9

TLE
Quarter 1 – Module 1:
CAREGIVING
TLE (Caregiving) – Grade 9
Alternative Delivery Mode
Quarter 1 – Module 1: Title
First Edition, 2020

Republic Act 8293, section 176 states that: No copyright shall subsist in any work of
the Government of the Philippines. However, prior approval of the government agency or office
wherein the work is created shall be necessary for exploitation of such work for profit. Such
agency or office may, among other things, impose as a condition the payment of royalties.

Borrowed materials (i.e., songs, stories, poems, pictures, photos, brand names,
trademarks, etc.) included in this module are owned by their respective copyright holders.
Every effort has been exerted to locate and seek permission to use these materials from their
respective copyright owners. The publisher and authors do not represent nor claim ownership
over them.

Published by the Department of Education

Secretary: Leonor Magtolis Briones
Undersecretary: Diosdado M. San Antonio

Development Team of the Module

Writers: Paul Jay J. Gonzales
Editors: Name
Reviewers: Name
Illustrator: Name
Layout Artist: Name
Management Team: Name of Regional Director
Name of CLMD Chief
Name of Regional EPS In Charge of LRMS
Name of Regional ADM Coordinator
Name of CID Chief
Name of Division EPS In Charge of LRMS
Name of Division ADM Coordinator

Printed in the Philippines by ________________________

Department of Education – Region (Ex. Department of Education-Region III)

Office Address: ____________________________________________

____________________________________________
Telefax: ____________________________________________
E-mail Address: ____________________________________________
 99

Technology and
Livelihood Education
Quarter 1 – Module 1:
Caregiving
Introductory Message
For the facilitator:

Welcome to the Technology and Livelihood Education Grade 9 Alternative Delivery

Mode (ADM) Module on ( Caregiving ) !

This module was collaboratively designed, developed and reviewed by educators,

both from public and private institutions to assist you, the teacher or facilitator in
helping the learners meet the standards set by the K to 12 Curriculum while
overcoming their personal, social, and economic constraints in schooling.

This learning resource hopes to engage the learners into guided and independent
learning activities at their own pace and time. Furthermore, this also aims to help
learners acquire the needed 21st century skills while taking into consideration their
needs and circumstances.

In addition to the material in the main text, you will also see this box in the body of
the module:

Notes to the Teacher

This contains helpful tips or strategies that
will help you in guiding the learners

As a facilitator you are expected to orient the learners on how to use this module.
You also need to keep track of the learners' progress while allowing them to manage
their own learning. Furthermore, you are expected to encourage and assist the
learners as they do the tasks included in the module.

1
For the learner:

Welcome to the Technology and Livelihood Education Grade 9 Alternative Delivery

Mode (ADM) Module on (Caregiving) !

The hand is one of the most symbolized part of the human body. It is often used to
depict skill, action and purpose. Through our hands we may learn, create and
accomplish. Hence, the hand in this learning resource signifies that you as a learner
is capable and empowered to successfully achieve the relevant competencies and
skills at your own pace and time. Your academic success lies in your own hands!

This module was designed to provide you with fun and meaningful opportunities for
guided and independent learning at your own pace and time. You will be enabled to
process the contents of the learning resource while being an active learner.

This module has the following parts and corresponding icons:

What I Need to Know This will give you an idea of the skills or
competencies you are expected to learn in the
module.

What I Know This part includes an activity that aims to

check what you already know about the
lesson to take. If you get all the answers
correct (100%), you may decide to skip this
module.

What’s In This is a brief drill or review to help you link

the current lesson with the previous one.

What’s New In this portion, the new lesson will be

introduced to you in various ways such as a
story, a song, a poem, a problem opener, an
activity or a situation.

What is It This section provides a brief discussion of the

lesson. This aims to help you discover and
understand new concepts and skills.

What’s More This comprises activities for independent

practice to solidify your understanding and
skills of the topic. You may check the
answers to the exercises using the Answer
Key at the end of the module.

What I Have Learned This includes questions or blank

sentence/paragraph to be filled in to process
what you learned from the lesson.

What I Can Do This section provides an activity which will

help you transfer your new knowledge or skill
into real life situations or concerns.
2
 Assessment This is a task which aims to evaluate your
level of mastery in achieving the learning
competency.

Additional Activities In this portion, another activity will be given

to you to enrich your knowledge or skill of the
lesson learned. This also tends retention of
learned concepts.

Answer Key This contains answers to all activities in the

module.

At the end of this module you will also find:

References This is a list of all sources used in developing

this module.

The following are some reminders in using this module:

1. Use the module with care. Do not put unnecessary mark/s on any part of the
module. Use a separate sheet of paper in answering the exercises.
2. Don’t forget to answer What I Know before moving on to the other activities
included in the module.
3. Read the instruction carefully before doing each task.
4. Observe honesty and integrity in doing the tasks and checking your answers.
5. Finish the task at hand before proceeding to the next.
6. Return this module to your teacher/facilitator once you are through with it.
If you encounter any difficulty in answering the tasks in this module, do not
hesitate to consult your teacher or facilitator. Always bear in mind that you are
not alone.

We hope that through this material, you will experience meaningful learning and
gain deep understanding of the relevant competencies. You can do it!

3
 What I Need to Know

This module is specifically crafted to focus on the different activities that will assess
your level in terms of skills and knowledge as to be demonstrated through the
learning materials. The learning procedures are divided into different sections - What
to Know, What to Process, What to Reflect and Understand, and What to Transfer.
Read and understand the suggested tasks. Perform and accomplish them to practice
developing a sustainable program while prioritizing needs and building a vision. So,
explore and experience the K to 12 TLE module and become a successful Caregiver
or Nursing Aide.

The module is divided into four lessons, namely:

• Lesson 1: Implement and monitor infection control policies and procedures

(IC)
• Lesson 2: Respond effectively to difficult/challenging behavior (DB)
• Lesson 3: Apply basic first aid (BA)
• Lesson 4: Maintain high standard of patient services (MS)

After going through this module, you are expected to:

1. Define what is infection control

2. Determine how to avoid infectious diseases
3. Used properly the caregiver PPE
4. To know what are the types human behavior.
5. Identify difficult and challenging situation
6. Strategies in dealing with challenging behaviors
7. Familiarize the step and procedure in getting the vital signs
8. Know the importance of first aid
9. Familiarize the step and procedure of basic first aid techniques
10. Assess environmental risk
11. Application of first aid for casualties
12. Request for medical assistance
13. Establish rapport to the client’s family and love ones.
4
 Implement and Monitor Infection Control
Lesson 1
Policies and Procedure
Infection prevention and control strategies are designed to protect service
users and healthcare staff from the risk of transmissible disease. A systematic
approach to infection prevention and control requires each healthcare provider to
play a vital role in protecting everyone who utilizes the healthcare system. Healthcare
staff must adhere to infection prevention and control guidelines and policies at all
times and use critical thinking, risk assessment, and problem-solving in managing
clinical situations

What is It

LO1. Provide Information to the Work Group About the

Organization’s Infection Control Policies and Procedure

LO1 1.1 Define Infection, Infection Control, Policy, Procedures, Hazard and
Infection Risk Assessment

People once believed that sickness was caused by evil spirits about 500 years
ago, scientists began to suspect that some diseases were caused by small living
things called microorganism. Micro means tin. An organism is a living thing. The
microorganism can be seen only under a microscope. Some microorganism is helpful
to people. Microorganism in the human digestive system break down food not used
by the body and turn them into the waste product (faces)
There is some microorganism, however, that are harmful. They caused disease
and infection. Diseases producing microorganisms are called pathogens. Pathogens
destroy human tissue by using it as food and give off waste products called toxins.
Toxins are poisonous to the human body. Every living microorganism has a natural
environment where it can exist without causing disease. When an organism moves
out of its normal environment and into the foreign one, it can become a pathogen.
For example, the bacterium Escherichia coli belongs to the colon, where it helps to
digest our food. When it enters the bladder or bloodstream, it can cause a urinary
infection or a blood infection.

