Principles for implementing duty of care in health, social care or children’s and young people’s setting

All practitioners have a duty of care all the children the setting, this also includes the staff. A duty of care is where a practitioner has to take care of them and not let them get harmed in any way. This will involve the children attention, watching out for hazards and preventing mistakes or accidents. If a practitioner has not met the duty of care required then they can be held accountable for allowing it to happen.

The Early Years Foundation Stage (EYFS) is a framework that provides an assurance to cares and parents that the setting that they put their child in will keep them safe and help them thrive. The aim of the EYFS is to help children achieve the five Every Child Matters outcomes which are •Staying safe

•Being healthy
•Enjoying and achieving
•Making a positive contribution
•Achieving economic wellbeing
These can be achieved by having quality, consistence and a set of standards which apply to all settings.

Children are entitled to basic human rights such as food, health care, a safe home and protection from abuse but because children can’t always stand up for themselves they need a special sat of rights to ensure that the adults around them take responsibility for their protection and development. The UN convention on the rights of the child applies to all children under the age of 18 and it spells out the basic human rights children and young people should have.

All children have the right to survive, develop and be protected from harm. There can be potential conflicts or dilemmas with professional’s record and share information about a child, the information on a child should only be collected and stored with the parents constant and should have free access to this information on request. The constant will be gained formally with a signature; the only exception is when a child might be at risk of immediate and significant harm if you share the information with the parent.

Safeguarding a child requires practitioners to make difficult judgments. As an early years practitioner your duty is promote the welfare, development and learning of each child sometimes this means raising difficult or sensitive issues with a parent or carer. It is important that the issues are raised in a way that shows concern for the child and not criticising the parent or carer.

In general it is important to have a confidential space and a clear focus on the child best interests, the vast number of parents will be supportive even if the first reaction in negative and it is important to involve senior staff in these discussions such as a room senior or the manager. 2.2

Whatever setting you are in, situations may arise where you need to respond to a complaint. People react in different ways to a situation. When responding to a complaint it is important to take into account the other persons point of view and find a solution to the problem. You should aim to deal with the complaint in a constructive manner in order to maintain positive working relationships. There are four positive steps that may help you respond to a complaint keep cool, listen, apologise if necessary and try for a win/win solution. 2.3

The colleagues that you work with should be able to provide additional support and advice about conflicts and dilemmas such as your room senior or settings manager. In addition there are a range of organisation that can provide support and advice for those working with children, young people and their families. These include local education authority, health services, social service department and charities and voluntary organisations. You should always remember to follow your settings guidelines regarding confidentiality and the sharing of information when concerned about the welfare of a child or young person.

Promote communication in health and social care setting

 Identify the different reasons why people communicate when working in a care setting communication is a key factor, you need to be able to communicate with a wide range of people such as service users, families and/or carers, other members or staff and management, you will also have to come into contact with other professional from time to time such as; doctors, nurses and social workers. Communication is the basis of all relationships, regardless of weather the relationships are personal or professional, and regardless of the nature of the communication.

Reasons why people communicate

Explain how communication affects relationship within the work setting Communication affects relationships in many different ways in the work setting. Relationships are important and relationships are built of trust and understanding between people makes it easier to get things done. The benefits of effective communication in the workplace are that it is:- A happier, less-frustrating workplace experience.

Frees up employees to focus on other more productive activities. An increase in satisfaction from workplace activities and workplace relationships. An increase in productivity can lead to an increase in pay, promotion, and prestige The key relationships are with the people that I support. The skills that I have learned as a care assistant will help me to build relationships and this will be important to ensure that the right outcomes are met, for example somebody may have identified that they would require support in their lives and they need to sure that the people they are working with are honest and trustworthy.

Relationships with colleagues and other professionals are vital if people are to work together effectively. Showing respect for the work that other professionals undertake is an essential building block of a good professional relationship. It is important to take the time to find out what other people do and think about what you could learn from them, and remember that everybody makes a contribution.

Demonstrate how to establish the communication and language needs, wishes and preferences of individuals. All relationships start through communication, when providing support for people you must ensure that you are a good communicator. You will have to gain an understanding of messages that are being communicated from others and be able to communicate back when you’re not always able to use words. When you first meet somebody and talk to them you would usually be using two language systems to enable communication and thy will be verbal and non-verbal communication. Verbal communication: is when we communicate our message verbally to whoever is receiving the message.

Nonverbal communication: is usually understood as the process of communication through sending and receiving wordless messages. Such messages can be communicated through gesture, body language or posture, facial expression and eye contact. Body language is very important when you communicate as it affects the way people interoperated what you are trying to say. Effective communication requires you to have the ability to understand you’re own and other peoples non verbal behavior. Your body often sends messages to other people unintentially.

Describe the factors to consider when promoting effective communication When people communicate they tend to take notice of somebody’s tone of voice and facial expressions first other than what is actually being said.

