Health and Disease

MOBEEN AKRAM

UNIT 3 – POSITIVE CARE ENVIRONMENT

INTRODUCTION

As part of my health and social care, a level, I have to produce a report on unit 3, which is on positive care environments. For this report I have to choose a placement and also choose a setting or a service user group to base this report on.

Here are the following settings or service user groups that I will have to choose from to base my report on:

Health
Early years
Care of older people
Individuals with specific needs

The setting or the service user group that I will be focusing on is:

Early years

And the placement that I have chosen to base my report on is:

Nursery

The purpose/objectives of this report will be the following:

The rights of service users when accessing services

The potential barriers experienced by that service user group when accessing services, and the effects of these barriers

Practitioner and organisational policies and practices designed to create a positive care environment, application of relevant policies and procedures adopted and implemented by the organisation which promote positive access for their particular service user group

Evaluation of how legislation safeguards and promotes the rights of service users, explaining organisations responsibilities under relevant legislation and explain methods of redress open to service users.

THEORY

WHAT ARE VALUES?

Values are beliefs that identify “something that is valued” or “valuable” in a situation. Beliefs and values can influence what people do and the choices and the decision that they make.

VALUES & INDIVIDUAL RIGHTS

A positive care environment makes an enormous difference to the quality of life of both the service user ands and the staff. Today a lot of care takes place in people’s homes, but where ever care is provided it is important to create a positive care environment and require ongoing maintenance.

There must be a bond of trust between a professional carer and a service user; this principle is stated in the GSCC code of practice. They also have a duty to act for the benefit of service users. These responsibilities and duties are recognised in law and as a result the courts views abuse on the service user will be taken seriously.

Within health and social care setting there are different approaches to the definition of values. Biestek - (1961) complied a list for values:

Vulnerability

Values are important because service users are vulnerable. Many service users are at a high risk of experiencing harm. This may be other form of abuse or their health is more at risk because of the poor conditions they are living in. People also can get vulnerable when there are ignored and have fewer services or people to support them. They might be in pain or experiencing marginalisation because of their age, race, sexuality or gender; this will also affect their sense of wellbeing and ability to deal with the particular problems they may be facing.

The rights of individuals cannot be up held where there is no commitment to a shared set of values. The individuals on a daily and ongoing basis should not only reflect values in the policies and procedures of the organisation but also.

In order to work effectively with vulnerable people it is centrally important that you value and work within the principles of:

Confidentiality
Effective communication
Anti discriminatory practice
Empowerment
Respect for individual choice, identity, culture and beliefs

These principles can be seen as forming a value base care work.

Roles of values in positive care - equality cannot happen automatically. The source of the many barriers that prevent equality being achieved can be tracked back to the values that are held by individuals and groups, both consciously and unconsciously.

The key to developing a positive care environment is to acknowledge how crucial values are:

Confidentiality - in situation of stress or need, personal information often needs to be shared. Information is therefore given in trust to the care worker. A key principal in positive care environment requires that permission is needed from a service user before such information can be shared. Information can also be seen as the property of a person; breaking confidentiality can cause considerable damage to be whose rights have been infringed.

Boundaries to confidentiality - however confidentiality cannot be seen as an absolute right and might at times conflict with the equally valid rights of others to protection. Confidentiality often has to be kept within boundaries or broken where the rights of others have to balance with the service user’s rights. Keeping confidentiality within boundaries occurs when a carer tells his or her manager something that was learned in confidence. This information is not made public so it is still partly confidential.

Giving information – when information is given to other professionals it should be passed on with the understanding that they will keep it confidential. It is also important that if you meet a person that you don’t know you ask for identity before passing any information on. Relatives will say that they have a right to know about the service users. Sometimes it is possible to ask relatives to discuss issues directly with the service user rather than giving information yourself. Service users have a right to accurate recording of information about them.

The dangerous of inaccurate information include:

Serious delays in meeting people’s needs
Inability to follow up enquiries
Making mistakes with arrangements for people’s care
Missing meetings or important arrangements
Not providing a professional service to people
Failing to organise services for other properly
Other professional workers not having the right information

But all services now need to have policies and procedures on the confidentiality of recorded information.

Effective communication – The GSCC code of practice identifies that care workers must communicate in an appropriate, open, accurate and straightforward way. In ...

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The dangerous of inaccurate information include:

Serious delays in meeting people’s needs
Inability to follow up enquiries
Making mistakes with arrangements for people’s care
Missing meetings or important arrangements
Not providing a professional service to people
Failing to organise services for other properly
Other professional workers not having the right information

But all services now need to have policies and procedures on the confidentiality of recorded information.

