What is a value base?

A value base is not words on a paper. It is developed in the meeting between people and is expressed in practical action. Respect for another person is experienced in the meeting itself. The one who is respected feels seen and listened to. There is a strong connection between value base, human rights, and ethical codes.

From our norms, a value base in elderly care must always be inclusive and encompassed by love for humanity. As employees in care, we bring experiences and knowledge that provide a pre-understanding. There is a risk that the pre-understanding leads to us not listening to the one we are talking to in order to understand their perspective.

How a value base is created

Many operations work with reflection and have guiding documents in ethical issues. But it is in the encounter with the resident and the relatives that the value base is created. It is hardly possible to talk about a value base without simultaneously using the concept of respect. By observing how we as employees maintain respectful treatment even in difficult moments in practical work, we can evaluate how the value base works in the business. Professionalism means being professional in your treatment. More about that in the chapter on treatment.

To create a common value base, a constant ongoing dialogue on value base issues is required. Reflection and supervision can be a support. Similarly, these conversations can be gathered into ethical councils in the business that can be shared with those who have not been part of the conversation. The value base should permeate the business and start with the leadership.

For us who work in care, we have two perspectives in care about the individual. It's about what the resident needs help with, and about the relationship. Many times we end up in situations that are sensitive to the resident. Integrity is a concept often used together with respect. Covering the resident's nudity and managing intimate hygiene in a dignified way to avoid embarrassing the resident are examples of actions to protect integrity.

A few times when I have visited nursing homes, I have seen employees sitting and scrolling on a mobile phone during working hours. This type of behavior is not respectful and is also a way to avoid your tasks. There is always so much that can be done to increase the well-being of the residents. Conversations, singing, reading the newspaper aloud, walking exercise, or offering fluids. The list can be made long.

There is a power aspect to consider in the nursing home. The residents are dependent on the staff. There is a risk that staff will pressure the resident to accept phenomena that do not feel completely good. Sensitivity is not only for what is said with words. Inviting and supportive non-verbal communication, such as body language and facial expressions, is a prerequisite for reducing the risk of violations.

Helping the resident maintain their dignity and being the way they want and have chosen to be. Respect for integrity means considering the resident's experiences and history. It requires both commitment and curiosity. To get close and be able to help, we need to build trust. We do this by being responsive, working functionally preserving, following agreements by, for example, working in accordance with the implementation plan and showing care by being ourselves.

An important part of the work is to convey hope. Hope is closely linked to health, quality of life, and happiness. There is a lot in what we do in our care for the residents that can make a big difference here. The way to handle worry and anxiety can show how the value base works in practice. Do we take the time to sit down, offer a cup of tea, hold the hand and talk, or is our first thought to give an anxiety-damping tablet?

Another aspect of experiencing health is feeling meaning and belonging to a context. It can be helping the resident with knowledge, understanding situations, and being able to see the meaning as an important part of the care. By discussing value base issues individually and in groups and documenting ethical councils in the business, an ongoing process where ethical positions are developed can be kept alive. We who work in care must continuously work not to let us be guided by prejudices, automatic thoughts, or experiences that limit our ability to put ourselves in the resident's situation.

Examples of value base

An example of a value base is the one found within diakonia and is based on Christian faith. They summarize it in two words - "See the human".
There is also a national value base for elderly care that we should all follow. It's about turning words into action. We must constantly work against discrimination and violence and with participation, communication, treatment, respect, accessibility, self-determination, and other aspects of the national value base. It is important to make it a valuable support in everyday work, so that it is not just a shelf warmer.

Good treatment is a prerequisite for participation and self-determination for the individual elderly person. Therefore, the care staff must provide the residents with support so that they can decide on their everyday life and be involved in how the support and help are given.

The social services' work should be based on respect for self-determination and integrity. This means that the initiatives that social services carry out should both be planned and implemented together with the resident.

Participation

Participation and influence in society are a fundamental prerequisite for public health. It is essential that individuals feel that they have the opportunity to influence their own living conditions and the development of society. Otherwise, the risk is that exclusion and feelings of powerlessness arise. The opportunity to have influence and be able to influence has a clear connection with health.