Condition Necessary for Bacteria Growth

1. Food – Bacteria grow well in the remains of food left in the patient’s room

2. Moisture – Bacteria grow well in moist places

3. Temperature – it depends on the temperature if it will increase its growth or

retard it growth
 1700F – high temperature kills most bacteria
7
500F - 1100F - Most disease-causing bacteria growth rapidly.
98.20F – Normal human body temperature Bacteria thrive easily on and in
the human body
320F – Low temperatures do not kill bacteria but retard their activity and
growth rate
4. Oxygen

• Aerobic bacteria require oxygen to live.

• Anaerobic bacteria can survive without oxygen.
5. Light

• Darkness favors the development of the bacteria. They become very

active and multiply rapidly
• Light is bacteria’s worst enemy. When exposed to direct sunlight, they
become sluggish and die rapidly

6. Dead and living matter.

• Saprophytes – bacteria that live on dead matter tissues

• Parasites – bacteria that live on living matter or tissue

LO1 1.2 Give Examples of Infection Control Policies and Procedures.

Chain of Infection

A series of events have to happen to enable germs (when we speak of germs in

this section, this refers to bacteria, fungi, and viruses) to cause infections in a person.
We call this the ‘Chain of Infection’. We can think of each part of the process as a
separate ‘link’ in the chain. And if we can break a link at any part of the chain, we can
stop the infection from arising.

The reservoir

By ‘reservoir’, we mean a place where germs can live and multiply. The ‘place’
can be a person – a patient/client or a member of staff – but it can also be any part of
the surrounding area of a health care setting, furnishings in the patient’s/client’s
room, and the equipment we use in health care.

The portal of exit from the reservoir

The ‘portal of exit’ is how the germ can escape from the reservoir. For instance,
think about some germs (the infectious agent) sitting on top of a used commode (the
reservoir). A health care worker comes along and touches the commode, and some of
the germs move onto her hands. The health care worker’s hands are now the ‘portal of
exit’ – how the germs can move from the commode to another place. Other ‘portals’
can be people’s normal excretions (stools, vomit), body fluids (blood, saliva) and the air
they breathe from their lungs, especially when they cough. The portal can vary from
one infection to another (for example diarrhoeal infections are usually passed on via
the patient's feces). Germs can even be spread around on the tiny flecks of skin that
peel off our bodies throughout the day and which form part of the dust that settles on
all kinds of surfaces. Non-human portals of exit for germs include items of equipment
 that haven’t been properly cleaned, such as commodes, bed mattresses, pillows,
and reusable equipment.
8

The mode of transmission

This is how the germs move, or spread, from one place to another. This can
happen in several ways, such as health care workers’ hands touching dirty equipment
or contaminated medical instruments, or through the air (coughs, sneezes).

The portal of entry into the ‘host’

This means that the germs that have been moved from the reservoir now invade
the person (the ‘host’). They can do this by entering wounds and cuts, being swallowed,
and being breathed in.
Patients who are having treatments that involve cutting the skin or placing medical
instruments inside the body, such as a catheter being placed into the bladder or a
feeding tube being passed
down the throat, are also at risk of infection. Another example is people who inject
drugs with used needles.

The susceptible host

Healthy people have their defenses which help them fight infection. This means
that even if some harmful germs enter the body, the person can ‘fight them off’ and
stay well. The ability of the body to defend itself against infection is called ‘immunity’.
Some people, however, can’t fight infection effectively.
These include very young children, older people, people who are ill or who are receiving
particular medicines that reduce their immunity, people with long-term health
conditions like diabetes, and those who are physically weak due to, for instance,
malnutrition or dehydration.
People such as these are ‘susceptible hosts’ – meaning they are vulnerable to
developing an infection when their bodies are invaded by germs.

The infectious agent

The infectious agent is simply the germ that causes the infection. Germs are all
around us and within us, and many play very important roles in keeping us healthy.
The problem comes when a germ leaves its normal place to go elsewhere in the body –
the germs that sit on your skin and which usually cause no harm, for instance, getting
into a cut. The germ could then cause infection. Many germs are not helpful to health
and cause disease. The entry of any of these germs into the body is likely to cause
problems.
 9
Seen below and the picture of the chain of infection figure 1.1

Interrupting Bacteria Transmission

One of the most effective ways of decreasing disease is to interrupt the
transmission of bacteria from one of the hosts to another. Transmission occurs in
one of the six ways

Direct Contact Transmission

Close physical contact is required to transmit some diseases, as the germs
can't survive for any time away from a host (the body). 6 They are spread via saliva,
wound secretions, sexual contact, or contact with blood. Sexually-transmitted
diseases are in this category. For other germs, this can be an additional mode of
transmission (e.g., passing a cold via kissing).
However, bloodborne diseases (including hepatitis and HIV) don't always require
close physical contact, as transmission can occur through shared personal objects,
like needles.

Indirect Contact Transmission

Some germs can live a shorter or longer time on a contaminated surface. They
may be spread to surfaces via droplets or transfer of mucus, blood, saliva, feces, or
wound secretions. The objects that harbor these germs are called fomites.
Surfaces that are touched frequently by different people carry the greatest risk, such
as door handles, tables, restroom surfaces, eating and drinking utensils, writing
utensils, shared electronic devices, and so on. Sharing personal items also raises the
risk that they may be contaminated, such as razors, utensils, and needles.
 10

Droplet transmission
Droplet transmission is the usual way that cold and flu viruses and some
bacteria are spread from person to person. You send droplets into the environment
via your saliva and mucus when you cough, sneeze or talk. Droplets might enter the
eyes, nose, or mouth of those who are nearby. Generally, droplets are not in the air
for a long time, but they can be breathed in; germs can also be transmitted when
someone comes in contact with a surface droplet that has landed on.

Airborne transmission
In airborne transmission, a virus or bacteria can remain in the air for a long
period, be distributed by airflow, and be inhaled. For this to occur, the size of the
droplet nuclei that remains and is aerosolized after the droplet is dried out must be
very small, and the germ must be able to survive being dried out. Germs capable of
airborne transmission can reach the lower respiratory tract when inhaled. It may not
take many germs for an infection to occur. Fortunately, only a few germs are
commonly spread by airborne transmission.
These include chickenpox, measles, and tuberculosis. There is scientific debate as to
whether influenza can be airborne, although most agree that droplet transmission is
the usual route.

Nosocomial transmission
Infection is required as a result of being in the health facility.

Implement and Monitor Infection

Lesson 1
Control Policies and Procedures
The policies and procedures set out in this manual are based on national and
international published best practices. As new information becomes available, this
document will be reviewed and updated.

Infection prevention and control strategies are designed to protect service

users and healthcare staff from the risk of transmissible disease.

A systematic approach to infection prevention and control requires each

health care provider to play a vital role in protecting everyone who utilizes the
healthcare system. Healthcare staff must adhere to infection prevention and control
guidelines and policies at all times and use critical thinking, risk assessment, and
problem-solving in managing clinical situations

What’s In

There are many different germs and infections inside and outside of the
healthcare setting. Despite the variety of viruses and bacteria, germs spread from
person to person through a common series of events. Therefore, to prevent germs
from infecting more people, we must break the chain of infection. No matter the
germ, there are six points at which the chain can be broken and a germ can be
stopped from infecting another person.

Several questions have been asking, is it possible to be a germ-free person?

Can we kill all the bacteria what is the best way to do it? The way to stop germs
from spreading is by interrupting this chain at any link.

15

Notes to the Teacher

The answers to the activities in this module will be written on a
separate piece of paper. Hence, a separate copy may be provided
to the learner. The teacher also can make his/her own activities.

LO2 integrate the Organization’s Infection Control Policies and

Procedure into Work Practice

LO2 2.1: Identify Hazards and Outcomes of Infection Risk Assessment

Infection Control is so important because at the end of the day that person’s
health is in your hands. If you are trained in Infection Control you must put your
understanding into action. Carers must wear correct PPE such as aprons and gloves,
wash their hands before and after preparing meals or making a drink, or even when
assisting with dressing a client. Bacteria and germs can spread like wildfire from one
client to another if they have an illness such as a cold. This is why it is important to
know when to wear correct PPE and to wash your hands and follow correct policies
and procedures as Infection Control can be prevented this way.

