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We are living in an ageing society where majority of population live longer and the age of the people over 60 is more than the children under the age of 16 years in United Kingdom.
Most of the older people need care. As Bracht (1978) noted, “Social works uniqueness come from its persistent focus on the physical, social-psychological and environmental health needs of clients” (p – 13)
1.1 Explain how principles of support are applied to ensure that the individuals are cared in health care settings.
All staff have a responsibility to ensure good standards of care are maintained and organisations need to have internal systems to monitor social care governance arrangements.
Communicate in an honest, open, positive and friendly manner that is appropriate to the Patient’s/clients’ need.
Ensure you have consent for everything you do with the patient/client.
Provide person-centred care and respect the person’s individuality and dignity.
Protect patients/clients from infection, accidents, injuries and breaches of confidentiality.
Carry out basic observations safely and effectively.
Record and report your findings accurately in the appropriate place.
Use your interactions with patients/clients as an opportunity to promote health.
Know and respect your role and the roles of others in the health care team.
Accept accountability for your actions and behaviour.
Be open to learning new knowledge and skills and to developing your role safely.
All patients should expect the same standard of care, whoever delivers it.
The level of supervision provided must be appropriate to the situation and take into account the complexity of the task, the competence of the support worker, the needs of the patient and the setting in which the care is being given.
1.2 What are the procedures for protecting clients, patients and colleagues from harm?
Many health care settings are now part of national and international initiatives to promote workplace health. The Health promoting Hospitals Network of the World Health Organization, for instance, recognizes the importance of workplaces as settings for promoting the health of service users and service providers. A big part of looking after others – clients you care for, the people who live with, visit and accompany them and the colleagues you work with and looking after your workplace. People cannot remain healthy in unhealthy and unsafe environment.
As individuals, all health professionals have a duty to protect patients. All health care professionals are personally accountable for their actions and must be able to explain and justify their decisions. While the scope of their practice varies they all have a duty to safeguard and promote the interests of their patients and clients. Health care professionals must act quickly to protect patients, clients and colleagues from risk of harm especially if either their own or another health care worker’s conduct, health or performance may place patients or clients at risk.
There are many things we can do that will help to make workplace safer and healthier we for instance:
Make sure keep working environment clean and tidy, using organization’s cleaning guidelines.
Keep equipment and furnishings safely stored when not in use and remove trailing electric cables from floors.
Report damaged equipment, floor coverings and lights immediately.
Look for signs that clients, staff and others, including yourself, may be in danger of harm or abuse or have been harmed or abused. This would include recognizing and dealing with early signs of violent or aggressive behavior.
Always follow organization’s waste disposal stream policies, particularly with sharps.
Clean away spillages immediately, using approved procedures and personal protective equipment if necessary guidelines.
Work with patients/clients in a way that respects their dignity, privacy, confidentiality and rights.
Keep equipment and furnishings safely stored when not in use and remove trailing electric cables from floors.
1.3 What are the benefits of following person centered approach with users of health & social care services.
‘There is only one way and that is the person centered way – it is a journey worth taking.’
Sally, member of the Transforming Adult Social (Care service user reference group)
Recent survey shows that around £2.7 billion could be saved each year by providing person-centered support for people with long-term conditions. Our society is based on the belief that everyone has a contribution to make and has the right to control their own lives. This value drives our society and will also drive the way in which we provide social care. Services should be person-centered, seamless and proactive. They should support independence, not dependence and allow everyone to enjoy a good quality of life, including the ability to contribute fully to our communities. They should treat people with respect and dignity and support them in overcoming barriers to inclusion. They should be tailored to the religious, cultural and ethnic needs of individuals. They should focus on positive outcomes and well-being, and work proactively to include the most disadvantaged groups. We want to ensure that everyone, particularly people in the most excluded groups in our society, benefits from improvements in services.
The trend towards a person-centred approach can be found in the work of Carl Rogers (1958) and his approaches to client-centred psychotherapy (Brooker, 2004) initially developed to support people with learning difficulties. Person-centred planning has since influenced work across the range of social care services. Person-centered planning is for learning how people want to live, to learn what is important to them in everyday life and to discover how they might want to live in the future. However, a plan is not an outcome. The only reason to do the planning is to help people move toward the life that they want and person-centered planning is only the first part of the process.’
