Job role and Accountability

“Here we will explain to you your job role and accountability. We will inform you of what to expect of your employer and what they should expect of you. We will highlight the importance of working within your job role and how to fulfill your duty of care.”

A health care professional is trained, is very well educated and skilled. The role of a health care professional is an extensive role that combines many skills and qualities not everyone has. Each role within the health and social care sector differs slightly and what may suit one person may not suit another. Understanding your own strengths, likes and interests can help you choose a role and support your long term development and retention in that area.

Your role.

As a health care assistant, you are responsible for those in your care, that not only covers the individual receiving the care but the other staff members you may be working with, any visitors who enter the building or service personnel such as deliver drivers or paramedics. 

You have a duty to provide care in a dignified manner with out prejudiced. You must remain transparent, holistic and confidential at all times. You must encourage individuals to lead as active and independent lifestyle as possible. You must know when to apoligise for accidents, because they will happen at some point in your career. Health care assistants are the first to spot any signs of changes within the individual(s) you care for, you must be vigilant and assess risks and hazards daily. Any changes or risks to the individual or staff must be reported to the line manager or nurse on duty. 

Listed are some duties below. You have the right to ask your employer for your job role description at any time, we recommend doing this during the interview process and always question anything you feel you haven’t been trained enough on or at all, or if you feel the duties don’t reflect the role at all, raise your concerns in writing to your line manager and ask for a review of the job description.

Soaking up life

You will be expected to provide some level of personal care, this will include: washing, dressing and undressing,  brushing teeth, hair, applying makeup, creams and filing finger nails. Maintaining catheter care, stoma care. Changing of continence aids including pads. Being aware of skin conditions and noticing any physical changes.

Taking to and from personal appointments such as: Hairdresser and chiropodist, supporting daily routine and promoting quality of life. Arranging family visits and documenting all communications and appointments had.

Each individual you care for will have a plan in place to explain their preferences when washing and dressing some may want a shower or bath where others may want to stand at the sink or sit on a commode. You may also have to wash somebody in bed this is referred to as a ‘bed bath’ and will normally require two people to assist, when manual handling is required, to roll or reposition an individual to provide all round complete care.

Washing and dressing an individual will mean that you will see the entire body, for an elderly person this in an extremely vulnerable situation, best practise, we promote, to keep the individuals dignity in mind at all times, draw curtains, close doors and offer extra towels to cover laps and chest areas while washing other parts of the body.

During the washing process it is best practise to keep in mind to be vigilant about any changes within the skin surface any new bruising or marks must be reported immediately to the team leader or line manager. If a bruise or pressure area is left unattended it can turn into an ulcer or ‘bedsore’ which can become extremely vulnerable and require dressings from a nurse or district nurse.

As health care assistants we must continue to promote independence to give the individual as much chance to do what they can for themselves for as long as they can, promoting physical movement, hand eye coordination, orientation and decision making.

Dining with herself - Tony Luciani. Photo subject to copyright

Providing the right amount of fluids and good nutritional meals at the right intervals can promote good physical and mental health. Regularly timed meals will support an individual’s routine, time keeping, daily planning and orientation. Good intake of fluids can reduce confusion, lower the risk of falls, lower the risk of a UTI. Each individual within the care setting will have a care plan clearly outlining their requirements, allergies, preferences, likes and dislikes. An individual may need to use adaptive cutlery, bowls, plates and cups/beakers.

You may be required to assist with a meal and supporting the individual by, cutting up food, sitting adjacent to the individual and providing food and drink, when they are unable to do so for themselves. Making regular drinks including teas, coffees, water and squash. Offering regular snacks, fruit and yogurt. In some cases, this information will need to be documented on ‘fluid and food’ charts. You will be shown this within your place of employment.

Other documentation relevant to weight will include:

Some individuals will require an assessment from a speech and language therapist, they provide assessment, diagnosis, therapy, support, practical advice and equipment (where appropriate) to help people with these difficulties. They may offer alternative food choices or thickness of food and drink. As seen in the IDDIS framework

muscles, skeleton, half body
Photo by massagenerds on Pixabay

A care assistant or carer is the first person to notice any changes within an individuals well-being, as you spend majority of the time with them. You need to be vigilant for any slight changes they can be a sign of deterioration. Acting on this change as soon as possible can be life saving for the individual in your care. Prevention is better than cure. 

Understanding how the human body works, what each organs purpose is, being aware about how medication is distributed throughout and broken down in the blood and body and how it can effect the organs function, what food and drink to avoid because of their medication is important to your role and how you provide care to the individual, it can also support your own professional development and knowledge.

