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Monthly Archives: October 2018

Moral Obligations

HCAs work closely with their patients/clients and have access to their health records.  Under State Law and moral obligation, the information gleaned from these records and from the patient must be kept confidential.   This means it must not be shared with anyone outside the multidisciplinary care team (MDT).   It must not be shared with the MDT either except on a need to know basis and out of earshot of anyone else who might be listening.   

Never discuss patient information on social media, it is not secure and not safe. 

The following is a true story which occurred about twenty years ago.   At that time a single mum was not entitled to the lone parents’ allowance if living with a partner.  I’m sure the rule around welfare has changed since then but the moral of the story is the same.   

An Example:  in the staff room of a health centre a Registered Nurse (RGN) was talking to the Public Health Nurse (PHN) about a single mum who was up most of the night with her ill baby.  The RGN assured the PHN that the young mum was not alone as the baby’s father was living there and was helpful.   During this conversation the Welfare Officer was in the staffroom on his break.   He noted the conversation and the name of the young mum.   The next day he visited and although there were no signs of a male living in the flat with her, the Welfare Officer stopped her lone parents’ allowance based on what the RGN had said.   

It is important when writing notes in the patient’s chart to express facts only and not to make assumptions.  Remember, patients can gain access to their health records and the notes you have written may be challenged.   

If you are concerned about the health or welfare of a patient you are caring for, the person to go to for advice is your immediate line manager.


The majority of residents in nursing homes today are Irish and have lived all their lives in this country.  This will not always be the case as non-nationals, who have made their homes here, become old and in need of care.  The older Irish people lived under the oppressive rule of the Catholic Church which controlled health, education and the intimate lives of the family.  The Government worked hand-in-glove with the Church in the nineteen twenties and thirties and only really began to break away after the Second Vatican Council in the sixties.  What did this mean?  It meant that the people didn’t think for themselves, the clergy had the answer for everything and the people went to them for advice.  Every aspect of the lives of the people was controlled by the clergy.   

Women suffered the most, there was no contraception, no divorce.  Woman’s place was in the home cooking, cleaning and producing children.  If a woman was working in the State or semi-State sector she had to resign her position on marriage, if she wanted to buy property a man had to sign the documents.  There were no refuges and no understanding for women victims of domestic violence.  Male victims of domestic violence were too ashamed to tell their story and there was no help for them if they did speak out. For so many people it was a very cruel society. 

You are aware of the horrors of the abuse of children in industrial schools, mother and baby homes where babies were forcibly taken from their mothers and sold to Americans and British families.  Women working in slave like conditions in Magdalene Laundries for thirty and forty years.  The last of the Magdalene Laundries had girls as young as 15 years still working there in 1993.  Young girls were deported to populate Australia and all of this in collusion between Church and State.   

As people become older they tend to dwell on memories, and these painful memories bubble up to the surface.  They may have suppressed difficult memories for years but now they need to express them and try and make some sense of them.  Whatever way they managed their lives it is important to listen to them and not to judge. 

In nursing homes particularly. Activities may be set up such as craft sessions where the residents can participate in the activity or simply be present, joining in the conversation.   The focus is on the activity, but the conversation is stimulated and guided by the facilitator who encourages the residents to reminisce.  It is good to share happy memories and compare stories of childhood and young adulthood.  This may lead the residents to share more difficult memories on a one-to-one basis at another time, as they build up trust.

Why the AHCAI?

The majority of HCAs who have been told about the Alliance of Health Care Assistants in Ireland (AHCAI), and have been asked if they would like to join, have wanted to know “what’s in it for me”? Now that is a legitimate question. However, it is surprising that not one person asked, “What can I do for my discipline through this membership organization?” 
Have we become a ‘wait and see’ rather than a ‘roll up your sleeves’ society, waiting to see success before joining, in the hope that others will do the work for us. The problem is there are no others. Unless you are prepared to chip in and do your bit the status quo is maintained. 
What is the status quo? 
The status quo is that HCAs have no voice. Those with vested interest in maintaining the status quo speak and act on your behalf without consulting you. In fact, there has been no improvement in the status of the HCA since first introduced into the health service 25 or so years ago. 
What has the AHCAI been doing on your behalf? 
The Alliance has produced a code of practice for HCAs which will be offered for ratification at our AGM later this year. We are also working with a consortium on a two-year apprenticeship training program for HCAs. We have short, free of charge, CPD courses on our website for members. There are ideas for activities for residential clients and much more on our open website. We are trying to create a career path and have the discipline of HCA recognized and respected and to achieve this we need more members, more ideas and more support. 
We need HCAs to join this membership organization, we need people who can contribute actively on our council, other people who would be willing to hold discussion groups with HCAs around the country and report back to AHCAI. 
We want to know what concerns you, how would you like your discipline to develop into the future? Working together we may be able to achieve your dream. We are aware that many of you are content with your working lives as they are and so be it. However, many more would like to contribute at a higher level, to work to their full potential.


