HOLLOWAY PAYNE Best Practice for Working with Caregivers ... ?? Imagine how you would like a caregiver to treat a close relative ... • Ask open‐ended ... HOLLOWAY PAYNE Best Practice for Working with Caregivers 2011.ppt

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<ul><li><p>Working with Informal Caregivers for FrontCaregivers for Front </p><p>Line Workers: Guidelines for Best </p><p>PracticesPractices </p><p>June9,2011Lori Holloway Payne Director PSNOLoriHollowayPayne.DirectorPSNO</p><p>lori.payne@ocsa.on.ca</p><p>1</p></li><li><p>AboutPSNO</p><p>ThePersonalSupportNetworkofOntarioisadivisionofppOCSAwhichstrivestohelppersonalsupportserviceprofessionalscarryouttheirworkmoreeffectivelyby</p><p>offering access to information resources and tools as wellofferingaccesstoinformation,resourcesandtoolsaswellasprovidingopportunitiestoconnectwithanetworkof</p><p>professionalsinthefield.</p><p>PSNOsvisionistobuildastrong,cooperativepersonalsupport service sector where providers managerssupportservicesectorwhereproviders,managers,trainers andemployees areequalcontributorsto</p><p>strengtheningtheprofession.</p><p>2</p></li><li><p>Agenda</p><p> UnderstandingtheRoleandscopeofpracticeofg p pPersonalSupportWorkers</p><p> UnderstandingthePrinciplesofTherapeuticR l ti hiRelationships</p><p> UnderstandingtheRoleofPersonalSupportWorkersinTherapeuticRelationshipsp p</p><p> PhasesofTherapeuticRelationships StrategiesforImprovingCommunicationinTherapeutic</p><p>Relationships Discussion,Scenarios,VideoTestimonials</p><p>3</p></li><li><p>WhatandWhoDeterminesWhatAPSWMay DoMayDo</p><p> Legislationg Employer Training CurrentExperience</p><p>4</p></li><li><p>Regulation&amp;PSWs</p><p>ManyhealthprofessionalsinOntarioareregulatedy p gunder RegulatedHealthProfessionsAct Defineswhichprofessionsareregulated</p><p> 26professionsinOntario</p><p> Establishescontrolledacts</p><p> Criteriaforexemption</p><p> Setsoutrequirementsforeachprofession'sregulatorycollege</p><p>5</p></li><li><p>Regulation&amp;PSWs</p><p>Professionalregulatorycollegesareresponsibletog y g pset Practicestandards</p><p> Educationalrequirements</p><p> Publicinformation</p><p> Complaintanddisciplinaryprocedures</p><p>PersonalSupportWorkersarenotregulated</p><p>PSW Registry is coming..6</p></li><li><p>PSWRole&amp;Accountability</p><p> TheRegulatedHealthProfessionsAct onlyidentifiestheactsthatanonregulatedhealthprofessional(suchasaPSW)cannot do orcanonlydoinspecificcircumstances</p><p> Under Common Law all PSWs must act responsibly and UnderCommonLaw,allPSWsmustactresponsiblyandexercisedutyofcare inallacts</p><p> Therearealsotheethicalobligationstoavoidharmandpromotegood</p><p>7</p></li><li><p>ScopeofPractise</p><p> PSWsdowhatapersonwoulddoforhimorherselfifpphysicallyand/orcognitivelyablethatareusuallynotcontrolledacts</p><p>PSWsmayperformcontrolledacts,onlyifroutineforthepersonh l dtheemployerpermits,andaspecifictrainingprocedureis</p><p>followed</p><p>8</p><p>followed</p></li><li><p>WhatDoPSWsDo?</p><p>According to the Provincial Role StatementAccordingtotheProvincialRoleStatement Dependsupontheindividualneedsofeachpersonyou</p><p>support Caninclude</p><p> Homemanagement Personal care Personalcare Familyresponsibilities(routinecaregivingtochildren) Work,socialandrecreationalactivities</p><p>9</p></li><li><p>Work,Social&amp;Recreational</p><p> The PSWs role includes assisting the person toThePSW sroleincludesassistingthepersontoparticipateinsocialandrecreationalevents,including accompanyingtheperson assistingwhilethere</p><p> APSWmayalsosupportapersonatthepersonsworkplace</p><p>10</p></li><li><p>Therapeutic Relationships</p><p> TherapeuticRelationshipPhilosophyp p p y ReviewPhasesoftheTherapeuticRelationship ReviewPhasesoftheNonTherapeuticrelationship</p></li><li><p>Philosophy</p><p> TheCaregiver/clientrelationshipisestablishedandd b h h h h f k l dmaintainedbythePSWthroughtheuseofknowledge,</p><p>skill,caringattitudesandbehaviors.