Employees in care should contribute to facilitating participation and self-determination for older people. It can, for example, be about:
• Support the older person to maintain their independence, for example, by applying a function-preserving and rehabilitative way of working.
• Work so that the older person can influence the content of decisions on assistance and how the measures are implemented.
• Work to ensure that the help and support are adapted to the individual's needs, conditions and wishes.
• Have an attitude that invites the individual to express their opinions and wishes.

The perspective of relatives means that the family or other people who are significant to the older person are made visible and – when possible – involved in the care and care of the older person. This means that the activities see, respect, and cooperate with both the individual and the people who mean a lot to him or her.

Communication

For older people to become involved and be able to participate, communication must work between the individual and those working in elderly care. One way to achieve working communication is to adapt it based on the older people's conditions and needs and to converse in a language they understand. As far as possible, the measures should be designed and implemented in collaboration with the resident.

National value base

The national value base for elderly care is based on specific provisions in the Social Services Act, Sol. The provisions mean, among other things, that the social services' care for the elderly should be aimed at older people living a dignified life and feeling well-being. Security is a fundamental part of well-being. Important conditions for feeling safe are having control over your situation and the opportunity to make yourself understood and understand your surroundings. Another aspect of well-being is that the older person feels meaningfulness in existence. It may, for example, be about the care staff supporting the older person in maintaining contacts and fellowship with relatives and friends, taking a walk, or training various abilities. The provisions in the Social Services Act mean that elderly care should cherish and respect each and everyone's right to privacy and physical integrity, self-determination, participation, and individual adaptation.

Support older people's will

Many older people in need of care have impaired decision-making capacity. The National Board of Health and Welfare has developed material that provides advice on how to support older people with impaired decision-making capacity to express their will. The material is aimed at people who work with support and care for older people, both as performers and as administrators.

Implementation plan

How a granted intervention for an older person should be implemented must be documented in an implementation plan. The implementation plan must be designed together with the individual and relatives or relatives. The purpose of the implementation plan is to create a clear structure for the implementation and follow-up of an agreed intervention. The plan clarifies both for the individual and employees what should be done, who should do what, when and how.

Treatment and knowledge

One way for employees to provide good treatment is by being responsive and empathetic in the meeting with the individual and respecting their integrity. It is important that the business is organized so that the employees have enough time to listen to and talk. They should think that the older person is in a dependent position and work for the treatment to be experienced as respectful.

It is important that good conditions are created within the care to meet older homosexual, bisexual, trans, and queer people, often called LGBTQ people. The shortcomings in treatment that occur may be due to inadequate knowledge. Training of employees is a way to increase knowledge about older LGBTQ people, for example, discussions at workplace meetings, and further training.

Discrimination

It is not allowed to discriminate against a person on the basis of gender, ethnic affiliation, religion, or other belief, disability, sexual orientation, or age. The Anti-Discrimination Act contains specific provisions on the prohibition of discrimination in healthcare and activities within social services.

In studies of elderly care, many foreign-born employees testify about everyday racism in care. It is not only exercised by the residents and relatives. Even colleagues can have a racist jargon.

Violence against the elderly

Both older men and women are subjected to violence. It can, for example, be about violence in close relationships, of employees in care and care, by neighbors in special accommodation, and by participants in day-to-day activities. Women are not only subjected to violence because they are older, but also specifically because they are women. It is almost exclusively women who are subjected to sexual violence and the violence against them is to a greater extent repeated.
These subject areas will return in depth later in the book.

Reflection - value base
Care staff:
• Do you have a good dialogue about the value base?
• Do you feel that your colleagues express the common value base in the meeting with your residents and relatives?
• Do you live according to the national value base in your work?

Manager, nurse, occupational therapist, and physiotherapist:
• Do you have a good way to work together with the value base issues?
• Do you start from the common value base in your leadership in the business?
• Do all employees have knowledge about and work based on the value base?

Resident and relative:
• Do you feel that the contact with staff is characterized by respect?
• Do all employees act correctly?
• Do you feel that the employees work from the national value base?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day