Man Div Discrimination Exercises

1a
Care
Values and Principles
(Higher)
Support Material
August 2007
Scottish Further Education Unit

1b,2a
Care: Values and Principles, Higher
Acknowledgements
SFEU is grateful to the subject specialists in
Scotlands 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

2b,3a
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

3b
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.

3c,4a
Contents
Reference Section 8
What is the Care Course all about? 9
The Course in Care (Higher) 17
Unit Outcomes, PCs and Evidence
Requirements 21
Tutor Support Section 25
How to Use This Pack 26
Rationale for teaching/learning approaches 28
Teaching Activities 31
Question Types in Higher Care Assessments 34
Guidance on Unit Delivery 36
Resources 39
Student Support Section 42
Key to Activity Symbols 43
Study Tips 43
OUTCOME 1 44
The Significance of Values in Care 47
Good and Bad Practice in Care 49
Relationship Between Values and Behaviour 54
Types of Service User 56
Discrimination and its Effects 59
Institutional Discrimination 69
Case Study on Discrimination A Class
Divided 70
Effects on Individuals: Worth, Dignity, Social
Justice and Social Welfare 70
Values for Professional Carers 71
Codes of Practice and Professional Conduct 78
Care Values and Communication 83
The Role of Effective Communication in the
Caring Relationship 85
Verbal Communication 87

Non-Verbal Communication 93
Barriers to Effective Communication 101
Carl Rogers Core Conditions 110
Gerard Egan A Systematic Approach to
Helping 114
Reflective Practice as a Tool for Evaluating
Personal Practice 122
Formative Assessment Outcome 1 123
OUTCOME 2 129
An Overview of Legislation 131
The Sex Discrimination Act (1975) 132
The Race Relations Act 1976 134
Disability Discrimination Act 1995 and Disability
Discrimination Act 2005 137
The Commission for Equality and Human
Rights. 140
NHS and Community Care Act 1990 141
Community Care and Health (Scotland) Act
2002 142
Data Protection Act 1998 144
Adults with Incapacity (Scotland) Act 2000 146
Regulation of Care (Scotland) Act 2001 147
Mental Health: Care and Treatment (Scotland)
Act 2003 150
Ways in Which Legislation Acts as a
Framework to Promote Positive Care Practice
154
OUTCOME 3 157
The Care Planning Process 160
Good Practice in Care Planning 162
Care Planning Models 164

5b,6a
4b,5a
The Role of Care Workers in Care Planning

and Implementation 168
Goal Setting: Short- and Long-term Goals in
Care Planning 172
Assessment of Needs 174
Tools of Assessment 174
Needs Assessment Using a PROCCCESS
Model 179
Holistic Care 180
Maslows Hierarchy of Needs 182
Implementing the Care Plan 194
Evaluation of Strategies 196
Answers to Formative Unit Assessment 206

6b
Reference Section

6c,8a
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

8b
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 candidates grade is based on the
Course assessment.

8c,9a
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

9b,10a
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

10b
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

10c
Further details of the Course assessment are given

in the Course Assessment Specification and in the
Specimen Question Paper.

10d,11a
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

11b
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.

11c,12a
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:

12b
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 individuals
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.

12c,13a
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 peoples 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

13b
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.

13c,14a
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

14b,15a
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.
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.
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

15b
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

15c,16a
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.

16b
Tutor Support Section

16c,18a
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

18b
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.

18c,19a
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: pupils 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

19b,20a
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 childrens 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 dont 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

20b
rather than just think: Great. Ive 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 learners 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.

20c,21a
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
Scotlands 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 Scotlands 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

21b,22a
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/2006/02/02
094408/0
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/

22b
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.

22c,23a
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

23b
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 Blooms taxonomy,
such as
http://www.educationforum.co.uk/HA/bloom.htm.

23c,24a
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
Egans skilled helper
model
6 Effects of stereotyping,
prejudice and
discrimination
7 Revision of outcome 1 Opportunity for
Formative
Assessment and

24b
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
Assessment and
Feedback
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
Malsows hierarchy
15 Analysis and evaluation
of needs
Strategies to meet
needs
16 Revision of Outcome 3 Opportunity for
Formative
Assessment and

24c
Feedback
17 SUMMATIVE
ASSESSMENT
18 Feedback on Assessment and Remediation
Review of Unit

24d,25a
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

25b,26a
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;

26b
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 Governments
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/divi
ded/etc/view.html

26c
Student Support Section

26d,28a
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 dont 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

28b,29a
you highlight too much, then nothing will jump out at

you and youll 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.
values and communication.
Mandatory Content for this Outcome

Caring relationships:
good and bad practice in care

29b,30a
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:

30b
Rogers core conditions

Egans skilled helper model.

