Working Practices Andstrategies in Health and Social Care Setting
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In this assignment I am going to explain my understanding of working practices and strategies that are used to minimise abuse within the health and social care contexts. The caring professions provide some examples of what people thought may have been a good practice of care then but actually is poor or even abusive practice. The main reason why this happens is due to the changes that occurs within working policies. Within my workplace we have different policies that safeguard vulnerable adults, here are some of working practices that I believe help safeguard:
• Complaints Policy Effective communication
• Record-keeping Policy Risks Assessments
• Confidentiality Policy Recruitment procedures
• Data Protection Policy Induction
• Protection of Vulnerable Adults Policy Training
• Whistleblowing Policy Codes of conduct
• Care plans – Person Centred Care Reflective practice
• Anti – discriminatory / Anti – oppressive practice
• Organisations safeguarding policy & procedures
Each resident is assessed before arriving at the home, once assessed our nurse manager produces a careplan for that resident. The resident and their family have the right to be involved in developing a meaningful and effective care plan. The nursing home must work with the resident to develop an individualized, written care plan and must update it at least quarterly and any time your condition changes.
Each resident important right is to receive good care. To give good care, the nursing home staff must plan to support the needs, abilities, interests and preferences. Under the law, residents and families are partners in this planning process. They have the right to give information, ask questions, participate in care plan meetings, offer suggestions, review care plan documents and accept or refuse offered care. If they get involved in the care planning process, it is almost certain that they will get better care and enjoy a higher quality of life. Assessment is a way of learning important information about a resident so that an individualized care plan can be developed. The staff members need to get a "whole picture" of who the resident is. Otherwise, it is likely that their needs will go unmet and their preferences unnoticed. Knowledge about who the resident is helps build respect and understanding. The nursing home is required to do a comprehensive assessment. It must gather information about health and physical condition and identify what type of help the resident needs. The assessment must also examine routines, habits, activities and relationships in order to help the resident live more comfortably and feel at home in the facility. The resident gets an opportunity to share important information about them. Describe what makes a good day for them. Discuss their goals, such as plans for discharge or hopes of improved health and independence.
Assessments must be done within 7 days of admission and at least once a year after that. Reviews are held every three months and any time that the residents condition changes.
Within seven days after the assessment is completed, the nursing home must create an initial care plan that addresses all the needs and concerns of the resident. If done properly, the care plan is a custom made strategy for how the staff will help the resident every day.
A good care plan should:
• Be specific by reflecting the residents concerns and desires;
• Support well–being and rights;
• Use a team approach involving a variety of staff and outside referrals as needed;
• Include specific goals;
• Assign tasks to specific staff members;
• Be written in common language everyone can understand
• Be updated as needs of the resident may change.
Care plans are a necessary part of the record-keeping of any home and facilitate good communication between residents and internal and external staff.
Record-keeping is an integral part of nursing care. Good record-keeping helps protect the welfare of patients by promoting high standards of care. Having continuity of care means better communication of information between members of the inter-professional health care team also. It is always important that any changes of treatment, care or clients condition is recorded as soon as possible when a change happens. Good record-keeping shows that nurses and cares are skilled and are safe practitioners, on the other hand careless or incomplete record-keeping can provide problems with the carers practice. Audit can play a vital part in ensuring the quality of care is delivered and applies equally to record-keeping. By audit records, the standard of the records can be assessed and identify areas for improvement staff development. A full account of record-keeping is vital to the care that nurses and carers has planned and provided relevant information about the condition of the resident at any given time and the measures taken to respond to their needs, this is also important evidence that the nurses and carers has understood and honoured their duty of care. Record keeping has proved to be less effective especially in the O’Neill Report. The report states that there was evidence of inaccurate recording of information relating to Madeleine at both hospitals. Knockbraken Healthcare Park insisted that they give Madeleine’s notes to her father, thou the father was clear that he never got the notes. Madeleine discharged herself from the Gransha Hospital after 13 days and still the hospital did not receive her notes. The Independent Inquiry Panel identified 17 major issues in the case and 1 off them highlighted was Recording of Information. I think in order for Record keeping being effective it must be clear and accurate without errors. Information has most value when it is accurate, up to date and accessible when needed.
The home in which I work are committed to achieving and sustaining high standards with regards to behaviour at work, the service that we provide and in all its working practice. Management require the staff to conduct themselves with integrity, impartiality and honesty at all times. Therefore for any inappropriate behaviour at any level is expected to be reported at all times. If there is inappropriate behaviour the employee has the opportunity to report this through the Whistleblowing Policy.
