Phil Clarke – Esplanade Hotel Llandudno
Unit 220 – Support individuals who are distressed.
Outcome 1 – Understand causes and effects of distress.
The causes of distress are extremely varied and can differ from one individual to the next. What distresses one person may not distress another. Causes of distress should not be confused with the reasons for it. Causes can be a range of external factors, whereas reasons have a deeper, psychological influence.
Common causes of distress can be due to:
Receiving bad news.
Bereavement/receiving serious illness news about .themselves/others.
Reaction to behaviour.
In an environment they find frustrating/restricting/irritating.
Lack of knowledge/information which can leave them fearful.
Anxious about a future event.
Unable to achieve a target/objectives they have been set.
These are just some of the reasons, this list is not exhaustive.
If you know a particular person, then it may be easy to see when they are distressed. However, if you do not know that individual so well, then it may be hard to see that they are distressed.
Some of the signs that an individual is becoming distressed can be:
Voice – This can become raised or the pitch can change in times of distress.
Facial expression – The person may start scowling, crying or snarling.
Body Language – The person may show agitation, aggressive, lean forward with fists clenched. Someone usually lively may sit still or vice versa.
Pupils – These may become dilated (get larger) and their eyes open wider.
Face – This and their neck for example may become reddened.
Sweating – The person may start to sweat profusely.
Breathing – They may start exhibit breathing pattern changes, e.g. start to breathe heavier.
Changes in behaviour – Someone normally chatty may become quiet, or vice versa.
These are just some examples, every person is an individual so may exhibit different signs. For example just small changes, maybe not as exaggerated as the points above can mean a person is getting distressed. If you are in doubt about a person, then advice should be sought.
When a person is distressed it may alter the way that they communicate in the following ways.
Become quiet and withdrawn – The individual may turn away from you and not make any eye contact.
Low self-esteem – This may cause them to seem disinterested or not wanting to communicate.
Body Language – This may seem closed and negative.
Feel like they are a burden – The individual may want support, but they feel like they are being a burden to the person trying to communicate with them. Conversations may be one sided, and the other person may feel they are not getting any feedback.
Angry – A person may be angry, their voice raised and they control the conversation and not prepared to listen to the other person. This can be as frustrating as lack of communication as a person may feel that they are not able to help.
Language/learning difficulties – If a person in distress does not speak the same language, or they have learning disabilities then that may add another dimension to communicating with them.
Dealing with a person that is distressed can be a very upsetting experience. The person supporting them could feel for example guilty that their circumstance is ‘better’ than the person who is distressed. It is possible as well that if the person supporting them may be having difficulties themselves, and supporting a distressed person can bring these difficulties to the surface.
It is perfectly normal when supporting a person who is distressed to feel upset, even angry. The person supporting may feel that they have not done their job properly and they could have done more. They may even question their ability to do their job properly, or their own actions and abilities. It may not always be feasible to ‘put the experience behind them’ and it may interfere with their work both with them or others. They will, hopefully, after a period of time be able to be able to put the experience behind them.
In particularly bad cases it can cause the person supporting’s well-being by causing them to suffer with stress themselves which can affect the quality of their work, relationships with family and friends, even cause relationship breakdown.
It is therefore vital that a person recognises when another person’s distress is having an effect on you. There are many sources of support offered. The best place to start is your line manager.
Outcome 2 – Be able to prepare to support individuals who are experiencing distress.
The level of help and support that an Individual should be offered is always best decided with the individual themselves. Wherever possible, this should be done through a process of discussion using open clear questions, designed to find out the level of support that is needed.
There may be times however when it is not possible to discuss the level of support that the person needs. This can be because they are too agitated, angry or in a very distressed state and unable to hold a calm conversation, or it may be that they are threatening to harm you, themselves or others. On the other hand, the individual may be very withdrawn, not wanting to communicate or behave in a manner that is way out of character.
In these circumstance, the best course of action will need to be decided. It is possible that specialist intervention is required. Getting to know a person will let you know the situations you can deal with, those that you cannot, and situations you may need specialist help for. If you do not know the person particularly well then the persons care plan may indicate an idea of a person’s normal mood and behaviour. This can tell you of both possible trends in their behaviour both improvement and detiriation.
The type of specialist support or intervention will obviously differ depending on the person or the situation. It is likely however, that you will need another person’s support and advice. You should always be up to date on the policies and procedures of your company. If a person’s mental or emotional health gets deteriorates rapidly, then this is known as a mental health crisis and it is important to get help quickly. There may be details of someone to call on the persons care plan or the person may need an emergency appointment with their GP or out of hour’s doctor. It is therefore vital that you have these details to hand always. These people may visit and advise on the best course of action to take.
Another source of contact could be your local mental health crisis team. This team is made up of Psychiatric nurses, social workers and support workers. These teams are part of social services, and the contact details found via the local council.
NHS direct can also offer help and support. Contact details can be found on their website or in the local directory.
Other sources can include bereavement counselling such as Cruse. This along with other similar organisations are mostly ran by trained volunteers, and are contactable by telephone or email. They do not however, offer immediate medical support.
Dealing with a person that is distressed can be a very upsetting experience and occasionally you may need to manage your own feelings after doing this. There are many different means of support that you can approach:
Talking to a trusted colleague/supervisor – These people may understand the feelings you are having as they may have had similar experiences themselves, they could help you with the best way to deal with your emotions.
Professional Counselling – You may need to talk to a professional to help you with your feelings. You may want to approach this form if you are not comfortable talking to an individual in your workplace.
GP – Your GP can offer support or lead you to someone who could.
Advice lines – There are many advice lines that you could access, details can be found on the internet, or at your local doctors surgery for example.
It should be noted that every person is an individual, what works for one person may not work for another. It does not make any person ‘better’ than others in the ways that they deal with stress, or stressful situations, everybody has their different mechanisms.
Outcome 3 – Be able to support individuals through periods of distress.
Outcome 4 – Be able to support individuals to reduce stress.
Outcome 5 – Be able to record and report on an individual’s distress
All incidents of distress and the support that has been provided must be recorded and reported to your line manager. Correct procedures must be adhered to at all times. A care worker is not in a position to decide the next step to be taken, or if the incident is serious enough to be followed up. The incident should be recorded as soon as is possible so the facts are still clear in your head. The report should only contain clear facts, and not what you think you saw or heard. The report should be clear, easy to read and in black ink only. No gaps should be left between statements and the report signed, dated and the time of your entry entered. The report must be stored in line with your company’s policies and procedures at all times. If a written report cannot for any reason be completed, then an audio copy, or dictation to another person may be ok in the interim until you can record it.
Record keeping and communication is vital in order to ensure that the person receives the proper care and support required. Records can also show trends of activities and can even prevent situations escalating seriously, e.g. to suicide.
Incidents of distress, no matter how trivial you believe them to be, must always be reported. All workplaces have policies and procedures, and these must be followed at all times. Even if you have worked for a particular organisation for a long time, then it is important to keep yourself refreshed as the policy or procedure may have been updated or changed. Procedures may differ due to the person you are supporting, e.g. a person may be considered ‘high risk’ and their distress so severe that they may self-harm or attempt suicide. In these cases it is likely that their behaviour needs to be monitored very closely and regularly, and to be recorded and reported upon.
As well as written records, information should be passed on verbally, e.g. during a handover in-between shift changeovers.