The purpose of putting polices and procedures in place for Infection Control
is to ensure employees, clients, and families are protected against infectious diseases
and infections by providing guidelines for their investigation, control, and prevention.

Aseptic

To protect patients from harmful bacteria and other pathogens during medical
procedures, healthcare providers use an aseptic technique. Aseptic
technique means using practices and procedures to prevent contamination from
pathogens. It involves applying the strictest rules to minimize the risk of infection.
Guidelines in Aseptic Techniques
• Wash your hands after using the bathroom or blowing your nose, before
handling food, after caring for the clients, before any procedure, and before
meals.
• practice good personal hygiene.
• cover your mouth and nose when you sneeze or cough. Turn your face to the
side when you cough. Wash your hands after you cough into your hands.
• clean wastebasket often.
• wash, dry, and put away all client-related equipment after each use.
• dispose of contaminated articles properly
• if you have an open area on your sink check with the supervisor before
giving client care.
• wash your hand before you put on gloves and after you take them off.
• report to your supervisor condition in the house that contribute to bacteria
growth and transmission
17
 Breaking the chain of infection

LO2 2.2 Apply infection control monitoring policies

and procedures at the workplace

Hand washing
Hand hygiene is one of the most important elements of infection control. Hand
washing aims to remove transient micro-organisms, acquired through everyday
tasks in the clinical setting, from the surface of the hands. Good hand
hygiene protects both patients and staff.
The WHO guidelines on “Hand Hygiene in Healthcare” describe five key
situations where handwashing is required (the 5 moments for hand hygiene):
• Before touching a patient
• Before a clean or aseptic procedure
18
 • After body fluid exposure risk
• After touching a patient
• After touching the patient surroundings

There are two main cleansing agents used in handwashing; alcohol-based

formulations and soap & water*. For both agents, however, the technique used to
clean the hands is the same.
To maintain optimum hand hygiene, it is recommended that nothing is worn below
the elbows (except for a plain band) and that the fingernails are clean and trimmed.

*The use of soap & water is specifically indicated when the hands are visibly soiled or
when they have come into contact with spore-forming pathogens, such as clostridium
difficile

Hands are responsible for the spread of 80% of common infectious diseases
and handwashing remains one of the easiest and cheapest ways to prevent the
spread of bacteria. However, 1 in 5 people don't wash their hands and of those that
do only 30% use soap.

So if keeping our hands clean is key in preventing illness, why don't more
people do it, and do it right?

The answer may be as simple as that most people don't know-how.

A. Hand Washing Technique

Happy Birthday, Twinkle Twinkle little star, 20 seconds, 15 seconds...with the
many different recommended hand washing techniques and guidelines that are out
there, it's difficult to know exactly which hand washing method is the most effective.

A recent study by the Society for Healthcare Epidemiology of America found

that the World Health Organization’s (WHO) 6-step handwashing technique was
more effective at removing bacteria than the simple CDC wash your hands for 20
seconds method.

The World Health Organization (WHO) recommends 15-20 seconds of hand washing,
using the following steps:

1. Wet hands with water

2. Apply a single shot of soap
3. Rub hands palm to palm
4. Rub the back of each hand with the palm of the other the hand with fingers
interlaced
5. Rub palm to palm with fingers interlaced
6. Rub with backs of fingers to opposing palms with fingers interlocked
7. Rub each thumb clasped in opposite hand using rotational movement
8. Rub tips of fingers in the opposite palm in a circular motion
9. Rub each wrist with the opposite hand
10. Rinse hands with water
11. Dry thoroughly

19
 The skin should always be properly dried to avoid the risk of chapping particularly
during cold weather. Clean towels should be available at all times – dirty towels mean
exposing the skin to more dirt and the risk of infection. Ideally, disposable paper
towels should be used, as the use of ‘communal’ towels can lead to contamination.
Proper handwashing may look intimidating, but once you learn it hand
washing is simple and essential.

When to Hand Wash

Knowing how to wash your hands properly is an important step in
preventing the spread of infections in the workplace, home, or schools. Also
important is knowing when to wash your hands. Here are the key times when
hand washing should be conducted:
• At the end of each work/school period
• Before each break
• Before eating or preparing food
• After going to the restroom
• Whenever hands are dirty or contaminated

Healthcare workers must follow a stricter hand washing process, using

the "The 5 Moments of Hand Hygiene" as recommended by WHO:
• Before touching a patient,
• Before clean/aseptic procedures,

20
 • After body fluid exposure/risk,
• After touching a patient, and
• After touching the patient surroundings

Educating staff and using posters or other visuals are a useful reminder for
employees, students, or healthcare workers when trying to implement an effective
hand hygiene program.

Remember, hand washing is vital to our health and those around us, if we can all
make proper handwashing a habit, we will all be better off.

B. Disinfection and sterilization

The purpose of sterilization and disinfection procedures is to prevent
transmission of microbes to patients. In addition to sterilization and disinfection,
other important measures to prevent transmission are included in the protocol of
“standard precautions” (previously known as Universal Precautions). These
standard precautions should be used in interaction with all patients because it is
unknown whether any particular patient may be the reservoir of transmissible
bacteria, viruses, or other microbes.

PRINCIPLES OF STERILIZATION & DISINFECTION

Sterilization is the killing or removal of all microorganisms, including highly
resistant bacterial spores. Sterilization is usually carried out by autoclaving,
which consists of exposure to steam at 121°C under a pressure of 15 lb/in 2 for
15 minutes. Surgical instruments that can be damaged by moist heat are
usually sterilized by exposure to ethylene oxide gas, and most intravenous
solutions are sterilized by filtration.

Disinfection is the killing of many, but not all, microorganisms. For adequate
disinfection, pathogens must be killed, but some organisms and bacterial
spores may survive.

Spores A spore is a cell that certain fungi, plants (moss, ferns), and bacteria
produce. Spores are involved in reproduction. Certain bacteria make spores
as a way to defend themselves. Spores have thick walls. They can resist high
temperatures, humidity, and other environmental conditions.

TYPES OF STERILIZATION

a. Moist Heat Sterilization

Water at a high-pressure level is used in moist heat sterilization. The
autoclave is the instrument in which this process is carried out. The temperature of
the steam in this method is lower when compared with dry heat sterilization, but the
high pressure helps with effective sterilization to take place.
The structural proteins and the organism’s enzymes are destroyed through moist
heat. This results in the death of the organisms. The moist heat method is used for
heat-sensitive materials and materials through which steam is permeable. Culture
media is also sterilized through moist heat sterilization.
Through moist heat sterilization, the most resistant of the spores require a
temperature of 121°C for around half an hour. It is a more effective method when

21
compared with dry heat sterilization. This can be supported by the fact that through
moist heat, sterilization can be achieved at lower temperatures in a shorter duration.
These were the main difference between the dry and moist heat sterilization
methods. If you want to sterilize materials that are more heat-sensitive when
compared with both these methods, you should go for filter sterilization or chemical
decontamination methods.
b. Dry Heat Sterilization
In dry heat sterilization, dry heat is used for sterilizing different materials.
Heated air or fire is used in this process. As compared to the moist heat sterilization,
the temperature in this method is higher. The temperature is usually higher than
356° F or 180 °C.
Dry heat helps kill the organisms using the destructive oxidation method. This
helps destroy large contaminating bio-molecules such as proteins. The essential cell
constituents are destroyed and the organism dies. The temperature is maintained for
almost an hour to kill the most difficult of the resistant spores.
Things such as glassware, metal instruments, paper-wrapped things, and syringes
are effectively sterilized through dry heat. The materials used in these things are heat
resistant or it can be said that they are heat stable. Powders impermeable to moisture
and anhydrous oils and fats can also be sterilized using dry heat sterilization.

