Role of a Care Assistant

·        You should act in a manner to promote and safeguard the well being and interest of the client you look after. You should act with honesty, integrity and professionalism and care and to do nothing that might cause offence hardship or unhappiness the client you look after.

·        You should safeguard the privacy of the client and should NEVER disclose any information about the client to anyone other than those directly involved in his or her care. Never discuss one client or care worker with another client or careworker.

·        You should respect the client's residence, property, and personal effects. If you should accidentally damage any thing of the clients you should report it immediately to the person in charge.

·        Respect the dignity and value of the clients you care for, each client has the right to make their own choice and informed decisions as far as their mental state permits

·        You should never discriminate against a client on the grounds of race nationality language religious beliefs age sex or sexual orientation nor on the grounds of social standing. You should also respect understand and take account of the customs, values and spiritual beliefs of all clients

·        If a client complains to you, you should report this to the nurse in charge

·        You should never undertake or attempt to catheterise a client, apply sterile dressings, administer any medication or give injections.

·        You should never agree to be the signatory to a will or offer advice of a general or specific nature to a client refer them to the nurse in charge

·        You must never accept any gifts from a client.

Whilst bathing a client you must:

Ensure that the water temperature is below 40'c and the water should be tested. Also ask the client to check the water temperature as well.

You must never leave the client alone in the bathroom

Your own personal hygiene

·        Always wash your hands before handling food, after blowing your nose and after using the toilet, before and after looking a client, after wiping a client's bottom, before and after emptying a catheter, before and alter you start a shift.

·        Always ensure that any wounds that you have are covered with a plaster

·        Always wear a clean uniform for each shift

·        Do not smoke whilst on duty except when on official breaks

·        Inform the head office when you are unwell or unable to do a shift

·        If you are going to be late for a shift you MUST contact the head office so they can inform the home that you are going to be late

·        Always arrive early for your shift

·        Do not wear your uniform to and from your shift

Accidents

If you have an accident you must:

·        Inform the person in charge of the shift, so the accident can be put in the accident book

·        Also inform head office in writing to the personnel manager

Communication skills

·        Give attention at all times to the client you are with

·        Do not interrupt whist the client is talking to you

·        Allow time for the client to respond and for thinking time

·        Make encouraging noises whist the client is talking to you

·        Check that you have understood the client

·        Watch your body language, use good eye contact, use open body posture, adjust your height so you are at head level with the client

·        Environmental issues, arrange the furniture to suit you and the client

·        Remove any back ground noise or distractions

·        Arrange for privacy where appropriate

·        Address the client to how they want to be addressed

Health and Safety

All cleaning materials should be kept in a locked cupboard; cleaning chemicals should be kept in their own-labelled container

Clinical waste should be put into a yellow bag.

Discarded syringe needles, cartridges broken glass and other contaminated disposable sharp instruments should be placed into a sharps container

All medications should be kept in locked cupboard

Risk assessment

Risk Assessments are a legal requirement under the management of Health and Safety at work 1992

Guidance from Health and Safety Executive is available to show of

conducting assessment and the advice given is based on their publication.

Five steps to Risk Assessment

·        Identify the hazards

·        Decide who might be harmed and how

·        Evaluate the risk

·        Record the findings

·        Review the risk assessment

This list in not intended to be exhaustive, but can be adapted or added to according to the circumstances in the area you work in.

Reporting accidents information

Under the reporting of injuries, diseases and dangerous occurrences regulation of 1995 (RIDDOR) the care team has a legal obligation to report certain types of accidents to the enforcing authority.

Failure to report accidents is a criminal offence

RIDDOR applies to some accidents to employees, residents and visitors to the working environment.

Accidents also include acts of violence upon people in the work place.

When accidents are not reportable to the enforcing authority it is still important to document them.

When accidents occur it is important to consider what the cause was, to seem if it is possible to prevent a reoccurrence.

Inspection Information     

            Some of the actions which can help to improve health and safety in the working environment are things which identify what can cause accidents and ill health and put in place measures to prevent these causes occurring.

