How Could Use of the Concept of ‘Critical Practice’ Help to Avoid the Creation of Unnecessary Dependency in Older People Who Are Users of Health and Social Care Services?

9 September 2016

It involves not just the one professional, but all professionals involved, and it needs for everyone to work together, as part of a team to ensure things run smoothly. (Kolb, 1995; Tsang, 1998) tells us that if each professional understands and completes their own job, this then leads to a satisfactory outcome and full professional practice . What is critical practice in Health and Social Care? Professionals from all backgrounds, from within the health and social care system are able to explore the development, and application of critical practice.

This means, that they encourage engagement in theoretical, critical and methodological debates and practices. It evaluates the present role of theory, and develops the necessary skills needed for treatment and care. Glaister (2008) tells us that critical practice is a practice that takes all variables into account, regardless of whatever particular demands that current situation requires. It allows flexibility and discretion, and is a very reflective and open-minded approach.

How Could Use of the Concept of ‘Critical Practice’ Help to Avoid the Creation of Unnecessary Dependency in Older People Who Are Users of Health and Social Care Services? Essay Example

Health and social care is being increasingly challenged to respond to the needs of not only diverse communities and people, but also many different types of illnesses and ailments. Critical Practice is being used more and more nowadays to enable medicine and treatments to keep on moving forward. Each time there has to be a good base set to begin with. This will always begin with forging a relationship, be that with a colleague, or with that, of the client/patient. How this is setup will define the beginning of that particular relationship.

They are many types of relationships and one type of relationship would be a constructive relationship. Forging relationships is the first pillar of critical practice (K217, a) Constructive relationships sometimes need to be further developed due to the diverse and challenging clients, and/or colleagues, or other parties who will be involved in the treatment and care for the client. Once a relationship has been forged, other factors such as being able mediate and being able to communicate effectively are very important factors.

The professional must have a good sense of themselves and this in turn will enable them to deal with any given situation. (K217, b) (Rogers, 1951) believes, that by acknowledging and accepting another parties viewpoint, whilst not allowing your own beliefs and feelings to be upset, that this is a great foundation for critical practice. This allows full openness without defensiveness or disempowerment, which in turn, allows each individual to be themselves, and do what needs to be done without being judged or criticised . The concept of empowerment is the second pillar of critical practice.

Concepts such as discrimination, oppression and equal opportunities over the years have shaped the structure of health and social care system as we now know it (K217, c) There is now a recognition, that someone who is either less powerful, or a member of a minority group, can become oppressed and feels less disadvantaged to those who are not. What practitioners have learned is that they need to understand the oppressive forces, and need to reconstruct the power imbalance that has been left (Pinkney, 1999). Successful caring processes must be both empowering and anti-oppressive.

The third suggested pillar of critical practice is ‘making a difference’. Practitioners need to be constantly reviewing their work and always need to be up to date with current procedures and treatment. To enable them to do this they need to understand recent research, always weighing up the evidence to their own knowledge base, and expertise. Scientific research enables an approach, to evolving knowledge and practice, and in this way, one can test out their beliefs to either prove or, alternatively, to attempt to disprove them.

Another name for critical practice is ‘evidence based practice’. Evidence-based practice (EBP) is an interdisciplinary approach to clinical practice. Its basic principles are, that all practical decisions made, should be based on research studies, and that these research studies, are selected and interpreted, according to some specific norms characteristics for EBP (Birger, 2011). Using EBP gives practitioners the reassurance that they are giving the patient the correct treatment, and not just giving them what they believe is correct, whilst using their own current knowledge only.

Practitioners make decisions every day, and for some, these decisions can be life threatening. This enables the practitioner to know, that what they are doing is the right thing to do. Marsh et al. (2005) argues that all practitioners’ actions and their final decision on medication and/or treatment should come from research and proven theory. They tell us, that the better a practitioner is informed; the better it is for those, who find themselves in a highly disadvantaged state i. e. someone who has been diagnosed with a life threatening illness or disease, and they don’t know what will happen next, or what variety of treatments, (if any), are available to them, and if they are available, what has research shown as to whether this particular course of action will work or not . I will now move on, and talk about theory and ideology. Theory is exactly that – theory. Theories are explanations and descriptions that allow us to understand the world around us (K217, d) it also allows us to see things from many different perspectives, and enables us to form our own opinions.

