NNCO_Carers Caring for adults

Looking after yourself

About this free course

This free course is an adapted extract from the Open University course .

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Contents

- Introduction

- Learning outcomes

- 1 Why your well-being is important

- 1.1 What is well-being?

- 1.2 Improving mental well-being

- 1.3 Improving physical well-being

- 2 Coping with stress

- 2.1 What is stress?

- 2.2 How do you respond to stress?

- 2.3 How to manage stress

- 3 Work–life balance and professional boundaries

- 3.1 What is a work–life balance?

- 3.2 Unpaid carers

- 4 Person-centred care and self-management

- 4.1 Providing the right kind of support

- 4.2 A different approach to support

- 5 Where to find support

- Key points from Section 5

- Further information (optional)

- Section 5 quiz

- References

- Acknowledgements

Introduction

In this section you will be looking at the importance of your well-being and that of the people you care for. People who are in a caring role, either as family carers or who work in health and social care, often find that they are so busy looking after others that they forget to look after themselves. This section offers some suggestions of how to look after yourself.

You will think about different forms of stress and the impact they have on your life and try to find ways of dealing with negative stress.

Making sure you take care of your emotional well-being as well as your physical health is key to a balanced life, so you will also consider ways in which you can support the people you care for to do this as well.

At the end of the section there is a short quiz to test what you have learned about looking after yourself. On successful completion of the quiz you will earn a digital badge.

This section is divided into five topics and each of these should take you around half an hour to study and complete. The topics are as follows:

1. Why your well-being is important explains why it is important for you and the people you care for to take care of your well-being.

2. Coping with stress looks at different types of stress and the ways you can cope with it.

3. Work–life balance and professional boundaries investigates what it means to have a good work–life balance and whether or not this is possible to achieve. It also examines how the boundaries between work and life can become blurred and the reasons for avoiding this.

4. Person-centred care and self-management discusses what person-centred care means and how you can support the people you care for to become increasingly independent, as well as the benefits of self-management both to them and to you.

5. Where to find support offers some places to go to for support, either in person or online, and the different kinds of support available.

Learning outcomes

By completing this section and the associated quiz, you will understand:

- why looking after your own physical and emotional well-being is vital to your role as a carer as well as for the cared-for person

- the impact of stress and a good work–life balance on your well-being.

1 Why your well-being is important

Although most people gain a lot from the relationship with the people they are supporting, the responsibilities can often have a negative impact on their health and general well-being. Carers may dedicate so much time and effort into caring for someone else that they can neglect or do not realise the effect it can have on their own health. In order for a carer to continue caring for as long as they wish to, it is important to be aware of the possible health risks. These can be both physical and emotional.

This is as true for people who are unpaid carers as for people who work in the social care field.

1.1 What is well-being?

When people talk about emotional health and well-being, do they mean happiness? Or confidence levels? Or feeling content?

The answer probably includes an element of all those things but a good starting point is to imagine it’s a feeling of being able to do all that you want to do.

It is often our emotional or mental well-being that has the biggest effect on feeling well, and the stresses and problems of everyday life, including loneliness and isolation, working long hours and not feeling supported, have a big impact on our mental well-being.

1.2 Improving mental well-being

Evidence suggests there are five steps we can all take to improve our mental well-being. If you approach them with an open mind and try them out, you can judge the results for yourself.

Activity 1

Allow about 15 minutes

Part 1

Watch this NHS video about the five steps to mental well-being.

Video content is not available in this format.

View transcript - Uncaptioned interactive content

The NHS has further information on their website about what these terms mean:

- Connect – connect with the people around you: your family, friends, colleagues and neighbours. Spend time developing these relationships.

- Be active – you don’t have to go to the gym. Take a walk, go cycling or play a game of football. Find an activity that you enjoy and make it a part of your life.

- Keep learning – learning new skills can give you a sense of achievement and a new confidence. So why not sign up for that cooking course, start learning to play a musical instrument, or figure out how to fix your bike?

- Give to others – even the smallest act can count, whether it’s a smile, a thank you or a kind word. Larger acts, such as volunteering at your local community centre, can improve your mental wellbeing and help you build new social networks.

- Be mindful – be more aware of the present moment, including your feelings and thoughts, your body and the world around you. Some people call this awareness ’mindfulness’. It can positively change the way you feel about life and how you approach challenges.

(Source: NHS, 2016)

Can these steps become part of your 5-a-day?

Part 2

Having watched the video and read about the five steps, now think about whether you already do any of these things or whether you could do more. For each step, try to write down one thing you could do to improve your mental well-being.

Provide your answer...

View comment - Part 2

We’d now like you to think about the people you support. Their well-being is as important as yours, but how easy is it for them to do any of the things on the five steps list?

Activity 2

Allow about 5 minutes

Write down in two or three sentences why you think it might be difficult for the person you care for to incorporate the five steps into their life.

Provide your answer...

