Care Theory for Adults With Learning Disabilities

Care Theory for Adults With Learning Disabilities Critically discuss care theory in relation to social work with adults with learning disabilities. Social work has undergone a radical transformation in the last two decades. Today ideas about the multi-layered nature of disabilities and the complexity of needs are commonplace in the public discourse on welfare and social work. People with learning disabilities and their carers and families have formulated their urgent demands upon society while academics and practitioners have supported this re-shaping of the social care agenda and the government has attempted to integrate the various challenges and interests in new and significant policy documentation such as Valuing People (2001). This essay will deal with three interrelated issues that are of particular importance to people with learning disabilities and their quality of life. It will (1) explore the relationship between care theory and the issues of ethical practice when dealing with adults with learning disabilities. It will look at the rules of engagement that have found their way into the various codes of practice for soci al work practitioners and the ethical problems that they may give rise to. And (3) it will consider the link between anti-discriminatory practice and the rights that service clients have and how these rights may influence the way in which practitioners may discharge their responsibilities throughout the social service sector. Within the confines of this essay, (1-3) will be examined through the following lens. Given the existing code of practice and policy stipulations, what could self-determination mean for people with learning disabilities? And how do ethical difficulties find their expression in particular practices of social work for adults with learning disabilities, such as person-centred planning and direct payments. There have been several attempts to regulate and standardise work practice for employees and employers of social work practitioners in the UK. These attempts have deep historical roots, such as the Hippocratic oath (Loewenberg 1992: 36). Yet the more recent attempt by the Scottish Councils to draw up a conclusive list of responsibilities and duties of social workers and their employers has been triggered by the desire to introduce reliability and transparency into a field of social care which has hitherto featured a plethora of often conflicting norms and standards. The code of practice sets out (for the first time) the expectations, obligations and duties under which social workers and their employers ought to operate. It is supposed to be the initial step in a broader process of standardisation of the social services (Codes 2001: 13). It echoes the definitions of the nature, aims and guiding principles of social work given in the Code of Practice by the British Association of Socia l Workers (BASW 1986 and Codes 2001). The various values that inform social work are human dignity and worth, social justice, service to humanity and integrity and competence of practitioners (BASW and CoP) In particular, the Code emphasises the right of individuals to control their lives and the obligation of social workers to promote the right to self-fulfilment by clients (Codes 2001: 15 and BASW 1986: 2). This agglomeration of values and norms that ought to inform social care practice however raises some serious questions when it comes to their application in the social work with people with learning disabilities. First of all, it is generally acknowledged by analysts of the service as well as by practitioners that the particular interpretation of the notion of self-determination is a culturally contingent idea. Loewenberg as well as Watson acknowledge that the ethical principles and rules of social work are derived from societal norms (Loewenberg 1992: 38; Watson 1985: 22). However, modern society encompasses a multitude of often conflicting social norms and it is this plurality of notions of a good life and standards of social agency which creates problems. The code explicitly urges social service professionals to take account of their client’s understanding of self-determination and individual independence. Yet, within a culturally diverse population, different notions of what is acceptable and desirable with respect to the independence of people with learning disabilities prevail. To promote independence of an adult or child with learning disabilities in a community that traditional ly places a fundamental emphasis on continuous care within the family can pose a particular dilemma to social workers. More generally, however, governmental policy and the codes of practice can produce significant problems for social care workers. The government has made inclusion one of the main policy priorities with regard to people with learning difficulties. Mainstreaming employment for individuals with learning disabilities is a pillar of this new approach. However, the competitiveness of the first labour market has traditionally represented a considerable barrier to finding viable employment for people with learning disabilities or emotional behaviour problems. Social care workers are tasked to identify problems that impact on the quality of life and decrease the chances of self-fulfilment for their clients. But often they are neither trained nor have access to resources in order to identify and put in place support programmes that ensure that adults with learning difficulties can find employment in the first labour market. The compartmentalisation of services continues to produce additional b arriers that prevent social care workers from discharging their duties with regard to their clients. Let us consider an example. Let us suppose that a social worker has the responsibility to support some individuals with learning disabilities which live in group homes (Beckett 2005: 138). One of the residents approaches him and tells him that she has got into a muddle with her benefits with the result that she has run out of money and is very distressed about this. The social care worker calms her down and places some phone calls to the local benefits office and sorts it out for his client. In a way, the social worker ‘has respected [the client’s] wishes and done exactly what she asked of him. Has he therefore supported her right to determine her own life?’ (Beckett 2005: 138) His commitment to support her desire to self-determine her life here clearly conflicted with her desire to draw on needed support. The real crux of the problem however lies elsewhere. The client has been unable to get sufficient support from the benefits office and therefore felt unable to sort out the issue on her own. In fact, the lack of adequate support on the side of the benefits office, possibly the absence of a trained worker in the office who has the skills and training to deal with people with learning disabilities has made it impossible for her to deal with it independently. Additionally, the social worker may have chosen to limit his support by assisting her in dealing with the benefits office rather than sorting it out himself. In this way, policy and practice may substantially collide when it comes to practical issues for individuals with learning disabilities. The codes of practice fail to give any meaningful guidance in these cases. This criticism is not new. Academic observers have repeatedly noted that the codes of practice are too abstract and cease to have any meaning unless sufficient resources are made available to enable service professionals to act in a positive way towards service clients (Watson 1985: 31). More worryingly, Watson writes: ‘the abstraction of the code of practice renders principles not simply incapable of application, but capable of application in a number of ways – only some of which are consistent with the conception of professional social work.’ (Watson 1985: 31) Again, this gives rise to some serious problems with regard to care for people with learning disabilities. Let us consider another example. The conception of self-determination as enshrined in the Codes of Practice draws on culturally contingent notions of autonomy. On the other hand they also pay respect to the need to recognise other culture’s diverse social commitments. The code however fails to recognise that these two principles conflict. For some families and carers who belong to ethnic minorities, service support may be seen as contradicting cultural norms and standards and the family may be the preferred vehicle for support. Societal inclusion and integration in the wider community may therefore be barred as an option. Social workers are in a dilemma here. It is their obligation to promote the self-determination of their clients, this however may contravene the cultural and religious norms prevalent in some families. This demonstrates that the Codes of Practice are bas ed on an understanding of social life that is predominantly Western in character. Different stipulations of the Code are therefore inconsistent with each other. As Beckett writes, the notion of individual autonomy may be differently stressed in the various cultures (Beckett 2005: 132), Often the rights of individuals with learning disabilities may run counter to the interests of the rights of particular groups or communities (Beckett 2005: 132). The second way of framing the idea of social care and its conflict with particular practices is utilitarian in nature. Social workers and their management may be led by calculations of expediency in determining the right way of dealing with problems of people with learning disabilities. Resource allocation and budget constraints are the primary factors in these considerations. This approach is however often detrimental to the interests of adults with learning disabilities. Their interests are defined through the limitations and budgetary restrictions that are placed on the service. The individual with learning disability is not placed at the centre of planning and support packages. One particular practice has tried to square the constraints placed on the service with the ethical demands under which social workers operate. Direct payments have been actively promoted by central government and are often seen as a way to empower clients with learning disabilities. They are considered as an appropriate means to re-focus the delivery of social services on the needs of the individual with learning disabilities as well as represent a viable answer to the resource allocation problem. Clients are granted a particular budget and exercise total control over its spending. Adults with learning disabilities become buyers in a market of social and care services, or so the theory goes. At a first glance this will alleviate several acute problems. It enhances the (chances for) independence of clients and motivates them to make their own choices about important life decisions. It increases their participation in the decision making process and improves quality of life. It also ef fects a significant shift away from total care packages which are expensive to the tax payer and facilitates the involvement of clients in more task-centred care packages which are less expensive (Mansell 2005: 20). It therefore adequately and neatly addresses resource constraints while mirroring the move to individualised care and support plans (Mansell 2005: 20). This way it mirrors the stipulation of the Code of Practice which places the duty on social workers to maximise participation of clients in the decision making process (BASW 1986: 5; Codes 2001: 16). However, it works with a very lop-sided notion of independence. While participation in the labour market may still be prevented to clients