In order for people to have real choice and control over their life and services, the people who support them will want to consider the following questions:
â- What is important to the person, so that services and supports are built around what matters to them as anindividual – instead of people being labelled according to a condition, an impairment or a stereotype.
â- How, when and where the person wants support or services delivered -rather than a standard ‘one size fits all’ approach.
1.4 What are the ethical dilemmas and conflict that a care worker may face when providing care, support and protection.
Ethics play a central role in the clinical decision making of all healthcare practitioners; however dilemmas can arise with practitioner morality and ultimately professional judgment being central to the correct management. As healthcare professionals there is a duty of care to increase the quality of life of those who present for treatment and above all else to cause no harm.The social worker can also provide emotional support and clarification to the patient and family as things unfold. Many times, the social worker acts as the voice of the patient and family, explaining to the consultants what their wishes are and advocating for them to be respected (Rothman, 1998).
Healthcare practitioners must “always place the welfare of the patient before all other considerations” (College of Optometrists Members’Handbook, 2007) Example of possible dilemmas includes being asked to prescribe the contraceptive pill to under – 16s without parental consent.
(Health and social care Book 2 Level -2)
2.1 Explain the implementation of policies, legislation, regulations and codes of practice that are relevant to own work in health & social care.
UK government had made numerous policies, legislation and regulation in order to protect everyone in health and social care setting including employers, employees, service users and their families as well.
Care Standards Act (2000):
Ensures all care provision meets with the National Minimum Standards.
Sets standards for the level of care given to individuals requiring social care.
Requires that all staff have a thorough police check before they begin working with children and adults and that a list is kept of individuals who are unsuitable to work with children or vulnerable adults.
Children Act (1989)
Made major changes to childcare practice;
Introduced concept of ‘significant harm’.
Introduced concept of ‘parental responsibilities’ rather than ‘rights’.
Made wishes and interests of the child paramount.
Children Act (2004)
Introduces Children’s Commissioner, Local Safeguarding Children Boards and provides legal basis for Every Child Matters.
Disability Discrimination Act (2005)
First came into force in 1995 and was amended in 2005.
Requires the providers of public transport to reduce the amount of discrimination towards
People with disabilities on their buses and trains.
Requires public facilities and buildings to be made accessible to those who have disabilities.
Requires employers to make reasonable adjustments to allow an individual with a disability to gain employment.
Data Protection Act (1998) Data Protection Amendment Act (2003)Access to Medical Records (1988):
Provide for the protection of individuals’ personal data with regard to processing and safe storage. The Acts cover:
Storage of confidential information
Protection of paper-based information
Protection of information stored on computer
Accurate and appropriate record keeping.
Health and Safety at Work Act (1974)
Aims to ensure the working environment is safe and free from hazards.
Employers and employees should share responsibilities for:
Assessing risks before carrying out tasks
Checking equipment for faults before use
Using appropriate personal protective clothing
Handling hazardous/contaminated waste correctly
Disposing of sharp implements appropriately.
Management of Health and Safety at Work Regulations (1999)
Explain to managers and employers what measures they must take to keep staff safe. The main focus of the regulations is risk assessment.
The regulations explain how to conduct a risk assessment and what the assessment should contain.
Mental Health Act (2007)
Updates the Mental Health Act 1983. The main changes are:
16 and 17 year olds can accept or refuse admission to hospital and this decision cannot be overridden by a parent.
Patients who are detained in hospital under a section of the Act are entitled to an independent advocate who will speak for them at a review to decide on their future.
Under Supervised Community Treatment Orders, patients who are discharged will be visited at home by a mental health professional to ensure that they take their medication.
There are many more policies and legislations which are relevant and need to be understand in health and care such as; Food Safety (General Food Hygiene) Regulations (1995), Lifting Operations and Lifting Equipment Regulations (1998), Manual Handling Regulations (1992), Mental Capacity Act (2005), Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (1995) (RIDDOR).
2.2 Explain how local policies and procedures can be developed in accordance with national and policy requirements.
Several stages are involved in shaping care policies, and nurses can play an important role in all of these. When trying to disentangle policies, it makes sense to look at the roles of the different organisations that develop them. Things that seem to be a matter of local decision-making, for example, what type of incontinence aids to use, can be determined by policies at a regional or national level. These might cover how suppliers or equipment should be chosen (for example, through tendering processes), or set budget or resource levels. In turn, national policies might be shaped by international policies: for example, a trade embargo might preclude the purchase of equipment from suppliers a certain country. One type of continence pad may be more comfortable for patients, more absorbent or more secure, but if it is too expensive, or made in a country that does not trade with the UK, it will not be used at local level.
