Higher Care - Unit 3 - Values and Principles

National Qualifications:
Values and Principles in Care

Higher
Support Material
August 2007
Care: Values and Principles, Higher
Acknowledgements
SFEU is grateful to the subject specialists in Scotland’s Colleges and other

agencies and industry bodies who have been involved in the writing of this and
other support materials for the national qualifications in Care.
SFEU is also grateful for the contribution of the Scottish Qualifications Authority in
the compilation of these materials, specifically for its permission to reproduce
extracts from Course and Unit Specifications.
© Scottish Further Education Unit 2007
Scottish Further Education Unit 2

Care: Values and Principles in Care, Higher
F17W 12
Introduction
These notes are provided to support teachers and lecturers presenting the
Scottish Qualifications Authority Unit F17W 12, Values and Principles in Care.
Copyright for this pack is held by the Scottish Further Education Unit (SFEU).
However, teachers and lecturers have permission to use the pack and
reproduce items from the pack provided that this is to support teaching and
learning processes and that no profit is made from such use. If reproduced in
part, the source should be acknowledged.
Enquiries relating to this Support Pack or issues relating to copyright should

be addressed to:
Marketing Officer - Communications

The Scottish Further Education Unit
Argyll Court
Castle Business Park
Stirling
FK9 4TY
Website: www.sfeu.ac.uk
Further information regarding this Unit including Unit Specification, National

Assessment Bank materials, Centre Approval and certification can be
obtained from:
The Scottish Qualifications Authority

Optima Building
58 Robertson Street
Glasgow
G2 8DQ
Website: www.sqa.org.uk
Whilst every effort has been made to ensure the accuracy of this Support
Pack, teachers and lecturers should satisfy themselves that the information
passed to candidates is accurate and in accordance with the current SQA
arrangements documents. SFEU will accept no responsibility for any
consequences deriving either directly or indirectly from the use of this Pack.

Contents
Reference Section 7
What is the Care Course all about? 8
The Course in Care (Higher) 12
Unit Outcomes, PCs and Evidence Requirements 14
Tutor Support Section 17
How to Use This Pack 18
Rationale for teaching/learning approaches 19
Teaching Activities 21
Question Types in Higher Care Assessments 23
Guidance on Unit Delivery 24
Resources 25
Student Support Section 27
Key to Activity Symbols 28
Study Tips 28
OUTCOME 1 29
The Significance of Values in Care 31
Good and Bad Practice in Care 32
Relationship Between Values and Behaviour 35
Types of Service User 36
Discrimination and its Effects 38
Institutional Discrimination 44
Case Study on Discrimination – A Class Divided 45
Effects on Individuals: Worth, Dignity, Social Justice and Social
Welfare 46
Values for Professional Carers 47
Codes of Practice and Professional Conduct 50
Care Values and Communication 55
The Role of Effective Communication in the Caring Relationship 57
Verbal Communication 58

Non-Verbal Communication 62
Barriers to Effective Communication 67
Carl Roger’s Core Conditions 72
Gerard Egan – A Systematic Approach to Helping 74
Reflective Practice as a Tool for Evaluating Personal Practice 80
Formative Assessment – Outcome 1 81
OUTCOME 2 85
An Overview of Legislation 86
The Sex Discrimination Act (1975) 87
The Race Relations Act 1976 89
Disability Discrimination Act 1995 and Disability Discrimination Act
2005 91
The Commission for Equality and Human Rights. 93
NHS and Community Care Act 1990 94
Community Care and Health (Scotland) Act 2002 95
Data Protection Act 1998 96
Adults with Incapacity (Scotland) Act 2000 97
Regulation of Care (Scotland) Act 2001 98
Mental Health: Care and Treatment (Scotland) Act 2003 100
Ways in Which Legislation Acts as a Framework to Promote Positive
Care Practice 103
Formative Assessment Outcome 2 104
OUTCOME 3 106
The Care Planning Process 108
Good Practice in Care Planning 109
Care Planning Models 110
The Role of Care Workers in Care Planning and Implementation 112
Goal Setting: Short- and Long-term Goals in Care Planning 115
Assessment of Needs 116
Tools of Assessment 116
Needs Assessment Using a PROCCCESS Model 119

Holistic Care 120

Maslow’s Hierarchy of Needs 122
Implementing the Care Plan 127
Evaluation of Strategies 129
Formative Assessment Outcome 3 131
Answers to Formative Unit Assessment 135

Reference Section

What is the Care Course all about?

The Course aims to provide the knowledge, understanding, and skills to
enable a candidate to recognise the role of sociology in fashioning care
priorities and practice. This is entwined with the role of psychology in
providing evidence of human behaviour and development. This will have an
effect on how the person in need of care responds to change in their life. The
application of theories to these clients enables us to account for specific
behaviour. The Unit Values and Principles in Care (Higher) examines the care
relationship as well as how legislation, values and principles underpin
professional care practice and how we plan to meet the care needs of
individuals.
Summary of Unit content
Values and Principles in Care (Higher)

This Unit is designed to develop an understanding of the caring relationship
and the values and principles that underpin professional care practice. The
Unit looks at the role of legislation and care planning in promoting positive
outcomes for those in need of care. The final part of the Unit looks at the
elements of the care planning process, who is involved, its approaches and
tools and how the effectiveness of care interventions can be evaluated.
In this Unit candidates study:
• The caring relationship between care professionals and service users

• The role of legislation in promoting positive care
• The care planning process
The mandatory content for this Unit is detailed in the Appendix to the Unit
Specification. This mandatory content is sampled in both Unit and Course
assessment.
ASSESSMENT
To achieve the Course award the candidate must achieve the Units as well as
pass the Course assessment. The candidate’s grade is based on the Course
assessment.

Assessment Objectives
At Higher, the key elements of knowledge and understanding, analysis,

application and evaluation are assessed in the following ways:
• Knowledge and understanding

Candidates should be able to demonstrate wide-ranging and detailed
knowledge and understanding of aspects of care practice and the relevant
concepts, theories and methods employed by care professionals in their roles.
The range of knowledge should extend to an understanding of key theoretical
and practical issues in sociology, psychology and values and principles for
care and their application in care practice.
• Analysis
Candidates should be able to select from, interpret and analyse different
sociological and psychological theories and models of care planning in the
context of care practice. In so doing, candidates should be able to present
information in a balanced, logical and coherent manner, which focuses clearly
on the issues under review. Candidates should be able to use, with
confidence, the language and concepts of care and demonstrate a clear and
in-depth understanding of the inter-relationship between evidence and theory.
Assessment of issues should be critical and comprehensive and should reflect
confidence in dealing with complex arguments.
• Application
Candidates should be able to demonstrate the application of theories,
concepts and methods covered in the Units and apply them to a care
situation. This will centre on case study and simulated situations from key
theoretical and practical issues in sociology and psychology as applied in care
practice, and values and principles in care.
• Evaluation
Candidates should demonstrate the ability to make balanced evaluations of
care related theories and practical examples and base these upon justified
and sustained arguments. Explanations offered and methods used by care
professionals should be examined critically and the conclusions drawn should
be well developed and reasoned, reflecting clear understanding of the care
topic being assessed.
The balance of assessment between knowledge and understanding and

analysis application and evaluation in Course and Unit specifications will be
approximately:
• Course — 50% knowledge and understanding, 50% analysis, application

and evaluation.
• Units — 60% knowledge and understanding, 40% analysis, application
and evaluation

Values and Principles in Care (Higher): Unit assessment
Satisfactory evidence of the achievement of all Outcomes and Performance

Criteria for each Unit is in the form of written and/or oral recorded evidence,
produced under closed-book, supervised conditions within a time limit of one
hour for each Unit.
Each assessment samples across the mandatory content for the individual
Unit and the nature of sampling is detailed in the Evidence Requirements
within the Statement of Standards within each Unit Specification. If re-
assessment is required, it should sample across a different range of
mandatory content.
Further details about Unit assessment for this Course can be found in the Unit
Specifications and the National Assessment Bank (NAB) materials.
An appropriate instrument of assessment would be a case study or case

studies accompanied by a series of structured questions. The questions
should sample across the mandatory Unit content and allow candidates to
generate evidence for all Outcomes and Performance criteria in an integrated
way.
Course assessment
The Course assessment consists of 2 Question Papers. Each Question Paper

lasts 1 hour 20 minutes. There is a break of 20 minutes between each paper.
Paper 1:
• Section 1 set on content of Psychology for Care (Higher)

• Section 2 set on content of Sociology for Care (Higher)
• The mark allocation for this paper is 50
Paper 2:
• Section 3 set on content of Values and Principles in Care

• Section 4 set on the integrated content of at least two of the three Units in
this Course
• The mark allocation for this paper is 50
Further details of the Course assessment are given in the Course

Assessment Specification and in the Specimen Question Paper.

Link between Unit and Course assessment/added value
The Course consists of three Units and an additional 40 hours study. The
Course assessment tests the candidates’ knowledge and understanding of
the content covered in all three Units and their ability to demonstrate and
apply knowledge and skills acquired throughout the Course.
In Units at Higher candidates are required to demonstrate knowledge and

understanding and the ability to analyse and evaluate a range of related care
theories and their practical application. The Course assessment will require
candidates to use their knowledge and understanding of psychology,
sociology and values and principles and to apply critical and analytical skills to
answer questions drawn from the whole Course.
Unit and Course assessment complement each other. Unit assessment

provides evidence of a specific level of achievement in the psychology,
sociology and values and principles sections of the Course. The Course
assessment confirms and expands on this, providing sampled evidence of a
range of skills exceeding those required for Unit success, such as retention of
knowledge.
The Course assessment at Higher requires that candidates demonstrate the

ability to:
• Retain knowledge and understanding from across all three Units of the
Course on a single occasion
• Analyse and evaluate theories and applications to the care context from all
three Units on a single occasion
• Apply theories and applications in a care context to a range of topics from
across the Units on a single occasion
• Integrate knowledge and understanding of theories and applications in a
care context
• Perform more complex analytical and evaluative tasks than required for
Unit assessment.

The Course in Care (Higher)
Course Rationale
Issues of health and social care are becoming increasingly important due to
an increase in the population of care service users. As a result, there is a
growing need for qualified health and social care professionals. The Higher
Care Course provides a strong foundation of knowledge and skills for
candidates who wish to progress to further or higher education or employment
in this area.
The Higher Course in Care relates to caring for people in society, other than
self or family, in an environment or agency whose codes of practice are
dictated to and guided by legislation, policy and professional ethics. This
includes formalised personal care in the community or home. It is concerned
with the holistic study of the client in context.
The Course will form an important part of the menu of provision, not only for
those who have identified the field of care as their chosen career path, but
also for any candidates who wish to extend their educational experience.
The knowledge acquired in the areas of the understanding of human

behaviour through applying psychological and sociological approaches and
theories to care situations is transferable to other academic or career
pathways, particularly those which involve working with people, either
individually or as part of a team. This Course can therefore have a number of
significant advantages for the candidate.
For example it:
• Helps candidates to understand the interrelationship between psychology,

sociology and care values and principles which form the basis for care
practice
• Provides an insight into the wide range of factors which might impact upon
an individual’s development and behaviour
• Enables candidates to inform and enhance their understanding of effective
service provision
• Increases candidates’ awareness of the dangers of viewing human
behaviour and development purely from their own ethnocentric perspective
• Raises candidates’ awareness of the psychological factors influencing
their perceptions of normal development and behaviour
• Raises candidates’ awareness of the role of sociology in shaping social
policy.

Aims
The Course provides opportunities for candidates to:
• Acquire specialist knowledge and understanding required to care for

others
• Develop the ability to apply knowledge in a range of contexts
• Develop awareness of their personal value base
• Develop self-awareness and self-reflective practice
• Identify people’s needs and develop skills for care planning
• Develop an understanding of the values and principles that underpin
professional care practice
• Develop awareness of the role of legislation and care planning in
promoting positive Outcomes for people requiring care
• Develop an understanding of the main sociological theories that provide
insight into the influences that shape individuals’ lives
• Develop an understanding of the way in which psychological approaches
help to understand aspects of human and behaviour
• Develop an understanding of why certain individuals or groups in society
require care services
• Acquire awareness of the role of sociology in shaping the values and
principles that underpin care practice
• Learn about some key approaches that can provide insight into
understanding human behaviour and development and apply these
approaches to a care context
• Develop an understanding of transition and loss and their relevance to
understanding human development and behaviour in a care context.

Unit Outcomes, PCs and Evidence Requirements

Unit Specification: statement of standards
SUMMARY
This is a mandatory Unit in the Care (Higher) Course but it can also be taken
as a free-standing Unit.
This Unit is designed to enable candidates to develop an understanding of the

caring relationship and the values and principles that underpin professional
care practice. Candidates will have an opportunity to examine the role of
legislation and the care planning process in promoting positive outcomes for
people requiring care.
The Unit is suitable for candidates who wish to gain employment in the health
and social care sectors at support worker level or to progress to further study.
OUTCOMES
1. Analyse the caring relationship between the carer and those requiring
care.
2. Explain the role of legislation in promoting positive care.
3. Evaluate the effectiveness of the care planning process.
Acceptable performance in this Unit will be the satisfactory achievement of the

standards set out in this part of the Unit Specification. All sections of the
statement of standards are mandatory and cannot be altered without
reference to the Scottish Qualifications Authority.
OUTCOME 1
Analyse the caring relationship between the carer and those requiring care.
Performance Criteria
(a) Explain the significance of values and principles in care.
(b) Explain the role of effective communication in the caring relationship.
(c) Analyse caring relationships in terms of care values and communication.
OUTCOME 2
Explain the role of legislation in promoting positive care.
(a) Describe the main features of relevant legislation.
(b) Explain how legislation promotes positive care practice.

OUTCOME 3
Evaluate the effectiveness of the care planning process.
(a) Explain the care planning process.
(b) Analyse approaches to assessing needs of service users.
(c) Evaluate strategies for meeting needs of service users.
EVIDENCE REQUIREMENTS FOR THIS UNIT
The mandatory content for this Unit can be found in the Appendix at the end
of this Unit specification.
Written and/or oral evidence is required to demonstrate the achievement of all

Outcomes and Performance Criteria for the Unit. The evidence must be
produced under closed-book, supervised conditions within a time limit of one
hour. 60% of the total marks available must be allocated to knowledge and
understanding with the remaining 40% of the marks being allocated to
analysis, application and evaluation.
As candidates will increase their knowledge, understanding and skills

throughout their study, assessment should take place towards the end of the
Unit.
The use of a cut-off score may be appropriate for this assessment.
An appropriate instrument of assessment would be a case study or case

studies accompanied by a series of structured questions. The questions
should sample across the mandatory Unit content and allow candidates to
generate evidence for all Outcomes and Performance criteria in an integrated
way
Each assessment must sample across the mandatory content of the unit and
will allow candidates to generate evidence which covers:
• The significance of two values for carers

• Two communication skills needed by carers
• The analysis of one caring relationship
• Two pieces of relevant legislation. This must include at least one of the
following Acts: Regulation of Care (Scotland) Act (2001); Data Protection
Act 1998; NHS and Community Care Act 1990; Disability and
Discrimination Act 1995; Race Relations Act 1976 (Amendment Act 2000);
Sex Discrimination Act 1975; Mental Health Care and Treatment
(Scotland) Act 2003.Adults with Incapacity Act(Scotland)
2000:Communiyty Care and Health(Scotland)Act 2002
• The way legislation promotes positive care

• The care planning process

• One approach to assessing needs
• Two chosen strategies used to meet the needs of specific service users.
If reassessment is required, it should sample a different range of mandatory

content.
The standard to be applied, the breadth of coverage and an appropriate cut-

off score are illustrated in the National Assessment Bank (NAB) items
available for this Unit. If a centre wishes to design its own assessments they
should be of a comparable standard.

Tutor Support Section

How to Use This Pack
There are a number of ways to bring Values and Principles for Care to life and
so there is a range of material which can be used with different class groups,
depending on their ability. Not all the worksheets and activities are intended to
be used with every class. For groups taking the external exam Care Higher,
more time will need to be spent on helping students to memorise and
understand key terms, so more time may be spent on self, peer and formative
assessment. For classes who are doing this as a stand-alone unit, then tutors
may spend more time investigating some of the websites and discussing
some of the real stories that can be found on these sites.
A lot of information and exercises have been provided for tutors and students
and it would be impossible to use them all within the 40 hours allocated to the
unit. It is therefore likely that some of the material will be used when students
are revising for the Care Higher external exam. Key points have been
summarised to assist candidates to revise for external exams. However, it is
important that candidates realise that memorising facts will lead to low marks
and they will need to work on analysis, evaluation and application of
knowledge to attract higher marks in assessment and external examination.
Students should be encouraged to provide stimulus material for class

discussion for outcome 1. They can be encouraged to collect media
examples that they would like to use in class. This will help raise their
awareness of values from everyday examples and to recognise values and
principles that exist, or are lacking, in everyday situations. In outcome 2, to
illustrate barriers to communication you could pre-arrange interruptions,
phones ringing, noise, etc. for the first 10 minutes of your class. Ask students
to reflect on the session and identify barriers. For outcome 3, visiting
speakers may be able to provide case study material that is useful to an
understanding of care planning and some of the issues raised in the unit.
Many of the websites mentioned in the pack have sections with personal
stories and these are excellent sources of ‘real life’ case studies.

Rationale for teaching/learning approaches

There are a number of policy initiatives which have been considered when
developing this pack. They are summarised below.
1) Assessment is for Learning Programme

http://www.ltscotland.org.uk/assess/
This programme is based on the principle that ‘good feedback is essential to

inform improvements at all levels in the education system’. In it, everyone –
the tutor as well as the students – is regarded as a learner.
There are 3 parts to the AifL approach:

1) Assessment for learning: day-to-day classroom interactions and feedback
that are focused on the learner and sensitive to their individual needs;
2) Assessment as learning: pupil’s participation in assessment and reflecting

on their learning helps them to become better learners;
3) Assessment of learning: concerned with enhancing teachers’ confidence

in their own judgements so that assessment information is reliable,
comparable and dependable.
This pack can only deal with points 1 and 2, but tutors will get an opportunity
to develop their skills in point 3 through SQA and SFEU workshops. A number
of the exercises in this pack will encourage the learner to reflect on their own
work and to assess other learners’ work, in order to build them into more
independent learners. This will include the use of formative assessment in
hopefully preparing learners to produce a more confident performance in
summative assessments and external exams.
Formative Assessment (process):

• clarifying learning intentions at the planning stage
• sharing these with pupils
• involving them in self evaluation
• focusing oral and written feedback around the learning intention of each
lesson or task
• appropriate questioning
• organising individual target setting
• raising children’s self esteem via the language of the classroom
• (Gardening analogy: feeding and watering the plant).