The Whistleblowing Policy within the nursing home has been written to ensure that all reported incidents are investigated in a fair, sensitive and confidential manner where individuals can act without fear of retaliation and humiliation that others will not consider the act trivial and unacceptable and more importantly will be taken seriously with confident that action will be taken.
The Whistleblowing Policy has to be effective and honest, all communication has to actuate and with this the aims will be achieved and bad practice will be dealt with properly, this will ensure that vulnerable adults and children are safeguarded at all times from abuse. At times the Whistleblowing Policy has been less effective eg: like in the Winterbourne View Hospital. Whistleblower Terry Bryan, a former nurse at the home, went to the BBC with his concerns after his complaints to owner Castlebeck and care watchdogs were ignored. Terry left employment when no investigation was carried out.
A serious case review published in August criticised Darlington-based Castlebeck Ltd, which owned the hospital, for putting profits before humanity. The final report into the events at Winterbourne View Hospital states that staff routinely mistreated and abused patients, and management allowed a culture of abuse to flourish. The warning signs were not picked up, and concerns raised by a whistleblower went unheeded. I do believe that management in any care setting must have a standard and must not let this happen.
Here are some of the Strategies that would be used to minimise abuse in the health and social sector
• Assessment framework (UNOCINI)
• Multi-agency working
• Working in Partnership with service users
• Vetting and Barring
• National Minimum Standards
• National Service Framework
• Case conference
• Child Protection register
• Child Protection Plan
• Case Management Reviews
A case conference is convened if a child is considered to have suffered, or to be at risk of suffering, significant harm. It brings the family together with a range of professionals who have relevant information. The conference will decide if the child should be placed on the child protection register. The Child Protection Register is a list of children who are known or believed to have been abused or injured in some way, or who are thought to be at risk of injury, abuse or neglect. The register is kept by the Social Services Department. It is strictly confidential and information from it is available only to professional people such as health vistors, teachers, doctors, police and social workers. All children whose names are on the Child Protection Register, must have a Child Protection Plan. The plan should make clear what is expected of each agency in contributing to help protect the child. It should also make clear what is expected of a parent in order to reduce the risk to their child. Parents will be involved in the preparation of this plan.
The case conference is effective if put into practice like the above description I give. A perfect example of a case conference going wrong is the Baby P case.
The secretary of state for children, schools and families, Ed Balls made a statement given on 1 December 2008 saying that, ‘I want to say very clearly at the outset: social workers, police officers, GPs, health professionals, all the people who work to keep children safe, do a very difficult job, often in really challenging circumstances – all around the country and in particular in Haringey. ‘They make difficult judgements every day that help to keep children safe – and many of them are unsung heroes. ‘But they must also be accountable for their decisions. And where things go badly wrong, people are right to want to know why and what will be done about it. In the case of Baby P, things did go tragically wrong.’
This case proved that a lack off communication between professionals was a huge downfall. A total of 28 experts - social workers, doctors and police officers - saw him during the period he was known to be at risk. And yet time and again he was returned to his home. Hall (2005) suggests inter-professional working is about professionals carrying out their own role, while working in partnership with other professionals to achieve joint goals. Inter-professional working between health and social care agencies promote effective ways of meeting the holistic needs of a person.
No single agency is to blame in the Baby P case, police and social workers knew that Baby P's mother had a new boyfriend and yet this was never followed up. Baby P's paediatrician missed eight broken ribs and a broken spine, with the evidence of these social workers was no longer the target. All the professionals involved in this case were all at fault and had poor judgement regarding Baby P. Maybe it is that the social workers had poor quality training support. The Social workers Miss Ward, 40, and her team manager Mrs Christou, 52 who were involved in this case, admitted professional failings and misconduct over their handling of the toddler's case, breaching professional standards in the case, including inadequate record-keeping and supervision.
Lord Laming's review of child protection ordered after the Baby P case it is set to lead to significant changes to the practice, training and management.
All of us find it impossible to comprehend how adults could commit such terrible acts of evil against this little boy. People are angry that nobody stepped in to prevent this tragedy from happening.