View comment - Activity 2

1.3 Improving physical well-being

Being physically healthy is hugely important. Having a healthy body means you are equipped to deal with the challenges of everyday life, fight off illnesses and function well, allowing you to do the things you want to do. Many physical health conditions are preventable, and being fully aware of potential problems gives you a true choice in whether or not to take on board the information and act to change things.

A balanced diet and regular exercise is a good starting point for looking after your physical health. Caring for others can be exhausting and time-consuming, resulting in constant tiredness, sluggishness and general apathy (that ‘can’t be bothered’ feeling), which can affect work, relationships and many other areas of life. This can also hold back your motivation for getting started on any plans to improve your lifestyle, so taking care of your physical health is an excellent first step to taking care of other areas of your life.

Good physical health is something achievable by everyone, no matter what the starting point. With so much (often conflicting) information in these health-conscious times, we could do with some sensible guidance.

The carers.uk website has a great deal of helpful information about looking after your physical health if you are caring for others. This information applies whether you are caring for loved ones at home or if you are working in the social care services.

Some of the most commonly occurring physical problems for carers are not getting enough sleep, back pain and damage to your back.

If you are not getting enough sleep you may find that you are constantly tired, go to sleep during the day, have trouble concentrating and making decisions, and feeling depressed. Long-term lack of sleep may also increase your risk of high blood pressure, diabetes and obesity.

Lifting and moving the person you care for, and helping them dress can all place a strain on your back. However, knowing how to protect your back can help to keep it in good shape. If you are a paid carer, it is a legal requirement for you to receive training and support in manual handling tasks. Unpaid carers can also access training, so if you regularly have to lift the person you care for, help them to sit or stand, or help them in and out of bed, your local support group or council should be able to tell you about training opportunities in how to lift and move more safely to reduce the risk of harming your back. Alternatively, your district nurse or community support team may be able to show you ways to lift and move more safely. Ask your doctor for more information.

There are many other services that can support you in your caring role and in looking after your own health. These include occupational therapists, physiotherapists, continence advisers and dieticians.

2 Coping with stress

Our lives nowadays are so hectic that for many of us stress is so common it has become a way of life. It isn’t always bad, though, as a certain amount of stress can help you perform under pressure, motivate you to do your best, even keep you safe in potentially dangerous situations. It is when stress becomes overwhelming that it can damage your health, mood, relationships and quality of life.

You can protect yourself by understanding how the body’s stress response works, recognising the signs and symptoms of stress overload, and taking steps to reduce its harmful effects.

2.1 What is stress?

Stress is your body’s way of responding to any kind of demand or threat. When you feel threatened, your nervous system responds by releasing stress hormones, which prepare the body for emergency action. Your heart pounds faster, muscles tighten, blood pressure rises, breath quickens and your senses become sharper. These changes help you to deal with the ‘danger’ your body thinks is coming.

This is known as the ‘fight or flight’ stress response and is your body’s way of protecting you. When working properly, stress helps you stay focused, energetic and alert – for example, giving you extra strength to defend yourself or spurring you to slam on the brakes to avoid an accident.

Stress is also what keeps you on your toes at work, sharpens your concentration or drives you to study for an exam when you’d rather be watching TV.

This is what we think of as positive stress but beyond your comfort zone stress stops being helpful and can start causing major damage to your mind and body.

2.2 How do you respond to stress?

All mammals, including people, have three ways of responding to stress:

- Social engagement – making eye contact, listening to others and feeling understood. This can calm you down and help avoid defensive actions such as the ‘fight or flight’ response. It helps you think more clearly, and things like blood pressure and heart rate continue to work normally.

- Mobilisation (or ‘fight or flight’ response). This is when we need (or think we need) to defend ourselves or run away from danger. Our bodies prepare for action, releasing those hormones we referred to earlier, and our digestive and immune systems stop working. Once the danger has passed, the nervous system calms the body, slowing heart rate, lowering blood pressure and returning to normal.

- Immobilisation – this is the most primitive response to stress, and is used only when the other responses have failed. A bit like a rabbit caught in the headlights of a car, you may find yourself ‘frozen’ or panic stricken. Some people have even lost consciousness if their life is threatened. This state helps them to survive high levels of physical pain, but until they come round again their nervous system may not be able to return to its pre-stress state.

(Source: adapted from Leonard Cheshire Disability, 2014)

Activity 3

Allow about 10 minutes

Think about some situations in your own life and see if you can recall a time when you used each of the stress responses listed above. Write a sentence about each of them.

Social engagement

Provide your answer...

Mobilisation

Provide your answer...

Immobilisation

Provide your answer...

