Working with patients and colleagues

Introduction

Welcome to Section 2 of the Introducing practical healthcare course where you will look at how the healthcare assistant role involves working with other people. Once completed, you will be given the opportunity to obtain a ‘Working with patients and colleagues’ badge. This section will take approximately 3.5 hours to complete.

This section will first consider how a healthcare assistant works in a person-centred way, and introduce the idea of patient care plans. You will reflect upon the importance of values when working in a caring role. It will then consider the need for successful communication within healthcare settings, and you will be shown a few examples of barriers to communication. Along with this, you will learn about the importance of correctly handling information and obtaining patient consent and confidentiality. Lastly, this section will explore working as part of a team and the reasons why situations of conflict may sometimes arise.

Learning outcomes

By completing this section and the associated quiz, you will be able to:

• explain what is involved in delivering a person-centred approach

• describe how to store personal information securely, and when confidentiality may be breached.

1 Working in a person-centred way

A lot of patients finding themselves in hospital meet situations that involve pain, anxiety and physical indignity with courage and good humour, but as individuals, their reactions will be varied. Becoming ill disrupts their normal life, upsets plans, may cause financial loss and produce a loss of self-esteem. The person-centred approach to healthcare focuses on the individual’s personal needs, wants, desires and goals so that they become central to the care and nursing process. It involves knowing the patient as an individual and as a person, not just as a patient with a certain condition and, where appropriate, involving their family and friends. Another way of being person-centred is to understand that everything you do for that person requires their consent, so you know they are happy for you to carry out the action.

1.1 Care plans

Another vitally important part of working in a person-centred way is having an individualised care plan. Care plans are usually written by the qualified nurse with the patient, and tell you what daily care should be provided. Whether handwritten or electronic, they are live documents and should be updated by the nurse whenever anything changes. A care plan is likely to include:

• the patient’s relevant medical history
• how they want to be cared for
• the type of care they want
• their specific daily care needs
• what works well and doesn’t work well for their care
• improvements that can be made to their care.

1.2 Consent

Working in a person-centred way requires that everything you do for a patient is done with their consent. If you are going to take their temperature or another straightforward observation, usually a nod or verbal consent is enough to tell you that they are happy for you to carry out the action.

In the next audio clip you will hear Gail talking about how important it is to always get the patient’s consent before carrying out any actions with them, using real examples as to whether this may be explicit/informed or informal consent.

Download this audio clip.Audio player: Obtaining patient consent

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Transcript: Obtaining patient consent

Gail:

You must always get consent from a patient and this can be in um different ways.

If a patient is having an operation or an intervention, normally they would have to sign a Formal Consent Form, and a Formal Consent Form can come in lots of guises – it could be that the patient consents for themselves; it can be that the patient has an advocate that will sign for them.

If it’s a patient that is under an age or doesn’t understand, then a parent can sign for that patient, so there are lots of different Consent Forms and you have to make sure that you use the appropriate Consent Form - that is really important!

Consent on a formal form is usually taken by the doctor that is going to do the procedure or the operation, and when the consent’s done, you will talk to the patient and tell them what the risks, complications, side effects could be, what they are going to do um and what may happen afterwards so this is what they call an Informed Consent.

So the patient then knows everything about that procedure or that operation, and he then can sign that consent if he agrees with it. So that is Informed Consent.

The other consent that there is, is a Verbal Consent. I would use this as a healthcare [assistant] um, all the time.

Every time you go to a patient to do anything with them you must gain an Informal Consent from them. This can be ‘Mrs Jones I’m just coming to do your blood pressure, is that alright?’ and the patient would say yes or no. If the patient says no, then we don’t do that blood pressure!

We would then maybe go and speak to a member of staff to pass that on and maybe go in from a different angle and actually explain why we need to do the blood pressure.

So everything that you do for a patient, you must gain consent. If you are actually saying to them ‘shall we put your nightie on’, that they say ‘yes’, that is a consent. You must gain consent!

End transcript: Obtaining patient consent

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Obtaining patient consent

1. Explicit (or informed) consent means that the person giving consent knows exactly what they are agreeing to. For example, a patient going for surgery needs to give written consent and, if patient information is to be shared, they need to understand what will happen as a result of this.
2. Implied consent: This is when someone has not explicitly said that their personal information may be shared but their behaviour suggests that they are aware that it will be passed on and they are happy with this. For example, because a patient agreed to go to the diabetes clinic, his GP reasonably assumed he also agreed to his information being passed on to the clinic (The Open University, 2015, p. 60).
3. Mental capacity and consent: There may be times when your patient lacks the mental capacity to give consent or make a decision, maybe due to physical illness or a learning disability or dementia, or they cannot communicate what they want. In such instances a family member might be asked to give consent on their behalf (The Open University, 2015, p. 60).