As a care assistant being able to understand the factors that contributes to good communication is very important as this will allow me to gain an understanding of every service user and also be able to tell if anything is affecting them or causing them upset or pain. Demonstrate a range of communication methods and styles to meet individual needs.

There are many different ways to communicate and ensuring that you are using the right level and type of language is very important to ensuring that you are being understood fully. Communicating with people may not always be about speaking or even non-verbal communication, you can communicate in a wide of different ways these are:- Email audio (speaking, singing) telephone conversation texting using a mobile (short messages) visual (seeing pictures, slides, artwork, written words) kinesthetic (teaching someone by showing them how to do something, hands-on instruction, texture) face-to-face vs. long distance  Interperators (if you are trying to communicate with somebody who’s language you do not speak) technological (some people prefer reading books, other prefer reading them via electronic screen)

Demonstrate how to respond to an individual’s reaction when communicating A response during communication is important for the communication to take place. If someone is talking to you and you are not responding, it is difficult for communication to take place. When you respond to someone, it shows that you are listening to them, which then shows that you understand what they are saying and are interpreting it correctly.

However, the response doesn’t need to be verbal. A simple nod can even be considered communicating, as long as both participants are aware of each other and understand what is being said. When communicating it is important to remember that when communicating you can often learn as much by observing as by what you hear. It is important to learn to listen with your eyes. An important part of responding appropriately to communication is recognizing when people are distressed and know how to deal with it. It is importing to have an understanding of the effects of emotions, as they can often be an indicator of a potentially highly charged or dangerous situation. There are some general indications that a person is becoming distressed and these can be obvious to see:- i. breathing patterns

ii. excessive sweating
iii. face and neck become red and flushed
iv. body language
v. eyes for example pupils dilate
vi. change in facial expressions
vii. change in tone of voice for example voice may become raised Explain how people from different backgrounds may used and /or interpreter communication methods in different ways When you are first communicating with somebody it is important to find out about communication issues the person you are communicating with. You can discover a great deal about possible communication issues by simply observing somebody’s behavior. Observation should be able to establish

What language is being used
If the person is experiencing any hearing or visual impairment If they have any physical illness or disability
If they have any learning disabilities
Any of these issues could have a huge affect on how well we communicate and can allow you to put steps in place to help communicating easier. Identify barriers to effective communication Hearing Impairment- A service user that has a hearing impairment in one or both ears. Visual sight- A service user that has no visual sight or poor vision or sight in one eye. Disability/learning difficulties- A service user that might have a condition that might stop them from communicating effectively and might need visual aids to help them communicate. Learning and speech impediment- A service user that finds it hard to communicate through speech and gets frustrated because they are not understood. 0ther languages (cultural backgrounds or English as an additional language)- you may need an interpreter or find other means of communicating with service user that do not speak English. Different family background personality.

Demonstrate ways to overcome barriers to communicate
Physical barriers

Physical and environmental factors can cause problems when we communicate. When you are communicating it is important to consider the surrounding that you are in when you’re communicating, for example people find it difficult to talk in noise and crowded places. Understand what could be barriers to
communication can allow myself to ensure that communicating id done effectively these could be:- Hearing loss

Physical disability
Visual impairment
Learning disability
Language differences

Demonstrate how to access extra support or services to enable individuals to communicate efficiently. If I am having any communication problems with a service user I would seek advice straight away as the longer I leave It the longer the problem will take to get resolved. Also the service user may become upset and frustrated and this can cause more barriers when communicating. The person I would go to first is my organiser and if they are unable to resolve the problem they will get in touch with people who can. These could be:- Translation services- can help with changing written txt from one language to another. Interpreter services – they convert spoken language from one to another. Speech and language services- support for people who have had a stroke or have problems with speech. Advocacy service- support people who are unable to speech for themselves. This service try’s to understand the needs and wishes of people and will argue on their behalf.

Explain the meaning of the term confidentiality
Within the care sector there are legal requirement under the data protection act 1998 to ensure that all records are confidential. This act gives people the right to see all the information recorded about them weather it’s their medical records or the social service file. Confidentiality means keeping all information with the work place safe and only be passed on where there is a clear right and need to do so if it could cause half to an individual.

Confidentiality is an important right to everybody and it is very important as a care assistant to remember this as because service users might not trust a care assistant who can not keep things private additionally by breaking confidentiality you may be putting service users at risk if their personal details get out for example home address. All service users records will be kept in a locked office and they will also be kept on the computer which will be password protected and there will be policies on record keeping within the office place. Demonstrate ways to maintain confidentiality in day to day communication. The principle of confidentiality is about trust and confidence that people might have in care workers.

Care workers need to ensure that they do not discuss one person who you support with another person that you also support. The most common way in which confidentially is breached is by people talking about work issues with family and friends. It is done very easy and very tempting to discuss the days events especially if you have had a stress full and it is often therapeutic. But by doing this if you don’t keep peoples details confidential and anonymous this could break confidentiality. Every organisation will have policies on confidentiality and the disclosure of information. As a care assistant it is important that I know where the policies can be found and what information is in the policies.