View comment - Untitled part

A 2015 survey by Direct Line Insurance found the top 10 stressful situations for British people were:

1. Not being able to sleep (46 per cent)

2. Losing your keys (37 per cent)

3. Being stuck in traffic when already late (35 per cent)

4. Losing an important paper or document (33 per cent)

5. Nowhere to park (32 per cent)

6. Printer not working when you need to print something (31 per cent)

7. Running out of battery on your phone whilst out (31 per cent)

8. Discovering you are out of toilet roll whilst on the loo (30 per cent)

9. Dealing with machine operated customer service (26 per cent)

10. Forgetting your bank card when paying for an item (25 per cent)

(Source: Morgan, 2015)

Stress overload

Our bodies can’t always tell the difference between daily stressors and life-threatening events. If you’re stressed over an argument with a friend, a traffic jam on your journey to work, or a mountain of bills, for example, your body can still react as if you’re facing a life-or-death situation.

Many health problems are caused or made worse by stress, including:

list items

list items

- pain of any kind

- heart disease

- digestive problems

- sleep problems

- depression

- weight problems

- auto immune diseases

- skin conditions, such as eczema.

2.3 How to manage stress

The charity Mind has published a booklet, How to Manage Stress (2015). It contains a lot of useful information about living with stress and how to manage it.

Stress isn’t a medical diagnosis so there’s no specific treatment for it, but if you are finding it hard to cope with things in your life and are experiencing stress, there are treatments available that could help. To access most of these, the first step is usually to talk to your doctor.

Sometimes it may help to speak to a trained professional. Talking therapies, such as counselling and cognitive behavioural therapy (CBT), can help you learn to deal with stress and become more aware of your own thoughts and feelings and why you behave in certain ways. Practising ‘mindfulness’ (which we talked about earlier) can help you deal with stress by focusing yourself in the present moment and not worrying about things you can’t do anything about.

Some people find that spending time outdoors in nature can help to reduce stress. This might include outdoor physical exercise such as running or walking, even tai chi, or gardening and conservation projects, alone or as part of a group.

There is no specific medication for stress because feelings of stress are a reaction to things happening in your life. There are medications that can help to reduce or manage the signs of stress though, and your doctor may prescribe antidepressants, sleeping pills, minor tranquillisers or medication to treat physical symptoms of stress such as high blood pressure. Or you might prefer to try alternative therapies such as acupuncture or aromatherapy. These are not normally available from your GP.

3 Work–life balance and professional boundaries

In this topic you will look at the necessity of making time and life away from your caring responsibilities, getting other people involved and the importance of professional boundaries.

You will probably have heard about the importance of work–life balance and how we need to achieve a ‘good work–life balance’ in order to be happy and successful. There are lots of posts, articles and video chats about it online, and we see it on television and read about it in newspapers and magazines. The problem with all this information is that it can make us feel like we are failing if we don’t have everything in check.

But for most of us a perfect work–life balance doesn’t exist! The balance part comes from coping with the ever-changing nature of life and work and this is where looking after yourself plays a big part.

For people whose work involves caring for others, either paid or unpaid, your work is an important part of life – it may help to pay the bills and gives a sense of purpose. Caring for others can be extremely rewarding. It can also be tiring, demanding and painful.

Work, though, is just a part of our lives. For some carers it feeds into every aspect of life, which is why finding a way to balance this part of life with everything else that’s important to us will make us feel more in control and therefore improve our well-being.

3.1 What is a work–life balance?

The answer to this question varies for everyone but basically it’s the amount of time and focus you give your work versus other aspects of life. This is why at the beginning of this topic we said that a perfect work–life balance doesn’t exist!

Of course, many unpaid carers have to fit in paid work around their caring responsibilities, which makes achieving the perfect work–life balance even more of an impossible dream. Naturally, everyone’s priorities change depending on their circumstances and so the balance changes as well.

Activity 4

Allow about 20 minutes

Read and reflect on the case study below before answering the questions that follow.

Case study: Edward’s dilemma

Edward is a marketing manager for a children’s charity. He is not married and lives with his partner, Mark, who works as a self-employed IT consultant. Mark has been experiencing memory loss and mood swings for some time, which the couple thought was caused by stress, but he recently received the news that he had developed early onset dementia and that his condition would deteriorate rapidly. The couple know this will have a huge impact on the way they live their lives and want to be prepared for how they will manage, particularly the end-of-life care that Mark will need.

Edward loves his job and receives a lot of satisfaction from it. But he also wants to be able to care for Mark as his condition worsens and he needs regular care and support. They know things will be difficult for both of them but want to make the most of the time that remains to them in a positive way.

What steps can Edward and Mark take to adapt to the changes in their work–life balance and make sure they are still leading positive and fulfilling lives?

Write a sentence each about:

1. What support do you think Edward might need from his employer?

2. What practical support might Edward and Mark be able to obtain?

3. What can Edward do to retain his feelings of self-worth and value if he becomes a full-time carer?

4. What can Edward and Mark do to make the end of Edward’s caring role and his return to work as positive as possible?

Provide your answer...

View comment - Activity 4

3.2 Unpaid carers

According to the Carers Trust, a charity that works to improve services and support for unpaid carers, there are approximately 7 million carers in the UK, and 1.4 million of them provide more than 50 hours of unpaid care per week. In a survey carried out by the charity, almost half these people sought help only after they were made aware it was available for them.