Summative Assessment (product):

• baseline testing
• end of topic tests
• National Assessment Bank
• (Gardening analogy: measuring the size of the plant).
Formative Assessment Strategies

Formative assessment improves learning. Assessment is used to allow
learners to develop an awareness of how THEY can improve their learning.
With written work, this can be done with:
• ‘Comment Only’ Marking i.e. they don’t get a mark, but do get feedback on
how to improve their answer. This is intended to encourage the learner to
think about what they can do to improve their work rather than just think:
‘Great. I’ve scraped a pass.’ followed by turning round to ask the mark of
the person sitting next to them. This type of feedback ties in to promoting
the learner’s intrinsic valuing of their work and taking pride and
responsibility for achievement and progress, rather than the extrinsic
pass/fail mentality.
• Peer- or Self-Assessment. These skills help the learner to develop an
awareness of what makes a good piece of work. It asks them to
independently judge what is strong or weak in an answer, rather than to
rely on the tutor. The tutor needs to support learners to achieve the
confidence and ability to do this, but it is a very useful technique once
developed.
The two techniques could be used together, with the student awarding
themselves a mark after considering the comments from the tutor. They can
then match this with the mark that the tutor would have awarded them.
2) Curriculum for Excellence (2004)

http://www.ltscotland.org.uk/curriculumforexcellence/index.asp
The Curriculum for Excellence Report aims to ensure seamless education for
children and young people (CYP) in Scotland, aged 3 – 18. The Care Course
can contribute to this by directly or indirectly meeting the aspects in bold
below. This subject area and the methods of teaching that are used are ideal
for meeting these aims.
• All CYP can be successful learners, effective contributors, confident

individuals and responsible citizens
• Every CYP fulfils their potential; attainment will rise across the board

• There is a renewed emphasis on equipping CYP with essential skills

including literacy, numeracy and creative thinking skills and promoting
good health and well being
• Scotland’s education system continues to meet the challenges of the 21st
Century.
Teaching Activities
A number of the suggested teaching activities suggested in the Curriculum
for Excellence framework are already used widely in care courses:
• Activity based
• Creative/innovative
• Direction of travel: do students know where they are going. Do they know
how to get there?
• Narrative: what is the story you want to tell? Not how difficult it is, but how
relevant/interesting it is.
3) Citizenship in Scotland’s Colleges (2006)

http://www.hmie.gov.uk/documents/publication/cisc.pdf
This HMIe report states that the development of skills for citizenship in
education is a priority in Scotland and throughout Europe. Citizenship involves
the development of skills and attributes to enable young people to participate
in the making of decisions, within the political, economic, social and cultural
contexts of their lives. Other aspects of citizenship education include the
development of knowledge and understanding; a focus on values and
citizenship issues; and opportunities for engagement in, and reflection on,
citizenship activities.
This unit enables students to develop skills for citizenship through course
content which encourages awareness of individual difference and
understanding of the needs of a range of people. The unit also provides peer
and self-assessment activities which help learners develop independence in
learning and critical thinking.
4) Changing Lives - Report of the 21st Century Social Work

review: Implementation Plan (2006)
http://www.scotland.gov.uk/Publications/2006/02/02094408/0
The report notes the need for ‘Programmes of learning that contribute to the
continuous development of the social services workforce’ and which ‘Support
the establishment of career pathways and career progression, in line with

emerging policy needs’. This course, based at SCQF level 5 enables learners
to enter into the social service workforce at care assistant level, or to develop
further underpinning knowledge by advancing to Higher and HNC care
Courses.
5) Learning Together (1999)

http://www.scotland.gov.uk/learningtogether/
The Scottish Executive produced the publication ‘Learning Together’. This

outlines a strategy for education, training and lifelong learning for people
working in the National Health Service in Scotland. There is an emphasis on
the value of education and lifelong learning in contributing to the delivery of
quality services within the NHS. Candidates who study and achieve care
units and courses can expect to improve their opportunities for employment
within a care sector with this learning ethos.
Please note that the materials and activities contained in this pack are
not intended to be a mandatory set of teaching notes. They provide
centres with a flexible set of materials and activities which can be
selected, adapted and used in whatever way suits individual centres and
their particular situations.

Question Types in Higher Care Assessments
Students are required to demonstrate Knowledge and Understanding (KU),

Application (App), Analysis (A) and Evaluation (E) in the NABs and the
external Exam. The external exam now has 25 marks allocated to a section
where students are expected to integrate their knowledge from the three units,
analysing and evaluating information in a holistic manner. It is important that
students are prepared by their tutor to answer these types of question.
Question setters use Blooms taxonomy (below) as a guide to the type of

question that is asked. This shows how the level of complexity of a question
moves from a simple task which asks for Knowledge - ‘Define’ - to a much
more complex task such as ‘Assess’ which involves Evaluation.
Source: http://www.officeport.com/edu/blooms.htm
Students should be made aware of the different types of answers they should
give, depending on the command word in the question
There are a number of sites on the internet which give more information about
Bloom’s taxonomy, such as http://www.educationforum.co.uk/HA/bloom.htm.

Guidance on Unit Delivery

Although centres will deliver this unit in a number of ways, a timetable for an
18 week course with 2 hour classes is provided below. As the unit is a
nominal 40 hours, this implies that there are at least 4 hours for self-study.
Apart from revision of notes, students can be expected to carry out some of
the activities in their own time and bring their work back to class for
discussion/marking.
Unit Content
1 Overview of unit learning outcomes
Introduce Outcome 1
Good and bad caring relationships
Values for professional care workers
2 Professional codes
3 Effective communication
4 Effective communication
Working with different service users
5 Rogers core conditions
Egan’s skilled helper model
6 Effects of stereotyping, prejudice and
discrimination
7 Revision of outcome 1 Opportunity for Formative
Assessment and Feedback
8 Investigating Key features of legislation
9 Investigating Key features of legislation
10 Promoting positive care with legislation
11 Revision of Outcome 2 Opportunity for Formative
12 Introduction to Outcome 3
The care planning process
Models in care planning
Care workers and the multi-disciplinary
team
13 Assessment of needs and goal setting
Using tools of assessment
14 Approaches to assessment
PROCCCESS
Malsow’s hierarchy
15 Analysis and evaluation of needs
Strategies to meet needs
16 Revision of Outcome 3 Opportunity for Formative
17 SUMMATIVE ASSESSMENT
18 Feedback on Assessment and Remediation Review of Unit

Resources
Book
Miller, J. and Gibb, S. (Eds) (2007) Care In Practice for Higher (2nd Edn)
Hodder and Stoughton
Magazines and Newspapers
Your college or local library might subscribe to these. If not, look them up on
the internet. They have up to date information about the ways in which the
approaches and theories discussed in this unit are applied in care settings.
www.careappointments.co.uk/
Care Appointments is an online resource for people involved in the caring
professions. It has relevant news, features and interviews, as well as
information about jobs and training courses.
Community Care
www.communitycare.co.uk
www.disabilitynow.org.uk Magazine on disability issues with good info and

links
Nursing Times
www.nursingtimes.net/
The Guardian: They have a special ‘Society’ section on Wednesday which

covers relevant issues for this unit.
society.guardian.co.uk/societyguardian/
The Herald: They have a special ‘Society’ section on Tuesday which covers
relevant issues for this unit.
www.theherald.co.uk/heraldsociety/
The Scotsman
thescotsman.scotsman.com/health.cfm Click on ‘ Health’, ‘Education’ and
‘Scotland’ topics.
Care Organisations on the internet
This is a list of some organisations whose services will be based on the

psychological approaches and theories discussed in this unit.
www.ageconcernscotland.org.uk/index.asp Age Concern site which covers

issues relating to older adults.
www.barnardos.org.uk Barnardos work with children and young people,

families and communities to work towards their vision that the lives of all

children and young people should be free from poverty, abuse and
discrimination.
www.carescotland.org.uk Care Scotland This website is produced jointly by

the staff of local council social services departments and the Scottish
Executive and has up to date information about care in Scotland – policies
and practice
http://www.nmc-uk.org The Nursing and Midwifery Council is the professional

regulatory body for nursing and midwifery.
www.nrcemh.nhsscotland.com/ The National Resource Centre for Ethnic

Minority Health (NRCEMH) is a unit of NHS Scotland and supports NHS
Boards to develop their cultural competence in delivering health services to
black and minority ethnic groups, to reduce inequalities and to improve the
health of these communities.
www.quarriers.org.uk/ Quarriers They provide a range of services in

Scotland through more than 100 projects for Adults and children with a
disability; Children and families; Young people with housing support needs;
People with epilepsy and Carers
www.seemescotland.org.uk A website dedicated to mental health issues
www.shelter.org.uk Shelter Homelessness campaign and information.
www.show.scot.nhs.uk Scottish Executive Health Department site.

Information on range of issues including homelessness and disability.
www.turning-point.co.uk/ Turning Point provides services for a range of

people, including those affected by drug and alcohol misuse, mental health
problems and those with a learning disability.
National Developments
www.scotland.gov.uk is the Scottish Government’s website. Access to

legislation and current developments in Health and Community Care policy
can be accessed through this link.
Film
‘A Class Divided’ is a powerful documentary on discrimination. It can be

viewed on the internet at:
http://www.pbs.org/wgbh/pages/frontline/shows/divided/etc/view.html

Student Support Section

Key to Activity Symbols
Reading Writing Discussion Reflection
Brainstrorming Case studies ICT Research Revision
Group Investigation
Study Tips
1) Highlighting Key Words
None of the key words have been put into bold in this unit, as it will be more
useful for you to be actively involved in highlighting the keywords on each
page. If you don’t already have some, go and buy yourself some highlighter
pens!
The point of highlighting each keyword is so that when you read over your
notes, the main point on each page jumps out at you. Therefore, it is crucial
that you only highlight one or two words at a time. If you highlight too much,
then nothing will jump out at you and you’ll need to wear sunglasses to read
your notes!
Occasionally, it is useful to highlight a sentence, if it gives a definition of a key

term but even then, it is better to try and highlight only the relevant parts of the
sentence. It might also be useful to highlight the key term in one colour, and
the definition in another colour, so again you are making the separate things
stand out differently.
Less is more when highlighting

OUTCOME 1
There are three learning outcomes for the Values and Principles (Higher) Unit.
Each outcome has a list of topics which is the mandatory content. These
topics form the structure for these teaching support notes and will provide the
basis for national assessment bank and exam questions. The first section of
the teaching notes relates to the mandatory content for outcome 1, and is
shown below.
OUTCOME 1
Analyse the caring relationship between the carer and those requiring care
(a) Explain the significance of values in care.

(b) Explain the role of effective communication in the caring relationship.
(c) Analyse caring relationships in terms of care values and
communication.
Mandatory Content for this Outcome
Caring relationships:
• good and bad practice in care

• relationship between values and behaviour
• differences between values for informal and professional care workers
• types of service users.
Respect for individuals:
• recognise and understand the effects of stereotyping, prejudice and

discrimination.
Effects on individuals:
• Worth
• Dignity
• social justice and social welfare.
Values for professional care workers:
• the value of respect for the worth and dignity of every individual
• the value of according social justice and promoting the social welfare of
every individual.

Codes of professional conduct:
• registration and professional accountability

• Nursing and Midwifery Council Code of Professional Conduct: standards
for conduct, performance and ethics (2004) Scottish Social Services
Council Code of Practice for Social Service Workers: six principles
• National Care Standards – six principles.
The Role of effective communication:
• verbal and non-verbal communication

• barriers to effective communication.
Develop a valued relationship:
• Rogers core conditions

• Egan’s skilled helper model.
Analyse caring relationships in terms of care values and

communication:
• good and bad caring relationships should be examined

• analysis of behaviours to determine the values in evidence or values
lacking in the relationship
• effects of stereotyping, prejudice and discrimination on the individual
• explanation of the values that the carer should display
• effects on the individual of professional caring relationship – autonomy,
independence, empowering, aspirations supported
• analysis of the effectiveness of communication in the relationship
• explanation of the role of communication in the professional caring
relationship
• Reflective practice as a tool for evaluating personal practice in relation to
communication.

The Significance of Values in Care

Outcome one of this unit requires you to analyse the caring relationship
between the carer and those requiring care. As you work through this section
you will find out what is involved in professional caring relationships. You will
learn about values and principles in care and how these are applied in care
practice. We will start with a look at what a value is:
ACTIVITY/DISCUSSION
• Take a few minutes to think about what you value.

• List five things that you value.
• Discuss these values with others in the group and find out if they share
similar values or have different values?
You may have discussed values such as education, the right to vote, money,
health and relationships. Because we consider these things to be important
they are worth something to us; they have value. So, a value can be defined
as ‘that which is desirable and worthy for its own sake’. For example the
words of the Declaration of Arbroath, 1320, reflect a number of values.
‘It is in truth not for glory, nor riches, nor honours that we are fighting, but for
freedom – for that alone which no honest man gives up but with life itself’
Question: Can you pick out the values in the declaration?
Answer: The values reflected in the statement are truth, glory, riches,
honours, freedom, honesty and life. All of these things are seen
to have value here, but what is valued most, and is seen to be
worth fighting for, is freedom.

As you work through this unit you will discover that it is important for all care
workers to express agreed care values so that service users will benefit from
the care that they receive. Values for care workers are reflected in Codes of
Professional Conduct and Care Standards and it is vital that these values are
shown in the words and actions of care workers. Care values are significant
because they underpin care practice and service users have the right to
expect care workers to adhere to these values so that service users can be
confident in the standard of care that they will receive.
Good and Bad Practice in Care

The values that we hold are reflected when we are in a situation where we
care for someone else. In care work there are attitudes and actions that are
considered to reflect good practice and attitudes and actions that reflect bad
practice. Care workers have an obligation to uphold care values so that good
practice is promoted and bad practice is opposed.
A relationship where the carer is encouraging and supportive is a good caring

relationship whereas by contrast, if the carer is abusive this is a bad caring
relationship. A relationship which is ‘good’ is one which allows the person
being cared for to develop and thrive whereas a ‘bad’ relationship denies the
individual the opportunity to realise their potential. The quality of the caring
relationship therefore has an effect on the individual receiving care.
We also have to carefully examine (analyse) what we think of as ‘good’ or

‘bad’ as ideas can change over time. For example at one time it was
considered ‘good’ practice to force left-handed people to use their right hand
to write and use scissors so that they would learn to use their right hand. At
one time too, it was considered a ‘good’ thing for people with learning
disabilities or mental illness confined to institutions. Attitudes and values
change over time and, as a consequence, behaviour and care practice may
change too.
Values for professional care workers
Good practice in care demonstrates agreed care values. The two core values
for care are:
every individual
(Miller & Gibb 2007)

These values are reflected in professional codes of conduct. However, there

is evidence that some care workers ignore these values in their work.
Unfortunately, there are regular news items about people being abused by
their carers.
DISCUSSION – Good and Bad Practice in Care
1. Explain why each of the scenarios listed below represents bad practice.
2. Explain the likely effect of the carer’s behaviour on the service user
3. Describe the care that the service users, in each situation, should have
received.
4. Explain the difference that good care practice would make to their
situation.
• A 35-year-old man strapped to his wheelchair for hours each day so

that he almost lost his ability to walk and suffered damage to his feet as
he struggled to get free.
• A man given his daily medication while strapped to the toilet and
crying.
• Improper medication procedures (not recording that medicines have
been given) for people in care, risking overdose.
• Adults left lying in their own excrement for hours during the night.
• A 76-year-old woman with severe learning disabilities suffered first and
second-degree burns after being bathed in scalding water. The carer,
who bathed her, failed to check the water temperature, and anti-scald
devices fitted to the taps were defective. The woman was only able to
communicate making "non-speech" sounds.
• A nurse ramming a paper towel into a terrified pensioner's mouth, force
feeding another so she nearly choked and using abusive language.
• A carer who stole £1,000 from the 91 year old woman she was looking
after (in her own home).
• A care worker at a nursing home suspended after an alleged sex attack
on an 80-year-old woman resident.

Sadly all of the above incidents are real and all of these incidents have
occurred because care workers have failed to:
• respect the worth and dignity of every individual

• accord social justice and promote the social welfare of every individual.
These examples demonstrate a lack of care values being implemented and

represent bad practice. The most serious consequence of the behaviour of
these care workers is the harm caused to the service users. This is
unacceptable and is regarded as misconduct. The care workers involved will
be disciplined and legal action may be taken against them.
For more information you may wish to visit the following websites:
http://www.learningdisabilities.org.uk
www.elderabuse.org.uk
Summary
Key Points
1. Bad practice occurs when core values are neglected

or ignored
2. Service users are harmed through bad practice. Bad

care practice can be socially, physical, emotionally,
cognitively and culturally damaging.
3. Service users should receive care that demonstrates

care values. They should be treated with respect and
have their dignity maintained. Service users should
be treated fairly and be protected from harm.
4. People thrive when they experience good care

practice. In good care practice social, physical,
emotional, cognitive and cultural needs are
acknowledged, respected and supported.