National policies have a major impact on the resourcing of health-care services but, increasingly, they also set performance indicators and evaluation criteria. For example, if one criterion for evaluation is that every patient should have a ‘named nurse’, then this will affect how you organise work, or at least the way you welcome a patient into your unit. Similarly, if a set of performance indicators set by national government focuses on measuring ‘throughput’ of patients, you may find yourself under pressure to discharge people from your care more quickly than otherwise.
The first type of policy-making process has the advantage of transparency – everyone knows what the process and outcomes are. It can, however, be very slow to respond to changing circumstances. If every change has to be discussed and debated by the full committee, and then formally communicated across the organisation (perhaps with opportunities for people to give their responses before the policy is finally adopted), it can take a long time for things to change.
The second type of policy-making process is more flexible, and arguably more responsive to change, but its informality can mean people in the organisation are not clear about what policies are, or how they were developed. It can sometimes be difficult to have an open debate if there is no process for doing this, and it is difficult for people to be updated on policy change with no clear dissemination mechanisms.
2.3 Evaluate the impact of policy, legislation, regulation and codes of practice on organizational policy and practice.
Every organization has some policies and producers that promotes equal opportunities and reinforce the codes of practice of specific professional bodies. Organizational policies are the mechanism by which legislation is delivered and implemented.
Policies in organization’s are includes:
Health and safety
Bullying and Harassment
Conflict of Interests
Since 2000, health and social care services have become strictly regulated and then it became essential for all settings to have a professional code of practice.Organizations have to follow government policies strictly. The code of practice for everyone working within the social care sector includes information on protecting the rights, and promoting the interests, of individuals who are receiving the care and their careers. Policies, legislation and regulation enable the organizations to perform their role efficiently and professionally.
3.1 Explain the theories that underpin health & social care practice
Social Care Theory for Practice is a major component in Social Care. Professional’s role can often be a powerful one. As a care worker you are potentially able to exercise a relatively high degree of control in a situation.
French and Raven (1959) identified five types of power:
Reward Power – based upon the perceived ability to guarantee positive consequences
Coercive Power – based upon the perceived ability to ensure negative consequences
Legitimate Power – based upon the perception that someone has the right to expect certainbehaviors (sometimes called position power)
Referent Power – based upon the desire of subordinates to be like leaders they believe have desirable characteristics
Expert Power – based upon the perception that a leader has expert knowledge the
Subordinates don’t have (sometimes called information power).
According to Stefanle Haffmann(2006), Motivation is a psychological process and it can be explained as willingness of individuals to do something for satisfies a need. When a worker motivated about his job/work employer can get more efficiency. (Robbin and Coulter, 2002) said that, in everyday life, people ask themselves the question why they do something or why not. A need is a psychological or physiological deficiency, which makes the attainment of specific outcomes attractive.
Maslow’s Hierarchy of Needs:
Abraham Maslow (1908 – 1970) along with Frederick Herzberg (1923) introduced the Neo-Human Relations School in the 1950’s, which focused on the psychological needs of employees.
Physiological; hunger, thirst, etc.
Safety and Security
Belongingness and Love
Cognitive; understanding, knowledge
Aesthetic; order, beauty
Self-Actualization; fulfillment and realization of potential
Self-transcendence; connection with something beyond the ego or to help others fulfill their potential
Maslow put forward a theory that there are five levels of human needs which employees need to have fulfilled at work.
Maslow Hierarchy of Needs
Frederick Winslow Taylor (1856 – 1917) put forward the idea that workers are motivated mainly by pay. His Theory of Scientific Management argued the following:
Workers do not naturally enjoy work and so need close supervision and control. Therefore managers should break down production into a series of small tasks. Workers should then be given appropriate training and tools so they can work as efficiently as possible on one set task. Workers are then paid according to the number of items they produce in a set period of time- piece-rate pay. As a result workers are encouraged to work hard and maximise their productivity.
3.2 Scrutinize how social processes impact on users of health & social care services.
Marginalization and social exclusion describe the process whereby individuals or groups are pushed to fringes and edges of mainstream activity, where minority groups are excluded from the available to the majority of people. The effect of marginalization is to disadvantage many people and sideline any social, economic and moral concerns for their wellbeing. It is likely that if a group of people experience discrimination and social exclusion, they are also experience health inequalities.
