According to Maurer & Smith (2005), organizational policies and practices are influenced a lot by the national rules, legislation and service standards. There are many rules, legislations and services like care standard act, care quality commission, commission for social care inspection, race relation act, age relation act, gender discrimination act which aims to ensure the best quality care for the people with all age groups. From the scenario, we have seen that Mr. Frazer is suffering from Alzheimer disease and he needs both long term and short term care as he is passing his days with lots of difficulty.
Hamm (2007) has stated that, people with Alzheimer disease need more likely long term cares. The UK legislations have set up lots of policies and standards so that organizations can give the best the possible care to their clients. Among them, the care standard act 2000 describes that, all the care homes or residential homes must fulfill some specific requirements which are necessary to take care of their patients or clients. For example, it describes a category of people who are not suitable to work with vulnerable adults. In addition, it reforms a regulatory system for the care service organizations such as care homes, children's homes, nursing homes, domiciliary agencies, voluntary adoption agencies, fostering agencies. While providing service to a patient like Mr. Frazer, they have to maintain the legislations. So, a service provider will must check whether they have employees with sufficient knowledge on Alzheimer disease before involving him/her to give him care. For example, whether she/he has got knowledge for the reason of this disease, medication, clinical trials, first aids, communication method, special needs etc. Thus legislation and national service standards influence organizational policies and practices for achieving best possible outcomes for people like Mr. Frazer.
Factors that may affect the achievement of best possible outcomes for Mr. Frazer
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According to Gauthier (2000), there are many factors that can affect the achievement of best outcome of people with Alzheimer disease as they usually need both long term and short term care. Some of the factors are given below:
Problems in communication: Communication problem creates severe problems while providing care as sometimes they can not understand both written and spoken language because of the damage of corresponding nerve. In addition, patients may speak native language where care giver does not speak the same. In this case, misunderstanding may occur that leads to negative outcome for both groups. Sometimes they may not understand proper language, sign language, body language or meaning of normal picture. In these cases, doctors or care workers may fail to realize their needs and may not the best care.
Aggression: Aggressiveness is common often among the Alzheimer patients. So, they may feel irritated if they are asked to describe about their present health condition. In the same time, care givers or doctors will not know patient's needs if he/she does not tell them. If they are requested to explain more than once, they become aggressive other than helping them by giving answer.
Culture, attitude and beliefs: Health care providers may fail to realize the cultural needs of patients. People from different culture have different cultural norms, beliefs, attitude and expectation. So, lack of cultural knowledge and about their belief can obstacle in the way of achieving best compliance. (Treatment and lack of adherence to medication for TB among Hispanic immigrants is one example)
Education and income: Sometimes, patient may think that, they are being asked for unnecessary information by taking the chance of their lower education and income. Also, they might need to pay them for any particular type of treatment though they are reluctant. This can create barrier to achieve the best outcome as well.
National rules and legislations: According to McHale & Gallagher (2003), a mature patient has the right to refuse treatment. Sometimes, they can say that the information which asked for will strike on their confidentiality or respect. So, information may not be available though that is essential for their safeguarding. In these cases, doctors or social workers may take decision against their wishes which will not let them to achieve best outcome.
Communication between care workers and individuals contribute to the delivery of outcomes
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According to Rabins et al (2006), usually people with Alzheimer disease face difficulty while communicating with someone. They may not realize even the simple words. In some cases, their understanding can be fully reverse from the speakers and they may react violently. So, we must be very careful while presenting something to them. A few ways are given below for effective communication to achieve the best outcome.
Awareness while speaking: Cayton et al (2008) have stated that, the care givers must be aware of their body language and voice of tone while talking with them. They must communicate very politely otherwise patients may feel threatened, undermined or confused which can rise the feeling of isolation, agitation and undermine the trust.
Mentioning name: Cayton et al has noted that, care givers must introduce themselves clearly before starting conversation with a patient. If patient's condition is critical then we may tell them our address as well to make the better feelings of the patients. Care giver or doctors should speak quickly, loudly or distinctly by no way.
Questioning: Obviously care providers or doctors need to ask questions to know patients' condition but they must not use long sentences to ask them any question as they need longer time than others to understand the meaning even sentence is not big enough. In addition, they should not be asked more than one question at a time. Also, they should be asked question that require answer only yes or no (Sadowski & Wisniewsk, 2004). Thus any individual can ensure the best outcome for the patients like Mr. Frazer.
2.1 Factors that may have contributed to loss of independence, non-participation and social exclusion for Ellen
According to Arber & Evandrou (1993), there are many factors which can contribute to loss of independence, non-participation and social exclusion and these can be being dependent to someone including care workers, not given time to make choice for them, constraint, changing something related to them without taking their permission, not giving chance to participate in decision-making.