Relationship Between Values and Behaviour

Socialisation is the term used to describe the process of learning to become a
member of a particular group or society. Through our interactions with others
we develop an understanding of how we are expected to behave in relation to
others (our role). For example if, as a result of our socialisation experience,
we value education, then we will think, feel and believe that education is
something worthwhile and we are likely to demonstrate attitudes and express
opinions that reflect this value. So, whether we are aware of it or not, the
values that we hold underpin our thoughts, feelings and beliefs and influence
our attitudes and behaviour. If I value money more than honesty I might be
prepared to keep a wallet that I find, rather than handing it in to the police.
Sometimes the values that we hold as individuals are at odds with the values
that other people hold. For example pro-life campaigners would seek to
protect life from conception to natural death. In contrast, people who value
the right to choose would support a woman’s right to choose abortion or may
argue that a person with a terminal illness should be able to choose how and
when to die. These attitudes and beliefs will therefore, influence behaviour.
Differences between values for informal and professional care workers
People develop their own personal values based on their socialisation

experience. If, as a friend, neighbour or family member, I become involved in
caring for someone I know, I may retain all of my attitudes and beliefs and my
values might be shared with my friend, neighbour or family member. For
example, if my friend Suzanne becomes ill, we might both share the belief that
women make better carers than men. This might be based on all kinds of
assumptions about women and men. However, we don’t need to question our
beliefs and in our discussions and actions we can support each other’s point
of view. As a result of our beliefs, we do not value men as carers, and my
friend might even refuse care from a man. Informal carers may hold such
values and opinions and this may not interfere with their ability to carry out
care for the person that they have an established relationship with.
However, if I decide that I want to become a formal care worker I will find that
I will have to examine my views. I would need to be aware that I have a
negative view of male carers, that is, I have a prejudiced attitude towards
male carers. If I continued to be unaware of this I might behave differently
towards male carers, and view their contribution to care less favourably than
that of a female carer. If my prejudiced views persist, and if I am involved in
recruiting staff, then I might not appoint men to care jobs; that is, my actions
would be discriminatory. This would be unacceptable and would be contrary
to core care values.
One of the main differences in values, therefore, between an informal carer

and a professional care worker is that a professional care worker must
examine their attitudes and opinions and be aware of any possible prejudices.
The professional carer has to be aware of these issues and address any
tendency to treat people either favourably or unfavourably based on any
personal prejudices.

Types of Service User

Care workers work with individuals and groups of service users. Service
users are sometimes categorised according to characteristics that they share.
For example, there are care services for children, older adults, and people
with learning disabilities, people with mental health conditions, people with
dementia and people with physical disabilities. These distinctions are made
so that appropriate support and services can be easily identified and
organised, but remember that people are individuals and should be treated as
individuals.
GROUP WORK - LOCAL INVESTIGATION
Action 1
Work in groups of 3 or 4.
Select one of the following service user groups and find out about services
that exist in your local area.
Older adults with dementia

People with addictive behaviours (e.g. drugs/alcohol/gambling)
Young people with autism
Children with cerebral palsy
Adults with learning disabilities
Adults with mental health problems
People with sensory impairments (e.g. hearing, vision, speech)

Mind mapping is a useful way to help organise information and help you
to remember important points.
(for information on mind mapping visit www.imindmap.com)
Example of Mind Maps created using iMindMap™
Action 2
Draw a mind map to describe the services available in your local area.

Discrimination and its Effects

Formal carers may work with a variety of service users. We have already
stated that the care worker should be aware of any prejudiced attitudes as
these could interfere with their ability to demonstrate respect for the worth and
dignity of an individual in their care. A good starting point is to understand
what is meant by the terms stereotype, prejudice and discriminatioin.
A STEREOTYPE
IS A SET IMAGE
Stereotype means ‘set image’ and is an instantly formed mental image of a

person or group, based on assumptions about their characteristics.
Stereotyping takes no notice of individual differences and a person or group is
thought of in terms of their shared characteristics. For example stereotypes
exist about people and their race, religious beliefs, gender, colour, age,
marital status, physical or mental status, sexual orientation, economic status
and even size.
ACTIVITY
Take a few minutes to consider the following groups.

What are the stereotypes based on?
• Goths
• Celtic supporters
• Teachers
• Asylum seekers
Task 1
Write down any stereotyped images that might be associated with each
group.

PREJUDICE IS A PRE-FORMED
OPINION OR JUDGEMENT,
OFTEN NEGATIVE
Prejudice is a judgement made about a person or group, based on a

stereotyped image. These opinions are often unfavourable or negative and
lack any knowledge of the facts; that is to say they are irrational. Prejudices
are often formed at a young age, during primary socialisation, and many
people are not aware of their own prejudices.
Task 2
Take a few minutes to write down any prejudiced judgements or opinions that
might be based on these stereotypes.
Group Stereotype Prejudice

Goths Dress in Black.
Evil people.
Celtic supporters All Roman Catholics.
Hate Rangers
supporters.
Teachers Get long holidays
Asylum seekers Scroungers
Discrimination is the unfair treatment of a person or group of people based

on stereotyped views and prejudiced opinions. Many people persist with their
stereotyped ideas and pay no attention to evidence that would contradict their
beliefs. This leads to behaviour based on these beliefs. So, whether
intentional or not, they behave differently towards the person or people who
display the characteristics associated with the stereotype. This is called
discrimination.
People are discriminated against on the basis of

race, religious beliefs, gender, colour, age, marital
status, physical or mental status, sexual orientation,
NO economic status, size and many other
characteristics.
ENTRY

Task 3
Take a few minutes to write down any discrimination that might be

experienced on the basis of existing prejudice.
Group Stereotype Prejudice Discrimination

Goths Dress in Black. Won’t make a
Evil people. good carer
Celtic All Roman Catholics. Can’t invite Jo
supporters Hate Rangers and Sam to the
supporters. party – they’ll
hate each other
Teachers Get long holidays Don’t deserve
another holiday
Asylum Scroungers Send them back
seekers
Discrimination is the result of stereotyping and prejudice on the individual.

The effects of stereotyping, prejudice and discrimination on the individual or

group of individuals is real and damaging.
• The Goth who fails to get into care work is unable to reach his or her
potential; simply because of the way that they are dressed.
• The Celtic supporter has been denied the opportunity of getting some free
tickets. The Celtic supporter may be the only Celtic supporter in a house
full of Rangers supporters!
• The teacher becomes more and more stressed. If the person who holds
the prejudice is the care professional who is supposed to be helping, then
their feelings of being unable to cope will be intensified.
• People seeking asylum will feel rejected and anxious about their future. If
care workers and other professionals hold these prejudices then the
asylum seeker will struggle to get information about housing, health and
welfare benefits.
Group Stereotype Prejudice Discrimination

Goths Dress in Black. Won’t make a Person dressed as
Evil people. good carer Goth fails to get into a
care course or job.
Celtic All Roman Would never want Employer gets

supporters Catholics. to see Rangers complimentary tickets
Hate Rangers play to a Rangers game –
supporters. but doesn’t offer them
to Celtic supporters
Teachers Get long holidays Can’t be stressed. Not listened to when

Look at all these complaining about
holidays! work stress
Asylum Scroungers Send them back People in host country

seekers to their own refuse help, – isolated
country in society
Remember that the stereotypes and prejudices that these discriminatory

actions were based on have no factual basis.

Take a few minutes to think about the prejudice opinions you have had about
people, or groups of people.
Set yourself the goal of finding out some facts about the people or groups that
you have pre-judged. Challenge your own and other people’s assumptions by
finding out the facts.
Everyone has prejudices. The importance in care work is understanding this

and being aware of when accepting a prejudice arises. We often don’t know
we have a prejudice until we are faced with a new situation where our beliefs
and values are challenged, or we feel threatened.
ACTIVITY - Discrimination and Mental Health
People with mental health problems often experience discrimination. The

‘See Me’ campaign is one strategy that has been developed to combat the
prejudice that exists around mental health issues. People with mental health
problems may be labelled as ‘psycho’ or ‘schizo’ and as service users they
experience stigma and discrimination even by care workers.
• Visit the ‘See Me’ website and read and take notes on some of the
personal stories of stigma and discrimination.
http://www.seemescotland.org.uk
Using information from the site, write a paragraph to describe the effects of
stigma and discrimination on individuals with mental health problems.

Case Study: John
John has just started a job as a support worker in a community mental

health team. The team leader has had a meeting with John to discuss
some of the important aspects of his role. John now knows that part of his
role requires him to:
• Reflect on personal values and attitudes

• Recognise stigmatising labels and challenge people who use them
• Show respect for the worth and dignity of every individual service user
• Accord social justice and promote the social welfare of every individual
service user.
Working in groups of 2 – 4 people discuss the following question based on the

case study. Summarise your discussion in writing and discuss the main
points with the class.
Question: Explain why John should carry out each of the above actions.
You should also analyse the contribution that these actions could
have in combating discrimination against people with mental
health problems, and in promoting good practice in care.

Institutional Discrimination
Discrimination doesn’t only happen at individual level. When an organisation
disadvantages a person or group of people either deliberately or unwittingly
then this is known as institutional discrimination. The discrimination can be in
the form of attitudes, systems, services or behaviour.
The McPherson Report, issued following the public inquiry into the murder of
Stephen Lawrence, defined institutional racism as follows:
"The collective failure of an organisation to provide an appropriate and

professional service to people because of their colour, culture, or ethnic origin.
It can be seen or detected in processes, attitudes and behaviour which
amount to discrimination through unwitting prejudice, ignorance,
thoughtlessness and racist stereotyping which disadvantage minority ethnic
people."
from: http://www.archive.official-documents.co.uk

Case Study on Discrimination – A Class Divided

View and take notes on ‘A Class Divided’, which is a documentary film about
discrimination. Jane Elliot conducted an experiment with her primary school
class, and later with adults, to demonstrate to them the effects of
discrimination. Individuals describe what it feels like to be stereotyped, and
experience prejudice and discrimination.
This can be viewed on the internet at:
http://www.pbs.org/wgbh/pages/frontline/shows/divided/etc/view.html
• Make a note of the prejudices that are expressed, based on the

characteristics of having either blue or brown eyes.
• Discuss the ways in which the blue and brown eyed children are
discriminated against.
• Describe the effects of the discrimination.

Effects on Individuals: Worth, Dignity, Social Justice and

Social Welfare
Examples of discrimination reflect bad care practice and this is damaging to
people. It can deny people of opportunities to participate fully in society and is
a barrier to fulfilling personal potential. Take a few minutes to look at the
following definitions of the terms individual worth; dignity; social justice and
social welfare.
Individual worth Dignity
An individual is a unique Respect and self-esteem

human being and this is are linked to dignity. An
the basis of their worth. individual’s dignity is
It is not dependent on maintained when their
any other characteristic. worth as a human being
is recognised.
Social Welfare
Social Justice
This refers to the provision
This refers to the fair that exists to support
treatment of an disadvantaged people in
individual and their right society. This can include
to a just share of housing, education, care
society’s benefits and financial aid.

Values for Professional Carers

Miller & Gibb (2007) refer to two core values for care practice.
every individual.
Respecting the worth and dignity of every individual requires care workers to
recognise a person’s importance as a human being with a set of unique
characteristics and personality. To show respect is to show regard for the
other person by being considerate and courteous. To ensure this,
professional carers work from a value base and use caring skills such as
empathy to develop an understanding of the individual.
One of the first, and perhaps most important, actions that care workers can
take is to critically examine themselves for any personally held stereotyped
ideas or prejudiced attitudes. This is to raise personal awareness of the
possibility that as a care worker the person may act favourably or
unfavourably towards others based on their biases. Care workers do not
have to ditch individually held beliefs or convictions e.g. about issues of
abortion or euthanasia, but these must be recognised and are not permitted to
become issues that will harm or discriminate against any individual cared for.
So, we can respect individuals by recognising stereotyping, prejudice and
discrimination both in our own attitudes and behaviour and in the attitudes and
behaviour of other care workers. Stereotyping, prejudice and discrimination
should always be challenged so that service users are not unfairly
advantaged or disadvantaged for any reason.
Other actions that care workers can take to demonstrate respect for the worth
and dignity of every human being, relates to the actions taken to understand
the service user’s individual needs. People have specific social, physical,
emotional, cognitive and cultural needs.
Social, Physical,Emotional, Cognitive and Cultural (SPECC)
S P E C C
O H M O U
C Y O G L
I S T N T
A I I I U
L C O T R
A N V A
L A E L
L

When working with people requiring care, using a value base will maintain
and nurture the service user’s identity. They can be themselves. There is a
sense of acceptance which will contribute to a positive self-esteem and help
people to self-actualise. That is to say, that the service user will feel good
about his/herself and can achieve their potential. If needs are not met, or
denied, this will also affect a service user’s self-esteem. In this situation self-
esteem will be damaged and the person will not reach their potential.
The value of according social justice and promoting the social welfare of every
individual refers to the idea that everyone in a society has the right to fair and
correct treatment. Social justice is the idea of fair treatment for people. It
means that service users should have equal access to resources (a resource
is something or someone that can help) and that the resources should be
fairly shared. Resources should be allocated on the basis of need and not
given to people we like or who we think deserve the help.
Welfare means wellbeing. People may have a variety of needs depending on

their age and stage of development and social circumstances. So, for
example, a seven year old who is blind will have different needs from an older
person with dementia. To promote social welfare is to promote wellbeing.
To do this a care worker will need to have knowledge about the services and
benefits available to support a person requiring care. A person should not be
disadvantaged because the care worker who is working with them is ignorant
about their condition or services available.
When care is delivered using a value base this has a positive effect on the
service user: Of course, when values are not put into action as principles of
practice then the effect or consequence on the service user is negative.
Figure 1. Care Values bring benefits to individuals

ACTIVITY
Visit the websites of the following organisations to investigate, and take notes
on, the values and aims of these self-help/voluntary organisations:
• ENABLE
• Quarriers
• Downs Syndrome Scotland
• Age Concern Scotland
KEY POINTS
Two core values for care practice.
• the value of according social justice and promoting the social welfare
of every individual.
Stereotype means a ‘set image’ and is an instantly formed mental image
of a person or group, based on assumptions about their characteristics.
Stereotyping takes no notice of individual differences.
Prejudice is a judgement made about a person or group, based on a

stereotyped image. These opinions are often unfavourable or negative
and lack any knowledge of the facts.
Discrimination is the unfair treatment of a person or group of people

based on stereotyped views and prejudiced opinions.
Institutional discrimination is when an organisation disadvantages a

person or group of people either deliberately or unwittingly.
Service users are individuals
When care is delivered using a value base this has a positive effect on
the service user; in other words the service user benefits from the care
received.

Codes of Practice and Professional Conduct

A code of practice or professional conduct reflects the values of a profession
and is a public statement about the expected behaviour of people who belong
to a particular profession. Care workers must maintain standards stated in
the code. They are accountable for their actions and legal action may be
taken if these standards are not kept.
The Scottish Social Services Council (SSSC)

publishes Codes of Practice for Social Service
Workers and Employers. These are standards of
conduct and practice which all social service
workers and their employers must follow.
The SSSC Code states that as a social service

worker you must:
1. Protect the rights and promote the interests of service users and carers
2. Strive to establish and maintain the trust and confidence of service users
and carers
3. Promote the independence of service users while protecting them as far

as possible from danger or harm
4. Respect the rights of service users while seeking to ensure that their
behaviour does not harm themselves or other people
5. Uphold public trust and confidence in social services
6. Be accountable for the quality of your work and take responsibility for
maintaining and improving your knowledge and skills
Each of the above main points of the code is broken down into more detail in
the publication.
http://www.sssc.uk.com

Codes of Practice and Professional Conduct (Continued)
The Nursing and Midwifery

Council code of professional
conduct details the standards that
service users can expect from
members of the nursing
profession.
This code is currently being

reviewed and a new publication
will be available following a period
of consultation.
The code states that as a registered nurse, midwife or specialist community

public health nurse you must:
A. Respect the patient or client as an individual.
B. Obtain consent before you give any treatment or care.
C. Co-operate with others in the team.
D. Protect confidential information.
E. Maintain your professional knowledge and competence.
F. Be trustworthy.
G. Act to identify and minimise the risks to patients and clients.
Each of the above main points of the code is broken down into more detail, in
the publication.
http://www.nmc-uk.org

ACTIVITY
Visit the Scottish Social Services Council websites and view or download a
copy of the code of practice to enable you to carry out the following exercise.
http://www.sssc.uk.com
Review the SSSC code of practice and select one main point where the carer
involved in this incident failed to uphold the standard stated in the code and
explain what the carer should have done.
INCIDENT A 76-year-old woman with severe learning

disabilities suffered first and second-degree burns
after being bathed in scalding water.
The carer, who bathed her, failed to check the

water temperature, and anti-scald devices fitted to
the taps were defective. The woman was only
able to communicate making "non-speech"
sounds
CODE OF PRACTICE
POINT IGNORED
CODE OF PRACTICE
WHAT THE CARER
SHOULD HAVE DONE

ACTIVITY
Visit the Nursing and Midwifery Council website and view or download a copy
of the code of professional conduct to enable you to carry out the following
exercise.
http://www.nmc-uk.org
Review the NMC code of professional conduct and select one main point
where the nurse involved in this incident failed to uphold the standard stated
in the code and explain what the nurse should have done.
INCIDENT A nurse ramming a paper towel into a terrified

pensioner's mouth, force feeding another so
she nearly choked and using abusive
language.
CODE OF PRACTICE
POINT IGNORED
CODE OF PRACTICE
WHAT THE CARER
SHOULD HAVE DONE

Key Points
SSSC Code of Practice
1. Protect the rights and promote the interests of service users and carers.
and carers.
3. Promote the independence of service users while protecting them as far as
possible from danger or harm.
behaviour does not harm themselves or other people.
5. Uphold public trust and confidence in social services.
6. Be accountable for the quality of your work and take responsibility for
maintaining and improving your knowledge and skills.
Key Points
NMC Code of professional conduct

F. Be trustworthy.

Care Values and Communication
If values are important in the caring relationship then the carer’s ability to
demonstrate these values through effective communication is essential.
Communication is the way that information is shared between two or more
people and reading, writing and speaking are all forms of communication. In
the course of their work as the care worker may communicate with service
users, families, volunteers, colleagues and other professionals. In this section
we will focus on communication with service users but it is important to also
apply this knowledge to work effectively as a team member.
To communicate effectively carers need to think about the way that they
communicate. Carers should reflect on their interactions and evaluate their
ability to communicate so that they can learn from their experiences and make
plans to improve their effectiveness. Interpersonal communication,
communication between people, is a complex process involving listening,
questioning, understanding and responding to what is being communicated.
Effective communication is achieved when the messages that are given and
received are transmitted successfully and interpreted accurately.
Message given Message received
I like working You like

with you. working with
me.
In care work, it is the responsibility of the care worker to develop an effective

means of communication and to take into consideration a number of factors,
when working with a service user. Studies show that there are three
components of interpersonal communication:
Verbal in the actual words used in the communication
Non-verbal by facial expression and other body language signals,

gestures and touch
Non-verbal paralanguage, that is to say through the vocal tones and
the way that the communication is expressed

Take a few minutes to consider the relative importance of each of the above
components (as a percentage) in transmitting a message. The three parts
should add up to 100%
Verbal %
Non-verbal/facial expression and body language %
Non-verbal/paralanguage or vocal tones %
Message 100 %

The Role of Effective Communication in the Caring

Relationship
You might be surprised to discover that how we say something is far more
important that the actual words that we use. So tone of voice and facial
expression and body language are vitally important if we want to make sure
that we transmit our message effectively.
55%
38%
7%
Verbal
Non Verbal - facial expression and body language
Non Verbal - paralanguage or vocal tones
Figure 2 Portions of communicating a message
Non-verbal communication may be transmitted consciously or unconsciously,

therefore when working with service users, it is important to think about the
non-verbal signals we send. Unless these signals support the verbal
message the service user will be less confident about the communication. So,
for example if we tell someone that we are listening to them, but don’t look at
them, or if we sound irritated when we say the words, the person is unlikely to
believe what we say.
Well, I think you sound

I am listening to irritated … and you’re
you. not looking at me!
This is an example of when non-verbal communication signals are

contradicting the words that are spoken.