</p><p> TheCaregiver/Clientrelationshipisbasedontrust,respect,andunderstandingoftheclient.Thetherapeuticrelationshiprequirestheappropriateuseofpower.</p><p> TheCaregiverengagesinreflectivepractice/selfawareness.</p></li><li><p>Philosophy</p><p> Establishmentofatherapeuticrelationshiprequiresreflectionofcare.Thisconceptincludesthecapacitiesof: selfknowledge,g awarenessofboundaries, limitsoftheprofessional/clientrelationship, empathyempathy, selfdisclosure, selfawareness</p><p>13</p></li><li><p>UnderstandingtheRoleofPersonalSupport Workers in TherapeuticSupportWorkersinTherapeutic</p><p>Relationships</p><p>14</p></li><li><p>15</p></li><li><p>Barriers</p><p> PSWs struggle to understand their rolegg</p><p> Little common understanding of where the role is going</p><p>Lack of appreciation for personal support services as Lack of appreciation for personal support services as essential to improving the quality of life for clients residents, and especially informal caregivers</p><p> Lack of interdisciplinary collaborations, d t di f th t ti t tunderstanding of the expectations, trust</p><p>16</p></li><li><p>Therapeutic Relationships </p><p> Highly intimate care</p><p> Delicate balance between professional boundaries pand fostering the therapeutic relationship between staff, client and caregivers</p><p> Strong personal connection makes for better care, quality experience for clients</p><p>17</p></li><li><p>Therapeutic Relationships </p><p>Negative side:</p><p> Strong relationships fosters dependencyg p p y</p><p> Lack of flexibility</p><p> Frustration for client</p><p>l k i d l i h b d PSWs lack ongoing support to deal with boundary issues, grief and loss</p><p>18</p></li><li><p>Phases of the Therapeutic RelationshipRelationship</p><p> 5 Phases 5Phases</p><p> MutualWithdrawal Grappling Orientation WorkingPhase ResolutionPhase</p></li><li><p>Mutual Withdrawal</p><p> Mutualwithdrawal: Bothclientandcaregiversavoidcontactand</p><p>appointments Therelationshipissuperficialconversationandlack</p><p>ofcommitment</p></li><li><p>Grappling</p><p> Grappling:pp g Bothclientandcaregiversarefrustratedtrydifferent</p><p>approachesbutdontgetanywhere Clientandcaregiverdreadmeetings</p></li><li><p>Orientation</p><p>Orientation: Bothclientandcaregiverareengagedinlearning</p><p>abouttheirroles Therelationshipischaracterizedbyexplorationof</p><p>possiblecareplansandactivities</p></li><li><p>Working Phase</p><p>Workingphase:(Identification Exploitation)g p ( p ) Clientworkingonbeingindependentcompetentand</p><p>developingnewskills Thecaregiverassistswithdecreasinganxiety,</p><p>meetingtheclientsneedsastheyariseandmovingtheclientforward</p></li><li><p>Resolution</p><p>ResolutionPhase: Clientnolongerneedssupportfromthecaregiver Client'smovestowardnewgoals Thehelperconnectstheclient'swithcommunity</p><p>servicesandterminatesrelationship</p></li><li><p>Communication Strategies for PSWs that Strengthen Therapeutic Relationships</p><p>25</p></li><li><p>Communication Strategies for PSWs that Strengthen Therapeutic Relationships with CaregiversCaregivers</p><p> Imaginehowyouwouldlikeacaregivertotreatacloseg y grelativeandthenmodelyourbehavioraccordingly</p><p> Introduceyourselfbyname(firstname)andyourrole Usetheclientspreferredname Makeeyecontact,whenculturallyappropriateandbe</p><p>aware of your body languageawareofyourbodylanguage Recognizeyouarenottheretoreplacethefamily Askabouttherolethefamilywantsyoutoplayy y p y Understandtheymayhavebeentoldyoucandothings</p><p>thatyoucant AskyourSupervisorforsupportexplainingthingstothe</p><p>family26</p></li><li><p>Communication Strategies for PSWs that Strengthen Therapeutic Relationships with li tclients</p><p> Askopenendedquestionstoencouragemorethatyesp q g yornoresponses</p><p> Listenactivelyandshowinterestinyourclients Inquireintounusualcommentsorbehaviours Understandyourclientscareneedsandgoals Provide sufficient information for clients to make