Dependency: Most of the cases, vulnerable adults like Mrs. Ellen loss their independency and social exclusion because of being dependant to someone such as care workers. Sometimes the patients may not be permitted to carry their day to day activities because of lack of ability or risk. Service users' physical and mental conditions may be considered strictly. They may not be given permission to choose how they will spend their times, how they spend their money, where will they spend their leisure time, what will be their regular diet etc. because of lack of skills. As a result, they will loss their minimum capacity to lead a life of their own. So, they may be reluctant to participate in social events as it may be insulting for them that they are dependant.
Keeping away from decision making: From the scenario, we have seen that Mrs. Ellen was given chance to make her own decision. But, usually service users in the care homes or nursing homes may not be given this opportunity because they may cause a problem. This can cause frustration and they become more dependant.
Constraint: this is one of the major ways for what service users become dependants. It can cause threat as they may be forced to think as other people think. Mrs. Ellen was not forced to do anything while staying in the care home. She was encouraged to perform her all day to day activity and as a result she become a role model in that care home. Basically, adults should be assisted to carry their day to day activity but not doing the total thing for themselves. They may think about their inability but they should be encouraged to work by themselves assessing the risks. Otherwise, they will be dependant, frustrated and will lose their taste of life.
2.2 Processes and support mechanisms to maximize independence and choice for individuals like Ellen
Sussex & Scourfield (2004) describe that empowerment of social, physical, emotional needs, intellectual factors, access to information, maintaining confidentiality, participation in decision-making and choice can maximize the independence and choice for individuals. These are given below:
Promoting rights of them. For example, letting them to maintain their confidentiality, safety and security
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Allowing them to take risks. But risk must be assessed. If that can cause severe problem, they might be encouraged restrain from certain things.
Allowing them to communicate and make relationships with anyone that they want.
Allowing them to individualised care, involving responsibilities etc. Everyone has responsibility not to infringe on the rights of other people.
Individuals must be given chance to take their own decision and make choices for them.
Individuals will get full access to gather information.
They must be given right to carry out their religion and cultural activities.
Providing a range of options from which they can make choices
Encouraging them to solve problems in the future on their own successfully.
2.3 Organisational systems to promote participation and independence for individuals
According to Sussex & Scourfield (2004), empowering individuals potentiality, ensuring performance of workers, proper guidelines and inspirations to work by own initiatives, staff training, getting feedback, inspection and opinion sources of information for each and every individuals can be a few examples to promote participation and independence for individuals by organizational systems. These are described below:
Empowering individuals: Heumann et al (2001) state that, each and every employee of any organization may be promoted to participation and independence by empowering their sleeping potentiality. According to him, the development of service delivery and service quality may be increased significantly by the empowerment of employees'. To implement this, proper guidelines to let them work by themselves will be necessary. Thereafter, they can be told the benefits so that they can realize the necessity of the empowerment.
Ensuring performance of individuals: Huber (2006) has shown that, organizational participation can be developed by ensuring performance of individuals. The organizational management will make sure that all the employees are up-to-date with changes so that they can perform in a better way. When they will find out their good performance, they will intend to take part extra organizational activities and feel free to work independently.
Sources of information: Employees from all the organizations should have free access to information so that they can solve their basic problems by themselves. In addition, they will know the pros and cons of the organization. As a result, they will think themselves as an individual and important part of the organization which results them to participate and involve throughout the organizations. (Anderson & Aydin, eds., 2005)
2.4 Tensions that arise when balancing the rights of the individual to independence and choice against the care provider's duty to protect
According to Thompson et al (2006), there are many factors which cause dilemma while providing care to the vulnerable adults e.g. Safety vs. independence, safety vs. rights and responsibilities of individuals etc. For example, if patients with dementia or frail people want to go somewhere by themselves, then care providers' are in trouble. People with dementia may loss their way and find it difficult to retrieve it. In addition, they can cause harm to others and themselves by their aggressive behavior. Frail people may fall down easily and cause serious harm to them. So, the relatives or even the person himself/herself may complain against the care providers when they are in trouble. Considering these factors, care providers are reluctant to let them do anything which can harm their clients. In the same time, each and every individual has right to live independently but it can cause conflict between relative vs. client, client vs. employee, employee vs. relative, children vs. parent, parent of children vs. service providers and staff vs. staff. Thus, tensions can arise while balancing the rights and choice against the care providers' duty. Overall, care providers will first consider and ensure their clients' safety and then independence.