1.3 Your values

Your values are a set of principles or beliefs that you believe are important in the way you live and work, and tend to guide judgements about what you consider to be right or wrong. Following the Cavendish review (Cavendish, 2013), NHS England (2012) described six core values which apply to anyone in a caring role, including healthcare assistants. They all begin with the letter C and are known as the ʿ6 Csʾ. You will need to put these six values into practice throughout your caring role:

The ʿ6 Csʾ: ­­

• Care: having someone’s best interests at heart and doing what you can to maintain or improve their wellbeing
• Compassion: being able to feel for someone, to understand them and their situation
• Competence: understanding what someone needs and having the knowledge and skills to provide it
• Communication: listening carefully but also being able to speak and act in a way that the person can understand
• Courage: not being afraid to try out new things or to say if you are concerned about anything
• Commitment: being dedicated to providing care and support but also understanding the responsibility you have as a healthcare assistant.

Activity 3

Timing: Allow about 5 minutes

In the next audio clip you will hear again from Gail. She refers to the crucial values of empathy, trust and reassurance which are needed even before the direct caring for patients begins. As you listen to it, think about the different feelings that patients will be experiencing on the operative preparation ward.

Download this audio clip.Audio player: Values of empathy, trust and reassurance

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Transcript: Values of empathy, trust and reassurance

Gail:

Patients come in because they come in for an operation onto my ward, um, so you are there to get them ready for… for theatre and make sure that they get up to theatre and that everything is alright.

But before you even start that, the care starts. As they are coming onto the ward, we may get patients that are upset, they’ve never been into hospital before.

You may get a person with a needle phobia. So your job starts - before the caring, your job starts with the empathy, the reassurance that everything is going to be alright, “I’ll be looking after you ... You can ask me anything”.

You’ve got to get the trust – and once they trust you and you can calm things down they feel better and we can do our job better so then the caring starts – but things start before then!

End transcript: Values of empathy, trust and reassurance

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Values of empathy, trust and reassurance

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Nearly everything you do when caring for others will involve the ʿ6 Csʾ, however ill they are, or however short or long their stay in hospital might be. During your time as a healthcare assistant you are likely to encounter patients with chronic or long-term conditions.

Activity 4

Timing: Allow about 30 minutes

In the next video you will be introduced to Malcolm, who talks about living with a long-term condition. He had a cancerous kidney removed and is suffering slow failure of the other. You will see what a dialysis machine looks like and how Malcolm’s treatment is carried out in hospital. If you haven’t cared for anyone with this condition or experienced a dialysis department before, this will provide insight into what it entails.

All ʿ6 Csʾ are required in Malcom’s care. As you watch the video, use the space below to write down three of the ʿ6 Csʾ you would need to use if you were supporting him.

[This video is provided for use within the course only.]

Download this video clip.Video player: End-stage renal failure – a long-term condition: Malcolm's story

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Transcript: End-stage renal failure – a long-term condition: Malcolm's story

Malcolm

My name is Malcolm Lawrence. I’m a dialysis patient. I’ve been on dialysis for four-and-a half years. I’m on dialysis because both my kidneys failed. My first kidney had a benign tumour called an oncocytoma 17 years ago and had to be removed. The second kidney, over a period of 12 years, gradually failed, which meant that at the end of those 17 years, I really couldn’t really exist without going on to dialysis. Dialysis is a way of filtering the blood externally, doing the things that the kidney should be doing, but isn’t doing. If you’ve not been a dialysis patient, you don’t really know what it’s like. There are plenty of other illnesses around but I can’t think of anything where you have to have this regime on a regular and very necessary basis.

Malcolm’s wife

You’ve obviously got used to the dialysis and accept it, and don’t want it to rule our lives, but essentially it does, um to a certain extent, it rules our timetable because Mondays, Wednesdays and Fridays, obviously we can’t make any major plans on those days and, in fact, when Malcolm goes to dialysis, I choose those days to do my own things.