C. PPE
Personal protective equipment, also known as PPE, is an item worn by you to
protect you from exposure to hazards during work. A work area assessment will help
you determine the potential hazards and select the appropriate PPE for adequate
protection. Common PPE used at home for health care includes glove, apron, and
mask.

a. Use of Gloves as Personal Protective Equipment

Medical gloves are examples of personal protective equipment that are used to
protect the wearer and/or the patient from the spread of infection or illness during
medical procedures and examinations. Medical gloves are one part of an infection-
control strategy.
Use medical gloves when your hands may touch someone else’s body fluids (such as
blood, respiratory secretions, vomit, urine, or feces), certain hazardous drugs, or
some potentially contaminated items.

Guidelines for using medical gloves.

• Wash your hands before putting on sterile gloves.
• Make sure your gloves fit properly for you to wear them comfortably during all
patient care activities.
• Some people are allergic to natural rubber latex used in some medical gloves.
FDA requires manufacturers to identify on the package labeling the materials
used to make the gloves. If you or your patient is allergic to natural rubber
latex, you should choose gloves made from other synthetic materials (such as
polyvinyl chloride (PVC), nitrile, or polyurethane).
• Be aware that sharp objects can puncture medical gloves.
• Always change your gloves if they rip or tear.
• After removing gloves, wash your hands thoroughly with soap and water or
alcohol-based hand rub.
• Never reuse medical gloves.
• Never wash or disinfect medical gloves.
• Never share medical gloves with other users.
22
 Procedure for Putting on Gloves

1. Perform hand hygiene.

2. Select the appropriately sized gloves.
3. Open the sterile package of sterile gloves with caution by using the flaps
surrounding the package. Remember you have 2 inches to grab around the
sterile field without contaminating it.
4. First, glove your dominant hand. Pick up the glove for the dominant hand
with your non-dominate hand by grasping the inside of the cuff of the glove.
Then slide it onto your dominant hand. Be careful not to touch anything
with this gloved hand other than the sterile packaging.
5. Take your sterile gloved hand and slip it under the cuff of the other glove to
glove your non-dominate hand. Gently push the glove (while the hand is still
under the cuff) onto your non-dominate hand.
6. Adjust the gloves carefully…making sure you don’t touch your skin or other
objects.

Tips on Putting Sterile Gloves

• Nurses should never touch anything other than what is required for the
procedure with sterile gloves.
• If the sterile gloving process is broken at any point, use new gloves from a new
package.
• Wear sterile gloves only when necessary.
• Never wash gloves and reuse them.
• Never use gels and alcohol to clean gloves, use a new pair each time.
• Use a new set of gloves on each patient and each procedure.
23
 Procedure in removing gloves
1. Pinch and hold the outside of the glove near the wrist area.
2. Peel downwards, away from the wrist, turning the glove inside out.
3. Pull the glove away until it is removed from the hand and hold the inside-out
glove with the gloved hand.
4. With your un-gloved hand, slide your finger/s under the wrist of the
remaining glove, taking care not to touch the outside of the glove.
5. Again, peel downwards, away from the wrist, turning the glove inside out.
6. Continue to pull the glove down and over the inside-out glove being held in
your gloved hand.
7. This will ensure that both gloves are inside out, one glove enveloped inside the
other, with no contaminant on the bare hands.
Gown
Gowns are examples of personal protective equipment used in health care
settings. They are used to protect the wearer from the spread of infection or illness
if the wearer comes in contact with potentially infectious liquid and solid material.
They may also be used to help prevent the gown wearer from transferring
microorganisms that could harm vulnerable patients, such as those with weakened
immune systems. Gowns are one part of an overall infection-control strategy.

A few of the many terms that have been used to refer to gowns intended for
use in health care settings include surgical gowns, isolation gowns, surgical isolation
gowns, non-surgical gowns, procedural gowns, and operating room gowns.

24
Mask

A surgical mask, also known as a face mask, is intended to be worn by health

professionals during healthcare procedures. It is designed to prevent infections in
patients and treating personnel by catching bacteria shed in liquid
droplets and aerosols from the wearer's mouth and nose. They are not designed to
protect the wearer from breathing in airborne bacteria or viruses whose particles are
smaller. Concerning some infections like influenza, they appear as effective
as respirators, such as N95 or FFP masks; though the latter provides better
protection in laboratory experiments due to their material, shape, and tight seal.
Surgical masks vary by quality and levels of protection. Despite their name, not all
surgical masks are appropriate to be used during surgery. Surgical masks may be
labeled as surgical, isolation, dental, or medical procedure masks. Chinese health
officials distinguish between medical (non-surgical) and surgical masks.

2
 LESSON Respond effectively to difficult and
2 challenging behavior

In this lesson, we are going to tackle the behavior of a certain person, how to
deal with it, and what causes them to have that certain kind of behavior. But first,
we must define what is a behavior. How one acts or behaves. a. The actions or
reactions of a person or animal in response to external or internal stimuli.

LO1. Plan Responses

LO1 1.1 Define difficult and Challenging Behavior
Some children and adults with severe learning disabilities typically display
behavior that may put themselves or others at risk, or which may prevent the use of
ordinary community facilities or normal home life. This behavior may include
aggression, self-injury, stereotyped behavior, or disruptive and destructive
behaviors. These behaviors are not under the control of the individual concerned and
are largely due to their lack of ability to communicate.
In most schools and for most teachers, challenging behavior can generally be
understood as something that either interferes with the safety or learning of the
student or other students or interferes with the safety of school staff.

Examples of challenging behavior include:

• Withdrawn behaviors such as shyness, rocking, staring, anxiety, school phobia,

truancy, social isolation, or hand flapping
• Disruptive behaviors such as being out-of-seat, calling out in class, tantrums,
swearing, screaming, or refusing to follow instructions
• Violent and/or unsafe behaviors such as head banging, kicking, biting, punching,
fighting, running away, smashing equipment or furniture/fixtures
• Inappropriate social behaviors such as inappropriate conversations, stealing,
being over-affectionate, inappropriate touching, or masturbation.

Influences on student behavior

There are many potential influences on student behavior, and many factors that can
lead to behavior that is challenging for schools to deal with. These include:

• biophysical factors, such as medical conditions or disabilities

• psychological factors, including emotional trauma or lack of social skills
• behavioral/social factors, including where a student’s problem behavior has been
learned through reinforcement, consequences, or adaptation to social practices (a
student with a learning difficulty repeatedly misbehaves knowing that he/she will be
removed from the class and this will avoid his/her learning difficulty being exposed)
• historical community factors, including for Koorie students whose family
member/s had difficult, sometimes traumatic, experiences of school and government
agencies
• cultural factors, (Koorie community ‘Sorry Business’)
• student group dynamics such as bullying and teasing, cliques or student apathy or
hostility
• environmental factors, (the level of classroom noise or classroom seating
arrangements)
• classroom organization issues, such as inconsistent routines, inadequate
materials, or obliviousness to cultural differences
• teacher behavior, for example, boring or disorganized lessons, over-reaction to
misbehavior, or over-reliance on punishment.
In many cases, there is no single “cause” of challenging behavior, but it is the result
of several factors operating in combination.

LO2 Apply Responses

LO2 2.1 List Strategies in Dealing with Difficult/Challenging behavior

What causes it, and how to manage it

Managing challenging behavior can be incredibly stressful for parents. An outburst
may be a known reaction to a daily activity, or sometimes it may be so out of the blue
you are struggling to work out what has caused it.
But it always happens for a reason; it’s a way of communicating.
However, once children learn that shouting and banging their head, for example, gets
the attention or gets them out of a situation, they do begin to see it as a way of getting
what they want. This is called learned behavior, according to the National Autistic
Society (NAS), but should not be confused with manipulating behavior; children with
special needs do not do this on purpose.
‘Challenging behavior indicates there is a problem in learning and not in the person,’
explains disability charity Scope.

