Factors that may be causing Discomfort or Distress to Individuals

Being aware of actions that may be causing discomfort or distress to individuals

As part of an individuals support plan you may have to do things that are uncomfortable or even painful for them, for example when moving or assisting them. You will need to carry out these with greatest care and sensitivity.

Before you begin any task or touch the individual in any way, you should ask them and explain what you are about to do. Consent is a vital part of care work and particularly important when you need to do things that are unpleasant. Work with the person to try and find a new way of making them feel more comfortable, for example helping them to change their position (make sure you do this in line with the agreed procedures for moving and handling as recorded in the support plan)

Recognising the signs that an individual is in pain or discomfort

When new agreed ways of working are put into place (which can result from a change in need), they need to be monitored continuously in case they create discomfort or distress which could not have been predicted at the time they were agreed with the person.

People who have additional health needs, in particular those who are immobile or wheelchair dependent, are likely to suffer from long term pain.

Verbal signs of discomfort or distress: Usually if someone feels uncomfortable they will usually say so (if they are able to)

Non-verbal signs of discomfort or distress: A person might move about until they find a more comfortable position. Individuals with limited movement or mobility might not be able to do this. Make sure you recognise if a person needs more help and support to feel at ease. Other non-verbal signs include doubling over, gritted teeth, pale complexion, sweating, tears, altered facial expressions (for example furrowed brows), changes in appetite, confusion, restlessness or changes in sleep patterns.

Changes in behaviour: A person might become quiet or withdrawn or they may show unusual behaviours like laughing or crying. Sometimes when a person is in pain they may display behaviour that challenges – this might include trying to hurt themselves or others.

It is important that you don’t assume changes in behaviour are because a person has a learning disability. A change in behaviour might be linked to the person being in pain.

It is important to think about when people might be in pain, for example:

  • Someone with epilepsy might have a headache after a seizure
  • Women may have pain when they have a period.

Many people with learning disabilities will not ask for medication for their pain. So, it is important that support workers notice if someone is in pain. If you think someone is in pain but the pain medication does not seem to be helping, seek medical advice from a professional.

Remove or minimise any factor that is causing pain or discomfort.

There may be additional environmental factors that could be causing distress, for example:

  • Wet or soiled clothing/bedding/continence products – follow the agreed ways of working for disposing of and changing soiled bed linen/clothing/continence products
  • Poor lighting – consider adding/ removing/ repositioning lighting
  • Noise – try to eliminate the noise or move away from the noise that is causing distress
  • Ill fitting or faulty equipment (including wheelchairs, prosthetics, catheter tubes etc.)– inform supervisor/ line manager who will contact the relevant professional to make them aware
  • Pain related to condition – check if the person needs repositioning or follow agreed procedures for administering prescribed pain relief medication

Talk through any action with the individual you are supporting so that they understand what you are doing and why you are doing it. It is important to reassure the person and keep them involved in every aspect of their care.

What social care staff can do to help minimize pain

  • Use pictures to help the person you support to communicate if they are in pain and to identify where the pain is.
  • If you are not sure if a person in pain, or not, consult with your line manager
  • For clients with a communication plan check their Disability Distress Assessment form (DisDat). The DidDat is based on the idea that each person has their own ‘vocabulary’ of distress signs and behaviours. It helps support workers to identify different signs of distress in individuals.

Use to answer question 5.5b and 5.5c of the Care Certificate

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