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Special Need In Healthcare
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The SHARP Team, (Social Inclusion, Hope and Recovery Project) is a community base team in North London that caters for both in-patient and those in the community. Their intervention is based on: clients’ choice, integrated psychological, social inclusion support and healthy Living programmes including attending the gym, woman’s fitness and football. As a student of health and social care studies you have been asked as part of the placement requirement to give a presentation on the concept of health, illness and wellbeing to a team of nurses, Psychologist, recovered Service users, Police officers, Religious representatives and a Carer’s social support group. Amongst the guest, was a 55 year old gentle man from Jamaica diagnosed with a form of mental illness with (challenging behaviour needs) well known to the local police. He gave a testimony of how his life changed around by attending the centre. He also suffers from type 2 Diabetes, Non compliance with his medication, had poor relationship with his GP, poor exercise regime and poor eating habit. “Since I started attending the centre, he says “my health changed completely. My eating habit has changed. I have developed self confidence. My blood pressure is stabilised and I now enjoy going to the gym, exercising regularly. My relationship with my GP and the community has improved and my blood sugar level is within normal limits. I now sleep adequately without any medication and befriended people who I hang out with so I’m healthy and I thank my God that my Pastor, who lay hands on my head each time I go to church”
1. Mr Jack testified of his blood sugar level being under control, his relationship with the community is civil. He complied with his medication and his spiritual needs are met. How would you analyse the care given to Mr Jack in terms of the holistic concept of health, disability, illness and behaviour. (A.C 1.1)
2. As a student of health and social care present at the meeting, you are asked to feedback to your colleagues about your experience. Assess how people’s perception of mental illness and other specific needs have changed over time. (A.C 1.2)
3. The SHARP team has been providing care based on a holistic approach. Analyse the impact legislation, social policy, society and culture has had on the way that these services are made available for individuals like Mr Jack with special needs? (A.C 1.3)
Mrs Murky, a 45 year old Polish woman has just been transferred from the A&E into a Respite nursing home waiting funding for placement. She is having communication difficulties. She is partially deaf and is registered blind. She seems to be happy when someone visits that speak Polish. The staffs of the nursing home have started facing difficulties of how to engage Mrs Murky who cannot speak English fluently.
1. Analyse the care needs of Mrs Murky as someone with specific needs? (A.C 2.1)
2. Explain what would be the current systems for supporting Mrs Murky at the Respite Nursing Home.
3. Evaluate the services available in a chosen locality for individuals with specific needs that would benefit service user like Mrs Murky. (A.C 2.3)
To gain a merit grade and a Distinction grade the following criteria as shown below must be met:
Discuss the skills of a health and social care practitioner in caring for an individual with communication deficit to enhance the care given.
Analyse the other professionals within the multidisciplinary team that you would invite to a case conference organised for a patient like Mrs Murky.
Explain the approaches and interventions available to support individuals with specific need such as Mrs Murky who may be suffering from dual diagnoses of being blind and deaf.
1. Evaluate the effectiveness of intervention strategies for an Mrs Murky as a service user with specific need(s)
2. There has been emerging developments in the UK in supporting individuals like Mrs Murky. Discuss how these would potentially impact the care given to people with specific needs? (A.C 3.3)
Task 4 case scenario
Mr. John has been in mattock nursing home for the past six years diagnosed with mild Dementia and is loved by everyone who visits the home. He used to be the “model patient” of the home and engages with every activity. He used to be ty and helps with domestic chores. Suddenly he started becoming aggressive towards staff and other service users. Mr John was observed by staff to become very lethargic, excluded himself from every form of activity within the home. Most times he will sneak from his own room into another resident’s room scolding them to leave his room or he would drag them off his bed or will call the police. He will rigorously question the staff and refused to comply with any form of treatment. Some staff started calling him names and labelling him as being “rude, insolent and a violent man”. During a case conference to review his care plan there was the proposal of transferring him to another nursing home specialising in challenging behaviour. Mr John was referred to his GP who later came to examine him. After a period of assessment, he was diagnosed with an acute Chest and urine infection. He was treated with Anti-biotic therapy (pharmacological intervention). Mr John got better and turned to his old ways of doing things.
To gain a pass grade the following criteria as shown below need to be completed
1.Explain the different concepts of challenging behaviour and situations whereby it can be misdiagnosed like in the case of Mr John in the above scenario.
2.Describe the potential impact of challenging behaviour to the individual and to health and social care organisations like Mattock Nursing Home.
