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Skills or Needs?
A research project is underway that looks at the way claiming essential state benefits requires people to emphasise their disability in ways that affect their self-esteem. When assessing people for care, focusing on the positives can still supply the information you need to provide necessary support.
We find ourselves in the age of the assessment tool. Community Care Assessments, Health Needs Assessments, Capacity Assessments; it’s all about the finding out.
Assessments come and go in terms of popularity, and over the years I have used a variety of formats. Sometimes a hybrid format that takes the best elements of a few styles and pulls them together works well. An example is one which considers activities of daily living (Roper, Tierney Logan) but in the context of independent community living, considering the level of support needed for the client to manage their life at home.
A negative view?
I was chatting with a colleague today about assessment, since in a couple of weeks I have to teach a group of learning disability nursing students on that topic. We both felt that the process often focuses disproportionately on the negatives – we are finding out what the subject can’t do. We are looking closely at their needs rather than considering their strengths.
It’s understandably difficult to concentrate on people’s skills and abilities when you are trying to judge how you can help them with support. You can’t decide how much carer time and assistance they need, for example, if you are looking at how well they can fasten their buttons or their ability to operate the toaster.
If the question is framed in a positive way, we give the subject respect and view them as a person of skill, rather than need. It doesn’t mean we are missing the needs. In a way, concentrating on the strengths will allow the needs to become apparent.
So how do we ask the question? A good start is to make sure we are asking the subject and not the carer. Even in non-verbal clients, it is good practice to direct your conversation to them in the first place, allowing their assistant or carer to help with the answer. Staying focused on the individual is a great way to uphold their dignity. It is also difficult to ask direct personal questions that emphasise the negative to the carer, such as “does he need help to go to the toilet?” or “can he wipe his own nose?” Instead, try saying to the individual: “Tell me about how you take care of yourself in the bathroom?” or “What would you do with your handkerchief?” as starters. The ensuing discussion will help you learn more about need than a direct question can.
Of course, one minefield of assessment is subjectivity; one person’s competence is another’s dependency. Charlie will tell you happily he can walk on his own for miles and miles, but his mum will remind him that he mostly forgets to check the roads when he crosses and will usually go out in bare feet unless reminded. For this reason, a balanced and multi-agency assessment is vital to understand the subject’s skills in different circumstances and contexts and to understand how much difference can be made with varying levels of supervision and support.
Assessment is only really as good as the assessor, the subject on the day and the understanding that any true evaluation of strengths or needs will need to be continuous to remain valid. But accentuating the positive is a pretty good start.
Ginny Tyler – QCS Learning Disability Expert Contributor