Different people, have many different theories, on many different things. If there have been clinical trials, or lots of research completed on a certain theory this then allows the theory to be used, and this in turn, then forms the basis for policy planning and implementation, for professional practice and audit, and for professional training and professional development. All of these things are needed, for critical practice to be put in place, and also, for it to be successful. An example of this happening would be Romme, M. and Escher, S. (1993) The Dutch Experiment.

One of their patients had a theory based on a book she had read regarding the voices in her head. They found this intriguing and set out to prove, or disprove her theory. After lots of hard work, and many one to one meetings with those who hear voices in their head; hundreds of questionnaires were sent out and analysed. When all data was examined, they held a conference, and they soon discovered, that every individual, who does hear voices, had their own theory on why they voices were there and what they interpreted them to be. This enables them to use the research, and they came up with a set of guidelines that sychiatrists etc. could use, when someone, who does hear voices, finally comes to them for help. Psychiatrists and other practitioners, who work in mental health, have a set of structured guidelines on how things should be done. This differs from that of Romme and Escher. However, their analytical and statistical data is only from that section of the community and this means that is a real, and true reflection of their thoughts and feelings, and how they feel it is best dealt with. Ideology is about having shared values, beliefs and ideas.

These can be made up from different variables, such as religious or scientific grounds, and it doesn’t matter as to whether they are factual or not (Abercrombie et al. , 2000). There has been a shift in ideology in health and social care due to changing times. Before, it used to be ‘doctor knows best’ or ‘take that pill and you’ll be fine’, but not anymore. Now there is much more involvement from the patient themselves focussing around patient-centred care, and there’s quite a lot of shared-decision, from the professionals in the various health and social care departments.

I will now move on and talk about dependency in older age. By dependency, I mean relying on other people for assistance or care. This can be in a physical, emotional, or a social domain. Dating back to the late 1940’s, those of the older generation, were seen to be a growing burden on society, and to the success of the health service. The disengagement theory was used at this time. Tanner and Harris (2008) suggested, that this meant that disengagement was a vital part of growing old. Disengaging was to withdraw or disengage from the world i. e. , the society and the people around them.

However, in the late 1960’s and early 1970’s, theories such as these were highly scrutinised and (Butler 1975) termed the concept of ‘ageism’. (Townsend, 1981) published as article named ‘the structured dependency of the elderly: a creation of social policy in the twentieth century’. He described this research as a ‘kind of theory of aging’ (K217, e) His research covered 4 topics all with reference to age and getting old. What he discovered was, that the apparent dependency in older age had been created by social policy and practise, and not by the innate, characteristics of old age; he called his structured dependency. Social policy refers to legislation, policies and interventions aimed at creating, improving and maintaining living conditions that are conducive to a reasonable quality of life and wellbeing (K217, f). He suggested old people were forced to retire, and live with what little they had, and for them to be grateful for it. He said older people should be able to make their own decisions, and to live, as they felt necessary . Townsend’s research was certainly a lot more different from that of the disengaging theory.

Some people of the older generation do require extra help. This can be due to the old age, but can also be due to mobility problems, or certain illnesses or diseases. There are a variety of reasons as to why some require more help than others. On the other hand, there are many people of the older generation who do not require any extra help at all. They have their health and they are more than happy with what they have, and they do not want to be put into a category of ‘being old’, or ‘having limited ability to do things’.

Independence and dignity are vital to all the older generation, regardless of whether they need extra help or not. Finding a balance on how the older generation are treated, and looked upon, rarely seems to happen. Secker et al. (2003) found, in their research, how independence can be misunderstood. They stated ‘Independence is important for older people, but not at the cost of choice, and the retention of a meaningful social identity and role’. Townsend suggests that the welfare system should be revised, so that older people are not cast into unwanted dependency.

He suggested such revision should promote independence in the sense of being enabled, through state provision, and support from others, to exercise choice as an equal citizen (K217, g ) Critical practice and dependency in older people, who use the health and social care services must allow for freedom of choice, independence and control . Obviously this must be judged on an individual basis, as not one older person is exactly the same as the other. They all have different wants, and needs, depending on the various factors that I have spoken of earlier.