The diagram below shows that interpersonal communication involves sending

a message, receiving and interpreting the message and then giving feedback
to the sender. This is a cycle of communication and people give and receive
messages in this way.
Message
21Receiver
Sender y
Interprets
Communicates Message
Message
Verbal and Non-
Verbal and Non- verbal signals
verbal signals are noted,
Feedback sent to using all
original sender who will available senses
receive and interpret the
response
Interpersonal communication therefore, contains four main elements, the

sender, the message, the receiver and feedback. The care worker and the
service user are both involved in sending verbal and non-verbal messages
and interpreting and receiving verbal and non-verbal feedback.
Verbal Communication
Verbal communication is concerned with the actual words used in
communicating a message.
Verbal communication relates to the actual words and sounds used in the
communication. Words and sounds have meaning and the words that we
choose to use convey the message we want to send. However, the words a
carer uses should be carefully chosen, so that the intended meaning is clear.
We will consider three main points in relation to verbal communication.
Firstly, words and sounds convey meaning. They are symbolic; this means
that they are used to represent ideas. Sometimes the meaning is culturally
specific, and the meaning is understood in different ways by different people.
Language also evolves over time and meanings change. So, for example the
word ‘cool’ has several meanings. If someone says ‘He was rather cool.’
Does this mean icy, detached, calm or trendy? If the receiver has other
information about the context or situation they may be able to extract the
exact meaning. But without additional information it is impossible to be sure
what is meant.

Secondly, people who belong to particular groups develop specialised

language. This includes jargon (technical language) and colloquialisms
(slang). Part of a care workers education is to begin to understand specific
terminology and use words accurately to convey meaning. For example you
may tell a colleague that Jean Brown is complaining of dysuria and should be
monitored. But we wouldn’t expect your colleague to ask Jean ‘How is your
dysuria?’ Jean might not understand. Instead your colleague may ask, ‘Can
you tell me how you feel when you are passing urine?’ or ‘Can you describe
how it feels when you go to the toilet?’ Similarly, colloquialisms or slang might
not be clearly understood by service users. For example ‘Did I hear you
Wallace and Gromit?’ or ‘Were you boking in the toilet? might be unfamiliar
terms for vomiting or being sick. If we want to know if someone has been sick
or vomited, then we need to make sure that they fully understand what we are
asking.
Thirdly, language used can also convey prejudice and care workers should
think about the meaning, in terms or prejudice that the words that they use
might convey. For example greeting an older man as ‘gramps’ or referring to
a service user as ‘mental’ conveys stereotypical meanings that are unhelpful
when trying to reflect the values of respect and dignity. Language is an
important factor in demonstrating respect and is vital to building up a trusting
caring relationship.
Although we have been speaking about verbal communication as spoken

words, there are people who have difficulty with speech and who rely on other
forms of communication. British Sign Language and Makaton are two
languages that people who have difficulty with speech may use in verbal
communication.

ACTIVITY
To find out more about verbal communication using symbols and signs, visit
the following websites.
http://www.findavoice.org.uk/symbolpages/makaton/mak-1.htm
http://www.british-sign.co.uk/

Verbal Communication - Questions
Asking questions is an important aspect of developing caring relationships. It

is part of the carer’s role to find out about the needs of the service user.
There are a number of different types of questions but we will look at two
types of questions that the carer can use.
Closed questions are used to obtain specific information. They require a

specific response. For example, ‘What age are you?’ or ‘Do you have any
pain?’ These can be effective to get relevant information quickly, but don’t
give the service user an opportunity to provide other details that may be
important.
Open Questions give the service user an opportunity to provide more detail.
This in turn allows the carer to develop a more in depth understanding of the
service user’s situation. For example ‘What do you like about going to
college? Or ‘What does the pain feel like?’ This gives the service user a
chance to talk freely about their experience. If you want to limit the response
you can prefix (put at the beginning of) the question with a phrase such as
‘Briefly tell me, what do you like about it?
Work in pairs to decide whether the following questions are open or

closed.
What time is it?
Who left the door open?
Why were you late?
What kind of day have you had?
Did you have a good time today?
Have you got a place at college?
Do you know how to work the microwave?
Could you explain how to work the microwave?

Non-Verbal Communication
Non-verbal communication refers to all the aspects of communication apart
from the actual words used. We have already found out that non-verbal
communication (NVC) can be divided into two main components;
paralanguage or vocal tones (which makes up approximately 38% of the
message) and body language and facial expression (which makes up
approximately 55% of the message).
Paralanguage or vocal tones
Paralanguage or vocal tones add meaning to the verbal message. The

volume and speed of speech can offer clues about a person’s emotions.
People generally speak faster when they are excited or in a hurry and slow
down when concentrating or trying to understand something. Shouting is
associated with anger and mumbling with shyness. Putting the emphasis on
certain words in a sentence can also change the meaning. Try saying the
following with the emphasis on the bold words:
Mandeep is my keyworker but she has never come with me to the cinema.
Mandeep is my keyworker but she has never come with me to the cinema.
Although both of the sentences contain the same words, the meaning appears
to change by emphasising different words in the sentence. Emphasising ‘my
keyworker’ sounds as if the speaker is keen to stress a relationship with
Mandeep. However, the emphasis on ‘me’ in the second example implies that
Mandeep has gone to the cinema, but not with ‘me’.
Paralanguage therefore includes, speed, tone, accent and emotional aspects

of the message.
Paralanguage in care work involves using the correct pace and tone to
communicate with the service user. To motivate a child you may use
encouraging tones whereas to calm an anxious or angry service user you
would slow down your speech and use soothing tones.

Body language and facial expression
Body language refers to the many signals that we transmit using gestures,
posture and touch. The first thing to bear in mind is that body language is
culturally specific. For example raising a thumb to an American will be
interpreted as a supportive good luck gesture whereas someone from Iran
would take offence as it regarded as an obscene gesture, a bit like a two
fingered gesture in Britain. In Britain it is considered polite to look at someone
when they are speaking to you whereas in Japanese culture direct eye
contact is limited and prolonged eye contact can be considered to be
disrespectful or even aggressive. We will look at body language and facial
expression from a British perspective, but as we live and work in a multi-
cultural society, carers should always be open to learning more about how
people from a variety of cultures may express themselves differently using
body language.
Body language includes eye contact, facial expression, proximity, posture and
gesture.
Eye contact can play an important role in establishing a relationship and an

unwillingness to make eye contact may even be associated with shifty or
dishonest behaviour. If you ‘catch someone’s eye’ then you are indicating to
the person, non-verbally, that you want to have a conversation with them.
Eye contact demonstrates interest in what is being said and is often
accompanied with head nodding and appropriate facial expressions.
Facial expression contains a substantial amount of information. A person’s

emotions are often revealed by their facial expression. In fact studies show
that there are seven universal facial expressions; that is seven facial
expressions that are seen all over the world. These expressions are anger,
disgust, fear, happiness, sadness, interest and surprise. Do you think that you
can read these facial expressions of emotion?

Picture Exercise – Seven Expressions
Test your own ability to recognise emotional expressions.
This exercise can be found at the web site below and there is a completion
panel for you to decide what the expressions signify.
http://www.cultsock.ndirect.co.uk/MUHome/cshtml/nvc/nvc3a.html
• Anger
• Disgust, contempt
• Fear
• Happiness
• Interest
• Sadness
• Surprise

Proximity refers to the distance between you and the person you are
interacting with. Generally speaking the more intimately you know someone
then the more comfortable you are with being physically close to them. There
are cultural variations but intimate space is thought to be around 15cms.
However if a stranger or even your class teacher came to within 15cms of
your face to ask you the time, you may think that this person was a bit too
close for comfort and is invading what psychologists refer to as a person’s
personal space. Psychological studies propose that personal space is around
15cm – 1 metre, and is the distance we like to be able to keep between
ourselves and others. So, we may be able to tell something about the
relationship between two people by the distance between them. When
working with service users we should be aware that being too close can be
threatening for the service user whereas if we don’t get close this might
suggest that we are disinterested.
Posture refers to a person’s stance. Even if we can’t see someone’s face we

will sometimes make a judgement based on their posture. If someone is
described as overbearing or dominating, this provides a mental image of
someone who towers over other people and who probably appears a bit
threatening. People may be described in a variety of ways. For example we
may interpret that someone is relaxed or anxious from postural signals. When
working with service users we should be aware of our own body posture.
Facing someone and leaning slightly towards them will suggest that we are
interested in them.
Gesture refers to body movements that are invested with particular

meanings. Gestures can be performed with the hands, head and feet.
Nodding the head generally means agreement and shaking it from side to
side means disagreement. Care workers can use gestures as a form of
communication with service users in situations where communication is
otherwise difficult. For example, when my dentist is drilling my teeth, he tells
me to raise my hand as a signal that I want him to stop.
Touch is a form of non-verbal communication that varies between cultures

but which is particularly important in care work. Because carers assist service
users with physical care tasks they are allowed to touch service users. Touch
can communicate the attitude of the carer to the service user. Touch can be
therapeutic, for example massage. Touch can convey gentleness and
sensitivity but it can also convey the opposite when carers are rough and
insensitive when working with a service user.

Verbal and Non-verbal Communication
Activity 1
• Record a television programme (10 minutes) and view it with the sound
off.
• Watch the way that people interact and try to work out what is happening
by observing their body language. Note down your understanding of what
is happening.
• View the recording with the sound and evaluate your understanding. How
accurate was your understanding? What body language clues did you
observe?
Activity 2
• Work in pairs
• You should sit facing each other
• You should both wear blindfolds and sit on your hands
• Discuss a topic of interest, for example where you like to go on holiday.
Try to spend 5 – 10 minutes talking to each other before removing your
blindfold.
• Evaluate this experience. Was it easy or difficult to keep the conversation
going? Were you more aware of clues from tone of voice in the absence
of visual cues? Did you want to use your hands to express yourself?
• Explain the insights that this exercise can provide to help you when
working with a blind service user?

Barriers to Effective Communication

When carers work with service users it is important to be aware of any
possible barriers to effective communication. A barrier is anything that
interferes with the message and can be attributed to personal, physical or
environmental factors.
Message 21
Sender
Barrier
Barrier
y Receiver
Feedback
Personal factors can be attributed to the sender or receiver. A person’s

age, stage of development and ability should all be considered when deciding
on the best way to communicate. The care worker is often responsible for
giving the service user information. If the message contains too much
information (information overload) or contains jargon or colloquialisms then
these things will prevent the message being effectively communicated.
Similarly if the care worker is listening to feedback and isn’t attentive or fails to
clarify understanding then this too can interfere with effective communication.
A person’s emotional state can be a barrier to communication. For example

the message may be poorly communicated if the person is nervous,
embarrassed, angry, anxious, or unable to make him or herself understood. It
is the role of the care worker to assess the situation and to limit any
misunderstandings.
Physical factors can include hearing, speech or visual communication

issues. A person with poor or no hearing or someone with limited sight may
have difficulty in sending or receiving the message effectively, without
assistance. The care worker should consider ways of improving
communication with service users who may need the message presented in a
way that is more appropriate to their needs.
Environmental factors relate to the surroundings where the interaction

occurs. Service users will benefit from surroundings where they feel safe and
comfortable. Where the interaction involves the transmission of personal
information, the environment should be private and free from interruptions.

Removing barriers
To give and receive messages from service users, care workers need to
develop effective communication skills. These include:
• Creating an environment that is conducive to people being able to

communicate well
• Recognising the person’s feelings, fears, insecurities and expectations
• Consider whether the service user has any difficulties with vision, hearing,
speaking or understanding
• Communicating clearly using verbal and non-verbal communication skills
• Listening effectively.
Effective listening involves paying attention to the speaker. This means that
the care worker should demonstrate their attention using appropriate body
language. If the service user is unable to see, then using touch and tone of
voice should be used to reassure the person that you are paying attention.
Gerard Egan suggests the following acronym to remember how to
demonstrate attentive listening:
S square: sit or stand facing the person

O open posture – don’t fold your arms or cross your legs (barriers)
L lean forward slightly to show interest
E eye contact
R relax your posture
When communicating, carers can use open and closed questions to check the
service user’s understanding. The carer can also check their own
understanding of what the service user is saying. They can do this by
reflecting back what is said, to check the meaning by paraphrasing or
summarising
Service User: I’ve been feeling sick all day
Carer Reflecting Back: I’m sorry that you’ve been feeling sick all day.
When did this feeling start and how is it affecting
you now?
Service User: It started soon after lunch. Now I’ve got pains in
my stomach and I want to throw up.

Effective Verbal and Non-verbal Communication
Brainstorm to identify ways improving communication for people in each of the

following service users.
• Older adults with dementia

• People with addictive behaviours (e.g. drugs/alcohol/gambling)
• Young people with autism
• Children with cerebral palsy
• Adults with learning disabilities
• Adults with mental health problems
• People with hearing impairments
• People with visual impairments
• People with speech impairments
Select at least five of the above client groups. For each group, write a short
paragraph to explain two specific ways that you as a carer, would improve
communication for this client group. You should avoid writing very general
statements such as ‘I would be aware of body language’. You should be very
specific, for example ‘When communicating with an older adult with dementia
I would note facial expression, as interest is a characteristic that is evident in
a person’s facial expression. This would help me to be aware of topics of
interest or items that hold a special significance for this individual and I would
be able to develop strategies for holding the person’s attention.’
There are many ways of improving communication between carer and service
user. Some suggestions are appropriate for a range of service users. There
are a number of possible answers but it is important to try to think of things
that may be particularly important for the service user you are working with.

Older adults with dementia • Remind the service user of your name
• Speak slowly and clearly
• Use short simple sentences.
People with addictive • Create a comfortable environment, privacy

behaviours (e.g. is important
drugs/alcohol/gambling) • Be attentive – SOLER
• Check understanding through open
questions and reflecting back.
Young people with autism • Try to achieve eye contact

• Remove background noise or distractions
• Use clear and unambiguous language.
Children with cerebral palsy • Use simple language as you are speaking
to a child
• Check the child’s understanding by asking
open questions
• Do not rush the child when he or she is
speaking.
Adults with learning • Support verbal communication with body

disabilities language and gestures
• Use objects and pictures if these help to
explain more clearly
• Let the person know that his/her
contribution is valued by giving them
him/her to think about their response and
then express him/herself.
Adults with mental health • Create an environment where the person

problems feels safe and comfortable
• Remind the service user that you will
maintain confidentiality (the environment,
and your non-verbal communication will
need to support these words)
• Check your understanding using open
questions and reflecting back.

People with hearing • Make sure that the person can see you
impairments approaching. (Don’t surprise them
suddenly from behind)
• If the service user can lip read make sure
you are sitting in a good light where they
can see you.
• Don’t cover your mouth when you are
speaking.
• If the person uses hearing aids, make
sure they are available and working.
Don’t shout.
People with visual • Let the person know that you are there
impairments and who you are.
• You can use touch to let the person know
how close you are; offer to let the service
user touch your face and hair to find out
more about you.
• Describe objects and events in detail to
enhance the service user’s experience
and understanding
People who find speech • Be attentive – SOLER

difficult • Don’t rush the person. Don’t finish off
sentences for the service user but give the
person time to express him/herself.
• Use a picture board if it is appropriate
Advocacy
People can have difficulty with communication for a variety of reasons.

Advocacy is one way that carers can support people to communicate. It
involves finding out what people want to say and helping them to express their
point of view. It is a means of empowering people. An advocate is someone
who helps someone to express their views, or concerns. Sometimes a carer
will fulfil this role. There are many different forms of advocacy, including self –
advocacy. To be effective as an advocate a carer must develop an
understanding of the service user’s needs and wants. The carer may speak
on behalf of the service user or work with the service user to enable them to
develop skills to speak up for him or herself (self-advocacy).
Find out about advocacy services – what do they provide?

