Category: Free Essays

In order for an individual to receive holistic, high quality health and social care services, effective communication and multi disciplinary working between professionals is imperative (Ashcroft et al, 2005). I will discuss my personal experience of interprofessional working, both in regards to the conference and the on line group work undertaken. I will also explore how the module relates to my own experiences in practice, drawing on literature and policy of both a political, professional and social nature.

The team of which I was a member consisted of students studying adult nursing and medicine. I was the only group member studying social work which initially did create a barrier in respect of the perception held by the other group members of what a social work practitioner’s role is. It was clear, following initial introductions, that some group members held a stereotypical view of social workers and were very dismissive of the work carried out by practitioners. It is essential, when working interprofessionaly that practitioners are mindful of the various methods employed by associated health and social care professionals and vital, therefore, that practitioners become aware of their own possible prejudices, through reflection on their practice. This reflective process assists to ensure potential negative stereotyping does not hinder the outcome of the work carried out by the team and have a detrimental effect on the care provided to the service user ( Fook, 2002).

Through discussion it transpired that much of this stereotypical view had been constructed through the influence of the media’s portrayal of social workers. During the conference group members cited television documentaries in which social workers failings were highlighted. Lombard ( 2009) argues that this type of media attention is damaging not just to social work but to all allied health and social care staff, attributing it to a possible lack of comprehension of the profession. Earlier this year a national advertising campaign was introduced. This aimed to draw attention to the role social workers play in safeguarding children and adults and to achieve a more positive, public perception of the profession ( McGregor, 2010).

The perceived lower professional position of social workers, held by other health professionals, however, is argued by Barbour (1985) as being a source of high anxiety for students studying on social work courses. However, it became apparent as the conference continued and discussions were held, that as a social work student I had gained experience of a wide range of practice settings and of working interprofessionally in order to achieve the best possible care provision for the service user. These practice experiences enabled me to reflect on both positive and negative factors of working with other professionals and to contribute to the group discussion with examples of interprofessional work in which I had participated. An example of which is regarding a case I care managed whilst working within a hospital social work team. In order to facilitate a safe discharge home for an older person with dementia, input was required from various disciplines. Occupational therapy support was necessary to ensure the home environment would still be suitable and assessment from the community psychiatric nurse was also completed in respect of service provision to maintain the emotional and mental well- being of the service user.

Ongoing communication between involved professionals was therefore essential, for an effective outcome for the service user to be achieved. This illustrates the highly significant role of interprofessional education for students studying to practice in the health and social care field. Reeves et al (2009) argue that interprofessional education has impacted notably on patient care in, for example, the improved knowledge and expertise of staff providing care to individuals with mental health issues.

The discussion of practice experience, I feel, added positively to the group and perhaps began to reduce the preconceptions held by other group members of lack of professional competency executed by social workers

(Carpenter & Hewstone,1996). Through the process of exchanging opinions, discussions and working as a group, the potential to overcome stereotypical views and facilitate change was engaged in (Mullender & Ward, 1991). Being a member of a group can determine a sense of familiarity, group members may have experiences in common and this sharing of situations can act as a supportive, cathartic procedure ( Johnson & Johnson, 1994). A fundamental element of effective interprofessional partnership, therefore, is trust. If facilitation and engagement in open debate and sharing of ideas between professionals is to occur, this must be apparent ( Cook et al, 2001).

The example of interprofessional working in respect of facilitating a safe discharge home from hospital, also raised further discussion regarding the role of input from the service user and their carers. They should be seen as part of the group, not externally from it and involved fully in the decision making process. This was challenged by one of the group members studying medicine, who felt that the responsibility to make decisions about care provision should be held solely by the professionals involved. Payne (2000) argues, however, that a focus on the interactions between the professionals can undermine the participation of the people who use the services. Involvement of service users, family and carers and recognition of their role as being experts by experience, may begin to create equality of power between professionals and the individuals they are supporting ( Domenelli,1996).

We explored this further through discussion within the group and I felt concerned by some of the group members attitudes towards the notion of making a decision as professionals, whilst excluding the service user from this process. This is an oppressive way to practice and the empowerment of individuals through maximization of control and choice, should be striven towards in all provision of health and social care services ( Banks, 2006). Respect for the individual choices and interests of the service user should always be paramount throughout provision of health and social care and the assessment process, as detailed in the National Occupational Standards for social work (2009).

Ongoing communication has been actively engaged in during my personal practice experience. However, throughout the module there was very little online participation from the team via blackboard. This was disappointing, as through the proactive exchange of ideas from the varying professionals perspectives, a more cohesive and beneficial learning experience may have been achieved. Indeed, the centre for the advancement of interprofessional education (1997) has documented that there are significant benefits in students from varied fields, learning together.

In contrast to the team work which took place at the conference, my experience of working alongside allied health and social care professionals in practice has been extremely positive. An example of which is in my previous employment within an adult care community team in which I attended weekly meetings with the district nursing team and local G.P’s. enabling effective sharing of information to take place. This communication enabled all involved professionals to gain knowledge of changes in service users health and care needs and provided a forum for any concerns regarding safeguarding issues, to be shared and explored further.

Within the conference team, therefore, further discussion and exploration of the differing views regarding this topic was carried out. The conclusion of which was the establishment of one of the teams sentences as “be open minded and willing to accommodate other professionals values, within a team working environment.”

The ideologies of interprofessional working are not always apparent in practice however, resulting in catastrophic failings in care. Victoria Climbie died after suffering serious abuse whilst under the care of the NHS and social services. Lord Laming (2003) reported a lack of sharing of information between professionals and argued that when practitioners did raise child protection concerns, there was a lack of feedback and little or no further communication between agencies.

The death of Baby Peter Connelly also sadly highlights concerns regarding how professionals work together. The serious case review reports that at a significant case conference held regarding Baby Peter, there was poor attendance from professionals, with neither doctors, police or lawyers turning up ( Laming, 2009). This illustrates that even after the reported failings in communication between professionals in the Victoria Climbie case, interprofessional working does not always appear to be fully engaged in.

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Section 2
Discuss how you would take what you have learnt about Interprofessional working into practice.

Attendance at the conference provided an opportunity to explore the process of working effectively with other professionals. In practice, the active joint working between health and social care professionals and the voluntary sector has become increasingly important with the introduction of the personalisation agenda, as detailed in the social policy ‘Putting people first: a shared vision and commitment to the transformation of adult social care’ (2007). The personalisation of social care services enables service users to take increased control of their own support packages and provides a high level of empowerment.

I will discuss this further in relation to interprofessional working and it’s application in practice.

Service users are now provided with the option to choose from which provider their care is sourced ie, from the private, pubic or voluntary sector. In 2004 the strategic concurrence between the NHS, Department of health and the voluntary sector of ‘making partnership work for patients, carers and service users’ (2004) was formed, which indicated a dedication to interprofessional working and a fully person centered approach to practice. However, the change in government this year and recent significant cuts in funding to the welfare state proposed by the coalition government may impact significantly on the initial goals set out in this policy ( Dunning, 2010).Significant changes in how funding is allocated impacts greatly on social care practice. On qualification as a social worker I will endeavor to carry out effective interprofessional practice, however with increasing reductions in front line staff and higher caseloads it raises concerns regarding how achievable this will be.

My own experiences of working within an adult care management team have been of positive interprofessional working. I have attributed this to the comprehensive, ongoing sharing of information between social work practitioners and community nursing teams, which took place. The desire to strive towards a common goal and achieve the best possible care for the service users, provided an effectual construct for professionals to practice within. The recognition of individual differences regarding ethnicity, culture and relationships by all involved professionals enabled truly anti-oppressive practice to take place (Dominelli 2002).

However, during the conference, team members voiced concerns regarding how engaging in interprofessional working may cause their specific professional identity to become vulnerable. This has been identified by Frost et al (2005), who postulates that the fusion of professional margins can create apprehension and resentment between practitioners. This discussion was an interesting aspect of my personal learning within the group. As a social work practitioner the opportunity to engage in joint working with other professionals is embraced and is essential to effectual, safe practice. The varied perspectives between group members however, has provided a deeper insight into how other professionals may view this method of working and I will be mindful of this in future practice.

Interprofessional working was illustrated further during the conference by a presentation from the Bristol Intermediate care team. The team consists of health professionals working alongside social work practitioners, aiming to reduce hospital admissions, providing a holistic approach to practice and enabling service users to remain in the community and to be cared for at home (Drake & Williams, 2010). I feel the cohesive working style of this team, provides the best possible outcome for service users through application of an anti oppressive, person centered approach. This interprofessional method of practice provides for less of a risk adverse approach to practice which can be present in community care teams consisting exclusively of social work practitioners (Roe & Beech, 2005). This may be due to the presence of multi disciplinary professional opinions being readily provided, enabling a more holistic view of a situation and perhaps also the fundamental ethos of the team which is to promote independence. The ethic of empowering others to achieve independence however, is a core value of social work and I endeavor to implement this within my own future practice.

In order to facilitate change in my practice, I will be conscious of the importance of information sharing with other professionals and engaging in the process of reflection on my previous experiences of working interprofessionally (Payne, 2006). An example which occurred whilst working within an adult care management team is regarding an allocated case concerning a couple, living at home in the community, both of which had multivariate care needs. In this circumstance a wife was providing care for her husband who has dementia, however she has limited mobility and depends on him to support her with some physical tasks. Joint working with other health and social care professionals was imperative in order to safeguard the needs of both service users (Meads & Ashcroft et al, 2005).

Combined assessments were carried out by myself as a social work practitioner, the district nursing team and community psychiatric nurse, enabling all involved professionals to be aware of each others role and involvement. This method of working was also highly beneficial to the service users in respect of limiting the amount of assessment meetings which took place and avoiding repetition of the same information to several professionals, which can become exhausting and create further anxiety ( Walker & Beckett, 2003). I did encounter difficulty in interprofessional working when liaising with the GP regarding a requested review of the couple’s medication. The GP held the opinion that both service users should be placed in residential care due to their age and health problems and was reluctant to engage in any discussion regarding alternative options. Through joint working between other professionals however, funding for a live in carer was secured to support the couple, alongside ongoing support from the community matron to ensure both health and community care assessed needs continued to be met fully and safely, in accordance with the NHS and Community Care Act (1990).

On reflection this was a challenging experience and I felt frustrated by the apparent disregard of the wishes of the service users and the discriminative attitude exhibited in respect of their age, by the GP. The reluctance to engage further with any of the involved professionals following a case conference in which the GP’s opinion had been challenged by myself and others working on the case, highlighted to me the hierarchy which is still in place within health and social care professions. Monlyneux (2001) argues that professionals who are assured in their professional role, are able to explore disparities in opinions and practice outside their own profession’s margin without feeling vulnerable. The importance, therefore, of maintaining focus on the service users wishes rather than difficulties in communication between professionals, ensuring their needs are met fully, is paramount. However, this incident demonstrates the difficulties which can occur when working within a team and the need for respect and equality for all members, in order to ensure effective interprofessional working takes place (Conyne, 1999).

The discussions held amongst the team during the conference have highlighted further to me the disparity between perspectives held by health professionals, who apply the medical model of practice and social work practitioners implementing the social model. As argued by Petch (2002), in order to respond fully and positively the uniqueness of the individuals needs should be identified. Through this process, empowerment and equality can begin to be accomplished. Both perspectives, therefore, are valuable when striving towards holistic health and social care provision. These are issues I will be mindful of in my future practice and I will endeavor to continue to practice with integrity and in an anti-oppressive way in order to implement person centered care provision.

To conclude, as a result of my practice experience and learning achieved from the conference, I feel strongly that a critical part of my future role as a qualified social worker is to facilitate the sharing of information between professionals. When appropriate, to advocate the service users individual wishes and to ensure all professionals are aware of these shared common goals. I feel this will contribute significantly to achieving the highest level of care for the service user and aims to support the safeguarding of both adults and children.

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Section 3.
References

Ashcroft, J. & Meads, G. With, Barr, H. Scott, R. & Wild, A. (2005) The case for Interprofessional collaboration: In health and social care. Oxford, Blackwell Publishing.

Banks, S. (2006) Ethics and values in social work. Basingstoke, Palgrave Macmillen.

Barbour, R.S. (1985) Dealing with the transsituational demands of professional socialisation. Sociological Review 3: 495 – 531.

Carpenter, J. & Hewstone, M. (1996) Shared learning for doctors and social workers: evaluation of a programme, British Journal of Social Work 26: 239- 57.

Centre for the advancement of interprofessional education (1997) Interprofessional education: A definition. London, CAIPE.

Conyne, R, K. (1999) Failures in group work: How we can learn from our mistakes. London, Sage Publications Ltd.

Cook, G, Gerrish. K, & Clarke, C. (2001) Decision making in teams: issues arising from two evaluations. Journal of Interprofessional Care 15: 141 – 51.

Dominelli, L. ( 1996) Deprofessionalising social work: Equal opportunities, competences and postmodernism. British Journal of Social Work 26 : 153- 75.

Dominelli, L. (2002) Anti-oppressive social work theory and practice. Basingstoke, Palgrave Macmillen.

Drake, S. & Williams. V. The Intermediate care team: Interprofessional working seminar 7th October 2010. UWE Bristol, IPE Level 2 Conference.

Dunning, J. (2010) Claim of ‘extra ?2bn’ for social care challenged as cuts loom’. Community care ( Magazine) 28 October 2010, p.5.

Fook, J. (2002) Social work critical theory and practice. London, Routledge.

Frost, N. Robinson, M. Anning, A.(2005) Social workers in multidisciplinary teams: issues and dilemmas for professional practice . Child and family social work 10: 187 – 96.

Johnson, D.W. & Johnson, F.P. (1994) Joining together: Group theory and group skills (5th edn), Boston, Allyn & Bacon.

Laming, Lord (2003) The Victoria Climbie Inquiry: report of an inquiry by Lord Laming. London, The Stationary Office.

Available from:

http://www.Victoria-Climbie-inquiry.org.uk/

(Accessed 29 October 2010).

Laming, Lord ( 2009). Peter Connelly – Serious case review.

Available from:

http://www.haringey/scb_org/executive_summary-peter-final.pdf

(Accessed 17 November 2010).