Anne Roberts (2012), Chief Executive of the UK Carers Trust, said: ‘As this survey shows many unpaid carers have never accessed any support services to help them in their caring role. We already know that many carers simply don’t have any awareness of the kind of help that is out there and what a huge difference it could make to their lives.’

Trying to carry out caring responsibilities without support can lead to serious problems that can affect carers’ working lives and their mental and physical health. Norman’s story is an example of what can happen.

Case study: Norman

Norman had to stop working in 2008 aged 56 to become a full-time carer for his wife, Linda, who has Multiple Sclerosis. He explains: ‘I was struggling with keeping my job going and trying to ensure that my wife was safe enough to allow me to go out to work. The pressure on me eventually led to my own health failing. The stress of trying to manage a challenging job and cope with Linda’s needs led to me ending up in the Cardiac Unit at our local hospital.

‘I was left with no choice but to give up my job and become a full-time carer. The impact of this choice had serious financial implications and this led to depression and a feeling that I had gone from being a person to a resource called “carer”. I was invisible.

‘When I first contacted my local Carers’ Centre, I spoke to a Carer Support Worker and for the first time in many years, there was someone willing to listen to me rather than offering the usual retort of “but it is much worse for your wife because of her illness”. The Carers’ Centre helped me to restore my self-respect and confidence and now I feel proud of what I do to look after Linda.’

(Source: Carers Trust, 2012)

In this topic you have learned that the idea of being able to perfectly balance work and the rest of your life is not realistic, and this can cause people more stress by trying to live up to unrealistic expectations.

What is possible, though, is to seek a better balance in your life, with work and the rest of your life. This will help give you a quality of life that you can manage without making yourself physically or mentally ill. It is not possible to achieve this without help though, and we know now that employees have rights that will support them to achieve this balance. Unpaid carers also have support, although many of them are less aware of the kind of help they can expect.

4 Person-centred care and self-management

Working in a person-centred way and encouraging people to manage aspects of their own care is good for you and for the person or people you are caring for. A person-centred approach to care will focus on the individual’s personal needs and goals, which brings them to the centre of the support they are receiving.

This topic looks at encouraging the people you support to take some responsibility for their own care and management. This is important for their well-being and also gives you some time to enjoy the person you are supporting. Supporting the cared-for person in the way that works best for them leads to better emotional and physical well-being for both parties.

Activity 5

Allow about 10 minutes

Listen to this audio podcast about meeting the needs of Jackie, who has a visual impairment.

This audio is provided for use within the course only.

Audio content is not available in this format.

Living with visual impairment

View transcript - Living with visual impairment

Jackie talks about how she needed not only support but also empowerment from her carers. Try to put yourself in the role of Jackie’s carer, and think about how you would support someone with a visual impairment without making them feel they are losing their independence.

- How do you think Jackie feels?

- What could be done to improve Jackie’s quality of life?

Provide your answer...

View comment - Activity 5

4.1 Providing the right kind of support

People receiving care should have a care plan that has been written by them (if they have capacity), with support from their carers. The care plan will help others to know what care should be provided, but also how to support that person in a way that is right for them.

Activity 6

Allow about 10 minutes

Video content is not available in this format.

Working in an empowering way – it’s too early

View transcript - Working in an empowering way – it’s too early

Watch this video and think about whether Tim was receiving person-centred support.

- Do you think Tim’s carer had looked at his care plan to see what kind of start to his day Tim would prefer?

- How could she have managed it differently?

- How do you think Tim felt?

- What could Tim have done differently?

Make some notes in the box below.

Provide your answer...

View comment - Activity 6

4.2 A different approach to support

Nottinghamshire County Council has developed a scheme called a strengths-based approach. The strengths-based approach is also referred to as an ‘assets-based approach’ in Scotland and has been promoted by the Institute for Research and Innovation in Social Services (IRISS) for a number of years. For example, see the IRISS publication Using an assets approach for positive mental health and well-being.

This type of approach helps to encourage people to become more independent by gradually withdrawing support once the carer can see the person has the skill or strength required to carry out certain tasks independently. This has the benefits of support still being in place as long as the person needs it, while allowing the cared-for person to become increasingly independent and self-sufficient.

In the next activity you will watch a video about Julie, who has mental health problems. Cheryl, from United Response in Nottinghamshire, supported Julie in her efforts to achieve a high level of independence. Julie wanted this independence so that her daughter Leanne, who had been caring for her, could move away from home.

Activity 7

Allow about 20 minutes

Video content is not available in this format.

Care Act – Promoting independence

View transcript - Care Act – Promoting independence

As you watch the video, think about what Cheryl did to enable Julie to take the steps towards independence. Make a note of your thoughts.

Provide your answer...

View comment - Activity 7

5 Where to find support

There are many online support services giving information and guidance on different ways to manage stress, such as Mind. Mind also provides a translation service – language line – for support in languages other than English.