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.

30c,31a
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

31b
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.

31c,32a
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.

32b,33a
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
promoting the social welfare of 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

33b
1. Explain why each of the scenarios listed below

represents bad practice.
2. Explain the likely effect of the carers 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
pensioners 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).

33c
A care worker at a nursing home suspended

after an alleged sex attack on an 80-year-old
woman resident.

33d,34a
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

34b,35a
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
Relationship Between Values and
should be treated fairly and be
Behaviour
protected from harm.
Socialisation is the term used to describe the
process of learning
4. People to become
thrive when a member of a
they experience
particular grouppractice.
good care or society. Through
In good care our
interactions
practice with others
social, we develop
physical, an
emotional,
understanding
cognitive andof how weneeds
cultural are expected
are to behave in
acknowledged,
relation to others (ourrespected andexample if, as a
role). For
resultsupported.
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

35b
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
womans 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 dont need to question our beliefs and in our
discussions and actions we can support each
others 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

35c,36a
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.

36b
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)

36c,37a
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.

37b,38a
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

38b,39a
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
Prejudice is a judgement
OPINION ORmade about a person or
JUDGEMENT,
group, based on a stereotyped image. These
OFTEN NEGATIVE
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.

39b
Group Stereotype Prejudice

Goths Dress in Black.
Evil people.
Celtic All Roman Catholics.
supporters Hate Rangers
supporters.
Teachers Get long holidays
Asylum Scroungers
seekers
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
NO
ENTRY
against on the basis of race, religious beliefs,

39c
gender, colour, age, marital status, physical or

mental status, sexual orientation, economic status,
size and many other characteristics.

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
Wont
Black.
make a
Evil people.
good
carer
Celtic All Roman Cant
supporters Catholics. invite Jo
Hate and Sam
Rangers to the
supporters. party
theyll
hate each
other
Teachers Get long Dont
holidays deserve
another
holiday
Asylum Scroungers Send
seekers them
back
Discrimination is the result of stereotyping and

prejudice on the individual.

39d,40a

40b,41a
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 Wont Person
Black. make a dressed as
Evil people. good Goth fails to
carer get into a care
course or job.
Celtic All Roman Would Employer gets
supporters Catholics. never complimentary
Hate want to tickets to a
Rangers see Rangers game
supporters. Rangers but doesnt
play offer them to
Celtic
supporters
Teachers Get long Cant be Not listened to
holidays stressed. when
Look at complaining
all these about work
holidays! stress
Asylum Scroungers Send People in host
seekers them country refuse
back to help,
their own isolated in
country society
Remember that the stereotypes and prejudices that

these discriminatory actions were based on have no
factual basis.

41b
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 peoples
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 dont 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

41c,42a
Using information from the site, write a paragraph to

describe the effects of stigma and discrimination on
individuals with mental health problems.

42b,43a
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

43b
discrimination against people with mental health

problems, and in promoting good practice in care.

43c,44a
Institutional Discrimination
Discrimination doesnt 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

44b,46a
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/divi
ded/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

46b,47a
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 Respect and self-

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

Miller & Gibb (2007) refer to two core values for
care practice.
every individual
promoting the social welfare of every individual.
Respecting the worth and dignity of every individual
requires care workers to recognise a persons
importance as a human being with a set of unique

47b
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 users individual needs.
People have specific social, physical, emotional,
cognitive and cultural needs.

47c
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

47d,48a
When working with people requiring care, using a

value base will maintain and nurture the service
users 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 users 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

48b
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

48c
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 respect for the worth and dignity of every individual
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.

48d

48e,50a
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

50b,51a
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.