Since the Black Report of 1980, it has been acknowledged that those from the lowest social grouping experience the poorest heath in society. Iike in UK inequalities in heath is still persisting. The statistics are stark: For example:
Young Black men are six times more likely to be sectioned under the Mental Health Act for compulsory treatment than their white counterparts.
Gay and bisexual men are seven times more likely to attempt suicide compared with the general population.
GPs often do not accept Gypsies or Travellers on their lists or refuse treatment after first visits.
24% of deaf or hearing impaired people miss appointments, and 19% miss more than five appointments because of poor communication (such as not being able to hear their name being called).
Take-up of breast screening is just 26% in women with a learning disability compared with over 70% for other women.
Children in the lowest social class are five times more likely to die from an accident than those in the top class.
Someone in social class five is four times more likely to experience a stroke than someone in class one.
Infant mortality rates are highest among the lowest social groups.
Under the age of 65, men are 3.5 times more likely to die of coronary heart disease than women.
Women experience more accidents in the home or garden, while men experience more accident in the workplace or while doing sports.
Suicide is twice as common in men as in women.
The poorest people in England are over ten times more likely to die in their fifties than richer people.
Obesity and smoking, two of the leading causes of preventable death, are more common in lower socio-economic groups.
Over recent years, we have become increasingly aware of our responsibilities in regard to issues such as equality, diversity and human rights. Like other public sector services, the NHS is under a legal and moral obligation to provide services to all people, regardless of gender, ethnicity, age, disability, sexual orientation, religious or cultural belief. From a public health perspective, the key concern is the extent to which people who are socially excluded or disadvantaged as a result of their ethnicity, sexual orientation or religious belief etc. all too often experience the poorest health and poorest experience of healthcare services.
3.3 Evaluate the effectiveness of inter-professional working.
According to Barrettet et al, (2005) Quality of service depends on how effectively different professionals work together. Schein (1972) believes that education of health professionals should be mixed in order for professionals to obtain new blends of knowledge and skills.
Recently Government stressed the need of inter-professional working which making a difference that our health system must move from one in which a multitude of participants, work alone focusing primarily on managing illness, to one in which they work collaboratively to deliver quality effective care to clients. Professionals working in collaboration provide care which is designed to meet the needs of clients’ .When a person seeks hospital care; they will interact with more than one healthcare professional. The number of professionals involved and the importance of their ability to work collaboratively increases with the complexity of the client’s needs. New initiatives to improve management of diseases such as asthma and diabetes invariably points to the need for a more collaborative approach (Iah and Richards, 1998)
4.1 Explain own role, responsibilities, accountabilities and duties in the context of working with those within and outside the health & social care workplace
Health service providers are accountable to both the criminal and civil courts to ensure that their activities conform to legal requirements. In addition, employees are accountable to their employer to follow their contract of duty. Registered practitioners are also accountable to regulatory bodies in terms of standards of practice and patient care (RCN et al., 2006).
The law imposes a duty of care on practitioners, whether they are HCAs, APs, students, registered nurses, doctors or others, when it is “reasonably foreseeable” that they might cause harm to patients through their actions or their failure to act (Cox, 2010).
HCAs, APs and students all have a duty of care and therefore a legal liability with regard to the patient. They must ensure that they perform competently. They must also inform another when they are unable to perform competently. This applies whether they are performing straightforward tasks such as bathing patients or undertaking complex surgery. In each instance there is an opportunity for harm to occur.
Once a duty of care applies, the key question to ask is: what standard of care is expected of practitioners performing particular tasks or roles?
In order for anyone to be accountable they must:
Have the ability to perform the task.
Accept the responsibility for doing the task.
Have the authority to perform the task within their job description, and the policies and protocols of the organisation.
Registered nurses have a duty of care and a legal liability with regard to the patient. If they have delegated a task they must ensure that the task has been appropriately delegated.
This means that:
The task is necessary and delegation is in the patient’s best interest.
The support worker understands the task and how it is to be performed.
The support worker has the skills and abilities to perform the task competently.
The support worker accepts the responsibility to perform the task Competently.
Employers have responsibilities too, and as HCAs and APs develop and extend their roles the employer must ensure that their staff are trained and supervised properly until they can demonstrate competence in their new roles (Cox, 2010).