Principles of communication in adult and social care settings

Ai Identify four different reasons why people communicate

Making and developing relationships

People communicate to make new relationships. The way I first speak and listen to a newcomer can make them feel welcome or overlooked. As I speak or comment, listen and watch, take an interest, smile and nod, whether to a service user, a member of their family, a colleague or a visiting practitioner I am building and developing my relationship with them. Communication will continue to be the main way I nurture and develop my relationships at work.

Giving and receiving information

At work I will be expected to give and receive different types of information. Perhaps a service user confides in me, or a member of their family asks me a question. A colleague could give me instructions a visiting practitioner might make an observation. The information I give, receive and pass on will help me to carry out my work effectively.

Expressing needs and feelings

Expressing needs and feelings is part of being human and these are communicated through behaviour as well as speech. Most people need to share needs and feelings with each other and in this way build up a sense of trust with the person they confide in.

Sharing thoughts and ideas

Human process many of their thoughts by discussing them. If I have ideas, questions and opinions about my work, sharing them with colleagues helps to clarify, develop and even change the way I think and act. The way in which I respond to the thought processes of service users could encourage or discourage their sharing with me.

Affirming one another

Affirmation is about acknowledging and encouraging each other and reassuring individuals of their worth and value. Affirmation is communicated through positive words, praise and gestures. Some care settings use support groups, staff meetings and appraisals as ways of affirming practitioners about their work performance.

Aii Describe two ways how communication can affect relationships in an adult social care setting between individuals using the service, their carers, colleagues and other practitioners.

The ability to communicate well is a key skill that enables me to work effectively with others. Communication process is much about listening and receiving messages as it is about talking and giving messages. As a care worker I need to be skilled in both aspects. My communication skills will develop and become more effective as I gain experience in my work role, learning from observing more experienced colleagues. Learning from others, seeking for advice and using support are all part of this process. During my work with service users there will be specific situations where good communication skills are particularly necessary.

Sharing information

In a care setting it is vital that information is shared appropriately between workers to enable each member of team to carry out his or her role effectively. I will also need to share information with service users and their relatives. Sometimes the information might be of a sensitive nature, such as when breaking bad news or dealing with private information, and I will need to be especially sensitive. In the course of my work I will need to find out information, pass on information and listen information.

Providing support

Communication is the main way in which I continue to sustain relationships and build this up. As a health and social care worker I will need to offer support to service users and their families and this is enabled through both verbal and nonverbal communication. I will need to listen, as much as I speak and the use of appropriate and non intrusive touch can add to sense of being supportive.

Aiii Using the table below, identify three ways of finding out the communication and language needs of an individual. For each method, describe how effective it is at establishing the needs of the individual.

Asking/Observing the Individual. Asking/Observing is probably the best way of establishing the individual’s communication and language needs as this would immediately allow me to establish their usual language, if they are visually or hearing impaired etc.

Check the Care plan for the individuals communication needs. The Care plan can be a good source of information on the needs of the resident, but if documented incorrectly due to human error this method becomes ineffective.

If the first two don’t provide me with the needed information I could ask resident’s family, friends, doctor or other professionals who have worked with the individual. This is another effective method, only to be used if the first two fail.

Aiv Describe three factors to consider when promoting effective communication


Physical distance: the better you know a person the closer I am likely to be physically. Closeness can encourage sharing. Positioning chairs at an angle rather than side by side makes it physically easier to talk to another person. Sitting directly opposite is more formal and can feel confrontational. Sometimes a table between me helps a person feel protected. Yelling from one room to another doesn’t aid communication.


Body position: leaning forward can communicate that you are interested, but too close might invade “body space”. Turning away can show lack of interest , but standing directly opposite a person can be too direct, where being at an angle can provide a helpful space.


Behaviour: folded arms can look defensive and discourage communication. Friends and family without realising, often mirror the other person’s posture during conversation, which is thought to increase a sense of familiarity. Standing over a person who is seated might feel patronising or threatening.

Av Describe three verbal and three non verbal communication methods and styles that a social care worker may use in an adult care setting.

Communication is a complex process made up of many different elements to do with verbal and non verbal language. These are reflected in a range of communication styles and methods. Communication is also a two-way process that must take into consideration the reactions of others and respond appropriately. To be a skilled communicator and interpreter of communication I must pay close attention to my words and actions, as well as the words and actions of others.

Verbal communication. It’s about the choice of words being spoken, but also the way the words are said.

Vocabulary. Choosing words that are appropriate to the service user’s level of understanding is important. Perhaps English is not their first language, or they have communication difficulties associated with a physical condition. At the same time, I need to be aware of not being too simplistic and coming across as patronising.

