Assessment of needs and care planning
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The aim of this assignment is to explore the impact of current legislation and policy on assessment of needs and care planning and also critically evaluating models and theories underpinning needs and care planning. Furthermore the assignment will examine the effectiveness of multidisciplinary working in needs assessment and care planning and also demonstrate critical understanding of safe guarding and risk assessment policy and practice.
Ethics and code of conduct are the foundation of my work as they guide me to; act in the best interest of the service user, do no harm, give them right to make choices, treat them with respect and dignity. Ethics are moral codes which are concerned with what is good for individuals and society, also forms the basis of decision making and aims to contribute towards a positive environment in work setting by improving relationships (Tadd, 1998).
The following case study is about a service user whom I had an opportunity to be present during an interview which was done by a multidisciplinary team to see if he could be admitted to a psychiatric hospital. He was presenting symptoms of schizophrenia which are hallucinating, delusions and sleeplessness (Borrill 2000). I will use a pseudonym and call the service user Mr P for confidentiality purposes REF. Mr P is thirty years old and used to live with his parents before he came to the residential home about six years ago. He has a past history of being admitted in one of the mental health acute psychiatric hospital in West Midlands under section 3 of the mental health Act 2007 0f (1983) for borderline personality disorder.
One morning I was delegated to assist Mr P with his personal care, I knocked at his door as usual expecting him to respond but he did not. I opened the door only to find him standing naked something which was strange to me. I asked him politely to be, descent before I came back to assist him and closed the door and stood outside. I knocked the door again, upon entering Mr P started swearing at me and calling me names and I thought to myself what I done wrong but still have made an effort to try talk to him.
He was furious in such that he took a cup and threw it through out the window. Then I left the room as I noticed that it was a serious matter which needed to be addressed. I went to call the manager, by that time he was shouting on top of his voice. The manager suggested we leave him alone to calm down as long as we made sure he does not cause harm to himself and others. This was done to safeguard the service user by using initiatives which are not part of other network measures aimed at safeguarding all citizens to live lives that are free from violence, harassment, humiliation and degradation.
From that day he started refusing to turn the volume on his music system down, not allowing people to enter his room, not attending his psychiatric appointment, not taking his medication on time, his eating habits and sleeping patterns changed as well and smoked more than he did.
This led to the arrangement of a multidisciplinary team meeting for the re-assessment and care planning for Mr P's needs as his actions displayed lack of mental capacity. As a result, The Mental Capacity Act (2005) was utilised which governs decision-making on behalf of adults, where they lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. This is a legal framework designed to protect people who are not able to make to decisions for themselves or lack the mental capacity to do so.
The company adheres to all relevant legislations and abides by the requirements of the Care Quality Commission inspections which ensure that every service user receives better care and support, with the principles of valuing people. Each service user has an individual person centred plan which promotes the rights to independence, choice fulfilment, develop communication needs and promote social acceptable behaviours (Policy and Procedure Manual)
An appropriate place was identified before the interview therefore treating Mr P as an individual with respect and dignity and the right to confidentiality. The environment was made safe, fully adhering with the responsibility of the employer under the Health and Safety at work Act and the Management of Safety at Work Regulations 1974 (Health and Safety Policy and Procedure Manual). Health and safety policy states that it is the responsibility of the employer to make sure the work place is safe to work in, prevent risks to health, safe working practices are set and followed, and to make sure all material are handled, stored and used safely.
This was done in a way to safeguard Mr P. and other service users in accordance with the safeguarding policy (2008) which states that safeguarding Vulnerable Adults' procedures should refer to the local area-based, multi-agency response which is made to every adult who is or may be eligible for community care services (National Health Service & Community Care Act 1990) and whose independence and wellbeing is at risk due to abuse or neglect. Whilst these particular adults are the specific focus of 'Safeguarding Adults' policy and procedures, this does not contradict with the public duty of those carrying out this work to protect the human rights of all citizens. Such work is the responsibility of all agencies and cannot exist in isolation (www.legislation.gov.uk).
The manager asked for consent from Mr P to allow me to be part of the assessmet team as I was his key-worker therefore allowing him to exercise autonomy (Hendrick 2000). During assessment he was given full attention, and quality time through active listening which is the most effective therapeutic communication skill (Hogston and Simpson 2002, Egan (2007). Norman and Ryrie (2004), states that a good interviewer requires good listening skills and active or reflective listening can involve repeating key words used by the interviewee.
