The inspiration for the Decision tree comes from my experiences as a health & social care trainer and the discussions I often have with workers from a variety of settings. It’s often very clear when discussing case studies or the real life dilemmas that come up in sessions that the problem of deciding what to do isn’t just an issue of knowing ‘the rules’. More often the difficulty isn’t around naivety in practice so much as a lack of structure in decision-making and problem-solving. Here’s an illustration from a training session I led a few weeks ago…

The situation involved performing regular ‘safe and well’ checks on a particular residential service-user who objected (occasionally violently) to the repeated interruptions. Before we can decide how best to carry out these checks we need to know what we’re trying to achieve and indeed, if we need to do them at all. Only then can we create a reasonable plan of action.

The conversation went something like this…

“Is this clinically necessary?”

“I don’t feel safe doing these checks on my own.”

“But are the checks necessary?”

“I don’t usually open his door. I just stand outside and listen.”

“What are you checking him for?”

“To make sure he’s safe.”

“Do you know he’s safe without going in?”

“Actually it’s about making sure he hasn’t absconded.”

“Can you tell that from outside the door?”

“No.”

“So is standing outside the door necessary?”

“I’m not safe to go in.”

The point to notice here is that we never got to the bottom of whether or not this observation regime is necessary. We didn’t even get really clear about what the checks are even for. This is because there was no structure of decision-making and that’s a problem. That’s the sort of thinking style that leads to knee-jerk reactions and/or ill-considered implementation of ineffective support plans. But the problem isn’t lack of ability, it’s lack of clarity.

Sometimes carers become so distracted by their understandable health and safety concerns or their need to ‘do something’ that they forget the more fundamental questions they need to ask.

The decision tree is based upon the idea that we need to approach care decisions in the right order. We need to know a range of other answers before we can determine what to do. This blog series is an attempt to make sense of that systematic question and answer process.

To make the series understandable we’ll stick with the same example (intermittent observations) but the principles will apply to a much wider range of decisions.

We will consider:

• Why write this series?
• Identifying the problem.
• What we want to achieve.
• Is this decision ours to make?
• Will this solution actually work?
• Is there a less restrictive solution?
• How restrictive must we be?
• How will we implement this?
• Do we need additional staff, training or resources?
• What do we need and is this realistic?
• Is this the appropriate service?
• Review, the nursing process & the social care problem-solving cycle

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Following a recent discussion with care workers it became clear that even the most experienced and undoubtedly intelligent among us can become confused when faced with complex care decisions. This isn't because the issues we face are necessarily too difficult to resolve. It's often simply because there are so many variables that it's hard to seperate them out into meaningful 'bite size' chunks.

So I've decided to write a new blog series outlining my version of how to get down to the basics of difficult situations in a systematic, understandable way.

I'm not sure yet whether it'll run on this blog or my personal wordpress blog but I'll make sure that the resulting PDF will be available through both sites either way.

As part of my own preparation for this I've developed a single page algorithm (the 'Decision tree' itself) to accompany the series. It is available on the freebies page but you can also access the 'Decision tree' here

It prints out as a single A4 sheet and should be easy to find space for on your office wall for quick reference at work.

Enjoy.

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My newest project is a blatant rip off. The materials are my own but the format is very definitely inspired by two bloggers and tweeters whom I admire so much I intend to emulate them. They do say (whoever ‘they’ might be) that imitation is the sincerest form of flattery.

Recently Twitter’s excellent @nurse_w_glasses who is responsible for the immensely popular 20 commandments for mental health workers and the ’20 commandments’ blog has seen her 1 page summary of the commandments posted in nurses’ stations all across the globe. It’s such a good format.

Even more recently a Leicestershire police inspector @MentalHealthCop who hosts his own extremely popular blog has begun posting ‘quick guides’ for serving police officers who may need fast access to pithy information as situations arise.

My project is based upon a combination of both these ideas. I plan to create relatively brief ‘quick guide’ summaries of mental health and social care principles that can either be used for quick online reference (like Mental Health Cop’s guides) or posted in staff rooms and offices (like Margreeth’s 20 commandments). I’m essentially ripping off two basic formats to create my own hybrid. Fortunately neither Margreeth nor Mental Health Cop seem to object. After all – we’re all chasing the same thing – information getting ‘out there’ to the people on the front line.

So my first offering in this series is a single page summary of the Mental Capacity Act 2005 for front line workers in England & Wales.

You can download it here: MCA 1 page summary

Feel free to print it off and post it in the office, nurses’ station or keep it in your bag for quick reference should you need it.

You can also download my longer PDF that explains the Mental Capacity Act in more detail if you fancy something a bit more meaty