Tone of voice. Tone of voice concerns the emotional message being conveyed alongside the spoken words. When these don’t match, people can become aware of my emotions and will pick up whether I am irritated or anxious, for example.

Pitch of voice. Pitch of voice concerns how low or high my voice sounds.

Speaking in a low voice can be calming and soothing, but too low and I can sound boring. In contrast, a high pitch can sound shrill and be unpleasant to listen to.

Non verbal communication
Non-verbal communication is a form of communication that take place almost subconsciously, that is, without being aware of thinking. It provides clues about the meaning of spoken language.

Body language. Body language relates to the way my body reflects my thoughts and feelings. This can add emphasis to my words, but if I don’t really mean what I am saying it can also reveal a truer and contradictory message beneath my words. For example, exclaiming, “how fascinating” might sound as though I am interested, but body language of tapping fingers, poor eye contact and stifled yawns betrays I am actually bored.

Gestures. Gestures are signs made with the hands and arms to illustrate or emphasise my words or to stand in place of words. People often gesticulate during conversations without really thinking about it. I might see someone gesticulating while talking on the phone, even though the person receiving the call cannot see their gestures. Some gestures are understood across many different countries of the world, such as thumbs up, meaning “good news”, but not all the gesture are universal and instead of clarifying a message, could create a confusion.

Eye contact. Eye contact is very important and sometimes it is difficult to know if a person is telling the truth unless I can look into their eyes. Holding someone gaze is a sign of intimacy, but to do so with a person I don’t know well can feel uncomfortable, even threatening. During most conversations it is normal for my gaze to flit to and from another’s face. When working with service users who have communication difficulties it can help to exaggerate elements of non-verbal communication to provide more clues about my spoken message.

Avi Explain why it is important to respond to an individual’s reactions during communication.

The following qualities will help to respond appropriately to the communication of others. Awareness of how my communication is being received. Look for nonverbal cues that indicates the recipient’s interest and understanding and equally those that indicate misunderstanding or boredom.

Sensitivity to tune into my recipient’s emotional responses to my words. Flexibility to change the way I am saying something in order to clarify my meaning and increase understanding.

Communication techniques. Some communication techniques assist with the process of responding to the reactions of others.

Echoing. Echoing is a technique where I repeat back what a person has said in a way that both checks my understanding of their words and also affirms the underlying feeling being expressed. For example, if a distressed resident of a care home tells me she thinks someone has stolen items from her room, I might say, “It must be upsetting for you to think someone has been interfering with your personal belongings.”

Mirroring. Mirroring is a communication technique used to improve rapport with another person. In many cases it happens naturally, where one person reflects the other person’s physical positions and mannerisms, their tone of voice, word use and communication style.

Asking questions. If I want a person to express their ideas and feelings I am best to ask open questions which invite broader responses. ‘How are you feeling today’ Is and example, where a service user is free to respond in a way they choose. If I ask a closed question the answer is usually reduced to one word, for example ‘Are you feeling better today?’ Invites a ‘yes’ or a ‘no’

Avii Explain how an individual’s background can influence the way they communicate.

Communication is all about sharing with one another and yet each person communicates slightly differently according to their different background and experience.

The impact of differences. Diversity is something to be celebrated and enjoyed, but our differences can also lead to misunderstanding and different interpretations of the same communication

Cultural background. Cultural differences refer to a variety of different influences, such as family background, peer group, religion, and ethnicity. These all play a part in shaping the way a person views the world and spin dot it. Cultural differences are revealed by particulars attitudes, values and practices, all of which have bearing on how a person communicates and understands the communication of others. For example, if an individual comes from a family where it is usual to make decisions through noisy and heated discussions, this person might find it difficult to accept an order without question.

Individual personality. Although individuals share personality traits in common with others, the unique make-up of these and the way they operate together is individual to that person. One individual might be quiet and reserved, another enthusiastic and bubbly and this will affect the way each communicates and responds to communication.

Levels of confidence. All communication requires a certain amount of confidence to speak up, make a statement, or share with others through spoken or written words. Sometimes a person has had their confidence undermined by a previous experience of communication, such as being misunderstood, or laughed at for mispronouncing a word, or perhaps an experience from childhood, such as failing their English exams. Confidence builds up over time but can be knocked down in seconds by a thoughtless or unkind response.

Competence in communication skills

Literacy skills refer to a person’s competence in reading, writing and speaking in a particular language. The service users I work with may be a different levels of competence in literacy and need to be communicated with a level they can cope with. Some adults struggle with literacy and may feel embarrassed by their difficulties. As well as literacy skills, some individuals will have better access to and be more competent using information and computer technology (ICT) than others. I should not assume that everyone I have dealings with at work has access to the internet and email, or mobile phones, or that they are competent in using such technology.

Aviii Identify three examples of barriers to communication and explain how you could overcome each barrier.