51b
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
PRACTICEA
nurse
ramming a
paper towel
into a terrified
pensioners
mouth, force

51c,52a 52b,53a
feeding
another so
she nearly
choked and
using abusive
language.CO
DE OF
PRACTICE
POINT
IGNORED
WHAT THE
CARER
SHOULD
HAVE DONE
CODE OF PRACTICE

53b,55a
Key Points
Key Points
SSSC Code of Practice
NMC Code of professional conduct
Protect the rights and promote the interests of service users and carers.
Respect the patient or client as an individual.
Strive to establish and maintain the trust and confidence of service users and
Obtain consent before you give any treatment or care.
carers.
Co-operate
Promote with others inofthe
the independence team.users while protecting them as far as
service
possible from danger
Protect confidential or harm.
information.
Respect the your
Maintain rightsprofessional
of service users while seeking
knowledge to ensure that their behaviour
and competence.
does not harm themselves or other people.
Be trustworthy.
Uphold public trust and confidence in social services.
Act to identify and minimise the risks to patients and clients.
Be accountable for the quality of your work and take responsibility for
maintaining and improving your knowledge and skills.
Care Values and Communication

If values are important in the caring relationship
then the carers 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

55b
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
In care
I like working You like
with you. working with
me.
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

55c,56a
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
and
i ta ted
irr
ound !
s e
n k you g at m
i
th looki n
ll, I
We re not

you
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
dont look at them, or if we sound irritated when we
say the words, the person is unlikely to believe what
we say.
I am listening to
you.

56b,57a
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
Receiver
Sender
Interprets
Communicates Message
Message
Verbal and Non-
Verbal and Non- verbal signals
verbal signals are noted,
using all
available
senses
Feedback sent to
original sender who will
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.

58b,59a
57b,58a
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

wouldnt 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.

59c
59b
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.

59d
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/

59e,61a
Verbal Communication - Questions

Asking questions is an important aspect of
developing caring relationships. It is part of the
carers 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 dont 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

61b
allows the carer to develop a more in depth

understanding of the service users 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

61c,62a
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 persons 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.

62b,63a
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.

63b
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
someones 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 persons 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?

63c,64a
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/n
vc/nvc3a.html
Anger
Disgust, contempt
Fear
Happiness
Interest
Sadness
Surprise

64b,65a
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 persons 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 dont
get close this might suggest that we are
disinterested.
Posture refers to a persons stance. Even if we
cant see someones 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

65b
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

65c,66a
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?

66b,67a
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
Barrier
Barrier
Sender Receive
r
Personal factors canFeedback

be attributed to the sender or
receiver. A persons 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 isnt attentive or fails to clarify understanding
then this too can interfere with effective
communication.
A persons 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

67b,68a
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 persons 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.

68b
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 dont 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 users
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: Ive been feeling sick all day
Carer Reflecting Back: Im sorry that youve

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

Ive got pains in my stomach and I want to throw up.

68c,69a
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 persons facial expression. This would

69b
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 persons 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.

69c,70a
Older adults with Remind the service

dementia user of your name
Speak slowly and
clearly
Use short simple
sentences.
People with addictive Create a

behaviours (e.g. comfortable
drugs/alcohol/gambling) environment, privacy is
important
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 Use simple

palsy language as you are
speaking to a child
Check the childs
understanding by
asking open questions

70b
Do not rush the child

when he or she is
speaking.
Adults with learning Support verbal

disabilities communication with
body 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

problems environment where the
person 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

70c,71a
reflecting back.
People with hearing Make sure that the

impairments person can see you
approaching. (Dont
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.
Dont cover your
mouth when you are
speaking.
If the person uses
hearing aids, make sure
they are available and
working. Dont shout.
People with visual Let the person know
impairments that you are there 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
users experience and

71b
understanding
People who find speech Be attentive

difficult SOLER
Dont rush the
person. Dont 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
users 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).

71c,72a
Find out about advocacy services

what do they provide?
Carl Rogers 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

72b
prizing (valuing the person). The carer

demonstrates verbally and non-verbally that they
accept the person as a unique individual. The
service user doesnt need to behave in particular
ways to gain the carers approval. Unconditional
positive regard means that the carer is non-
judgemental about the service users 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 users 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

72c,73a
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 users
point of view. This is sometimes known as being
within a persons 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

73b
get to know the service users 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 elses 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.

73c,74a
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 Egans
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

74b,75a
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
users 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
1 b. BLIND LISTENER
SPOTS Demonstrate:
CURRENT c. LEVERAGE UNCONDITIONAL
SCENARIO POSITIVE REGARD
CONGRUENCE
EMPATHY
Use open and
closed questions
Paraphrase
(restate the story to
check your
understanding)
Reflect feelings
(check you
understand how the
person feels)

75b
Summarise the
story and help the
person to focus on
specific issues
Observe non-
verbal
communication.

75c,76a
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
b. CHANGE to use the
PREFERRED ANGENDA skills used
SCENARIO c. COMMITMENT in stage
one.
In addition,
the helper
should:
Communicate
a deeper
understanding:
through

76b
increasing
empathy and
congruence.
Help the
service user to
set SMART
goals (specific,
measurable,
achievable,
realistic and
time based).

