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25th October 2021

Why a robust code of conduct is the best way to maintain professional boundaries

The story of a care worker, who was convicted of theft and subsequently banned from supporting vulnerable adults, made the headlines earlier this year. Despite receiving a letter from the Disclosure and Barring Service (DBS) in 2019 informing her that she was not allowed to work with vulnerable adults, she carried on doing so. When it was discovered that she had been barred, she was instantly dismissed and faced prison, but was given a community order instead.

While cases like this are thankfully few and far between, they remind us of the importance of ensuring that adult social care staff understand the code of conduct, follow it, and that most crucially, it becomes deeply ingrained in the culture of every care service in the UK.

If the code of conduct is not central to the culture, there is an inherent risk that professional boundaries may begin to erode. It is not so much binary cases like the one I have outlined in my introduction that are likely to surface, but more nuanced ones, where staff might not understand how and why they have infringed professional boundaries.

Social media challenges

Take social media for example. In the golden age of connectivity that we live in, the defining line between personal and professional lives is often blurred. It is this grey area which sometimes sees care workers overstep professional boundaries. Let me give you an example. It might be that a professional carer, who is rightly proud of their vocation, decides to include the name of their place of work on their Facebook profile. In their free time, they then have a little too much to drink and post the photos on Facebook. The person may not have breached any care service regulations, but it may be that a local resident, who knows the family of a service user that the care worker is supporting, sees the pictures. They then tell the individual’s family, who then informs the CQC, claiming, for example, that the staff member had gone to work drunk while caring for vulnerable adults. A safeguarding investigation then ensues.

This may seem an overly circuitous and unlikely scenario to put forward, but believe me, if a person has thousands of connections, the world can suddenly seem very small. Having worked as a Registered Manager for over 15 years, while social media guidelines in the homes that I managed were very clear, it wasn’t uncommon to hear of instances like this taking place in other settings

Social media must be tightly controlled in care settings

Part of the issue too is that carers have often read and understood the code of conduct. In a care setting, they know not to breach the video policy and the mobile phone in the workplace policy, but somehow smart phones, which provide instant access to Facebook and, in turn, an audience of millions, muddles the distinction between as to what is acceptable and what is not.

The reason that I am telling you this, is because I have heard of cases – particularly in supported living settings – where a care worker videos a service user engaging in a hobby because they are really proud of the progress that person has made. They then post the video on their social media channels and consequently the link to the video is shared. Complaints are raised – both inside and outside of the service – and as a result the person is severely disciplined or dismissed.

While it is absolutely right that the care worker, who posted the video should face disciplinary action, it is social media that has magnified their mistake, as once a video is in the public domain, the care worker posting it has lost all control and it can be shared by anyone, in any country at any time. That is why many care homes simply ban care workers from using mobile phones when they are on shift. A good set of policies and procedures, supported by a clear handbook, covering induction and training are regularly used to reinforce this issue.

How QCS can help you to develop a set of robust social media policies

The examples that I have given also demonstrate why every care service needs to cultivate a robust and up-to-date social networking policy and procedure. Quality Compliance Systems, the leading provider of content, guidance and standards for the social care sector, and the organisation that I now consult for, has a raft of protocols including code of conduct templates, social media network and a professional boundary policy, that Registered Managers, and staff alike, can access.

So what makes an outstanding social media and networking policy? I think, at its very heart, it must instruct as well as educate. Take QCS’s social media policy and procedure, for example.  It doesn’t just provide a template. It goes much further than that, in that it helps frontline care managers identify the root cause of a potential breach and puts in place clear guidance to prevent any future transgressions.

Understanding how actions are likely to be perceived by the public is vital

Having helped craft some of this policy, I think the most important point, as the examples I have provided all point to, is public perception. An outstanding policy should raise awareness of how the public – both in the community and online – might perceive their actions. A code of conduct, of course, should make it absolutely clear that the social media policy applies both in the service and when care staff are accompanying service users outside in the local community. That said, sometimes – and not often – a small minority of carers may feel that they can call a friend, text them or ignore a vulnerable service user – just because there is nobody monitoring them. Not only are they breaching professional boundaries, and care and support plans, but in a world where everyone has access to a camera, it only takes a member of the public to video their actions and post them online for an investigation to begin.