Understanding continence. Fluid input and output through the urinary system, knowing the importance of good fluid input for a healthy system. What effects bad fluid intake it can have on an individuals continence requirements and the signs of deterioration and urine infections through the colour of an individuals urine. You will need to know the Bristol stool chart a change in an individuals feces can show constipation, diarrhea or overflow from a blockage within the gut. 

Being aware of how the skin changes as we age, it becomes weaker and softer, like tissue paper, it changes colour and takes longer to repair if bruised or damaged. It can be damaged by: skin tears, a build up of moisture, pressure sores, poorly fitting clothes or incontinence aids and bad manual handling. Understanding the signs of and how to treat, pressure sores and ultimately how to avoid them. 

Understanding good posture, how to stand and sit correctly to reduce physical stress and lower than chances of an accident occurring. How to sit an individual when assisting a meal in a chair or in a bed to avoid asphyxiation. The benefits of regular exercise, repositioning, increasing blood flow and strengthening muscles to improve and retain mobility. Good mobility can lead to an independent life and improve mental well-being.

 

Morning Coffee - Tony Luciani - Photo subject to copyright Your role will include manual handling, assisting to stand, roll, reposition in a chair or on a bed, using of equipment, hoists free standing and ceiling, stand aids, slide boards or transfer boards, rotunda, sara stedy and weighing scales. Each individual who requires the use of a hoist will need to be assessed for a sling for their weight and height. Please be aware the residents size will contribute to the weight you will carry when using the above equipment.

You may not use every item listed. These will vary based on the requirements of the individuals with-in the care setting. Each individual will be assessed on their mobility and provided with the equipment needed to assist them. You must be trained on each item you use and have refreshers to keep up to date with any changes with policies, procedures and new models of equipment. It is best practice to refresh learning to keep everything fresh in your mind to avoid accidents from occurring.

When conducting any form of manual handling you must ensure your surroundings are safe and ready for the action you are about the carry out, for example: rolling an individual in bed to provide personal care. Talk to your college and the individual to clearly state which way to roll and where to support them, is there enough room on the bed? Ensure you have all equipment ready to hand on a table, try to avoid ‘nipping’ off for a flannel, creams, wipes etc

When using equipment for example, a hoist. Ensure the equipment has been serviced. Ensure the weight limit is not exceeded (labels should be visible on equipment). Visually inspect the equipment for any damage, if observed, do not use and find an alternative piece of equipment. Ensure your area to move in is clear, move cables, slippers etc, have a clear line of sight from point A to point B. Follow the procedure to attach the sling to the hoist. Communicate at all times.

Never complete a maneuver without the correct equipment, you will get asked by the individual to ‘lift’ or ‘pick’ them up from their seat, bed, or floor, if they have fallen. Decline. You should never lift an individual from under their arms, legs, back of their neck. This can cause serious damage. It can be distressing for the individual if they have fallen and are in shock, they will assume they can be lifted and will want to be moved from their position immediately. Calmly advise the individual it is safer for them to remain where they are until they have been inspected by the nurse or paramedic, put a small pillow under their head and do not attempt to move them any further until assessment is complete.

Certain aspects of your job you will find more physically challenging like manual handling due to lack of training or no training at all. You may come across a new piece of equipment and be requested to use it without formal training. Decline. You are under no obligation to use the equipment without any formal training.

You may have to discuss with other professionals about the individuals within your care. You must ensure this is done in confidentiality to ensure no breach of personal information occurs. You may require consent from the individual and their family if required to speak on behalf of the individual in your care. GP’s may need to be informed of any changes in care, circumstances, medication and errors, or to book a visit. Other services may include: District nurses, Physiotherapists, Speech And Language Therapist and Hospice.

You are here to support: Residents and Relatives as well as, your team which will consist of:
Management, Deputy Management, Care Coordinator, Nurse, Team Leader, Senior Healthcare Assistants, fellow Healthcare Assistants, Housekeeping, Hospitality, Admin, Office, Waitress, and all those who are included in your daily team.
 
During the day the day staff will also need to support when required- GP, District Nurse, Speech and Language Therapist, Physiotherapist, Chiropodist, Wheelchair Specialist, Dietitian, Hairdresser and Priest. 

Health care assistants spend the majority of time with the residents therefore we are relied on by all of the above to provide information when needed and to provide daily updates to the nurse in charge of any changes regarding the physical and mental well-being and care needs of the residents.
 

Documentation for each individual within care will vary in different care settings. Consistently you will be required to read the documentation provided for the preferences of each individual which may include: Care plans for personal care, mobility, nutrition, daily life, history, medical history, end of life, risk assessments, consent forms, next of kin, personal information. These documents should be securely locked within the care setting and only accessible to professionals who have had consent from the individual or their family if they are unable to do so themselves. Care plan documentation will be updated as per your employee’s policies and procedures unless a significant change occurs, for example: A fall resulting in hospital and change of mobility aid now required. New risk assessment to be put in place.