3.1 Identifying and explaining risk of abuse or harm from the case study through the case study.
From the given scenario, we have seen that Mr. Simon was abusing eight elderly clients in his care which affected his client's very badly. His clients' might have to face (opuronio) loss for that abuse. Now the risk of abuse and the way they could be harmed are given below:
It has been said in the scenario that one of the lady who is aged 78 years old was poured cold water and stocking over her head. Researchers have shown that cold water during shower helps to get good health for the normal aged people where it harms elderly people. According to Thygerson (2007), it can increase the risk of heart attack. Putting stocking over the head can choke the lady and lead to death. It can cause paralysis as well.
Mr. Simon also harassed sexually one of the elderly ladies who are 92. It is really matter of shame and strong sexual abuse against that lady. That lady must feel very ashamed that can lead her to suicide. Also, she can be injured seriously physically as body structure becomes very sensitive at those ages.
Obviously it is illegal and humanistic to force anyone to do anything though sometimes that can be good for the person. Anyone can be requested to do anything but is up to the person to accept any help or service or whatever. A 96 year elderly client was forced to eat her food though she was reluctant. Also, Mr. Simon poured sherry into one of his client's throat who was 81. that could cause her choke. As a result, she might die. It could also cause her vomit which can lead to loss of appetite. She was being physically abused during her care.
Without this, as many of his clients' were suffering from senile dementia and psychological problem, they might not remember what happened to them during their care and might think whatever has been done as a part of their treatment! This is a clear indication of physical and mental abuse. Physical abuse was acute for the clients who were wheelchair bound because they could not either protect him or take themselves in safe position quickly. In addition, their privacy, self esteem, dignity, choice, respect, safety have been neglected instead of giving them appropriate care.
3.2 Options to protect individual from abuse whilst balancing legislation requirements and guidance with the tensions involved
According to Pritchard ed. (2008), there are some legislations and guidance to protect and safeguard of the vulnerable adults in the UK. Among them human rights act 1998, Disability discrimination act 2003, Protection of Vulnerable Adult (POVA), Care standard act 2008 are the most effective acts to ensure the safety of vulnerable adults and protect them from any kinds of harm. The scenario has shown that some of the clients' were being abused mentally and physically during their care though they were staying in a nursing home. Basically, abuse can happen because of lack of proper implementation of national legislations. According to the legislations, vulnerable adults may be suggested to stay in their own home or care homes or nursing homes or hospitals in accordance with their health condition. But risks must be assessed before taking any decision. In addition, clients have the right to choose any types of service they need for. They can also refuse all the services as well if they want unless they are mentally handicapped. Thus individuals can be protected from abuse at the same time as balancing legislation requirements and guidance.
3.3 The effectiveness of policies, procedures and managerial approach for promoting management of risks for a known setting
According to Torrisi & Hansen-Turton (2005) and Kemshall & Pritchard (1997), every organization should have some organizational policies, procedures and managerial approach of their own to run their business effectively and to gain their goals easily along with national policy, procedures and laws. For example, a nursing home should have some legislations regarding acceptable and unacceptable risk, protection from unacceptable risk, assessing and recording risk, participation in creating abuse-free environment, complaints procedures, leadership style, whistle blowing policy along with national service standards. Among them assessing risk, leadership style and complain procedures are significant to promote management risks. A nursing home must have adequate equipment to deal with patients. In addition, early identification of possible abuse, screening of people who are going to start work, reporting to people with proper procedure, getting feedback and opinion from clients, keeping as eye and proper monitoring system of the client's finance, psychological and physical issues can also promote management of risk.
3.4 Justify recommendations for improving management approaches to managing risks of abuse in the setting of the case study
Parsloe (1999) and Messer & Jones (1999) have shown that, the management can play an important role to manage the risks of abuse. Some important recommendations are given below to manage risk:
A care worker may be monitored or supervised by an authorized person while providing care.
Screening of people will help to obtain an employee's mentality about his/her job role.
Getting regular feedback from client will disclose the quality of service that they are getting. So, staff will try to give their best to achieve reputation which will minimize risk.
Having necessary equipments cut the danger of life respectively. For example, a service user may need to be transferred for emergency. In this case, having ambulance facility is a plus point to cut risk and abuse of treatment.
Stealing, creating psychological or physiological harms are the cases that happen in care homes, nursing homes or in hospitals. So, monitoring of employees' will help to manage risk of abuse as well.