A stern face is off-putting. A person who is moody and unpredictable is difficult to approach. The approachable person smiles, doesn’t over react to situations or exaggerate, use harsh words or sarcasm. He/she is ready and willing to listen without judgement and talk through the issue with you. 
One of the characteristics necessary to work as a HCA is to be approachable, another way of expressing this is to have good interpersonal skills. Being able to interact with people, to glean from them their worries and concerns and to be able to comfort and reassure them as necessary. 
People in hospital are in an unfamiliar environment. They may be anxious; the approachable HCA or Nurse who can ease their anxiety by communicating with them, explaining the treatment process, relieves the anxiety making the situation bearable for the patient who is now more likely to co-operate. 
In the residential care centre the new patient, with or without a cognitive disability, will be feeling lost, out of their comfort zone. To be greeted and welcomed by a warm smile and friendly demeanor will mean a lot. This is a person the new resident will feel they can approach without hesitation. 
It is often more important to take the time to answer a question or to comfort a person than to complete a task. An unhappy, lonely patient doesn’t care if the sink is not cleaned or the bed isn’t properly made. That doesn’t give the HCA a license to be sloppy, this is where good judgement comes into play. The tasks can be done around the emotional care of the patient.


Tactful people are careful not to hurt the feelings of others. They can often defuse a confrontational situation by their appropriate intervention, appealing to both sides to resolve their differences. A shy or socially awkward person will be welcomed and eased into a gathering of people by the tactful hostess. 
Similarly the HCA will quickly pick up on the sensitivities of the patient regarding his/her body image, physical flaws or disabilities, treating the patient with equity and respect; making sure not to give offense. 
That one should behave tactfully is as important as communicating tactfully. The following is a true example of tactlessness: 
A HCA was mentoring a student on placement; the HCA was in the process of teaching the student how to give a male patient with cerebral palsy a blanket bath. The process had gone well, student instructed, patient’s cooperation gained. The necessary equipment had been brought to the bedside and the patient had been stripped in readiness for the bath. The sheet was turned half way down his body when the HCAs phone rang. Without excusing herself she stepped away from the bedside to answer it. For the next ten minutes she spoke on the phone in a foreign language, leaving the student in a quandary not knowing what to do; feeling awful for the patient who couldn’t communicate. The student pulled the sheet up covering the patient. When the phone-call ended the HCA resumed the task without an apology or explanation to either the patient or the student, both of whose feelings had been hurt by the incident.


Hobbies, leisure activities and physical exercise may be carried out alone or with others. They benefit the older person because they are relaxing, relieve stress and give pleasure. When carried out with others they fulfill the person’s need to socialise, to communicate, share thoughts and ideas and reminisce. Such activities assist in maintaining physical health as they lead to a sense of contentment and they play a part in keeping the mind alert. The residential centre which has a rota of chores that residents can carry out is meeting the needs of the older person to have a sense of belonging/ownership and dignity.

Tasks such as setting and clearing tables, arranging flowers, folding clean linen, keeping a noticeboard up to date, making tea for visitors, supervised baking and much more, would free up staff in a residence and help to give the residents a sense of dignity and belonging.  Only those who wish to should participate in these activities and with their or their families signed agreement.  Health and Safety regulations have deprived us of many of the simple tasks in life for fear of being sued.

When an older person moves into residential care they may experience some or all the following:

  • Loss of identity as a productive member of a family and community
  • Loss of possessions -home, household items, care, and so on
  • Loss of independence
  • Loss of real-world experiences – shopping, traveling, cooking, driving, hobbies, etc.
  • Loss of health and mobility

The person may feel useless, powerless and hopeless.” (Mosby 2017, P150)


Sorrentino and Remmert, Mosby’s Textbook for Nursing Assistants 2017, Missouri, Elesevier