Barrier: sender speaks different language. Overcome: to have a translator or a dictionary Barrier: poor or incomplete information selection. Overcome: to give as many details possible Barrier: hearing difficulties, visual difficulties. Overcome: to seek for medical advice and find a way of communication Barrier: sender cannot express message clearly, I speech or writing. Overcome: to use body language and sign language Barrier: distraction. Overcome: to change the environment, to focus

Aix Describe two strategies that you could use to clarify misunderstanding

Communication is a complex process and Health and social care is a complex area, so it is inevitable that misunderstandings will arise from time to time. When a. Is understanding happens it is important to have a range if methods to clarify the situation and improve communication.

Adapt my message: Sometimes the message needs to be said or written in a different way. Perhaps the tone need to change, or the message style. The language I have used might need to be simplified. Maybe a phone conversation has been unsatisfactory in some way, but a face to face meeting would help establish better communication.

Change the environment: It might be necessary to make changes to the environment to enable better communication. For example, if I am conducting a meeting in an office where people are constantly coming in and out, or the phone keeps ringing, I will need to find a quieter place to speak.

Ask for feedback: In most situations it is acceptable to stop the flow of conversation with the person I am speaking with to check that I have understood correctly what is being spoken about. Equally, I can check that the person I am communicating with can hear me or understand me.

Ax A social care worker wants to enable more effective communication with individuals using the service. Explain how they could access extra support or service that they may be helpful.

There is a range of support available to enable effective communication with the service users I work with and members of their family. Importantly, individuals need to be informed about these services and be able to access them. For example: – support available via local authorities and services, such as NHS and adult social services departments. Help is also available from national charities, such as ICAN, for speech and language needs and the national Autistic society for those with autism. – The Citizens Advice Bureau (CAB) is another source for advice and assistance on advocacy, translation and interpretation. – in addition there may be projects operating in local areas and these are likely to be advertised at a local library or community centre, or in a health centre. Communication support tends to include these categories:

– speech and language services
– translation and interpreting services
– language service professionals (LSP)
– advocacy services.

Task B case study

You are a social worker and a service user, Hannah, tells you she is unhappy taking her medication. She thinks she does not need it and so she is throwing it away. You know from her care plan that Hannah does not need to take the medication regularly and gets confused. Hannah begs you to keep this confidential and not to tell anyone especially her daughter, who she sees regularly, as her daughter will be very angry.

Bi How would you explain the term ‘confidentiality to Hannah’

I would say to Hannah that confidentiality refers to the need to handle personal information in ways that are appropriate, safe and professional and meet legal requirements. And it is my duty of care to look after her and to inform the appropriate people about possible situations when she might be at risk. In this case, not taking medication could be a risk for her mental health and I need to report to my managers in first instance and to seek for medical advice or other professional advice if need it and to explain all this to Hannah. And also that might need to involve family if necessary or if it specified in Care plan.

Bii Describe the possible tensions that may arise between telling others or Hannah’s decisions and keeping this information totally confidential.

The relationship I built with service users and their families are central to my care role. If I share their personal information with others who have no need or right to know I risk breaking their trust in me. Hannah also needs to know thee are secure systems and procedures operating in the care stating to protect confidential information. Some information must be kept confidential for safety reasons. For example, some service users as categorised as vulnerable adults, such as a person with special needs whose wearer outs might need to be protected from a relative who abused them in some way in the past.

Biii Describe ways to maintain confidentiality in day to day communication

A great deal of information will pass around at my work placement through conversations, hand-over reports, letters, written reports and emails. Some of it will be confidential and I need to know how to manage this appropriately in a care setting. If I am unsure whether information is confidential, ask a senior member of staff.

Spoken information: Oral information can be transferred via face to face conversations, or over the phone. These might take place during meetings, or in less formal settings. If I need to discuss a confidential matter with a service user, family member, or with a colleague or visiting practitioner, I have to make sure I find somewhere private where I will not be interrupted or overheard. In care settings it is not generally the policy to discuss confidential matters over the telephone, unless I can verify the person is who they claim to be. Never leave confidential messages on an answering machine. Do not at any time be tempted to gossip about confidential work matters.

Paper information: Personal records including notes, reports and letters concerning individual service and their families should be kept together in a file which is locked in a safe place. A lockable filing cabinet is inky safe if keys are not left lying around. Equally, rooms with keypads are not secure if the door has been propped open. To be aware of leaving documents around such as diaries, telephone messages and faxes if these contains confidential information. Many organisations have a policy that personal records must not be removed from their workplace, because could be lost, seen by others, damaged, or the information could be taken and used wrongly.

Electronic information: These days great deal of information is stored and transferred electronically, via computer. Computer files should be protected using passwords which are only shared with authorised individuals. Care must be taken to close private documents after use, to prevent individuals who are passing from catching sight of the screen. To be vigilant when transporting information between computers via memory pens or discs. To make sure the memory pen doesn’t get lost and that the information doesn’t remain on the hard drive of the computer it was played on.