Carl Roger’s Core Conditions

Communication with people can be more effective if certain conditions are
achieved. Carl Rogers developed a Person Centred approach that can help
when working with individuals. The person centred approach starts from the
basis that an individual knows his or her experiences better than anyone else
and that all individuals are capable of change. However sometimes service
users may need help to make more sense of their experiences or to make
decisions about changing their situation. Rogers suggest that there are three
core conditions that are important in creating a relationship to enable growth
and therapeutic change. These core conditions are:
• Unconditional Positive Regard

• Congruence
• Empathy.
These core conditions are particularly relevant when involved in counselling
service users, when there is an opportunity to build up a relationship over a
period of time. However these conditions can support effective
communication with any service user.
Unconditional positive regard can also be thought of as respect,

acceptance, warmth or prizing (valuing the person). The carer demonstrates
verbally and non-verbally that they accept the person as a unique individual.
The service user doesn’t need to behave in particular ways to gain the carers
approval. Unconditional positive regard means that the carer is non-
judgemental about the service user’s situation. This opens up an opportunity
for the service user to be able to express thoughts and feelings without fear of
rejection or condemnation. Unconditional positive regard does not mean that
the carer has to be approving of all of the service user’s behaviour, but the
service user knows that they are not judged on the basis of their behaviour.
The service user does not have to work hard to earn the approval of the carer.
It is the job of the carer to clearly communicate that they accept the service
user. This can be done through words of support and encouragement and the
creation of a climate where a service user feels safe. In these conditions a
service user can build up trust in their carer and is able to relax and begin to
reveal their concerns.
Congruence is the idea of being ‘in tune’ with the service user. This means
that the service user is being genuine with the service user and is open and
honest with them. Congruence is about people being real with each other and
not pretending to be what the other person wants them to be. Both people in
the relationship should be able to be open and transparent but it is the carer
who has to work hard to help this happen. If the carer says they will maintain

confidentiality this has to be true. If the carer says that they are not shocked
to know that the service user has downloaded pornographic images on their
computer, this has to be true. The carer can only achieve congruence by
being aware of his or her own personal feelings and thoughts. If the carer is
persistently offended by something that the service user says or does, and
has strong feelings about this, then the carer should be aware that this is
something that may ‘leak out’ to the service user, probably non-verbally, and
get in the way of the therapeutic relationship. So, if the carer is shocked that
the service user is downloading pornography, this should be voiced so that
there is no deception in the relationship. However, although there is shock
there is still ‘acceptance’ of the person. Unconditional positive regard, by the
carer, is maintained and the service user should find that they are increasingly
able to be him or her self rather than pretend in the relationship.
EMPATHY is a characteristic which involves being able to perceive a situation

from the service user’s point of view. This is sometimes known as being
within a person’s ‘frame of reference’. Support groups bring together people
who have had similar experiences, for example bereavement as people in
similar circumstances may find it easier to empathise. However, empathy is
different from sympathy. Sympathy is imagining how someone must feel,
because that is how we would feel in a similar situation. Empathy, on the
other hand, requires a lot of hard work to find out from the other person how
they see their situation. Because we are all unique, we think and feel
differently about similar events. To develop empathy the carer has to get to
know the service user’s thoughts and feelings and to try to understand the
issues as if they were the service user. This involves the use of open
questions, reflecting back and paraphrasing, to check our understanding is
accurate.
Empathy can be thought of as the ability to enter someone else’s private

world and being sensitive to their feelings and experiences. Understanding
how another person is experiencing their situation is essential when
considering needs, care planning and strategies to meet needs.

Gerard Egan – A Systematic Approach to Helping

Caring relationships are able to develop when Rogers’ core conditions are in
evidence. When trying to achieve effective communication it is also useful to
have a guideline to follow. Gerard Egan’s Skilled Helper Model, offers a
systematic approach to helping using a process of exploring, understanding
and acting. Egan further proposes a 3-stage model or framework to guide
the helper who is working with a service user to solve problems or develop
opportunities. The purpose of the model is to empower the service user by
helping them 'to manage their problems in living more effectively and develop
unused opportunities more fully', and to 'help people become better at helping
themselves in their everyday lives.' The model is not a rigid step-by-step
formula but can be used flexibly with the helper moving backwards and
forwards between the stages to explore issues, help the service user to
develop their understanding and make decisions about future actions.
Although the process is dynamic, here, we will describe the stages in order
from start to finish.
The model has three stages:
1. The current scenario

2. The preferred scenario
3. The action strategies

1. The current scenario is the stage where the helper (or care worker),
enables the service user to explore their situation from their own frame of
reference and then to focus on specific concerns. During this stage the carer
finds out the service user’s story. There may be parts of the story that the
service user brushes over or ignores and the carer is alert to these ‘blind
spots’ and helps the service user to explore these areas to expose all aspects
of the situation. The carer also helps the service user to focus on issues that
are of particular concern to the service user and to decide on priorities; that is,
the issues in order of importance.
This stage could be summarised as:
Stage How the helper

does this
a. STORY • BE AN ACTIVE LISTENER
1
Demonstrate:
CURRENT • UNCONDITIONAL POSITIVE
SCENARIO b. BLIND SPOTS REGARD
• CONGRUENCE
c. LEVERAGE • EMPATHY
• Use open and closed questions
• Paraphrase (restate the story to
check your understanding)
• Reflect feelings (check you
understand how the person feels)
Summarise the story and help the
person to focus on specific issues
• Observe non-verbal
communication.

2. The preferred scenario is the stage where the helper (or care worker),
helps the service user to understand and consider all the choices and
possibilities available to them. The care worker helps the service user to
imagine all the options and to consider the resources that are available to
support them to make changes. The service user is empowered through this
process and a change agenda or plan is formulated. The care worker helps
the service user to work through the implications of these potential changes
and to formulate some goals. It is also necessary to check the commitment of
the service user to achieving these goals.
This stage can be summarised as:
Stage What happens How the helper

does this
2 a. POSSIBILITIES Continue to use

the skills used in
PREFERRED stage one.
SCENARIO b. CHANGE ANGENDA
In addition, the helper
should:
c. COMMITMENT
• Communicate a
deeper understanding:
through increasing
empathy and
congruence.
• Help the service user
to set SMART goals
(specific, measurable,
achievable, realistic
and time based).

3. The action strategies formulate the third stage of Egan’s model. At this
point the care worker helps the service user to look at ways of achieving the
goals that they have set. Possible actions are considered and the advantages
and disadvantages of these actions are evaluated. The service user begins to
achieve a sense of the most appropriate action to take in their situation; that is
to say the actions that are best fitted to achieving the desired goals. Once the
service user has made these decisions a specific plan of action is formulated.
This is stage can be summarised as:
Stage How the helper

does this
3 a. POSSIBLE ACTIONS Continue to use the skills of

stage 1 and 2
ACTION b. BEST FIT
In addition:
c. PLAN
• Help the service user to
evaluate their actions by
considering advantages
and disadvantages
• Decide on actions that
will lead to the desired
outcomes

Establish the caring

Positive Regard, Congruence, Empathy. Use a systematic
relationship
approach.
SOLER
using
Remember
Explore,
Rogers
ACTION LEADING TO VALUED OUTCOMES
Act. and Understand

Conditions. Unconditional

Key Points
Effective Communication in the caring relationship
• Is used to demonstrate care values

• Is required to understand individual service users and their needs
• Involves listening, questioning, understanding and responding
• Includes verbal messages – the actual words
• Includes non-verbal signals – paralanguage e.g. pace and tone and
facial expression and body language
• Barriers to communication can be personal, physical and
environmental
• SOLER skills used in effective listening
• Communication must be appropriate to the needs of the service user
• Rogers’ core conditions are Unconditional Positive Regard,
Congruence and Empathy
• Egan’s Systematic approach is Explore, Understand and Act
• Egan’s Skilled Helper Model – 3 stages – Current Scenario, Preferred
Scenario and Action Strategies
• Advocacy is a way of empowering service users, so that their voice
can be heard.

Reflective Practice as a Tool for Evaluating Personal Practice

Reflective practice is simply thinking about what you are doing or what you
have done. This is known as reflection in action (in the present) or reflection
on action (reflecting on a past event). The person who is reflecting can ask
themselves questions about their actions. For example:
Why did I do that?

Why did I say that?
How did I feel?
How did the service user feel?
Did I communicate well?
How can I communicate more effectively with this service user?
What did I do that was good practice?
What did I do that was bad practice?
How do I know what is good or bad practice?
Am I using any theory in my practice?
Could I use any of my current knowledge of theory to improve my practice?
Do I need to learn more to be able to improve my practice?
Where can I find out more about people with this condition/in this kind of
situation?
Was that the best I could do for this person?
How would I feel if someone did that to me?
What could I do differently?
A professional care worker will reflect on their actions and the actions of
others, to learn from their experiences. Reflective practice lets the
professional care worker think about what they do and why they do it. The
aim of this reflective practice is to gain a deeper understanding of the service
user – carer relationship and to act on what is learned to improve care
practice.
Reflective Practice
Is a way of improving practice.
Means deliberately thinking about what you did.
Involves asking lots of why, how, what, or any

other questions to gain a deeper understanding
about experiences.
Is a way of learning from experience and acting

on this new knowledge to improve practice.

Formative Assessment – Outcome 1
Analyse caring relationships in terms of care values and communication
PLEASE READ THESE NOTES
Before you do this formative assessment you should review your notes. You
should try to make notes of the main points you need to remember. You can
highlight main points, use mind-maps, memory cards or mnemonics to help
you remember. Sometimes it is useful to work with one or a few other people
to revise. You can discuss topics together, take turns in explaining topics to
each other and also ask each other questions.
When you have completed your revision, try to do the assessment without
referring to your notes.
You should be aware that in the National Assessment Bank (NAB) instrument
of assessment and in external exams you will be asked questions that test
both Knowledge and Understanding (KU) as well as your ability to carry out
Analysis, Evaluation, and show the Application of theory to practice (AE/App).
KU marks are awarded for accurate information given in answers, AE/App
marks are awarded for doing something with this information, for example
discussing advantages and disadvantages or analysing or applying this
information in relation to a particular situation or client group using case study
material.
In this formative assessment there are no actual marks given but each
question indicates whether it requires KU and/or AE/App.
If you have difficulty answering the questions, review your notes again and
then try again. You may refer to your notes when answering the questions but
try to put things into your own words.
You should discuss your answers, and any difficulties you have with your
class tutor.

Read the following case study and answer the questions that follow.
You are on placement in a care home for older adults, some of whom have
dementia. You are assigned to work with a senior care assistant, Amy. It is
8.30 am and Amy tells you that the first job to be done is to get the residents
up for breakfast.
You follow Amy to the first room and she enters without knocking. ‘Time to
get up Fred, ‘wakey wakey’, she calls and goes over to the window to open
the curtains. Fred looks a bit startled and gives you a weary smile. Amy goes
into the cupboard and brings out some clothes for Fred to wear and asks you
to check that there are towels in the en-suite shower. Amy doesn’t introduce
you and you feel a bit awkward as there isn’t an opportunity to introduce
yourself as Amy has asked you to check for towels. You find that there are no
towels and tell Amy this. Meanwhile Amy has managed to get Fred out of bed
and has stripped his pyjamas off. ‘He’s wet himself’ she explains, old people
do that. ‘You keep an eye on Fred and I’ll get some towels’. She then rushes
out of the room to get the towels but leaves the door open. She returns after
a couple of minutes and shuts the door. Fred is helped to shower and dress.
He tries to put his own trousers on but Amy hurries him saying that there’s no
time to wait as breakfast is on the table. Fred uses a walking frame and you
and Amy help him to the table. On the way to the dining room, Amy explains
that Fred has dementia. She says that he has one son who lives in the town
but his son is an alcoholic and when he visits he just causes trouble. When
you get to the dining room Amy says he should sit beside the window, and
asks you to get him some porridge.
Later in the day you are assigned to Ron who is a care manager. Two people
are coming to see Ron, a woman and her son. The woman Jean Anderson,
has dementia and she lives with her son and his family. They want to find out
about the possibility of a short break at the home. Ron is preparing for their
visit. He says it might be possible for you to be present when he speaks to
them but he will have to ask for their permission. He asks if you have learned
anything about communication skills at college. You discuss the importance
of communication skills and are permitted to be present at the meeting. You
note that Ron uses verbal and non-verbal communication skills as well as
aspects of both Rogers and Egan’s theories.
When you are leaving for the day, you meet Amy again. Amy asks how you
got on and looks genuinely interested. Amy says that she is on a study day
tomorrow. The topic is ‘reflective practice’.

Note: Main Points from Professional Codes of Practice/Conduct are

listed on the following page to help with questions 2 and 3.
Questions
1. Outline two advantages, to the service user, of care values underpinning

care practice. (KU/AE)
2. Select one main point from the Social Services Council Code of Practice
for Care Workers and evaluate Amy’s practice in relation to that point.
(KU/AE/App)
3. Select one other main point from a Professional Code of Conduct or Code
of practice and explain how this could be put into practice when working
with Fred. (KU/AE/App)
4. Explain the meaning of stereotyping. (KU)
5. Explain one reason why care workers should be aware of stereotyping.

(KU)
6. Explain one reason why care workers should be aware of their own body
language. (KU)
7. Explain two ways of improving communication with someone with

dementia. (KU/AE/App)
8. Explain two ways that Ron could demonstrate effective listening at the
meeting. (KU/AE/App)
9. Describe what is meant by ‘blind spots’ in Egan’s skilled Helper Model.

(KU)
10. Explain the purpose of reflective practice and why this might benefit Amy.
(KU/AE/App)

Main Points from Professional Codes of Practice/Conduct to help with

questions 2 and 3.
Key Points
SSSC Code of Practice
1. Protect the rights and promote the interests of service users and carers.
and carers.
3. Promote the independence of service users while protecting them as far

as possible from danger or harm.
behaviour does not harm themselves or other people.
5. Uphold public trust and confidence in social services.
Key Points
NMC Code of professional conduct
F. Be trustworthy.

OUTCOME 2
Explain the role of legislation in promoting positive care.
(a) Describe the main features of relevant legislation

(b) Explain how legislation promotes positive care practice
Mandatory Content
Main features of relevant legislation:
• legislation that is currently in use and that can be seen to have an

influence on current care practice.
• Legislation can be seen to reflect values and the links between legislation,
policy, procedures and social or cultural values.
Legislation to be considered:
• Regulation of Care (Scotland) Act 2001

• Data Protection Act 1998; NHS and Community Care Act 1990
• Disability Discrimination Act 1995
• Race Relations Act 1976 and Amendment Act 2000
• Sex Discrimination Act 1975
• Mental Health: Care and Treatment (Scotland) Act 2003
• Adults with Incapacity Act (Scotland) 2000
• Community Care and Health (Scotland) Act 2002.
Ways in which legislation acts as a framework to promote positive care

practice:
• by promoting health and wellbeing

• social, cultural, mental, physical, emotional and cognitive aspects
• reflecting values associated with human rights
• safeguarding human rights and bringing benefit to individual requiring care
• providing benefits to individuals
• maintaining quality of life
• protecting rights and choices
• maintaining confidentiality
• promoting equality of opportunity
• enforcing professional accountability
• specifying professional care workers responsibilities under legislation
(updating, accountability etc.)

Introduction
To be effective, a care worker will need to be familiar with legislation that

concerns their work and has an effect on the lives of service users. Care
workers have a responsibility to keep up to date with current legislation and to
be aware of impending changes. If a care worker is ignorant of their legal
obligations when working with others this is detrimental to service users and
could also jeopardise their own professional registration. There are also legal
consequences for care workers, as for anyone, who breaks the law.
Legislation compels people to behave in certain ways and legislation is turned

into policy in the workplace. A policy is a course of action and there are a
range of policies in place in care settings, for example an equal opportunities
policy. When working with a service user or group of service users, carers
must work in accordance with legislation and workplace policies.
In this section we will consider a number of Acts of Parliament that have been
introduced to address issues in society and which have direct relevance to
many service users. It is only necessary to know the main features of each
piece of legislation and to appreciate the difference that the particular piece of
legislation can make.
An Overview of Legislation
The key features of each piece of legislation are described and summarised in
the following pages. Links between some pieces of legislation are made,
where appropriate, to show the way that legislation has been developed and
changed. It is important to remember that legislation may change and to keep
up to date with these changes.
You should work through this information, visiting the websites referred to for
further information. The information mainly provides you with knowledge and
understanding. Visiting the websites and looking at some of the situations
where the legislation is used will give you the scope needed to help you to
analyse, evaluate and apply this knowledge and understanding.

The Sex Discrimination Act (1975)
The Sex Discrimination Act was introduced to address inequalities between

men and women in response to stereotypes and prejudices that existed (and
continue to exist) in relation to sexual identity. For example, the stereotype
that men being physically and emotionally strong are suited to work as
builders and company directors, whereas women being the opposite aren’t
considered for these jobs. Subjects studied at school reflected these
stereotypes with girls directed into domestic science and boys into technical
programmes. In addition, women and men doing the same jobs were paid
different rates with men paid more, as they were seen to be the ‘breadwinner’
for the family. The Sex Discrimination Act made it unlawful to discriminate on
the grounds of sex and specifically refers to discrimination in employment,
education, advertising or the provision of housing, goods, services or facilities.
Discrimination may be direct or indirect. However the individual has to raise a
complaint and provide evidence of discrimination.
Direct sex discrimination is where a woman (or man) is treated less

favourably than a person of the opposite sex in comparable circumstances is,
or would be, because of her (or his) sex.
Indirect sex discrimination exists (in employment) where a provision criteria

or practice is applied (or would be applied) to both sexes but which puts one
sex (or married persons) at a particular disadvantage and cannot be shown to
be a proportionate means of meeting a legitimate aim. For example, a
requirement to work full-time might be unlawful discrimination against women,
who might also have responsibilities as carers.
The Equal Opportunities Commission (EOC) was set up to monitor the

implementation of this legislation. Current policy issues relate to gender
equality and stereotypes that exist in relation to ethnic minority women at
work.
The Gender Equality Duty (GED) is a new law that

came into effect in April 2007 to address ongoing
discrimination in the workplace. Thirty years after the
introduction of the Sex Discrimination Act, there is still
widespread discrimination in society. The amendment
introduces a duty that places the legal responsibility on
public authorities to promote gender equality in the
workplace. Sometimes exemptions are allowed where
there is a genuine occupational requirement. For
example recruiting a female worker for a women’s
refuge.