Effective communication – The GSCC code of practice identifies that care workers must communicate in an appropriate, open, accurate and straightforward way. In many care situations this will involve the effective communication skills that improve communication:

Respecting for other people’s beliefs and views – we all has different ideas about how we conduct our lives. It is predictable that a care worker will come across many people with vastly different backgrounds, beliefs and outlooks on life. Regardless of your own views, you should always respect the views of others. This involves:

Not passing judgment on the way other people live
Avoiding stereotyping people on the basis of age, sex or ethnicity
Not trying to impose your views onto others

Establishing boundaries – all organisations operate within some set of boundaries or limits, which determines the extents of their willingness and the ability to respond.

Establishing boundaries within care settings might include:

An explanation of policies and practices
How long a interview or meeting is to last
Arrangements for the future meetings

Showing interest in the individual - it is important to try and show a bond with clients and patient. This can be achieved by:

Being patient
Listening carefully to them
Trying to remember their names, hobbies, interest, likes and dislikes
Not changing the subject
Asking relevant questions
Using effective body language
Sharing personal information

Using appropriate body language – you should make sure how you should sit and how you should use gestures because using good gestures and sitting in a good way will show that you are interesting and that you are aware of what message you are conveying by your body language.

Active listening – research has shown that we all are poor listeners and that we only listen when we are interested in something and not listening to the things that we are not in. But in health and social care active listening requires lot of concentration and the following skills are essential to active listening:

Eye contact – must have a good eye contact when having a conversation. The person talking will look to see that the other person is listening and then will look away and will keep on doing this. But the listener’s eye contact tends to be stronger.
Postures – the listener should keep the body and the hands neat and relaxed.

Conveying warmth – in health and social care for example the client may have personal and painful information to share but may decide not to because of the care worker being rejecting or cold. But warmth maybe conveyed none verbally by:

A warm smile
Open welcoming gestures
A friendly tone of voice
A confident manner
Offering help – physical e.g. helping an elderly to stand up
The general appearance of the care worker
Calm and relaxed movements

Conveying understanding – a care worker conveys understanding through empathy, acceptance and non-judgemental attitudes, So that the client has a great relief at being able to tell the truth without getting an emotional reaction from someone else.

Conveying sincerity – is also conveyed by:

Setting boundaries for example the care worker will clearly state how long the interview should last
Reassurances about confidentiality
Clear assessment at the end of the interview

Conveying the positive value of others – a psychologist Carl Rogers developed a theory that all human beings need:

The need for self-actualisation – basically we are born with a tendency to be healthy as possible, physically and mentally.

The need for positive regards – it is when effective communication should take place, we all need good relationships, which provide us with love, affection and respect from others.

Such positive regards could be unconditional: it does not matter how badly we behave, we are still loved for being ourselves. Roger argues that if we receive unconditional positive regards then we will also give our self the unconditional regards. Also if our parents love us conditionally, when we do something good at school at a job then we will constantly seek approval from others as we grow into adults.

Using non-verbal signals such as may do conveying positive value of others; smiling, calm movements, listening skills, eye contact, open gestures.

The positive value of others may be shown through; empathy, freedom from any type of stereotyping or discrimination, conveying warmth, respect for individual etc.

Seeking feedback, paraphrasing and reflection – the care worker must try and imagine how it would be like as a client. This understanding is demonstrated to the client by means of feedback – showing that they have understood what it is like to be in the client’s position.

The techniques that are used are:

In paraphrasing – the care worker will summaries what the client has said, demonstrating that it has been fully understood. In this way the care worker can check that they have really understood in what the client has said.

Anti – discrimination practice – means being able to recognise and identify the different levels of discrimination and the disadvantage as you can see from this table:

Empowerment: enables a service user to make choices and take control of his or her own life. The GSCC code of practice for health and care workers says to promote the independence of service users while protecting them as far as possible from danger or harm. The principle of empowerment might be developed with different service user groups as shown in below:

Respecting for individual choice, identity, culture and beliefs

Anti discrimination and empowerment are not possible without respecting for diversity, respecting for individual dignity and privacy, and respect for the individual rights of service users, The GSCC code of practice emphasis the importance of respecting the service users. Without receiving respect from other people it is difficult to feel that you belong and perhaps impossible to develop self-esteem. If you are to maintain a sense of self-esteem you will need to feel that other people respect you. Respecting and valuing others is not just the first principle in the GSCC code; it is perhaps the central value in any social situation.

