Principles and Practice of Support in Health and Social Care
In health and social care settings there are principles which govern the practice of healthcare workers to ensure that quality care is provided for service users. This essay will discuss how principles of support are implemented in health and social care practice. It will also explain the theories that underpin health and social care practice and make some contribution to the development and implementation of health and social care organisational policy. A principle maybe defined as “a fundamental truth or proposition that serves as the foundation for a system of belief or behaviour or for a chain of reasoning” (Oxford Dictionary, 2013).
It may also be defined as a code of conduct or rule and regulation. In health and social care settings there are principles which govern the practice of care workers to ensure that quality care is provided for service users. Many principles are applicable to health care practice but some of the most important are: promoting effective communication and relationships, promoting anti – discriminatory practice, maintaining confidentiality of information, promoting and supporting individuals’ rights, acknowledging individuals’ personal beliefs and identity and providing individualised care.
In ABC Care Home, supported housing is provided for homeless adults from various, nationalities, religious, cultural and social backgrounds. These principles are being applied to promote quality care for each resident. In the Care Home promoting and supporting of individuals’ rights is key. The privacy and dignity of residents are ensured. Every client has their private room with their own key. Staff can only go into residents’ room when on official duties such as bed checks and they must knock before entering. Staff cannot enter except with residents’ permission.
Another principle of health and social care practice which is central to the operation of ABC Care Home is anti-discriminatory practice. In line with the Equality Act 2010, ABC Care Home has a policy of promoting equality, diversity and inclusion. Residents are treated equally irrespective of colour, ethnicity, religious belief or sexual orientation. The population of the Care Home consists of blacks, white as well as mixed race individuals from African, Caribbean and European origins. There are Christians, Muslims, Hindus, Buddhists, atheists and freethinkers.
There are also heterosexual, bisexual and homosexual people. Everyone’s identity and religious belief is respected. During the Muslim fasting period, special arrangements are made to provide Muslims who are fasting with food during late evening and early morning outside the normal operating hours of the canteen. Harm may be defined as “physical or mental injury or damage or moral or evil doing” (Collins Dictionary, 2012) while abuse is to “use or treat in such a way as to cause damage” (Oxford Dictionary,2013).
Both service users and healthcare workers are susceptible to harm or abuse in the healthcare environment. There are environmental hazards such as wet or slippery floors, cluttered passage way or corridor, electrical flexes, hazards associated with equipment and materials such as faulty gas or electrical appliances, damaged lifting equipment, etc. ; as well as hazards connected with people such as intruders, visitors, violent and aggressive behaviour, etc. Another protection issue is protection from illness and infection.
In ABC Care Home policies and procedures have been put in place in line with existing legislation to ensure protection of clients and staff from these hazards. For example all staff are made to undergo regular training in first aid and fire safety procedures. There are concierge workers whose duty is to secure the premises against intruders and unwanted visitors. They are also to ensure that passageways are free from clutters and electrical flexes. They are to ensure that spillages are mopped and appropriate caution signs are in place to warn staff, clients and visitors of potential hazards.
In ABC Care Home staff are prohibited from getting involved in any form of financial or sexual dealings with residents. It is also an offence punishable with summary dismissal for a staff to physically abuse a resident at ABC Care Home. In the same vein, any resident guilty of physically abusing staff will be evicted from the hostel. There is a robust complaints procedure in place for the residents. Any residents guilty of bullying another resident or perpetrating any form of abuse against another may be evicted depending on the seriousness or extent of the abuse.
The person –centred approach was born from the work of Carl Rogers as a method of counselling and psychotherapy . According to Rogers (1980) “individuals have within themselves vast resources for self –understanding and for altering their self –concepts, basic attitudes and self-directed behaviour; these resources can be tapped into if a definable climate of facilitative psychological attitudes can be provided. ” This approach places emphasis on putting the client at the centre of health care practice and giving them choice and control over the care plan and service provided for them.
The person-centred approach is about engagement between the service provider and the service user whereby the health care worker treats the client with empathy and understanding and gives them unconditional positive regards without being judgmental. The approach also focuses on respect for service users and their decision as well as commitment to quality, safe and ethical care. This approach is opposed to the directive approach where the professional’s decision is final, service users are not involved in their own care plan and treatment, and no choice and control is given to clients and little or no autonomy.
ABC Care Home is committed to the person-centred approach in dealing with clients. For example care plan and support is personalised for the service user. A risk assessment is carried out for the client by a support worker to know the individual’s background and peculiarities. The assessment will show if the person has alcohol or drug – related problems, health issues, depression, anger management problems and if they require any specific feeding and mobility aids while living in ABC Care Home.
There are specialist key workers with specialisation in alcohol and drug abuse and those with mental health training. ABC Care Home also has inter-professional working arrangements with external organisations to support clients in areas where the experience or skill is not available in – house. Special arrangements are made to provide meals for clients who cannot come to the dining hall during service hours due to their work schedules or other engagements. Wake up calls are given to clients who need to meet up with one appointment or other at their request. The benefits of person centred care are enormous.