Malcolm

I have dialysis. I have what’s called a fistula. This is when a vein is joined to an artery in your forearm which gives a good site for needling. I put anaesthetic cream on it and tape it down, and then I have some lunch, and then I get to the unit about quarter to one. So here I am on the dialysis unit. I’ve been here about an hour today and my whole session will be four hours, not including putting me on the machine and putting me off the machine. This is the great dialysis machine here next to me, and this is the filter which is red as my blood is passing through it. The blood goes through the machine and back into me, and out again, and here you can see the two needles that have been put in. Being on the machine is perfectly fine normally, but one or two things that occasionally happen – sometimes blood pressure drops, and sometimes one gets cramps – but these are very infrequent. Most of the time it’s really quite nice sitting here. They keep the temperature well controlled and the seat’s quite comfortable, now that I’ve brought my cushions in, and it’s really just a matter of whiling the time away. The main problem of being on dialysis would be perhaps the next day you might feel rather tired and a little bit strange as well, but actually being on the machine, as far as I’m concerned, is quite a passive thing. I feel very fortunate I’m here. It’s only a 20 minute journey by car when I drive here, the unit is very, very efficient, I’m always seen within half an hour of arriving, so one must count one’s blessings.

End transcript: End-stage renal failure – a long-term condition: Malcolm's story

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End-stage renal failure – a long-term condition: Malcolm's story

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Comment

Malcolm has suffered issues with his kidneys for seventeen years. He describes how he couldn’t exist without his dialysis treatment. He has accepted the treatment as part of his routine but it is quite disruptive of his week and limits the other arrangements he can make. When he is spending such a long period of time in the hospital, it is important to reduce the delays before treatment as much as possible and ease his transition onto the machine. The first ʿCʾ you use will probably be communication, by greeting Malcolm on arrival and listening carefully to any requirements he may have before the treatment starts.

Throughout his time on the ward you will be promoting Malcolm’s physical and emotional comfort, applying the ʿCʾ care. For example, during the dialysis, it is important to make him feel comfortable, ensuring his cushions are in the right place and that the temperature is controlled to suit him.

Malcolm returns regularly for his appointments, and you would need to understand him and show another ʿCʾ compassion towards his situation, and try to keep him occupied. Malcolm may feel more at ease if he is encouraged to bring activities and home comforts to break up the session.

Malcolm mentioned a couple of complications he might receive as a result of dialysis. If you were part of his treatment team, you would need to be aware of these potential issues and monitor his progress while he is having treatment­­. This calls for another ʿCʾ: a level of competence to understand what he needs and have the knowledge and skills to provide it.­­

In addition, there are two other ‘C’s which you need to be aware of, although at first they may not seem directly relevant to Malcolm’s issues: courage and commitment. You will need to show a commitment to Malcolm’s treatment: even on days when the treatment will feel draining, it will still be important to continue in a positive way. Similarly you will need the courage to act quickly and correctly if there are any complications with the dialysis, to ensure that Malcolm’s safety is maintained.

Figure 1 Previously active people may suddenly find themselves without mobility or confined to a wheelchair

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The picture shows a female healthcare worker notifying the handler of a wheelchair in which a male patient is seated in a wheelchair. Both are looking out of a window. Another woman, not in uniform, is standing alongside.

Figure 1 Previously active people may suddenly find themselves without mobility or confined to a wheelchair

Activity 5

Timing: Allow about 5 minutes

In the next podcast video, you will encounter Robert, a motorcyclist who was severely injured in a road accident. He talks about how the accident has changed his life irreversibly. He describes how his behaviour became challenging at times, and how it is important for those in a caring position to remember that, although he looks normal, the extensive injuries he suffered brought out difficult feelings which were reflected in his challenging behaviours.

All 6 Cs will be required in your care for Robert. As you watch the video, write down three that you would need to use if you were supporting him.

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Transcript: Motorcycle accident

Robert:

If people come up to me and tap me on the back, you know it really hurts and it, you know, it feels like they’ve stabbed me.

Sitting in a chair or laying on my back is not so much painful because I’ve got used to it now but I can always feel it, and it’s just a bit of a nightmare to be quite honest.

There are times when you’re thinking like oh, do I have to be like this every day for the rest of my life, then there are other times when you just completely forget about it because I’ve got so used to it.

What’s still affecting me now is apart from the sore back and the no skin on my knees it’s the mental things that are affecting me, which are really terrible memory and fatigue, because a lot of people think tiredness is physical, but it needn’t be.