choices Providesufficientinformationforclientstomakechoices</p><p>andhaverealisticexpectations Collaboratewithclientstofindbestsolutionstoanyy</p><p>problems Followthroughonyourclientscommitmentsandnotify</p><p>li t f h i ticlientsofanychangesinroutine Reflectregularlyonhowyourclientsperceiveyou</p><p>27</p></li><li><p>Ideas to improve the client and caregiver experiencecaregiver experience</p><p> Moretimeforreflectivepracticep</p><p> Moretrainingintherapeuticrelationshipsandcommunication</p><p> Invitation to participate/inclusion as part of the team Invitationtoparticipate/inclusionaspartoftheteam</p><p> Deeper understanding of their role and role boundariesDeeperunderstandingoftheirroleandroleboundaries</p><p> Supportforgriefandloss</p><p>28</p></li><li><p>Supporting PSWs</p><p>Howyoucanhelp:y p Leadershiptomakechangehappen Recognition/awarenessoftheroleandcontributionto</p><p>caregiversupport Providermoreeducationandtrainingonhowtodealwith</p><p>caregivers and familiescaregiversandfamilies Familiesneedmoreeducationtounderstandwhatis</p><p>happening</p><p>29</p></li><li><p>Video testimonials</p><p> Keeping the home in Home Carep g Keeping the home in home care is a research </p><p>project is funded by Saint Elizabeth Health Cares (SEHC) C t K C t d th C di(SEHC) Care to Know Centre and the Canadian Health Services Research Foundation. The goal of the project is to improve home care clients experience of personal support services.</p><p>htt // i /15889434http://vimeo.com/15889434http://paulholyoke.ca/?p=264</p><p>30</p></li><li><p>Test Your Knowledge of Professional BoundariesBoundaries</p><p>Josie works in the community and had provided y pcare to Mrs. Zakia for several years until another agency took over the care. Josie still keeps in contact with Mrs Zakia and visits occasionallycontact with Mrs. Zakia and visits occasionally because she feels that Mrs. Zakia is very isolated without regular caregiver support. During these visits, Josie criticizes the care that Mrs. Zakias new care giver Hanna, is providing. This upsets Mrs. Zakia, leading her to check with the doctor and her , gcase manager several times. Each time Hannas care is found completely satisfactory. Mrs. Zakia has mentioned to Josie that while she appreciateshas mentioned to Josie that while she appreciates her visits, Josie does not have to check up on her so frequently. 31</p></li><li><p> Has Josie crossed a professional boundary in p ythis situation?</p><p>Y J i i b i th i h t iYes Josie is abusing the power inherent in the therapeutic relationship</p><p>No Josie is simply acting as a friend to Mrs. Zakia</p><p>What would you do in dealing with this situation?situation?</p><p>32</p></li><li><p>Questions and Discussion </p><p>33</p></li><li><p>Resources </p><p>1. Caregiver support best practice guideline, VON 2004http://www.von.ca/english/Caregiving/CaregiverManual/Guideline/CaregManual_Guidelines.pdf</p><p>2. Centre for Addiction and Mental Health Family Centred Care Initiative2. Centre for Addiction and Mental Health Family Centred Care Initiative "Putting Family Centred Care Philosophy into Practice" and Caring Together" http://www.camh.net/Care_Treatment/Community_and_social_supports/Social</p><p>3 C di M t l H lth A i ti 2002 S ti S i M t l3. Canadian Mental Health Association, 2002 Supporting Seniors Mental Health through Home Carehttp://www.cmha.ca/data/1/rec_docs/158_smhhc_polguide.pdf</p><p>4. Alzheimer's Society of Canada, 2011 "Guidelines for Care: Person-centred care of people with dementia living in care homes,"http://www.alzheimer.ca/english/care/guidelines-care-intro.htm. 5 S i t Eli b th H lth C t k t htt // t k /5. Saint Elizabeth Health Care, caretoknow centre, http://www.caretoknow.org/</p><p>34</p></li><li><p>KeepupwithPSNObyvisitingourwebsite:www.psno.ca</p><p>LoriHollowayPayneDirector PSNODirectorPSNO</p><p>35</p></li></ul>

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