3.Analyse strategies for working with challenging behaviours associated with specific needs in relation to the service user who suddenly changed from being a “model patient” to a patient whose behaviour was seen as “challenging”. (A.C 4.3)
Conduct a Literature review on the subject of “Managing Challenging behaviour” in health and social care.
Discuss how this module have changed your views on caring for people with Challenging behaviour needs compared to how people within your own culture perceive it.
Health care is a multifaceted hence it is a complex domain which requires multi-modal approach. The health care requirements differ from person to person due to difference in faith, belief, culture, practice and various other factors. The traditional healthcare system was focussed only on treating particular health conditions and symptoms however with the time the health care system evolved a new definition of health with inclusion of different bodies governing different aspects of health hence the focus shifted from symptoms centric treatment to patient and community centred (Dossey et al, 2012). The huge improvement shown by Mr. Jack leading to both physical and mental stability have been possible only through holistic health care approach provided through SHARP (Social inclusion, hope, recovery project). The holistic health care method considers the overall needs of a patient as the centre of treatment which consist of body, mind, emotions and spiritual needs (Helman, 2014). These parameters are taken into consideration to achieve complete wellness and stability. As per Mr. Jack, previously he suffered from many difficulties such as following diet chart, treatment regimen, communicating with his GP and socialising. This reflects that the previous treatment regimen was only focused upon the disease without meeting the spiritual and emotional requirements of Mr. Jack. The holistic care approach balances the treatment given for the disease and emotional wellbeing of the patient which results into faster recovery (Myers, Sweeney, Witmer, 2000). The word health in holistic care approach does not mean only physical health rather it includes mental and social health as well. Illness results into reduction in the functioning ability eventually leading to social isolation due to either inability of the society to accommodate with such people or due to the low esteem of such people. The distinguishing features of the SHARP project helped Mr. Jack to not only recover from his illness but also to socialize which positively affected in his overall wellness. As Mr. Jack testifies that father and pastor of the church helped him a lot during his bad days it showed his social inclusion. The primary focus of the project is not to improve only the physical condition of Mr. Jack but also to convince the entire community to increase tolerance and to accommodate such individuals among it. Working with such an approach gives a new hope and ability to look beyond conventional health conditions and to start fresh having complete physical and mental wellbeing (Koshlander, Silva and Lexberg, 2009). The SHARP project works with different strategies such as intervention at the occupational level, sharing the experiences with users of this service, involving education and increasing the social s. Mr. Jack after joining SHARP got opportunity to mingle with others and gain knowledge form the experiences of others who once had gone from stages similar to his. The stories of their struggle and success played a major role in his healing and recovery process. Hence the holistic approach of SHARP project not only resulted into speedy recovery of Mr. Jack but also normalized his life.
The sessions conducted during the entire period of SHARP project and the presentation given was an eye opener for the participants in many ways. Prior to my presentation the common perception of mine towards general public was that the mental illness is not well accepted among them and that they still consider it as unsocial and negative. However after I gave presentation and had discussion with people from different sections of the society I came face to face with total different scenario which forced me to change my perceptions. The perception of the common public from all the communities consisted of positive feedback towards the mental illness and social inclusion of such individuals. The mass showed increased tolerance for disabled people. Thus it can be concluded that people started accepting mental illness instead of taking it as social stigma and they also strongly believe that the mental health of such individuals can be achieved and that such individuals also have same rights in the society( Thoits, 2011). However the session gave both kind of experience, apart from positive there were some negative interactions encountered and such people rather than accepting mental illness socially suggested several alternatives. For example some people expressed that they don’t want to stay in the neighbour of a mentally challenged individual but at the same time accepted the fact that such individuals should get social rights. Hence their action and acceptance showed a gap which can be only filled through education and increasing awareness. Apart from this in general it appeared that over the time people have started accepting the mentally challenged or disabled individuals as normal and supporting them to regain their health and social well-being. This was the biggest positive attitude of the people encountered(Bunnk, Gibbons, Bunnk, 2013). The spiritual and emotional requirements of the people should be met irrespective of their ethnicity, age and health status. From the discussion session it came up that sometime they believe that these accessories help them to overcome all the challenges they come across during health care. The mass that gathered during presentation and discussion had groups of different ages and hence their likings and preferences were also different from each other. For example the aged section of the mass emphasized more upon the emotional, spirituals and social inclusion as the elements for healing and recovery. Whereas the younger section of the mass accepted these elements for recovery and at the same time they had belief that good habits and healthy regimen together with above mentioned elements will result into recovery and complete wellbeing. This difference in the approaches of the two age groups clearly showed the gap between their thinking although both the age groups had same goal of achieving better and complete health. Thus from this it can be concluded that though in the session both positive and negative approach of the people from different community came up but overall outcome of the session was positive which presented that the perceptions of the people are changing towards individuals requiring special care.
