Defining Independence

Independence is most commonly associated with an individual’s functional capacity and their ability to complete activities of daily living without assistance (Davies, Laker, & Ellis, 1997).

People who are receiving care, whether that be short or long term, are generally experiencing some form of reduced function. With that often comes a sense of powerlessness associated with a lack of independence (Williams, 2015). As Healthcare Assistants, without even meaning to, we can contribute to these feelings of powerlessness by simply doing too much, or taking charge of a situation we do not necessarily need to take charge of. Williams (2015, p. 210) states that “doing too much for a person is perhaps more damaging than doing too little…individual dignity and control are too often sacrificed to efficiency”.

This notion of dignity and control is an important one.

Dignity is our inherent value and worth as a human being. Every individual is born with a desire to be seen, heard, listened to, recognised, understood, treated fairly and treated as something of value (Hicks, 2013). Part of our responsibility of upholding dignity for clients is to promote choice and control. Some of these choices may invoke a health and safety risk, therefore it is part of your job to develop different ways the person can be supported to maintain their independence, and do the things they want (Williams, 2015). This could mean different things for different people. It is at this point that we must become creative!

Take a look at the following video, then respond to the Journal Reflection below.

ADD VIDEO

Independence means different things for different people depending on their age, life stage, and circumstances. Here are some examples.

ADD IMAGE SLIDER HERE

A lot of these beliefs about what independence is, can be related back to our life roles. A life role is a socially accepted pattern of behaviour which we may take on at different times in our lives. People play many roles over their lifetime, often several at the same time (Williams, 2015). Examples include man, woman, husband, wife, mother, father, grandparent, son, daughter, sister, brother, chef, hairdresser, plumber, pilot, doctor, nurse, administrator, mechanic, and home maker.

The roles that people play often inform their identity and self-image, and this can be threatened when roles are lost (Williams, 2015). Role loss can be as a result of a sudden injury or disability, ageing, retirement, changes in living arrangements, loss of a job, death or loss of a spouse or friend or loss of full health. When this happens, there is often a process of grieving where people adjust to new roles and new circumstances.

The Health and Disability Code of Rights (Health and Disability Commissioner, 1996) identifies the rights of a healthcare service consumer, and the obligations and duties of health professionals to comply with these.

The Code of Rights is a regulation under the Health and Disability Commissioner Act making it a legal responsibility to take "reasonable actions in the circumstances to give effect to the rights, and comply with the duties" in the Code (Health and Disability Commissioner, 1996, p.4). This legal responsibility applies equally to Healthcare Assistants meaning there is a day to day responsibility to adhere to this code to the fullest extent possible.

Let’s talk about one right in particular: Right Three: The Right to Dignity and Independence.

"Every consumer has the right to have services provided in a manner that respects the dignity and independence of the individual” (Health and Disability Commissioner, 1996, p.1).

But how do we do this? Here are some practical suggestions that can be applied in order to uphold this particular right.

1. Adhere to the client’s personal care plan. This has been developed in accordance with their personal goals. Goals are set based upon tasks that are meaningful and purposeful to the client.
2. Report and record all observations pertaining to the improvement and deterioration of a client’s condition. This supports in ensuring that care approaches are in alignment with the client’s goals.
3. With every client interaction, ask before offering support as clients may be able to manage without you.
4. Encourage clients to do as much as they can on their own.
5. Do not underestimate clients’ abilities. Be creative and find out what they can do on their own.

(Adapted from Health and Disability Commissioner, n.d.).

You might be already practicing these suggestions. They are great practical ideas that can be easily built into your everyday support of your clients, which will make an immediate impact on their independence and dignity.

Maximising independence refers to supporting or enabling someone to do something for themselves. This closely related term of enablement, also happens to be one of our person-centred care principles, prompting us to provide care in partnership with the client to maximise independence, and to empower clients to take responsibility for their own health (The Health Foundation, 2014).

Let us have a look at some of the principles that underpin the concept of maximising independence:

Adapt

Adapt means to make something suitable for a specific use or situation (Townsend & Polatajko, 2007). One example is adapting the task of dressing to maximise independence for someone becoming less steady on their feet. You could suggest that they sit instead of stand while they dress to prevent them from falling. This allows them to continue dressing without you assisting them whilst still ensuring they maintain their balance.

Collaborate

Collaborate means doing things with clients rather than to or for them (Townsend & Polatajko, 2007). One example is supporting a client to prepare a meal in their home. Rather than taking over and providing full assistance, you can communicate and come to an agreement on who does what, promoting feelings of mutual respect, partnership, and common goals. You are still providing much needed support, whilst also creating opportunities for the client to feel included and in control.

Educate

Part of maximising independence is potentially introducing new tasks and activities, or new ways of going about existing ones. Educating clients is a key part of this process and learning through doing is often the most effective approach (Townsend & Polatajko, 2007). One example is a client using a raised toilet seat following a hip replacement. When using this for the first few times, they may need to be prompted on where to position their hands and how they should sit and stand safely. Once they have become accustomed to this new way of using the toilet, you have empowered them to go about this task independently, which they may not have otherwise done had the raised toilet seat not been introduced.

Engage

Independence often means new opportunities, choice and variety. By engaging clients, we empower them to participate and contribute towards new things to build confidence, improve social connections and interactions, spark possibility and foster creative expression. This provides purpose and control over one’s life (Townsend & Polatajko, 2007). Examples include prompting clients to participate in the activities program at the rest home, join a community social group, or take up a new hobby or community service.

Although a large portion of our responsibility as Healthcare Assistants revolves around maximising independence within the context of individual care tasks, it is important to understand this responsibility within the wider context of reablement.

Reablement is closely associated with personal care planning, and aims to maximise long term independence and quality of life through intensive and strategic input from a number of health professionals over a set window of time. Reablement builds upon what people can do rather than what they cannot, and is a process of regaining skills, confidence and independence following an accident, disability or illness (Office for Public Management, 2012).

Reablement involves setting and working towards goals that are personalised according to the client’s preferences and needs. Interventions are then put in place in response to these goals, and commonly involve the likes of nursing staff, physiotherapists, occupational therapists, and speech and language therapists. The role of the Healthcare Assistant is to contribute towards implementing these established care approaches, and to report and record information that may be important to the client, or relating to improvements or deteriorations in the client’s condition.

Watch the following video for an insight into the value of reablement.

ADD VIDEO HERE