Biv Explain when and how a social care worker should get advice about confidentiality

Anytime need it.
We can always ask our superiors for advice, read policies and procedures and talk with appropriate bodies. When we are not sure about a situation or a person we should always double check first with our manager and to go to their files or documents and find out more information. We can always ask HR department as well.

Promote communication in health, social care

Learning outcomes:

Outcome 1

Understand why effective communication is important in the work setting

1.1 Identify the different reasons people communicate.

The main reason we communicate is because we want or require something.

This may be for comfort: We may require something for our comfort in the form of food or drink, keeping warm or cool, the use of the toilet, bathing etc. or emotional comfort. Exchange of information: We may need to give or receive information about ourselves and the choices we may need to make. Expression of our emotions: We communicate our emotions so that the people around us know how we feel and how to support us whether we are happy, sad or scared.

Communication may be verbal, non-verbal, formal or informal. All communication should remain confidential on a need to know basis whatever the type of communication that has taken place.

1.2 Explain how communication affects relationships in the work setting.

Communication plays a vital role in the care of an individual. I need to know what I am required to do at each service user’s call. This information is communicated to me in a variety of different ways. The service user may tell me, it is written in the care plan and in the assessment when a package is taken on. I may speak to family members or be left notes by family or other carers. If a service user is unable to communicate verbally they may gesture to me to let me know what they need or how they feel. Effective communication helps to build a trusting relationship which allows care to be successful.

Communication between carers is very important as we need to make sure that care is continuous and we work as a team. Discussions about how a service user likes their care, how difficulties can be overcome, safeguarding and general tips can and should take place via the appropriate forum. Without this communication the care team cannot function at its best. A good working relationship with open communication will lead to a good level of care for our service users.

Communication from line managers is vital for me to carry out my role well. I need to be aware of situations that have occurred and the outcomes so that I can give the best care possible to my service users. As a senior carer I also need to be able to communicate well with my team of care workers. If information is not passed on this can lead to failures in the care we provide.

Outcome 2 Be able to meet the communication and language needs, wishes and preferences of individuals.

2.1 Demonstrate how to establish the communication and language needs, wishes and preferences of individuals.

2.2 Describe the factors to consider when promoting effective communication. I need to be clear of the subject that I am communication. I need to know the person has the ability to understand what I need to communicate I need to know if I need someone to interpret for me.
Is there any way that I need to adapt my communication for the individual I need the environment to be suitable
Does the individual need someone with them for support?
I need to actively listen to what the individual is communicating to me.

2.3 Demonstrate a range of communication methods and styles to meet individual needs.

2.4 Demonstrate how to respond to an individual’s reactions when communicating.

Outcome 3 Be able to overcome barriers to communication 3.1 Explain how people from different backgrounds may use and/or interpret communication methods in different ways. There are a few different ways that differences in background can affect communication. Different cultures have different views of acceptable behaviour regarding verbal and non-verbal communication for example eye-contact, distance between individuals communicating or patterns of formal conversation. In some cultures a woman should not speak unless spoken to. Different cultures also show different levels of emotion in their conversation or discussions. I some cases some cultures seem to get very emotional whereas some are encouraged not to show emotion. Language differences between cultures can cause problems.

Words that are similar or even the same may have different connotations to different cultures. For example it is unacceptable for certain words to be used by certain people but fine for others to se them. Differences in body language and gestures can cause problems. For example in some cultures the nod of the head actually means no and a shake means yes. These differences mean that we need to research the cultures of the people we work with to promote effective communication.

3.2 Identify barriers to effective communication.

Differences in languages, cultures and dialects including slang and jargon. Hearing or visual impairment.
Relationship between those communicating.
Generation difference.
Physical environment e.g. noise levels, light levels and distance between those communicating. Emotion or distress.
Mental health problems.
The pace of communication.
Learning disabilities.

3.3 Demonstrate ways to overcome barriers to communication.

3.4 Demonstrate strategies that can be used to clarify misunderstandings.

3.5 Explain how to access extra support or services to enable individuals to communicate effectively. If I come across a difficulty in communication I would consult my line manager for advice. Depending on the barriers to communication I could always contact the service user’s doctor or talk to the local authority about support services that are available.

Outcome 4 Be able to apply principles and practices relating to confidentiality

4.1 Explain the meaning of the term confidentiality.

‘Confidentiality is a set of rules that limits access or places restrictions on certain types of information’. Confidentiality relates to the duty to maintain confidence and respect a person’s privacy. I have a duty to keep any information given to me by a service user on a need to know basis. The service user’s personal information that they share with me should not be shared by myself unless it is in the interest of the service user for me to share with an appropriate professional or person with a proven need to know. There are a number of legislations which cover confidentiality within care work.

