Principles of support are applied to make certain that service users are treated fairly and cared for with a holistic approach. A holistic approach is centred around meeting the needs of the whole person, these are referred to as PIES (physical health, intellectual well-being, emotional wellbeing and social wellbeing).
A principle is a basic rule or idea that explains or controls how something happens or works. (Dictionary.cambridge.org, 2019)
The seven main principles in health care are promoting effective communication and relationships, promoting anti-discriminatory practice, maintaining confidentially of information, promoting and supporting individuals’ rights to dignity independence empowerment safety and choice, acknowledging personal beliefs and respecting diversity, protecting individuals from abuse and providing individualised care.
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Promoting effective communication: Communication underpins how we as humans’ function and operate in all areas of our lives, the appropriate use of language and communication forms the basis for success in almost all domains of human activity from politics, business, all areas of work and even family and personal life
Improper communication in the workplace can cause relationships to suffer. There are numerous forms of communication one of which is written communication. lack of written communication can result in improper reporting processes it is especially important that we use the correct communication with dementia patients.
At Fleetwood hall home a visitor raised concerns about unexplained bruises on their family members body, they did not believe that anybody had investigated how the bruising occurred and there was no report of this in the handover book
At Fleetwood hall home there were several communication issues that were not reflective of the communication principle. Communication between staff managers and service users was dysfunctional, staff mentioned that they had not received an appraisal or any supervision for some time and staff training was not up to date.
The provider was not informing the Care Quality Commission (CQC) of all the events the CQC are required to be notified about. After the CQC inspection the service was deemed inadequate in effective listening.
Protecting individuals from abuse: This principle expands on safeguarding service users, it’s the prevention of harm, abuse and neglect to adults with care and support needs. Staff in health care settings have a duty of care to service users and colleagues.
People have the right to live in safety, free from neglect and abuse. Abuse and neglect can happen anywhere: in healthcare settings, at home, at work and study settings like college or university (nhs,2018)
The care act 2014 cites that freedom from neglect and abuse is a crucial aspect of a person’s wellbeing.
At Fleetwood hall home certain areas of the home were not safe, fire doors were wedged open on the mental health unit and certain areas of the corridor floor were moving creating risk and harm to service users and staff, also considerable risk to people with limited mobility. Staff on the mental health unit conveyed that there was not enough staff to minimize and manage risk that certain people presented, in particular those with unpredictable behaviour that may be challenging to others. Staff felt that service users in Fleetwood hall home were unsafe and even showed concern for their own safety. One member of staff said that an individual living on the mental health unit attempted to set fire to another service users’ jacket with a cigarette lighter, staff were also uncertain if an incident report form had been completed for this incident.
At Fleetwood hall home there was no sturdy process in place to ensure service users were protected from actual and possible abuse. Not all staff members understood adult safeguarding and majority did not believe verbal and minor forms of abuse needed to be reported, they also thought the same for intimidation and unexplained bruising. After looking at training records it was shown that up to 65% of staff were not up to date with adult safeguarding training. Staff did not know that all forms of abuse needed to be reported, there needs to be improvement in the service because this is a form of neglect which is a form of abuse.
Providing individualised care: with this principle we apply a person-centred approach to how we care for service users. Every human being is different and our needs and wants differ from person to person. Staff must plan care around the service users’ specific needs, this is the implementation of a person-centred approach.
In Fleetwood hall home individualised care was not always implemented, women did not feel safe living at Fleetwood hall home, they felt unsafe around some of the men. Female and male mental health units had been joined together which meant women and men were sharing the same washrooms and lavatories, some men did not comply with signs on bathroom doors due to memory loss. (Health Safety and Welfare Regulations 1992) act states that men and women should have separate rooms with the correct convenience.
Mental capacity assessments were done in a generic way rather than an individualised way. Day trips at the home happened sometimes but were not always planned around specific needs, this is not reflective of a person-centred approach.
Harm in health care settings is anything that can severely impair or affects the safety of patients in drug therapy, clinical care and public health sectors. Harm can be side effects of treatments, bad reactions to medicines and other unwanted consequences of healthcare services and or products. farlex and partners. (2009). harm.
