A Care relationship has to be ‘constructed’ (K100 course team 1998, p191) otherwise conflicts and pressures will arise. In all forms of care a person will encounter conflicts and pressures at some point whether it is a care receiver or a care giver, unless attention is paid to develop a constant relationship. Using relevant literature and personal experiences, I will explore the conflicts and pressures associated with the Intimate care relationship. I will do this from two perspectives, the perspective of the carer and the care receiver. I will firstly outline each conflict, and then I will suggest reasons why such a conflict might arise and suggest a solution. I define Intimate care or personal care as something that a care receiver would normally do for themselves, for example washing, dressing and using the toilet. In the essay I will refer to the care receiver as the ‘client’.
The first conflict that I will discuss involves what might be termed ‘caring styles’.
In my employment, I carry out intimate care on a regular basis. One of the conflicts which I come across most often is the approach to care by a carer with a different caring style. Some people’s views on privacy are different from my own. For example, when dressing a client I tend to try and minimise the length of time that the person is unclothed and if they are sharing a bedroom I would always bring a screen across to reduce the embarrassment for both clients. However someone who has different views may leave the client undressed for lengthy periods of time and when in a shared room would undress both clients in full view of each other. However, as Twigg has noted ‘Nakedness creates vulnerability’ (cited in K100 course team 1998, p215) and it can be very embarrassing for clients especially if they are unable to voice their own opinion on the situation. Thus the care receiver can feel very vulnerable when being cared for by another person in an intimate way.
The reason why these conflicts occur may be linked to a different childhood upbringing where intimacy was very open, or from training within a different organisation where the emphasis on privacy was different. When two carers come together from these different backgrounds the conflict arises. One example of this is where carers were trained some years ago when caring procedures were different. Lawler cites evidence from nurses who were trained to control their emotions: ‘You had to appear what they termed ‘professional’ which was very cold and caught up’ (Lawler 1998, p242) Carers were not allowed to express their feelings and were never taught how to ‘cope with a person’ (p241)
These kinds of conflicts can be reduced, and even ended, by up-to-date training. One of the ways is to have all staff in one employment to undertake the same methods of care required by that company. The existing staff might help new comers to learn the companies approach to care. Also if everyone works as a team the conflict will lessen. However training must be of the right kind and duration. I watched a BBC documentary some time ago where a young girl applied for a job in care in the community. She was given the job and sent out to work on her own with vulnerable people to care for after only one day of shadowing another carer. I do believe that relevant training should be taken before a person is allowed into the caring field and this will reduce the conflicts and pressures from both the careers and the care receivers’ point of view.
Another example of conflict of caring style relates to the age differences between carers and care receivers; an age gap between carers and clients can create conflicts and pressures. A young carer caring for an older person sometimes does not know how to relate to the older client, thus creating a communication barrier. Recently my Great Aunt, who is severely disabled, had to spend some respite time in a care home. When she arrived at the home, she told everyone there that she likes to be called Mrs Jefferson. Previously the carers who went into her home to help her with meals and toileting etc, always respected her wishes to be called Mrs Jefferson, so when she went into the nursing home she expected the same. However the staff there totally ignored her desires and continued to call her Erica. She said she felt that her identity had been compromised.
Young care staff sometimes adopt a very familiar approach when talking to an older person in the caring environment. The client may react negatively to this kind of approach. Newsom recognises that "Negative reactions to help, for instance, may result from too much or too little help, help delivered in an inappropriate manner or at the inappropriate time, or negative or critical behaviours. (Newsom 1999)(my emphasis)
This example also illustrates how when care receivers are placed into a care home or a hospital they seem to become powerless. "You bring them into hospital, strip them of all their clothes, put them into pyjamas and shove them into bed and tell them to behave." (Lawler, cited in K100 course team, 1998 p.229) Individual clients are frequently treated like all the other people in the home and have to comply with a strict regime of being told when to go to bed, when to get up, when to have dinner and when to have a bath. It can make the client feel like their life is not their own any more. The pressure identified with this is that sometimes people can feel like their loosing their identity. Clients also have to cope with not having their personal belongings with them and this can arouse and all kinds of feelings for an elderly person when they first go into care. My Great Aunt said that being taken, helpless, into such an unfamiliar place bought back all the memories of when she was evacuated in the war. I can not imagine how this must feel but it sounds horrific. Having to cope with emotions like this, getting to know new people who may not respect your wishes and letting strangers help with personal care must be so daunting.
Again training particularly in communication, would lessen these pressures and conflicts: "Effective communication can not only reduce misunderstandings, conflicts and stress; it is also important in maintaining a cheerful mood and in promoting good interpersonal relationships." (Department of Health, 2003) We communicate with people for various reasons. For example when we give or receive information, to provide support or to carry out an assessment for individual needs. People will feel respected when they have been listened to, they feel that their wishes have been understood by the carer. Good communication skills are important for this, and carers need to find ways of overcoming the communication barriers such as age differences and a person feeling unsure of themselves, these often arise between the carer and the client.
In this essay I have explored some of the conflicts and pressures experienced by carers and care receivers in intimate care. I have identified that lack of consistent training is a major issue which is being experienced in a lot of establishments within the care environment. This is so not just in care homes and hospitals but also in home care. The pressures and conflicts which I have identified relate to different caring styles, intimate care, age differences and familiarity, loss of identity and powerlessness. The solution I have identified is proper training with communication skills at the forefront of company training schemes. In this way any care relationship can be constructed to overcome conflicts and pressures.
Department of Heath (2003) Carers Corner, Available from: http://www.info.gov.hk/elderly/english/healthinfo/elderly/comm_skilful-e.htm (accessed 1st March 2004)
K100 Course Team (1998) K100 Understanding Health and Social Care, Unit 4, Understanding Care relationships, Milton Keynes, The Open University.
Lawler, J. (1998) Body care and Learning to do for others in Allot, M and Robb, M (1998) Understanding health and social care, London: Sage.
Newson, J. (1999) Another side to care giving: Negative reactions to being helped. Available from:
http://www.upa.pdx.edu/IOA/newsom/current1.pdf (accessed 7th March 2004)