Lombard, D. (2009) Negative coverage often fails to give right of reply. Community care (Magazine) 12 May 2009, p.21.

Making partnership work for patients, carers and service users: A strategic agreement between the Department of Health, the NHS and the community and voluntary sector (2004).

Available from:

http://www.dhgov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4089516.pdf

(Accessed 28 October 2010).

McGregor, K. (2010) Unison campaigns to boost appreciation of social workers.

Available from:

http://www.communitycare.co.uk/articles/2010/03/15/114049/unison-campaigns-to-boost-appreciation-of-social-workers.htm

(Accessed 04 November 2010).

Meads, G. & Ashcroft, J. With, Barr, H, Scott, R. & Wild, A. ( 2005) The case for interprofessional collaboration in health and social care. Oxford, Blackwell Publishing.

Molyneux, J. (2001) Interprofessional teamworking: what makes teams work well? Journal of Interprofessional care 15: 29 – 35.

Mullender, A. & Ward, D. (1991) Self directed groupwork: Users take action for empowerment, London, Whiting & Birch.

NHS & Community Care Act ( 1990).

Available from:

http://www.legislation.gov.uk/ukpga/1990/19/contents

(Accessed 16 November 2010).

Payne, M. (2000) Teamwork in multiprofessional care, Basingstoke, Palgrave Macmillen.

Payne, M. (2006) What is professional social work? Bristol, The Policy Press.

Petch, A. (2002) Intermediate care: What do we know about older peoples experiences?

Available from:

http://www.jrf.org.uk/sites/files/jrf/18593513/x.pdf

(Accessed 14 November 2010).

Putting people first: A shared vision and commitment to the transformation of adult social care (2007).

Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081119.pdf

(Accessed 01 November 2010).

Reeves, S. Zwarenstein, M. Goldman, J. Barr, H. Hammick, M. & Koppel, I. (2009) Interprofesisonal education: effects on professional practice and health care outcomes. The Cochrane Collaboration, Wiley & Sons.

Roe, B. & Beech, R. (2005) Intermediate and continuing care: Policy and practice. Oxford, Blackwell Publishing Ltd.

Skills for care ( 2009) National occupational standards for social work.

Available from:

http://www.skillsforcare.org/developing_skills/national_occupational_standards/National_occupational_standards_(NOS)_Health_and_social_care.asp

(Accessed 01 November 2010).

Walker, S. & Beckett, C. (2003) Social work assessment and intervention, Lyme Regis, Russell House Publishing.

Section 4.

The objective of this research paper is to discuss the personal attributes that are required in a physically and emotionally healthy counselor. A healthy counselor has a positive effect on his or her client. The field of counseling is becoming significant part of people’s life. This paper establishes its basis on the conflict of values of counselor and its effects. Another important aspect of the paper is to research about consequence of counselors-in-training interacting with clients prior to their master’s level training. It will highlight the consequences of engaging in practice prior to the training and its effect on capability of handling the client’s issues and queries. This could also lead to issues with the credibility of the counselor. These aspects are studied through literature and case studies done by other writers. Different researches conducted in the past are the major source of information. Foundation of this paper is based on the personal characteristics that a counselor should possess and their values.

Personal Characteristic of Counselors

Counseling is about giving advice and guiding the clients through their difficult times. It relates to the mental health and emotional state of the client. People seek counseling for their careers, jobs, relationships, addictions and general issues of their lives. Counseling is usually used as a synonym for psychotherapy. When in difficult times family and friends are unable to help someone, they seek for guidance, strength and answers from their counselor. Counseling is practices in sessions of an hour or so for once or twice in a week. Counselor and client both play vital roles in the recovery of client. Counselor’s expertise will be of no use if client does not fully share his or her problem. So, both have to be supportive and persistent while conducting these sessions.

Counseling is a field that requires patience, rational thinking and empathy. Counselors make a difference in the lives of other people. It is important for a counselor to feel empathy for the client. As Guidon (2010)describes, a sympathetic person wants to solve the issue him/herself but a person who feels empathy does not mix client’s problem with their own. Counselors lead a demanding life. Their clients require not only their time and advice but also trust and care. Therefore, a counselor needs to have very specific qualities in their personality in order to provide effective service to their clients. Other than the obvious personal abilities like interpersonal skills, counselors require many personality traits to be effective and efficient. Corey (2009) says that there are many characteristics of counselors which seem unrealistic but these are equally essential for any counselor. Before giving advice to clients, a counselor him/herself needs to be sure of their capabilities. Sincerity and honesty are very important in this field.

A counselor needs to be observant, active listener, interviewing, influential and focused. The effective councilor also requires a sound knowledge of theory and ability to put theory into practice (Gregoire & Jungers, 2007). Corey (2009) states that it is very important for effective counselor to maintain healthy boundaries, this way they should be able to maintain a balance between their personal and professional lives. Corey also concluded from his research that counselor should have a good sense of humor in order to lighten the mood. Guindon (2010)believes that clients give a counselor many non-tangible gifts like trust, care and confidence. Corey (2009) also says that the relationship of client and counselor helps both parties. Consolers learn how to admit their mistakes and become open to change in their lives.

McLoead (2011)discusses the qualities of people who are drawn to the field of counseling. Usually people who become counselors believe that relationships are the most important aspect of human life. They are also firm believers in the values that prove the worth of people and they are clear about their role in society and their future goals. Another most important personal trait of counselor is to be honest and keep the privacy of patient. It is their moral and professional obligation.

Values and its Confilcts

Values are the standard held by people about what is desired, proper and acceptable. It gives people a criterion of standards for shaping their lives. Both personal and professional values are important. Personal values affect the way of interaction with the client. Personal values of a consoler are developed as he/she grows up; they depend upon the upbringing and culture in which the counselor spends most of the time. Personal values include honesty, truth, helping others, doing meaningful work and positive influence on others (Corey, 2009). There is always a chance that the personal values of a counselor conflicts with the work values. Busacca (2010) tells that personal values conflict with the work values. If a counselor has a personal belief that a terminally ill person should have the right to end their lives; however, he cannot impose this thinking on anyone else. Studies show that counselors, while training, question their self-concepts with those requires for their field of work. Counselors have appeared to be molding themselves in their professional values after certain period of time. They have to create their own boundaries in which they want to practice.

Research (Sanders, 2003) shows that cultural difference between client and counselor can have a major impact on the relationship and therapy. The personal biases on either side can result in failure of professional values and ethics. High level of sincerity can reduce the cultural barrier among client and counselor. The counselor has to have a non-judgmental attitude towards the client regardless of his/her personal values. Campbel & Christopher (2012)also say that the counselor has to be physically, mentally, emotionally and cognitively on the same level with the client at all times. Mostly, counselors have to deal with grief counseling for their clients. Counselors, who are more self-aware and comfortable in sharing their feelings, are more efficient and effective at their work (Ober, Granello, & Wheaton, 2012).

Professional values determine the role of a person in organization and the ability of balancing work and family. Work values of counselor include taking responsibility, empathies, develop counseling style, share responsibility with client and tolerate ambiguity. The common issues where conflict of values occurs are religion, sexual orientation and someone’s right to die. Serious consequences might occur as a result of these conflicts (Guindon, 2010).

We can conclude that personal values of counselors can conflict with the professional values. However, strong personal values will work in favor of the counselors. A counselor with strong moral and ethical values will have a positive influence on the clients. Whereas if a counselor doesn’t practice honesty, integrity and privacy of others than he or she is more likely to face difficulty in understanding a client with strong moral values. Although a counselor cannot impose their personal values on clients but they can have a very positive effect in influencing and helping the client in their difficult times. If there is a strong disagreement between the values then it might result in referral to another counselor but most of the times this conflict can be resolved with cold-mindedness and rational thinking.

Trainee Counselor

Survey (Busacca, Beebe, & Toman, 2010) shows that practicing counselors show matured level of values than trainee counselors. Yager & Tovar-Blank (2007) also comment that counseling is a profession which is very stressful, tiring and with constant threat of fatigue and burn out. Trainee counselors do not completely practice cognitive counseling and usually under their instructors influence. For students of counseling it is very important to learn the wellness of the client and themselves. The curriculum has to be designed in such a way that they are completely aware of this idea and its implications. Grief counseling is a very important aspect of psychotherapy. If the trainees indulge themselves in practice before understanding the importance of wellness, skill and knowledge required for grief counseling, they are bound to miss lead the client. Without the master’s level training, the trainee counselors are not fully prepared to help the client and understand the delicate nature of the job. At this level, trainees themselves are in conflict with requirements of their profession and their personal moral and ethical values and beliefs (Ober, Granello, & Wheaton, 2012).

Statistics by Gaubatz & Vera (2006)show that only 4-5% trainees enrolled in master’ or doctoral program are prevalent than those in undergraduate level. Statistic also shows that only 10% of students enrolled in mater’s program are suitable for the field of counseling. However, Woodside (2007) says that it is better for trainee counselors to interact with the clients. But, this interaction should be under the guidance of a practicing professional counselor. Internships are a very effective way of learning by example. Yager & Tovar-Blank, 2007 (2007) on the other hand is of the opinion that if an emotionally unstable student is enrolled in counseling program then the course should be deigned in such a way that it should enlighten the student and make him self-aware. If such a student practices before being properly trained, he will not be able to understand the client and might make the situation worse of the client.

The research (Woodside, Oberman, Cole, & Carruth, 2007) shows that the student of undergraduate level is not fully matures and trained. Most of them show signs of anxiety and confusion about converting theory into practice. Those who feel confident are not fully trained and hence experience disanointed clients and they themselves become more confused. There are three basic stages of counselor’s professional development including the helper, the beginning student and the advanced student. Passing through various techniques and training, trainees reach the next level of their professional development. Another research (Busacca, Beebe, & Toman, 2010) shows that at training level counselors-to-be explore their inner values and self-concept. This stage defines who they actually are and what they actually want to be. Being self-aware and knowing personal characteristics is as important as learning the theories of counseling. Once they are clear about their own values, they can determine the bounties in which they want to work. Not everyone can work in a profession that demands occasional conflicts of personal and professional values and ethics.

Hence, keeping the view of the research conducted by various experts, we can say that trainees who start seeing clients before their master’s level training are bound to suffer a shock. They will not be able to handle the clients. Their own values will not be in sync with their professional demands. Being not fully self-aware and lack of proper training might lead them not only to a dissatisfied client but they might also add to the misery of their client. If they give advice according to their personal ethics and values rather than professional values, their clients will doubt their sincerity towards them. All in all, it will not be a good decision to practice before having some master’s level training.

Conclusion

Counseling is not only a profession but also a great responsibility. It is a vast field which includes career counseling, grief counseling, behavior therapy, heath counseling and also covers issues like addiction, mental health and relationship issues. Clients confine everything in their therapist and seek their guidance in various aspects of their lives. To become a counselor, one has to possess certain qualities like theoretical knowledge of personality, empathy for client’s situation, understanding behavior, attentive listening ability and power of deduction.

After studying the literature pertinent to personality and values of a counselor, it can be concluded that both of these are very important for the professional development of a counselor. Their personality not only defines who they are but also determines how efficient they are in their profession. Strong moral and ethical values of a counselor can make the relationship with clients stronger. Clients will rely on the counselor for his/her advice. If in-training counselors try to treat their patients before master level training, they are more likely to have cognitive issues and difficulty in dealing with their own personality and work value conflict. So, it is better to start practicing once you are finished with training so that there is no confusion between personal and work values.

Values are part of my upbringing and play a big part in my life, as they underpin my thoughts and actions. As a social work student I need to question my personal values, beliefs and ethics as these will have a big impact on my behaviour as a professional. My personal values are congruent to the values of social work, which is the reason why I have chosen a career in a social care. This values are self – determination to promote social justice, being caring and helpful toward others, truthfulness (honesty) and respect. Working in Residential and Care Homes further developed my interest in promoting social justice and social change on behalf of the service users. I understand, that as a social work student I need to act in accordance with the values, and ethics of the profession, recognizing how personal and professional values may conflict with the needs of diverse clients.

VALUING DIVERSITY

To value diversity means acknowledging my own prejudices, allowing people to be different and respecting these differences. Being raised in Poland, where 96, 7% of population is polish my upbringing was “white” and influenced my prejudice about people from other cultures. Due to lack of contact and knowledge I have made a preconceived judgment about other races. My social environment such as religion and culture has influenced me to behave in certain ways towards other people. My religion created a stereotype and prejudice about homosexuality. My beliefs would not accept homosexuality due to influence of the church on my attitude towards sexual orientation. Moving to England and changing my social environment made me realize how wrong those perceptions were. Living in multicultural environment made me aware of different cultures, religions, races, which helped me to change my attitude towards people from diverse backgrounds. I have made friends from different parts of the world what helped me to enhance my understanding of different cultures and religions. I have learned how to accept and respect the differences. I understand and recognise that we living in a diverse society and that there is much

to be gained by having a variety of people, with a variety of backgrounds, approaches, talents and contributions.

DISCRIMINATION

My experience with discrimination started when I moved to England in 2004. I was often subject to insulting racial jokes. The stereotypes about my culture and people along with labelling were very offensive and painful. The people with whom I have been working held hostile attitudes toward Polish people and culture. I was working in Bed and Breakfast where the majority of employees were English. My employer treated me differently than other employees. When allocating the tasks, she would often give me the most of them living the rest of the staff doing almost nothing. On one occasion one of the employees did not complete the given task and she said “Let the Polish get on with this”. She would not have dared to treat other employees the way she treated me. Probably she thought that she could get away with it because I did not know my rights and my English language was very poor. I found that experience very painful and could not understand why I was treated this way. Later on I have discovered that it was a direct discrimination and it is against the law to be treated this way. There are a number of policies and legislations that could apply to my situation such as:

The 1976 Race Relations Act, which “makes it unlawful for an employer to discriminate against you on racial grounds. Race includes: colour, nationality, ethnic or national origins”. ( www.direct.gov.uk)

The Equality Act 2010 “provides a new cross-cutting legislative framework to protect the rights of individuals and advance equality of opportunity for all; to update, simplify and strengthen the previous legislation; and to deliver a simple, modern and accessible framework of discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society”.( www.equalities.gov.uk)

I could also use agencies such as Citizen Advice Bureau, which provides free advice to foreigners, and often offer a translator to provide information and advice on employment rights, including discrimination. ACAS is another organisation, which provides general information on employment rights and responsibilities.

