Informed decision making for patient empowerment
The current study focuses upon empowering the users of health and social care services. Some of these are delivered in the form of patient centred care approaches whereby the patients or the service users are made an integral part of the care planning and decision making process. The empowerment of the users is done through policy of informed decision making. Additionally, the importance of current legislation practices have been highlighted though the current study. The study conducted over here helps in understanding the contribution of the policies and legislations in safeguarding as well as promoting individual rights.
The current study highlights the case study of Solomon and Jamila who are an old couple in their eighties. The couple had a history of physical and verbal abuse and had often been contacted by the local authority over the same. The matter had been investigated through the local authority adult safeguarding procedures. However, any such charges of abuse have been refuted by the couple when the local adult safeguarding committee would visit them at home. The couple had been attended by a social worker who suggested the couple to participate in a family group conference along with regular counselling session at the local community centre. The couple had been provided a drop in facility for attending the counselling sessions offered at the local community centres. Additionally, the couple have also been advised targeted medical sessions at the local community hospitals for additional support.
Impact of the current legislation
In the present context, targeted medical sessions have been implemented in order to promote a person centred approach where care plans are designed taking into consideration the requirements of individual service users. The counselling sessions could help in understanding the mental and emotional issues faced by the services users. These could help in empowering the service users though empathy and effective communication approaches. The organizations providing services to vulnerable people are entitled to conduct inspection processes. The inspection process should be conducted in association with the legal authorities or bodies. Some of the important legislations which could be applied to the present case study are the Care Act, 2014, which defines an adult at risk as a person who is in need of support and is unable to protect themselves against abuse . Moreover, the Mental Health Capacity Act, 2005, provides the patient with the right to decision making. It is believed that even after old age and presence of certain mental illnesses the cognition and decision making capacity of an individual may not be completely compromised. Therefore, practising the right to decision making and informed consent taking can lead to optimum patient inclusion. Since the condition of Solomon was deteriorating as he was being subjected to increasing domestic abuse there was a need for urgent intervention. Some of the guidance within the policies has been revised to maximise the well being of the older adults receiving care, reducing the incidence of delay in supplying their basic needs and services. The local authorities are responsible for implementing the policies and codes of practice effectively. In case of a breach of the same legal action could be taken against the local authorities .
Importance of policies and legislations to safeguard individual rights
Some of the factors which could affect the individual rights of the patients are age, changing health conditions, level of dependence. A number of health complications may arise in the patient due to increasing age. Some of the age related issues are heart and kidney related disorders. The disorders of the skeletal system are most common as the patient may develop conditions such as gout and osteoarthritis. Some of these may make activities of daily life difficult for the patient. Additionally, a number of mental health disorders may develop in the patients due to advancing age such as depression, bipolar depression. The bipolar depression is often subjected to environmental circumstances and could develop mood swings within the patient. In this respect, some of the contributory factors are old age and loneliness. Solomon and Jamila have been fighting amongst themselves, which could be attributed to emotional stress. Hence, the counselling sessions would have been effective in providing the couple with old age mental health support. The changing health conditions may make an individual dependent upon others. Some of aspects such as continuing professional development could help in enriching the standards of the care services by training the healthcare professionals further.
In order to promote maximum patient inclusion a number of communication approaches could be used such as therapeutic communication. The therapeutic communication is based upon the skills of apathy and cultural intelligence present within a nursing professional. As mentioned , the cultural intelligence helps to take into consideration the faith and religious paradoxes of the patients which often prevents them from approaching the right channels for health and support care services. The therapeutic communication means are also aimed at making the patients a part of the decision making process. This helps in promoting informed planning which reduces the chances of disputes within an organization.
There are five important communication aspects which could be applied within a healthcare sector. Some of these are- listening, verbal and non-verbal, questioning and written modes of communication. One of the communication means which could be applied by the nursing professional over here when dealing with both Solomon and jamila over here is patient listening. It had been revealed in studies listening actively to the grievances and the worries of the patient are a part of therapeutic communication approaches. The nursing professional can also engage the patient in verbal queries such as the hobbies and the likes of the patient. This level of communication can help in unwavering important character sides of the patient. These could be used by the nursing professional to design counselling strategies for the patient. It has been seen that recording information helped in continuous improvement.