Types of challenging behavior:

• Self-injury or self-harm: This can present as head banging, hand or arm

biting, hair pulling, eye-gouging, face or head-slapping, skin picking,
scratching, or pinching, and forceful head shaking.
• ‘About half of all people with autism engage in self-injurious behavior at some
point in their life. People who used these behaviors as children may return to
them as adults during times of stress, illness, or change,’ says NAS.
• Being aggressive: Hurting others; biting, pinching, slapping, spitting, hair
pulling, and screaming or shouting.
• Being destructive: Throwing things, breaking furniture, ripping things up.
• Pica: Eating or mouthing non-edible items, such as stones, dirt, pen lids,
bedding, metal, feces.
• Smearing: Of feces.
• Repetition: Rocking, repetitive speech, and repetitive actions or manipulation
of objects.
• Running away or stripping off
‘Most children without learning disabilities display lots of challenging behavior
during the terrible twos, but usually, this doesn’t last because most two-year-olds
develop a range of communication and social skills which enable them to get what
they want and need more easily. Many children with learning disabilities do not
develop these skills, and are left with the same needs as other children of their age,
but are much less able to get them met,’ says Peter McGill, professor of clinical
psychology of learning disability at the University of Kent.

Causes of challenging behavior:

• Feeling unwell or in pain. It may be difficult to communicate this to others.

Headbanging is a way of coping with pain or discomfort.
• Hormonal changes may cause aggression during puberty.
• Frustration at being told off, not being listened to, or not being understood.
Self-harm can be a way of communicating this frustration.
• Feeling upset or distressed about something, perhaps a change in routine. Or
even loneliness.
• Depression, anxiety, or even excitement. Hand biting may help them to cope
with these feelings.
• Boredom or lack of stimulation may lead to skin picking.
• Lack of understanding. For example, what’s edible or inedible, or what’s the
correct way to wipe themselves on the toilet.
• Sensory needs. Exploring how things feel or smell, like feces.
• Seeking attention. Wanting a reaction or avoiding a demand.
• Fear of where they are or what they’re doing.

Monitoring challenging behavior

Keep a diary. Look for patterns or contributing factors – what was going on at the
time, or directly leading up to the incident? What had happened earlier in the day –
was this just the tipping point after frustrations had built up? Look for the positives
as well as the negatives – what were the circumstances of a good day, what worked
to quickly calm your child?
Monitor medications as well, something could be making them feel groggy or hungry,
and some medications can affect continence.

Managing challenging behavior: At the moment

1. Learn to recognize the warning signs and intervene early with a distraction. If
that doesn’t work, take them somewhere that is calm and away from
distractions.
2. Use simple language and acknowledge their frustration, show them you
understand. Be calm but assertive. Keep your face neutral and lower the
volume and pitch of your voice
3. Minimize the risk. Keep them safe. If they throw themselves to the ground,
allow them to do this, but guide them so that they do not hurt themselves. If
there is headbanging, use a pillow or your hand to keep their head from hitting
a hard surface.
4. Be consistent. Avoid confrontation. Avoid physically restraining if possible,
stopping the movements may cause the behavior to continue or get worse.
Avoid paying too much attention or showing too much reaction.
5. Exercise can help release anger and stress. Parents recommend punch bags,
trampolines, running around the garden, or going for a long walk. ‘When we
can see Matthew is getting heightened, we get him out of the house for a walk,
 and that invariably calms him down,’ says Louisa Caines, whose 13-year-old
son is autistic.
6. Rewards and praise. Use descriptive praise when they get things right or
begin to calm down: ‘You did what I told you to do as soon as I asked’. ‘You’re
swallowing your medicine, even though you’re angry’. ‘You’re not grabbing
now’. ‘You’ve stopped shouting’.

LO2 2.2 Select Strategies in Dealing with Challenging Behavior

Strategies for managing challenging behavior in the longer term

1. Recognize that the behavior may often be a result of fear about the unknown.
Use social stories to prepare your child for any new experiences or activities
they are worried about.
2. If your child has disturbed nights, look into strategies to improve their sleep,
which can have significant effects on behavior.
3. Make sure they eat regularly. Low blood sugar can cause mood swings and
tantrums. Prepare a meal or a healthy snack every three hours. Include some
protein, some fiber, and some complex carbohydrates for energy, but no
refined carbohydrates. If your child is a fussy eater they should eat
something, even if it is not a healthy choice.
4. Reduce sugar intake. ‘Sugar and refined carbohydrates (especially any
products with white flour) often make children more moody, angry and
oppositional, especially children who are starting with a more extreme
temperament,’ says Scope, which recommends ‘removing all sweet foods and
refined carbohydrates for a month to see what results you get’.
5. Cut down on screen time. Noel Janis-Norton, learning, and behavior specialist
and author say, ‘Too much time in front of a screen often makes children
angry, reactive and uncooperative. You may find that in the first week or two
of this new limit on electronics they maybe even angrier but stay strong
because your children will get used to the new rules, and soon you’ll see the
benefits.’
6. Try relaxation techniques. Bubble lamps, smelling essential oils, listening to
music, massages, or swinging on a swing are all worth trying.
7. Try also some sensory toys and devices. Rompa has a range of products to
help with sensory integration such as fidget toys, weighted blankets, and
compression tubes.
8. Encourage independence. Allow your child to make their own decisions or try
doing things for themselves. Reduce the number of demands placed on them.
Encourage them to make friends, join a club or group.
9. Rule out any medical problems, oral pain, or nutritional deficiencies. See a
GP, dentist, nutritionist, or occupational therapist if you think this may be
the cause.
10. Help them to understand. If smearing is the problem, focus on toilet training.
If pica is the issue, use visuals (PECS) to learn what’s edible and what’s not.
If it is a sensory-based issue, try replacing inappropriate items with an
appropriate alternative of a similar texture, eg a crunchy carrot stick, popcorn,
chewing gum.
11. Get support. Contact your local community support networks. Discuss your
child’s behavior with professionals and therapists. Speak to other parents. Get
your family involved.
LO2 2.3 Select appropriate strategies/strategies in dealing with challenging
behavior

10 Strategies for Dealing with Challenging Behavior in Your Classroom

Whilst you may not necessarily be able to control its causes, you should be aware
of some strategies you can use for managing challenging behavior in the classroom.
Here, we offer ten to help you do so.

1. Turn Negatives into Positives

Information and commands sink in better when we’re told what we should do, rather
than what we shouldn’t. For example, we react much better to statements like
“Thomas, please talk quietly” than “Stop shouting Thomas.” Framing your
instruction positively, as opposed to negatively, will have much better results.

Furthermore, when a child behaves in a typically ‘negative’ way, identify their reasons
for acting that way instead of just punishing them. Then, discuss alternative ways
that they can achieve their desired outcome. For example, if they misbehaved
because they wanted attention, establish a turn-taking system where they get plenty
of opportunities to speak. Children will soon learn new behaviors when it helps them
get what they want without punishment.

2. Teach Positive Behavior

Rather than trying to completely remove unwanted behavior, you should focus
instead on facilitating the behavior you want. Identify what counts as good behavior
and how you want your class to behave. Then, work on ways to communicate it.

Have a class discussion about positive behavior and base activity on it, such as
creating reminder posters for the classroom. In doing this, you’re getting students
involved in a stimulating activity rather than directly telling them what to do, which
will have better results.

3. Model the Behavior You Expect

Be a positive role model and behave in the same way you expect your students to.
For example, if you ask your students to always be on time, make sure you
demonstrate good time management. Similarly, if you ask students to be organized,
ensure your organization matches it.

You should also try to be considerate of your students’ feelings, just as you want
them to be considerate of others’. If you feel an emotion that they feel, such as
frustration, act out how you’d want them to respond: count to ten and then carry on.

4. Establish a Class Code of Conduct

At the start of a new school year, both you and your students should work together
to establish a class code of conduct. Discuss the different types of behavior that you
think is acceptable and unacceptable and how you want students to act towards
each other, such as ‘treat each other with respect’. Type this up and display it in the
classroom so students can always see it.

Involving students in this is important, as it gives them a sense of ownership and in

turn a greater commitment to following the code of conduct themselves.
5. Communicate Well
Always ensure that you communicate clearly and consistently. The way you phrase
your comments can have a big impact on the way children perceive them. For
example, you can try to:

Preface your requests with ‘thank you’. For example, “Thank you for
putting your crisps packet in the bin.” This is a closed request and doesn’t
give the student any element of doubt to hold onto or argue with.