Clients are satisfied with care provision and it gives them a feeling of worth and well-being when they are involved in decisions which affect their lives. Life becomes more meaningful to care users when they are made the focus of service provision. Giving autonomy to clients also promotes their independence and individuality. For care providers, the person – centred approach promotes creativity and helps identify areas of improvement, thus ensuring holistic care provision and good practice. It also enables care users to take responsibility and set direction for their life.
“A dilemma can be defined as a situation requiring a choice between equally undesirable alternatives” (Dictionary. com, 2013) while an ethical dilemma is defined by Rae (2009) as “a conflict between two or more value – or – virtue driven interests”. Ethical dilemmas arise “when it is necessary to choose between ethics that appear contradictory” (Kadushun and Egan, 2001). For example situations arise where a difficult choice has to be made between what is considered to be the best interest of the client versus the principle of individuality or independence of the client.
A case in point is that of 67 year old Mrs M who cannot stop smoking and drinking despite having sustained a life threatening disease (lung cancer) from these habits. She is also suffering from acute pains that are not being relieved by the prescribed pain killers. The doctor has refused to prescribe stronger pain killers because of serious adverse effects. It is an ethical dilemma for the social workers to prevent the patient from smoking and drinking because this would infringe on her individual rights and autonomy even though the habits are seriously impairing her health.
It is also a dilemma for the doctor to not give her stronger pain killers to relieve her pain because of the adverse effects while she is suffering and screaming due to acute pains. Managing ethical dilemmas is not easy and it involves making difficult decisions within a limited time scale. In making such decisions, the risks are weighed against the benefits to the service user and the aim is always to achieve the most beneficial outcome for the client. In the above scenario a care plan might be agreed with the patient and her family whereby the cigarettes and alcohol will be locked up and only given
to the client at jointly agreed times. The doctor may also be consulted for the possibility of giving nicotine patch to the patient rather than cigarette. Neuropathic treatment may also be considered for the patient e. g. acupuncture to alleviate her pains rather than allow her to use the strong pain killers which might worsen her state of health. Legislation is the act of making laws. A legislation can also be defined as a law or set of laws enacted by a parliament. In the UK several pieces of legislation have been put in place to regulate healthcare practice and to ensure high quality of service delivery to clients.
ABC Care Home where I work have also formulated policies and procedures based on national policies and legislations to ensure that staff adhere to principles of healthcare practice as stipulated by law and that service users receive the highest quality of service provision as required. Examples of legislation which regulate the policies and procedures which underlie healthcare practice in ABC Care Home are Care standards Act (2000), Health and Social Care Act (2012), Equality Act (2010), Data Protection Act (1998) and Health and Safety at Work Act (1974).
For example the anti-discriminatory policy in ABC Care Home is based on the Equality Act (2010). All clients and staff must be treated equally and fairly irrespective of colour, gender, nationality, religions belief, disability or sexual orientation Policies and procedures are developed in ABC Care Home to enable the organisation comply with legislative requirements by providing a structure for activities carried out by staff. “A policy is a set of principles that provide a definite direction for the organisation while a procedure is a step by step method for implementing an organisation’s policy or responsibility” (www.
ahmrc. org, 2013) Legislations are more broad based and may contain a lot of information which are not relevant to a particular organisation. Policies are developed in response to the need to comply with the requirements of legislation or deal with other identified problems, either existing or anticipated, in the organisation. For example the Manual Handling Policy in ABC Care Home is based on the Health and Safety at Work Act (1974) while the Recruitment Policy is based on the Care Standard Act (2000) and the Equality, Diversity and Inclusion Policy is based on the Equality Act (2010).
Procedures then spell out the step by step guidelines for implementing these policies e. g. the complaints procedure. In ABC Care Home, the development of policies and procedures is a function of top management who then communicate such to all branches, staff and clients electronically as well as in writing. Generally speaking, policy, legislation, regulation and codes of practice have a positive impact on the policies and practices of ABC Care Home.
They ensure the smooth and efficient running of the home, help to minimise conflict and confusion in the way staff carry out their work and reduce the incidence of abuse and harm to clients and colleagues. They also serve as catalysts for improvement of the quality of service delivery. According to Greene (2008) a “theory is a logical system of concepts that provides framework for organising and understanding observations” Several theories of human development have been put forward to enable us understand the impact of hereditary and environmental factors on the personality and emotional make-up of individuals and hence, their behaviour.
Some theories argue that individuals are shaped by genetic factors while others contend that social systems are the principal determinant of human behaviour. This controversy is referred to as the “nature” versus “nurture” debate. However, the consensus among modern theorists is that personalities are shaped by a combination of both biological and social factors. Thus factors which contribute to the make – up of individuals include the genes they inherit, their physical characteristics, culture, social class, their upbringing, the choices they make, opportunities that they have and the impact of other people in their lives.
Examples of theories which underlie healthcare practice are Erickson’s psychosocial stages, Albert Bandura’s social learning theory and Piaget’s stages of development. Piaget’s theory has classified stages of human development into 4 broad categories namely, sensorimotor (0 – 2 years), Pre-operational (2 – 7 years), concrete operational (7 – 11 years) and formal operations (11+). Understanding of human development theories enables me to understand the people that I work with in ABC Care Home, how they develop and to be able to place their life in context of the expectations of normal life span development.