Employers accept ‘vicarious liability’ for their employees. This means that provided that the employee is working within their sphere of competence and in connection with their employment, the employer is also accountable for their actions.
Delegation of duties is summarised in this statement from NHS Wales (NLIAH, 2010) “Delegation is the process by which you (the delegator) allocate clinical or non-clinical treatment or care to a competent person (the delegatee).
You will remain responsible for the overall management of the service user, and accountable for your decision to delegate. You will not be accountable for the decisions and actions of the delegatee”.
Delegation must always be in the best interest of the patient and not performed simply in an effort to save time or money.
The support worker must have been suitably trained to perform the task.
The support worker should always keep full records of training given, including dates.
There should be written evidence of competence assessment, preferably against recognised standards such as National Occupational Standards.
There should be clear guidelines and protocols in place so that the support worker is not required to make a clinical judgement that they are not competent to make.
The role should be within the support worker’s job description.
The team and any support staff need to be informed that the task has been delegated (e.g. a receptionist in a GP surgery or ward clerk in a hospital setting).
The person who delegates the task must ensure that an appropriate level of supervision is available and that the support worker has the opportunity for mentorship. The level of supervision and feedback provided must be appropriate to the task being delegated. This will be based on the recorded knowledge and competence of the support worker, the needs of the patient/client, the service setting and the tasks assigned (RCN et al., 2006).
Ongoing development to ensure that competency is maintained is essential.
The whole process must be assessed for the degree of risk.
4.2 Evaluate own contributions to the development and implementation of health and social care organizational policy.
You will need to know and understand:
Codes of practice and conduct, and standards and guidance relevant to your setting and own and the roles, responsibilities, accountability and duties of others when developing, implementing and reviewing care plans
Current local, national and European legislation and organisational requirements, procedures and practices for:
health and safety
risk assessment and management
protecting individuals from danger, harm and abuse
your responsibility for keeping yourself, individuals and others safe
making and dealing with complaints and whistle blowing
multi-disciplinary and multi-agency working
working in integrated ways to promote the individual’s well-being
the planning and provision of services
developing, implementing and reviewing care plans
How to access, evaluate and influence organisational and workplace policies, procedures and systems for developing, implementing and reviewing care plans
How to access and record information, decisions and judgements for care plans
How different philosophies, principles, priorities and codes of practice can affect inter-agency and partnership working when developing, implementing and reviewing care plans
Knowledge of the physical, emotional and health conditions of the individuals for whom you are developing, implementing and reviewing care plans and how to use this information to make informed decisions for the content of the care plans
The factors to take account of when evaluating whether your organisation has the resources (human, physical and financial) to provide the services and facilities
Methods of supporting staff to work with individuals, key people and others to deliver, implement and evaluate care plans
The stages, procedures, paperwork and people involved in developing, implementing and reviewing care plans
The use of evidence, fact and knowledge based opinions in records and reports and why it is important to differentiate between these and make clear the source of evidence
Legal and organisational requirements on equality, diversity, discrimination, rights, confidentiality and sharing of information when developing, implementing and reviewing care plans
Knowledge and practice that underpin the holistic person-centred approach which enable you to work in ways that:
place the individuals’ preferences and best interests at the centre of everything you do
provide active support for the individuals
recognise the uniqueness of individuals and their circumstances
empower individuals to take responsibility (as far as they are able and within any restrictions placed upon them), and make and communicate their own decisions about their lives, actions and risks (when developing, implementing and reviewing care plans)
How to manage ethical dilemmas and conflicts for individuals, those who use services and staff/colleagues when developing, implementing and reviewing care plans
Contribute to, participate in and run meetings and discussions to agree revisions to care plans, taking account of any benefits and risks
Ensure that review meetings are arranged and run in ways which promote the full participation of individuals and key people
Collate review information and revise care plans within agreed timescales
Ensure that individuals and key people understand the revisions that have been made to the care plans and the implications of these for the health and care services that individuals receive
Complete, and support individuals to complete, any necessary paperwork when the final plan has been agreed
Ensure that the plan is stored and able to be accessed within confidentiality agreements and according to legal, organisational and any service requirements
4.3 Make recommendations to develop own contributions to meeting good practice requirements.
Protect the rights and promote the interests of service users.
Strive to establish and maintain the trust and confidence of service users.
Promote the independence of service users while protecting them as far as possible from danger or harm.
Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people.
Uphold public trust and
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