76c,77a
3. The action strategies formulate the third stage

of Egans 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 Continue to use the skills

ACTIONS 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

77c
77b
Positive Regard, Congruence, Empathy.

SOLER
Remember
Establish the caring

Use a systematic
relationship
approach.

77d,80a
using
Care
Key Points
Reflective Practice as a Tool for Evaluating
Effective Communication in the caring relationship
Personal Practice
Is used to demonstrate care values
Reflective practice is simply thinking about what you
Is required
are doing or to understand
what you individual
haveservice
done. usersThis
and their needs
is known as
Rogers
reflection in action
Involves listening, (in the
questioning, present)
understanding and or reflection on
responding
Explore,
action (reflecting
Includes on a the
verbal messages past event).
actual words The person who
is reflecting cansignals
Includes non-verbal ask themselves
paralanguage e.g. questions about
pace and tone and
facial expression and body language
their actions. For example:
Why did Itodo
Barriers that? can be personal, physical and
communication
environmental
Why did I say that? ACTION LEADING TO VALUED OUTCOMES
SOLER skills used in effective listening
How did I feel?
Communication must be appropriate to the needs of the service user
How did the service user feel?
DidRogers
I communicate well?
core conditions are Unconditional Positive Regard,
Congruence and Empathy
How can I communicate more effectively with this
Egans Systematic approach is Explore, Understand and Act
service user?
Egans Skilled Helper Model 3 stages Current Scenario, Preferred
What did I do that was good practice?
Scenario and Action Strategies
What did I do that was bad practice?
Advocacy is a way of empowering service users, so that their voice
How cando I know what is good or bad practice?
be heard.
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

80b,81a
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

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

81b
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.

81c,82a

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 doesnt introduce you and
you feel a bit awkward as there isnt 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. Hes wet himself she explains, old people do
that. You keep an eye on Fred and Ill 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 theres
no time to wait as breakfast is on the table. Fred
uses a walking frame and you and Amy help him to

82b
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 Egans 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.

82c,83a

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 Amys 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 Egans
skilled Helper Model.
(KU)
10. Explain the purpose of reflective practice and

why this might benefit Amy. (KU/AE/App)

83b,84a
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.
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.
Key Points
NMC Code of professional conduct
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.

84b,85a
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:

85b,86a
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

86b
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.

86c,87a
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 arent 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.

87b
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
Key there is a genuine occupational requirement.
features
For example recruiting a female worker for a
The Sex Discrimination Act 1975
womens refuge.
and
You can
Gender keep
Equality Duty up to date by visiting their website.
2007
YouThecan also find an

Sex Discrimination excellent
Act 1975 publication
prohibits sex discriminationgiving
against an
overview ofthe30areas
individuals in years of progress
of employment, since
education, theprovision
and the Sex of
goods, facilities and services and in the disposal or management of
Discrimination
premises. Act was introduced in 1975.
http://www.eoc.org.uk
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
87c,89a
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.

89b
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

89c,90a
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 organisations 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 persons
dignity or creates an intimidating, hostile, degrading,
humiliating or offensive environment for them.

90b,91a
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:
Eliminate unlawful discrimination
Promote equality of opportunity
Promote good race relations between people of different racial

groups
Disability Discrimination Act 1995 and

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
individuals 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.

91b
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
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 peoples needs,
even if this requires more favourable treatment.

91c
Key Features

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.

91d,93a
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.

93b,94a
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,

94b
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 individuals needs.
The aim of an assessment is to find out about a
persons individual needs and the services and
support required to meet these needs. A persons
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 users 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 individuals
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.

94c,95a
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.

95b,96a
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.

96b
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

96c,97a
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
Key Features
welfare ofIncapacity
Adults with the service user
(Scotland) Actby
2000encouraging the use
ofPermits
existing skills. This means that every effort has
people to make decisions on behalf of another adult who lacks
tocapacity
be made to empower the service user and to help
him/her to reach their full potential.
Safeguards the welfare and finances and property of adults with incapacity
Decisions taken must:

You can visit the following website to find out how
theBenefit
Highland
the adultCouncil is implementing policy to
comply withandthe
Recognise legislation.
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
Scottish Further Education Unit
skills. 147
97b,98a
www.highland.gov.uk/socialwork/olderpeopleservice
s/adultswithincapacity

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

98b
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.