You can keep up to date by visiting their website. You can also find an
excellent publication giving an overview of 30 years of progress since the Sex
Discrimination Act was introduced in 1975. http://www.eoc.org.uk
Key features
The Sex Discrimination Act 1975

and
Gender Equality Duty 2007
• The Sex Discrimination Act 1975 prohibits sex discrimination against

individuals in the areas of employment, education, and the provision of
goods, facilities and services and in the disposal or management of
premises.
• It also prohibits discrimination in employment against married people.
Since the Civil Partnership Act 2004 came into force on 5th December
2005, the same protection is afforded to those in a civil partnership as
those who are married.
• The SDA applies to women and men of any age, including children.
• Genuine Occupational Requirement exemptions
• The Gender Equality Duty 2007 places the legal responsibility on public
authorities to promote gender equality in the workplace.
http://www.eoc.org.uk

The Race Relations Act 1976

Racial discrimination means treating a person less favourably than others on
racial grounds. In the 1976 Act Racial discrimination relates to unequal
treatment based on race, colour, nationality or ethnic or national origin.
The Act was introduced in response to evidence that people from ethnic
minority backgrounds were treated unfairly in society. It put into place
protection for individuals from being discriminated against in employment,
education, training, housing and the provision of goods, facilities and services.
The Race Relations Act (1976) is concerned with actions that discriminate
against people and the effects of these actions. It is unable to protect
individuals from the negative opinions and beliefs that other people might
have, that is to say, racial prejudice. For example, it would be illegal for a
health centre to display a sign saying ‘No Asylum Seekers’. This would be an
action that would discriminate against this group. However, a person working
in the health centre may hold prejudiced views about people seeking asylum.
So prejudice still exists but acting on this prejudice to disadvantage asylum
seekers, or any other group on the grounds or race, is illegal.
The Act defines three different forms of discrimination.
Direct racial discrimination, which is open and obvious. So putting a sign up

to exclude people from a certain racial group would be direct discrimination.
Indirect racial discrimination is a more subtle form of discrimination. The

person or organisation may not be aware that their actions are disadvantaging
people in a certain group. For example failing to provide essential information
about a service in a language that a person can understand.
Victimisation means being singled out for unfavourable treatment. The Act
protects people who have complained under the terms of the Act from any
hostile repercussions.
The Commission for Racial Equality was set up to monitor the

implementation of the legislation. Their website can be visited at
http://www.cre.gov.uk
Under the terms of the 1976 Act the individual has to show that he or she has
been treated less favourably than someone from a different racial group in
similar circumstances. So, for example a person from an ethnic minority
group is constantly having appointments to see a social worker or nurse
cancelled and always has to wait a long time for an appointment. However,
the same social worker or nurse is always available for local Scottish people,
who can always get an immediate appointment.

The Race Relations Amendment Act 2000
An amendment is a modification or alteration. This amendment widens the

scope and strengthens the provision of the 1976 Act. The amendment was
introduced in response to widespread racial discrimination in public service
provision. This is known as institutional or organisational discrimination.
Under the terms of the 1976 Act, the individual has to present evidence of
discrimination and this can be difficult to prove.
The amendment compels public authorities to be proactive in preventing

discrimination and places a duty on them to promote racial equality. The
duty extends to all aspects of an organisation’s activity. Public authorities
have a duty to eliminate unlawful discrimination, promote equality of
opportunity and promote good race relations between people of different
racial groups.
The Amendment extends the scope of indirect discrimination to include race,

ethnic or national origin and also introduces a definition of harassment on the
grounds of race or ethnic or national origins. Harassment occurs when the
behaviour of a person violates the other person’s dignity or creates an
intimidating, hostile, degrading, humiliating or offensive environment for them.
Key Features
Race Relations Act 1976 and Amendment 2000
This legislation provides protection from discrimination due to race,

colour, nationality or ethnic or national origins.
The following forms of discrimination are unlawful:
• Direct discrimination on grounds of race

• Indirect discrimination on grounds or colour or nationality. Amended
to include race, ethnic or national origin.
• Victimisation
• Harassment
The Race Relations Amendment Act 2000
Public authorities have a duty to:
1. Eliminate unlawful discrimination
2. Promote equality of opportunity
3. Promote good race relations between people of different racial

groups

Disability Discrimination Act 1995 and Disability

Discrimination Act 2005
These pieces of legislation aim to end the discrimination faced by many
disabled people. A disability is a long term (chronic), mental or physical
impairment that has an adverse effect on an individual’s ability to carry out
day to day activities. The 1995 Act establishes rights for disabled people in
employment, education, access to goods, facilities and services, and buying
and renting land or property. The Act also allows the government to set
minimum standards so that disabled people can use public transport easily.
The 1995 Act places duties on service providers and requires reasonable
adjustments to be made when providing access to goods facilities, services
and premises. The Disability Rights Commission was set up by the UK
Government to support the Act. You can visit their website at
http://www.drc.org.uk and follow the link to Scotland.
The Disability Discrimination Act 1995 has been

amended by the Disability Discrimination Act 2005 to
place a duty on all public sector authorities to positively
promote disability equality. The duty applies in England,
Scotland and Wales.
The Disability Equality Duty (DED) requires that a public authority, when
carrying out its functions must:
• Promote equality of opportunity between disabled people and other people

• Eliminate discrimination that is unlawful under the Disability Discrimination
Act
• Eliminate harassment of disabled people that is related to their disability
• Promote positive attitudes towards disabled people
• Encourage participation by disabled people in public life
• Take steps to meet disabled people’s needs, even if this requires more
favourable treatment.

Key Features
Disability Discrimination Act 1995

and
• Rights for disabled people in employment, education, access to goods,

facilities and services, and buying and renting land or property.
• Minimum standards so that disabled people can use public transport
easily.
• Reasonable adjustments to be made when providing access to goods
facilities, services and premises.
• The Disability Rights Commission was set up.
• Disability Equality Duty (DED) to enforce public authorities to promote

equality of opportunity between disabled people and other people and
encourage participation by disabled people in public life.

Keeping up to date
The Commission for Equality and

Human Rights.
The Equality Act 2006 establishes the
Commission for Equality and Human Rights
(CEHR) that will come into being in October
2007.
The CEHR will bring together the work of the three existing Commissions, the
Commission for Racial Equality (CRE), Disability Rights Commission (DRC)
and Equal Opportunities Commission (EOC) in this new body.
Equality, diversity, and respect for the human rights and dignity of every man,
woman and child are defining values of British society. The CEHR will
enforce equality legislation on age, disability and health, gender, race, religion
or belief, sexual orientation or transgender status, and encourage compliance
with the Human Rights Act 1998. This development is aimed at challenging
prejudice and discrimination and removing barriers that may prevent
individuals from fulfilling their potential, or participating fully in society.
Equality Legislation
Promoting Positive Care Practice
When working with service users it is vital for care workers to recognise
barriers that prevent people from fulfilling their potential.
Some of these barriers are based on prejudice and discrimination in relation

to age, disability and health, gender, race, religion or belief, sexual orientation
or transgender status.
Care workers should be prepared to challenge prejudice and discrimination

and work towards removing barriers that may prevent individuals from fulfilling
their potential, or participating fully in society.

NHS and Community Care Act 1990

This piece of legislation introduced a number of changes to the way that care
is delivered to people with ongoing needs. It makes provision for people who
have care and support needs to live independent lives in the community.
People with physical and/or mental health needs can be supported in the
community, whilst living in their own home or in a residential care home.
One of the main changes under the act was the idea of assessing need in the
community. Local Authorities were given the responsibility of assessing the
needs of people in their area, and to arrange for the provision of care services
to meet these needs. Care services can include meals on wheels, home
care, respite or short-break schemes, day care and nursing home care.
Assessment of needs is carried out at macro level and at micro level. Macro
level simply means looking at the big picture. So, local authorities must
produce a community care plan every three years. This plan considers the
budget, existing service provision and the need that exists in their area. The
plan might be for the development of new services, the expansion of existing
services or the closure of services that are no longer needed.
Micro means small and this refers to the obligation on local authorities to
assess an individual’s needs. The aim of an assessment is to find out about a
person’s individual needs and the services and support required to meet
these needs. A person’s needs are assessed by a member of the community
care team. The assessment of needs is ‘person centred’. This means
considering need from the service user’s perspective
If a person needs a service then there is an obligation to provide the service.
This is a move away from people with needs having to fit their lives around
available services to one where the services are ‘needs led’ and are provided
in a way that best suits the individual’s requirements.
A number of other provisions of the Act have been amended or replaced by

subsequent government reforms.

Community Care and Health (Scotland) Act 2002

The Scottish Parliament has the responsibility for Community Care and Health
matters in Scotland. This Act extended the role of local authorities and
introduced the following reforms.
• Nursing and personal care provided for people over the age of 65 is free of
charge.
• Local joint working between local authorities and NHS Scotland is to be
expanded. This has resulted in the formation of Community Health
Partnerships or Community Health and Care Partnerships.
• Direct payments for home care services is to be extended.
• Informal carers, including young carers have the right to assessment of
their own needs. Local authorities have a duty to ensure that carers are
aware of this right. This means that a parent who cares for a child with a
disability, or a husband who cares for a wife with dementia, can have their
needs assessed. The views of carers and the person they care for, have
to be considered before deciding which services to provide
To keep up to date with developments you can visit the Health and
Community Care section of the Scottish Executive website:
http://www.scotland.gov.uk/Topics/Health
Key Features of the
NHS and Community Care Act 1990

and
Community Care and Health (Scotland) Act 2002
• Local authorities are responsible for needs assessment

• Individual needs assessment is person centred and if a service is
required it must be provided
• Nursing and personal care for people over the age of 65 is free
• Joint working between local authorities and NHS Scotland is to expand
• Direct payments for home care services is to be made more widely
available
• Informal carers, including young carers have the right to have their
needs assessed and local authorities must make carers aware of this
right
• Carers and the person cared for should have their views taken into
consideration before deciding which services should be provided

Data Protection Act 1998

This piece of legislation ensures that personal data is obtained fairly and
lawfully, allowing for privacy and protection of the individual. Data is any
information recorded in manual or electronic format. Personal data includes
names, dates of birth, telephone numbers, bank details, e-mail and home
addresses. Data stored has to be kept up to date and accurate and must not
be kept for longer than necessary.
This means that a carer who is working with a service user can only obtain
details that are necessary for the service that is to be provided. Data is
recorded in assessment of needs, care planning, letters and paper or
electronic files containing personal details. Data must be kept safely to
prevent loss or damage or unauthorised access and use of the information.
If an organisation holds personal information about an individual, the Act
makes provision for the person to access this information. The person can
make a ‘subject access request’ to the organisation asking for a copy of
information that they hold.
Key Features
Data Protection Act 1998
• Data is any information about a person held in paper or electronic

format
• Data stored has to be kept up to date and accurate
• Data must be kept safely to prevent loss or damage or unauthorised
access and use of the information
• Subject Access Request can be made for a copy of personal
information held by an organisation.
For more information about how one organisation applies this legislation you
can visit The NHS Scotland Confidentiality and Data Protection Website:
http://www.confidentiality.scot.nhs.uk

Adults with Incapacity (Scotland) Act 2000

This Act was introduced to safeguard the welfare and manage the finances
and property of adults (16 years old or over) who do not have the capacity
(ability) to make their own decisions. Adults may lack capacity because of
mental disorder or because they are unable to communicate in any way. The
legislation permits other people to make decisions on behalf of these adults
but safeguards the interests of the person with incapacity. Some of these
safeguards include the requirement that decisions taken on behalf of an adult
with incapacity must benefit the adult. This helps to protect service users
from exploitation by others. Decisions must also recognise and reflect the
wishes of the adult, nearest relative or primary caregiver. This promotes the
rights of the service user to be treated as an individual and to make the most
of their ability. The act also requires that decisions taken on behalf of a
service user should achieve desired benefits, so that a person making a
decision on behalf of a service user should be able to justify the decision and
demonstrate the benefits to the service user. Decisions are required to
promote the welfare of the service user by encouraging the use of existing
skills. This means that every effort has to be made to empower the service
user and to help him/her to reach their full potential.
Key Features
Adults with Incapacity (Scotland) Act 2000
Permits people to make decisions on behalf of another adult who lacks

capacity
Safeguards the welfare and finances and property of adults with incapacity
Decisions taken must:
• Benefit the adult

• Recognise and reflect the wishes of the adult, nearest relative or
primary caregiver
• Achieve desired benefits
• Promote the welfare of the adult by encouraging the use of existing
skills
You can visit the following website to find out how the Highland Council is
implementing policy to comply with the legislation.
www.highland.gov.uk/socialwork/olderpeopleservices/adultswithincapacity

Regulation of Care (Scotland) Act 2001

The Regulation of Care (Scotland) Act 2001 is responsible for some major
changes that are aimed at giving greater protection to people who use care
services in Scotland.
The act established a new independent body to regulate care services in

Scotland.
The Act set up a new organisation called ‘The Scottish Commission for the
Regulation of Care’ known as ‘The Commission’. This new organisation is
responsible for the registration and inspection of care services.
Registration means that a range of care services including hospices and care
homes for older people must apply to The Commission to be put on a register
to offer a care service. Registered care services must abide by a set of Care
Standards which are agreed by the National Care Standards Committee and
published by Ministers in the Scottish Parliament. The Care Commission will
judge whether the service is able to comply with any legal rules and care
standards. If the service is approved it can be registered.
Inspection means that The Care Commission has the power to visit care
services to make sure that the service is keeping to the agreed legal rules and
care standards. The Commission uses the care standards to measure the
performance of the care service and will produce a report of their inspection.
If the inspectors find that the care given is not acceptable then the
Commission has the power to insist on changes and if the service fails to take
action, the Commission can close the service down.
The Government in Scotland introduced these changes to protect service

users by making certain that the quality of care given and received would
meet the same standards anywhere in Scotland.
Care standards are based on six principles. These are:
• DIGNITY
• PRIVACY
• CHOICE
• SAFETY
• REALISING POTENTIAL
• EQUALITY AND DIVERSITY

You should become familiar with the principles and how care workers put
them into practice.
You can also visit the Care Commission Website at:
http://www.carecommission.com
The Regulation of Care (Scotland) Act 2001 also established the Scottish
Social Services Council (‘The Council’) to regulate social service workers and
to promote and regulate their education and training. The Scottish Social
Service Council publishes Codes of Practice for Social Service Workers and
Employers. These are standards of conduct and practice which must be
followed and which have been discussed in Outcome 1.
Key Features
Regulation of Care (Scotland) Act 2001
• Established a system of care regulation to promote high quality

services appropriate to service users’ needs
• Established the Scottish Commission for the Regulation of Care ‘The
Commission’
• Publication of National Care Standards
• Registration of care services
• Inspection of care services against required national care standards
• Able to take action to enforce standards.
• Established the Scottish Social Services Council
• Publishes Codes of Practice for Social Service Workers and
Employers.
• Regulation of social service workers
• Promotes and regulates education and training of social service
workers.

Mental Health: Care and Treatment (Scotland) Act 2003
This law came into effect in April 2005. Its

purpose is to make sure that people with mental
health disorders can receive effective care and
treatment. A mental health disorder refers to
mental health problems, personality disorders and
learning disabilities.
http://www.scotland.gov.uk/Resource/Doc/26487/0
013533.pdf
Firstly the law is based on a set of ten guiding principles, including the
principles of non-discrimination and equality. Anyone who takes any action
under the Act has to take account of the ten principles.
The Act sets out the circumstances in which a person with a mental disorder
may receive treatment and/or be detained on a compulsory basis: which
means against their will. When a person refuses the care and treatment
being offered to promote their health and wellbeing there are clear procedures
that have to be followed. When this help is considered to be essential to the
person’s wellbeing the person can be legally required to comply with this care
and treatment.
The Mental Health Tribunal is a special panel that was set up by the Act to
provide an independent and impartial service to decide on the compulsory
care and treatment of people with mental health problems.
http://www.mhtscot.org
The Act also deals with how the criminal justice system should deal with
someone with a mental disorder who is accused or convicted of a criminal
offence. This includes provision for ongoing treatment and care.
The Act sets out a number of rights and safeguards to protect the rights of a
person with mental disorder. This includes a new right for service users and
carers to request an assessment of the service. Local authorities have new
duties to provide ‘care and support services’ and ‘services designed to
promote well-being and social development’ for people who have, or have
had, a mental disorder. Health Boards will also have to provide services for
children and young people (aged under 18) that are appropriate for their
particular needs. A person with a mental disorder also has the right to access
independent advocacy services.
The Mental Welfare Commission has the task of monitoring the

implementation of this Act. http://www.mwcscot.org.uk

Key Features
Mental Health Care and Treatment (Scotland) Act 2003
• Guiding principles, including the principles of non-discrimination and

equality
• Compulsory powers to require a person with a mental disorder to go
into hospital or accept treatment that they may not want
• The Mental Health Tribunal will decide on cases under the act
• Deals with how the criminal justice system should deal with someone
with a mental disorder who is accused, or convicted, of a criminal
offence.
• Protects the rights of a person with a mental disorder
• People with a mental disorder have rights to access independent
advocacy services
• Local authorities and Health boards have duties to provide appropriate
services
• The Mental Welfare Commission has the task of monitoring the
implementation of this Act.

REVISION
Key features of legislation
To develop your knowledge and understanding of key features of legislation

and help you to remember them:
• Copy or cut out the Key feature boxes.

• Work in pairs to either name the piece of legislation from a description of
the key features or, if one person names the legislation the other person
should try to describe the key features.

Ways in Which Legislation Acts as a Framework to Promote

Positive Care Practice
Positive care practice is care practice that brings benefits to the service user.
The legislation discussed acts as a framework to promote positive care
practice as care workers must adhere to the law when carrying out their work.
Each piece of legislation has specific benefits to particular groups of people.

These specific benefits are described in the key features of the legislation.
There are general benefits to the service user too. These are shown in the
diagram below.
Figure 3. Benefits of legislation to the service user

Formative Assessment Outcome 2
Explain the role of legislation in promoting positive care
Before you do this formative assessment you should review your notes.
If you have difficulty answering the questions, review your notes again and then
try again. You may refer to your notes when answering the questions but try to put
things into your own words.
You should discuss your answers with the class tutor.
1. What is the function of the Commission for Equality and Human Rights? (KU)
2. Describe two main features of the NHS and Community Care Act 1990
and Community Care and Health (Scotland) Act 2002. (KU)
3. Explain two ways that the Regulation of Care (Scotland) Act 2001 promotes
positive care. (KU)
4. Explain two ways that the Mental Health Care and Treatment (Scotland) Act
2003 supports the rights of people with mental health disorders. (KU)
5. Explain why care workers should know about legislation and suggest one way
that a care worker could keep up to date with changes to legislation. (KU)

Formative Assessment
Explain the role of legislation in promoting positive care
Chloe is a 20 year old young woman, who has Down’s syndrome*. Chloe lives at
home with her mother and she has completed a catering course at a local college.
Chloe wants to work in a restaurant and has applied for a job in the college
canteen. At college she has made friends with Dan, who also has Down’s
syndrome. Dan is living in supported accommodation, and has a key-worker who
helps him with independent living and Dan can do his own shopping, cooking and
cleaning. Chloe likes the idea of independent living and has been talking to her
mother about this possibility.
1. Describe one key feature of one piece of legislation and explain the relevance
of this feature in supporting Chloe. (AE/APP)
2. Describe one key feature of a second piece of legislation and explain the
relevance of this feature in supporting Chloe. (AE/APP)
*for information on Down’s Syndrome visit http://www.downs-syndrome.org.uk

OUTCOME 3
Evaluate the effectiveness of the care planning process
(a) Explain the care planning process

(b) Analyse approaches to assessing needs of service users
(c) Evaluate strategies for meeting needs of service users
Mandatory Content for this Outcome
Role of care workers in planning and implementation including:
• Social worker
• Community-based nurse
• Hospital-based nurse
• Speech therapist
• Dietician
• Occupational therapist
• Physiotherapist.
Goal setting:
• Short- and long-term goals in care planning
Assessment of needs:
This includes preferences and choices
• Tools of assessment e.g. meetings, assessment forms, checklists, observation

and asking questions, diaries and scrapbooks and shared activities
• Needs assessment using:
• (PROCCCESS) Physical needs
• Relationship needs
• Organisational and operational needs
• Communication needs
• Cultural needs

• Cognitive/intellectual needs
• Emotional needs
• Social and spiritual needs
• Maslow’s hierarchy of needs
• Involvement of others in assessing needs preferences and choices
• Values demonstrated in assessing and supporting needs
• Strategies for meeting the needs of service users.
Evaluation of strategies:
• communication, teamwork and values and principles used.