4.1 The legislation, guidance, codes of practice and policy that apply to the handling of medication
According to Association for Real ChangeÂ (ARC) et al (2006), there are some particular laws, legislations, guidance and policies to handle medication as well as it's ordering and maintaining, administration, storage, recording, and disposal. These are Drug act 2005, PoisonsÂ and Therapeutic Goods Act 1966 No 31, PoisonsÂ and Therapeutic Goods Regulation 2008, Public Health (General) Regulation 2002, Medicines act 1968, Drug misuse act 1986 etc.
These laws and legislations have described the management and supervision systems for the administration, storage, disposal and recording of medication. According to a new law, a registered nurse (grade 1, minimum) must handle the administration of medication to ensure the standard of care in the care homes. In addition, it provides safeguards for the administration of medication along with personal care attendants and in the hostels.
Medicines act 1968 has provided a legal framework within which doctors, surgeons, pharmacists, suppliers and nurses are able to administer medications. According to this act, there are some medicines which are restricted to sale, supply and administration. A drug handler must have to have license to prescribe or dispose any medicine. They also have to renew every licence granted under this Act, unless previously renewed or revoked or will expire at the end of the period of five years from the date on which it was granted or the date as from which it was last renewed.
Drug act 2005 and misuse of drug act 1986 have provided very strong law to handle and protect the misuse of drugs. According to this act, a supplier of drug has to prove that, it has a valid intention to provide drugs. Court can assume against a supplier for abusing drug if they can find out less amount of drug than prescribed. In addition, an issue can be raised if the accused may not have had the drug in possession with the intent.
Thus these legislations, guidance and policies help to safe handling of medicine.
4.2 National service standards to promote safe practice in the handling of medication
According to Crouch et al (2008), today's medicines are powerful compounds to control disease, ease discomfort and prolong life for millions of people and are generally beneficial. But nothing in the world gives us only blessings. Almost all the medicines have got side effect to human body. This is why, national standards, legislation, national enquiries e.g. the Shipman Enquiry, ethical issues, service user choice, acceptable risk etc. have been introduced to minimize the risks and promote safe practice of medication.
Another author named Railton (2007) has stated that, all the clinicians, doctors, nurses, care workers, pharmacists have to meet national minimum standard while handling the medicine. For example, a practitioner must have to have a valid license for practicing or prescribing medicine. According to McGee ed. (2009), some of the key principles to promote safe practice are given below:
Clients of social care services have freedom to choose concerning their provider of pharmaceutical care and services including dispensed medicines.
Care staffs have to be aware of medicines that each client has and a complete account of medicines will be recorded by the social care service.
Care staffs help people with their medicines have to be well-trained and competent.
Medicines must be given correctly and safely, and care staffs have to preserve the privacy and dignity of the individual while giving them medicine.
Medicines should be available when the patient/client needs them and the service provider will make sure safe disposal of unwanted drugs.
Medication orders must be timed; dated, signed and handwritten orders must be readable.
Only approved hospital abbreviations will be used.
Medicines must be stored safely.
The social care service will have an access to advice from the pharmacists.
Medicines have to be used to cure, prevent disease and to relieve symptoms.
Medicines can not be used to punish or control behavior.
4.3 Evaluating the effectiveness of policies and procedures for administering medication to achieve best possible outcomes for service users
Thomas et al (2003) has shown that the policies and procedures help to achieve the best possible outcome for administrative medication and care homes are one of the examples of it. He shows that, care homes reduce the risks of medication by following the policies and procedures. As a part of medication administration policy, now they keep all the records of medication to avoid future risk. Sometimes they check or review the side effects of any drugs in the internet and discuss with any third party if necessary. According to Thomas et al (2003) and Boon et al (2006), effectiveness of policies and procedures are given below:
Each and every written order for medication must state the names of medication clearly which have been ordered. They also mention the dose, the time of any medication is to be administered, route for administration, the reason of the prescribed medication. In addition, any specific time of medication or the first dose is to be considered for administration. So, there will be a rare chance to cause any mistake will lead a good outcome for the patients. Because of the changes in policy nurses are no longer allowed to gather information or obtain the medication from the night locker unless a pharmacy is available to dispense the medication. So, misuse of drugs will fall down. In addition, only hospital approved abbreviations are being used in prescriptions so that clinicians and medical professionals can understand those without any difficulty. It saves time and care service is becoming fast. Violence and silent punishment by the medication in the care homes have been stopped as medicines are not allowed to punish or control behavior.
Harrison (2006) has shown that about 7000 deaths are occurred every year. But now the number has been decreased significantly after the full implementation of medication administrating throughout the care homes, children homes, nursing homes and hospitals. It also ensures the safe practice of care by providing a guideline to the responsible persons by giving idea about right dosage, right medication, right time, right patient, and right route. Thus medical administration helps to achieve the best outcome for the service users.