According to Roper et al (2000) an assessment is a cyclical rather than once only process which includes; gathering information, assessing needs, care planning, implementing, intervention, monitoring and reviewing or evaluating. It can also be used as a way of establishing a professional relationship between the service user and practitioners.
Barker, 2004, assets that an assessment is a decision-making process, based upon the collection of relevant information, using a formal set of ethical that contributes to an overall estimation of a person and his circumstances. A care plan starts with an assessment to identify needs that are then summarised and developed into a care plan that the service user and the multidisciplinary team will agree to work on together in the delivery of care and it is then regularly reviewed continually to improve the service users' situation.
Roper, Logan and Tierney (1980) affirms that physiological needs are basic or primary needs that include food, beverages, and sleep which every human being needs to survive of which Mr. P was no longer having. Following the care planning cycle enabled the team to focus on factors that contributed to Mr P.'s mental health problems and to draw a care plan to his needs. This was done by assessing Mr. P's sleeping patterns, his eating and the way he was relating with others and everything that he did was not beneficial to his needs.
Principles underpinning needs and care planning are that; services must address the identified needs of the service user, there should be a continual demonstration of what is effective and what is not and the resources provided should be designed or meant for the effectiveness of interventions (Thornicroft 2001).
The multidisciplinary team who were dealing with Mr P's assessment were the GP, community nurse, psychiatric nurse, psychologist, social worker, family member, the manager, key-worker (myself). The multidisciplinary team provide a range of skills to meet the complex needs of service users who require professional involvement (Ovretveit 1995). According to Moss (1994), multidisciplinary teams in the community enables the following three key functions to be available to service users; continuing proactive care for those with long-term serious mental health problems; 24-hour access to information and support, intervention and treatment before and during crises, and an organised response to requests for help from primary care.
Jefferies and Chan (2004) describes the multidisciplinary as the main mechanism that ensures truly holistic care for service users and a seamless service for service users throughout their disease trajectory and across the boundaries of primary, secondary and tertiary.
During the multidisciplinary team meeting I asked Mr P about his presentation and behaviour and he said that he had fleeting thoughts of self harm one week ago and wanted to harm himself with a knife, but did not act to these thoughts. He also said that he could see Mr L on the wall and kept on hearing voices and was unable to control the instructive thoughts.
The meeting was successful as it led to Mr P being admitted again under section 3 of the Mental Health Act (1983) which has now been amended to Mental Health Act (2007) and was diagnosed with schizophrenia which is his current condition. Rogers and Pilgrim 2005 describes schizophrenia as a mental disorder marked by severely impaired thinking and emotions that affects behaviours as shown by abnormality in language, thought, perception and sense of self.
The effectiveness of the multidisciplinary team in the care of Mr P was that the team was comprised of the correct people at the right time who were able to share different expertise, the ability to take a comprehensive holistic view of his needs. This also enabled the team to diagnose Mr P as I was not in a position to do so, as observed by Borril et al (2000) that shared objectives and individual roles by a team has a significant bearing of their effectiveness in the work they do.
According to Webster (1995) risk is a likely occurrence of harm to self, to others, attempt of suicide and abuse or exploitation by others. Risk assessment is an integrated part of the care delivery contributed by the multidisciplinary team. This TAG tool was used to gather information about Mr P clinical history and current clinical presentation to enable the multidisciplinary team to come to a judgement on how to manage these risks. The severity of Mr P.'s mental health problems was rated under each domain numbered from 1to7 where the assessor was ticking according to the severity of mental health problem.
The rating of the severity of Mr P.'s mental health problems was rated under each domain numbered 1to 7 by looking at three areas: Safety- intentional/unintentional self harm, Risk-risk from others or to others, Needs and disabilities-survival concerns about basic amenities, resources or living skills. This risk assessment enabled the staff and anyone who read the risk assessment to be in a position of knowing how to assist Mr P. with his daily living.
Whilst Safeguarding Adults policy and procedures, were being followed, this did not contradict with the public duty of those carrying out the work to protect the human rights of all citizens. Mr P. was not kept locked in his or away from the community but instead of being left to his own device, he had a member of staff who was to be with him at all times to ensure his safety and that of others. Such work is the responsibility of all agencies and cannot exist in isolation (www.legislation.gov.uk).
In conclusion Mr P's needs were finally met with the contribution and the effectiveness of the multidisciplinary team in needs assessment and Mr P was involved in the decision making (person centred care). I now understand the presentation and behaviours of people with schizophrenia the risk involved to them and others and the legislations that underpin the rightful care.
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