Online communities such as Big White Wall and Elefriends are helpful and provide support for people who are finding it hard to cope. These online communities are completely anonymous, which allows people to speak openly in confidence.

Local authorities now have ‘living well’ and well-being services – online and in the form of leaflets and related information, support groups, workshops and courses. You can find more information online, for example on the NHS Wellbeing website, or through your doctor, local library, Citizens Advice Bureau or local council offices. These places will also be able to provide you with information about other local community groups and support if you prefer an offline approach.

Time to Change is an organisation that challenges mental health stigma and discrimination. It also provides information on stress and workplace well-being for employers and employees.

You heard from Norman about the support he received from the Carers Trust. There are other organisations like this, such as Care UK, who also offer support and guidance.

Activity 8

Allow about 15 minutes

Search online for five well-being support groups.

List them here and write a short statement about what they do.

If you would rather not go online where else can you seek support?

Write down three places you could go to for support.

View comment - Untitled part

Key points from Section 5

In this section you have learned:

- why it is important to look after your own well-being and that of the people you care for

- some strategies for coping with stress and to understand that not all stress is bad for you

- that a healthy work–life balance and establishing boundaries is important for your physical and emotional well-being

- more about person-centred care and self-management

- where you can find support.

The ‘Next Steps’ section provides you with the opportunity to reflect on what you have learned on this course and to consider what you would like to do next. It will also give you information about options available to you for further learning.

Further information (optional)

Stress symptoms, signs and causes: this article from HelpGuide contains information on the signs and symptoms of stress and some suggestions on how to cope with stress and stressful situations.

If you are employed as a carer, you have certain rights to help you achieve a good work–life balance, such as flexible working, time off work for emergencies involving dependants, shared parental leave and paid annual leave. The Working Families website has lots of information to help working families achieve a healthy work–life balance.

A Pocket Guide for Employees: Balancing Work and Being a Carer: this is a guide written by Liz Morris with Susanne Jacobs for Working Families (2012). The guide offers practical help and support to enable carers to balance paid work with their caring responsibilities.

Section 5 quiz

Well done, you have now reached the end of Section 5 of Caring for adults, 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 ‘Looking after yourself’ section (plus you get more than one try!).

- I would like to try the Section 5 quiz to get my badge.

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.

I’ve finished this section. What next?

You can now choose to move on to Taking my learning further where you can reflect on what you have learned and find suggestions of further learning opportunities.

If you have not done so already, you might like to visit one of the other sections so you can continue collecting your badges.

We would love to know what you thought of the course and how you plan to use what you have learned. Your feedback is anonymous and will help us to improve our offer.

- Take our Open University end-of-course survey.

References

Carers Trust (2012) New Charity Finds Many Unpaid Carers Battle for Years without Help [online]. Available athttps://www.carers.org/press-release/new-charity-finds-many-unpaid-carers-battle-years-without-help (accessed 15 March 2016).

Leonard Cheshire Disability (2014), ASPIRE Management Development Training Course, London, Leonard Cheshire Disability.

MIND (2015) How to Manage Stress [online]. Available at http://www.mind.org.uk/media/1993364/how-to-manage-stress_2015.pdf (accessed 15 March 2016).

Morgan, M. (2015) ‘Sleepless nights, being stuck in traffic and running out of loo roll WHILE on the toilet: The top 10 everyday things that Brits find most stressful revealed’, Daily Mail, 10 April [online]. Available at http://www.dailymail.co.uk/femail/article-3030649/Top-10-everyday-things-stress-Brits-revealed.html (accessed 15 March 2016).

Morris, L. and Jacobs, S. (2012) Working Families: A Pocket Guide for Employees – Balancing Life and Being a Carer [online]. Available at http://www.lse.ac.uk/intranet/staff/humanResources/pdf/Balancing-work-and-being-a-carer.pdf (accessed 15 March 2016).

NHS (2016) Five Steps to Mental Wellbeing [online]. Available at http://www.nhs.uk/conditions/stress-anxiety-depression/pages/improve-mental-wellbeing.aspx (accessed15 March 2016)

Acknowledgements

This free course was written by Frances Doran (Operations Training Supervisor at Leonard Cheshire Disability) and John Rowe (Lecturer 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.

Text

Section 2.2: Text extract from Morgan, M. (2015) ‘Sleepless nights, being stuck in traffic and running out of loo roll WHILE on the toilet: The top 10 everyday things that Brits find most stressful revealed’, Daily Mail, 10 April

Section 3.2: Extract from Carers Trust (2012) New Charity Finds Many Unpaid Carers Battle for Years without Help [online]. Available at https://www.carers.org/press-release/new-charity-finds-many-unpaid-carers-battle-years-without-help

Audio

Activity 5: Audio and transcript © The Open University

Videos

Activity 1, Part 1: Video and transcript: http://www.nhs.uk/video/Pages/five-steps-to-mental-wellbeing.aspx?searchtype=Search&searchterm=wellbeing&offset=1& NHS Choices © Department of Health

Activity 6: Video and transcript courtesy © Leonard Cheshire Disability, https://www.leonardcheshire.org/

Activity 7: Video and transcript courtesy © Nottinghamshire County Council, http://www.nottinghamshire.gov.uk/

Activity 1

Part 2

Comment

You may have written:

- Get out and about a bit more in my neighbourhood and greet the people that I meet.