Being discriminated in the past made me realise how damaging the effects of discrimination can be. I have started to wonder why people discriminate against each other. On many occasions I have witness discrimination but due to lack of knowledge I was not able to challenge it and simply accept or ignore it. Last year on the Access Course I have developed a knowledge which helped me to understand why discrimination happens in society. I have learned different theories behind discrimination which helped me to understand its roots. Since then I have become more observant and started to reflect on my own actions and actions of others. Schon (1983) identifies two types of reflection. Reflection – in – action, which is “thinking back on what we have done in order to discover how our knowing in action may have contributed to an unexpected outcome. We may do so after the fact, in tranquillity or we may pause in the midst of action (stop and think) “(Schon,1987:26). Reflection -in -action is about challenging my assumptions, thinking again, in a new way about the problem that I have encountered. Reflection – In – Action is happening “where we may reflect in the midst of action without interrupting it. Our thinking serves to reshape what we are doing while doing it” (Schon, 1987:26).

By observing others in my current work place I have identified negative experiences present in a Care Home based on feelings of discrimination and unfair treatment which was against my own values and believes. One of the examples of discrimination that I have witness was discrimination through the language. Working in a Residential Home as a carer I have noticed a member of staff using patronising and insulting language towards residents. I found that language very disrespecting and decided to challenge my colleague. I have realized that he held a negative attitude towards older people, as he regards to residents as ” dirty old woman”, and call them as “useless “. I have explained to him that one day he also will be old and

is that the way he would like to be seen. At this point my Manager came in and after explaining what has happen, the member of staff was asked to leave the premises. In reflection on this experience I have realized that people have different attitudes to aged population, which are different to my own attitude.

Another observation involves a resident having negative attitudes towards black people. The resident would not allow a black member of staff to provide any kind of help or personal care. She would shout and swear using insulting language as soon as they entered the room. Because the majority of carers are black it is hard to allocate a white member of staff to help her. When asking her why she does not want a black member of staff she answered that she “does not want blacks to help or touch her because they are dirty and “useless”. On one occasion when attending this resident I decided to challenge her perceptions about black people and called a new black member of staff to help me when giving personal care. I have explained to the resident that she is a new member of staff and she will only observe me. She accepted it but was not very happy about it. While working with resident I started to ask the girl questions, such as why she wants to work here and does she like her job. She responds that she was looking after her grandmother who passed away recently and has a lot of experience and that she enjoys helping other people. The resident was listening but did not say anything. I was hoping that she will change her negative attitude after spending some time with the black member of staff, after watching me having a positive interaction with her. Not being aware of the resident attitude the girl asked her if she would like her to do her hair because she used to do it very nice to her grandmother. The resident did not answer just sat on the chair and gave the girl a hair brush. On that stage I have left the room hoping that this experience will change her attitude and prejudice against black people. The resident now is being attended by black staff without any problems, and communicating in a respectful way.

REFLECTION ON THE POLICIES OF CHALLENGING DISCRIMINATION IN MY WORK PLACE (JEWISH RESIDENTIAL HOME)

The use of Anti – Discriminatory practice at my work place is fundamental to the ethical basis of care provision, and equality legislation is crucial to the protection of service users dignity. It imposes particular responsibilities on public and service providers to avoid stereotyping and to respect service user’s diverse needs and cultural diversity. To challenge discrimination Jewish Care has put into place a written policies and procedures to deal with discriminatory behaviour and practice.

CHALLENGING DISCRIMINATION AND OPPRESSION

A starting point in challenging discrimination and oppression is having awareness of the different types and ways that discrimination and oppression can occur. Thompson PCS Analysis provides a clear and understandable method of consideration discrimination and oppression in the context of personal, cultural and societal levels. The process of empowerment is also crucial in challenging oppression. On a personal level we could empower individuals to take control over their lives, for example through enhancement of self-esteem and confidence. On a cultural level empowerment is concerned with becoming aware of ideologies premised on inequality. Discriminatory assumptions and stereotypes should be challenged in order to break down an oppressive culture. On a structural level empowerment involve abolition of structural inequalities from the structure of society. Education plays important role in challenging discrimination. By educating people to understand the causes and effects of discrimination we can challenge traditional beliefs and practices concerning particular groups and promote equality, diversity, inclusion and tolerance.

ANTI – DISCRIMINATORY PRACTICE

Anti – discriminatory practice is an approach which seeks to combat discrimination and oppression, in terms of challenging all forms of discrimination and oppression from our own practice and practice of others (Thompson, 2006).

As a social work student I need to develop further my anti – discriminatory practice. To do so I have to recognise the significance of discrimination in people’s lives, especially in the lives of disadvantaged people. I also need to develop self-awareness and make sure, that my own action does not reinforce discrimination.

The aim of this essay is to critically evaluate my readiness to start counselling employment. There will be a number of key issues integrated into this essay that will explore my learning needs in the context of my professional counselling. These will include personal reflexive and reflective practice where I will introduce Argyris & Schon’s ( 1974) Increasing Professional Effectiveness Model, self awareness, issues of difference, placements and supervision.

I will discuss the values and moral qualities of the BACP ethical framework in relation to experiences of my placement. I shall discuss and explore the importance of professional boundaries along with contracts within the counselling setting. I will introduce Kolb’s experiential learning inventory and apply its elements to how it has influenced my learning since starting my counselling degree and how it has become a part of who I am. In relation to placement and supervision I hope to discuss some of my experiences with clients in therapy, the organisation in terms of policies and procedures, as well as how I found the experience of supervision to be.

In relation to this I will also discuss beginnings and endings, my feelings around both and how I manage these. I will discuss the topic of stress and burn out and strategies for preventing the risk of this as I prepare myself for a career in the field of counselling.

The end is near, my counselling journey I mean and although I am full of mixed emotions revolving around the end, I am at a stage of this journey where I feel comfortable in relation to who I am and where I am going in terms of a career in counselling. All endings bring mixed emotions, for some it is change, rebirth and goodbyes, for me it is the question of what is expected of me next and will I meet these expectations. Schon (2001) states that change is a fundamental feature of modern life.

I never had many negative experiences around beginnings and I think one of the reasons for this is because of my top character strength which is social intelligence. I always seem to be aware of the motives and feelings of others and know what to do to put people at ease along with knowing what to do to fit in to various social situations. Although in saying this I found making the contracts with my clients a difficult task.

It wasn’t that my clients didn’t want to make the contract, the difficult part was collaboratively working together on a contract that best fitted each client, bearing in mind two of them were under eight years of age. I successfully managed to make a contract with each of my clients and it was a great experience, for two of them were pieces of clay. According to Molteni and Garske (1983) contracts may increase compliance with the processes of the therapeutic process.

Endings on the other hand are not as easy for me, I understand they are part of life and sometimes we need to end so we can grow and develop as individuals. This course and especially this module has helped me to bring these fears and emotions into awareness and reflect on them so I can understand what lies behind them. It is important for individuals to let go and move on as this is like the child leaving home for the very first time.

The child needs to leave to gain independence and knowledge about the world. I seem to be experiencing quite a lot of endings this year in particular. I have just recently finished a placement where I was working as a trainee counsellor with children.

I have been working with three clients close to a year and was quite worried at how these endings would go. Along with the ending work with my clients I was also ending with my supervisor who has been very supportive of me during my time there, I never once felt isolated or alone. I am quite pleased to say that these endings went extremely well as I have been working hard for a number of months with my clients on them.

During these months I would make small endings at the end of each session as it was like a countdown for my clients so when we got to the final session it wasn’t a big dramatic ending, they were well aware and ready for it. I feel extremely proud of the therapeutic work I have done with each of my clients. It was not easy at times but I persevered and learned a lot from my struggles. It is not easy to hear a child introduce erotic material but I coped well.

On reflection of these endings in particular, I was surprised at how well I managed my own, I have come to the understanding that I managed mine so well because I knew my clients where ready to end and move on. This allowed me the incentive to then manage mine so well. I love the metaphor that Dallas and Stedman (2009) use to describe reflection. They describe it as a mirror reflecting our own image back to us (Dallas and Stedman 2009). Dallos and Stedman (2009) suggest that reflective practice is best seen as a process of analysing and reanalysing important episodes of activity.

The term reflection in action is used to refer to the spontaneous act of reflecting in the moment (Dallas and Stedman 2009). I have had a lot of these spontaneous acts and found myself at times getting lost in them. When working with children, metaphor and symbols act for a lot of the communication. I have often found myself questioning something in my head while I am reflecting in action and at times had to snap myself out of it as I was aware my focus was coming away from the client.

Reflecting on action which Dallas and Stedman (2009) call reflexivity is a great way to question what was going on for me at that time and what was it about that particular episode that I lost my focus. I find reflection is a great strategy for promoting self care. For me this means quiet time for myself to reflect and get lost in my own cognitions without being disturbed. I feel it is important to look after ones self as this can prevent the cause of stress and burnout. Also by having quiet time to yourself to mull over the day or week that has passed is an excellent way to manage ones stress.

The feedback from supervision has been outstanding with reference to how quickly I built trusting relationships with my clients and the depth I was able to work at despite this being my first year of any placement. The experience around ending with my supervisor was another healthy ending. I think the biggest reason for this is after all of the positive feedback I received from her I knew I was then ready to end.

This brings me to the conclusion that it isn’t really the endings I have trouble with, it has more to do with how I end. What I mean is that I may not deal with a spontaneous ending as well as one I know is coming, which makes sense. Although saying this I know I would handle it better than I think I would. My counselling endings remind me of personal endings I have experienced in the past. The ending that comes to mind is when I left my family home in Ireland for the first time. I remember how lonesome I felt after moving away as myself and my family are very close. It was like the end of an era and even though I visit them quite often, every time I leave them to come back to London, its another ending in itself.

In relation to ending with my clients, if I ended and seen that they weren’t ready to end, or that I knew I hadn’t been doing all I could to apply emotional support to my them, then I am sure the endings would not have went so smooth for me. I have learned a valuable lesson from these ending experiences, although they went well, its ok that I feel sad, it shows that I care. The feelings I have are quite calm and peaceful , of course I wont forget my first clients and I will think about them from time to time but the important thing for me is that I don’t have any emotional ties with them so It is ok for me to think about them and move on. I really don’t think these endings would have gone as well if it hadn’t been for all of the support I received from supervision.

My supervisor and I jelled straight away and because of my honesty and openness in supervision it allowed us to examine my work in depth and maximise my learning. I feel the greatest compliment I have received from supervision is being told that I have begun to develop my own internal supervisor.

Ongoing supervision is a requirement of the BACP (2010). The BACP (2010) believes that supervision can positively contribute to the maintenance and development of ethical professional practice. In my opinion it is a necessity for all counsellors to have ongoing supervision to support counsellors, to enhance effective practice and a supervisor can act as a safety net for the counsellor. According to Feltham (2010) supervision is mandatory for all counsellors regardless of their experience even if it is difficult to find a suitable supervisor.

The atmosphere always seemed quite calm and relaxed which I enjoyed. I like to avoid confrontation at all costs, a negative atmosphere in the work place doesn’t just effect who is involved in it but affects everyone. This can have quite a negative effect on the job that one is doing and the clients whom we are working with. It can also lead to stress and burn out as research has shown that people who don’t feel supported and are not happy in the work place are more prone to stress (Salami 2011). I am quite lucky as I have very rarely experienced confrontation in the work place.

On the rare occasion that I have, I dealt with it by discussing the problem and having it out in the open. We were then able to keep our professional heads, get past it and focus on the job at hand. Money could not by the experiences I have had on my placement. I followed all the rigorous procedures for dealing with a child protection matter which I dealt with very well and in context to the BACP (2010) ethical framework.

When placing myself in the context of values, moral qualities and personal boundaries of the BACP (2010) Ethical Framework I feel that I am ethically mindful when delivering these services required by the BACP(2010). My moral qualities include empathy, resilience, respect, Integrity and courage. I believe one of the reasons I am so mindful comes from my therapeutic core model which is person centred (Rogers 1961). The emphasis is on creating a safe environment to discuss issues in a warm and non judgemental way. By using the core conditions effectively I feel there is little chance of harming my clients.

I followed all of the Place 2 be policies and procedures from the no touch policy to holding the boundaries firmly. It was quite difficult at times to avoid my clients trying to hug me but after a while I was able to use my body to my advantage of avoiding my client hugging me as I would intuitively know when it was going to happen and was able to move my body to the side so it would be avoided, keeping in mind that I didn’t want it to come across as rejection.

I understand that life in general can be suffering and we don’t have all the answers to our issues but it is about managing that suffering so it doesn’t take over our lives. Becoming a counsellor may have different meanings for many individuals. It can be the lust for power to sit in the power chair, for others it may be the need to feel needed, for me it comes down to supporting clients emotionally so they can end as much of their suffering as possible.

I believe self awareness to be one of the most significant skills I have learned during this degree. Over the duration, my self awareness has developed and I have a greater understanding of my inner and outer self. I think self awareness is crucial for understanding my own feelings as well as the client’s feelings in the therapy room. I believe it is extremely important to be mindful of the diversity in the counselling profession. I am well aware of my biases towards other individuals but I will leave them outside of the therapy room.

My mentality is that I am here to provide a service and why should I let my own values and beliefs get in the way of applying emotional support to an individual. I also feel that a lot of my biases come from being uneducated around a certain culture or race. I feel it is my professional duty to educate myself around these different culture so I am not creating unnecessary boundaries. Lago (2006) states that counsellors should educate themselves about the specificities of different cultures in order to develop competence for working with what has been classed as the culturally different.

I have found reflection to be very useful in relation to areas of the Johari window (Evans 2007). The area in which I seem to struggle with the most is giving constructive feedback. The reason for this is the individual may misinterpret what I am saying if they feel the feedback is negative. I have enjoyed learning about the johari window (Evans 2007) and have used it in a number of different areas of my life.