Regular inspections of all parts of the working environment to  look for

health and safety hazards can be a useful way of prevent accidents.

·                                            The inspection may cover

·                                            The condition of the floors

·                                            Changes of level

·                                            Trailing cables

·                                            Condition of appliances

Control of substances hazardous to health

      To make an assessment you need to consider what substances you use that are hazardous to health

These may be labelled as:

·      Toxic

·      Harmful

·      Corrosive

·      Irritant

The supplier must by law provide you with a data sheet for the hazardous substances giving you information about;

·        How they can cause harm e.g. by inhalation or skin contact

·        The type of ill effect which could result

·        Precautions to be taken in use

·        Storage and disposal

Infection control

Infection control refers to the measures taken to limit the acquisition and
spread of infection into any environment

All employees are responsible for controlling infection

·        Cleaning staff may have to use cleaning solution, which kill bacteria

·        Kitchen staff have to be aware of the risk of cross infection when preparing food

·        Nursing and Care staff are exposed to clients bodily fluids and are involved in procedures which can increase the risk of infection such a giving injections and changing dressings.

·        Visitors to the work place also have a part to play in the control of infection.

Guide to Handwashing

 Handwashing technique

Remove all rings, jewellery and wristwatches and cover any cuts or abrasions with an occlusive dressing.

The hands are moistened and 3-5ml of soap or detergent is applied to cupped hands. The hands are then rubbed together five times, as indicated in the pictures.

This technique, which normally takes 15-30 seconds, is suitable for handwashing and disinfection in all clinical areas, and for surgical scrub, provided the forearms are included.

3-5 mi of soap or detergent should suffice, but additional liquid may be necessary for the more prolonged (2 minutes) surgical scrub.

The wrists are similarly rubbed and the hands rinsed and dried. The same technique is recommended for alcohol hand.rubs but no water is used and hands are rubbed together until dry.

When, why and how to handwash

There are three different rationale for handwashing, each based on the same technique, shown in pictures.

Social handwashing: this should be carried out before all routine nursing tasks. It makes the hands socially clean, removes 99% of transient micro-organisms.

Hygienic hand disinfection: this should be employed during infection outbreaks, and after contract with excretions. Idea is to remove micro-organisms.

Surgical scrub: prior to surgery, the aim is to remove all micro-organisms. Wash for a minimum of two minute and finger nails brushed. Hands should be dried with a sterile towel.

References:   Professional Nurse 1997

Nursing Standard February 2001

Bed Making

Firstly prepare your equipment:

Laundry bag, clean linen, gloves(?), apron, 2 care/nurses.

Client  to be aware of what is going to happen.

The list from day one:

Communicate, co-operate, consent, appropriate time, aware of client needs for privacy etc.

Practical:

·        Empty bed

·        Patient in bed

To ensure patient is safe, warm, dignity maintained, co-operation of patient it is necessary to talk appropriately, talk to client not other care staff. Try to avoid interruptions.

When client has vacated the bed follow policy/procedure on cleaning of bed and turning of mattress.

Bed Bath

Why we give a bed bath?

·        Attending to a clients hygiene needs is a vital part of the role of a healthcare assistant, some clients may require help with their hygiene needs as they may be confined to bed

·        Bed baths can help clients psychologically as it will help to maintain their self esteem and retain a positive body image

·        Giving a bed bath can help build a good relationship with the client and it may be during a bed bath the client may discuss problems with you

·        It is also a good opportunity to check the clients skin

·        A clients hygiene needs to bed addressed a least once a day and more if it is necessary

What should be done before a bed bath?