Social process can be described as “those ways of interacting which we can observe when individuals and groups meet and establish system of relationships or what happens when changes disturb already existing modes of life (Gillin & Gillin, www. preservearticles.. com 2013). Three important social processes can be identified. These are marginalisation, social isolation and social exclusion. Marginalisation occurs when a section of population within a larger society is excluded from meaningful participation in that society.
Social isolation is an objective condition in which people have little interaction with others. This has been linked with higher risk of death in older people. Social exclusion is a multi – dimensional process involving lack or denial of resources, rights, goods and services. It also involves not being able to participate in economic, social, political or cultural activities available to the majority of people in a society. Social exclusion affects the standard of living of individuals as well as social cohesion and equity (www. poverty. ac. uk 2013).
Factors leading to marginalisation, isolation and exclusion are poverty, unemployment, poor health, disability, lack of education and other sources of disadvantage. All these factors have been associated with ill health, either directly or indirectly. According to WHO, for example, poverty creates ill – health because it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation. Most of our residents in ABC Care Home (which cares for the homeless) are victims of poverty, unemployment, little or no education and one form of disability or the other.
Many were sleeping rough on the streets before being admitted into the home. Many lost their jobs or are unable to secure jobs due to criminal record and lack of education or employable skills. Many are products of broken homes and became involved in crime, alcoholism and drug misuse. All these led to their becoming victims of social exclusion. Hence, in ABC Care Home, the understanding of social processes and the effects on clients underlies the provision of personalised services based on individual circumstances and needs. According to Pollard et al
(2005),”inter-professional working is the process whereby members of different professions work together to provide integrated health and/or social care for the benefit of service users”. In inter-professional working, different professionals bring their different skills together with the aim of providing the best possible care for service users. For example, the GP Surgery, district nurse, care home, social services, and hospital and pension services may all collaborate to provide the highest quality care for patients or clients, using their various expertise.
The benefits of inter-professional working include improving the efficiency of the care system, streamlining assessments so that families do not have to give the same Information to various professionals, coordinating the provision of care and improving the sharing of information among professionals. Other benefits include creativity in service provision, job satisfaction, speed, accuracy and safe delivery of care, reduction in errors and minimising of risks.
However, there are formidable barriers militating against effective and successful implementation of inter-professional working such as ideological differences, differences in work culture and ethics a well as lack of clarity about roles. Nevertheless the benefits outweigh the disadvantages. In ABC Care Home service users benefit immensely from inter-professional partnership among support workers, resettlement officers, specialists in alcohol and drug misuse, life coaches, mental health workers, probate officers and GPs.
As a new manager in ABC Care Home my roles and responsibilities will be to operate within the established principles of health and social care practice and to ensure that all other workers in the home do the same. I will promote and support the rights of every individuals. Individuals’ personal identity and beliefs will be respected. Anti – discriminatory practice will be rigorously enforced. Service users will be given control of their lives and the opportunity to make informed choices. Equal opportunities will be given to all service users and staff.
Respect will be accorded to all clients and employees irrespective of cultural diversity, religion, gender, colour, ethnicity or sexual orientation. I will promote effective communication and relationships within the Home. The privacy, individuality and dignity of service users will be respected at all times. Confidentiality of information will be promoted and the policies of ABC Care Home in respect of confidentiality will be explained to service users and carers. I will put in place processes and procedures, for challenging and reporting dangerous, abusive, discriminatory or exploitative behaviour.
Colleagues will be obliged to report unsafe practices or practices which may jeopardise the standard of care. I will also make it mandatory for operational or resource difficulties to be reported. Compliance with health and safety policies will be rigorously enforced. Staff will be made to undergo training in health and safety matters from time to time. As manager of ABC Care Home I am accountable for the quality of work done by myself and colleagues and I will ensure that we constantly update our knowledge and skills so that relevant standards of practice will always be met in the Care Home.
I will also ensure that accurate records of operations in the Home are maintained and kept. Policies and procedures will be put in place to ensure that service users and colleagues are protected from abuse, neglect, harm or exploitation at all times. Inappropriate personal relationship with service users will be discouraged. An effective complaint procedure will be put in place and complaints will be taken seriously and attended to quickly and appropriately. Staff training will be a matter of priority and the staff recruitment policy will ensure that unsuitable individuals do not find their way into the organisation.
References and police checks will be considered before employing staff. Disciplinary measures will also be taken against staff found guilty of unprofessional or other form inappropriate behaviour in the work place. All these steps will go a long way to correcting all the shortcomings identified in ABC Care Home and repositioning it as a high quality and safe care service provider. In this essay I have endeavoured to show that quality, safe and effective healthcare practice is based on certain established and time tested principles.
These principles are codified as laws by government and translated into policies and procedures by healthcare organisations for implementation by their employees. I have also shown that the understanding of human behaviour as a product of biological and environmental factors will help healthcare workers in providing personalised and contextualised care to their clients. Also, I have endeavoured to make my own little contribution to the development and implementation of sound, qualitative and effective healthcare policies for ABC Care Home.