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
Copy this transcript to the clipboard
Print this transcript
Show transcript|Hide transcript

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
Download
Values of empathy, trust and reassurance
Interactive feature not available in single page view (see it in standard view).

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
Copy this transcript to the clipboard
Print this transcript
Show transcript|Hide transcript

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
Download
End-stage renal failure – a long-term condition: Malcolm's story
Interactive feature not available in single page view (see it in standard view).
To use this interactive functionality a free OU account is required. Sign in or register.
Interactive feature not available in single page view (see it in standard view).

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.

Described image
Figure 1 Previously active people may suddenly find themselves without mobility or confined to a wheelchair
Show description|Hide description

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.

Download this video clip.Video player: Motorcycle accident
Copy this transcript to the clipboard
Print this transcript
Show transcript|Hide transcript

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
Download
Motorcycle accident
Interactive feature not available in single page view (see it in standard view).

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.

1.2 Consent

2 Communication