The policies of SHARP project aims to improve the quality of life through holistic health care approach especially in case of people requiring special attention or individuals with specific needs. It must be noted, to improve the life of individual’s like Mr. Jack not only SHARP like project has been initiated , there are other legislative and social policies framed by government addressing people with special need. In 2013, the department of Health released a policy update on social care and health care services emphasizing upon its parallel working. The government decided to help in integration of local councils with health care organizations to give better care. This has helped SHARP like projects gets success. Through local bodies, people like who requires specific care can be included in this project, which will be benefitted by project actions. The health and social care act was launched in 2012, in order to integrate social care and health care. Similarly, the care Act of 2014 has emphasized upon implementation of certain guidelines towards healthy ageing and care for older adults. This guidelines will came into effect after April 2015. The statutory guidelines say’s the health care of aged individuals (majority individuals with specific needs) must address health and wellness promotion, prevention and reduction of needs, delaying needs must be addressed. The aged care must provide information’s as access to care services gets improved through dissemination of information. Assessing financial status, integrating with local authorities to provide care and adult safeguarding are some features which is going to be implemented. Looking into the special need domain and health care these legislative guidelines and social policies will improve the care facilitation. The current social policies such as reform in disability act, changing of disability living allowance to independence daily allowance is a welcome move which encourage SHARP like projects to get started.TASK 2
2.1 As per NHS, the level of deafness and blindness determines the level of care required which will help in designing the care plan. As per NHS, Deafblind condition is majorly found in older people as seen in Mrs. Murky case. Although her care needs include improvement of hearing, communicator or translator for effective communication and basic day to day supporter the target of care should be different. The first target of her care should be to preserve other sensory functions which are dependent upon effective communication and hearing aid. Since, it is not possible for support systems to provide for all life long, so she must be taught alternative communication techniques. Thirdly, rehabilitation training must be facilitated to improve her independence which is a difficult task to accomplish. In time health check-ups must be carried out to keep a note of interventions taken and its effect on her mental and physical health (NHS, 2013).
2.2 The current support system must have enough interpreters for communication. Similarly, the respite care system must have hearing aids and other medical aids for visually impaired persons. Enough beds must be available and assisting staff’s must be available at least to make things go smoothly in order to prevent waiting issues. Person having knowledge on different services facilitated by government and free of cost must be employed to provide information correctly(Xie et al, 2013).
2.3 In a nearby respite care a number of services are available, which would be more beneficial for Mrs. Murky. For example- the respite care has all types of adaptive aids, physiotherapists, occupational therapists, information center, living assistance staff’s etc. It has a full-fledged pharmacy to supply medications 24 *7. The respite care employs a nutritionist and behavioral support team to address both dietary and behavioral issues for disabled people. This type of facility would help Mrs. Murky better than the current facility.
3.1 The major hurdle in case of dual disabilities is communication which leads to major health and mental issues. So, the very first approach should be employing a full time professional polish to English language translator and interpreter. Once, the language interpreter and translator is employed, the next approach should be improving her hearing capability. Since she is partial deaf, she might be able to communicate properly. An audiometry test along with hearing aid for her will help in making communication perfect. Third and one of the basic requirements is a support staff for helping her in daily routine works. Since she is blind, she needs help while walking, finding things and carry out her daily personal hygiene activities. The persons employed must be as per patient preference (such as male or female). While addressing these issues proper care must be taken for ethical guidelines and protection of her self-respect and identity(Council, 2012).
3.2 As previously mentioned Mrs. Murky needs a registered professional interpreter, hearing aid and other supportive services based upon her health status. These three interventions will definitely help Mrs. Murky in leading a healthy quality life. Since she is polish and has difficulty in speaking and understanding English, a communicator can help her in translating her needs and requirements in English. She can know the services which she can avail for her disabilities, agencies which support such disable people. The effectiveness of communication in continuity of care has been reported extensively. Secondly, hearing aid will help her in hearing the normal communication and can interpret properly. As she is partial deaf, a hearing aid can help her to listen clearly and convey her needs and requirements. Thirdly, being a registered blind person residential care for adults with disability can address her daily needs and act as support for her daily routine. This can significantly improve her quality of life(Weaver, 2012).