At Fleetwood hall home there were claims that vulnerable adults were being mistreated. An example of this, service users were left soiled in their beds with some unexplained bruising. There were allegations of residents being underfed and medication was not dispensed at the correct dosage which resulted in wrong doses of medication and overdose of medication.
The home was judged as inadequate, there were a few breaches of care principles that were established during the Care Quality Commission inspection. The dignity and privacy of service users were compromised, men and women were sharing lounge areas and using the same toilet facilities, the (Health and safety act 1974) state that employers must
Service users were at risk from harm because the home did not follow health and safety policies. People in the home were not safe from individuals that presented challenging and uncertain behaviour. Staff training was not abreast, and they had not received an appraisal for some time. Managers, nurses and staff had limited understanding about what constituted safeguarding.
The CQC found many incident reports that should have been reported as safeguarding concerns but was not reported as such. Care staff and nurses were uncertain of how many people were being deprived of their liberty. There was not a lot of activities for the residents of the home, activities were planned as a collective and not to meet specific hobbies, preferences and interests.
Healthcare managers, care professionals and care providers have a duty to ensure they comply with relevant care legislation, this ensures that service users and staff are kept safe. From the findings in the CQC report management in the home need to address the issues and sought to fix them
As a healthcare manager I would use RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) to ensure anything that can harm service users/staff are reported properly and the correct procedures are followed. COSHH (Control of Substances Hazardous to Health) I would use this act to ensure correct use of hazardous substances and the (Medicines Act 1968) to ensure the proper distribution of medication.
I would introduce regular staff training to ensure all staff have a clear understanding of their duty of care and I would ensure all staff are trained about fire safety to ensure if a fire erupted in the home they will be equipped to follow the correct steps to ensure service users are safe. I would update all care plans and ensure care staff are fully informed of all changes to care plans.
Staff should be cleared of CRB and DBS to ensure safe recruitment decisions. Continuous risk assessments of the environment would minimise any risks that could potentially threaten the welfare of service users. During handover from one care staff to another there is a chance for error if all the crucial and relevant information is not assiduously and accurately shared, here I would have everything reported on a computer that all staff has access to and will be able to see what has been reported previously this way there will not be any errors when staff handover. The introduction of monitoring in the home would be an advantage due to reports of poor care and mistreatment of vulnerable service users, perhaps the use of CCTVs, spot checks and regular feedback from clients and family members.
In health and social care person centred approach is providing care that puts the individual first, it is care that is tailored to suit the needs of each individual person. By following a person-centred approach, we seek to empower the service user and empowerment can promote the service user’s independence and autonomy. The wellbeing of the service user is critical when providing care and by following this approach there will be an improvement in the care provided. We should make sure the service user is at centre of all decision making and have an input on what he/she may want in their care plan. This way allows the service user to feel independent.
For an example the service users living on the dementia unit all have dementia, but this does not mean they all require the same care, and this is where a person-centred care approach applies.
There are two types of care approach, directive and non-directive. Directive approach is when the service user has no say and no control over the care they receive, and their autonomy is disregarded. Professionals decide what is best for the service user and there is usually isn’t any involvement of family members or service user.
Non- directive approach is when the service user and family members and relatives have a say in the care they receive. Their wants and needs are considered and put into their care plan; this is a form of freedom for the service user.
Following a person-centred approach encourages creativity for service users, through new ideas and plans. Service users may feel empowered and see improvement in their wellbeing. Care providers and service users may have greater relationships by following a PCA. PCA can allow service users to take responsibility of their life as they also are part of the decision-making process.
There are also barriers to providing a PCA, time can be an issue because following a pact may take up time, this can interrupt with a schedule the staff may have. Communication is also a barrier to providing PCA because some service users may have dementia or may find it difficult to communicate due to language barriers or deafness. Another barrier may be if staff do not undertime or are not fully aware of what constitutes person centred care.