Policies and procedures - all care organisations will have written policies and procedures that need to be followed with respect to service users rights. The National Minimum Standards (NMS) for the different care services will require every organisation to have a documented complaints procedures and policy of confidentiality. Services are inspected by the commission for social care inspection (CSCI) and the organisation will refer to National Minimum Standards in their reports. Organisations may have a range of other policy documents including a policy on advocacy.

Advocacy - This can be defined as ‘pleading the cause of another or a ‘means of transferring the power back to the service user, to enable him or her to control there own affairs.

There are different forms of advocacy such as:

Peer advocacy
Citizen advocacy
Self advocacy

Redress - things can and do go wrong in the health and social care. Means making a good or righting a wrong. It also has the idea of compensation and making good the balance within it. All local authorities must have a complaints procedure. This was required by the Local Authorities and Social Services Act 1970. The department of health has also issued further regulations. The children’s Act 1989 requires complaints procedures for actions involving children and families, so does the NHS and community care Act 1990.

Many care environment are privately owned or in the voluntary sector. The requirements of the care standards Act 2000 have to be followed.

BARRIERS TO ACCESS

Language/ communication barriers –

People who do not speak English as their first language will need an interpreter or translator to be able to find out about and be appropriately assessed for services. People who communicate using British Sign Language will also need an interpreter in order to access services. Having to access a different language system is an obvious barrier, but even with the same language, terminology can create a barrier to understand.

Organisational barriers -

Sometimes organisations have systems in place that unintentionally excludes certain people. Many organisations expect staff to work long hours and to put family commitments second to work commitments. Promotion to senior post may depend on always being available to do overtime. But such organisation culture might create a barrier for people who have child care responsibilities.

Emotional barriers –

Many people do not perceive themselves as carers or as in need of services. One of the emotional barriers to accessing services is that people do not like to see themselves as needy or dependent. The name of some benefits also set up emotional barriers. For example, attendance allowance suggests that a claimant has to have someone attending to them.

Stereotypes exist around characteristics that particular groups are believed to show. These can impact and create barriers, sometimes with devastating consequences.

Geographical and physical barriers -

Rural areas are often very poorly served with services. This is often made worst by the lack of reliable and affordable transport. Often facilities may be many miles away and there are often difficulties in recruiting home care staff for rural locations. Physical and geographical barriers were deliberately created in the past. People with disabilities and people with mental or physical health problem were segregated from mainstream society.

Discrimination –

Discrimination and prejudice results in many vulnerable groups and individuals experiencing barriers to accessing the services and support they need. These barriers can be tracked back to the values, attitudes and beliefs that affect behaviour and the way society is organised.

Types of discrimination are the following:

Direct discrimination - is where the discrimination is open and obvious.
Indirect discrimination - may do equal harm but it is less clear
Victimisation - this occurs where an individual has experienced difficulties and challenges the practices of an organisation, yet there is no protection for employees.
Harassment - this is defined as unwanted conduct that violates people’s dignity or creates a hostile, degrading, humiliating or offensive environment.

Anti – discriminatory legislation - here are some of the main Acts of parliament covering discrimination are:

The race relation act 1976/2000
Sex discrimination act 1975/1986
Equal pay act 1970/1983
Disability discrimination act 1995
Employment equality regulation 2003

Stereotyping & labelling - sometimes people try to save mental energy and just make the assumption that groups of people are” all the same”. Perhaps a younger person meets an 80 year old who has a problem with their memory. Perhaps they have seen someone else who also has a bad memory and then it will be easy then to say that all old people are forgetful. This would be stereotyping. Stereotyping is a fixed way of thinking.

CREATING A POSITIVE ENVIRONMENT

There are two key elements to creating a positive environment. The fist element is the responsibility of individual care practitioners to challenge behaviour and practices that discrimination against service users. The second element is to understand the role of the organisation. The size, structure and practices have a big impact on the care environment.

The individual practitioner - why do people have discriminatory beliefs? One explanation is that they are socialised into thinking this way. Theories have been put forward by vygotsky who said that this happens from a young age. When a child learns effective ways of behaving this encourages self-confidence.

Norms – this is described as the general standards of expected behaviour of a particular group or individual. Idea of how people should behave varies over time.

The importance of the care value base - when people work together they may develop a common group identity that involves shared values and norms. Tuckman 1965 argues that a group of people become a functioning group when they have been through the norming stage; that involves sharing beliefs and expectations.