I found supervision to be an excellent way of acquiring my blind spots. I think personal therapy would be fundamental in relation to the johari window (Evans 2007), not only would it help to discover areas within myself but I feel talking around them may to become more aware of them.

I believe this is sufficient for all trainee counsellors before they start to practice. I don’t believe it is fair to start counselling without having experienced what it is like to sit in the clients chair. My plan to access a counsellor will be through a professional body such as the BACP (2010) because anyone can advertise themselves as counsellors. I believe this is the safest way as the counsellor will be an accredited member of a professional body. Personal therapy enhances professional development and relational capacities aswel as increasing personal development capacities and well being of the counsellor (Orlinsky, Schofield, Schroder and Kazantzis 2011).

In conclusion of this essay I am very pleased with my development thus far, both personally as well as professionally. I feel I am shifting every time I learn something new. I am so enthusiastic about the work with clients and I feel I would benefit from fully recognising my strengths and letting my confidence grow still further. I would also benefit from further reading of a variety of different theoretical approaches which I plan to do as should every counsellor regardless of experience. I am proud of the feedback I received from my supervisor, this has influenced my competence levels as a counsellor.

For further training and professional development needs I would like to work with adults using symbols and metaphor. My greatest influence has come from the work of Carl Jung’s Archetypes (Jung 1961) and the magic of metaphor through working at the Place 2 be. I would also be interested in more work with children as I would like to gain more experience in this field. According to my supervisor I seem to have a natural style of being with children. I have really enjoyed working with them, it has been very experiential and exciting. I go from here in search of a new placement where I hope to get a similar experience although knowing if I don’t I will learn something knew.

PERCEPTIONS OF HEALTH, DISABILITY, ILLNESS AND BEHAVIOUR

How health and social care users relate to the concepts of impairment and challenging behaviours

Users of health and social care are usually in need of social care depending on the nature and intensity of their illness. Disabled individuals like Mr. Holland Park are why the importance of the underlying relationships between health, disability and illnesses must be understood and further develop strategies that will ensure better quality of life for him and other users alike. Severe medical conditions can result in limited access to proper healthcare; even as many in the general public have the misconception about how healthcare is received by individuals with disabilities. Recent laws and policies by the government like the Disability Discrimination Act, which covers all community health care services and hospitals compels service providers to make specific adjustments to healthcare practices, and also to ascertain the practicality of these adjustments is directed towards users with specific needs as is the case with Mr. Holland Park.

Impact of past and present policies and legislations on available healthcare services

Mr. Holland Park is currently a member of a family that cares for him for very much hence it is typical for other members of his family to worry about his wellbeing in any care home he lives in.

In the past, legislations and social policies are developed in general terms that encompasses every health and social sector with policies affecting the general public and everyone residing within the United Kingdom. However, changes that been made over the years to suit specific aspects of the community, and precise laws are developed and others redefined to guarantee that every individual regardless of their medical condition, race, social class, religion or ethnicity receives the best care available.

Mr. Holland Park is over a certain age and may be worried about being subjected to any kind of abuse or neglect due to his health. This is because the society may sometimes be unwelcoming to behaviours exhibited by individuals with certain illness, as some exhibit behaviours that may view as strange and unusual. This is why the legislations are defined in such a way that people, especially workers of care homes must abandon the general negative perceptions about disabled users, and commit only to the provision of suitable and adequate health care services to such individuals.

The family of Mr. Holland Park will have nothing to worry about as every kind of misconception about any kind of illness will be overlooked and the best care made available for him in this care home or whichever one as the policies are well monitored and regular unannounced checks are done to certify adherence to these legislations.

The promotion and protection of disability rights has been improved majorly in the United Kingdom, making the United Kingdom a pioneer in liaison of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

Policies and Legislation in recent years

Under the Disability Discrimination Act 1995 (DDA 1995), it is a violation of law to discriminate against disabled people in areas of including provision of services, employment, goods or facilities. Hence making it an obligation for service providers to ensure sensible modifications are made to engage disabled individuals in using their services. Consequent modifications were made via derivative legislations like Disability Discrimination Act 1995 (Amendment) Regulations 2003 through principal legislation like the Disability Discrimination Act 2005 and Special Educational Needs and Disability Act 2001. These acts made provision for a Disability Equality Duty making it a responsibility for public authorities to take passive roles in the promotion of fairness in treatment of disabled people.

The Human Rights Act 1998 calls for the need for every public authority to operate in a way which is attuned with the rights put in place in the European Convention on Human Rights. Should public authorities fall short, affected individuals and their families are permitted to seek a judicial remedy. Public authorities include central social and health care homes, National Health Service (NHS) and their trusts, Government, and most providers of public services.

In recent times, there is a more direct approach to the UK anti-discrimination legislation via the Equality Act 2010 which annulled and replaced the DDA in Great Britain alone. This Act not only encompasses the protection of disabled individuals from any kind of segregation, but also applied modifications to certain responsibilities of the public authorities regarding the participation of disabled individuals in policy decisions.

The Equality 2025 was created in 2006 as a government has a themed goal ‘Improving the Life Chances of Disabled People’ with a year 2025 target for disabled individual living in Britain to the treated as equal members of the society and have full access to develop their quality of life. It is particularly designed to assist disabled people attain independent living by moving gradually towards individual budgets that will bring together various services they will be entitled to and giving them various choices over diverse support from either direct provision of services and/or money.

HOW HEALTH AND SOCIAL CARE SERVICES SUPPORT INDIVIDUALS WITH SPECIFIC NEEDS

Available care needs for Mr. Holland Park

Mr. Holland Park being an elderly man in the early stages of dementia and additional visual and hearing disabilities means he will be needing special attention as his behaviours might sometimes be queer, and at other serious times sporadic and violent. The care home will be focused on providing assistance that will uphold his independence and therefore enable his stability whilst receiving dependable services that will suit his individual needs.

Provision of audio-visual equipment will assist Mr. Holland Park to make the best of his little sight. This will be after a proper assessment has been carried out by professionals to determine the seriousness of his blindness. As he is also hearing impaired, it will be best to make sure that he moves around the care home safely by having rotational care staff check on his whereabouts on a regular basis and a log kept to this effect. Also, he will need to participate in regular activities to keep him in good spirit.

Being partially deaf-blind can be challenging for Mr. Holland Park as he may sometimes feel less capable, it is the duty of our care home to ensure that he feels less challenged by engaging him in peer group activities that involves other service users. This way, he feels more active and energetic and he can take his mind off any heavy thought of being a burden to others.

The most important factor to providing the best care services to Mr. Holland Park is that the care staffs will never regard his challenging behaviours as a form of challenge, but will work towards providing him with a comfortable lifestyle by ensuring his hygiene is well taken care of. Also, his laundry will be done for him and meals and drinks will be prepared as he wants it on a timely basis and he will have a variety of menu of choose from. Should he be entitled to any benefits, we will make it our duty to assist him in claiming these benefits for him and the family and provide any necessary references or letters to state that he is under our care.

Available local services to support Mr. Holland Park and his family

Disabled individuals like Mr. Holland Park with dementia care are eligible for Special Rehabilitation Services that are provided by Disability Service Teams via direct referrals from health care providers. He and his family will benefit from this service as it will help to develop his independence and quality of life.

A register for blind and partially blind are kept by the local authority, for provision of further assistance with the Eye Care Trust, and Mr. Holland Park is entitled to receive subsidised and mostly free consultation and treatment, and extra support should he choose to register.

The Alzheimer’s Society is an organisation that assists individuals with dementia (as is the case with Mr. Holland Park) and is supported by the National Health Service (NHS) and Community Care 1990, to assess his needs and provide certain services as required. His family will benefit from subsequent aids and care that will not affect their budget heavily.

Powers of Attorney

It is possible sometime in the future when Mr. Holland Park’s symptoms become very serious and he is unable to decide on his finances or medical treatment. It is best to make arrangements for this by drawing up different Lasting Powers of Attorney- the first to take care of financial decisions and the other to handle health and welfare decisions. Mr. Holland Park will need to appoint a trusted member of the family to act on his behalf should his disability get to this extent. You can find out more information about this, you can call AGE UK or Carers Direct.

APPROACHES AND INTERVENTION STRATEGIES FOR INDIVIDUALS WITH SPECIFIC NEEDS

Intervention strategies for Mr. Holland Park who is the early stages of dementia focuses primarily on tackling the cognitive symptoms that can lead to erratic behaviours. The effectiveness of these interventions will help to enhance his individual functioning and reduce stress, depression or agitation which is common in individuals experiencing disability.

The best therapy applied to Mr. Holland Park and other service users alike was to promote his independence and this boosted his confidence and willingness not just to survive but to live an active daily life and make the best of his body. The promotion of independence will delay or change the later stages of dementia which is usually much harder to manage. Independence in Mr. Holland Park was encouraged by engaging him in reasonable activities up to any level he can tolerate. Also, a balance of maintained for him across personal care and productive leisure, while monitoring his tolerance level.

Potential impact of emerging developments on service users with specific needs

It is critical to access the needs and strengths of service users with specific needs to determine the effectiveness of interventions implemented. The best strategies are accessed through initial stages and the environment was considered to determine the continuity and they include:

Effective communication: Communication strategies applied involved using non-verbal cues and language and sentence structure to integrate high level of individual comprehension and enhanced sensory abilities. Effective communication is essential to the provision of high value health and social care. Without it there cannot be a significant coordination amongst service users and carers. Poor communication is frequently a considerable causative reason for complaint against Health and Social Care organisations and is the basis of numerous depressing user experiences.

Involvement of individuals with challenging behaviours and their carers in the planning, delivery and monitoring of services ascertains that the care and support received meets their desires and objectives.

Activities of Daily Living (ADL) Skills Training: ADL involved accessing users’ abilities, impairments and task performance to understand the psychological factors inhibiting their capabilities. Skills training are carefully assessed during activities that focus on empowering users to independently carry out ADL tasks. During the programmes, users are required to complete individual tasks with minimal assistance. Minimal assistance provided include: visual gestures, facial expressions, physical direction and partial physical assistance.

The potential impact of the development of these strategies is the provision of vital support to effective improvement in health of service users, especially disabled users. There is improved strength through empowerment of independence and mobility and increased endurance levels. Also the physical performance of the users is improved significantly. Another essential benefit of these support systems is the maintenance of functional capabilities of users with physical or communication impairments.

STRATEGIES FOR COPING WITH CHALLENGING BEHAVIOURS

Concepts of challenging behaviours

The relationship that exists between challenging behaviours is mostly viewed as a disorder of some form. There is no such thing as an analytical meaning for challenging behaviour but it can be categorized in various forms including psychological disorder, learning disability, mental illness and many others. A functional disorder of some form generalises the concept of challenging behaviours but will never fully define it.

Challenging behaviour is an expressive concept, which is mainly socially created, and its definition is dependent on changes in social norms and provision of service cross geological areas. The expression itself carries no analytical meaning, and no presumption about the aetiology of the behaviour is made. Challenging behaviour may not relate to psychiatric disorder, but can also be a major or resultant symptom of it.

Challenging behaviour is a moderately objective phrase that has apparent phenomenon. However, this is not the case with most mental illnesses, many of which depends on self-report by the individual for proper analysis. The need of an established expression in individuals with challenging behaviours has caused problems concerning suitable expressions. Different terms like: ‘mental disorder’, ‘mental illness’, ‘emotional distress’ have been utilised inter-changeably e.g. ‘mental illness’.

Potential impact of challenging behaviours on health and social care organisations

Managing the potential impact of challenging behaviours does not lie on one organisation, but rather a collective responsibility of every member of the health and social care system. That is how much impact the challenging behaviours of individuals have affected the health and social sector. This is because different people exhibit various disorders at diverse stages and severity ; hence the effective reason why organisations must work much harder to ensure that every individual is well taken care of regardless of his or her disability.

Organisations have been made to build larger and more effective workforce and research on increased skills and improved knowledge have been carried out.

Cost impact

The continuing occurrence of challenging behaviours in various individuals has had its impact on cost as the weekly care ranges from over ?200 to as much as ?1600 depending on the severity.

In other words, the care services offer to individuals is relative to the features of the care settings and the cost implication. It will always cost more to take care of people with severe challenging behaviours and the greater levels implying that organisations will need to increase their budget on regular basis to adapt to new fiscal year. Eventually, these cost implications will mean that larger facilities must be built and the weekly expenses are likely to increase over the years.

Strategies for working with challenging behaviours

Managing challenging behaviours involves intervention strategies that must recognise and take note of individual’s past and present experiences and must also maintain a standard environment. One of the things that must be noted is that it is inappropriate to label any service user with the term ‘challenging behaviours’ as this is very derogatory and changed the perspective they are related with. Also, the mindset with which they feel about how they fit into the environment is changed should they get used to this label.

Intervention strategies

Depending on how serious the behavioural problem is, intervention strategies are in different categories:

Biological intervention: This deals with analysis of the causes of the particular behaviour. This will mostly require professional assistance in order to source and prescribe proper medication and treatment.

Social intervention: This elemental intervention involves encouraging communities to involve disabled people in social activities so as to make them feel welcomed within the society.

Counselling: This is usually an intervention suitable for individuals with moderate disability. The counselling will involve different behavioural methods like anger-management and relaxation therapy, for possible effect. There is no clear indication as to whether direct or indirect counselling methods will work with individuals that show high level of challenging behaviours like aggression.

Psychotherapy: For over 50 years, psychotherapy has been in practice as a form of management and treatment for people experiencing challenging behaviours. The effectiveness may sometimes vary depending on the level of aggression displayed by the person.

There is a surprisingly long history of psychotherapy with

Cognitive therapies: This kind of therapy is suitable for people whose behaviours are based on personal experiences. The therapist works on improving the behaviour of the individual by changing his/her insight and perception of life.