Health and social care act 2008 stipulate that service users must be provided with care that is based on an assessment of their needs and preferences. This way we can ensure a PCA is used to care for service users
Ethical dilemma is a situation in which a choice is to be made between two options but neither option resolves the dilemma at hand in an ethical way. (YourDictionary, 2019).
There is ethical framework that directs healthcare specialists in their behaviour when confronted with a problem. Autonomy, beneficence, non-maleficence and justice are the main considerations for these ethical frameworks. It is necessary to distinguish between ethics, principles, morals and regulations and practices in determining what represents an ethical dilemma.
In the case study we learn that Mrs z likes to start fires and calls them fire dancing lights. Mrs z starting these fires pose a risk to service users and staff at the home, staff have a duty of care to protect everyone in the home including Mrs z. The human rights act 1998 article 8 states that everyone has the right to respect for his private and family life, his home and his correspondence. This means that Mrs z has the right to respect for her private life and her home. There is conflicting laws as the human rights act 1998 article 2 states that everyone’s right to life shall be protected by law, so although Mrs z has a right to privacy and respect for where she lives, staff also have a duty of care to protect everyone in the home by law and Mrs z. Fleetwood hall faced a dilemma because in the risk assessment of Mrs z a psychiatrist has given clear instructions to search Mrs z every time she comes back from the community unsupervised, given this Mrs z hasn’t started a fire in 3 years.
Care professionals must exercise beneficence whilst caring for service users, however a service users’ autonomy is sometimes taken away by certain decisions. The decision to search Mrs z was in line with the ethical framework but this was an invasion of her privacy which made Mrs z annoyed, however justice must still be exercised to safeguard all service users and employees.
To move past this ethical dilemma managers must do a more recent risk assessment of Mrs z and I believe her care plan should be reviewed to have her supervised whilst out in the community so that whenever she returns to the home she will not be subject to search anymore.
Legislation guarantees that the freedom of people in health and social care are recognized, shielded and maintained. It is essential that people’s principles, integrity, and opinions are shielded from harm. (Whereyoustand.org, 2019)
The Health and Social Care Act 2008 was introduced to regulate and make certain that local authorities and service providers were adequate in their duty of care. One of the fundamental aims of this act is to protect vulnerable people from neglect and abuse. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is intended to ensure that providers employ qualified, experienced and competent staff to allow them to meet all regulatory requirements, staff must receive the correct support, training, supervision, appraisals and professional development needed for them to carry out their role and responsibilities.
The CQC found the home in breach of Regulation 12 of the health and social care act 2008 staff training was not up to date, not all staff understood what constituted adult safeguarding and up to 65% of staff were not up to date with adult safeguarding training. Some staff didn’t believe that minor abuse and verbal abuse needed to be reported and there was a shortage of staff at the home. Staff left in pairs to smoke outside leaving service users unsupervised, staff cannot monitor service users every minute of the day but leaving a service user alone is a risk and is a form of neglect.
There were not always enough members of staff to manage potential risk and general nurses were sometimes left on the dementia unit rather than a mental health nurse. To implement the health and social care act 2008, I would have regular staff training and workshops to ensure all staff understand all relevant legislations and adhere to them correctly.
policy is a collection of concepts or a schedule of what to do in specific circumstances formally decided by a community of individuals, a business organization, a government or a political party.
Developing strategy is of fundamental importance to organizations. An organization without a strategy is an organization without control. If there were no official recorded strategies, then organization staff at any level would have no instruction on how to create choices. (Leoisaac.com, 2019)
The adult safeguarding policy 2018 lays out the statutory criteria for NHS to exercise its suitable responsibility for safeguarding at-risk kids, youth and adolescents.
Safeguarding adults is to promote their right to live in safety, without abuse or neglect, by doing so we allow service users to have the best quality of life.
At Fleetwood hall home this policy was not always implemented, for example there were allegations of service users left soiled in their bed and unexplained bruising of people on the dementia unit also claims that some residents were underfed, In these situations the service user is left with a loss of dignity, their right to be valued and respected is abandoned. All healthcare professionals have a duty to ensure they adhere to the correct legalisation; this ensures that service users are kept safe from neglect and abuse with their dignity respected.