Be specific. For example, “Hand your homework to me at the start of the

lesson on Monday” is much more specific than “Hand your homework in on
Monday”. In doing this, you have communicated to the student exactly what
they should do.

6. Recognize Good Behavior and Achievements

Most children misbehave from time to time – that’s just a fact of childhood. However,
they also learn new things and make magnificent progress every day, and that’s an
achievement in itself. When a child behaves well or completes a good piece of work,
make it known. Tell them well done and show the rest of the class how proud you
are. In doing so, other children are more likely to behave positively to get a similar
reaction.

7. Proactively Develop Relationships

Take the time to get to know each of your students and build relationships with them.
Talk about common interests, open a casual conversation, and always ask them how
they are. You could even ask them for advice and recommendations on something,
such as “I want to read a new book. Has anyone read any good ones recently?”

8. Have a Quiet Area

Establish a time out/quiet area in the classroom that students can go to when they’re
displaying challenging behavior. However, rather than making this an area for
punishment, make it an area for reflection and calming down. Ask students to bring
an item for the area, like a teddy or a picture of their pet, that they can use to bring
enjoyment when they’re struggling to manage their behavior.

9. Keep Class Disruptions Minimal

When you do have to call a student out on their behavior, ensure you do it in a way
that minimizes class disruption. Shouting at a student in front of them will likely
make them feel embarrassed about their behavior. As a result, they’ll likely feel
annoyed at you and won’t want to listen to what you say next. Instead, use a simple
glance or a directed question to let them know that you’ve recognized their behavior
and there’ll be further consequences if they continue.

10. Communicate with Parents

Maintaining frequent communication with parents is essential for managing
challenging behavior. Keep them in the loop when their child has misbehaved, and
ensure that they establish similar rules at home to the ones you have in school.
 Lesson
3 Apply Basic First Aid
The lesson will tackle the basic first aid of its importance and developing the
skills of the learner about the first aid. Knowing about first is important and can be
used when it is needed. First aid is the first and immediate assistance given to any
person suffering from either minor or serious illness or injury, with care provided to
preserve life, prevent the condition from worsening, or to promote recovery.

LO1 Assess the Situation

LO1. 1.1 Define first aid and its principle

First Aid

The immediate care is given to a person/victim who has suddenly become ill or has
been injured.

Role of First Aider

• Bridge the gap between the time of the accident and the arrival of the
physician.
• Ends when medical assistance begins.
• Doesn’t intend to compete with or take place of the physician.
Objectives of First Aid
• To prolong the life
• To alleviate suffering
• To prevent further or added injury
Characteristic of a Good First Aider
• Observant- notice all signs
• Resourceful- make the best use of all things
• Gentle- shouldn’t cause pain
• Tactful- shouldn’t be alarming
• Sympathetic- should be comforting
First Aid kit
• Rubbing Alcohol • Band-aid
• Povidone Iodine • Gauge pads
• Hydrogen Peroxide • Gloves
• Cotton • Bandage (triangular)
Elastic Roller bandage
• Cotton swab
• Penlight
• Safety pins
• Forceps
• Scissors
• Tweezers
• Medical tape
• Splints
• Tongue depressor

LO1 1.2 Identify Physical Hazard to Self and Casualty’s Health and
Safety

Conditions Requiring First Aid

A. FAINTING
Caused by a sudden fall in the supply of blood to their brain that results in the
temporary loss of consciousness.
Signs & Symptoms
• Sweating • Paleness
• Dizziness • Ringing in the ears
• Nausea • Blurred vision
• Weakness
Procedure
• Lay the person flat on the ground. Elevate
the legs to coax more blood into your brain.
• If a person is on a chair, push his head down
between his knees.
• Loosen tight clothing.
• Avoid crowding the patient.
• Call a doctor if necessary.

B. NOSE BLEED
occurs when a small blood vessel in the lining of the nose bursts. It very common in
children and often result from harmless activities such as your child picking their
nose, blowing it too hard or too often, or from getting knocked on the nose during
play.
Procedure
• Sit down and lean forward slightly.
• Pinch the lower part of the nostrils just
below the bony part of the nose for 10minutes
while breathing through the mouth.
• Release nostrils slowly, repeat the
procedure if bleeding continues.
• Do not touch or blow the nose for about
24hrs. Do not pact the affected nostrils with
cotton.
• Bring the patient to the hospital if
necessary.

C. Wounds
Break in the continuity of tissue either external or external.
CLASSIFICATION
• Closed (internal)
• Open (external)
• Explosion
Signs & Symptoms
• Pain
• Swelling
• Discoloration
• Hematoma
•Uncontrolled
restlessness
• Thirst
• Shock
• Vomiting
The types of closed wounds are:
• Contusions, more commonly known as bruises, caused by a blunt force
trauma that damages tissue under the skin.
• Strained Muscles- Over-stretching of muscles that have not been
sufficiently warmed-up (could be called "cold" muscles).
• Sprained Ligament- Sudden force causing joint to move beyond its natural
range of movement e.g. to break one's fall at speed during an activity such as
ice-skating.

First Aid
• Rest the affected area
• Ice application or cold compress
• Compression o the affected area
• Elevate the affected area above the heart

Open Wound
• Abrasions (grazes), superficial wounds in which the topmost layer of the
skin (the epidermis) is scraped off.
• Lacerations are jagged, irregular, or blunt breaks or tears in the soft tissues.
• Avulsion is the forcible separation or tearing of tissue from the victim’s body.
• Incised wounds, or cuts in-body tissues are commonly caused by knives,
metal edges, broken glass, or other sharp objects commonly cause incised
wounds, or cuts, in-body tissues.
• Puncture wounds are caused by a sharp object that penetrates the skin.
First Aid
The major principles of open-wound treatment are to:
• Control bleeding.

– Direct pressure
– Elevation
• Prevent further contamination of the wound
(wound dressing & bandaging)
• Immobilize the injured part.
• Stabilize any impaled object.
D. Fracture
a medical condition in which there is a break in the continuity of the bone. A bone
fracture can be the result of high force impact or stress or trivial injury as a result of
certain medical conditions that weaken the bones
Types of Fracture
• Greenstick fracture: an incomplete fracture in
which the bone is bent.
• Transverse fracture: a fracture at a right angle
to the bone's axis.
• Spiral fracture: a fracture in which the break
has a curved or sloped pattern.
• Comminuted fracture: a fracture in which the
bone fragments into several pieces. • Compound
fracture - meaning the bone ends are no longer
touching.
Signs and Symptoms
• Pain and swelling at the fracture site.
• Tenderness close to the fracture.
• Paleness and deformity (sometimes).
• Loss of pulse below the fracture, usually in an extremity (this is an emergency).
• Numbness, tingling, or paralysis below the fracture (rare; this is an emergency).
• Bleeding or bruising at the site.
• Weakness and inability to bear weight.

First Aid
• Initial treatment for fractures of the arms, legs, hands, and feet in the field includes
splinting the extremity in the position it is found, elevation and ice. Immobilization
will be very helpful with initial pain control.

Bandaging
Bandages have three key uses: applying pressure to bleeding wounds; covering
wounds and burns; and providing support and immobilization for broken bones,
sprains, and strains. These include gauze, triangular, Elastic, and tubular bandage.
The ideal size of the Triangular Bandage is 36 inches on the sides and 52 inches on
the base.
1. Head Top (for head injuries)
• Fold the base at least 2-3”
• Place folded base aligned with eyebrows
• Pull back and cross-over at the back,
tucking apex beneath
• Pull both ends in front/secure with a
square knot at the center of the folded
base/tuck ends • Pull down apex (tuck sides
neatly)
• Tuck apex neatly at cross-over area

2. Chest Bandage
• Apex at the shoulder of the injured part
• Pull back folded base and secure with a square
knot at the center indention of the back.
• Knot/tie the longer end with the apex

3. Hand Bandage
• Place the hand in the middle of the triangular
bandage with the wrist at the base of the
• Place the apex over the fingers and tuck any excess
material into the pleats on each side of the hand
• Cross the ends on top of the hand, take them around the wrist,
and tie them with a square knot.