Aspects of care values –

Empowerment – this has been changed because they have to now identify areas of oppression and disadvantages then analysing biased policies and challenging these in order to achieve the changes.
Respect for individual’s choice – this is basically giving the choice to the service user and making them to become independent for as long as possible. The role of social worker was to provide clear and accurate information to the service users.
The importance of identity – this means having the sense of who you are. But now in a health and social care setting it has been recognised and taking an action upon it.
The importance of culture and beliefs – now in health and social care work very one needs to be aware has and be sensitive to culture and race.

The Organisation

Policies and procedures – policies reflect organisations views about a particular area; this is usually combined with an expectation and procedures as to how staff working for the organisation will behave.

Effects of organisational size, structure and culture – many organisations providing social care is commercially run in order to make a profit.

HOW SOCIETY PROMOTES SERVICE USERS RIGHTS

In working in the field of health and social care there are specific and general areas of law that affect people’s rights.

The essential laws are; Human Rights Act 1998, Discrimination Legislation and Data Protection Act and Freedom of Information.

Discrimination legislation:

Sex Discrimination Act 1975 and 1986 - this law covers discrimination and make direct and indirect discrimination illegal.

Employment Equality Regulation 2003 - this law covers direct and indirect discrimination, harassment and victimisation on the grounds on sex7ual orientation.

Race Relation’s act 1976 and Amendment Act 2000 - this act 1976-made discrimination unlawful on the grounds of colour, race, ethnics or national origin or nationality.

Employment Equality Religion and Belief Regulation 2003 - this also protects people from harassment, prejudice, victimisation and harassment on the grounds on beliefs.

Disability Discrimination Act 1995 - this is a requirement on employers to make reasonable adjustment is seen as the equivalent.

Data Protection Act and Freedom of Information Act 2000 - this access to personal files act 1987 and access to health records act 1990 made it legal requirement to keep service user information confidential. The data protection act establishes rights to confidentiality covering both paper and electronic records.

The specific laws in health and social care are:

Freedom of Information Act 2001 – the principle underlying this act is that information should be readily released unless there is evidence that harm would be caused.

The Children Act 1989 - the act established rights and responsibilities of parents and tried to set a framework for balancing the rights of children and parent against responsibilities of the local authority to protect children from harm.

ASSESMENT OBJECTIVE

The nursery that I went to have a learning centre - this area was for older children up to the age of five years old. The children here enjoy a variety of dance and drama as well as messy play, construction and creative sessions. Also at this stage children receive a gentle introduction to other subjects such as science, maths, English and IT.

This is where I carried out my interactions with the children. But before I could carry out any interactions I had to get permission from the manager of this nursery. I also can’t use any of the children’s names in this unit because of protection. So the children are called; child 1, child 2, child 3 and child 4.

AO1 –RIGHTS OF SERVICE USERS

In the nursery setting to create a positive care environment it offers the following:

Flexible hours from 8am - 6pm
A loving and caring environment with a home from home feel
Little learners have a bright and spacious home room also divided in two facilities
They have all kinds of activities including painting play and other activities
Out door play area all safely made up and other outdoor equipment

Also the organisation has to follow all of the laws such as:

Sex discrimination act 1975 and 1986
Employment equality regulation 2003
Race relation’s act 1976 and Amendment act 2000
Employment equality religion and belief regulation 2003
Disability discrimination act 1995
Data protection act and freedom of information Act 2000

But the specific law that they have to follow at the nursery are:

Data Protection Act - this is because they have to make sure that no information of the children’s is past to any one who has no connection with the child. They also have to make sure that permission is given from the parents that information on the children can be shown before showing it to someone else. The parents have to sign the form of data protection act that the nursery provides and state whether they are happy to share information with other people or of they would not like to share their information with any one.

AO2 – BARRIERS TO ACESSING SERVICES

I don’t think there were major barriers in the nursery setting. But the barriers that I discovered were the following. Out of the 8 children, two of the children didn’t speak English at all and they didn’t understand what the teacher and the helping staff were saying to them. So them two children were doing there own things and kept getting into trouble and then very upset because they couldn’t do what they wanted to do. This was a barrier to them and also they didn’t have an interpreter at the nursery to help these two children to understand.

The second barriers I think was that the children were not able to say the following words to express their feelings such as naughty, like, no. The “naughty” and “no” words not allowed to be used because they would encourage the children to behave badly and to use other inappropriate words to express their feelings as well. The “like” word was not allowed to be used because they had to use other words to describe what they thought about things and this would then increase their knowledge of other words. The third barrier was that all of the children were not allowed to socialise with the other age grouped children at break times and lunch times at all and this was because it would create problems and some children would get upset about leaving the other children when they have to go back to their own areas.