·        Explain what you are going to do to the client even if the client is unconscious

·        Move any obstructions or obstacles so you can move around freely

·        Ensure the room or bath room is warm enough for the client

·        Ensure you have all the equipment ready and at hand so you do not have to leave the client alone

·        The toiletries used should be the preference of the client

Equipment you need

·        Clean night clothes of the clients choice

·        Clean bed linen

·        Bowl of hand hot water

·        Soap

·        2 flannels

·        brush and comb

·        2 towels

·        blanket to cover the client

·        slide/glide sheet

·        toothbrush or mouth care pack

·        if applicable catheter care equipment

Procedure

·        2 nurses should carry out a bed bath if the client is unable to help if the client is able to help encourage them to draw the curtains around the client or close the door if they are in a room of their own

·        maintain the clients dignity and privacy and to keep the client warm place a blanket or sheet over the client

·        the water in the bowl should be hand hot, ask the client to tell you if the water is to hot

·        start washing the clients face, check if the client uses soap first

·        Wash the limbs next starting with the arm furthest away from you. Place a towel under the arm to stop the sheet getting wet

·        repeat the procedure for the arms

·        roll the client on their side to insert the glide/slide sheet

·        whilst the client is on their side wash their back

·        also whilst the client is on their side you can check for pressure sores

·        return the client on to their back and roll them on to their other side to wash the rest of their back.

·        Return the client on their back, and wash the genital area.

·        If they have a catheter at this point give catheter care

·        Change the bed linen and reposition the client using the slide/glide sheet

·        Dress the patient taking care of any catheters, drips or drains

·        Help the client or give mouth care

·        Comb or brush the clients hair

Always check the clients care plan for hygiene and mouth care needs.

Mouth Care

Preparation for mouth care

·        Explain what you are going to do

·        Obtain consent and co operation form the client

·        Ensure you have privacy for the client

·        Help the client to get comfortable and in a sitting position

·        If the client is unconscious position the client on their side

Equipment required

·        Towel and tissues

·        Tooth brush and toothpaste

·        Denture pot container and strident

·        Beaker of water and a bowl or receiver for the client to spit into

·        Mouthwash solution or mouthwash solution the home or hospital use

·        If require foam sticks and cleaning agent if required

·        Lip balm or lubricant if required

·        Clinical waste bag

What you need to do

·        Wash and dry your hands well

·        Put on gloves and an apron

Procedure

·        Cover the clients chest with a towel

·        If applicable remove the clients dentures and place them in the denture pot of clean water and strident

·        Using a toothbrush and toothpaste gently clean the teeth, gums and tongue, you must take care not to cause trauma to the mouth.  Use small individual stokes away from the gums, remember to clean both the inner and outer aspects of the teeth

·        If the client has a dirty mouth use the foam sticks and the cleaning solution the home or hospital recommend. Gently clean the mouth with the foam sticks.  Use the foam sticks once only and dispose into the clinical waste bag

·        Once you have cleaned the mouth, the mouth should be rinsed with water to remove any debris or remaining toothpaste. The client should be encouraged to rinse vigorously and then to spit into a bowl. If the client is unconscious the foam sticks should be used

·        If the client has dentures these should be cleaned with a toothbrush and denture cleaning paste or toothpaste and rinsed thoroughly before giving them back to the client, do not dry the dentures as this makes it difficult for the client to replace them back into the mouth

·        If the lips are dry place a thin layer of lip balm or petroleum jelly  on the lips

Post procedure

·        Make sure the client is comfortable

·        Inspect the mouth for any sore areas

·        Rinse the toothbrush and replace both the toothbrush and toothpaste back into the clients locker or wash bag

·        Discard or cover any unused cleaning solution

·        Discard any used equipment into the clinical waste bag

·        Remove your gloves and apron and dispose into the clinical waste bag

·        Report any problems with the clients mouth to the nurse in charge

Definitions of Incontinence

·        Incontinence: the inability to control urination or defecation

·        urinary incontinence: denotes a failure of the mechanisms associated with normal storage and voiding or urine so involuntary passing of urine occurs inappropriate places or at inappropriate times

·        so incontinence is basically the loss of ability to control the emptying of the bladder or bowel

To be continent you must be able to:

·        Recognise the need to pass urine

·        identify the correct place in which to pass urine

·        reach the correct place in which to pass urine

·        hold on until you reach that place

·        pass urine or faeces when you get there

·        if someone has a problem with any one of these actions, they are in danger of becoming incontinent

Promotion of continence

Improving the environment

·        Is the toilet clearly identifiable?