• Reflective practice as a tool to evaluate practice.

The Care Planning Process

The care planning process is the system of assessing the needs of service users,
devising an individual care plan, implementing the care plan, monitoring and
adjusting the care plan where necessary and reviewing and evaluating the
relevance and success of the care plan. This evaluation of the care plan should
then inform the development of future care plans and lead to service
improvement.
A care plan is a plan which identifies the most appropriate ways to meet the needs
of the service user as agreed in the assessment process. Resources have to be
available to meet the needs identified. Priorities have to be set with timescales
and action points. Many service users who have a care plan will have a range of
different types of need. A care plan may include a combination of support and
care, enabling and medical or therapeutic treatment as forms of intervention. For
some service users the care plan will be much simpler and identified needs may
just be met by the provision of a single service.
The whole care planning process of assessment, planning, implementation and

evaluation must be carried out in the context of adherence to the core values of
care and in accordance with the principles set out in codes of practice and
professional conduct.
EVALUATE ASSESS
Values and Principles

place the service user
at the centre of the
process
IMPLEMENT PLAN
ONGOING
MONITORING
AND
REVIEW
Figure 4. The Care Planning Process

Good Practice in Care Planning

Miller & Gibb (2007) identify ten different points of good practice in assessment
and care planning. These are:
1. Rest upon a firm value base with respect for the dignity of every individual
and promotion of choice, rights, empowerment and protection, at the
forefront.
2. Have the service user at the centre; be with, and not of, the service user and
be available to him or her. The aim is to empower and optimise the
participation of the service user in developing an agreed care plan.
3. Have good communication, including listening, at the core of the process.
4. Be part of an on-going process which should never be regarded as complete.
5. Be needs led and not service led; ‘needs led’ means focusing upon a full
examination of needs; ‘service led’ means the way in which, in the past,
people were assessed for a particular service for which they had been
referred – service came first, needs second.
6. Be based upon accurate, up to date information. It is important to distinguish
clearly what is fact, what is opinion, intuition or something else.
7. Guard against labelling, stigmatising or making a scapegoat of a person. For
example, if Joe is described as ‘difficult’ in an assessment this is a label
which can lead to stigma (a negative sign) which can lead to scapegoating
(being unjustly blamed for everything which goes wrong).
8. Be specific about who is responsible for what, and outline the responsibilities,
as well as the rights, which the service user has in the process.
9. Have a built-in evaluation procedure.
10. Emphasise that there is not just one right care plan, there are no absolutes
and assessment and care planning should be tailored to individual needs.

Care Planning Models

A model is a pattern or example of how to construct something. Models are used
in care planning to as a guide when developing a care plan. There are a number
of models that can be used in care planning. We will consider two, the exchange
model and person centred planning.
The exchange model emphasises the importance of communication between

care workers and the service user. The model makes the most of the knowledge
and experience of both the care worker and the service user. The care worker
may have expertise in problem solving and knowledge of available resources. The
service user also has expertise and is viewed as an equal partner in the process
of planning their care, since they know best about their situation. The model
recognises the service user’s wider social network and takes this into account
when planning care. This social network will include family members, friends,
partners as well as formal care workers. The process of producing a plan involves
an exchange between the service user, their social network and members of the
multi-disciplinary team who may be involved in supporting and caring for the
service user. One of the main tasks for the care worker is to facilitate an
exchange of information between everyone involved. A named person, a social
worker or key worker, has the responsibility of co-ordinating the plan and
negotiating agreements about who is to do what for whom and when it will be
done.
To use this model the care worker uses effective communication skills, including
problem-solving skills.

Person-centred planning aims to empower the service user to take as much

control as possible over decision making. This approach emphasises the role of
the service user in planning for their future needs. If the service user is unable to
understand what is happening or unable express their views it is important that
someone is advocating on the service user’s behalf. Some of the features of
person centred care planning include:
Moving from Moving towards
clinical descriptions of people seeing people as human beings
professionals being in charge Sharing power
professionals inviting people the person choosing who attends

meetings
meetings in offices at times to suit meetings in a venue chosen by the

professionals person, when it suits her/him
meetings being chaired meetings being facilitated
not asking what person wants encouraging person to dream
assuming inability looking for gifts in people
filing plans away giving the plan to the person
Writing notes of meetings graphic facilitation of meetings
professionals putting plan into all team members having some

action responsibility for implementing plan
Figure 4. Person Centred Care Planning

Adapted from Miller and Gibb 2007

The Role of Care Workers in Care Planning and Implementation

Multi-disciplinary team working involves co-operation and effective
communication between everyone involved in the support and care of an
individual. Multi-disciplinary teams can include social worker, community based
nurse, hospital-based nurse, speech therapist, dietician, occupational therapist
and physiotherapist. One person in the team usually takes the lead in managing
the care planning process. The Community Care and Health (Scotland) Act 2002
expanded local joint working between local authorities and NHS Scotland.
The advantages of multi-disciplinary team working to the service user include a

more effective use of resources. Overlap in services should be reduced and gaps
in service provision identified and addressed. When planning and implementing
care it is decided who will do what, and when they will do it. However this requires
increased co-operation between care providers, including sharing of assessments,
resources, communication of information and contribution to evaluation. This
approach requires everyone in the team to fulfil their role, as failure to co-operate
or share information will disadvantage the service user. It can be helpful for the
service user to have a named key-worker who will be the main point of contact for
any concerns that the service user may have.
The principles that all care professionals put into practice are derived from the
same values. They also share many of the same skills, for example
communication and care planning skills. However each professional group has a
particular set of skills that may be more significantly used in relation to meeting
specific needs of particular service users.

ICT ACTIVITY
Work in groups to research careers in care work. You should use a range of
websites to research these careers, and complete the table below.
Careers Scotland and NHS Careers may be a useful starting point for your
search.
http://www.careers-scotland.org.uk
http://www.nhscareers.nhs.uk
Professional Role description • Describe service users

Carer these professionals
work with
• Explain reasons why
these service users
might benefit from their
particular professional
skills
Community
based nurse
Dietician
Hospital-based
nurse

Occupational
therapist
Physiotherapist
Social worker
Speech
therapist

Goal Setting: Short- and Long-term Goals in Care Planning

Care planning is the part of the process where the decisions about what is to
happen are agreed and written down. The care plan sets out the strategies for
providing the help that the service user requires to meet their needs by setting
goals. Goals are targets that the service user is aiming to achieve and planning is
about discussing options and deciding on the best way to support the service
user.
When deciding on goals care workers should support the service user to set
SMART goals. They should be: Specific, Measurable, Achievable, Realistic and
Time framed.
If the goals set are specific, measurable and achievable it is more likely that the
service user will be motivated to keep working to succeed. If the goals are
unrealistic with no real way to measure success then people involved won’t be
able to tell if they are making any progress towards the goals. A short-term goal is
a step towards a long-term goal.
You may have learned about goal setting and completed exercises in the
Psychology for Care Higher Unit or the Intermediate 2 Values and Principles Unit.

Assessment of Needs
People who use care services have rights that are supported in law and when
needs are assessed this must be in accordance with the requirements of relevant
legislation.
When needs are assessed it is the service user who is given control over decision
making and in the case of someone with incapacity a named person will advocate
on their behalf. The NHS and Community Care Act (1990) introduced the
concept of a ‘needs led’ assessment. This means that it is the individual’s needs
that determine the services required to meet these needs. This is unlike a service
led assessment where the services are provided and a person has to try to fit into
existing services to have their needs met.
Services that can be drawn upon to meet an individual’s need may be sought
in the statutory or independent sectors, including voluntary and private care
providers. Informal care providers may also be involved in meeting need.
Sometimes it is difficult to know exactly what is needed, especially when needs
are complex. Tools of assessment are helpful in providing some objective
evidence of individual need.
Tools of Assessment
A person’s needs may be expressed subjectively, that is the person can tell you
how they feel, and also objectively by considering evidence of their situation
through observation or information from a range of sources. Tools of assessment
can be used to draw attention to a service user’s needs or changes in their needs.
These tools can take the form of meetings, assessment forms, checklists,
observation and asking questions, diaries and scrapbooks and shared activities.
A number of these tools can be used together so that a clear picture of an
individual’s needs may emerge.
A meeting is useful in bringing people together. Using person centred planning it

is the service user who decides where and when to meet and who should attend
the meeting. A meeting is useful for facilitating a discussion about the service
user’s needs and possible strategies for meeting those needs. There may be a
series of meetings to enable the service user to consider all the information and
possible options. Ultimately, it is the service user who selects the strategy that
they believe is best suited to meeting their individual needs.

Assessment forms are used to gather essential information about the needs of
the service user. The form usually poses a number of questions for the service
user to answer. The answers give the care provider an overview of the service
user’s general needs. There may be questions relating to mobility for example,
‘Do you walk without any help?’ ‘Do you use a walking stick or other walking aid?’
‘Are you unsteady on your feet?’
Checklists have a number of questions, usually in boxes, and the box is ticked to
indicate the service user’s situation. This kind of assessment is usually a starting
point for a more in depth assessment of need.
Observation and asking questions is a way of assessing a person’s ability or

mood. For example, you may observe an older adult bending down to pick up a
paper from the floor. You can observe if they have any difficulty in bending, if they
appear unsteady or if their hand shakes. Or someone who has a mental health
problem may be observed to see whether their mood is improving, for example if
someone has been depressed you may observe whether they smile or appear
interested in activities or interacting with others. Asking open or closed questions
can help to support your observations. For example, ‘You seem quite fit, but it
looked as if your back was a bit sore when you bent down. Was it?’ Or, ‘you
seem happier today, are you?’ Remember to use your knowledge of
communication theory when asking questions.
Diaries and scrapbooks are built up over a time to record significant feelings or
events in the life of the service user. This helps to build up a picture of the
individual’s experience over time and provides insights into the unique life
experience of the person and enables carers to identify particular areas of need.
Shared activities
A person’s needs may also become more apparent when a carer is doing
something with the person. You may be shopping with someone, helping prepare
a meal or playing bingo. The service user may discuss likes and dislikes, wants,
dreams and nightmares on such occasions. This information may make an
important contribution to care planning and shouldn’t be ignored.

Case Study: Andy and Assessment Tools
Read the case study and discuss answers to the questions which follow.
For the last two years Andy has been drinking at weekends with his friends. It
began as a bit of a laugh but now Andy’s drinking is getting out of control. He
began adding vodka to cola in a bottle and drinking this every day, even at school.
There is now more vodka than cola in the bottle. He looks tired in class and lacks
interest in schoolwork and sport. Andy’s guidance teacher has been meeting with
Andy to try to get him to talk about the reasons for the changes in his behaviour.
Andy gets on well with the guidance teacher but is ashamed to admit that he is
abusing alcohol. He has started to steal money from his mother’s purse and is
dodging school. Andy’s mother has had several rows with him but he denies that
he has stolen any money and says he doesn’t have a problem. Things came to a
head last night when Andy came home drunk. He fell on the floor and began
vomiting. His mother became alarmed as he was unconscious and he nearly
choked on his vomit and died. Andy was taken to hospital where his condition
was monitored. Andy has been frightened by this experience and he has asked
one of the nurses what he should do.
1. What are the advantages of having a meeting?

e.g. The issue can be discussed.
2. Are there any possible disadvantages?

e.g. Andy might find it difficult to express his feelings.
3. Suggest the kind of questions that might be asked on an assessment form or

checklist.
e.g. How much vodka do you drink in a week?
4. Discuss how Andy’s guidance teacher could use observation and asking
questions to assess Andy’s situation.
5. How could Andy use a diary to help him assess the extent of the problem?

Needs Assessment Using a PROCCCESS Model
PROCCCESS
When a care worker is working with a service user to assess needs it is important
to do this in a logical and organised way to achieve a holistic assessment. A
holistic assessment considers the different needs that a person has and
recognises the inter-relationship of needs. There is a recognition that if one area
of need is not met then another area of need might also be negatively affected.
For example if someone is unable to get out because they have poor mobility
(physical need) then they may be unable to maintain friendships and attend social
events (social need).
One way of carrying out a holistic assessment of needs is to use the

PROCCCESS approach. PROCCCESS, reminds the assessor to consider,
Physical needs, Relationship needs, Organisational and operational needs,
Communication needs, Cultural needs, Cognitive/intellectual needs, Emotional
needs, Social and Spiritual needs.

Holistic Care
Holistic care is care that considers the needs of the whole person. This is
because there is an inter-relationship between the different needs that a person
has.
For example: Brian is an adult man who is depressed.
• The word depression tells us how Brian is feeling but we don’t know why he is
feeling this way. So as well as finding out that emotionally we want to plan to
help him to feel happier we need to consider other needs too.
• Assessing social needs would tell us something about employment and
relationships which can be an important factor in a condition like depression.
Social support may or may not be available, so these needs should be
considered as part of an assessment.
• Physical needs should also be assessed. Brian may look healthy but we know
from research and health promoting strategies that exercise can improve
mood. If Brian isn’t taking any exercise this might be included in the care plan.
• Cognitive assessment would tell us about what this man knows about
depression. He may need to be given new information to help him to make
future choices.
• Assessing cultural needs will provide an insight into his attitudes and beliefs.
As an adult male he may feel cultural pressure to have a heterosexual
relationship (with a woman) but he himself may not want this. If carers are to
be able to provide holistic care all of these factors are important in assessing
Brian’s need for care and support.

Case Study: Ali
Read the case study and then carry out the activity that follows
Ali is eleven years old. He has cerebral palsy*. He needs some help to wash and
dress and has difficulty with speech. He lives at home with his mother, Fatimah,
who has been unusually tired and short tempered over the last few months. She
has now been told that she has a heart condition and will need a major operation.
She will need to rest for a few months following the operation. Fatimah’s husband
died three years ago and she has no family support
Use the PROCCCESS approach and write short notes explaining the possible
needs that could be considered using this model.
• You should consider both Ali’s needs and Fatimah’s needs.
Discuss the usefulness of this approach in pairs or small groups and summarise
your discussion to help when you revise this topic.
Summary
*for more information on cerebral palsy you can visit http://www.scope.org.uk

Maslow’s Hierarchy of Needs

In professional care work it is considered important that the actions that care
workers take are based on evidence that has been well researched and that gives
us powerful reasons for doing the things we do. If we want to provide the best
care to meet someone’s needs we need to know something about how to work out
(assess) what needs a person might have.
The name of the psychologist Abraham Maslow is strongly linked to ideas we

have about needs.
Maslow (1954) proposed that all human beings have a number of needs. From
his investigation of human needs he found that we are all motivated to try to fulfil
these needs. It became evident that some needs are more important than others
so Maslow put these needs into a hierarchy.
Because unmet needs can be a cause of stress this theoretical model can be
used as a way of assessing the needs that a person may have.
Growth
Needs
Deficiency
Needs

Fig 5. Maslow’s Hierarchy of Needs adapted from Wikipedia.org
From this diagram you can see that five levels of need are identified.
Physiological, safety, love and belonging, esteem needs and at the top is self-
actualisation. Needs at the bottom of the hierarchy are absolutely essential for life
e.g. food and water. To move up the hierarchy a person has to satisfy needs at
the lower levels first.
You can also see that there are two main types of needs: deficiency needs and
growth needs. Maslow believed that the lower levels were deficiency needs
because when they aren’t satisfied people are motivated to try to do something to
fulfil these needs. Higher level needs are known as growth needs. Activity that
relates to these is more concerned about making efforts to fulfil abilities and
talents. This leads to personal growth and is what Maslow called self-
actualisation or working towards reaching our full potential.
You should be aware that if you carry out more detailed study of Maslow’s work
that the original model illustrated in Figure 5 has been adapted and later models
(1970) and (1990) have additional levels for growth and development, including
cognitive and aesthetic needs.
Involvement of others in assessing needs preferences and choices
A more comprehensive assessment of needs, and a greater understanding of

preferences and choices can be achieved by involving others in the assessment
process. A range of people can contribute by sharing their point of view. This
provides the opportunity to see things from a variety of perspectives. The service
user is central to the process but significant others (family and friends) as well as
care workers can also contribute to help the service user and those contributing to
his/her care, to develop a clearer picture of needs preferences and choices.
Values demonstrated in assessing and supporting needs
It is important to remember that to achieve good practice in assessing and

supporting care needs, the agreed core values for care must be maintained.
• the value of according social justice and promoting the social welfare of every
individual.
For example, questions asked in forms and checklists or discussion at meetings

should be free from prejudice. People should be treated as individuals and
provided with equality of opportunity.

Revision of Knowledge and Understanding of Needs
1. What is a need?
2. Give an example of a need.
3. What is a want?
4. Give an example a want.
5. Describe three circumstances that can affect needs.
6. Draw a diagram of Maslow’s hierarchy and name the five main levels.
7. Put the following needs into the correct level of the hierarchy.
• Morality
• Food
• Confidence
• Access to employment
• Friendship
• Breathing
• Security
• Problem solving
• Sleep
• Family
• Respect of others
• Creativity
• Intimacy
• Protection from abuse
• Achievement
8. Explain what is meant by the term ‘deficiency’ needs.
9. Explain what is meant by the term ‘growth’ needs.
10. Why is it a good idea to involve others when considering needs, preferences
and choices?
Peer assessment – get someone else to mark your answers

and discuss any points on which you differ.