4.2 Demonstrate ways to maintain confidentiality in day to day communication.

4.3 Describe the potential tension between maintaining an individual’s confidentiality and disclosing concerns. Care work is all about supporting an individual’s choices and allowing them to live their life as independently as they can, but, our duty of care sometimes interferes with this if their choices mean that they are in harm’s way or suffer a loss. If we suspect a service user is in harm’s way, suffering abuse or that they could cause harm to another person we need to disclose this information to those who are in a position to help. If we do disclose confidential information the individual needs to know why we need to share the information and that we are obliged to do this. Policies and procedures we are given to follow help us to understand what we should and should not disclose about someone in our care.

Health Care Financial Terms Week One

Controlling is the practice that managers use to ensure that the company plans and goals are being attained. By comparing report to each other areas that are working and succeeding are defined and the areas where problems are occurring can be addressed and corrected (Baker & Baker, 2011).

A manager has four different, lets say teams” that report to this manager. Controlling would be when team A, B, C, and D submit the teams’ financial report to the manager. The manager would review all four teams to ensure the teams are meeting the financial goals. So, in this scenario Team A, B, and C is on target and meeting the goals. However, Team D has not met the goals.

The manager needs to review the team D’s progress determine where the problem is, such as cutting cost, the resource allocation, operating procedure, or other issues. Without controlling the teams and reviewing progress, other area will suffer.

Decision making

Decision making is management making informed decisions based on all information that accomplishes the company’s goals (Baker & Baker, 2011).

The company is making a decision on purchasing electronic medical records. The financial reports will inform management of the financial status on the company and the amount of money they can budget for the purchase of this the EMR.


Organizing is a term for companies to decide how to use resources for the best outcome for the company (Baker & Baker, 2011).

A manager is given a certain amount of revenue and the manager decides where the money is allocated for the department to accomplish the goals set by the


To succeed, companies need corporate goals. Planning is identifying the goals and resources. Laying out the steps by using the resources to accomplish those goals (Baker & Baker, 2011).

A manager has a specific project to install and to perform the primary function of the project. The manager works out a step by step plan from the beginning to the end of implementing the project until the project is complete and accomplishes the goal.

Original records

When a transaction is recorded into a journal or ledger this becomes the original records (Baker & Baker, 2011).

A patient makes a payment of $100. This payment is entered into the patient’s file and payment history. This entry is an original record in the company’s income ledger.


Baker, J. J., & Baker, R. W. (2011). Health Care Finance Basic Tools for Nonfinancial Managers (3rd ed.).

Sudbury, MA: Jones and Bartlett Publishers, LLC.

Institutional Racism and Racial Discrimination in the U.S. Health Care System

Institutional racism and racial discrimination in the U.S. health care system has been part of a long continuum dating back over 400 years. After hundreds of years of active discrimination, efforts were made to admit minorities into the “mainstream” health system but these efforts were flawed. Colin Gordon in his book Dead on Arrival portrays a very strong stance towards this issue when he states, “The American welfare state has always been, at root, a Jim Crow welfare state – disdainful of citizenship claims of racial minorities, deferential to a southern-controlled Congress, and leery of the racial implications of universal social programs” (172).

It is evident that throughout the history of U.S. health care that race has shaped health provisions in a number of ways, most noticeably in private and public health care institutions. Gordon throughout his books discusses the ways in which institutional racism, specifically in the field of healthcare, has manifested itself throughout history. One of the most prominent manifestations of institutional racism in the healthcare field comes to light when examining past (and sometimes present) policies regarding admission (to healthcare facilities) and discrimination of minorities.

It is evident when observing the adoption, administration, and implementation of these policies in the past that they were purposefully constructed to be exclusive of minority citizens (specifically African Americans and Latinos). Gordon gives an example of such policies in 1939 under the Social Security reforms. In the formative years of the New Deal southerners in Congress pushed for and won for the exclusion of agricultural and domestic labor from coverage under the National Recovery, Agricultural Adjustment, Social Security, National Labor Relations, and Fair Labor Standards act, this affectively excluded 90 percent of the southern black workforce (185).

The implications of this act of agricultural exclusion are most clearly evident in the South and Southwest—regions whose economies were dominated by agriculture, who agriculture systems were peculiarly labor intensive, and whose agricultural labor markets were organized around low wages, tenancy, harsh legal controls, and violence.

Gordon argues that segregation persisted in medicine and hospitals longer than in any other public institution or facility partly due to the fact that Southern Congressmen pushed for local control of any federal expenditure; and later on this pushed Southern and Southwestern leaders into a partnership with doctors, employers, and insurers to keep racial minorities excluded from the health system. Southern interests led to a push for job-based private insurance, locally administered subsidies for hospital construction, and penurious charitable programs for those left behind, “southerners persistently worked to exclude African Americans from coverage, tap into federal funds without sacrificing local practices, and ensure that charity programs remained under local control” (174).