SELF EVALUATION

Mental health problems are common and widely misunderstood; they are an integral part of public health and can affect all of us. The World Health Organisation (WHO) stated that: “The single most important barrier to overcome in the community is the stigma and associated discrimination towards persons suffering from mental and behavioural disorders” (WHO, 2001, p. 98). Mental health problems are still surrounded by prejudice, fear and ignorance, despite the fact that one in four adults has experienced them. Individuals who suffer from mental health problems often are discriminated against and have to deal with other people’s stigma; these concerns have led to national campaigns. In this essay I will attempt to discuss the concepts surrounding discrimination and stigma in relation to mental ill health and also discuss a current campaign, “See Me”, which is Scotland’s national campaign aimed at putting an end to the negative attitudes and behaviours affecting those who have mental health issues.

In 2002 a Scottish campaign called “See Me” was launched, and was aimed to tackle the issues surrounding mental health problems, and to put an end to the discrimination against mentally ill individuals. Financed by the Scottish government, “See Me” is co-ordinated by five mental health organizations: Highland User Group, Penumbra, and the Royal College of psychiatrics – Scottish division, the Scottish Association for Mental Health Support and in Mind.

In recent years, research has indicated a widespread social stigmatising attitude directed at individuals who suffer from mental health problems (Byrne, 1997, 2001). This has attracted increased attention amongst the general public, health professionals and the press. Stigma has been described by Goffman as “a situation of the individual who is disqualified from full social acceptance” (Goffman, 1963, p. 9). It refers to the negative attitudes and behaviour directed at individuals who suffer from mental health problems.

Stigma can be a variety of issues ranging from being ignored, to being bullied and physically abused. These stigmatizing attitudes as founded upon the belief that someone is not normal, or of lesser value, and can lead to discrimination. Discrimination stems from the lack of knowledge towards mental ill health. To “discriminate” means to apply special treatment, generally unfavourable, to an individual because of their gender, race, age, religious beliefs, or disability. Discrimination can be direct or indirect, positive or negative and in the negative from is unlawful. According to Corrigan and Miller (2003), discrimination is “a direct result of negative attitudes and behaviours towards a group of people.” In 1995, the Disability Discrimination Act ruled that discrimination of individuals based on their disability would be illegal. This applied to workplaces, schools, transport and the provision of goods or services.

Mental Health is a major focus of concern and interest in contemporary society, The world health organisation qualifies mental health as: “a state of well being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community.” NHS Scotland suggests that: positive mental health is about feeling in control, being in touch with our feelings, being able to make rational decisions and feeling good about ourselves, there are many barriers which can effect positive mental health, such as the social world, emotional resilience and structural factors, in order to achieve positive mental health we have to overcome these structural barriers and to do this we need the use of health promotion. Health promotion has been described as ‘the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions”. The term refers to the wide variety of approaches that are applied to help improve health within people, the community and the population. Health promotion allows people the ability and resources to control and improve there overall health. “Health Promotion is concerned with making healthier choices easier choices” (Dennis et al 1982)

Discrimination of all kinds has a detrimental effect on mental health. People with mental illness say that discrimination and the stigma attached to it can in fact be more difficult to handle than the mental health problem itself. Statistics show that almost 66% of the population are in contact with an individual who has mental health problems. Discrimination can pervade every part of their daily life ranging from their personal life to the ability to maintain a basic standard of living. Penn and Wykes (2003) stated: “there is evidence of less favourable social interactions, discrimination in work opportunities and housing as well as their access to health care.” This may exclude individuals from day-to-day activities such as going shopping, going out with friends or being part of local community groups. Social exclusion can be psychologically damaging, harmful to health and can also increase risks of premature death. Statistics also show that nearly 75% of individuals who have mental health problems have been put off applying for jobs due to fear of rejection and job insecurity. Dorling (2009) said that unemployment is associated with worsening mental and can increase the levels of depressions, especially in young people. Penn et al (2003) argues this generates: “a negative worsening effect on ill health.”

The general perception of mental illness has advanced within the last three decades. However, research shows that this has not helped to reduce the levels of discrimination. Every year the Department of Health conducts a survey to find out the attitudes towards mental health. The latest statistics were published on the 8th of May 2008. Some of the key findings showed that 17% of people said that there are particular characteristics of individuals who suffer with mental ill health that distinguish them from people who do not suffer from the illness. 12% stated that they would not choose to have a neighbour who suffers from mental health problem. 7% of people agreed that the mentally ill were a burden to society. So what can we do to help?

See me Scotland was launched in 2002 with one aim ‘to eliminate stigma and discrimination’ in order to succeed in this there were set out five core aims; To challenge individual incidents of stigma and discrimination, To involve people in anti-stigma activities across Scotland at national and local levels and across sectors and communities of interest, To ensure that the voices and experiences of people with mental health problems and their carers are heard and promote a culture of learning and evaluation through all its work, so that effectiveness can be demonstrated and lessons shared. The campaign is based on a set of principles these include non-discrimination, equality, respect for diversity, reciprocity, informal care where possible, and participation. “See me” is working locally and with the media to improve people’s perceptions of mental health problems. “See Me” is also attempting to reconfigure the public’s perception, attitude and knowledge of mental health, to make sure that it is improved in the hope that it will end discrimination against the mentally ill. It will also improve the ability of people who suffer from mental health problems to challenge any discrimination they may face. It will also make sure that businesses value and include mentally ill individuals, as well as those who support them. It also looks to improve the media’s coverage of mental ill-health.

In conclusion despite research showing that knowledge about mental ill health has increased we can see that there is still a great deal of discrimination against those with mental ill health.

Autism Spectrum Disorders start without diagnosis. And ASD is unexpected. The consequences that affect the children are they do not have close relationship with their siblings, their grandparents and even with their parents. ASD children are unable to feel love from their family, especially on mother. In the school, they cannot make a good friendship with other same aged children. In their childhood, they are poorly having imaginative or creative plays. In their teenage life, they start to recognise that they are different. For some of them, they might be encouraged to learn more and try to improve their social skills when they meet the barriers however, others would feel depression, anxiety, or other mental disorders. They may not be able to find pleasure in their daily activities and the environment. People with ASD will fail to respond the emotional signs in human society. Because they are unable to build up the relationship with other people, they would not be able to understand others. This awareness may make them be helpless and hopless.

B. the Family / whanau

I think when there is a child with autism spectrum disorders, their family would suffer more from it. For their parents, they might compare with other children of same age and feel desperate and hopeless. They have to observe their children carefully. Also parents will have uncertain future for their children. Parents also are not able to have their own personal dream, future and even their job because they need to take care of their children. If their children are growing up, taking care of them is very hard and finding a job for them is also a big challenge. Stress is one of the most things that family or whanau will suffer from their children’s disorder. Specially in sleeping problem, parents will have very stressful night everyday and they will burnout so easily. For the family and whanau, there should be lots of caring centre which established by the government so they can use it without a pressure of money spend.

C. the Carers

When carers are taking care of children with autism, they have to keep their eyes on them every time and every moment. Because children with autism cannot have sufficient sleep at night, they become impatient and anxious. This might lead them to have emotional or physical abuse. When parents fail to manage their children’s behavior, children have many bad habits like splitting on the ground, frequent screaming and hitting others. Carers must be aware of their client’s health and don’t let them stay in dangerous situation. Also Carers need to be listenable for their family’s complaints.

signs and symptoms associated with people with Autism Spectrum Disorder(ASD)

Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment, or disability, that children with ASD can have. Some children are mildly impaired by their symptoms, but others are severely disabled. In general, they fall into three areas:

Social impairment
Communication difficulties
Repetitive and stereotyped behaviors.
Social impairment

Most children with ASD have trouble engaging in everyday social interactions.

Make little eye contact

Do not readily seek to share their enjoyment of toys or activities by pointing or showing things to others

Misread or not notice suitable social cues – a smile, a wink or a grimace – that help them understand social relationship or interaction

Have difficulties following directions, being cooperative and doing things on other people’s terms

Their facial expressions, movements, and gestures are often vague or do not match what they are saying. Their tone of voice may not reflect their actual feelings either.

Communication difficulties- both verbal (spoken) and non-verbal (unspoken, such as pointing, eye contact, and smiling)

Develop language at a delayed pace

Learn to communicate using pictures or their own sign language

Use words that seem odd, out of place, or have a special meaning known only to those familiar with the child’s way of communicating.

Repetitive and stereotyped behaviors-repeating words or actions, obsessively following routines or schedules, and playing in repetitive ways
They may insist on eating the same exact meals every day or taking the same exact route to school.
Children with ASD may become fascinated with moving objects or parts of objects, like the wheels on a moving car. They might spend a long time lining up toys in a certain way, rather than playing with them. They may also become very upset if someone accidentally moves one of the toys.
Other related disorders
Sensory disorders

Dislike or show discomfort from a light touch or the feel of clothes on their skin

Experience pain from certain sounds, like a vacuum cleaner, a ringing telephone, or a sudden storm; sometimes they will cover their ears and scream

Have no reaction to intense cold or pain.

Impacts on the diverse dynamics of the family/whanau

To care of children with autism spectrum disorder, family members spend a lot of time and put efforts till their energy burns out. It makes their parents difficult to have a moment for their own interest and their lives. They lose their relationship and social contact with other people. It brings a lack of communication and finally it occurs decreasing of life quality. They cannot spend time for their parents as well because it is too busy to care of their autistic children. The other children in the family would be lack of love because their parents put every attentions and every interest to autistic child so parents cannot spend time for others. The family also experience role changes. Change of the roles requires new skills and grabbing with new ideas. They need to collect the information about ASD, search for the programs or facility supports. On the other hand, change of roles empowers family. Perhaps, children with ASD’s siblings might not like to walk or, even, talk with them.

4. The way in which the individual, family/whanau , and carers interact and respond to evolving stressors

There are many ways that individual, family, and carers interact and response to stressors. Autistic children focus on what they want to and what they can do. Need to get information and supports from the family or friends when take care of them. Family and carers can receive a help from their friends. Friends can take care of the autistic children and family and carers can have a break to recover their energy. For example, having a catch up with good friends, sharing the worries and information with other family member who has autistic children and attending activities or teachings related of supporting ASD people are very helpful, cheerful and encouraged to the group of people who have a lot of stress from caring autistic people. They need to make best product with environment, help and support of others who are around them. Visiting a Day care centre or hiring of a community support worker can be a good idea as well.

5. The way in which the Code of Right is applied to people with Autism Spectrum Disorder (ASD)
The right to effective communication

People with autism have the right to effective communication in a form, language, and manner that assists the client to understand the information provided. Where necessary, this includes the right to a competent interpreter.

Rights in Respect of Teaching or Research

People with autism have the right to give informed consent to participate in research, including risks, and whether this treatment is new (or new for this purpose).

Right to be Treated with Respect

People with autism has the right to be treated in a respectful manner, regardless of her/his race, culture, colour, religion, sex, age, mental or physical disability, class/economic position, sexual orientation, gender identity, diagnosis, inpatient status, or legal status, Like using recognized name, respect for choice and privacy.

6. The needs ( support and other) which I have identified for the people with Autism Spectrum Disorder (ASD)
Child Disability Allowance

Child Disability Allowance is a payment made to the main carer of a child or young person with a serious disability. It is paid in recognition if the extra care and attention needed for that child.

Services for children with special education needs

Some service are providing information about play techniques to teach the child new skills, offering ways to improve social and learning skills and manage behaviour and co-ordinating physiotherapy, occupational theraphy and equipment.

Support for students with high special education needs

Some supports are the Communication Service to support children who have difficulties with talking, listening and understanding language, the Severe Behaviour Service to assist children experiencing behaviour difficulties.

2) People with Dementia

1. Consequences of people with Dementia in relation to
A. Individual

Those with dementia need help with everyday tasks such as showering, dressing, etc because they forget how to do them. They no more have interests in their hobbies and what they do unlike how they used to be. At the same time, they do not want education and trying out new ideas. They also tend to avoid communicating with others as they cannot respond and catch complex ideas since they make them uncomfortable. People with dementia may have to give up their work due to the lack of planning, organization and decision making-skills. They have difficulties going out by themselves, because they cannot find the way back home. They become less interested in their surrounding environment and take less care about others. They tend to find someone to blame when something is wrong. During Dementia progress, they sometimes confuse children or grandchildren to their relatives or friends. This can hurt their family members. They find it hard to name objects and how to use them. Furthermore, they require reminders to eat, wash, dress and using toilet. Their communication skills drastically worsen because they get difficulty understanding what is said to them and their words and sentences only make little sense. Hence, people with dementia totally become isolated.

B.Family / Whanau

They cannot believe that the one they love have dementia, and it is unacceptable when the person with dementia fail to recognize them. They feel shame and are unwilling to let others know. When they fail to cope with the difficult situation, they feel anxious, irritable and impatient with themselves and others. They lack energy and burnout which result in the decrease in strength of their immunity system and the increase in the frequency of getting the flu and becoming sick. Thus, they lose concentration and become forgetful which lead to bad performance at work. They express negative thoughts about themselves, thinking they are losing control of everything like a failure. They need to deal with emotions like grief and guilt. Watching the person slowly deteriorate can be particularly stressful as often the family members feel they have lost the person they love. When they think that they have not done or are not doing enough for the person, they feel guilty.

C. Carers

Reduced leisure time and personal freedom is one consequence on the carers. They may not be able to spend as much time as they would like with their friends and colleagues, loss of regular contact with friends who can share hobbies. They become so involved in caring for the person with dementia; they do not take care for themselves or their own health. They have not found the time to take a moment that day to smell the scent of a rose or to look at the beauty of nature. Heavy workloads or hard physical works cause tiredness, loss of appetite and poor digestion. Most of the carers experience tension or pain in the muscle, chest, abdomen and shoulders. Getting responsibility for maintaining standards and for observing and recording changes can be very stressful. It is annoying when they have conflicts with others in the support team. Some of the carers may suffer oral or physical abuse from the one they are caring for; it is unacceptable and hurtful which leads to the decision of giving up the job

2. The signs and symptoms associated with people with dementia.

Dementia is a broad term to describe the symptoms which caused by a large of illness that result in a progressive decline in a person’s ability to remember, to think, reason and response to others in an appropriated way. The signs and symptoms of dementia:

Gradual memory loss

They have trouble in remembering the telephone numbers, where they put their bag, keys, and wallet, what they did yesterday.

Repeating statements or questions

They can constantly repeat one or more phases or sounds again and again.