A) Factors contributing to the loss of independence
Some of the factors which may be contributed to loss of independence within the patients are increase in age. With increase in age an individual may develop certain physical and mental ailments. Some of these may affect the activities of daily living of the patients and make them more dependent on others. As mentioned, financial instability may also make a person dependent upon others. In this context, both Solomon and Jamila were in their eighties and were dependent upon their daughter who used to visits them regularly. Additionally, the couple have been living isolated without much participation in social groups. This could be attributed to their old age which often makes an individual feel less contributing to the society. This could be also attributed to the reduce cognition within an individual. In old age a person is often seen to develop mental illness such as depression, Alzheimer’s etc. The Alzheimer’s have been seen to affect the thinking and decision making capabilities within an old age person. The lack of job and financial engagements also makes a person more dependent in old age. Therefore, in order to empower the service users some of the policies and legislations could be applied over here which are the Mental Health Capacity Act, 2005 and the Equality Act, 2010.
Case study of Solomon and Jamila
The Mental Health Capacity Act helps in ensuring that the support users are provided maximum independence so that they could participate in their care planning and decision makes process. Additionally, the implementation of the Equality Act, 2010, helps in ensuring that the patients are not subjected to any forms of discrimination either in the place of care or within the community. Here, the patients could be facing discrimination owing to old age. Hence, the implementation of the law could reduce the chances of social exclusion and encourage well being and good living conditions for the patients.
B) Current policies, systems and processes available to local authority
In this respect, a number of policies, systems and processes could be mentioned over here which play a crucial role in safeguarding the adults. One such policy is the Care Act, 2014, which protects an adult’s right to live safely free from abuse and neglect. It is aimed at supporting the adults in making choices and having optimum control in the way they would want to live their own lives. It also covers the aspect of making the surroundings and people aware of the incidents of older people abuse and take precautionary measures. In this respect, Solomon was at risk of harm from physical abuse. Hence, effective strategies should have been implemented in place to prevent the patient from further abuse. Some of these were regular inspection of the patient condition along with provision of help through family support units.
The Care Act could be divided into six principles of safeguarding which could be used to support user empowerment. Some of these are- empowerment, prevention, proportionality, protection, partnership and accountability. The empowerment aspect focuses upon making the service users a part of the decision making process. The service users need to be helped by the nursing professional in taking appropriate decisions. Whistle blowing serves as another important aspect of prevention programs where the healthcare staff looking after the patient needs to inspect the incidences of abuse and report it the concerned authorities. Some of the risk mitigation strategies which could be applied over here are conducting regular internal audits whereby a comprehensive check up of the patient could be conducted which help sin identification of the grievances faced by the patient. The services should act proportionately to the identified risks and may range from single agency responses to steps undertaken by joint agencies. The safeguarding agencies need to take the necessary steps such as calling the police if they think that an incidence of abuse has taken place and that the safety concerns of the services users have been jeopardised.
Another aspect which could be implemented over here is supporting the service users through multiple agency channels such as family group conference and local community centre. Therefore, attending the family group conference would have helped Jamila and Solomon address their mutual difference which had often taken violent turns between the two. The community centres could acts as effective counselling centres of the couple.
The communication aspects play a pivotal role in promoting and maximising the rights of the patients. Effective communication practices helps in connecting with the patients on a personal level. It helps in understanding the mental and emotional dilemmas faced by them. In order to provide proper support to the care service users a number of different communication approaches could be used.
