However, front-line carers are only as good as their management and it is the responsibility of management to conduct effective recruitment processes and employ competent staff. In Elspeth’s case (K101, Unit 17, pp.14-16), it was the responsibility of the care worker’s agency and supervisor to train the care worker in accordance with the organisation’s guidelines and protocols. At the Somebody Cares agency, a careful programme of induction for new staff is provided. “This includes shadowing an experienced member of staff for a week during which they are shown how to undertake intimate care tasks (K101, Unit 17, p. 27). The care worker should have spent time observing another care worker and received advice and training with regard to Elspeth’s situation beforehand. Once trained, a supervisor or an experienced member of staff should have accompanied her on her first visit.
In addition, if the care worker is not properly prepared she should have taken responsibility for her own training or asked for support. She should not rely on her own initiative and judgment and always ask for help. It is also her responsibility to follow the policy and procedures in place, and to know who she should report to if in difficulty. The level of care can also become poor if the care worker is overwhelmed by too much work. We can see this is the Elspeth case study (K101, Unit 17, pp.14-16) where another care worker looking after Elspeth continually arrived late and was always in a rush. It is the care worker’s responsibility to bring the problem to the attention of her supervisor who in turn needs to re-assess the workload and manage time more effectively. Of course, the most important person in the whole care process is the service user and their opinion counts. Therefore, Elspeth should be responsible for speaking up in a clear and assertive manner, if she is in any doubt about the level of care being received. As we can see from this case study, the responsibility to provide good quality care is shared between the front-line care worker, management and the service user. Poor quality care can come in various forms and one of the most difficult areas of care work where unsafe or abusive care is common, is dealing with challenging behaviour.
The issue of challenging behavior is experienced by care workers on a daily basis. Care workers frequently work alone and within another person’s environment, and can be confronted with values, attitudes and beliefs at odds with their specific training and experience. When working with services users who display challenging behavior, it is the care worker’s responsibility to put the behavior in context and try to understand why the behavior is being displayed. The term “challenging behavior” has replaced older terms such as ‘problem behaviour’ or ‘difficult behaviour’. Lowe and Felce (1995) explain that ……..the change in terminology served to point up the onus on services to understand and help the individual (K101, Unit 17, p. 33) i.e. to shift responsibility for difficult behavior from the service user to the service provider. Challenging behaviour comes in physical, emotional and psychological forms, and it can demonstrate that a person is distressed, unhappy or in pain.
In the case study of Rosalie, (K101, Unit 17, p. 30) one care worker thought that Rosalie has so few ways of communicating that she has to resort to violence (K101, Unit 17, p. 32). It is the care worker’s responsibility to bring challenging behaviour to the attention of management. In turn, management are responsible for providing a safe working environment and managing the institutional and organizational features of Rosalie’s surroundings. Furthermore, they are responsible for conducting risk assessments and setting guidelines and protocols. These guidelines and protocols should be set clearly by management, and centered on relevant research evidence based practice. It is also management’s responsibility to develop a code of practice for intervention if a difficult situation arises, on how to administer physical intervention safely. Unfortunately, there is always the danger of physical force being used too readily or too harshly and certain care workers may use bullying behaviour to control the service user. This happens when Lauren, a care worker in Cedar Court (K101, Unit 17, p.48), is concerned about the effect of another care worker’s actions when she locks a patient in the toilet to stop him shouting. It is Lauren’s responsibility to report the care worker to management and it is management’s responsibility to discipline the care worker involved and to have clear whistle blowing policies in place. Furthermore, they must ensure that this type of abuse does not continue as the workplace could build up a negative culture where bad practice becomes normal. Everyone involved in the care process is accountable for their actions and keeping records is an extremely important aspect of accountability and providing safe care.
Keeping records plays a significant role in making care safe as it ensures that the service user’s medical history is not forgotten, which could prevent inappropriate or dangerous care being provided. If something goes wrong and a care worker does not keep accurate records, they may be made accountable for their actions as there is no written evidence to back up their account. However, it is management’s responsibility to provide suitable processes and record-keeping systems, including clear confidentiality policies. In the case study of Rosalie (K101, Unit 17, p. 30), if she was referred to a psychologist then her medical records would need to be shared but this information must be shared with her consent, or someone could give this on her behalf.
In conclusion, it has been established that care can go wrong in specific cases and the responsibility of ensuring that poor quality, unsafe or abusive care does not lie solely with the front-line care worker. Providing good care is a shared responsibility between the front-line care worker, management and the service user. Firstly, the front-line care worker is responsible for letting management know that they require training before they provide care, asking for support, keeping good records, sharing confidential information appropriately, and following guidelines and protocols. Secondly, it is the management’s responsibility to provide good recruitment processes, proper induction, training and support, manage workloads effectively and set guidelines and protocols.
Finally, it is the service user’s responsibility to speak up, where possible, if there is in any doubt about the level of care being received. As determined, the responsibility is shared and everyone involved must work as a team to ensure good quality, safe and non abusive care is carried out. This was demonstrated through the case studies of Elspeth, who received poor quality intimate care, Rosalie who presented challenging behaviour for front-line care workers and Cedar Court Nursing Home where bad care became normal practice. Providing care is an extremely complicated area but if the front-line care workers, management and service users work together then poor quality, unsafe or abusive care can be avoided.
Word Count: 1593 words
References
Lawler, J. (2008) ‘Body care and learning to do for others’ in Johnson, J. and DeSouza, C. (eds) Understanding Health and Social Care: An Introductory Reader, London, Sage/Milton Keynes, The Open University.
The Open University (2010) K101 An Introduction to health and social care, Unit 17, ‘Unacceptable care’, Milton Keynes, The Open University.
Task B
Disclosing information may have led to harm for:-
- Dan as he is very unstable at the minute. He seemed to calm down with support from his group members. Therefore, passing on the information to Jonti fuels the argument again and Dan may get in trouble with the police if he and his mates decide to beat Jonti up. He may also turn back to drugs on the street for support.
- Jonti as he is also unstable and possibly taking heroin as well as his methadone and he is not attending the NIAS weekly meeting. Jonti is already agitated when he comes to see Pat, so disclosing the information will only agitate him even more and lead him back to the streets for heroin.
- The other service users because Pat has disclosed confidential information to Jonti so they may decide they cannot trust Pat any more and stop attending the support group. This could in turn lead them back to the streets for drugs.
- Other members as they may feel that Pat cannot be trusted and may withhold information in future meetings or decide not to attend future meetings. With no support, this could leave them feeling helpless and could lead to them back to the streets for drugs.
- The Wednesday group as a whole may be worried about the possibility of violence in their meeting and may also feel that Pat cannot be trusted, may loose faith in the group and stop coming. They may even loose faith in the whole organization and decide not use their needle and syringe exchange. Without this support, service users could possibly end up back on the street buying drugs.
- NIAS as if loose numbers in the support group then NIAS will no longer function properly. They will loose their reputation for strict confidentiality for service users. This would be very difficult to re-build and NIAS may have to close.
Word Count: 314 words
Self Reflection
My introduction and conclusions were quite weak but I took my tutor’s advice and I have made both strong in this TMA. I found staying within the word limit quite difficult and also deciding which information was most relevant. I feel my essay writing skills have improved immensely since starting this module.
