Barriers to Maximising Independence

Attitude is everything! We hear about it a lot and we talk about it often. But you may or may not be aware that your attitude can majorly impact your clients.

There is a growing perception that older people are dependent and a burden to society (Ministry of Social Development, n.d.). This perception can influence some older people to “lose confidence and assertiveness both in making contributions to society and in dealing with their own needs… regarding older people as dependent, fails to preserve an active and useful role for them” (Ministry of Social Development, n.d, pp. 58-59).

Reverse the roles for a moment. What if every person you spent time with thought you were a burden to society, difficult to be around or an inconvenience to them? What if rather than allowing you to be who you want to be, and do what you want to do, they disregard you and make assumptions about what you are able to do?

This is how powerful someone’s attitude can be!

With this in mind, here are some key commitments Healthcare Assistants can make to be intentional in our attitude and our approach to the people we care for:

• Recognise the uniqueness of each individual and their life achievements
• Show respect for the people you care for
• Work towards making people feel valued, by finding out their preferences and opinions
• Work towards reducing divisions between the young and the old, the sick and the healthy

It is generally held that people prefer to age in their own homes. This is commonly associated with a fear that moving into an institutional living environment will result in a loss of independence (Hillcoat-Nallétamby, 2014).

Williams (2015) explains that in an attempt to meet the needs of so many people in an institutional living environment, it is easy for staff to lose sight of the uniqueness of each individual. Instead, the needs, routines and priorities of the institution come before the desires of the resident. If Healthcare Assistants do not value each client as an individual, then the organisation will take over their lives (Williams, 2015).

This primarily comes down to routine. We saw in Section 2.2 a clip about Emily, who wanted to make her own cup of tea first thing in the morning. Originally, the care staff thought this not only to be a risk to Emily’s safety, but also highly disruptive to their routine. This was because they were occupied with other residents and the tasks they needed to get through.

The initial solution was to lock Emily out of the kitchen (in what should be considered as her home) to prevent her from doing this. But it wasn’t until the care staff reconsidered and began to view Emily as an individual with a unique history and her own preferences, that an alternative and safer solution was provided.

If we can actively consider each and every client and how we can realistically adjust our routine to fit in with theirs, this will empower them to choose how they run their lives.

Time limitations are a common barrier to maximising independence in a healthcare setting. It is a constant struggle to try to cater to individual needs and allow the time necessary for clients to do things for themselves.

In addition to this, staff shortages place even more limitations on capacity and time. This level of stress can cause staff to become frustrated, impatient, and even aggressive! In extreme cases, there have been situations where staff have used restraints on clients, arguing that there is not enough staff to mind them (Stratton, n.d.). This is a major loss of dignity and independence for clients and is a form of abuse.

Achieving a balance between catering to the needs of the client and keeping to schedules is not always easy. The key concept to consider and apply here is flexibility.

Part of flexibility is allowing clients the freedom to do what they want, when they want, and in the way they want to do it, provided no other clients are at risk. If you are in a situation where you are making decisions between the needs of two or more clients, then you must negotiate, problem solve and come to a compromise that suits all parties (Stratton, n.d.).

Congratulations on completing Client Independence in Healthcare!

You have had the opportunity to explore the underpinning principles and key approaches to maximising independence with clients in your workplace.

You have discovered the importance of independence to the overall wellbeing of a client and the way in which it promotes self-worth and dignity. It is hard to overstate the importance of this concept, and we encourage you to put it to practice!

Be creative and collaborative in your approaches. Enlist the help of your colleagues and the multidisciplinary team to maximise opportunities for your clients to be who they want to be, and do what they want to do.

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Ministry of Social Development (n.d.) Factors affecting the ability of older people to live independently. Retrieved from https://www.msd.govt.nz/documents/about-msd-and-our-work/publications-resources/archive/2000-factors-affecting-ability-of-older-people-researchreport.pdf

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