4. Arm Sling
• Place folded base vertically over
• One arm, with pointed directly under the elbow of the
injured arm
• Lower ends of the base at the side of the neck using a square
knot
• Make several twists with apex and tie a knot
• Hide the knot
5. Underarm Sling
• Same procedure as arm sling except that the
lower end of the base is tucked under the injured
arm.
• Secure end of base and apex with a square knot
the center indention at the back.

6. Cravat Bandage for Forehead

• Place the center of the cravat over the
compress covering the wound.
• Carry the ends around to the opposite side of
the head, cross them. Bring them back to the
starting point and tie them.

7. Cravat Bandage for the Cheek or Ears

• Use the wide cravat. Start with the middle of the cravat
over the compress covering the cheek or the ear.
• Carry one end over the top of the head and the other under
the chin.
• Cross ends at the opposite side.
• Bring the short end back around the forehead and the long
end around the back of the head.
• Tie them down over the compress

8. Cravat Bandage for the Eye

• Lay center of the first cravat over top of he with the front
end falling over the uninjured eye.
• Bring the second cravat around the head, over eyes, and
loose ends of the first cravat. Tie in front
• Bring ends of the first cravat back over the top of the head,
tying there and pulling the second cravat up and away from
an uninjured eye.
9. Cravat for Elbow
• Bend arm at elbow and place center of cravat at point of the
elbow
• Bring ends up and across each other in overlapping spiral
turns. Continue one end up the arm and the other end down
the forearm.
• Bring ends to the front of the elbow and tie.
10. Cravat for the Knee
• Start on top of the knees.
• Cross over and twist 2-3 times under the knee.
• Cross over on top/pull ends to opposite sides.
• Secure with a square knot under the knee

11. Cravat for the Forearm, Arm, Leg and Thigh

• Place center of cravat over the dressing
• Begin ascending turns wit upper end and
descending turns with the lower end, with each
turn covering two-third of the preceding turn until
dressing is covered.
• Terminate by tying both ends in a square knot.

12. Shoulder Armpit Cravat

• Start at the armpit.
• Cross-over at injured shoulder
• Tie at the opposite armpit (side of front)

CPR
Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed
when the heart stops beating. Immediate CPR can double or triple the chances of
survival after cardiac arrest.

Before Giving CPR

1. Check the scene and the person. Make sure the scene is safe, then tap the
person on the shoulder and shout "Are you OK?" to ensure that the person
needs help.
2. Call 911 for assistance. If it's evident that the person needs help, call (or ask a
bystander to call) 911, then send someone to get an AED. (If an AED is
unavailable, or a there is no bystander to access it, stay with the victim, call 911
and begin administering assistance.)
3. Open the airway. With the person lying on his or her back, tilt the head back
slightly to lift the chin.
4. Check for breathing. Listen carefully, for no more than 10 seconds, for sounds of
breathing. (Occasional gasping sounds do not equate to breathing.) If there is no
breathing begin CPR.

Red Cross CPR Steps

1. Push hard, push fast. Place your hands, one on top of the other, in the middle of
 the chest. Use your body weight to help you administer compressions that are at
least 2 inches deep and delivered at a rate of at least 100 compressions per
minute.
2. Deliver 2 rescue breaths. With the person's head tilted back slightly and the chin
lifted, pinch the nose shut and place your mouth over the person's mouth to
make a complete seal. Blow into the person's mouth to make the chest rise.
Deliver two rescue breaths, then continue compressions.

Note: If the chest does not rise with the initial rescue breath, re-tilt the head before
delivering the second breath. If the chest doesn't rise with the second breath, the
person may be choking. After each subsequent set of 30 chest compressions, and
before attempting breaths, look for an object and, if seen, remove it.

3. Continue CPR steps. Keep performing cycles of 30 chest compressions and 2

rescue breath until the person exhibits signs of life, such as breathing, an AED
becomes available, or EMS or a trained medical responder arrives on the scene.

Note: End the cycles if the scene becomes unsafe or you cannot continue performing
CPR due to exhaustion.

LO1 1.3 Demonstrate Vital Sign taking

and taking casualty’s vital
signs

Vital Signs
Vital signs are measurements of the body's most basic functions. The four main vital
signs routinely monitored by medical professionals and health care providers include
the following:
• Body temperature
• Pulse rate
• Respiration rate (rate of breathing)
Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the
vital signs.)

A. Temperature
The normal body temperature of a person varies depending on gender, recent activity,
food and fluid consumption, time of day, and, in women, the stage of the menstrual
cycle. Normal body temperature can range from 97.8 degrees F (or Fahrenheit,
equivalent to 36.5 degrees C, or Celsius) to 99 degrees F (37.2 degrees C) for a
healthy adult. A person's body temperature can be taken in any of the following ways:
• Oral: 97.6 to 990F (36.4 to 37.20C)
• Rectal: 98.6 to 1000F (37.0 to 37.8 0C)
• Axillary: 96.6 to 98 0F (35.9 to 36.7 0C)

Procedure in using a digital thermometer

Wait at least 15 minutes after bathing or exercising before taking your axillary
temperature.
1. Take the thermometer out of its holder.
 2. Put the tip into a new throw-away plastic cover. If you do not have a cover,
clean the pointed end (probe) with soap and warm water or rubbing alcohol.
Rinse it with cool water.
3. Put the end with the covered tip securely in your armpit. Hold your arm down
tightly at your side.
4. Keep the thermometer in your armpit until the digital thermometer beeps.
5. Remove the thermometer when numbers show up in the "window".
6. Read the numbers in the window. These numbers are your temperature. Add
at least 1 degree to the temperature showing in the window.
7. Your caregiver may want you to keep a temperature record. Write down the
time and your axillary temperature each time you take it.
8. Remove or eject the throw-away cover if you used one.
9. Place the thermometer back in its holder.

B. Pulse Rate
A normal resting heart rate for adults ranges from 60
to 100 beats per minute. Generally, a lower heart rate
at rest implies more efficient heart function and
better cardiovascular fitness. For example, a well-
trained athlete might have a normal resting heart rate
closer to 40 beats per minute.

Procedure in getting pulse rate

1. To check your pulse using this method, you’ll

be finding the radial artery.
2. Place your pointer and middle fingers on the
inside of your opposite wrist just below the
thumb.
3. Don’t use your thumb to check your pulse, as
the artery in your thumb can make it harder
to count accurately.
4. Once you can feel your pulse, count how many
beats you feel in 15 seconds.
5. Multiply this number by 4 to get your heart
rate. For instance, 20 beats in 15 seconds
equal a heart rate of 80 beats per minute
(bpm).

C. Respiratory rate
A person's respiratory rate is the number of breaths you take per minute. The normal
respiration rate for an adult at rest is 12 to 20 breaths per minute. A respiration rate
under 12 or over 25 breaths per minute while resting is considered abnormal. Among
the conditions that can change a normal respiratory rate are asthma,
anxiety, pneumonia, congestive heart failure, lung disease, use of narcotics, or drug
overdose.

Procedure
1.Wash your hands.
2.Place your fingers on the individual’s wrist (either side).
3.Count breaths (inhale + exhale = 1 respiration) for one minute.
4.Document respiration rate, noting any observations (such as wheezing).
Factors like fever, agitation, illness, age, and even sleep can affect breathing and
therefore the respiratory rate. Respiratory rate fluctuations are often seen as an early
warning sign for acutely-ill hospital patients, and it is closely monitored within acute
care settings.

D. Blood pressure
For a normal reading, your blood pressure needs to show a top number (systolic
pressure) that’s between 90 and less than 120 and a bottom number (diastolic
pressure) that’s between 60 and less than 80. The American Heart Association
(AHA) considers blood pressure to be within the normal range when both your
systolic and diastolic numbers are in these ranges.

