Recognising Ill Health – Soft Signs.

For many people who use home care services, the only people they may see in a day are the staff who provide care and support to them. This means as well as providing companionship and personal care, the care staff also need to be attuned to how the person in receipt of care is both emotionally and physically.

In this blog, we will consider the ways in which staff providing home care can recognise ill health in the people they support. We will concentrate on the soft signs, as these often point to ill health in the frail elderly and people living with learning disabilities for example, and can be easily misinterpreted or missed, especially during the winter when viral diseases are prevalent. In a later blog, we will look at specific scenarios such as spotting a stroke or signs of cancer.

Physical deterioration

Deterioration is any negative change in the health or wellbeing of a person, in this case specifically a person in the receipt of care.

Spotting deterioration and knowing what to do about it are important for the wellbeing of people who are in receipt of care. There approaches to recognising and gathering information about deterioration in someone’s condition which are helpful when communicating with other professionals who may be needed to help manage the problem.

Skills for Care, provide access to some excellent training resources which can be used to help understand the use of the RESTORE 2 mini – a tool for helping carers identify when someone they are caring for is declining in health.

Soft Signs

Tools like RESTORE2 mini make it easier to identify deteriorating health because they do not rely on the ability to take measures of health such as a pulse or blood pressure. The term “soft signs” refers to the signs of deterioration which can be spotted by people who know the person well and therefore spot changes in their behaviours which are out of the ordinary for them. There is a brief video about soft signs created by “eLearning for health”.

Soft signs might appear before actual signs of illness, so they can be useful not only in spotting ill health, but in doing so early. It is however important to understand that different people will experience different soft signs even for the same health issue, so there is no one-size fits all approach which can be taken to understanding them.

General soft signs include:

• Becoming more unsteady when mobilising or stop mobilising.
• The person has a change in how they urinate, that is:
• They cannot urinate.
• They are not producing urine.
• The urine has changed in colour.
• Wanting to stay in bed / being tired or dizzy.
• Being withdrawn / being irritable / confused / agitated.
• Not eating as much as usual or changing their eating and drinking habits.
• Becoming breathless / chesty or coughing.
• Being quieter / being noisier than usual.
• They feel hot or cold to touch or may be shivering.

Soft signs for pain might include things like them being:

• Quieter than usual.
• More agitated than usual.
• Irritable or tearful, which is out of character for them.
• Unable to sleep.
• Reluctant to move about.
• More restless than is usual for them.

The simple truth is that family, friends, and carers who know people well are more likely to notice these signs than healthcare professionals.

Maintaining care plans

In care settings where care staff might alternate or inexperienced staff join the team, it is imperative that known soft signs are added to the care plan to help staff spot when something is not right. For example, the care plan, perhaps written using https://nursebuddy.co/, might identify that Dorothy is prone to urinary tract infections and that care staff might consider this possibility if she becomes confused or disorientated to an extent which is not usual for her.

Communicating what you see

Care staff should feel comfortable with reporting any soft signs they see when providing care. Waiting to report soft signs might mean an individual’s condition deteriorates further and healthcare professionals, such as practice nurses and GPs to whom cares might be reporting their concerns are conversant with the implications of soft signs in people who are receiving care such as the frail elderly or people living with a learning disability or autistic people.

It is helpful when communicating the observed soft signs that care staff do so using the SBARD tool to ensure they communication is clear and understood. SBARD stands for:

• Situation – what is happening and how is the person?
• Background – how does how they are now compare to their usual self?
• Assessment – what have you seen / done and what do you make of it?
• Recommendation – what do you need from the healthcare professional?
• Decision – what have you agreed on after the conversation?

SBARD also provides a clear and precise way to write up what has happened and any conversations in the daily care record.

Summary

There are many things for care staff to be alert to as we enter the winter months. People in receipt of care are more prone to illnesses caused by viral diseases especially at this time of year. This blog has identified how carers might identify some of the soft signs of ill health in people who may not always be able to communicate, or may not appreciate, that they are unwell.

We have seen that soft signs of ill health, while common, are not universal and that carers need therefore to be familiar with what is normal for the people they care for and alert therefore to changes in the person’s behaviours.

Bettal has a well tried and tested suite of policies, procedures, risk assessments, and documents which are available to help social care providers in providing care. These include policies covering issues such as person-centred care planning and responding to people’s needs which will help providers in terms of planning and providing care.

If you would like to know more, browse our website or get in touch:

Email: info@bettal.co.uk
Telephone: 01697741411

Peter Ellis MA MSc BSc (Hons) RN
Consultant
Bettal Quality Consultancy