with learning disabilities, acting as a buyer in an economic relationship is seen as a form of empowerment. The conception of social agency is severely restricted to co-operative schemes that are economic in character. The enhancement of social involvement may benefit little from this. This demonstrates that ethical issues in social work are often critically influenced by practices that are understood to reflect universal cultural attitudes but, more appropriately, may only resonate with erroneous and impoverished notions of social agency. Bibliography Beckett, Chris and Andrew Maynard (2005), Values and Ethics in Social Work. An Introduction. London e.a.: Sage British Association of Social Workers [1986], A Code of Ethics for Social Work, Birmingham: BASW Codes of Practice for Social Service Workers and Employees (2001), Scottish Social Services Council, Dundee 2005 Loewenberg, Frank M. and Ralph Dolgoff (1992), Ethical Decisions for Social Work Practice, Itasca: F.E. Peacock Mansell, Jim and Julie Beadle-Brown (2005), Person Centred Planning and Person-Centred Action. A Critical Perspective, in Person Centred Planning and Care Management with People with Learning Disabilities, London and Philadelphia: Jessica Kingsley, pp.19-33 Watson, David (1985), What’s the point of A Code of Ethics for Social Work? In A Code of Ethics for Social Work. The Second Step, edited by David Watson, London e.a.: Routledge and Kegan Paul, pp.20-39 Valuing People (2001). A New Strategy for Learning Disability for the twenty-first century, London: The Stationary Office

Organizational Systems Essay

Root Cause Analysis (RCA) is a tool designed to help identify not only what and how an event occurred, but also why it happened. We can see from this scenario that the root cause is the lack of oxygen given to this patient, however it is not the only cause. A string of events lead to this patients demise. The first and most important cause was that hospital policy was overlooked. In the scenario it stated. Root Cause Analysis (RCA) is a tool designed to help identify not only what and how an event occurred, but also why it happened. We can see from this scenario that the root cause is the lack of oxygen given to this patient, however it is not the only cause. A string of events lead to this patients demise. The first and most important cause was that hospital policy was overlooked. In the scenario it stated â€Å"A moderate sedation/analgesia (â€Å"conscious sedation†) policy requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedur e and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void).† The trained nurse had the equipment to insure that this policy was followed, however failed to perform her duties as required by this policy. The second event is that the LPN reset the alarm and made no effort to provide an intervention for the alarm. The LPN did not inform the RN of the O2 Saturation level. The LPN Was not trained properly. The third event was that there was not enough staff called in for the level of acuity that these patients had. The administration should have been made aware of the emergency coming in and called in more staff to accommodate the staffing need. The errors or hazards in care in the scenario were that the RN failed to follow hospital policy to continuous monitor the patient. LPN was not properly trained to handle patients with a higher acuity. LPN failed to report and respond to the alarm. It would be helpful if the parties involved with this event come together and discuss on what failed and how they can improve the system. To decrease the likelihood of this happening again the data collected from the RCA needs to  be presented and a plan needs to be implemented so that all the staff can know what to do if this situation occurs in the future. Implementing a plan where all the parties are involved will insure that policy that is implemented will be followed through and a since of teamwork and collaboration will be felt. Lewin’s change model talks about people that are frozen in their idea of how certain processes should work, and need to be unfrozen in their process in order to make a change. In the scenario, the staff may be stuck in a process of how they perform their job. When things in the ER got busy, The nurse may have felt that since she has experience and is qualified she could handle things in the ER with just the help of the LPN. If this Nurse was not frozen in her old ways she would have realized that knowing when to call for help early enough is a nursing key behavior. Sometimes being stuck in your old ways is not what is best for the patient or yourself. If the future with change this Nurse has the potential to be a good advocate for other nurses and staff. She will be helpful in supporting change for the better of the patient. Lewin’s second model talks about what needs to be changed in a situation. In the scenario, the process of how moderate sedation is performed and followed up for each and every patient in any department needs to be changed. In order to make a change, staff needs to become involved and understand why this change will benefit the patient and the nursing staff. In order to make a change and have it successful the staff will need intrinsic motivators. According to Lewin’s change theory the staff will need to first, be open to the idea of this change and second, see how it can benefit the quality of care given to patients. Updating the moderate sedation policy to include a one on one â€Å"qualified† staff member to stay with the patient after sedation at all times until discharge criteria is met. Staff education, annual education and possibly mock sedation scenerio’s could help the staff learn in a â€Å"real life† situation what could go wrong and what could be done better. When the change has been introduced. Trial and errors are started and perfected and staff