person's. Do not gossip
about their ailments or personal affairs with people inside, or outside,
Fitzroy Falls Aged Care Facility but feel free to talk about these things to
your manager or co workers when it may help us to provide better care.
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2. Make sure any personal details in files or written records are kept secure
and in locked cupboards or filing cabinets.
3. If someone asks for access to their personal information, first see if they
are prepared to discuss what it is they want. If it is just to check who we
have recorded as their personal contacts, preferred name, doctors details
etc, just print out or copy the information we have, give it to them, and if
they make any changes make sure that our records are amended.
4. If they want more information or want to look at care notes, refer them to
the manager. You can tell them that normally we require requests for
access to information to be in writing.
5. If someone is ill and you are asked about them, confine your comments to
how they are feeling, whether or not they would like visitors etc and do
not discuss their ailment or treatments.
6. If the person is a nominated contact or advocate in some cases we can
go further than this, but make sure we have documented this either by
recording the resident/client's wishes.
7. If a person unknown to Fitzroy Falls Aged Care Facility phones a facility
asking about a current resident and seeking to contact them, we should
tell them their postal address (including unit number) unless the resident
has given specific instructions for maintaining their privacy. (There is
provision on the Admission Form and the Emergency Information Form
for people to record their wishes in this area.) With regard to phone
numbers, we do not always know when a person has a silent number, so
we should not divulge phone numbers, but tell the caller to refer to the
telephone directory or directory enquiries.
8. Where people call after residents who have moved out, again we should
check whether we have any specific instructions from the person, and if
not we should give them a forwarding address, but not a phone number
for the same reasons as above.
9. If people ask about a deceased former resident or client, then we should
inform them that the resident has passed away. If the caller wants to
contact the family/executor we should take the caller's name, address and
phone number to pass on (we should always have a contact address for
forwarding any mail).
Reporting Resident/Client Changing Care Needs
Resident/client care and service needs are assessed on admission to the service
by their organisation, using procedures and admission documents used by the
organisation. Care and service need information is gathered from a variety of
different sources including health professionals and through discussing care and
service needs with the resident/client or representative.
Information is gathered through the initial assessment process, this information is
then used to develop the resident/client care and service needs. Care and
service needs are recorded on relevant documents including care and service
plans. Care needs are reviewed on a regular basis through the process of regular
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care plan evaluations and through case conference between the care provider
and resident/client/representative. Resident/client care and service needs can be
subject to change. The changes are most commonly monitored through a regular
process of evaluation of care and service plans. Changes in care and service
needs can occur at any time though for many varied reasons.
It is important as a care worker to report these changes either in written or verbal
form to assist in the process of providing accurate care and service to
resident/client's. Residents/client's may request a change in their care and
service delivery themselves or alternatively you may identify that a change is
required through your own observation. As a care worker it is important to
remember that resident/client's are able to make individual choices and their
choices must be respected. These choices may impact on a change to their care
or service need. It is a requirement to provide information to your supervisor
regarding changes to your resident/client as this information may impact on a
change to their care plan or service and impact on their overall wellbeing.
Duty of Care
When a resident/client moves into residential or community care services, the
intended care to be given is known and agreed to. The law expects that the
agreed care will be delivered with the required skill and at a level of competence
equal to the needs of the individual. You, as a trainee care worker and Fitzroy
Falls Aged Care Facility have a duty of care to the individual entering your care.
It is the responsibility of Fitzroy Falls Aged Care Facility to make sure the people
they hire to care for the resident/client can carry out the care to the required
level. It is also the responsibility of the employee to let Fitzroy Falls Aged Care
Facility know if they feel they are unable to effectively and safely carry out that
care, for whatever reason.
As a staff member who is employed to give care and support to older people,
your responsibilities and duty of care to the residents/clients are that you " must
do everything reasonable that you can, to ensure that there are as few as
possible infringements of any residents'/clients' rights". The key word here is
Whilst at work you will need to consider your duty of care. In considering your
duty of care you should ask yourself the following questions:
Am I in a situation where the resident is relying on me to be careful?
Is it reasonable to believe that this resident/client, or other people, could
suffer harm or injury if I am not careful?
Have I done everything that any reasonable person would/could do in this
Am I complying with all laws, regulations and standards that govern this
situation and require exercise of a duty of care.
Negligence is a failure to take reasonable care to avoid causing injury or loss to
another person. There are four steps in proving negligence. These are
1. That there is a duty in the circumstances to take care (duty of care).
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2. What is the standard of care which a reasonable person would meet in
the circumstances (standard of care).
3. That the behaviour or inaction of the defendant in the circumstances did
not meet the standard of care (breach of duty).
4. That the plaintiff has, as a result, suffered injury or a loss which a
reasonable person in the circumstances could have been expected to
foresee (damage).
Where a duty of care is not exercised (as a reasonable person may be expected
to exercise it) and harm comes to the resident/client, then the resident/client may
bring a charge of negligence against the employee and the employer. The
resident/client may seek compensation for any loss of quality of life that results.
Where the intent has been malicious, a charge under criminal law may be
required to be answered in court.
© J.N. Bailey 2009
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Version 1.0.0
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