·        Does the client know where the toilet is?

·        Do they know where the light switch is?

·        Is the lighting suitable

·        Are there signposts to the toilet?

·        Is the toilet clearly labelled?

How to make the toilet easier to use

·        Is there enough room for the client and helper to turn round?

·        Can a wheelchair be manoeuvred?

·        Would a raised toilet seat be useful for the client?

·        Is the toilet hand/chain in easy reach for the client?

·        Is the room warm for the client/

Make clothing easy to manage

·        Is the client wearing several layers of clothes

·        Is the clothing loose enough for the client to move

·        Would Velcro be more helpful for the client instead of buttons and zips

·        Clothes pegs may be useful to pin clothes out of the way

Factors that may contribute to the development of incontinence

Physical

·        Acute illness

·        Reduced mobility

·        Constipation

·        Reduction in fluid intake

·        Diabetes, multiple sclerosis, stroke, dementia

·        Drugs- diuretics, sedation

·        Urinary track infection

·        Poor sight

·        Poor manual dexterity

Psychological

·        Depression and anxiety

Social and environmental

·        Insensitive helpers

·        Intrusion of privacy

·        Lack of toilet facilities

·        Poor directions to the toilets

Promotion of continence

·        Set interval toileting

·        Avoid constipation

·        Adequate fluid intake

Skin care

·        Avoid leaving a client in wet pads

·        Clean and dry skin

·        After incontinent episodes

·        Use barrier creams sparingly

·        Change the client’s position at regular intervals

·        Ensure the client has adequate fluid intake

Odour control

·        Use air fresheners or neutralising sprays

·        Wash clothes as soon as possible after incontinence

·        Dispose of soiled pads in a sealed clinical waste bag

What is a catheter?

·        A catheter is a hollow tube, which is placed in the bladder by a trained nurse to allow urine to drain freely into a drainage bag.

Constipation

·        Causes of constipation

·        Insufficient fibre or fluid

·        Loss of appetite or poor diet

·        Decreased exercise and mobility

·        Neglecting the call to open bowels

·        Physiological problems

·        Social conditions

·        Medications

Management of constipation

·        If possible increase activity

·        High fibre diet

·        Right routine

·        Right environment

·        Psychological support

·        Give prescribed medication

Catheter care

Preparation

Explain the procedure to the client

Ensure the privacy and dignity of the client

Lay the client downs with their knees and hips flexed and slightly apart

Equipment

Soap and water

Disposable washcloths

Clean towel

What you need to do

Wash and dry your hands

Put on gloves and an apron

Procedure

For female patients

·        Clean the vulval area from above downwards using warm soapy water

·        Clean the catheter by gently wiping in one direction from the top downwards

·        Rinse well

·        Dry the area by patting with a towel

For male patients

·        Retract the foreskin before cleaning

·        Clean the catheter from the top downwards and rinse well · Dry the area by patting with a towel

·        Replace the foreskin on completion of cleansing

Post procedure

Ensure the patient is dry and comfortable

Dispose of all waste appropriately

Remove your gloves and apron and wash your hands well

Record you have done catheter care and report any abnormalities to the nurse in charge

Why we need to eat

To maintain and repair the body tissues

To provide energy

To help fight infection

To aid growth

Social aspects

Essentials of nutrition

We need to have the following groups of foods within our diet.

Carbohydrates

Fibre

Vitamins and minerals

Fluids

Protein

Common problems associated with eating and their management

Physiological changes

loss of sense

gastrointestinal changes

dental problems

practical difficulties

poor manual dexterity

poor eye sight

The effect of preparation and presentation on appetite

poor presentation of food

poorly prepared food

Diets: An Overview

 

Diabetic

Two types of diabetes, one is diet controlled, the other is medicated.