You will be required to write documentation of your visit to an individual, within their home or in a care home environment. You will be required to write any communications had with the GP or family so the next health care professional on duty can be made aware of what was discussed. The documents should be clearly legible with the individuals first and last name shown, a time and date of entry, a factual insert of how the individual is mentally, physically, any personal care provided, any changes noticed, food eaten, bowls open and what type, any reposition’s or exercise completed. Signed off with your own name. In black ink only. Do not use tipex to hide errors, strike through and sign next to the error with your own initals.

These documents have a legal purpose, if required they will be used in court if a case is raised. Therefore, it is incredibly important they are filled correctly, clearly, and factually. No hearsay or personal views.

Other documentation you will need to be aware off is policies and procedures within health and social care:

Inconsistent Job role

Because the job role is so varied and each home, employer, company and council in every district trains to their care ‘requirements.’ Health care professionals are provided with knowledge and information others miss out on. This causes flaws in the sector. With care provided differing from home to home, community to hospital. It has risks and it fails. Causing accidents and In turn putting more pressure on the NHS. This is easily avoidable by ensuring everyone who is trained for their job role is done so in a standardized way.

Nightingales Army aims to be the first and only Comptency monitoring program who provides hands on practical training to those before they enter the role.

Healthcare assistants (HCAs) are being expected to do the work of nurses without adequate training or proper supervision according to survey results published by UNISON. Nearly two thirds (63%) say they are being left to care for patients without enough support from doctors and nurses. The impact is that almost two in five (39%) of HCAs say they do not feel confident that those they are caring for are safe.

Personal appearance and Uniform

A health care assistant is a professional. In uniform. Nightingales Army recognizes the service health care assistants provide to the public daily and feel they deserve to be recognized as a uniformed public service. Within the health and social care sector health care assistants wear uniforms provided by their employers, recognized by their peers and service users as a visual representation of their job role and responsibilities.  

In most cases employers will provide you with uniform for your contracted period of employment. Based on how many hours you work you will be provided with 2-3 tunics and 2-3 pairs of trousers. You may wish to purchase your own trousers to wear. Ensure they are black full length trousers, you are not permitted to wear three quarter length or leggings. It has been reported the trousers provided by employers from uniform companies are not well fitting for a female, can cause chaffing and irritation. We encourage you to be comfortable during your shift. Speak to your colleagues to find out where they get their trousers from. Or search Google Here. Tunics will be unique to each home and branding, with logos and colour schemes to represent job roles. You will not be able to purchase a different tunic. Ensure you get sized correctly for the tunic provided to you. It is important you get a comfortable fitting tunic not to tight, you need room to move freely and keep cool.  

It is important for us as professionals to ensure we uphold good, clean personal appearance:

  • Tie hair back where longer than shoulder length.
  • Keep nails short, clean and free of any jewelry.
  • Hands should not have rings except for a single wedding band. No diamonds or studs in your ring. This is due to infection control and skin monitoring. You can and will pick up bacteria on your hands, studded rings are a perfect harboring ground for bacteria. And an offset ring with high diamonds can tear someone else’s skin even through a glove. Any sharp object is a risk to individuals skin.
  • No bracelets. Hooped earrings. Long necklaces. These can all be a hazard when providing care. They can also be used against you if an individual is in distress or living with dementia, Learning difficulties or other neurological concerns, they will use these items to pull and grab.
  • Fob watch or Silicone watches are preferred as they can be sterilized and washed easily.
  • Wash your uniform daily on high wash separate from your other clothes, to reduce the chance of spread of infection

Have an unanswered question? Contact us today and we will help you to find an answer.

Accountability

We all have accidents daily, a slight slip of the hand dropping and smashing a glass, tripping over a curb or bumping into someone. When an accident occurs it is best practice to take a visual assessment: based on the severity of the accident attend with a nurse present. If an individual is harmed and needs an assessment before being assisted to move the nurse or paramedic can do this safely. If the accident does not involve an individual attend with the correct equipment and PPE to clean and remove the risk before another accident occurs. Then report and document the accident to all the relevant people, such as: team leader, nurse, maintenance personnel, safeguarding.

You are accountable for all your actions, directly or indirectly towards an individual in your care this includes all your colleagues and visitors. The duty of a health care assistant covers so many vast aspects and areas of responsibility we will explain them here:

A direct action, either intended or by accident, must be documented.

A directly intended action towards an individual is classed as abuse. Any physical, mental, verbal, financial or sexual action that is directly aimed at an individual are grounds for dismissal and possible court proceedings.

