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write a holistic and analytical account concerning one aspect of care in a chosen individual who has complex needs, down's syndrome and diabetes

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The purpose of this essay is to use a systematic approach and write a holistic and analytical account concerning one aspect of care in a chosen individual who has complex needs. Before choosing a client it is important to understand what complex needs are. There is no commonly agreed definition, however both of the definitions below illustrate clearly what complex needs are. Stalker, et al (2003:1) suggest complex needs include "those with acute and chronic medical conditions, multiple and profound impairment and learning disabilities." Another definition provided by Tait and Genders (2002: xi) suggests that, "People with by virtue of their disability and additional physical, emotional or behaviour problems require a co-ordinated approach that meets their everyday needs." Therefore, with these definitions in mind I have chosen to focus upon the challenging behaviour(s) of a forty-five year old man who has a moderate learning difficulty and Down's syndrome. With due consideration of protecting the individual's identity in accordance with the NMC 'Code of Professional Conduct' (2002) the name 'Henry' will be applied throughout this essay. Henry lives in a six bedded private home for adults with moderate learning disabilities. Previous to this Henry lived at home with his parents until his father died three years ago. After this Henry received counselling through his community nurse in order to help him go through the bereavement process. No signs of grief have been identified since the counselling sessions finished two years ago. The manager of the home contacted Henry's community nurse as she was unsure of the causes of Henry's behaviour and how staff could manage it. Before considering the behaviour(s) Henry is displaying, it is useful to consider the importance of forming a therapeutic relationship in order to help Henry. A therapeutic relationship between a nurse and client compromises of intimacy, partnership, reciprocity, trust and respect. The most important skill in this relationship is communication and this requires the nurse to overcome any barriers, which may stand in the way. ...read more.


developed by Van Houten, et al, (1989) (See Appendix Two). It is a comprehensive semi-structured interview consisting of 41 questions. The questions attempt to assess whether the target behaviour is associated with biological factors, physical environment, communication, escape, demand factors, elicited or adjunctive behaviour, activity transitions, and/or positive reinforcements (Sturmey, 2001). When using the tool Van Houten, et al (1989) suggested that at least two or more people who have daily contact with the individual should be used to avoid bias. The next two tools selected were the 'Antecedent Behavioural Consequence Charts' (A.B.C.s), and 'The Motivation Time Sampling' (M.T.S.) (Durand, 1990). To support the Functional assessment staff at Henry's home and day service were asked to complete A.B.C. charts through direct observations. Observations are the foundation of the functional assessment process. It enables us to describe the behaviour at any given moment such as what the behaviour looks like and how often it occurs, as well as its length and intensity. When carrying out observations it is important that carers are objective and record what is seen or heard without making assumptions (Tait & Gender, 2002). Therefore a number of staff on different shifts were asked to observe Henry when his behaviour was challenging. No training was required as the staff were familiar with the charts, although sufficient time was required to complete observations and charts. They were used to determine the patterns in Henry's behaviour and were collected over a period of one week. Analysis of the charts is often useful in developing initial hypotheses or summary statements of the behaviours. Momentary time sampling was carried out over a period of three hours a day for five days (See Appendix Three). M.T.S. is an important tool as it helps give an insight into the frequency of Henry's behaviour. Therefore the M.T.S. is a good tool to be used as it helps identify how many times Henry shows this behaviour and what he was doing at the time it occurred. ...read more.


The community nurse also arranged a review date to discuss Henry's achievements and goals after six months to see how he was doing. Providing predictability and routine to Henry's activities has appeared through daily observations to be positive in limiting his self-exclusion in activities and hoarding, which in turn reduced his, out-bursts of aggressive episodes. The use of familiar staff and settings has provided Henry with security, thus reducing his stress, which in turn has reduced his behaviours. In Henry's case, appropriate style, tone of voice and use of similar phrases has appeared to be useful in reducing incidents of opting-out and aggression in both home and day-centre. The suggested intervention of respecting Henry's decision to leave an activity has also been successful. If an explanation is given by staff regarding change in activity Henry seems to be able to cope better and if he decides he does not want to participate he will sit close by and watch. Tait and Genders (2002: 37) stated that, "To deliver care that is both individual and appropriate, it is important to adopt a structured approach to care delivery." By taking into account what Tait and Genders stated, I believe that the aim of the essay has been met and that Henry's behaviour has been reduced through implementation of care plans. Individuals similar to Henry continue to represent an ongoing challenge to the services they encounter however; it was felt that many of the interventions used have appeared to be of benefit in reducing his hoarding and self-exclusion. In general the challenging behaviour seems to be an effective way for Henry to control what is going on around him. By understanding the variation in his behaviour we were able to help him deal with the situations in a positive manner. Whilst it is not possible to ascertain progress in Henry's behaviour over a longer period of time, improvements should be ongoing. Henry's case is of a complex nature, with many environmental, physical and social contributing factors, which must be considered in his long-term care. ...read more.

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