starts to use these changes in practice. It has a possibility to become normal to them and then the â€Å"refreezing† process can begin. Lewin’s refreezing process is referred to as, once new change is in practice the staff will then start to implement that changed process in everyday procedure, cause a refreezing process of new and improved procedure. After, Nurse J and the other staff members in  the ER and everywhere else in the hospital, practice and start applying these new changes into their everyday routine after several weeks, it will become second nature to them! (â€Å"Change theory,† February) Failure modes and effects analysis (FMEA) identifies all possible failures in a service rendered. â€Å"Failure modes† means the ways, or modes, in which something might fail. Failures are any errors or defects, especially ones that affect the customer, and can be potential or actual. â€Å"Effects analysis† refers to studying the consequence of those failures. (The Quality Toolbox.2004) The interdisciplinary team that should be included in the RCA and FMEA are everyone involved like all doctors, RN’s, LPN, administrators, and the joint commission. We would start by developing steps to assess risks of failure to patients in the process that is being used. The pre-steps needed to implement FMEA is that the interdisciplinary team needs to be in agreement with how many steps and the steps that accurately describe the process. For each Failure mode the team needs to assign a risk priority number (RPN), this is used to detect the likelihood of occurrence, detection an d severity. For every failure mode identified, the team should answer the following questions and assign the appropriate score. (the team should do this as a group and have consensus on all values assigned) 1) How likely is it that this failure mode will occur? 2)Assign a score between 1 and 10, with 1 meaning â€Å"very unlikely to occur† and 10 meaning â€Å"very likely to occur.† And 3) How likely will the error be caught before causing harm to the patient. (IHI.pdf) The first step in FMEA is to analysis how likely is it that this failure mode will occur and its severity of affect on the patient. To do this the hospital would assign a severity number to the process step that they are testing. The FMEA would have number 1 through 10. 1 would mean no harm would be done to the patient, 5 would be moderate harm to the patient and 9 or 10 would mean that the severity would be very bad with the worst possible outcome for the patient. Like in the case scenario if the process step they chose was: with no equipment for monitoring of a patient after sedation and without staff present or staff present and all equipment was present. The process failure mode was that the patient stops breathing and no one or no equipment was present. The number value for this scenario would then be assigned the highest number because of the high likelihood that it would have the worst outcome for the patient. The second step in the FMEA is  to analyze how often the error or potential problem is likely to happen in the process. The occurrence scale also has a numeric value of 1 to 10. 1 would be that the problem could occur in under 0.01 to every 1,000 people, 5 would represent about 5 people to every 1,000 people and 10 would have the highest occurrence of over 100 people to every 1,000 people, which would make it very likely that the event will occur. The hospital staff would than take their process step of not monitoring a patient after sedation and rate the occurrence of the process at how likely the event would happen. The hospital then can look at data from other hospitals that did not monitor patients after sedation to see the likelihood that they stop breathing to rate the number. The third and last step is how likely the error or problem can be caught before reaching the patient and on what degree of harm it can cause to the patient. The same principle applies to the detection scale of a scale of 1 to 10. All of the numerical scores would then be multiplied together: Severity x Occurrence x Detection = Score. A score over 100 would prompt the hospital to look into the problem more closely and anything below that number they may want to take off their agenda and focus on the more dangerous outcomes for the patients. (Forrest, 2010) The key role nurses would play in improving the quality of care in this situation. Are to implement a plan of action. They can sponsor classes for other staff to get educated. They can attend drills to rehearse different scenarios to be prepared for other events. Having nursing staff advocate for the change will also help the other staff follow by example when changes are made, especially if they know the reason is to help prevent harm to patients in their care. Nurses with the right tools, guidelines and policies are able to make sure that the care is the best quality for their patients. References Change theory. (January, 2014, 02). Retrieved February 20, 2015, from http://wgu.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=e348f20b-e819-43e4-abcaf191f99bc Failure Modes and Effects Analysis (FMEA) Tool. (n.d.). Retrieved February 20, 2015, from http://www.ihi.org/resources/FailureModesandEffectsAnalysisFMEATool_IHI.pdf Forrest, G. (2010, December 31). Quick guide to failure mode and effects analysis. Retrieved February 20, 2015, from http://www.isixsigma.com/tools-templates/fmea/quick-guide-failure-mode-and-effects-analysis/ IHI Institution for Healthcare Improvement. (n.d.). Lesson 5 testing changes (Pages 1-2). Retrieved from http://www.ihi.org/education/ihiopenschool/Pages/default.aspx Policy name: Root cause analysis. (n.d.). Retrieved from www.precisionlens.net/UserFiles/rootcause-analysis.doc Nancy R. Teague The Quality toolbox, 2nd edition, ASQ Quality Press, 2004, pages 236-240.

Evolution Of Western Literature John Milton, Walt...