The important aspect is the intake and measurement of carbohydrate. All diabetics have a prescribed amount of carbohydrate intake per meal, they have to eat regardless of illness etc. Protein and fat are not included in the diet.

Soft Diet

Given to people with swallowing difficulties i.e. dysphagia, oral conditions. It can vary in consistency, but will always lack presentation, psychology involved in this, visual need, embarrassment, segregation.

Nasoqastric (NG)

Most common form of internal tube feed and is only a short term solution.

Fine-bore feeding tubes should be used whenever possible as these are moro comfortable than wide-bore (Payne .3ames 1995).

Some have a wire-introducer and some are weighted.

They have 10-14 day lifespan (Patrick 1997).

Gastrostomy

This is appropriate for long-term feeding. It is cosmetically more acceptable and avoids delays in feeding and discomfort from tube placement (Moran 1994).

P.E.G or Percutaneous Endoscopically Guided Gastostomy.

Nil by Mouth

This means nil orally either diet or fluids. Can be associated with a number of reasons.

·     Pre-operative

·     Pre-investigation

·     Post operative

·     Due to illness

·     Refusal to eat or drink

Will require nutrition from another source either NG or intravenous and may or may not have an NG tube.

Gluten Free

If the person is gluten intolerant it means they cannot digest wheat based products; and these have to be removed from the diet. Host food products will Inform you whether or not they are gluten free.

Ethnic

The persons cultural background and religious beliefs have ot be respected and not abused. Care staff have to be aware of such requirements and adhere to them.

Veqan/Veqetarian

This can either be religious or cultural or it can be through personal choice. Care staff are to be aware and adhere to the persons wishes. Not to be Judgmental.

Fluid/Food Chart

Has to include all fluid and dietary intake. Food has to be measured and the amount taken recorded. Also all fluid has to be documented accurately - no guesses. Output is also important. Cover all 24 hours and to be tolerated. Relevant - not Just for the sake of it.

Nutrition and hydration

·        It is important that we all have an adequate diet, an adequate diet promotes health and also aids recovery form trauma, surgery and disease

·        Poor nutritional status delays recovery, clients will have longer hospital admissions

Reasons clients may not eat

Mental condition

Is a client's mental condition changes or deteriorates this will likely affect the patients desire and ability to want to eat and drink on their own this will increase the risk of malnutrition

Ability to eat

An important factor is for client to eat independently. Clients who need assistance with eating or have difficulty with chewing or swallowing are at higher risk of malnutrition, those who are unable to eat or drink are at even greater risk

Functioning of the gastrointestinal track

The presence of diarrhoea or constipation is likely to affect the desire to eat and drink and may also lead to malabsorption. Nausea and vomiting will lead to a reduced intake to food and fluids.

Pressure sores

The presence of pressure sores are often associated with poor nutritional intake. Those clients who have pressure sores require an increased intake of nutrition

Medical conditions

There are a number of conditions that will affect the ability to eat and drink and will increase the risk of malnutrition.

These include:

·        Neurological conditions especially those affecting co-ordination and mental state

·        Surgery or trauma

·        Malignant disease

·        Reduced mobility or confined to bed

·        Bereavement depression and other mental illness

Feeding an adult

Preparation

·        Ask the client what they would like to eat and drink, always check to see if the client is on any restrictions or on a special diet

·        Always make sure the client is comfortable; ask if they need to go to the toilet before eating, help to wash the client’s hands, if applicable make sure that the person has their dentures in.