Wander

They wander around home or streets, perhaps at night, sometimes becoming complete lost.

Decline in ability to perform routine tasks

A person might have trouble with certain skills such as dressing. As the dementia progress, people become slower and more disorganised.

Impaired judgement

They may show poor judgements and have difficulties making judgements.

Disorientation of time and place

They confuse about daytime and nighttimes and fail to find their way home.

Changes in mood or behaviour

They take their clothes off inappropriately and become angry or unset or distresses very rapidly.

Changes in personality
Some people with dementia retain a similar personality to their earlier life, although sometimes a little exaggerated – the person who was always irritable, stubborn and difficult to get on with may remain so. The person who was friendly and affectionate may remain sweet and loving.
Loss of language skills

They are unable to express themselves using a whole sentence, just repeating one word or phrase again and again

Or their speech may make little sense.

Difficulty handling money

They forget to pay their bills and manage their account.

Loss of initiative

They loss of motivation and feeling of worthlessness and uselessness

Deterioration in driving skills

Some may no longer drive their car.

However, a person with dementia may not experience all of these symptoms.

3. Impacts on the diverse dynamic of the family/whanau

When there is a person living with dementia in a family, it affects all the family members who are challenged physically, emotionally and financially. When the dementia develops as the illness progresses, those who are close to them are constantly faced with the loss of the person as they used to be, the gradual loss of the person as their companion, and the loss of their relationship. Children would be angry or may withdraw if it is too painful to see their parents suffer dementia, grandparent or family member slowly deteriorating. Husband s or wives may be upset or worried about living the rest of their lives without their partner. Family member may spend their time due to the increasing demands of care for the person living with dementia. Leaving work and taking an extended break may cause financial struggle. The loss of income causes the poor quality of life and it comes as a stress. Paying for home alterations, transport to places and medical supports are the extra costs. However, some people feel pleased of their new abilities if they are competent for their roles. They improve the relationship with the person with dementia while supporting. Thus, caring for the person living dementia may tie up the whole family members together. Also they share the responsibility within the family so they become more close.

The way in which the individual, family/Whanau, and carers interact and respond to evolving stressors

Essentially, we need to understand how dementia affects people. When the person living with dementia show challenging behaviors, group of carers are not going to be panic and know how to deal with it. Knowledge and skills are the most important one when take care of dementia people. Knowing what works for each of the people being able to interact with them in their preferred way is a skill that is developed overtime in dementia care. This helps the carer to understand the process that the person is going through. Having a break, attending relaxation group or meditation, practice positive thinking everyday and get support from friends or other workers are all helpful and releasing stress for the workers and family. These rests bring them to have their own time for interest and make their stressful life be peaceful.

5. The way in which the Code of Right is applied to people with dementia
The right to complaint

Person with dementia have the right to make a complaint if they are unhappy with a heath or disability service they received. If they are not satisfied with how they complaint was handled by the provider, or do not feel comfortable making a complaint to them, talk to their nearest health and disability advocate.

The right to support

Person with dementia has the right to assistance in obtaining; financial support, housing, recreation, employment supports, social support, and community supports in keeping with their needs and wishes

The right to dignity and independence

People with dementia have the right to have services provided in a manner that respects the dignity, independence and self-determination of the individual. They have the right to contact with clergy or other spiritual advisors of her/his choice, and to exercise religious and spiritual observances, rituals, customs, and dress.

6. The needs (support and other) which I have identified for the people with dementia
Disability allowance

The Disability allowance is a weekly payment for people who have regular, ongoing costs because of a disability, medical condition or illness. It can help for things like regular visits to the doctor, prescriptions or some travel costs.

Social Workers

Social Workers provider counseling, support for grief and loss, adjustment to change, relationships, problem solving and decision making.

Community Day Services

Community day services help disabled adults who can’t find work to take part in their community and improve their personal skills by providing access to regular meaningful social contact and stimulating activities.

The services will include a range of activities depending on the provider, and what you’re interested in and able to do. Activities may include:

daily living skills

education and learning activities

social activities

recreation and leisure activities.

People with dementia can go to day services as well as getting other Ministry-funded support services.

REFFERRENCE

http://www.hdc.org.nz/the-act–code/the-code-of-rights

http://www.helpguide.org/elder/alzheimers_disease_dementias_caring_caregivers.htm

http://www.nichd.nih.gov/health/topics/asd.cfm

http://www.medicinenet.com/dementia/article.htm

http://www.ehow.com/dementia/

http://www.health.govt.nz/

We are faced with a lot of different learning experiences, which has greater impacts than others in our lives and one can chalk this down to the learning approach – this is the process where individuals define information about their environment and has a different learning style, and by this I mean the way in which they absorb, analyze, and retain information which makes every one of us unique in our own special way.

All individuals learn differently, some by stimulation of their five senses, and when enhanced greater learning takes place. Every individual has a method by which they learn; therefore one person’s way of learning is very different from that of their peers.

Understanding the learning approach of individuals consists of the question, “what is a learning approach?” which is the preferred way of acquiring knowledge and processing information. This approach affects how we learn, solve problems, partake in different activities and react to the environment.

The original research work to the approaches of learning was carried out by F. Marton and R. Saljo (1976),where they explored an individuals’ approach to learning and identified two main approaches: ‘surface’ and ‘deep’.

Surface learning is the silent acceptance of information, memorization and unlinked facts which leads to superficial memory. Whereas deep learning involves critical analysis of new ideas, and principles, leading to the understanding and long term memory of concepts which is used for problem solving.

The basis of this understanding is to identify the individual with a fixed approach to learning and an opportunity to encourage that individual to adopt a particular learning approach.

Most of us are easily confused with the difference between learning and acquiring knowledge, they are different; ‘learning is the continuous process of addition,’ and ‘acquiring knowledge is memory, an idea stored up as experience.’ Learning as the cognitive process of acquired change in behavior, results from a learner’s interaction with the environment which brings about experience. Learning is the acquiring of new knowledge, skills, values, preferences and understanding. It also strengthens, organize and shape our brains.

Learning effectively entails the possession four abilities: concrete experience; reflective observation; abstract conceptualization and active experimentation. These styles were developed to challenge an individual’s mode of learning that seeks to reduce the potential of their intelligence.

There is a lot of information about how one learns and many of us understand that each individual learns differently or has a preference to learning. David A. Kolb (1984), a pioneer in this field of experiential learning, created four learning elements and states we learn by following this cycle.

Honey and Mumford (1992), defined four styles based around these four stages of Kolb’s learning cycle, and these styles were developed to challenge an individual’s mode of learning. Depending on an individual’s preference, they are classified as: ‘Reflectors’ are substituted for divergent (reflective observation), these are people who are thoughtful analyzers of situations, they listen to others before speaking, collect data and analyze before making decisions. ‘Theorists’ are substituted for assimilator (abstract conceptualization), these people are objective rather than subjective, they collect, analyze and use logical approaches in developing theories concerning a given course of action, and likes theories that makes sense. ‘Pragmatists’ are substituted for converger (concrete experience), these people are interested in trying out new ideas to see if they work, they like getting things done rather than seeing ideas discussed and delayed for consideration, they stick with long term activities if it shows promise of working or being functional.

‘Activists’ are substituted for accommodators (active experimentation), they are risk- takers, are willing to try new experiences and are open-minded to new things, enjoy challenges and are bored easily with long term activities.

Learning takes place through a wide variety of methods and styles, which encourages an individual to challenge new ideas, views and beliefs. The effectiveness of this approach caters to the different learning styles each individual brings to the fore. There are a diverse range of cultures and backgrounds of different people and individuals that have opportunities to learn from their peers through discussions, debates and joint study.

As a Social Care student applying learning styles, these helps service users learn by structuring what works for them which supports their learning and creates character.

Service users are individuals that need motivation in order to learn, which in turn develop their learning styles to help them with problem solving, exploring new ideas and issues based on their intelligences. They have to make their learning a priority and the benefits of the learning styles help them to identify with their ability to learn, which gives them an outline on the effectiveness they have learned from experience.

Learning styles determine the things people learn and the methods they use to learn them. The elements of these styles are to highlight the individual’s preferred learning style which will equip them to choose learning opportunities that expands their knowledge to reflect, which improves ones learning and performance, by identifying what that individual had done well and what should be improved for that same individual to become an all-round learner, which in turn makes them a success for the future.

Over the last decade in India , boom in the IT and the BPO sector brought about an increase in the number of people employed for shift work . Employers face tough competition from other companies and the global business environment . In order to increase productivity and to make themselves available to employers and consumers based abroad , many companies work round the clock and have made provisions for night shift work . Increase in job opportunities in this sector has also given rise to dual earner families and more women entering the work force , working in day shifts as well as non standard work hours . This paper focuses on women who work in the night shift . While night shift jobs may have its perks and financial benefits , there are many disadvantages that add to the stress of the daily life of the employees . To explain night shift schedule , it can be defined as work schedule that is full time , extending after midnight with atleast 8hours and 5 days work , which means that the employees are expected to work in the dark and sleep during the day , bringing in major alterations to their life styles and the life styles of those living with them . Night shift work can vary in terms of fixed or rotating patterns . In a fixed schedule , the employee works in the night shift on a permanent basis , where as in a rotating schedule , the employee alters between day shifts , evening and night shifts depending on the arrangements made by the employers .

Physical and mental Health

There have been numerous studies conducted to examine the effects night shift work has on health , sleep , circadian rhythms and mental health . Findings from research studies that explore health disorders of shift workers stated that there is a relationship between certain medical disorders and shift work . Evidence stated that heart and gastro intestinal problems and complications in pregnancy outcomes , ulcers were some of the medical disorders commonly faced by shift workers (Knuttson 2003 ) .A study conducted on nurses working in

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the night shift reported that shift workers have a higher prevalence of physiological problems like digestion problems caused by change in eating patterns, inadequate sleep , fatigue , colds , muscle pains , cramps and heart problems .

Disturbance to the normal sleep cycle or the circadian rhythms is likely to cause shift work sleep disorder (SWSD), especially when employees are working in the night shift for prolonged periods . Insomnia and excessive sleepiness while working non standard schedules are the primary signs of SWSD . Desire to take short naps , dozing off while at work , shorter and lowered quality of sleep , poor work performance , reduced mental accuracy are some of the negative effects brought about by SWSD , which inturn leads to the expression of psychological syptoms like irritability , anger , erratic mood and depression . A study conducted on dairy workers in India working in the night shift examined stress levels , health and mood states and provided evidence that night shift workers face higher work stress , negative mental health outcomes and life stress . Role over load , increased work -home conflict , role ambiguity were significant indicators of increased stress levels and mood states

. Findings also indicated that night shift work did increase physcial , physiological , psychological and social problems when compared to day shift workers (Srivastava , 2010 ) .

There has been an upsurge of interest in studying mental health effects of shift workers .Early research studies have shown evidence that night shift work is associated with depression . Findings from a study that examined the effects of physical health and mental depression due to night shift in nurses revealed that disruption in the circadium rhythm has a direct influence on physical health and depression , reducing quality of life and affecting work performance and social relations . Another model in this study suggested that job schedule limited participation in social activities , affecting social and personal life leading to depression . (Skipper & Jung , 1990 ) . Burn out , lethargy , exhaustion , irritability , anger or psychological symptoms like irritability , depression not only affect personal well being ,

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but can also affect one’s social life and satisfaction of their marital relationship (Fam , Econ

& Iiss , 2007) . The negative consequences that affect physical , psychological , psychosocial well being can seep into the workers marriage , reducing the quality , stability and satisfaction of marital relationship adding to existing stressors .

Since this paper focuses on marital satisfaction of night shift workers and the strategies they use to make their marriage work , the definition of marital satisfaction will help gain an understanding as to what this paper purports to examine and the aspects that need to be considered . According to Stone (2007) Marital satisfaction reflects a mental state of percieved benefits and costs of a marriage to a particular person . The more costs the partner inflicts on a person , the less satisfied one generally is with their marriage and with their marriage partner . Similarly the greater the percieved benefits are , the more satisfied one is with their marriage and their marriage partner . Some of the components that come under marital satisfaction would be leisure time spent together , communication , conflict resolution etc . But the challenges that shift workers have to face in their marriage is to face new demands posed due to their work schedule . This would involve them to make adjustments on the home front , especially for female employees , since they have added roles and responsibilities to perform . For a marriage to work , one of the important aspects of marital satisfaction is leisure time spent together . But for a night shift worker , because of the work schedule , quality time and the quality of leisure time spent together would be lower . Quality time would involve the married partners to indulge in favoured activities and pursue shared interests . Weekends seem to be the only time workers could indulge in leisure time with their partners . For a night shift worker , weekends would be used to recuperate from the week’s stress , which could lead to lowered quality of leisure time spent together . Leisure satisfaction especially if the leisure activities performed are favoured by the couple is related to marital satisfaction (Heather , Zabriskie , Hill & Brian , 2009) Also , Contribution to

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leisure time by night shift workers in their marriage would be less because of the disruption between the workers time off and the family’s time off .

Work would come in the way of some of the family’s rituals , for which the worker would be absent or too tired to be part of , like being present at the table at meal times , going out together , attending community events etc . The worker would either be working into the night or would be sleeping and recuperating from work .

Social and community life .

Since most community and social activities take place in the evening , a night shift employee would probably find difficulty in making time for such events. While weekends provide time to engage in social activities , a night shift employee might be too tired and may not be able to give in fully to social activities as their schedule and life style causes inconvenience to enjoy a social life and for the couple to participate in community activities . In a study that was conducted on families of workers working a modern shift roster , 67.2% of employees reported that night shift work frequently intervened in their social life . This could result in the worker having poor social support in the long run , unless the worker can maintain a balance between work and time for socialization . Social support also helps improve a person’s psychological state , their mood and feelings about themselves .

Women shift workers challenges .

A changing work force has led to an increase in women entering the work force and women opting for non standard work schedule , challenging traditional roles that women held and bringing about changes in family dynamics . The challenges that a woman shift worker has to face is to fulfill multiple roles ie to fulfill family and role obligations , needs and expectations of the family , fulfill social obligations by being part of community activities and fulfill responsibilities at the work front . Women face more role strain when compared to men as a result , night shift work exacerbates and intensifies the stress that women employees have

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to face . For a married woman night shift worker maintaining work to home balance and reducing work-home conflict would be a major hurdle .