Now, for example after we’ve, you know, talked now I’ll probably have to have a lay down this afternoon, just simply because my brain is completely worn out, or might not be, but that’s by far the worst thing and that’s the reason why after three years on I’m not back to work because I was originally thinking, my old boss came to see me in hospital, you know a couple of months after the accident, and I was saying oh don’t worry, I’ll be back to work by Christmas, you know, I set myself, you know, January the first I’ll be back to work and whatever, that was you know two-and-a-half years ago, and the way that things are going at the moment I certainly won’t be able to go back to doing the job that I was doing.

If you look at me physically, well if I’m standing there with my shorts on, you wouldn’t know that I’d got any sort of injury at all, and I say it often but 50 per cent of the time talking to me you wouldn’t think that there’s anything wrong with me, but a lot of people when you go out they don’t see the time when you’re at home, and the time when you’re sitting there and oh god, can hardly move, and of course you know I get tired and irritable, and completely zombified, and that’s one of the worst things about having a head injury, or it’s a brain injury, is that it’s a hidden injury, completely hidden.

So life I think has changed, I mean it’s changed massively financially because I was a salesman in the past, I used to earn a lot of my wages as commission so, but now I don’t so that’s changed an awful lot.

But I think you get used to, well I’m used to now… what I’ve got and rather than what I had, so it puts things into perspective a lot.

End transcript: Motorcycle accident

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Motorcycle accident

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Comment

Robert’s story illustrates why it is so important to take the time to understand the context behind a patient’s behaviour and to work in a person-centred way. This meant having the compassion, or ability to feel for Robert, to understand him and his life-changing situation. His needs might not have been obvious from the outset, but by getting to know him as an individual it was possible for his nursing team to care for him, placing his best interests at heart and doing what they could to maintain or improve his wellbeing.

As a healthcare assistant you will need to be competent in recognising the invisible symptoms causing his discomfort and behaviour. Robert is clearly in constant pain and has suffered a brain injury as a result of the accident. Memory loss and extreme tiredness are both symptoms that affect his life which are hidden to the outside world. You will also need to demonstrate competence in how best to alleviate his symptoms, and be knowledgeable about how to provide appropriate support. You would need to remember to ensure that he can have regular breaks and support as required; as well as space when he is feeling more irritable.

Robert describes how his life has completely changed, and he is now unable to work in his previous job as a result. Healthcare assistants working with him would need to be compassionate to his circumstances and recognise all of the symptoms that Robert faces (including those hidden issues). It is important to understand how these are driving his behaviour. You would also need to take a caring attitude in your ongoing work with Robert, carrying out actions which are best to maintain his wellbeing and comfort.

As a healthcare assistant, you would need to be aware of how your communication is affecting him. Any touch should be carried out in a way to avoid pain, and you would need to convey empathy and understanding, even when Robert is displaying more aggravated behaviours.

As a healthcare assistant, you will be required to draw particularly upon the commitment and courage Cs here: you would need to be committed to Robert’s continual care, even through difficult periods, and have the courage to demonstrate empathy even when he becomes demanding or negative towards his situation.

2 Communication

Let us now look further at one of the ʿ6 Csʾ in more detail: communication. Good communication is important, both between your team and your patients. Only a small proportion of communication is verbal: when Robert was in pain or frustrated, he communicated those feelings through his behaviour rather than expressing how he felt in words. By observing Robert’s body language during a conversation, you might be able to see visible signs of his discomfort or pain. His healthcare team had to learn about his specific needs, however he chose to express them. By getting to know him as an individual, they would learn how best to support him, and speak or act in ways that both expressed empathy and understanding, and explained any treatment or care plan.

Now you are going to look at an example where there was a lack of good, basic communication between the patient and the healthcare assistant, who did not seem to be working in a very person-centred way.

Activity 6

Timing: Allow about 15 minutes

As a healthcare assistant, one of the roles you might be asked to carry out is to record a patient’s blood pressure. This will alert you to any changes from previous readings, such as high blood pressure (hypertension), which puts extra strain on the heart and blood vessels.

As you watch the video, write down ways in which the healthcare assistant could have been more supportive and reassuring with the patient.

[This video is provided for use within the course only.]

Download this video clip.Video player: Measuring blood pressure

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Transcript: Measuring blood pressure

Kerri

Right, let's just do your blood pressure. If you just want to roll up your sleeve.

Lovely, pop your arm in there for me.

OK if you just want to relax your arm. Try not to move or talk.