- Connect more with family and friends by telephone or email as I don’t see them often.

- Learn a new skill or take up a hobby (it doesn’t have to be expensive and you can get information about groups or classes at libraries and community centres, or online).

- Volunteer with a charity.

- Think of the good things that have happened each day – this is a step on the way to mindfulness. Being ‘mindful’ does not happen overnight but with practice many people find this a useful way to improve their emotional well-being.

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Activity 2

Comment

The people you care for may struggle to get in touch with their local community because they find communication difficult or they worry that people will not accept them because of disability or other conditions that they find socially disabling.

They may be inhibited from learning new things because they have told themselves, or been told by other people, that they cannot learn anything new, and they may have got used to a life of inactivity.

Becoming more involved with their community will help the people you care for to see that there are many ways to become ‘tuned in’ to what is going on around them and to help others in lots of ways, big and small.

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Activity 3

Untitled part

Comment

While social engagement is probably the healthiest response to stress, it’s not always possible to respond in this way. Many of us have become conditioned to responding to every stressful situation by going straight into ‘fight or flight’ mode, which over time can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, speed up the ageing process and leave you vulnerable to mental and emotional problems.

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Activity 4

Comment

1. Taking time out from work and flexible working

Becoming a carer no longer means an ‘either or’ decision between working and caring. In many situations it is possible to do both if you want to.

These are some of Edward’s options for time off from work, or changing how he works to enable him to continue working as well as caring:

- emergency time off for a dependant

- flexible working

- compassionate leave

- unpaid leave

- career break/extended unpaid leave.

2. Practical help with caring

Practical help is essential for Edward to be able to look after his own well-being and to find the energy to continue caring. Practical help includes having a carer’s assessment, which will look at Edward’s role as a carer and what he needs to be effective, including how caring impacts his work. This is obtainable from local social services departments.

Mark may be eligible for community care if he needs help with day-to-day living such as mobility, cooking, washing or getting dressed.

Family and friends will want to help Edward and Mark but may not know what to do. They should ask for help with specific practical things, such shopping or cooking, and this will help people know what support to offer.

Mark and Edward could contact organisations such as the local carers’ centre, or Carers UK. They could contact dementia charities or their local church, mosque or synagogue if they have a religious faith.

3. Edward’s well-being

Edward will need to take care of his own well-being if he is to become Mark’s full-time carer eventually. Taking regular breaks will help him to keep his emotional balance and remain strong. Of course, being a full-time carer doesn’t always mean you cannot work, and once his caring duties settle down Edward may decide to think about how he can balance his career with his caring role. Edward’s career is important to him and gives him a sense of connectedness, intellectual satisfaction and a feeling of being able to influence and being valued. Understanding these needs will help him design a positive work–life fit for himself and Mark.

4. Life and end-of-life planning

Edward’s caring role will eventually end, as Mark’s condition will either worsen to the extent where he can no longer be cared for at home or his life will end. While Mark still has capacity he will be able to make plans and decisions about his wishes for the future and his future care. He and Edward will need to be flexible enough to make the most of the good times, especially as they get less frequent. When this stage is reached, Edward will need to cope with this drastic change, and manage his return to work. Depending on the circumstances, Edward will be able to phase his return to work over a period of time that again takes into account his needs and enables him to re-establish his work–life balance.

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Activity 5

Comment

Jackie was worried about not having a diagnosis for her condition, and felt that the healthcare team would not notice her symptoms. Her carer would need to remain supportive and attentive, asking her to speak about how she was feeling and what support she needed.

Jackie talks about the balance between allowing a person the independence to carry out everyday tasks, and supporting them to do so. Jackie’s independence is important to her so you would need to think of ways to make her feel independent, such as helping her to find out about aids to enable her to carry out tasks on her own, but still being on hand to offer support should she need it.

Jackie may benefit from assistive technology to improve her quality of life, such as a large keyboard or talking telephone, books in large print or Braille. Assistive technology is covered in Section 4 of this course; see Topic 2, ‘Promoting independence’.

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Activity 6

Comment

Tim’s carer was not working in a person-centred way. She did not consider his privacy when she entered the room without knocking or checking to see whether he was ready to get up.

When Tim asked for ‘another five minutes’ she could have gone to see if the next person was ready to get up and come back to Tim afterwards.

She could also have asked Tim what he wanted to do about his breakfast – perhaps he could have had it in his room if he wanted to stay in bed.

Also, she didn’t need to get his clothes out for him. Tim could have told her what he wanted to wear when he was ready to get dressed.