Cambridge dictionary defines work-home balance as the “amount of time you spend doing the job compared with the amount of time you spend with your family and doing things you enjoy” . Shift work is linked with work-home conflict and this conflict is faced more by women when compared to men (Tuttle & Garr , 2012) .

Barnett and Baruch ( 1985 ) define.role balance as “rewards minus concerns” , more rewards recieved from a particular role and less concerns experienced would lead to a positive role qualtiy where in lower levels of role conflicts,role overload and anxiety is faced . Considering that employed women working the night shift face role strain , rewards recieved in one of the roles could reduce role conflict and stress and increase well being . If family support is one of the positive role quality on the home front , it is likely that job involvement and control over job would increase .

Following role theory , Greenhaus (2003) in his theory of work-home balance , describes work home balance as a continuum where in imbalance in family role lies on one end and balance in work role lies at the other . Greenhaus theory on work – family enrichment includes three concepts . Time balance ie equal time invested , Involvement balance ie psychological effort and physical presence expressed and Satisfaction balance ie rewards and satisfaction recieved from both work and family front . Frone (2003) views work-family balance as bi directional . Engaging in one role or domain can either create conflicts or enhances the other domains . Involvement in the family role can either enhance the work domain or create conflicts in the work domain and involvement in work domain can wither create conflicts or enhance the family domain .

Stress .

Bodenmann ( 2005 ) defines stress as a dyadic phenomenon which involves common

6

concerns , emotional intimacy between the partners and maintaining a close relationship .

Dyadic stress concerns a stressful event which confronts the couple , the source of stress could be external , originating between the couple like job stress , culture , society , other relations etc , or could be internal , originating within one of the partners or when the stress of one of the partners seeps into relationship . The impact stress has on one couple will be different for another . It is therefore important to take into consideration the locus of stress , duration and intensity of stress . The locus of stress could either be external or internal . When there is an interaction between the social environment and the couple’s relationship causing conflicts and internal stress originates within the couple relationship like job stress , personal needs and desires etc .Intensity of stress can be either major or minor and can be measured based on the impact the stressor has had on the relationship and the duration of stress can be seen as acute or chronic ie temporary or prolonged

Bodenmanns stress – divorce model analyses the effects minor daily stressors , acute or chronic in nature , on stability and functioning of marital relationships . External stressors , those coming outside the couple system can prove to be more damaging to relationships . such external stressors are usually outside of couple’s conscious awareness and are minor stressors (time spent together , communication) and not major (critical life events), causing mutual alienation over time , if the stressor is persistent , causing dissatisfaction with the marital relationship ,eventually leading to divorce .

According to Bodenmann , external stressors cause impact on marital relationships by decreasing the amount of time spent together so that there are fewer joint expereiences between the couple leading to a lowered feeling of togetherness , poor coping at times of stress . This would eventually lead to a poorer quality of communication and interaction . Interaction between the couple would be largely negative , driving the couple to withdrawing from each other . These stressors leading to deterioration in the quality and stability of

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marriage would later increase risk of physical and psychological problems like trouble sleeping , sexual dysfunction etc . The impact and reaction to these stressors would eventually lead to negative expression of emotions between the couple like anger , anxiety , increasing conflicts . This entire process would lead to couples alienating and withdrawing from each other . The situation they have landed themselves in would lead to marital disatisfaction , eventually leading to divorce if the problem persists .

Bodenmann’s model can be applied to a shift workers marriage . Since night shift schedule makes it inconvenient for the couple to indulge in shared experiences and quality time . The job schedule and stress from the job can be seen as a stressor that doesn’t permit quality time between the couple . The couple might feel that the amount of time spent together is less eventually leading to poor quality of interaction . When joint experiences shared are lower and the amount of interaction between the couple is low , there could be instances when one of the partner feels lonely and might percieve that the quality of their marriage is deteriorating leading to expression of negative emotions like anger , frustration , sadness . Eventually appraising their marriage as dissatisfying .

The effects that shift work has on the physical and mental health of workers can seep into their marital relationships . They sleep during the day when the entire household is active which disturbs their sleep adding to marital distress . Psychological symptoms like irritability , depression can bring down the level of satisfaction of their marriage . Since they feel tired and fatigued frequently , engaging in leisure activities with their spouses becomes difficult . With there being hardly any time for contact , communication becomes difficult

between the spouses , which is essential in a relationship . There are many problems that night shift work poses to a workers marriage . This study seeks to find strategies that workers who are satisfied in their marriages use to overcome problems induced by night shift work .

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Rationale : There have been studies conducted to understand and analyse the impact shift work has on the lives of employees , their physical and mental health , social life and their families .With many of the problems faced by shift workers being covered , this study seeks to gain insight into what makes a shift workers marriage work and explores strategies they use to make their marriage work and to study how night shift employees maintain work – home balance .

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Review of literature

Following studies discussed analyze the effects shift work has on health , general well being , and on marital relations .

This study analyses the impact that non standard work hours versus standard work hours has on marital satisfaction in five domains which are global distress , problem solving communication , time together , sexual dissatisfaction and affective communication , measured by marital satisfaction inventory , which is a 280 item questionaire that assesses certain domains of marital satisfaction .30 employees who worked the day shift and 20 night shift employees at Western Union in New jersey were selected for the study . The research was built around 5 hypotheses . Hypotheses 1 predicted that day shift workers when compared with non day shift workers would display higher levels of marital satisfaction . Hypotheses 2 predicts that day shift workers would express better problem solving communication and there would be fewer conflicts in their marriage when compared to non day shift workers . Hypotheses 3 predicted that the time spent in quality and leisure time by day shift workers with their spouses would be higher when compared to non day shift workers . Hypotheses 4 predicts that day shift workers would experience higher levels of sexual satisfaction with their spouses when compared to non day shift workers .Hypotheses 5 predicted that day workers would be more content in their marriage because of the affection and understanding provided by their spouses . ( Lauf-Goldstein ,1990) research findings could not support the predictions of any of the hypotheses . Unlike many other studies on shiftwork’s influence on marriage , this study proved that there was not much difference in marital satisfaction between day shift and non day shift workers.

The study summarises the effects and consequences of shift work while discussing some of the benefits of shift work ( Finn ,1981). The information for this article is derived from many of the studies conducted on employees who work non standard hours in and

10

outside the U.S.A . Some may accept night shift work because of lack of job opportunities while some would use their night shift work schedule as an opportunity to hold a part time day job as well or pursue education during the day . Night shift work also provides for financial incentives and accomodates employees who function better at night than during the day . The drawbacks are that it takes a toll on ones health , interfering with the normal sleep cycle and reducing the quality of sleep and appetite and causing physical and emotional problems . On the job accidents would also rise if the employees would have to handle machinery . In terms of family life , shift workers experience more work – home conflict because of the discrepency between the workers time off and the spouse’s time off . The workers spouse would have to adjust to the shift workers job schedule and would have to alter their patterns to their working spouse’s atypical pattern inorder to be able to spend quality time for leisure , meals and recreation . This would take a toll on the mental and physical health of the shift workers spouse especially if theyre working the day shift . The time a shift worker gets to spend time with family could also be poor in quality because they experience fatigue and sleepiness and would find difficulty in carrying out normal activities with their spouses or would show less interest in attending social events or go out together to spend quality time . Sexual activity is another aspect that is interfered by night shift work .In terms of social life , it becomes difficult for a shift worker to attend events for which they’re invited by their friends . It becomes difficult for the spouse to plan any social activity before hand . From this article it becomes evident that shift work impairs one’s physical and mental health , their family life , job safety and social life .

A study conducted in Netherlands examines the effects non standard shifts have on partnership quality through semi structured interviews . Findings reveal that women were more dissatisfied with varying hours , especially if they had children , as it created stress

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when compared to men . Men found varying hours more comfortable for tag team parenting . The research explored into the relationship between non standard hours and its effects on marriage . The results indicated a weak link between non standard shift and relationships indicating that non standard work hours did not reduce relationship quality. The study also found that partner support in families with night shift workers , expressed more satisfaction with their relationship which reduced the negative effects that non standard work has on relationships ( Mills & Kadri , 2010) .

This study assessed both percieved family well being and stressors influenced by non standard work schedule in two studies (Kelly , Amy & David , 2008). The goal of this study was to assess work-family spill over and whether the spill over was positive or negative and if working non standard work hours decreased marital instability . The study was conducted on 1166 people aged between 25 – 74 . Findings of the study revealed that night shift work increased marital instability and also increased negative work – home spill over , which are the attitudes , experiences of work transferred to home . Since night shift work can come in the way of ones sleep cycle causing fatigue and stress , the stress gets carried into the workers family life .Stress increases with the presence of a child at home since workers have the added responsibililty to care for the child and causes stress at a daily level .

This study investigates the association between shift work and family satisfaction and goes a step further by including people from different work backgrounds into their sample instead of analysing people from one company or a particular type of work . This study also examines different categories of shift from day , evening , night , rotating to split shift and hypothesises that workers experience family satisfaction in degrees , with satisfaction being higher for day shift and lessens as it progresses towards split shift . The study also examines the relationship between the number of work hours , job autonomy and nature of job on family satisfaction . Findings indicated that being in a non standard , non flexible job reduced

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family satisfaction , especially for evening and night shift workers (Davis , Goodman , Piretti & Almeida , 2008). The study also revealed that job autonomy and the nature of the job and work atmosphere resulted in high family satisfaction , since work – family spillover would be less .

168 fire personnel from 3 working shifts were part of this study . The purpose of this study was to examine the effects that the 3 types of shift work has on emotional exhaustion as it pertains to work – family conflict and social support (Jonathon & Halbesleben , 2009). The subjects were made to complete measures on emotional exhaustion , work – family conflict and support and demographic controls .The study revealed that work to home conflict increases when the shift work is more demanding and when time spent at home is less

. This work – home conflict can also contribute to emotional exhaustion in fire fighters . The support that an employee recieves from ones family can break down the stress that an employee faces at night shift work . The study suggests that the schedule should make allowance for the employees to be able to spend more time at home , so that with quality time spent with family could lead to building emotional support for the night shift employee .

This research study examines the relationship between shift work and work to family fit . The study hypothesis that employees working in the non standard shift would have poor work to family fit when compared to those employees working in the day shift or flexible hours and also examines if negative work – home spillover would be less if the employees had control over their work schedule . The study took 2008 national study of workforce to examine the influence shift work has over employees . (Tuttle & Garr 2012) indicated that shift work did largely influence work – home conflict , especially in female employees even if the control over shift schedule was more . In the case of men , the results revealed that men had less work to family conflict when they had a greater control over their schedule .

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This study examines the effects of shift work on marital quality on six domains .

Marital happiness , interaction , disagreements , general problems , sexual problems and child related problems (White & Keith 1990) . National panel of 1668 men and women were interviewed.. The result revealed that shift work does have a negative impact on marriage . Every domain that the study examined were also affected negatively due to shift work .

This study investigates the effects night shift has on marital relations (Messer , 1992) . 65 married men , with 19 full time employees at grocery stores and 46 full time employees of the southern california state departments were chosen for the study.. The employees worked consistent morning , evening , night and rotating shifts . Marital satisfaction inventory was used to assess the level of marital satisfaction / distress . Findings revealed that night shift workers experienced higher work – home conflict when compared to day shift workers . The study predicted that people working in consistent day shifts , evening shift , night shift ,and inconsistent rotating shifts would experience different levels of job satisfaction . The results suggest that employees working different shifts express different levels of job satisfaction , with rotating shift workers being most dissatisfied with their work schedule because of the inconsistency of the work schedule .

The impact of different timings of work and rotating shift on Work – home conflict , job satisfaction and health among the military police is the focus of the study . The study was conducted on 3122 Dutch military police . (Demerouti , Sabine , Arnold & Euwema , 2004) revealed that non day shift work resulted in work – home conflicts . The findings also revealed that employees from the rotating shifts experienced low job satisfaction since it is inconsistent

. Consistency in the timing of shift even if its a non standard work hour didn’t result in low job satisfaction when compared to rotating shifts , but only incr eased work – home conflict .

An article in hindustan times reports that night shift work can disrupt ones life in many ways . David maumes research on the effects of shift work on marriage suggests that

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both men and women feel that night shift work affects and strains their marital relations . Women are more affected than men by shift work due to role strain . It becomes difficult for them to manage time and to fulfill responsibilites at home , engage with their family members and care for them when compared to men causing strain in their marriage and increasing work -home conflict .

The study is built around three themes .Economic trade offs , family routines and emotional adjustments (Handy ,2010) . With night shift work comes financial benefits . In many families , the members have to adjust around the shift workers routines and patterns , spouses would have to give up their own jobs so as to manage family life . Financial benefits comes in handy , making it comfortable to rely on the shiftworker while the spouse takes care of the family , resorting to traditional family roles .the study also focuses on emotional health of the shift worker . The physiological and psychological effects of shift work could take a toll on ones emotional well being In terms of family routines , the workers had little knowledge of the family routines , since the spouse takes prmary responsibilty to ensure that the family members rituals fall in line with the workers . This shows the amount of effort spouses expend to make the marriage work and play a part in reducing work to home conflicts

Psychopathological symptoms caused by night shift work and its influence on the quality of life of health workers is examined in this study (Dusunen ,2010) . 45 nurses working the night shift were the sample for this study . Symptom checklist and short form 36 was used to measure psychopathological symptoms and quality of life . Night shift nurses reported higher scores for somatization , obsessive compulsive , interpersonal sensitivity , anxiety , paranoid ideation and global severity scores than day shift workers . Shift work also reduced the quality of life and the night shift nurses scored higher on pain and physical function . The study’s implications were to improve the quality of life of the nurses by adjusting their work schedule , keeping in mind the influence night shift has on their

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psychological state.