The last barrier that I thought was that they weren’t given a choice of what hot dinners they would like. But what ever was cooked that day all of the children would have to eat it even if they liked it or not. The effect of this barrier would be that the children would not have their main meal during lunchtime and would only have the deserts that were also provided at lunch times.

(Lunch menus for the week are included in the appendix)

AO3 – POLICIES AND PRACTICES

There weren’t any major policies and practices of the nursery. But to create a positive care environment the parents of the children would have to follow the nurseries terms and conditions, which are also included in the appendix, and they were:

Opening hours
Meal times
Dress code
Other activities
Sickness
Health and safety
Special requirements
Nurseries fees

The staff would have to follow:

Dress code – where blue shirts given and any black trousers
Fill-in application form
Follow teddies rules and procedures
Make sure that health and safety rules are followed at all times
Make sure that the children and them selves did not use the words mentioned above
Made notes on each individual child and how their day has been and report it to the parents at the end of the day and the manager.

If all of these were followed at the nursery then it would create a friendly and positive environment for the children and the staff and will send out a good image to other people.

AO4 – LEGISLATION

They would also have to follow the following acts such as:

Sex Discrimination Act 1975 and 1986 - this law covers discrimination and make direct and indirect discrimination illegal.

Employment Equality Regulation 2003 - this law covers direct and indirect discrimination, harassment and victimisation on the grounds on sex7ual orientation.

Race Relation’s act 1976 and Amendment Act 2000 - this act 1976-made discrimination unlawful on the grounds of colour, race, ethnics or national origin or nationality.

Employment Equality Religion and Belief Regulation 2003 - this also protects people from harassment, prejudice, victimisation and harassment on the grounds on beliefs.

Disability Discrimination Act 1995 - this is a requirement on employers to make reasonable adjustment is seen as the equivalent.

The specific laws in health and social care are:

Freedom of Information Act 2001 – the principle underlying this act is that information should be readily released unless there is evidence that harm would be caused.

All of the above laws would have to be covered at the nurseries setting and make sure that the staff do this if any staff does not follow or breaks them will face the consequences.

EVALUATION

Overall I found out that the service users’ rights are displayed positively and that they provide a lot of facilities for the children at the nursery, which include providing a loving and friendly learning environment. It is important that the nursery follows all of the laws that I have stated above because they have to protect the children and their staff. They do not want to be found to be negligent towards the children or have their staff found to be negligent to the children. The laws are there to safeguard the employees as much as the children.

The most important laws that would concern the children would be the Children Act 1989 and the Data Protection Act. This Children Act is all to do with the protection of the children when they are in the nursery and what the parents can expect their children to be in a safe environment in line with what the law says. There is a certain expectation when you leave your children at a nursery, i.e. that they will be looked after and no harm will come to them and so forth. The Data Protection Act basically means that no other person except certain individuals with special right and the parents/legal guardians can access the Childs individual personal date, i.e. school reports, results, address, telephone number etc. This again is in the interest of the child so no stranger may come off the street and pretend to be the Childs guardian or have a right to any information. This further protects the children, as no one should be able to access such information or even the child unless he/she has a right to.

There were no major barriers at the nursery for the children in my opinion. Though I did think would affect the children was the words that they could not use and I found this strange and wrong because the children could not express them selves. The words were “like”, “no”, “naughty”. I also think that this barrier would affect the children in expressing them selves and also this barrier would not be able to be broken down.

I found the policies and procedures very simple and helped to create a positive care environment and user friendly for the children to follow in the class room (i.e. Rules) and for the parents and staff, the terms and condition, again very simple and in accordance with the laws applicable to the nursery. Obviously the children, parents and staff try to do their best to follow these policies in order to create a positive, and friendly environment for each other, but there is no doubt somewhere down the line someone either disagrees or wants to go against these rules or even is unaware and through ignorance fail to follow them. This then causes problems, which is rare, but not unknown, as the teachers too well know. The teachers I found tried to their best to the extent they could and all in all were quite successful in achieving their goals and objectives of the nursery in line with the discussed rules.

Due to lack of time and resources available, I was not able carryout research in other areas of the positive care environments and therefore I could not do this portfolio in detail. If further studies were to be undertaken and more information obtained from the organisation, I feel I could have found out much more about how these areas interact with each other and I would have seen a wider picture. If I had more time I would of carried individual interactions and more group interactions to find out more on this portfolio and I would have compared my findings to see what results I would get. But due to external resources being very restrictive and time constraints I was some what held back. Nevertheless, if I were to attempt again I would definitely compare other care environments against this one.