98c,99a
Key Features
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.

99b,100a
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/26487/00
13533.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
persons 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

100b
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

100c
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,

100d
if one person names the legislation the other person

should try to describe the key features.

100e,102a
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.

102b
Figure 3. Benefits of legislation to the service

user

102c,104a

Explain the role of legislation in promoting
positive care
Before you do this formative assessment you should
review your notes.
When you have completed your revision, try to do the
assessment without referring to 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)

104b,105a
Formative Assessment
Explain the role of legislation in promoting
positive care
Chloe is a 20 year old young woman, who has Downs

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 Downs
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 Downs Syndrome visit
http://www.downs-syndrome.org.uk
OUTCOME 3
process
(a) Explain the care planning process

105b,106a
(b) Analyse approaches to assessing needs of

service users
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

106b
Emotional needs
Social and spiritual needs
Maslows 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.

106c,108a
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.

108b
EVALUATE ASSESS
Values and Principles

place the service user
at the centre of the
process
IMPLEMENT PLAN
Figure 4. The Care

Planning Process
ONGOIN
G
MONITO
RING
AND
REVIEW

108c,109a
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

109b
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.

109c,110a
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 users 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

110b
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.

111b
110c,111a
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 users behalf. Some of the features of person centred care planning include:
Moving from Moving towards
clinical descriptions of seeing people as human
people beings
professionals being in Sharing power
charge
professionals inviting the person choosing who
people attends meetings
meetings in offices at meetings in a venue
times to suit chosen by the person,
professionals when it suits her/him
meetings being meetings being facilitated
chaired
not asking what encouraging person to
person wants dream
assuming inability looking for gifts in people
filing plans away giving the plan to the
person
Writing notes of graphic facilitation of
meetings meetings
professionals putting all team members having
plan into action some responsibility for
implementing plan
Figure 4. Person Centred Care Planning

Adapted from Miller and Gibb 2007

111c,112a
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

112b
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.

112c
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 Describe service

Carer descr users these
iption 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

112d
Social worker
Speech
therapist

112e,115a
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 wont 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

115b
Higher Unit or the Intermediate 2 Values and

Principles Unit.

115c,116a
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 individuals
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
individuals 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 persons 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

116b
sources. Tools of assessment can be used to draw

attention to a service users 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 individuals 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 users 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.

116c,117a
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 users 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
users 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 persons 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

117b
individuals 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 persons 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 shouldnt
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 Andys 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. Andys
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
mothers purse and is dodging school. Andys mother

117c,118a
has had several rows with him but he denies that he

has stolen any money and says he doesnt 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 Andys guidance teacher could use
observation and asking questions to assess Andys
situation.
5. How could Andy use a diary to help him assess the
extent of the problem?
Needs Assessment Using a PROCCCESS

Model
PROCCCESS

118b,119a
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 dont 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 isnt 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 Brians need
for care and support.

119b,120a

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. Fatimahs 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 Alis needs and Fatimahs
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

120b

120c,121a
Maslows 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 someones
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.

121b,122a
Growth
Needs
Deficien
cy
Needs
Fig 5. Maslows 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 arent 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 Maslows 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.
every individual

123b
122b,123a
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.

123c
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 Maslows 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

123d
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.

123e
CASE STUDY
Read the following case study and then answer the

123f
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 Joes birthday.
Over the past year his neighbours have noticed that he
has been more and more confused. He has been
forgetting names and sometimes doesnt seem to know
what day of the week it is. This week one of Joes
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 Joes
daughter who is very concerned about her fathers
changing circumstances. She contacted social
services and Joe is to have an assessment of needs.

123g,124a
Using Maslows hierarchy of needs as a model (guide)

write about some of Joes circumstances that would
help you to understand his needs at each of the levels.
Needs Joes circumstances
Physiological
Safety
Love and belonging
Esteem
Self-actualisation
You might have noted some of the following points
about Joes circumstances.
Needs Joes circumstances

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

Joe left gas on but not lit
Joes food is mouldy

124b
Love and Joes family live at a distance but are

belonging 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
Continue to use Maslows hierarchy to note down some of Joes needs.

