a balance between a duty of care and physical intervention

[becky]

Just wondering how you would respond to the following scenario:

You have a client who requires personal care quiet quickly. The problem is this client will become agitated and physically agressive when you try to encourage then to wash/changed. The clients skin is in poor condition can regularly breaks down to the increased aggitation the client when staff are trying to assist. The clients condition will get worse if they dont intervene, but intervening will mean potentailly using a physical skill as distraction methods have failed.

What would you do?

[Hans]

Hi Becky

I don´t know whether it is tried, but at a service here in Denmark they have a similar problem, just with toothbrushing. The way they came around it, was by brushing the clients teeth 4 - 6 times to get all the teeth, because thats the way the client can cope with it and without using physical intervention. But it seems to me, that the client you describe will already get anxious, as they start to encourage him/her. could it be possible to look at how they encourage him/her, what kind of informations do they give him/her, are the different settings it can be possible to wash the client, e.g. swimming time. Seen from my perspective it is either to find the way so that it is possible for the client to cope with it or to find out whether it has some sensory issues and if it is sensory issues there can be other ways of working with it.

This question is quite normal at courses, because we/people get caught in, what we will call caring for the other person and of course there is a limit of how much self-injury og personal deprivation we should be witness to, but as I see it the issue often is that caretakers haven´t thougth other ways of solving the "problem" and therefore use what I call the ethical apologie to solve a difficult situation.

At a course once I had a person who had knitted a blouse for a client with closed arms, so that she wouldn´t hurt herself, and i asked me whether that was legal! It´s not far from a straight-jacket! But she thought she was helping the client, because the client hit her self hard in the head or bit her finger to bleed.

Hans

[becky]

Thanks Hans for your comment.

Its interesting how just being objective about a situation can bring up a way forward. Once you debrief staff and give them a few low arousal tips then actually what was percieved as a very challenging situation can change instantly into a more positive one. When staff feel supported and can discuss there worries and concerns, they can then find a way forward.

[Hans]

Hi Becky

No doubt taht by debriefing the staff it will help them to act more proffesional, but my experience is that sometimes they need to fully understand what they are doing with the client. I still get astonished by the thought, that because a person has a disability we can treat that person different that another person without a disability. Lets take food for an example. I recently did a course on autism and food. There were lot of the staff membars that meant that the children they worked with had to eat what was served, because they needed the nutricition. I pulled out the famous question about their own manor of eating and hat they liked or disliked, and how they would feel is someone forced them to eat something they disliked, because it was good for them. As often before it worked.

But it seems that it is a normal neurotypical thinking, that because we know better others have to suffer!

Hans