To implement the adult safeguarding policy, I would provide staff with information packs that outline policies and procedures that must be adhered to. I would also hold regular staff training and staff meetings instead of annual meetings to ensure everyone has the same understanding of policies and legislations and can demonstrate this in the care they provide.
The objective of healthcare policy and procedure is to provide consistency in day-to-day operations. (Leahy, 2019)
There are numerous policies, procedures and legalisation that preside over the health and social care sector with , they focus on health, safety and wellbeing of service users. The health and social care act 2008 and the adult safeguarding policy 2018 rely on the ability of the service providers to comply, uphold and implement the requirements needed to ensure the successful operation in health and social care settings. (Tannas, 2019)
At Fleetwood hall the adult safeguarding policy 2018 and the health and social care act 2008 were not successfully being implemented and they were not currently meeting the requirements set out by the CQC, there are numerous reports that reflect this.
Development of health and social care act 2008 could be improved through consultation of national legalisation and policies, to improve effectiveness policies must be simple and clear. I would assess the specific needs of the home and research the best practice for developing those areas.
I would analyse the situation and discover ways to improve in all the areas the CQC found to be in breach of regulations and policies, I would then develop a writing plan, and draft new policies and procedures that will help Fleetwood hall, staff would attend induction days so they can engage in communication and education. My next step would be to obtain approval for any new policies.
As a new manager I would make it mandatory for staff handing over to briefly discuss any relevant information from their shift, document this clearly and sign the handover book to say they understand. All policies and regulations need to be monitored correctly and frequently to implement the correct use of the adult safeguarding policy and the health and social care act 2008.
I would ensure all staff adapt a person-centred approach to uphold empowerment, prevention, proportionality, protection, partnership, and accountability. Preventative measures would be put in place to prevent harm to service users and staff, and I would inform staff on accountability if they fail to adhere to the rules and regulations.
Policies are vital as they set a general plan of action which is used to pilot desired outcomes, policies are fundamental guidelines to help make decisions. It is essential for people within a healthcare organisation to be involved in the implementation of policies and procedures and processes and to understand what they are and how they are used. (Leahy, 2019)
We need policies legislations and codes of practice as they support health and safety at work, they are intended to protect service users and staff. The CQC can bring prosecutions against service providers who breach health and safety standards.
Adhering to policies would have a positive impact on Fleetwood hall home, this is because this impact will bring a change to Fleetwood hall and eventually safeguard both service users and service providers.
Barriers to implementing policies and legislation include time, time is one of the biggest obstacles when trying to implement legislations and policies. Time is required for training, recording events and follow-ups, as well as time consuming in practice and any modifications in policies and legislation are expensive for healthcare organisations.
The overall contemporary view is that our characters are formed by a combination of biological and cultural variables. Scientists investigating human development split growth factors into three fields;
Physical domain is physical development changes in size and strength. Physical domain also covers the development of motor skills such as gross motor skills and fine motor skills, this domain also includes the development of senses and using our senses.
Cognitive domain is the development of mental skills and obtaining knowledge. There are five stages of cognitive behaviour which are, sensorimotor stage from birth to age 2, the preoperational stage from 2 to 6, concrete operational stage from age 7 to 11 and formal operational stage which is age 12 to adulthood.
Social domain is our development of skills, our self-esteem, our relationships with others, our moral reasoning, identity and interpersonal skills.
The humanistic theory by Abraham Maslow stipulates that until our fundamental demands are encountered, we will concentrate all our efforts on meeting them and not be prepared to make further strides. (ALDWORTH, BILLINGHAM and LAWRENCE, 2010)
Abraham Maslow hierarchy of needs details that people are motivated by five basic categories of needs: physiological, love, esteem, safety, and self-actualization. (ThoughtCo, 2019). These needs are presented as a hierarchy triangle which varies from more concrete needs such as water to more abstract notions such as self-fulfilment.
According to Maslow basic needs need to be met before progression to the next level can occur.
Erikson’s theory of psychosocial development suggests that every human being must go through a sequence of eight interrelated stages throughout their full life cycle. (Verywell Mind, 2019).