Needs Joes circumstances Needs
Joe was nearly run Joe has no food in the
overPhysiological
Joe left gas on but not lit house
Joes food is mouldy
Joes house is cold

Love and Joes family live at a
belongingSafet distance but are
y 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
actualisation and playing jazz

124c,126a
You might have noted the following needs

Needs Joes Needs
circumstan
ces
Physiological Joe has no food in Joe needs food
the house
Joe needs
Joes house is warmth
cold
Safety Joe was nearly Joe needs to be
run over safe from
Joe left gas on but dangers of traffic,
not lit unlit gas and
Joes food is mouldy food
mouldy
Love and Joes family live at Joe needs to
belonging a distance but are know his family
emotionally close care for him
Joe has lived in Joe needs his

his home for over pictures and
50 years souvenirs as
they have
important
memories
Esteem Joe is respected Joe needs to

126b
in his local maintain links

community with his local
Joe is a talented community
musician where he is
respected
Joes needs to
maintain his
musical abilities
Self- Finds fulfilment in Joe needs
actualisation singing and opportunities to
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

126c,127a
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 persons 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 persons 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

127b,128a
example the following may be considered to be

strategies:
Anti-discriminatory practice
Rogerss core conditions
Egans 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 doesnt work, for example the persons 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
Joes 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 arent

128c,129a
128b
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 isnt 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 Joes

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.

129b
ACTIVITY - Analysing approaches to assessing

needs and evaluating strategies for meeting
Joes 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 Joes 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.

129c,130a

process
Before you do this formative assessment you should
review your notes.
When you have completed your revision, try to do the
assessment without referring to 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 Maslows 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)

130b
Read the case study and then answer the

130c
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 didnt 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 Annies 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.

130d

130e,131a
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 Sallys
situation.
(KU 4
AE/App 4)

6. Explain the importance of evaluating a care plan.

(KU 4)
Glossary of Terms
Advocacy Speaking on a persons 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 in a persons own home
care
Empathy Developing a sense of what it is like
to be in another persons 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
A bias towards others Accepted way of doing things
based on stereotyped
ideas Norm

131b,133a
133b,134a
Principle Standard
Prejudice
Psychologist Someone who studies the human
mind
Reflective Thinking about what you do and why
practice you do it
Research Study or investigation
Residential Care home where people live and
care 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.

134b,135a
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 persons 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 individuals 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

135b
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 Annies 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 Annies self-esteem

135c,136a
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 Sallys
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 Sallys situation. The
points may be related to access to public transport,
involvement in school life or equality of opportunity in
employment.

136b
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)
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

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1a

Values and Principles

Scottish Further Education Unit

Scottish Further Education Unit 2

Care: Values and Principles in

Scottish Further Education Unit 3

Scottish Further Education Unit 4

Scottish Further Education Unit 5

Scottish Further Education Unit 6

The Role of Care Workers in Care Planning

Scottish Further Education Unit 7

Scottish Further Education Unit 8

What is the Care Course all about?

Scottish Further Education Unit 9

The mandatory content for this Unit is detailed in

Scottish Further Education Unit 10

Scottish Further Education Unit 11

simulated situations from key theoretical and

Scottish Further Education Unit 12

Specification. If re-assessment is required, it should

Scottish Further Education Unit 13

Further details of the Course assessment are given

Scottish Further Education Unit 14

Link between Unit and Course

Scottish Further Education Unit 15

Apply theories and applications in a care context

Scottish Further Education Unit 16

The Course in Care (Higher)

Scottish Further Education Unit 17

Helps candidates to understand the

Scottish Further Education Unit 18

Scottish Further Education Unit 19

and development and apply these approaches to a

Scottish Further Education Unit 20

Unit Outcomes, PCs and Evidence

Acceptable performance in this Unit will be the

Scottish Further Education Unit 21

Analyse the caring relationship between the carer

EVIDENCE REQUIREMENTS FOR THIS UNIT

Scottish Further Education Unit 22

Performance Criteria for the Unit. The evidence

Scottish Further Education Unit 23

Treatment (Scotland) Act 2003.Adults with

Scottish Further Education Unit 24

Tutor Support Section

Scottish Further Education Unit 25

How to Use This Pack

Scottish Further Education Unit 26

and to recognise values and principles that exist, or

Scottish Further Education Unit 27

Rationale for teaching/learning approaches

This pack can only deal with points 1 and 2, but

Scottish Further Education Unit 28

learners to produce a more confident performance

Summative Assessment (product):

Formative Assessment Strategies

Scottish Further Education Unit 29

rather than just think: Great. Ive scraped a pass.

Scottish Further Education Unit 30

All CYP can be successful learners, effective

3) Citizenship in Scotlands Colleges (2006)

Scottish Further Education Unit 31

cultural contexts of their lives. Other aspects of

Scottish Further Education Unit 32