3.3 A number of developments have occurred to help people or children with special needs which include Mrs. Murky like condition. A huge number of services are being facilitated by government of UK for disable people. Guidance has been passed by NHS named as Deafblind Guidance in 2009 which provides an instructional guideline for managing such people. Charter like Tameside Interpreting and Communication service has been facilitated to be availed by those persons who are registered blind and deaf (either partially or fully). Technological help such as providing hearing aid for disabled people has been facilitated free of cost. A number of respite care services addressing a host of disabilities has also been launched in recent times. To minimize the communication gap, every private respite care has been directed to have interpreter or translator for at least two nearby local language and one international language. Communication gap can directly affect physical health of an individual. To address such issues, services such as home respite care, adult day centers, residential programs which includes behavioral support, diet support and other residential care such as cooking, bathing , doing regular activities are involved. Thus, it will improve the situations of Mrs. Murky and others in future.
4.1 Challenging behavior can be defined as behavior which is shown by an individual having harmful effects on others as well as on self which degrades the quality of life. The individuals showing challenging behavior fails to carry out day to day activities reflected by self-harm, aggression, disruption from regular activities, and infringement of others privacy rights and responsibilities (Hewett, 2012). All these characters can be seen in Mr. John which places him under challenging behavior category. The case of Mr. John must be analyzed on concepts of challenging behavior. The term implicates the behavior is challenging in nature rather than the person and it is not mandatory, the person must be patient of mental disability (Osborne, Simpson and Stokes, 2010) . Thus, calling Mr. John in different negative attitudes name is another reason behind is challenging behavior. Research suggests poor understanding and concluding with false assumptions on personality of an individual can lead to irritation and challenging behavior (Poppes, Putten and Vlaskamp, 2010). From a challenging behavior perspective, it is absolute necessary find the factors which might have influenced the behavior leading to challenges from all perspective. Behavioral changes is linked with bio psychosocial perspective which forces researcher’s, scholars and clinicians to look into medical influence led challenging behavior as first priority (McAlister, Perry and Parcel, 2008). When, the pain is unrecognized it might lead to discomfort. Similarly, background medical condition might lead to challenging behavior. From the above case study, Mr. John was diagnosed with acute chest infection and urine infection which has its own debilitating effects causing pain and discomfort. The current case study confirms other reported studies where it has shown misdiagnosis can lead to behavioral changes and mostly challenging behavior as found in case of Mr. John. Living and working environment can lead to changes in behavior if it doesn’t suits to an individual immediate need (Teneij and Koot, 2008). As he was suffering from acute chest infection and urine infection, he must have symptoms which confirms he was in pain. Instead of being diagnosed and treated, he was given rough treatments from social care staff’s. One major function of challenging behavior is to gain control over own life and have power. Thus, Mr. John was showing challenging behavior to gain attention a control over his life where he can get relief from pain.
4.2 Challenging behavior with misdiagnosis and dementia is a well reported issue in research as well as evidence based guide. Potential influence of such behavior is causing harm to others and self (Bird, Jones and Korten, 2009). The symptoms exhibited by Mr. John are reflection of first influence of challenging behavior usually seen and reported in patients. For example- he started abusing staff’s and infringing privacy of others. This disturbs not only the Mattock nursing home facility environment but also act as a potential risk factor for more mental issues in context of mental patients. He was observed as lethargic, and do not engage himself in daily activities (Andrews, 2006). These activities which are not deliberately planned can worsen the dementia condition and effects. While these influences reduces the success chance of any treatment, scolding and abusing staff’s increases the physical as well as emotional distance between the staff and patient. In long term it leads to breakage in continuity of care and poor health care delivery. This is not only limited to Mr. John but also to other patients at Mattock nursing care. Healthcare organizations are under constant pressure due to an increased patient number and shortage of staff. In such situation, events like this can degrade the quality of care. The mismanagement of above case also suggests, the staff’s working may not be competent enough to work in such organizations where mental health is the first priority. Therefore, in long term such challenging behavior reduces the chances of employment for both Mr. John and others working at mattock nursing home.
