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Personal boundaries

Intimate care involves stepping over people's usual boundaries. It takes us out of familiar territory in terms of how we relate to each other. It necessitates breaking the usual rules about how to behave in order to attend to bodily functions which we normally take a lot of trouble to keep private, and this 'secrecy' [i.e. lack of discussion, support and training] extends to the work itself...A key the assumption that this area of the work does not need to be mentioned.

Open University, 1999

Coping with personal care
Specialist toilet and washbasin facilities
Children will have feelings about their bodies, and they need to be respected.
  • Personal care can involve some very intimate tasks which most people keep private (e.g. taking someone to the toilet, washing intimate parts of their body).
  • Staff may have concerns about this at first.
  • They need support so they can ask questions, request advice or discuss concerns.
  • Managing staff feelings and sensitivities about intimate care is important so that both staff and children feel comfortable with the way intimate care is given.
Adapted from Open University, 1999

A framework for personal care

Listen to these discussions about some of the activities involved in personal care

  • Group discussion (1)
    Personal care, toileting and puberty
  • Group discussion (2)
What is personal care?

What personal/medical tasks do you think are required on a day-to-day basis?

For an overview of personal care and permitted interventions for carer access, have a look at this presentation.

Whiting, M. (2009) Children with complex health needs: parents, nurses and carers – making things work for children

A framework for personal care
Teacher at a review meeting

Providing the highest quality personal care is not something an adult is expected to cope with alone, nor is it acceptable as an ad hoc process. A proactive, planned approach is essential in promoting good practice to ensure proper care and support.

Education staff should expect to be working within a clear school policy framework understood and accepted by parents and staff.

This is part of the safeguarding process which protects both pupils and staff and promotes best practice. It ensures that pupils have a positive daily experience and staff can be confident in what they are doing.

Support in delivering high quality personal care
A review meeting in progress
Here are some ways your school might support the delivery of high quality personal care:
  • School ethos.
  • School policies, guidelines and protocols.
  • Individual education, health and care plans.
  • Specialist training (generic and focused on individual).
  • Medical/health supervision and advice.
  • Day-to-day advice/supervision/mentoring.
Harvey, 2010
Health care plans
A boy in a seat holds his teacher's
All plans for delivering health care for a child or young person with SLD/PMLD/CLDD need to be located within a person-centred health care plan in the context of their life planning, 'where all that is constructed is done so in partnership with the person with intellectual disabilities and their families or carers'. (Matousova-Done and Gates, 2006)

Families should be involved in developing their son/daughter's health care plan, and have the implications explained.

The Green Paper, Support and Aspiration (Department for Education, 2011) proposes a combined and dynamic Education, Health and Care Plan which will reflect the holistic needs of children as they age from 0-25 years.
The inter-relationship of care planning and delivery and caring terminology in intellectual disability nursing
Diagram showing the 'Individual' at centre
                  who is inter-connected by double headed arrows with the 'Care plan', the 'Health action
                  plan', the 'Care programme approach' and 'Care management'. These last four elements
                  are additionally inter-connected with each other. All of these elements are wrapped
                  by and connected by single-headed arrows to the 'Person-centred plan'. This in turn
                  is wrapped by and connected with single-headed arrows to 'Life planning'

Matousova-Done and Gates, 2006

Find out more

Matousova-Done, Z. and Gates, B. (2006) 'The nature of care planning and delivery in intellectual disability nursing'. In: B. Gates (ed.) Care Planning and Delivery in Intellectual Disability Nursing. Oxford: Blackwell.

Whiting, M. (2009) Children with complex health needs: parents, nurses and carers – making things work for children.