·        Check with the person in charge if the client is able to swallow to prevent choking and aspiration

The environment and equipment

·        Remove any thing that is offensive such as sputum pots or urinals from the clients eating area

·        Make space for the tray

·        Position a chair beside the bed for you

The carer

·        Make sure you wash your hands before you serve food or feed a client

·        Put on an apron (each environment has different coloured aprons for food)

Procedure

·        Aim to make meal times an enjoyable experience for the client

·        Make sure you obtain the correct food and drink for the client you are looking after

·        Take the tray to the client bedside or where they are sitting. If the client if unable to see, explain what food they have and where it is on the plate

·        If necessary cut the food up for the client

·        If the client requires place a napkin or bid on to protect their clothes

·        Sit down by the client and get comfortable so you have a relaxed approach towards the client

·        Place small amounts of food on the fork or spoon and place in the clients mouth

·        Allow the client to chew and swallow before presenting the next mouthful.

·        Avoid talking to the client whilst they are eating

·        Respect the clients dignity and use an napkin or paper towel to remove any dibbles of food and drink

·        When giving an drink, gently tip the cup or glass so the flow is controlled

·        Encourage the client to eat and drink if it is required. Do not press a client if they do not want any more to eat or drink. Report to the nurse in charge if the client has only had a small amount to eat and drink.

Points to remember

·        In some hospitals or nursing homes different coloured aprons are used for different jobs IE: washing a patient or feeding a client

·        If a client is able to feed them selves place food and drink in easy reach.

·        If the client is blind use the clock to explain where the food is on the plate

·        If the client is only able to use one hand use a plate guard of non slip mat

·        A client who has difficulty in holding cutlery try using large handled cutlery

Food hygiene

Food hygiene is important in any care settings, as infections can be more serious and even fatal for the elderly or infirm. Infections can spread rapidly due to the high number of people sharing the same facilities and living close together

High risks foods that can cause sickness are: poultry, cooked meat and other meat products such as gravy and stock, dairy produce, products made from eggs such as mayonnaise, shellfish and other seafood and cooked rice.

Main causes of food hygiene are poor temperature control, poor hygiene and cross contamination

You should wash your hands when entering the kitchen, after handling raw food, before handling cooked food, after using the toilet or after contact with your nose or mouth, after handling refuse and before any contact with residents, after touching your hair.

If you have any open wounds these should be covered with a blue plaster so it can be easily detected if it becomes detached

Cross contamination is  bacteria being transferred from raw food to cooked food,

The ideal temperature for the multiplication of food poisoning bacteria is 37 degrees Celsius (body temperature)

The danger zone in which bacteria can multiply quickly is between 5 and 63 degrees Celsius

Food should be defrosted in a refrigerator, food should never be left at room temperature to defrost and hot water should not be used to defrost food.

Food can safely be reheated once only

Food products should be prepared on the following colour coded chopping boards

Yellow - cooked products

Red - raw meats

Blue - raw fish

Green - fruit and salads

Brown - vegetables

White - dairy and bakery products

Pressure Sores

Definition of pressure sores

It is the lack of oxygen and blood supply to the tissues of the skin, resulting from pressure; this causes ulceration of the skin and possible death of the skin

Causes of pressure sores

Direct pressure – on the skin or static friction

Shearing – the downward load on a surface

Areas of the body that are prone to pressure sores

·        Head

·        Elbows

·        Ankles

·        Knees

·        Heels

·        Sacrum

·        Hips

Development of a pressure sore

·        Normal skin is kept healthy blood supply through small blood vessel called capillaries

·        Where large bones lie close to the surface such as heels, shoulders elbows hips and sacrum

·        When you sit or lie down the skin is compressed between the bones and the surface such as a chair or bed, this stretches the tissues and prevents the blood supply to that area of the skin. It is at this point that a person is at higher risk of developing a pressure sore.

Factors that contribute to pressure sores

·        Poor nutritional state of the client

·        Anaemia

·        Poor mobility or reduced mobility

·        Damp or wet skin

·        Age

·        Illness

·        Infections

·        Drug therapy

·        Psychological factors

·              Social factors

How to prevent pressure sores

·        Good skin care – not leaving patients in wet pads or wet clothes

·        Good nutritional intake

·        Good fluid intake

·        Turning or moving a client 2 hourly or more if needed

·        Using pressure relieving equipment

·        Being aware of who is at risk

·        Recognise the development of a pressure sore