4.3 From the case of Mr.John , it can be concluded certain event or incidence might have triggered such behavior or any discomfort which was there but was misdiagnosed led to such behavior. As he was regarded as model patient once, the chances of having mental disability or any major mental health issue is less unless he is subjected to any traumatic situation. Since he was a patient of Dementia (Mild), the first benefit of doubt goes to medical causes of challenging behavior. Assessment of health is the first and most important criteria. Misdiagnosis, poor communication might lead to long term pain and discomfort in patients which irritates the patient and forces him/her to show challenging behavior. What makes John an individual showing challenging behavior must be defined. Secondly, assessing any significant change in Johns daily life must be assessed post health assessment to manage his behavior. In case of John, he was diagnosed with two medical conditions which is relatively easy for carers to manage compared with other patients showing challenging behaviours. The first step is to assess and look for early warning signals. Post assessment, carers must look for triggers or antecedent to find out what exactly occurs before the challenging behavior. This can provide important leads or cues on exact causes. For example- Mr. John might be asking for some pain relief from acute chest infection which is ignored by the carers. This can be the cause behind his challenging behavior. In case carer fails to know the triggering events it is essential to look after consequences of challenging behavior, i.e. what the person is getting from this type of behavior or not getting that motivates them to repeat such actions again and again. Based upon the findings, a positive behavior support plan can be designed which will be beneficial for the patient.
The carer must keep a note of their own actions and behaviors during such assessment and management. Keeping calmness while dealing with such patients and distracting them can help in minimizing their behavioral influence. The strategy must be proactive in nature which acts in a positive way. In proactive strategies, the carer looks for trigger and consequence and meets the need of the patient. The patient is rewarded for adhering to the treatment regimen and the environmental factors are adjusted to keep the patient calm and composed. In the above case, the carer must stop calling him rude or violent and must behave with him normally to find out the reason behind such behavior. Once identified, preventive interventions must be taken to reduce the problem which is forcing the candidates to show such behavior (Cook et al, 2012).
D2 this module was an eye opener for me, as it gave me an opportunity to do an in depth study of core concepts of challenging behavior. The main theme or the concept which was learned from the module is the target should be modulating neither the behavior nor the person, which suggests the person, must not be harmed while managing. Although I was aware of the fact, every challenging behavior must have an unmet need which is either mental or biological in origin, the influence of environment and working conditions was not known. The case studies gave an opportunity to look after holistic approach as an evolving strategy in addressing patient as a whole. Health is a multidimensional terminology which has to be understood from more than one perspective in order to keep a person healthy. The perception of challenging behavior shown by different persons is usually perceived as mental disability or developmental disability. In my own culture, certain section of people still believes in occult effects and paranormal effect for such behaviors. Therefore, it demands translation of knowledge to common mass and educate them on influence, effect, managing of challenging behavior.
Andrews, G. J. (2006). Managing challenging behaviour in dementia. BMJ,332(7544), 741.
Buunk, B. P., Gibbons, F. X., & Buunk, A. (Eds.). (2013). Health, coping, and well-being: Perspectives from social comparison theory. Psychology Press
Bird, M., Llewellyn-Jones, R. H., & Korten, A. (2009). An evaluation of the effectiveness of a case-specific approach to challenging behaviour associated with dementia†. Aging and Mental Health, 13(1), 73-83.
Council, A. (2012). Help When You Need It-Health and Disability-Information on Services.
Dossey, B. M., Certificate, C. D. I. N. C., Keegan, L., & Co-Director International Nurse Coach Association. (2012). Holistic nursing. Jones & Bartlett Publishers.
Moniz Cook, E. D., Swift, K., James, I., Malouf, R., De Vugt, M., & Verhey, F. (2012). Functional analysis-based interventions for challenging behaviour in dementia. Cochrane Database Syst Rev, 2.
Choices, N. H. S. (2013). Communication problems and support-Carers Direct-NHS Choices.
Helman, C. G. (2014). Culture, health and illness: An introduction for health professionals. Butterworth-Heinemann.
Hewett, D. (2012). Challenging behaviour: principles and practices. Routledge.
McAlister, A. L., Perry, C. L., & Parcel, G. S. (2008). How individuals, environments, and health behaviors interact. Health behavior and health education; theory, research, and practice, 169-188.
Osborne, H., Simpson, J., & Stokes, G. (2010). The relationship between pre-morbid personality and challenging behaviour in people with dementia: A systematic review. Aging & mental health, 14(5), 503-515.
Poppes, P., Van der Putten, A. J. J., & Vlaskamp, C. (2010). Frequency and severity of challenging behaviour in people with profound intellectual and multiple disabilities. Research in Developmental Disabilities, 31(6), 1269-1275.
Tenneij, N. H., & Koot, H. M. (2008). Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour. Journal of Intellectual Disability Research, 52(2), 114-124
Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145-161.
Weaver, D. (2012). Supporting different methods of communication. Nursing & Residential Care, 14(5), 220-223.
Xie, C., Hughes, J., Chester, H., Sutcliffe, C., & Challis, D. (2013). Exploring the role of independent organisations in care coordination for older people in England. Journal of Social Work, 1468017313478330.
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