Evolution of Western Literature Starting from the Renaissance era, where man struggled with the power of God, the Romantic era, when self-expression flourished, and the twentieth century, which saw the onset of modernism, Western literature has saw a significant evolution. Three works, Paradise Lost, an epic poem that shows the struggle for man to grasp the concept of God, Leaves of Grass, a set of poems that celebrate the author’s sense of life through self-expression, and Metamorphosis, which illustrates the life of a man who let modern life demean him, illustrate through different styles how they reflect their times. Their authors, John Milton, Walt Whitman and Franz Kafka, were able to show how in these different stories through the content, their choice of language and style of writing, how they helped evolved Western Literature. In the three works of literature, their content is what plays an important part of their contribution to Western Literature. The content in a story is what the story consists of and the information that makes the story what it is. In Paradise Lost, Milton’s content consists of his own take on the biblical fall of man or the temptation from Adam and Eve. It was here that the struggle with God and his power was brought upon by Milton’s use of subject matter. In the first book, Milton describes someone who is most opposed to the power of God, Satan. Milton writes, â€Å"In utter darkness, and their portion set /As far remov d from God and light of

William Dubois And African American Achievement Since The...

William DuBois was one of this country s most important activist and educator. He was born in 1868 in a small village in Massachusetts. DuBois was attacked by racism in 19th century while attending Fisk University in Nashville. While completing his graduate studies at Harvard , W.E.B Duboi wrote an passage on the history of the slave trade. The slave trade is still considered one of the most talked about subject today. In 1895 W.E.B. Dubois was the first ever African American to earn a doctor degree from Havard University. In 1897, DuBois occupied a job at Atlanta University. During the time that he spent there he conducted studies of how african americans were treated in america. In the passage W.E.B Dubois 1868-1963 it states â€Å"In 1900†¦show more content†¦The group was also not able to obtain alot of support. (Phil, 2017)â€Å"After the Springfield (Ill.) Race Riot of 1908, however, white liberals joined with the nucleus of Niagara militants and founded the NAACP the following year, 1909. The Niagara Movement disbanded in 1910, with the leadership of Du Bois forming the main continuity between the two organizations.†( 2017) (Phil, 2017)†Throughout the first half of the 20th Century, W.E.B. DuBois continued to work as an author, lecturer and educator. His teachings were an important influence on the Civil Rights Movement of the 50s and 60s. Ironically, DuBois died on th e eve of the historic march on Washington in 1963. Actor and playwright Ossie Davis read an announcement of his death to the 250,000 people gathered the next day at the Washington Monument.†(2017) W.E.B Dubois organized his life s work around the study of what was called the Negro Problem. He ended his years laboring on an global publication that might have been the sylbom of greatness of that ambition:(Hutchins Center, 2017) â€Å"to document the experience and historical contributions of African peoples in the world. Having witnessed the formal dà ©tente among European powers by which the African continent was colonized in the late nineteenth century, he lived to taste the fruits of the struggle to decolonize it in the late twentieth century and to become a citizen of the first new African nation. Having posed at the end of the nineteenthShow MoreRelatedLangston Hughes Research Paper25309 Words   |  102 Pageshad not seen his father since he was a small child, and he was excited about making the trip. However, during this visit, no affectionate bond would develop between Langston and Jim. Jim Hughes was a cold, difficult man, who was driven by ambition to make money and achieve respect. He had moved to Mexico to avoid segregation and racial injustice in the United States. As the manager of an electric company and owner of a ranch and mines, Jim expressed contempt for black Americans who continued to submitRead MoreNotes18856 Words   |  76 Pagesthe African Experience Virtually everything that has gone wrong in Africa since the advent of independence has been blamed on the legacies of colonialism. Is that fair? Virtually all colonial powers had â€Å"colonial missions.† What were these missions and why were they apparently such a disaster? Did any good come out of the African â€Å"colonial experience†? Introduction Colonization of Africa by European countries was a monumental milestone in  ­ the development of Africa. The Africans considerRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 PagesVan Gosse and Richard Moser, eds., The World the Sixties Made: Politics and Culture in Recent America Joanne Meyerowitz, ed., History and September 11th John McMillian and Paul Buhle, eds., The New Left Revisited David M. Scobey, Empire City: The Making and Meaning of the New York City Landscape Gerda Lerner, Fireweed: A Political Autobiography Allida M. Black, ed., Modern American Queer History Eric Sandweiss, St. Louis: The Evolution of an American Urban Landscape Sam Wineburg, Historical