To make a set list of guidelines, and apply them to individual people is wrong. This can take away the older persons freedom of choice and their independence. This, in turn, can make them more vulnerable, than what they already are, which will then lead on to them being more dependent on others. Whilst doing this, there has to be a list of pros and cons. A risk assessment is also a very important factor. The risks must be assessed, in case that person is a risk to themselves or others ; and if this is the case, that individual can have their own plan drawn up for them to meet their particular wants and needs.

Autonomy is vital in these circumstances. Autonomy gives the obligation to respect the individual’s ability and freedom of choice regarding their situation. It allows choice without input from other parties. It also requires that people are adequately informed so that the choices they do make are informed choices and are right for them. In order to explain how and why, unnecessary dependency in older people might occur I am going to use Mrs Horton as an example . Mrs Horton had always lived an independent life, and had always looked after her own financial affairs.

As she got older, and was not as mobile as she once was, she had asked a neighbour to withdraw her money from her bank for her on a regular basis, but she did not want to be of inconvenience either, so she always ensured that he withdrew all of the available funds that were there at that time. She would then keep her money in her purse, as she had done so her whole life, and carried it around with her. Eventually she had to move into a home, though she chose to continue her arrangements with her next door neighbour, and he continued to bring the cash to her.

She continued to carry it with her, in her purse, in her handbag. When the manager of the home became aware of the situation s he had asked Mrs Horton would she like to keep the money in the office safe, but she declined. The manager was very worried as Mrs Horton has regularly left her bag lying around unattended. The manager spoke to Mrs Horton’s daughter, who agreed with her mother that she should be able to be independently responsible for her own money, and belongings. A year later, Mrs Horton’s handbag, along with the money, had been stolen.

The matter had been referred to the police, but nothing had ever come of it. No one knew who was responsible for doing this and Mrs Horton’s money was never found. The use of the concept of ‘critical practice’ could help to avoid the creation of unnecessary dependency in the case of Mrs Horton by getting everyone together , i. e. , Mrs Horton, her daughter, the manager etc. and coming up with a plan of action that would be suitable to all parties, without taking away Mrs Horton’s rights or independence.

The outcome of the handbag being stolen was probably always inevitable, and the manager would have known this, but she could not force Mrs Horton to put the money away in a safe place, nor could Mrs Horton’s daughter be forced to make her mother hand the money over. Policies are always going to be in place in all health and social care departments, but obviously, these are based around the patient-centred care, therefore needing to allow for situations such as this. It’s about finding balance and following procedures through, without creating rules and regulations for a general audience.

Critical practice in theory is a very good idea. It is more and more known for the benefits to outweigh the risks. However, there will always be things like ethics, ageism, diversity or inequality getting in the way, therefore, assessing each individual situation as exactly that, must be done and critical practice should then be applied, to ensure a person-centred, shared-decision making can be done exactly how it should be . Word Count 2635 References Abercrombie, N. , Hill, S. and Turner, B. S. (2000) ‘Book 4: Exploring Critical Practice’, Section C: Ideology and conflict over theory [Online].

Available at https://learn2. open. ac. uk/mod/oucontent/view. php? id=136354&section=1. 3 (Accessed 10th March 2013) Butler, R. N (1975) ‘Book 4: Exploring Critical Practice’, Section C: Ideology and conflict over theory [Online]. Available at https://learn2. open. ac. uk/mod/oucontent/view. php? id=136354&section=1. 3 (Accessed 10th March 2013) Glaister, A. (2008) ‘Introducing critical practice’ in Fraser, S. and Matthews, S. (eds) The Critical Practitioner in Health and Social Care, London, Sage Publications Ltd/The Open University. [Online]. Available at https://learn2. open. ac. k/mod/glossary/showentry. php? courseid=200840&eid=37220&displayformat=dictionary (Accessed 12th March 2013) Hjorland, Birger (2011). Evidence based practice: An analysis based on the philosophy of science. Journal of the American Society for Information Science and Technology, 62(7), 1301–1310. Available at http://en. wikipedia. org/wiki/Evidence-based_practice (Accessed 10th March 2013) Kolb, D. A. (1995)’Becoming a critical practitioner’, K217 Study resources [Online]. Available at https://learn2. open. ac. uk/mod/oucontent/view. php? id=136357&section=10. 2 (Accessed 14th March 2013)

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