While most studies indicate that night shift work can reduce marital satisfaction and increase work – home conflict , there are few studies which have proved that night shift work doesn’t affect marital relationships . Employees with better control over their schedule and job autonomy and job satisfaction showed having a better family life and marital satisfaction as work – home conflict is less . Greenhaus and powell (2006) came up with a theory called work to family enrichment , a concept that explains that being able to manage time , carrying over the positive mood from work back home and using networks from work to help their families lessened work to home conflict . Some studies also indicate the possibility that couples working the night shift score high on marital satisfaction because they already have conflicts with their spouses , not induced by working the night shift . They find night shift work convenient as they can avoid conflicts at home and interacting with their partners .

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CHAPTER 4

RESULTS AND DISCUSSION

This chapter presents results in a tabular format following content analysis . The responses were coded , categorized and placed under a broad category of themes .

Following each table expansive responses as examples are provided by the participants , representing each theme .

Analysis .

Content analysis for the first question “Mention some of the advantages of working in the night shift” revealed 5 themes and are mentioned in a table below .

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Table 1.Mention some of the advantages of working in the night shift

Category

Sub – categories

Number of responses

Advantages of night shift.

More pay

5

Travelling easier

4

Find time for chores

3

Husband has experience

2

in the same field.

The second most frequent theme which accounted for 40% of the responses is easy commuting while working in the night shift . Respondent 9 stated that ,

Respondent 3 stated that “travel time to office and back home is less ” and “the roads are relatively empty while getting out ” says respondent 8 . Travelling to and from work becomes more convenient as traffic will be smooth and the stress involved in travelling

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reduces considerably.

30% of the participants responses falls under a category termed as “Find time for chores” . These participants find night shift work favourable as it allows time to complete chores during the day . The following response given by respondent 9 will help describe this theme .

Table 2

Can you list the problems you face working in the night shift

Category

Sub category

Frequency of responses

Disadvantages of night shift.

Less time with partner

15

Health issues

14

Partner frustrated.

4

Worries about having a baby.

4

Normal routine affected

4

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Relationships and friendships 2 affected.

Analysis for this question revealed 6 themes under the category “Disadvantages of night shift”. The most apparent theme seen as a disadvantage of

Ololade Abasa
Summary of Report

This report looks at how partnership working is developed, the benefits and legislation governing partnership relationship in the UK. And how there is now a shift from professional to patient autonomy. Health and social care is a vast service sector undergoing rapid change, with new government initiatives giving it a higher profile than ever.

The report is a brief overview and not in depth focussing on the main points and benefits of collaborative working and the sharing of information with some focus on Stafford hospital following the Francis report.

A working or collaborative partnership or partnership in general could be defined as “two or more independent bodies working together or collectively to achieve more efficient outcomes than could be possible by working individually or separately” (Joint improvement team 2009). When two people come together to share risks and profits in a business for the good of others. (The concise English dictionary 1992).

The focus today in frontline health and social care is on giving service-users more independence, choice and control. These developments mean there’s greater demand for well-trained multi-agency and multi-skilled collaboration of team’s organizations and people across a range of services giving more opportunities and choice to service users. In this report will focus among other things, looking into working in partnership in the health and social sector in general and some philosophies, concepts, relationships, models and legislation of collaborative and working in partnership.

Different working practices exist across the health and social care sector, which will be part of what this report will also look into briefly with what may be perceived to be barriers to developing an effective partnership relationship within the health and social care sector and strategies that can be developed to improve or overcome these barriers.

Concepts of Partnership Working

For partnership in health and social sector to be successful in delivering services to service users there has to be co-ordination, co-operation and most importantly clear communication between partners for the partnership to survive.

This did not seem to be the case (in our case study) at the Mid Staffordshire NHS foundation trust Stafford hospital in 2007 which led to the public enquiry in 2010 by Robert Francis QC. (The Francis Report).

Some of the philosophies and concepts of working in partnership that will be discussed are:

Power sharing
Autonomy
Making informed choices
Independence
Empowerment:
Respect.

this is giving health care users the choice or opportunity to take care of their health decisions and control their lives if they are capable of doing so (Gibson 1991) patients do have a right to information and choices offered to them.(National Health Care in England (NHS2013)) Health care staff should be encouraged to listen and be involved in decision making that involve their patients’ health care treatment.

Patients unable to make informed choices or decisions regarding their health and treatment should be accorded respect and dignity, by health care professionals who take on such decisions with the patients interests at heart. (Mental Capacity 2005)

Autonomy allows the decision as to will see or attend to their treatment requirements and processes with little or no interference from health care professionals. Autonomy basically gives most of the power of decision making and choice to the patient.

Independence relates to freedom being accorded to service users to feel free in the health and care setting. Service users are allowed privacy and the opportunity to take care of themselves as they desire provided they have the mental capacity and ability to do so. Health care professionals are duty bound to provide up-to-date information to service users regarding patient’s treatment and care and any risks relating to their welfare. (Care Quality Commission).

Collaboration is the lynchpin to power sharing this involves organizations collaborating for a common purpose this enables a common understanding of duties to share and achieve set objectives in a partnership (Gallant et al. 2002).

Respect focusses on offering service users the choice to decide on aspects of their care or health with minimum intervention (Health and social Act 2008) and fairly without any discrimination (Equality Act 2010).

Partnerships have become more necessary today in the health and social care sector, service users issues which atimes could be complex in nature requiring input from a number of professionals and services is more important when designing services than the traditional, centralizing distinctions between community nurses and social workers, or community justice workers and social workers. Different areas and sections of the society have their specific needs and requirements prevalent to the area, for example Enfield may require more specialized care for elderly people than neighbouring or other areas. Also a service user with a health issue may need a particular type of care package that was previously available or provided by the national health service and social services, in the new way of working together the health and social care could come together in partnership to provide a seamless or a one stop shop which meets the needs of service users. Needs over time could change in the same area that traditionally provide a specific service, partnerships may be formed to respond to these type of changes and flexibility. (Aldridge, N. 2005)

Models of Partnership

From time to time it will become necessary to evaluate the partnership relationship, there should always be a care and backup plan should something go wrong. An effective joint contribution can have positive impacts on service users and providers of services. These were some of the factors that were not implemented or ignored among many others at the Stafford hospital.

The Green paper, every child matters, was published by the government in 2003, with a view to safeguard and support young people in need of help and at risk. (Children Act 2004). Under section 18 of the children act 2004, the director of children services has the responsibility of ensuring that local authorities meet specific duties (Department of Education 2013). According to health and social care act 2008/12. Local authorities should work together in partnership with education , health and social care organization to support vulnerable service users by making sure health care workers are properly trained and valued, deal with core problems and intervene to protect children before a crisis situation gets out of control. (Susan Balloch, 2001)

Figure 1 (Health & Social Care Partnership Model)

Figure 1 above shows a typical model of a partnership working across the health and social care.

The hybrid model among other models applicable that shows different partnership functioning in an organization, is likened to an umbrella for some models with organizations working tactically in combination with other models to achieve the best services. This was not the case at the Mid Staffordshire NHS Foundation Trust (Stafford hospital) according to the Francis report, where corporate self-interest and cost control were put ahead of patients and their safety, a lack of care, compassion, humanity and clear leadership. With the most basic standards of care not observed. The failure of collaborative working and an effective partnership model working effectively and efficiently across the Mid Staffordshire NHS Foundation Trust have identified a number of barriers to establishing effective professional partnership. (Babington and Charley, 1990).

There could be other barriers, for example health professionals not sharing the same goals, lack of communication, an organization feeling superior to the other for various reasons. (Scott Reeves, 2010)

Legislation for Partnerships

Legislation is, ‘’Law which has been enacted by parliament” or a governing body, and a Policy the statement of an agreed intent that sets out an organisations’ views with respect to a particular practice. Setting out principles and rules that provide the direction for an organisation to follow.

A Practice is the step-by-step method of implementation of the policy and responsibility.

The current and relevant legislation for organisation practice, policies and procedure affecting partnership working in health and social care include:

Equality Act 2010,
Care Standard Act 2000,
Disability Discrimination Act 2005.
Care Standards Act (2000) (England and Wales)
Health and Safety at Work Act (1974), the act ensures that any working environment should be safe and free from hazards for both employers and employees.
Human Rights Act (1998), empowers individuals if they feel unfairly treated can resort to court action.
Manual Handling Regulations (1992), covers the safe moving and handling of equipment, loads and patients.
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (1995) (RIDDOR)

In the scenario case of the Mid Staffordshire NHS foundation trust at the Stafford hospital in 2007, there was enough legislation in place at the time to have prevented the incidents and scandal that took place in at the hospital at the time. But working practices and policies were lacking, relaxed not in place or plainly ineffective or not in force or enforced. (Susan Balloch, 2001)

Effects of Negative Working Partnerships

Hospital management and staff, nurses etc, mental health and GPs, social services care and service users, and so on, all within the health and social care sector. The differences in working practices across the health and social care sector cannot be more pronounced in the negative impact it can bring more than what has been seen and the numerous scandals and mistakes that happened at the Stafford hospital Mid Staffordshire NHS foundation trust, where patients were left unattended, patients drinking from flower vases. There was no collaborative working practices in place, where the planning process should involve a number of practices and practitioners working together (cited in the oxford university press 1996 pg. 317). Professionals and organizations should be working together, for example

GPs (general practitioners) first point of call for patients health problems,
Support workers, bringing some form of independence to vulnerable service users by helping and support of vulnerable service users and recommending available services.

A disjointed service sector with different working practices not harmonised can not only be very ineffective, wasteful and more expensive but can also end up to be dangerous to service users, in the absence of any form of follow up and or expertise which may well be available but not accessed or utilised.

The Team Ro les that Meredith Belbin identified are widely used in organisations. They are used to identify people’s behavioural strengths and weaknesses in the workplace. This information can be used to:

Build productive working relationships
Select and develop high-performing teams
Raise self-awareness and personal effectiveness
Build mutual trust and understanding
Aid recruitment processes

(Evans, D. & Killoran, A. 2000)

Case Study

When most a times outcomes of partnerships are scrutinized or looked at it often almost involve a tragic case, in this report I have been looking at the tragic case of a patient which I refer to as patient A. which prompted a case review in Greater Manchester. A Multi-disciplinary and multi-organisational partnership with good communication and relationships with organizations and people from different disciplines will enlarge the efficiency and size of the service team to service users which allows for a holistic approach and responsiveness to service delivery, better value for money with reduced duplication of services.

Looking again at our case scenario of patient A, (a 64 year old male) who was not mentally and physically able to defend himself, and made few demands on the health and social care services for support and did not have much support considering his condition to exercise control over his own life, the outcome of these failure in partnership was that patient A was not empowered to make choices and neither were the professionals supposed to be on the lookout for vulnerable people empowered with responsibilities or resources to make necessary changes, and neither the health professionals get to understand the issues or get involved fully and should be accountable for lack of action. There was no body or institution tasked to monitor situations adequately leading to no proper assessment of the situation even by psychological professional services, these outcomes can also be attributed lack of proper information gathering and sharing which led to exclusion of necessary and important participants, contributors and help to give patient A that was readily available due to lack of a clear leadership, clarity of role and a unified information and management system. For positive outcomes in partnerships and to provide person centred care it is essential that communication between interagencies, individuals, key people, service user’s family and friends, G.P’s, nurses, opticians, dentists, Physiotherapists, O.Ts, psychologists etc. to be really effective. Any barriers to communication should be minimised to ensure good communications. There should be an opening of a subject to widespread discussion and debate to enable the communication of ideas to all those working together in the partnership, so that they can be used and lead to change. This should be an on-going activity which is used to inform changes to policies and procedures within the workplace and involves the sharing of good practice leading to reduced professional isolation. (Frances Sussex, 2008)

Barriers to Effective Partnerships

While working in partnership is significantly crucial and important in the health and social care sector, working in collaboration and partnership across various agencies can be a daunting task, as there need to be an understanding of respective duties, roles, and organizational structure of different professionals, agencies and their language, therefore this could frustrating and be a barrier that could lead to poor communication and misunderstanding, coupled with the fact of having to deal with different legislations, funding streams, professional complexes and organizational structures.

Where there is a perception of superiority differences in status between individuals or partners in a partnership, this creates a barrier for a proper partnership relationship. There could be ways in which the above stated barriers could be overcome.

The sharing of objectives, goals and outcomes.
Sharing information and the use of a standard and common terminology.
Meetings not being too formal and joint team building activities.
Having joint training and face to face working.
A full commitment to the partnership relationship with a clear demarcation of roles.

(Hudson, B. 2002)

If we look at one of the above points for example having joint training and face to face working will create a closer relationship and understanding in partnership relationships by reducing formality, improving understanding among partners, and an opportunity to bring up any problems or issues that may require resolving.

Recommmendations

Having looked at the issues relating to patient A, published in the Guardian newspaper of Friday 12 March 2010 a Serious Case Review such as that of Adult A gives an invaluable lesson to be learnt in what can be done to prevent such incidents and tragedies. A range of strategies need to be considered to improve outcomes and partnership working. Professionals working in different health and social care services have a shared responsibility to know what their role is individually within any partnership, with measures to be taken jointly or individually to protect vulnerable people from preventable harm.

Before dwelling on inter-agency co-operation and participation, it is important to consider the promotion, participation and empowerment of the service user. The effectiveness of interagency collaboration and information sharing can be diminished and less productive if the service user does not feel part of the process and the chances of a successful outcome will be significantly reduced. Hence it will be produce a better outcome to work in partnership with carers, families, advocates and other people who are sometimes called “significant others”. In order to work well in partnership, there has to be good communication and you will need to have good communication skills.

Some suggested strategies for an improved and positive outcome for an effective and productive partnership in the health and social services are to:

Analyse the importance of working in partnership with others.
Develop procedures for effective working relationships with others.
Agree common objectives when working with others within the boundaries of own role and responsibilities.
Evaluate procedures for working with others.
Deal constructively with any conflict that may arise with others.

(Department of Health (DH) 2007)

Conclusion

In conclusion, having looked at the issues at the Stafford hospital coupled with the issue of patient A in Manchester, the factors that have impacted the hospitals could be looked at as down to lack of the full and proper training coupled with effective implementation of partnership with relevant bodies like the voluntary sector and families.

Most of the factors discussed above will have impacted on the provision of effective services to service users

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