C) Analysis of inherent tensions in adults safeguarding
Promoting person-centred care through targeted medical sessions and counselling
There are a number of barriers faced in the safeguarding of adults. For instance an inherent tension lies in balancing risk with protection. In old age, an individual may need support from one or more health care channels. The implementation of the healthcare policies and procedure has been seen to be effective in promoting the rights of the services users. However, often a lack of knowledge regarding the same could affect the quality of the support care services. One of the most inherent risk factors which could be faced is with regards to facing ethical dilemmas in adult care. It had been seen that the older adults often depict violent or aggressive behaviour towards the healthcare providers, as they may not agree with the care plan or services provided to them. This results in a situation of dispute within the healthcare environment and could affect the care delivery process. For instance, both Solomon and Jamila had called up the local authorities on several occasions reporting domestic abuse. However, when the local authorities have arrived they have declined any such incidences. Therefore, some of the factors such as lack of sufficient participation and cooperation from the patients can affect the quality of the care services. One such policy which could be highlighted over here is the Mental Health Capacity Act, 2005. It provides the patient population sufficient opportunity to participate in their own care plan. An old age patient undergoing care for dementia and other related sickness may exhibit reduced cognition and decision making abilities. The mental capacity act allows patients to take important decision pertaining to their healthcare. As argued, the patients with reduced cognitive abilities may not be capable of taking the right decision which may affect their overall safety standards. It has been seen that provision of too much freedom to a mentally unstable patient may endanger the safety of the others around him.
In this respect, the underpinning principles of the Mental health capacity act could be discussed with respect to Solomon and Jamila. Some of these are – a presumption to capacity where every individual is considered to possess sufficient ability to make their own decisions; in this respect Solomon and Jamila should be given all support to make effective decisions pertaining to their life and care; an individual has the right to make an eccentric and an unwise decision; the actions which are taken on behalf of the patients must be in their best interests; the interventions implemented for supporting the people with reduced cognitive abilities should be in their best interests.
A) Risk of harm of service users at Winterbourne
The current study highlights the incident at winterbourne where the service users were regularly abused, insulted, harmed. The incidents of abuse continued within the current workplace as there was proper inspection. Additionally, the legal rights were breached during the patient care. The winterbourne view hospital was responsible for supporting people with difficult needs and complex behaviour. The winterbourne hospital belonged to the Castlebeck Care Ltd. which left the vulnerable adults in the hands of the poorly trained and poorly supervised staff. There were incidences of torment and abuse towards the one entrusted in care. For instance, a senior support worker was punished for sitting and stamping on an 18 year old patient. There were incidences of regular ill treatment and abuse against the clients. The residents had been pinned down, slapped and doused in water.
Factors affecting patient rights and well-being
There were a number of loopholes which affected the quality of the care services. Some of these were lack of trained professionals, poor supervision of the services and quality offered at the hospital. Hence, the biggest issue which have been faced over here is an irresponsible management. It was found that the management conducted little or no inspection which resulted in the healthcare staff violating the rules. Additionally, an ineffective management resulted in the staff depicting autocratic leadership whereby the patient interests were not considered.
B) Review of policies, procedures and approaches in lieu of the Winterbourne Case
The policies and procedures at workplace play a crucial role in the effective delivery of healthcare services. Some of the legislations and codes of practices have been highlighted before such as the Care Act, 2014 and the Mental Health Capacity Act, 2005. The implementation of the policies helps in ensuring that some of the aspects such as person centred care could be implemented which gives the patients sufficient right to participate in planning and designing making pertaining to their own care. Some of the aspects which should be revised over here are implementing effective administration and recording standards. There has been violation of a number of policies and procedures which could amount to legal action being initiated against the hospital staffs. Some of these are safeguarding adults and children policies and procedure. This aims at acting in the best interest of the service user. The Care Act, 2014, on the other hand provides the service user with a number of features such as empowerment, protection, prevention, proportionality etc. It mainly aims at empowerment of the service users through a person centred approach. It was seen that a person centred approach promotes the aspect of care planning with regards to the consent of the support use. The Mental Capacity Act, 2005, on the other hand provides the service users sufficient right to undertake their own decisions. In this respect, the vulnerable people who have difficulty in decision making should be helped by the support carer in effective planning. Hence, there was a breach of the Mental Capacity Act as the patients were tormented and abused within the winterbourne care hospital. Additionally, the leadership styles also play a crucial role in the management of healthcare practices. It had been highlighted through a case study over here that a laissez faire leadership style could affect the healthcare quality and overall well being of the patients. On the other hand, a transformational leadership style could help in bringing about changes within the current working frame of the organization as per the current healthcare requirements.