The carer’s actions shown in the video would have made Tim feel helpless about everyday decisions about his own life being taken out of his control. There wasn’t much Tim could have done at that moment because the carer was not listening to him – she was just focusing on getting through her tasks of getting people up and ready for breakfast. But Tim could have arranged to have a ‘please knock’ sign put on his door for a start, and he could also have put into his care plan that he liked a lie-in in the mornings so that he could be left longer before care staff got him out of bed.

Having some control over our own lives is vital for our well-being.

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Activity 7

Comment

The first thing that Cheryl did was to establish a relationship with Julie by finding out what was important to her and what she could already do. Cheryl then built on these foundations to give Julie the confidence that she could manage certain activities independently. These initial steps helped Julie to gain the self-confidence and self-esteem to take further and more difficult steps.

Both women acknowledged that there was a long road ahead but that it couldn’t be rushed. As Cheryl worked with Julie, she would be able to gradually withdraw the level of support and Julie would do more and more for herself.

It was evident from the video how much this has increased Julie’s well-being and that of her daughter, who was also working towards her aim of being able to leave home.

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Activity 8

Untitled part

Comment

It is relatively easy to search online for all kinds of support – both for general well-being and for support for specific conditions. It is not so easy to begin to seek out support without the aid of the internet but your doctor would be a good place to start, as would a Citizens Advice Bureau, local council office or public library.

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Uncaptioned interactive content

Transcript
Five steps to mental well-being
[MUSIC PLAYING]

WOMAN 1:

There are five steps we can all take to improve our mental well-being: connect, keep learning, be active, give to others and take notice. Here are just a few examples of how people fit these steps into their daily lives.

WOMAN 1:

Connect.

MAN 1:

Joining the local football team has helped me to meet people and has made me feel more part of my community.

WOMAN 1:

Keep learning.

WOMAN 2:

I’ve just started learning to play a musical instrument and, as well as being really fun, it’s really rewarding when you manage to get a new piece right.

WOMAN 1:

Be active.

MAN 2:

I’ve got two left feet but I still enjoy dancing. It energises me and it puts me in a good mood.

WOMAN 1:

Give to others.

MAN 3:

If I know a friend’s having a hard time, I’ll make an effort to check up on them regularly and see how they are.

WOMAN 1:

Take notice.

WOMAN 3:

I find cooking so calming, as I’m totally focused on what I’m doing. I switch off from the day’s stresses and it also allows me to express my creative side.

WOMAN 1:

Lots of activities fulfil more than one of these five steps. For ideas and inspiration about what you can do, go to www.nhs.uk/fivesteps.

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Living with visual impairment

Transcript
Living with visual impairment: nurse support

JACKIE

I needed the nurses to comfort me, which sounds quite a strange term to use. I wanted sympathy, which again is not a term that you would often use with anybody with an impairment or a disability, but because I was so, I’ll say ill at that time, I just needed somebody to look after me. I also needed the nurses to believe in me because sometimes with this type of impairment it is not visible to the other person – I can only describe and explain what I’m seeing or feeling or hearing etcetera – and when you haven’t got a diagnosis as such, as I hadn’t at that time, you haven’t got anything to hang it on so I needed the nurses to believe what I was saying and to comfort me and to calm me.

Independence to anybody with any type of impairment is extremely important but the road to independence is quite long and arduous. At the beginning you are mostly dependent on people and you do need that sympathy, you do need that support and you do need that help to get through the initial symptoms of what you are experiencing. As you learn to live with the impairment, then you need to be able to take control of your life and this is where nurses can play a big role, by being able to give the power to the person with the impairment. It’s very easy to want to do things for people but that's not actually helping anybody in the long run; you need to enable that person to do things for themselves. You talk to them, you ask them what they want to do, you ask them what they think they can do for themselves and you try and just push them a little bit more each time. But again you have to be very clever here and you need to note when that person needs to stop, they need to just pull back a bit and they need some support. So for a nurse it is very difficult here because you don’t know how a person is going to be. You don’t know exactly how much dependence and independence he or she might need at any particular time so you have to read that person on not only a day-to-day basis but perhaps an hourly basis at some times when there are certain things going on, but promoting independence is one of the main roles that a nurse can provide for somebody with impairment.

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Working in an empowering way – it’s too early

Transcript
Working in an empowering way – it’s too early

COWORKER

So how are you? I’ve not seen you for ages.

ANN

Oh, I’m fine. Thanks.

COWORKER

Oh, yeah.

ANN

Yes. I’ve just had a few days off.

COWORKER

All right.

ANN

Just stayed at home, relaxing.

COWORKER

Yeah. Yeah.

ANN

Yeah.

COWORKER

Are you in this weekend?

ANN

Yes. I’ll see you this weekend.

COWORKER

Oh.

ANN

I’m just going to get Tim up.

COWORKER

All right, then. See you later.

ANN

See you. Morning.

TIM

Morning.

ANN

Time to get up.