OK lovely, that's not too bad at all.

End transcript: Measuring blood pressure

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Measuring blood pressure

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Comment

If this was the patient’s first blood pressure test, the healthcare assistant would normally describe to the patient how the blood pressure check would be carried out and why the blood pressure needed to be measured. She gave no reassurance to help the patient feel more relaxed, and should have explained that the cuff was going to tighten and there might be a bit of pressure. She could have checked that he was comfortable and his arm supported, though she did ask him to try and relax his arm. If a patient is particularly nervous it helps to suggest they visualise being in a nice place, to help them relax. Afterwards she just said the blood pressure was ok, with no explanation of what the figures meant and how they related to the ʿhealthyʾ scale.

The Open University and Unison Partnership website (2015) notes that ̔'communication is a two-way process and good communication is about being a good listener as well as a good speaker. You need to be empathic, so that you can understand how others will interpret your words and behaviour'. Communication therefore is an essential part of a caring relationship and helps to build trusting relationships with the individuals you care for as well as their families and other workers.

Communication occurs through many different means: verbal, visual or in written form. It will take up a large part of your day, and it is important to communicate effectively. Only a small proportion of communication (7%) is down to actual words. Indeed, in face-to-face conversations, over a third of communication is made up of the tone, pitch and speed of your voice (38%), and just over half of communication is non-verbal, comprising gestures, expressions, posture and other body language (55%). You are probably already familiar with a number of features of body language, including the movement of your body (for eample shrugging, nodding or shaking your head, waving), facial expressions, eye contact (showing that you are engaged and listening), and even your muscle tension and breathing.

The way you look, listen, move, and react to another person tells them more about how you’re feeling than words alone can. Think about when you communicate with others over technology and cannot see their non-verbal communication signs: such communication can be more difficult and meanings can be more easily misunderstood.

The following advice has been drawn up by The Open University and Unison:

Here are some further tips that you should consider:

• Make sure the person is wearing their hearing aids if they are hearing impaired, and that they are working properly with operational batteries.
• Ensure where possible that you are facing towards the light (for example looking towards a window) so that the other person can see your face and expressions clearly. This is particularly important if your patient is hearing-impaired, as they may rely on your lips and expression for communication.

Communicating effectively can be difficult. In order to get it right, it is important to be able to tailor communication skills to different situations: for example you might be using a different tone, pitch and volume in a formal conversation than you would in an informal one; and you might convey information differently in a verbal conversation than in an email. When caring for patients it is best to avoid using difficult words or abbreviations such as those which you might use when talking with other health professionals. Your speech should be respectful and adjusted to suit the individual you are communicating with.

Working in healthcare means some situations have specific or specialised needs. Part of your person-centred approach and knowing your patient as an individual will include finding out their preferred method of communication. In the UK we use British Sign Language (BSL) when communicating with hearing-impaired people. Makaton is another sign language which uses a large collection of signs and symbols, and is often used with those who have learning and physical disabilities, or hearing impairment.

Whatever your healthcare setting, as a healthcare assistant you will be working as part of a team. This will probably include qualified nurses, students and support workers, but there will also be a range of other professionals and support staff whom you will encounter on an everyday basis, including domestic staff and clerical assistants or receptionists. Whoever you work with, trust and reliance on others in the team are important ingredients to good working relationships and will help working partnerships to be open, honest and successful.

Figure 2 The typical healthcare team has a range of professionals and support staff

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There are two photos showing a range of professionals and support staff working in the healthcare sector. The first shows a hospital cleaner, the second shows a surgical team with (from left) operating theatre technician, consultant surgeon, ward nurse, theatre sister, theatre staff nurse and surgical registrar.

Figure 2 The typical healthcare team has a range of professionals and support staff

2.1 Barriers to good communication

Learning Guide 12 from the OU’s K101 course (Open University, 2015) specifies that ‘Communication between two people often comes naturally. When communication is difficult, it is often because of some kind of barriers of one kind or another … Being aware of barriers, and developing ways of overcoming them are important in helping you to deliver effective care.’ (The Open University, 2015, pp. 108–9)

When communication is difficult, it is often because of some kind of barrier; being aware of barriers, and developing ways of overcoming them, are important in helping you to deliver effective care.