Another case study which shows professional failings is Victoria Climbe. The Working Together to Safeguard Children 2006 came to pass after the death of this child. This is an updated act providing help to agencies to work individually and as team to safeguard and promote the welfare of young children. This was necessary especially after it was obvious in the Laming report 2003 that lack of communication between social workers, nurses, doctors, police officers led to death of Victoria Climbe. Lord Laming review of children's services in England concluded that child protection issues in England had not had "the priority they deserved" and many of the reforms brought in after Victoria Climbie's death in 2000 had not been properly implemented. Other findings informed us that
There had been an "over-emphasis on process and targets", resulting in a "loss of confidence" among social workers, who were overstretched and undertrained. Dr Eileen Munro, said social workers spent 80% of their time in front of their computers and "hardly had time to talk to the parents, let alone the children". She also made the points of
• Progress was being "hampered" by the lack of a centralised computer system and an "over-complicated... tick-box assessment and recording system"
• There was a lack of communication and joined-up working between agencies
• A lack of funding made social and child protection work a "Cinderella service".
Working practices and strategies are not always enough!
Lord Laming's Report into Victoria Climbie's death expressed his amazement that nobody in the agencies “had the presence of mind to follow that are relatively straight forward procedures on how to respond to a child about whom there is concern of deliberate harm”.
The new Vetting and Barring Scheme (“the Scheme”) came into law after the murders of Holly Wells and Jessica Chapman by Ian Huntley. The new scheme is set up so everyone working with children or vulnerable adults should be checked and registered.
The inquiry led to The Safeguarding Vulnerable Groups Act 2006 (“the Act”) and the Safeguarding Vulnerable Groups Order (Northern Ireland) 2007 (“the Order”) which set up the scheme. This new Scheme will affect everyone who works with children aged under 18 or vulnerable adults. I do believe that the scheme recognises the need for a single agency to vet and register all individuals who want to work or volunteer with vulnerable people, and to bar unsuitable people, by the vetting and barring it minimises the risk of abuse.
The Minister for Health, Social Services and Public Safety, Michael McGimpsey said:
“We in Northern Ireland are part of this Scheme, to increase safeguards and reduce the risk of abuse to children and vulnerable adults in Northern Ireland”.
Improvements in any aspect of life are important, especially when they take place within the health and social care sector. Collaboration is important, because general practitioners and social services staff act as gatekeepers to other services. General practitioners control access to secondary and community health services through patient referrals. Social services departments manage funding for home care services and residential and nursing home places and control access through assessment and care management. When one professional or organisation depends on another professional or organisation to obtain services, their ability to achieve their own professional or organisational objectives is affected crucially. For many general practitioners, I think closer links with their social services department could be a high priority.
In the field of healthcare work, effective collaboration and interaction can have direct ramifications for patient care. For example, the Victoria Climbé inquiry (Department of Health, 2003) and the Bristol inquiry (Department of Health, 2001a) both indicated the need to move towards collaborative teamwork, and the need for a review of professional education and training in the UK (Humphris and Hean, 2004).
The modernisation of healthcare in recent years has initiated a move towards a team-based model of healthcare delivery (Baker et al., 2006; Wagner, 2004). Poor teamwork skills in healthcare have been found to be a contributing cause of negative incidents in patient care, while effective teamwork has been linked to more positive patient outcomes (Grumbach and Bodenheimer, 2004; Runicman et al., 1993).
Inter professional teamwork and communication within a case can be deemed by some professionals to be acceptable, with room for improvement.
Undre et al.’s (2006) findings suggest that health professionals are not required to view themselves as a unitary body, in order to achieve acceptable levels of teamwork. However, this does not mean that shared understanding is not desired or encouraged; as this can lead to a barrier to the efficacy of inter professional healthcare teams.
The references throughout my assignment prove to me that recommendations for changes within the inter professional protection teams are required and that communication is a huge barrier and downfall within the professional teams and if this problem could be solved, professionals would be able to safeguard vulnerable adults and children from abuse.
Hall (2005) http://hsb.sagepub.com/content/47/2/111.refs
Michael McGimpsey Health, Social Services and Public Safety
(Department of Health, 2003) and the Bristol inquiry (Department of Health, 2001a)
Humphris and Hean,2004). http://www.contemporarynurse.com/archives/vol/26/issue/1/article/581/multiprofessional-working-interprofessional
Grumbach and Bodenheimer, 2004; Runicman et al., 1993
Undre et al.’s (2006) http://www.radpsynet.org/journal/vol6-1/ramon.htm