TIM

What time is it?

ANN

It’s after 8:00.

TIM

8:00 o’clock?

ANN

Yes, it’s early.

TIM

It’s too early.

ANN

No. Your breakfast is ready downstairs. The kitchen staff have got everything.

TIM

I’m not bothered about any breakfast. Can I just have a bit longer?

ANN

I’ll just get you some nice clothes. You’ve a nice shirt here.

TIM

But I wore that yesterday. Couldn’t I have some shorts on?

ANN

No. It looks nice and clean. I’ll just leave those there a minute. So you get yourself awake, and I’ll be back shortly.

TIM

What do you mean?

[SIGHING]

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Care Act – Promoting independence

Transcript
Care Act – Promoting independence
Strength-based approach

Taking a strengths based approach – seeing the individual

Julie has mental health difficulties. Her daughter Leanne, a young carer, wanted to move out of home. Julie was assessed by a social worker and offered support from United Response, one of a number of support providers within Nottinghamshire. Julie was introduced to Cheryl, who took a strength-based approach to working with her.

When Cheryl met Julie she

had low self confidence

could not do her own shopping

could not manage her money

didn’t get much exercise

was not developing her art work

was becoming isolated.

[MUSIC PLAYING]

CHERYL PLATTS

I’m Cheryl Platts. I work for United Response, and I support people within their own homes to stay as independent as possible. And I began supporting Julie approximately two years ago. She’s a lady with mental health problems. She lives in her own home and has brought up a family.

JULIE UNDERWOOD

My name is Julie Underwood, and I’ve been having help from Cheryl from Assertive Outreach for the last two years.

LEANNE BETTS

I moved out of home just over two years ago, when Cheryl first started supporting my mum.

CHERYL PLATTS

We spent time getting to know each other and to see what her strengths were and where we could build upon them strengths. Julie needed to build upon her confidence quite a bit. But she already had them strengths within her. It was just about finding the best way to get the strengths out of her.

JULIE UNDERWOOD

Because Leanne was moving out and going to her own home, and she wanted to lead her own life, after being a young carer and looking after me for a number of years. Cheryl came to help with the shopping. She also helped me very much with my confidence and made me more outgoing.

LEANNE BETTS

You used to have panic attacks sometimes, didn’t you?

JULIE UNDERWOOD

Yeah.

LEANNE BETTS

Yeah, she used to get very worked up, and she just wouldn’t be able to cope with it. So I just did it for years and years. So she needed someone else to actually step in.

CHERYL PLATTS

It’s really important to actually get to know that person. So for me to get to know Julie, what her likes are, what’s important to her, and not look at the problems that she’s got.

JULIE UNDERWOOD

I chose Cheryl because I was just attracted to her, and we made a connection straight away.

CHERYL PLATTS

She told me all about her family and the things that really meant a lot to her, so we could make conversations about them.

JULIE UNDERWOOD

And we were discussing art, and we were discussing things I’d like to do for the future, and things I’d like to build on. I think Cheryl picked upon some of my inner strengths and my weak points, helped me with my weak points, and built upon the strengths, and the things that I did have going for me.

CHERYL PLATTS

It’s made Julie feel like a person. She knows that I’m there to help her and not help the problem that she’s got. So it has built up her confidence to be able to know that she can go and do her shopping.

JULIE UNDERWOOD

I can pay all the bills. I’ve lost half a stone in weight over the last few weeks by going swimming.

CHERYL PLATTS

The strength-based approach that we are taking enables Julie to make sure she’s got them links with her family and the neighbours, especially. So if Julie does feel that she’s having a bad day, or if something happens in Julie’s life where she would need some more support from people, rather than her having to call the emergency services or calling some crisis team, she now has them connections and the confidence to be able to pick up a phone, to speak to a family member, to pop round to the neighbours, to gain that help from them before it gets to that crisis point.

JULIE UNDERWOOD

I knew I’d be able to cope. And I knew I had that organisation to fall back on if anything did go wrong.

CHERYL PLATTS

Once we can see that a particular activity or a particular skill is working well for them, I might just drop one little part of that skill or that task that I’ve been doing and encourage them to do it for themselves.

Other organisations could use this way of working because we found that it works really well for us. We strive on being person-centred. We use a number of tools around that to make it work

LEANNE BETTS

It’s support needs, not care needs. And they sound like the same thing, but actually they’re not. If you’re meeting someone’s basic care every moment, you’re doing things for them. But necessarily, people might see that as doing the right thing, where actually, it’s not.

CHERYL PLATTS

Now Julie’s made them connections she feels more confident in herself. So, eventually, we will look at pulling out the support gradually over time. And then we can use our resources with other people that need the help.

[MUSIC PLAYING]

Because of the strength-based approach Julie is now more independent. She

has friends and neighbours she can call on in an emergency

does her shopping with Cheryl’s support and is working towards doing this alone

manages her own money

goes swimming

shares her art work with other people and is working on producing her own book.

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