There are a number of communication barriers, presented in the K101 Learning Guide above (Open University, 2015), which you should consider when working as a healthcare assistant

• Physical barriers: ‘sometimes the way a building is designed makes it difficult to communicate. Noise, lack of privacy and busy environments where there are a lot of interruptions are barriers to communication.’ Consider also the way desks and chairs are positioned, as this can cause a barrier to communication; and it is also important to remember that dimly lit areas might make it more difficult for hearing-impaired patients to understand you’
• Attitude: ‘Some people are apprehensive about being able to communicate with professionals. This may be because of the technical language some professionals use. But it may also be related to the idea that professionals are busy: they may not have time or be interested in hearing what you have to say. Sometimes incorrect assumptions are made about communicating with people who have a disability. [This] can mean conversations are directed mainly at their carers. It is likewise important that staff have a positive attitude towards patients and don’t become defensive if a patient complains.’
• Emotions: ‘Communicating clearly can be a problem if we are feeling emotions such as distress or anger. Fear can prevent someone from making an initial approach for help. People may be so overwhelmed by their emotions that they struggle to interact with other people.’
• Cultural and language barriers: these ‘can be obvious if we are dealing with someone who does not speak or understand the same language that we do, but there may also be other hidden cultural differences about the way we use language. Language examples might include causing confusion when terms such as ‘passing water’ or ‘breaking wind’ are directly translated word-for-word because the meaning does not translate well.’ Cultural norms may mean, for instance, that many Japanese people have difficulty saying no, or that women may feel inhibited discussing personal matters with male medical staff.
• Illness, disability or pain: ‘Some people may have a disability and/or a sensory impairment, such as a sight, hearing or speech impairment, which makes communication [harder].’
• Memory loss or a learning disability: 'This [might make] it difficult for a person to understand information’, particularly that which is being communicated to them.

Other points to remember:

• Body language: it is important to consider how you are standing or sitting when communicating, as crossing your arms whilst speaking and listening, or looking at your mobile phone, will pose a barrier.
• Time: always try to make time for listening and communicating even though you may be very busy.
• Confidentiality: when communicating information that is sensitive or personal, it is important to find a private place and ensure you will not be interrupted.

Figure 3 The way you communicate with your body language is important

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The photo shows a male healthcare worker holding a packet of orange tablets in his left hand and pointing firmly with his right index finger at his patient. The patient sitting next to him is not making eye contact

Figure 3 The way you communicate with your body language is important

Occasional disagreement may arise between workers from different agencies or between the person receiving care and support and those providing them, and this can lead to conflict. This can be compounded by different personalities and temperaments, differences in beliefs and values, or strong feelings and emotions. Conflict in teams that is not resolved can affect the quality of care, so must be managed quickly and effectively.

3 Handling information

Within your healthcare assistant role, you will be asked to handle various pieces of information given to you regarding patients and their needs; including confidential information about individuals and possibly their families or carers. The Data Protection Act (1984) first introduced rules on how to store information and who will be given permission to access such data, which are still in force today (subject to the Data Protection Act, 1998).

If you work for a public authority such as in hospitals or doctors’ surgeries you should be aware that patients have a right to view anything written about them. They can make a formal request for this through the Freedom of Information Act (2000). This may include documents, reports and even emails between healthcare workers. Patient care plans can become legal documents of evidence if at any point there is cause for legal action, so if you add to any of these records you need to remember that what you write must be accurate and suitable to be viewed by those it concerns.

Figure 4 You might be asked to handle or contribute to hard data within a paper filing system

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The photo shows a female healthcare worker looking through a shelf containing numerous paper files.

Figure 4 You might be asked to handle or contribute to hard data within a paper filing system

Problems would be likely to arise if no records are kept. For example, a patient who is allergic to penicillin could be given inappropriate care and prescribed penicillin as it wouldn’t be shown on her medical history.

Another example of why keeping records is important would be to help care workers remember past actions and future plans, otherwise details and even major issues might be forgotten, time would be wasted finding out the same information again, and repeating some forms of care, such as medical treatments, could be harmful.

In Activity 8, look at the examples and think of a problem that might arise if records are not kept. Try to write an example from your own experiences of healthcare services, click to save it and then click to reveal the comment.

(Activity adapted from K101 Learning Guide 14, Open University 2015a)

3.1 Medical records

The growth in access to computers and the internet has led to changes in how some personal care records are held. The NHS plans to introduce integrated digital records across all healthcare settings in England by 2018, so the use of electronic records is set to become increasingly common (The Open University, 2015, p. 52).

Figure 5 Medical records are increasingly being filed electronically

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The picture shows a computer screen displaying an Electronic Medical Record System.