Procedure
1.Wash your hands.
2.Disinfect stethoscope earpieces and diaphragm (round disk).
3.Check to make sure that the blood pressure monitor is in good working order.
4.Place fingers on the underside of the elbow to locate pulse (called the brachial
pulse).
5.Wrap and fasten deflated cuff snugly around the upper arm at least one
inch above where you felt the strong and steady brachial pulse.
6.Insert stethoscope earpieces and position the diaphragm directly over the brachial
pulse.
7.Turn the knob on the air pump clockwise to close the valve.
8.Pump air, inflating the arm cuff until the dial pointer reaches 170.
9.Gently turn the knob on the air pump counter-clockwise to open the valve and
deflate the cuff.
10.As the dial pointer falls, watch the number and listen for a thumping sound.
11.Note the number is shown where the first thump is heard (systolic pressure).
12.Note the number shown where the last thump is heard (diastolic pressure).
13.Deflate and remove cuff.
14.Document the reading, written as systolic/diastolic, and note any unusual
observations.

Lesson
Maintain High Standard of Patient Services
4

This topic gives you an overview of communication and introduces you to the
main elements in the communication process. It also highlights the importance of
writing clear, positive messages and offers you some basic tips and guidelines on this
form of communication so that you may become more proficient in the kind of writing
needed at home as well as in the college and workplace. You will also learn about
some of the common pitfalls which may impede the effectiveness of written
communication.
 What is It

LO1 Communication Appropriately with Patient

LO1 1.1 Define Patients Communication and confidentiality

Communication
is about making contact with others and being understood. When
communicating, people send and receive ‘messages’. We all communicate
continuously by sending messages. The communication cycle is a way of showing
that communication involves a two-way process of sending and receiving messages.
These messages can be:
▶ verbal, using spoken or written words
▶ non-verbal, using body language such as gestures, eye contact, and touch.

The communication cycle

• Idea occurs
• Message code
• Message sent
• Message receive
• Message decoded
• Message understood

Confidentiality
Is not about keeping secrets; it is about protecting an individual’s right to
privacy. You may obtain private, personal information from service users, their
relatives, or from other practitioners as part of your work role. As a health and social
care practitioner, you have a duty to:
▶ keep personal information about service users private
▶ only share information about service users with those who have a right to
know or when a person has given their permission to disclose information
about them.

LO1 1.2 Discuss the different mode of communication

Mode Of Communication
The mode is a term used to describe the way something is done or experienced.
When we use the phrase mode of communication, we are describing the way
communication is expressed. In other words, we are discussing the method of
communication. There are three modes of communication:

• Interpersonal communication is a two-way means of communication that

allows the participants to evaluate and respond to each other. For example,
two people who are speaking and listening to each other, either in a face-to-
face conversation or over the phone, are participating in interpersonal
communication.
• Interpretive communication refers to the ability to understand the target
language in both written and spoken form. Students may not understand
 every word but are expected to understand main ideas and keywords. This is
one-way communication, so students must be able to understand the spoken
or written text on their own. Students will use English to demonstrate what
they understand.
• Presentational communication allows students to plan and rehearse what
they will write or say. In writing, students have time to draft and revise before
producing a final product. In speaking, students may be able to rehearse
and/or to record multiple times until they are satisfied with the final product.
Students create presentations that will be shared with the class and beyond,
when possible.

LO1 1.3 Identify effective communication

Effective communication with service users People who work in health or

social care settings are expected to be able to communicate effectively with the adults
who receive care in the setting. This is not always easy or straightforward.
Communication with the people with whom you work is more likely to be effective if
you:
▶ get the individual’s attention before you start talking, making eye contact
at
the person’s level
▶ use simple language, short sentences, and a friendly tone of voice
▶ give the person time to understand what you are saying and enough time
to
respond to you
▶ are patient and attentive when an individual is talking to you, give them
time
to express themselves and don’t rush them or interrupt to speed things up
▶ listen carefully and use simple questions to clarify what the person is telling
you if you are not sure that you fully understand their communication
▶ are aware of your body language and also take note of what the other
person’s body language is communicating to you
▶ use your facial expression in an active, positive way to support what you
are
saying and as a way of responding to what the person says to you
▶ use pictures, colorful posters or displays to express ideas or to
communicate information in easy to understand ways. This might involve
having information leaflets translated into other languages.
▶ summarize what the other person has said as a way of checking and
confirming your understanding of what they mean.

Being respectful, consistent in your approach, and patient in the way you listen and
respond to people in your work setting, will encourage them to trust and
communicate with you.
 LO2 Establish and Maintain
good Interpersonal Relationship with Patient

LO2 2.1 Establish Rapport and Interpersonal relationship with the patient.

Good rapport creates a close and harmonious relationship with patients. It

allows you to understand your patient's feelings and communicate well with them.
The importance of rapport can’t be stressed enough in nursing. It connects you to
your patients and can improve patient care.

7 Ways To Build Rapport With Patients

1. Maintain Eye Contact

Maintaining eye contact communicates care and compassion. It can also show
empathy and interest in your patient’s situation. Eye contact and social touch
connect you to your patients and communicates understanding.

2. Show Empathy
Empathy is the ability to understand the patient’s situation, perspective, and
feelings. It allows you to deliver more personalized patient care. The
empathetic nurse communicates and acts on their understanding of the
patient.

3. Open Communication
One study found good communication to be a key factor in improving patient
outcomes. Understanding your patient’s communication preferences and
state of mind will help build rapport. Informing your patient about new orders
or changes in their condition is one way to do this.
Encouraging your patient to share their feelings with you is another. Open
communication is one of the most essential nurse communication
skills needed for success.

4. Make it Personal
Being a patient can be scary. To help ease their stay, take the time to get to
know your patients. Ask about their friends and family, hobbies, and other
important aspects of their life.
This communicates your desire to understand them as a person, not only as
a patient. This is an easy way to learn how to build rapport with your patients.

5. Active Listening
Active listening is an essential holistic healthcare tool. It is a non-intrusive
way of sharing a patient’s thoughts and feelings. To practice active listening,
follow these steps:
• Listen to what the patient is saying.
• Repeat what you heard to the patient.
• Check with the patient to ensure your reflection is correct.
• The goal of active listening is to reflect the feeling or intent behind their
words. You should listen to understand, not to respond. Practice active
listening as one of several ways to build rapport.

6. Practice Mirroring
 Matching the patient’s demeanor, disposition, and rhythm quickly establishes
rapport. This may even mean raising your voice to match a loud patient to
create a synchronized bond.
Then, with a low voice and measured movements, lead the patient to a better
place. Use mirroring to become attuned to the patient during difficult
conversations.

7. Keep Your Word

Keeping your word is one of the most effective ways to build rapport with
patients. If you tell them you will do something, do it. If your ability to complete
a task changes, communicate this with the patient. Don’t over-promise and
under deliver. Keeping your word with patients not only builds rapport, but it
also builds trust.

There isn’t a manual on how to build rapport with patients. Some techniques will
come easier to you than others. Practice each of these 7 ways to build rapport and
choose the ones that come most naturally to you in your daily practice.

LO2 2.2 Exhibit genuine courtesy to the patient family and visitor at all time

Effective communication with relatives and visitors Health and social care
service users and their relatives need to be able to trust you and have confidence in
your ability to support and care for them. Communication with relatives and visitors
is more likely to be effective if you: ▶ establish a good rapport with each individual

▶ show people respect by using their preferred names (e.g. ‘Mrs. Griffiths’ not
‘Jenny’, if preferred) and recognize that they should always be consulted
about anything that affects their care.

▶ speak directly and clearly, using positive body language and good eye
contact

▶ give each enough time to understand what you are saying and
listen carefully to what they say to you

▶ respond quickly and in an appropriate way to an individual’s

communication
by phone, email, or in-person

▶ respect confidentiality by communicating personal, sensitive, or private

information about individuals in an appropriate, private area of the care
setting

▶ adapt your communication skills to meet the needs of a people who have
hearing or visual impairments or whose first language is not English. People
will trust and respect you if you adopt a consistent, professional, and
respectful approach when you communicate with them.

They need to be confident that you value them as a person and that you can
communicate with them about their particular needs, wishes, and preferences
relating to care.