A) Application of legislation and codes of practice to handing of medication
There was a clear lack of effective leadership and management styles which affected the overall quality and standards of care being delivered at the winterbourne hospital. There was a breach of the important legilastions and policies such as the Care Act, 2014; and the Mental Capacity Act, 2005. Additionally, inappropriate auditing and control measures were implemented as there was lack of proper whistle blowing and effective documentation procedures.
The winterbourne incidents of abuse had been followed closely by a number of institutes of national, international stature. Some of these were the National Health Service commission (NHS) and the Care quality commission (CQC). Some of the associated healthcare regulating organizations which were directly responsible for viewing and monitoring the activities at interview were- the healthcare commission, the mental health act commission, and the care quality commission. It was found that the Healthcare commission failed to follow up on the outcomes of safeguarding alerts and incorporate theme within the regulatory records. Hence, in order to deal with the whistleblowing allegations at winterbourne hospital a specialist team had been put into place. Form the COC perspectives there were process and management failures. The goal was to ensure that the dignity and the rights of the vulnerable are protected.
Effective communication approaches for maximum patient inclusion
In this regard, the National Health Service Commission had laid down a number of policies and procedures which were based upon the protecting the rights and interests of the service users. The number of guidelines stated over here was that the patient should be able to excise choice and control in decision making and should be treated with equal dignity and respect. The patients need to be provided with personalised support along with access to improved infrastructure. Some of the aspects which have been highlighted over here are providing the staff with positive behavioural support. Some of the aspects which could go against the interest of the care workers are long working hours, insufficient pay, limited scope of growth, low appraisal. Some of the factors such as compassion fatigue have long been associated with the nursing profession. The overworked staff may often develop feelings of burnout which may affect their mental and psychological well being, which affects the kind of behaviour adopted by theme with the patient population.
In my workplace more focus is placed upon documentation standards. In my opinion, the effective documentation standards help in keeping track with the present health conditions of the patient along with the past records. The documentation also places sufficient importance upon the rules and regulations which are pivotal in ensuring that the patient rights are maintained. Some of these are also aimed at provision of optimum environment for the patient well being. However, I find there are number of loopholes such as there should have been more focus on the protection and safety rights of the patients. As mentioned, the installation of additional security features such as CCTV cameras can help in arresting the incidents of abuse and torment within the healthcare units. In this regard, for winterbourne hospital there was no effective management overseeing the safety features as a result many patients were abused and tormented.
In my current workplace, a transformational leadership style is being followed which helps in training the staff as per the organizational needs. The adoption of the transformational leadership helps in the development of an industry ready staff. It also helps in the development of a culturally sensitive workplace where the cultural and the religious beliefs of the individual workers are taken into consideration.
In this respect, a number of codes and regulations apply in the handling of medication. Some of which have been discussed over here such as The Medicines Act, 1968; the Misuse of Drugs Act, 1971; The controlled drugs regulations 2013; Drug Protection Act, 1998. With response to the administering of medications a number of areas could be improved further. The Data Protection Act, 1998 regulates the manner in which the confidential medical history and details of a person are shared. In my opinion the staff needs to be trained appropriately regarding the data protection rights as leakage of confidential details of the patient could lead to breach of the confidentiality concerns.
Conclusion
The current study focuses upon the aspect of empowering users in health and social care. It focuses upon the legislation, policies, procedures and individual rights. The policies focus upon advocating the individual patient rights by implementing a person centred approach. The person centred approach provides the service users with sufficient choice and control over their own care and medication plan. Some of the legislations have been highlighted over here such as the Care Act, 2014 which promotes the empowerment of the service users through a number of objectives such as protection, prevention and proportionality etc.
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