Figure 5 Medical records are increasingly being filed electronically

Guidelines published by the Department of Health state that with electronic records, NHS staff in England must:

The huge increase in social media and mobile technology such as phones and tablet computers means that it can be easy to share information with the wrong people, which can breach confidentiality in the same way as leaving a patient’s records out of the filing system or remaining logged in to a computer when you have walked away. As a healthcare assistant, you have a responsibility to oversee and to protect an individual’s personal information. You should also treat personal information about other workers that you have access to in the same way.

3.2 Confidentiality

As you have seen, patients’ health information and their interests must be protected through a number of measures. However, there are some exceptional circumstances when a professional can share information about a patient without their consent. For example:

• where there is a risk of serious harm to the patient or to others, or a risk of a serious crime being committed. For example, someone could tell their doctor that they were going to try to severely hurt themselves or other people. The doctor could decide to share this information with someone else who is working closely with that person, or contact the police.
• when a professional has to weigh up the need for confidentiality against ʿpublic interestʾ. This means that, if they feel the information could be helpful to the public as a whole, it can be released in certain circumstances. So, if someone has been diagnosed with a serious contagious disease such as swine flu, a medical professional may disclose this information to the public via the media in order to prevent the spread of this disease. This would only include information that is necessary to inform the public and personal details would not be shared. Likewise, if a court of law demands that confidentiality should be breached healthcare staff have no choice but to obey.

It is always difficult to judge when it is justified to breach a confidence, so healthcare assistants should not decide on their own. It should always be discussed with a line manager or other specified colleague.

What you have learned in this section

• A person-centred approach to healthcare focuses on the individual’s personal needs, wants, desires and goals.
• Everything you do for a patient requires their consent; this may be explicit or implied.
• Six core values are recognised as applying to anyone in a caring role: Care, Compassion, Competence, Communication, Courage and Commitment.
• Communication involves both listening and being heard.
• There is a wide range of potential barriers to effective communication.
• Under the Data Protection Act (1984) you must follow rules on how to store and handle information.
• In some circumstances personal information cannot be kept confidential.

Further information (optional)

If you want to find out further information about the Freedom of Information Act (2000), it is available here: www.gov.uk/ make-a-freedom-of-information-request/ the-freedom-of-information-act

Section 2 quiz

Well done, you have now reached the end of Section 2 of Introducing practical healthcare, and it is time to attempt the assessment questions. This is designed to be a fun activity to help consolidate your learning.

There are only five questions, and if you get at least four correct answers you will be able to download your badge for the ‘Working with patients and colleagues’ section (plus you get more than one try!).

If you are studying this course using one of the alternative formats, please note that you will need to go online to take this quiz.

Acknowledgements

This free course was written by Joanne Thomas (consultant for the Open University) and Emma Lipscombe (Learning and Workforce Development Officer for UNISON), with contributions from Ruth Beretta (staff tutor for the Open University).

Except for third party materials and otherwise stated (see terms and conditions), this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence.

The material acknowledged below is Proprietary and used under licence (not subject to Creative Commons Licence). Grateful acknowledgement is made to the following sources for permission to reproduce material in this free course:

Every effort has been made to contact copyright owners. If any have been inadvertently overlooked, the publishers will be pleased to make the necessary arrangements at the first opportunity.

Figures

Figure 1: Tommi/iStockphoto.com

Figure 2: Rawpixel ltd/iStockphoto.com and sturti/iStockphoto.com

Figure 3: SoumenNath/Istockphoto.com

Figure 4: © unknown

Figure 5: Pandpstock001/iStockphoto.com

Audios

‘Living with visual impairment: nurse support’ including transcript: from OU pre-reg nursing programme, © The Open University

‘The importance of care plans’ including transcript: courtesy Unison (https://www.unison.org.uk/)

‘Values of empathy, trust and reassurance’ including transcript: courtesy Unison (https://www.unison.org.uk/)

‘Obtaining patient consent ’ including transcript: courtesy Unison (https://www.unison.org.uk/)

Videos

‘End-stage renal failure – a long-term condition: Malcolm's story’ including transcript from SK120 Diabetes Care, © The Open University

‘Motorcycle accident’ including transcript: from SDK125 Introducing Health Sciences: Trauma, Repair and Recovering, © The Open University

‘Measuring blood pressure’ including transcript: from SK120 Diabetes Care, © The Open University