Trust vs mistrust, autonomy vs shame/doubt, initiative vs guilt, industry vs inferiority, identify vs role confusion, intimacy vs isolation, generativity vs stagnation and integrity vs despair.
I want to concentrate on integrity vs. despair. Integrity is being honest and getting powerful personal values that you hesitate to modify; with integrity you can look back and experience a feeling of achievement. Service users must feel a sense of fulfilment from the life they have lived. Service users who feel proud of what they have accomplished will possess integrity. Service users who feel unsuccessful at this time will feel like they have wasted their life and will experience regret and feelings of despair.
In Fleetwood hall home, service users over 65 may begin to feel anxious about the ending of their life. People who have fulfilled life goals and achieved what they planned will feel a sense of integrity and may be a positive and happy person because of this. Someone who does not feel as if they have achieved life goals may have feelings of regret and despair. Service users who feel this way are most likely to be unhappy and a negative person and may be difficult for service providers to care for them.
Theory practice gap could be filled by staff having placements before starting their job. Well informed mentors will be an advantage to ensure they do not create misconceptions or give incorrect advice based on bad habits. Also, easy access to new research and building a culture of research led establishments, and support collaborative working where staff of all levels and academic training work and share together.
Social process is ways in which groups and individuals interact and build social relationships. (Your Article Library, 2019). Social process can lead to isolation, exclusion, and marginalisation.
Social isolation describes the lack of social contact and may contribute to loneliness. It is a state of being torn off from social networks, which can be caused by, reduction of mobility, poverty or health problems. Social isolation is associated with a greater risk of death in elderly people, independent of whether they regard themselves lonely.
Social exclusion is a method by which individuals or groups are separated from amenities, advantages and opportunities that give joy. Social exclusion is the demonstration of making certain groups of people within a society feel isolated and unimportant. (Collinsdictionary.com, 2019)
Marginalisation is the way toward driving a specific gathering or gatherings of individuals to the edge of society by not permitting them a functioning voice, personality or a spot in it. Preventing somebody opportunities from claiming their personality like racism, sexism and ableism.
Social processes affect service users in different ways. In Fleetwood hall service users may feel isolated, poor health of a service user is a factor that may negatively impact a service user, living in the home with an illness may allow feelings of sadness and disappointment. Unemployment may also be an issue in present day society which also have a negative impact. Disabled service users may feel isolated and disappointed about their life, these situations may prompt suicide cases and extraordinary consideration must be advanced for such individuals.
At Fleetwood hall there are service users at risk of social isolation due to mental illnesses, dementia and mobility restrictions due to physical disability.
Inter-professional working is the method by which employees of different professions and/or organizations operate together to provide embedded wellness and/or social care for the advantage of service user. (Pollard et al 2005).
The importance of Inter-professional collaboration improves access to care, patient safety and overall satisfaction is improved. It improves care and services and develops good teamwork. Finding and maintaining health professionals.
Advantages of inter-professional working include, improve professional skills in giving quality health care to patients and their families, newfound respect for professionals, workload is easier manage, colleague support, exchange of ideas, and skills and knowledge are also advantages of inter-professional working.
Disadvantages of inter-personal working include liability issues, conflict may arise between professionals, professionals may find it difficult in organizing meetings with different staff members from different professions. Dissatisfaction with outcomes and partners may also be a disadvantage, for example hospitals must wait to discharge service users because housing and community services have not responded.
There are barriers to inter-professional working such as differences in care professionals’ values and power struggles between professionals. They may feel a lack of sense of how to work together, also it’s not always possible to organize meetings where everyone is present. Professionals may also face a lack of respect amongst each other. Funding may also be a barrier for interprofessional working. Barriers to inter-professional working are very prevalent in health and social care, contributing to unfortunate consequences and causing vulnerable individuals harm and neglect.
These barriers can be overcome by facilitating trust and communication, all professionals need to set shared goals, with regular contact between team members and share knowledge. Set to fix differences in language and jargon so better communication can develop. Everyone being aware of responsibilities of each team member and fix any differing professional routines.