CASE STUDY
Read the following case study and then answer the questions that follow.
Joe is seventy three and lives alone. He has lived in his present house for
over 50 years and is surrounded by pictures and souvenirs that have precious
memories for him. He is a well-known and popular person in the town. Joe
has one daughter. She and her family live in the north of England. Joe also
has two younger brothers who live in a nearby town. Although they only see
each other three or four times a year they consider themselves a close family.
They phone each week and never forget Joe’s birthday.
Over the past year his neighbours have noticed that he has been more and
more confused. He has been forgetting names and sometimes doesn’t seem
to know what day of the week it is. This week one of Joe’s neighbours,
Shamira saw him wandering late at night and nearly being run over by a car.
She went to help Joe and saw that he was dressed in his pyjamas and a
jacket. Joe said that he was going to work. Joe had a career as a musician
and he is particularly fulfilled when he is playing and singing, especially jazz.
Shamira took Joe back home. She found that the house was cold and there
was a smell of gas. She saw that the gas fire had been left on but not lit.
Shamira made this safe and went to the kitchen to make him some warm tea.
She found that there was nothing in the cupboards and that the food in the
fridge was mouldy and out of date. Shamira phoned Joe’s daughter who is
very concerned about her father’s changing circumstances. She contacted
social services and Joe is to have an assessment of needs.
Using Maslow’s hierarchy of needs as a model (guide) write about some of

Joe’s circumstances that would help you to understand his needs at each of
the levels.
Needs Joe’s circumstances
Physiological
Safety
Love and
belonging
Esteem
Self-
actualisation

You might have noted some of the following points about Joe’s circumstances.
Needs Joe’s circumstances

Physiological Joe has no food in the house
Joe’s house is cold
Safety Joe was nearly run over

Joe left gas on but not lit
Joe’s food is mouldy
Love and Joe’s family live at a distance but are emotionally close
belonging Joe has lived in his home for over 50 years
Esteem Joe is respected in his local community

Joe is a talented musician
Self- Finds fulfilment in singing and playing jazz

actualisation
Continue to use Maslow’s hierarchy to note down some of Joe’s needs.
Needs Joe’s circumstances Needs

Physiological Joe has no food in the house
Joe’s house is cold

Safety Joe was nearly run over
Joe left gas on but not lit
Joe’s food is mouldy
Love and Joe’s family live at a distance
belonging but are emotionally close
Joe has lived in his home for

over 50 years
Esteem Joe is respected in his local
community
Joe is a talented musician

Self- Finds fulfilment in singing and
actualisation playing jazz

You might have noted the following needs
Needs Joe’s circumstances Needs

Physiological Joe has no food in the house Joe needs food
Joe’s house is cold Joe needs warmth

Safety Joe was nearly run over Joe needs to be safe from
Joe left gas on but not lit dangers of traffic, unlit gas
Joe’s food is mouldy and mouldy food
Love and Joe’s family live at a distance Joe needs to know his family
belonging but are emotionally close care for him
Joe has lived in his home for Joe needs his pictures and
over 50 years souvenirs as they have
important memories
Esteem Joe is respected in his local Joe needs to maintain links
community with his local community
where he is respected
Joe is a talented musician Joe’s needs to maintain his

musical abilities
Self- Finds fulfilment in singing and Joe needs opportunities to
actualisation playing jazz sing and play and listen to
music, especially jazz
Implementing the Care Plan

The next question is how are these needs to be met? Deciding on the best way
to meet these needs is the planning part of the process.
Remember that at the start of this outcome we stated that:
“A care plan is a plan which identifies the most appropriate ways to meet the
needs of the service user as agreed in the assessment process. Resources have
to be available to meet the needs identified. Priorities have to be set with
timescales and action points. Many service users who have a care plan will have
a range of different types of need. For many service users the care plan will
comprise a combination of support and care, enabling and treatment forms of
intervention. For other service users the care plan will be much simpler and
identified needs may just be met by the provision of a single service.”

The implementation of the plan simply means putting the plan into action and
following the agreed decisions. The arrangements made to meet needs are the
various strategies that have been developed to meet the goals. For example if X
needs to sit up to avoid a chest infection and if X needs a hoist to move from bed
to chair then this should be done. If this is not done then there could be serious
consequences for the service user e.g. chest infection develops if left in bed or
dislocated shoulder if moved without the help of a hoist. There can also be
consequences for the care worker, e.g. back injury, as well as legal implications.
Effective planning and implementation involves relevant care provision and

appropriate strategies to meet needs.
Care provision refers to the actions that are taken to meet a person’s needs.
There is therefore a relationship between recognising needs and providing
services to meet these needs. There are many different types of care provision.
Care can be provided in many different settings including hospitals, day centres
residential homes and a person’s own home. There are also different care
workers who provide care services including social workers, community-based
nurses, hospital-based nurses, speech therapists, dietician, occupational
therapists and physiotherapists.
Strategies are actions that are taken to meet needs. A variety of potential
strategies for developing a caring relationship are contained throughout this unit.
For example the following may be considered to be strategies:
• Anti-discriminatory practice
• Rogers’s core conditions
• Egan’s skilled helper
• Advocacy.
There are also a number of strategies used to meet identified needs. In care
planning, the service user may have a range of options to choose from. A
strategy is usually always implemented with the expectation that it will
successfully meet the aim and allow the service user to achieve their desired
goals.
However there may be a number of reasons why a strategy doesn’t work, for
example the person’s health or circumstances may change.
To analyse something you have to carefully examine it in detail and to evaluate

something you have to weigh up advantages and disadvantages, positives and
negatives, and consider different points of view.
In the previous exercises you have analysed some of Joe’s potential needs.
These needs could be met in a number of ways.

Evaluation of Strategies
It is important to evaluate whether a care plan is meeting the desired aims.
Evaluation is built into the care plan so that a date is set for a formal evaluation of
the plan. This may involve a meeting but may equally involve completing a
checklist. However, rather than waiting for a formal review, strategies used to
meet goals should be continuously monitored and reviewed. If they aren’t working
for any reason then consideration should be given to changing the care plan
before the formal review takes place. If goals are being met, then new goals may
be discussed and agreed.
When you evaluate the effectiveness of strategies used in the care planning
process you need to analyse the particular reasons why the plan is or isn’t
working. It is useful to consider the effectiveness of communication with the
service user and with other members of the care team. It is also useful to
consider whether care values and principles were evident in the process. You
should recognise any barriers to progress, e.g. failure to communicate effectively
or prejudiced attitudes that exist.
Reflective practice, discussed in Outcome 1 is one way that care workers can
evaluate their own personal practice.
One possible strategy for meeting some or all of Joe’s needs would be for him to
move into a care home in the same town.
Evaluate this strategy by discussing two advantages and two disadvantages of

Joe moving into a care home.

ACTIVITY - Analysing approaches to assessing needs and evaluating

strategies for meeting Joe’s needs
To analyse something you have to carefully examine it in detail.
To evaluate something you have to weigh up advantages and disadvantages,

positives and negatives, and consider different points of view.
• Suggest two care professionals that could contribute to planning Joe’s care
and explain the contribution they could make.
• Suggest two goals for Joe.
• Suggest two different ways (strategies) that these goals could be met
(remember it is important to offer service users’ choices).
• Evaluate each of the strategies, outlining potential advantages and
disadvantages for Joe, his family and the community.
• Consider the needs of a variety of different service users and suggest
strategies for helping to meet these needs. Evaluate strategies by considering
advantages and disadvantages.

Formative Assessment Outcome 3
Evaluate the effectiveness of the care planning process
Before you do this formative assessment you should review your notes.
If you have difficulty answering the questions, review your notes again and then
try again. You may refer to your notes when answering the questions but try to put
things into your own words.
You should discuss your answers with the class tutor.
1. Explain what is meant by a ‘needs led’ assessment? (KU)
2. Explain why the involvement of significant others can be beneficial when care
planning. (KU)
3. Describe one level of Maslow’s hierarchy and explain how one assessment
tool could be used to assess need at this level.
(KU/AE App)
4. Explain two advantages of multi-disciplinary team working (KU)
5. Describe two ways that an elderly person who has had a stroke that has
affected mobility and speech could be helped by a particular care professional.
(KU/AE App)

Read the case study and then answer the questions that follow.
Case Study
Sally is 43 years old. She is married with four children. She qualified as an
accountant and had a senior job with an organisation before choosing to leave
work when she had her children. She planned to return to work when her
youngest child started school. However at this time she became unwell and
was diagnosed as having multiple sclerosis. The main symptoms that Sally
has are fatigue and muscle spasms. Sometimes she uses a wheelchair to
minimise these symptoms and to improve her mobility. This makes travel on
public transport difficult and she was unable to go to a school meeting because,
although there is a lift in the school, the classroom was upstairs in an area of
the school without a lift. Sally has applied for several jobs but has never had
an interview when she has disclosed her condition on the application form.
When she omitted this information on one form she got a job interview. At
interview she discussed her situation but didn’t get the job. She was told that
she lacked recent experience but she believes that discrimination exists. Her
daughter Annie is 14. Annie is overweight and her three brothers sometimes
tease her about her weight. Annie has been quite withdrawn, not wanting to
go out with her family and friends and spending a lot of time in her bedroom.
Today Sally saw some cuts on Annie’s arms and she has found out that Annie
is being bullied at school. Annie started crying, she says that people call her a
‘freak’ and that she hates herself.
Several weeks have passed and a care plan is in place for Annie. A multi-
disciplinary team is working with the family. The team includes Kim, a
community psychiatric nurse. Kim is working with Annie to raise her self-
esteem and to help her work towards her goals, including the goal of becoming
more assertive. This involves her being able to speak up for herself.
Things seem to be settling and so Sally is considering another job application.

Question Paper
1. Explain two possible effects of using labels such as ‘freak’ (KU 4)
2. Describe one professional care value and explain how this will influence the
care that Kim will offer Annie.
(KU 3 AE/App 3)
3. Describe the three core conditions of the person centred approach to helping
and evaluate the contribution that this approach could make, in facilitating
change for Annie.
(KU 6 AE/App 6)
4. Explain what is meant by using a multi-disciplinary approach to care planning

and explain one advantage of this approach for Annie.
(KU 4 AE/App 2)
5. Describe two key features of legislation relating to disability and explain their
relevance to Sally’s situation.
(KU 4 AE/App 4)
6. Explain the importance of evaluating a care plan. (KU 4)

Glossary of Terms
Advocacy Speaking on a person’s own behalf or on behalf of

another person
Analyse Examine carefully
Assertive Saying what you thinks or feels, without being
aggressive
Chronic Long term
Cognitive Thinking and problem solving skills
Concept Idea or thought
Culture The way of life of people in society
Discrimination Treating people differently often unfairly due to a
particular characteristic e.g. age or sexual orientation
Discrimination Unfair treatment based on prejudice
Domiciliary care Care in a person’s own home
Empathy Developing a sense of what it is like to be in another
person’s situation
Empowerment Transferring power to others
Evaluate Weigh up / consider advantages and disadvantages
Interaction Communication between people (includes verbal and
non-verbal)
Need Something necessary for maintaining life and wellbeing
Norm Accepted way of doing things
Prejudice A bias towards others based on stereotyped ideas
Principle Standard
Psychologist Someone who studies the human mind
Reflective practice Thinking about what you do and why you do it
Research Study or investigation
Residential care Care home where people live and receive care
Respite Relief
Socialisation The process of learning to become a member of a
society
Stereotyping Ideas about people based on characteristics or
membership of a particular group.
Value Something considered as having worth
Want Something we would like to have but is not essential
Students should be encouraged to add to this Glossary as they go through

the Unit.

Answers to Formative Unit Assessment
There are a range of possible answers for these questions.

The following is for guidance only.
1. Explain two possible effects of using labels such as ‘freak’

(KU 4)
2 marks are available for explaining 2 effects. For example 2 marks could be
given for an answer similar to the following:
Labels reflect stereotyping and prejudiced attitudes. They do not demonstrate

their respect for the individual and they are damaging to the person’s self-
esteem.
2. Describe one professional care value and explain how this will influence the
care that Kim will offer Annie.
(KU 3 AE/App 3)
3 KU marks are available for a full description of a professional care value. A

brief description should only be given one or two marks. For example 3 marks
could be given for an answer similar to the following:
One care value is to respect the worth and dignity of every individual. This
means recognising that an individual is a unique human being and this is the
basis of their worth. It is not dependent on any other characteristic. Respect
and self-esteem are linked to dignity and an individual’s dignity is maintained
when their worth as a human being is recognised.
3 AE/App marks are available for explaining how this will influence the care
that Kim will offer Annie. This requires candidates to apply their knowledge and
a range of answers are possible. 3 marks could be given for an answer similar
to the following:
Respecting Annie’s worth and dignity will mean that Kim will treat Annie as an
individual. Kim will not judge Annie on the basis of her age or weight. Kim will
listen to Annie and recognise her right to be in control of her own life. Kim will
discuss options with Annie and respect her preferences and choices.
3. Describe the three core conditions of the person centred approach to

helping and evaluate the contribution that this approach could make, in
facilitating change for Annie.
(KU 6 AE/App 6)
2 KU marks are available for the description of each of the 3 characteristics i.e.
2 marks for describing unconditional positive regard; 2 marks for describing
congruence and 2 marks for describing empathy.

If these are simply listed with no description then a total of one mark only can
be awarded.
6 AE/App marks are awarded for developing the above knowledge and linking
each of these core conditions to points such as:
• helping Annie to feel valued as an individual

• helping Annie to feel safe in disclosing her feelings
• reassuring Annie that Kim understands her situation
• building up trust in Kim
• raising Annie’s self-esteem
4. Explain what is meant by using a multi-disciplinary approach to care

planning and explain one advantage of this approach for Annie.
(KU 4 AE/App 2)
4 KU marks can be awarded for knowledge contained in the answer such

as:
Multi-disciplinary team working means that care professionals work
together to assess, plan, implement and evaluate care. A range of
professionals are involved and this can avoid overlap or gaps in services as
well as a more effective use of resources.
2 AE/App marks can be awarded for explaining one advantage such as:
One benefit to Annie would be sharing of assessment information. This
would help Annie because members of the team could share information
and she would not have to repeat distressing events to different care
workers at different times for different assessments.
5. Describe two key features of legislation relating to disability and explain

their relevance to Sally’s situation.
(KU 4 AE/App 4)
2 KU marks can be awarded for each of 2 features from the Disability

Discrimination Act 1995 or Disability Discrimination Act 2005 or the
Disability Equality Duty (DED)
4 AE/App marks can be awarded for explaining how each of the points is
relevant to Sally’s situation. The points may be related to access to public
transport, involvement in school life or equality of opportunity in
employment.

6. Explain the importance of evaluating a care plan. (KU 4)
4 KU points are available for an explanation that should make two main
points. For example these points might include:
• it is important to find out if goals are being met

• to find out if there are difficulties in meeting goals and what these
difficulties are
• to discuss with the service user alternative strategies that could be
implemented
• to set new goals.
(KU 25 AE/App 15)

Scottish Further Education Unit
Argyll Court
Castle Business Park
Stirling
FK9 4TY
Tel: 01786 892000 Fax: 01786 892001 E-mail: sfeu@sfeu.ac.uk Web: www.sfeu.ac.uk

Higher Care - Unit 3 - Values and Principles

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Values and Principles in Care

SFEU is grateful to the subject specialists in Scotland’s Colleges and other

© Scottish Further Education Unit 2007

Scottish Further Education Unit 2

Care: Values and Principles in Care, Higher

Enquiries relating to this Support Pack or issues relating to copyright should

Marketing Officer - Communications

Further information regarding this Unit including Unit Specification, National

The Scottish Qualifications Authority

Scottish Further Education Unit 3

Scottish Further Education Unit 4

Scottish Further Education Unit 5

Holistic Care 120

Scottish Further Education Unit 6

Scottish Further Education Unit 7

What is the Care Course all about?

Summary of Unit content

Values and Principles in Care (Higher)

In this Unit candidates study:

• The caring relationship between care professionals and service users

Scottish Further Education Unit 8

At Higher, the key elements of knowledge and understanding, analysis,

• Knowledge and understanding

The balance of assessment between knowledge and understanding and

• Course — 50% knowledge and understanding, 50% analysis, application

Scottish Further Education Unit 9

Values and Principles in Care (Higher): Unit assessment

Satisfactory evidence of the achievement of all Outcomes and Performance

An appropriate instrument of assessment would be a case study or case

The Course assessment consists of 2 Question Papers. Each Question Paper

• Section 1 set on content of Psychology for Care (Higher)

• Section 3 set on content of Values and Principles in Care

Further details of the Course assessment are given in the Course

Scottish Further Education Unit 10

Link between Unit and Course assessment/added value

In Units at Higher candidates are required to demonstrate knowledge and

Unit and Course assessment complement each other. Unit assessment

The Course assessment at Higher requires that candidates demonstrate the

Scottish Further Education Unit 11

The Course in Care (Higher)

The knowledge acquired in the areas of the understanding of human

For example it:

• Helps candidates to understand the interrelationship between psychology,

Scottish Further Education Unit 12

The Course provides opportunities for candidates to:

• Acquire specialist knowledge and understanding required to care for

Scottish Further Education Unit 13

Unit Outcomes, PCs and Evidence Requirements

This Unit is designed to enable candidates to develop an understanding of the

Acceptable performance in this Unit will be the satisfactory achievement of the

Explain the role of legislation in promoting positive care.

Scottish Further Education Unit 14

Evaluate the effectiveness of the care planning process.

EVIDENCE REQUIREMENTS FOR THIS UNIT

Written and/or oral evidence is required to demonstrate the achievement of all

As candidates will increase their knowledge, understanding and skills

The use of a cut-off score may be appropriate for this assessment.

An appropriate instrument of assessment would be a case study or case

• The significance of two values for carers

Scottish Further Education Unit 15

• The care planning process

If reassessment is required, it should sample a different range of mandatory