The burden of harm – Patient saftey WHO
Diagnostic errors occur in about 5% of adults in outpatient care settings, more than half of which have the potential to cause severe harm. Most people will suffer a diagnostic error in their lifetime.

An indirect action, Seen as a neglectful act that may cause an accident, must be documented.

An indirect action is an action that can leave an individual at risk of harm. For example: leaving a wheelchair in a room with no brakes on, an individual may enter that room and try to sit in it, causing the wheelchair to move and they slip out of it onto the floor, or they are stationed in their chair in a crowded room without brakes and they push away from the table, or floor with their feet, hitting another resident with their chair. 

Another example: Leaving washing up liquid or any chemical within reach of an individual that may cause harm if digested this would be seen as negligent and an indirect action that may cause harm.

You must be cautious of speaking in front of residents and their family, GPRD and confidentially means you should never disclose another individuals information outside of the team and the security of the locked office space or private room away from others. Individuals over hearing conversations and personal details can cause conflicts between people, it starts rumors and encourages a toxic culture where an indirect comment is made it can be extremely harmful to those over hearing it. An indirect action such as a comment can be detrimental to the individual you are speaking about and yourself.

You are accountable to your employer to complete your contract.

You have a duty to complete your written contact to your employer, they will request you to attend staff meetings, keep up with in house training, follow policies and procedures, these are mandatory requests and must be followed. Within your contract you will be requested to do a list of duties that underpin your role, these currently vary in each employment, so what you have done in one job may not be reflected in your next employment placement. Be sure to read your contract carefully as fulfilling your role correctly is part of your duty of care, you do not want to go outside of your duties, going outside of your role will mean you are not covered by your employer if something were to happen to either yourself or the individual in your care. If you have not been trained on an item or have been asked to do something you do not feel is withing your job role. Decline.  You have the right to decline anything you do not feel conformable doing without checking your job role or speaking to a trainer for help, training or a refresher first. Remember we are working with peoples lives you have to be confident in what you are doing is correct.

Mobile phones

Nightingales Army recognizes 80% of health care assistants are women and as such they have a duty of care not only to those in their work place but to other individuals and dependents outside of work. This is classed as a sandwich carer. The duty of an individual who is sandwich caring doubles as they have commitments to their external duties as well as their contracted duties. This can require the individual to be more vigilant of the needs of others who rely heavily on them. 

Within your contract mobile phones are generally not permitted on the floor during shift.  This is due to GDPR and confidentially. Phones are not permitted to be used on the floor, in front of residents or in the offices where public and residents can see. We advise those who have dependents out side of work to speak to their care home manager to request they keep their phones on their person during shift. This can support you as an employee to be able to be the first contact in an emergency. Dependents or school are able to call the home to pass on a message, but Nightingales Army do not recommended this due to the low staffing levels and constant use of the phone lines for professionals such as doctors, therapists and pre-assessments. Messages do not get to the individual in good time. Passing messages around the home to reach the correct individual is also a breach of GDPR where information can be spread against the individuals wishes. 

We know by experience this happens within the home and can cause friction between staff. Personal information should not be shared publicly, with colleagues or residents. We do not promote use of mobile phones on the floor and feel health care assistants should be responsible for their own actions. If you breach this, you will be taken through the disciplinary route which can lead to dismissal.

Speak to your manager to set out an agreed way of working with mobile phones.

Watch out:

You are accountable to manage your work load to ensure you get your break. You are entitled to 20 minuets every 6 hours. Ensure you take these as it is beneficial to your physical and mental well-being.

Your employer has a duty of care to provide you with staff rest break area(s), access to fresh water, an area to eat, hand washing facilities and a smoking area. Paid breaks are held onsite as you are expected to answer emergency calls during this time. Unpaid breaks do not need to be situated on site.

Care Elderly Woman
Et call home. Tony Luciani Photograph. Subject to copyright

Employers accountability, law and legislation

Your employer also has a duty to uphold your contract to you, we discus this more in the contract section on Knowing your rights.

You are accountable to comply with the law and legislation’s set out and agreed by government

Here are some legislation’s for you to view: 

Health and social care Act 2008

Health and safety at work act 1974

Care Act 2014

Equality Act 2010

Mental Capacity Act 2005

You can find more at legislation.gov.uk/

You are accountable to comply with CQC standards and your own companies procedures.

The fundamental standards

You are accountable to fulfill your duty of care. 

Your duty of care covers all we have mentioned above and further on in our website. Your duty is to yourself, your employer, the individual in your care, visitors, public, friends and family. Your duty of care is a legal obligation which is imposed on an individual (yourself), requiring adherence to a standard of reasonable care. You must uphold your obligation to act towards others in a certain way, in accordance with certain standards. Your duty of care goes with you everywhere.