Videos captured on social media are sometimes not all they seem

Perhaps another important point to make is that sometimes video is an artifice. By this I mean, it sometimes doesn't provide the necessary context for the person viewing it to make a sound judgment on what has transpired. So, for example, what if one of the requirements for a care worker to take a particular service user on a trip is that they carry a mobile phone? It may look to the member of the public who captures the video that the care worker is breaching their duty of care to the service user. But, in this instance, it may be that they are simply following the terms agreed in the care plan, or in the age of electronic care planning , they could be reading a care plan instruction, adding entries or checking routes to activities or hospital appointments.

Care plans must be at the root of any code of conduct policy

This brings me to my final point. While care workers and managers need to be aware of how their actions are perceived by the public, they also need to evidence their actions in detailed and up-to-date care plans, which involve the service user’s circle of support, and have been approved by the Registered Manager.

Nowhere is this more evident than in learning disability settings. During the pandemic, due to COVID-19 the only contact that many people with learning disabilities had with their families was via video conferencing platforms. As a result, many went months without a hug. It put many care workers in a difficult position. To provide comfort to service user with a hug or a cuddle would have been to breach professional boundaries, but if not care workers, who else would fill the emotional void in the absence of their circle of support?

Should you hug a service user?

It is a question that many care providers asked QCS at the peak of the pandemic. The advice I am giving now is exactly the same as I gave to providers when the crisis was at its zenith. Registered Managers need to always approach the service users first. They can’t just assume that he or she needs the comfort that a hug brings. So, care workers should find out what the service users want and also what it is that they need. If a person has severe learning disabilities, the best way forward is to fully utilise the skillset and broad experience that only a Multi-Disciplinary Team brings.  That might include engaging the services of a specialist nurse to bridge the communication gap. It could also be that more work needs to be undertaken to ensure that the core principles of the Mental Capacity Act – especially regarding consent and best interests – are followed.

Think about the fact too that the service user might not actually want a hug. That might be the collective interpretation. But, it’s really important to maintain a rational approach and not let emotional feelings take over. If, however, it transpires that a hug is what a service user requires, it must be documented in a multi-layered care plan, which must be approved by the Registered Manager, frontline carers, the service user’s appointees, and of course the individual. Signing off such specialist care plans is rarely straight forward even if the service user and their loved ones are in full support. Staff may have reservations for not wanting to engage in a cuddle and with good reason. If other service users – especially those with learning disabilities – perceive that one person is being hugged, they may think that the carers do not like them and, in some circumstances – that could lead to service users displaying behaviours of concern.

Secondly, as I eluded to earlier, care workers may feel even with a robust care plan in place, hugging a service user in public may raise public concerns. However, I have witnessed many conversations between families and care teams. Families often can’t understand why care workers aren't able to give their loved one a hug as they have requested. This can be a very difficult conversation, as families often don’t understand the regulations providers must adhere to.

Is there an alternative to a cuddle?

Therefore, it is very important to explore whether there might be alternative to a cuddle. For example, many individuals were happy with a handshake or a pinkie hug. On many occasions too, it became apparent that the sensory need could be met in other ways. Would a weighted blanket suffice, for example? Or perhaps, HUG, which is a therapeutic comforting device for people living with advanced dementia, might help to alleviate a person’s stress and anxiety?

For some service users, it is recognising that is it not so much meeting an emotional need, but instead having an opportunity to channel anger. In order for service users to do so, a previous manager purchased some used plates from a charity shop and created a smash cabin, which proved to be extremely effective.

Whatever, the exchange or the activity, it should send a positive message to the individual. If they communicate their wants and needs to a service manager, care workers will do their very best to meet them, while remaining true to the code of conduct and keeping within professional guidelines, which means keeping everyone safe.

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Barry Price

Specialist in Adults with Learning Disabilities and Complex Needs

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