Employment-based benefits, initially developed as a surrogate for national policy, was successful in leaving behind the majority of African Americans and Latinos due to the fact that they were grossly underrepresented in the unionized industrial economy, and in part because benefits such as these did not extend to casual or domestic or agricultural workers. Private health benefits came to be looked upon by many Americans as a “wage of white-ness” (176). Federal agencies, both out of practical and political necessity, consistently surrendered control over federal funds and standards over to state and local administration, “states set their own standards for care and eligibility and controlled the pace and scope of federal matching funds.

Local political and medical authorities wielded considerable informal power and discretion” (187). In 1948 the Brookings Institution published a book-length assault on health reform. The conclusion of this publication was that higher black mortality rates are “predominately the result of economic, cultural and social differences” although, the research for this publication based cost estimates off of the ordinary expenditures of white families and confined comparative mortality rates to the white population, this led to them to conclude that the United States was among one of the most healthful nations in the world (188).

Seconding this conclusion and also asserting that higher rates of non-white mortality were due to such things as poor sanitation, housing, education, and the lack of ordinary individual and community common sense was the AMA. The partnership between these two organizations is evident. At the root of the hospital issue in the South was not only professional and patient segregation but also the way in which it was countenanced by federal efforts to address the region’s dearth of facilities.

What is shown here is the long-standing political strategy to try and appease reformers by granting federal funds but to simultaneously placate opponents by relinquishing control to local or private interests; federal aid to hospitals both in 1940 and under the 1946 Hill-Burton Act “avoided any commitment to maintenance: once built, hospitals would reflect local control and local custom” (193). This however did nothing to prevent segregation seeing as in order to be considered nondiscriminatory a hospital was only required to grant equal access to the portion of the hospital that was built with federal funds.

Perhaps the most compelling public health issue during the formative years of the American welfare state was the dismal status of rural services. In places in the South and Southwest and the nation’s inner cities basic services such as a hospital, public health clinic, and a doctor accepting Medicaid patients did not even exist. Gordon offers the example in Mississippi in 1948, there were only five general hospital beds for every 100,000 blacks in the state—at a time when four beds for every 1,000 citizens was considered adequate (175).

It is evident that health care in the twentieth century has been shaped by a myriad of “direct and indirect discrimination, strong southern interests and local administration, the uneasy intersection of public and private (job-based) benefits, and the sharp political distinctions routinely drawn between contributory and charitable programs” (209).

According to the U.S. Commission on Civil Rights, “Despite the existence of civil rights legislation equal treatment and equal access are not a reality for racial/ethnic minorities and women in the current climate of the health care industry. Many barriers limit both the quality of health care and utilization for these groups, including … discrimination.”

Importance of Health Care
Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. Access to health services entails the timely utilization of personal health services in an effort to achieve the best possible health outcomes.

The utilization of and access to health care has many substantial impacts on a person’s life. A person’s overall physical, social and mental health statuses are all impacted by the ability to be examined and treated by a medical professional. Health care also plays a significant role in the prevention of disease and disability, the detection and treatment of health conditions and a person’s quality of life. A structured healthcare system assists in providing a foundation for a healthy lifestyle for both individuals and their families. Without access to healthcare, minor health issues have the potential to escalate either permanently affecting living standards or worse resulting in death.

The health care sector also has an impact on the local economy. Health care facilities such as hospitals and nursing homes provide jobs and income to people in the community. As these employees spend their income in the community, a ripple spreads throughout the economy, creating additional jobs and income in other economic sectors. Also, providing healthcare may also be a business incentive to companies. Healthy employees can mean a healthier, happier, more productive workplace.

A company’s decision to invest in and offer health care to their employees not only filters back into the economy but also may help them to recruit and retain quality employees, improve employee satisfaction, and reduce absenteeism due to sickness. Business that offer health insurance as part of their employee benefits package are probably better able to attract more qualified applicants than those who don’t. Also, offering health insurance coverage is a way of keeping operating costs low, because employees are generally more apt to take a position at a lower salary when health insurance benefits are provided.

This is because it generally costs more for someone to obtain an individual or family health insurance policy than to get employer-sponsored coverage, making the difference of a lower salary negotiable. Businesses offering health insurance can deduct their portion of the contribution toward their employee plan as a business expense and get a tax advantage. If the business is incorporated, the business owner’s insurance and the coverage paid for employees are deductible. Access to health care services and insurance plays a vital role in individual and families lives along side society as a whole.

HCS 483 Final project: health care robots

Types and Uses of Health Care Robots
Health Care Information Systems
HCS 483
September 08, 2013

Types and Uses of Health Care Robots
Health care robots are exciting advancements in health care delivery by providers. The future of robots in health is promising and the different types of robots are growing. Using robots helps the providers give better care to their patients and using robots behind the scenes for more accurate delivery of care as well. Surgical robots

The da Vinci is currently the most known surgical robot. It is the only surgical robot available for commercial use. The da Vinci robot is in use for gynecological, prostate, and cardiac surgeries. The da Vinci allows the surgeon to work from a computerized workstation across the room from where the patient is prepped on the operating table. The surgeon maneuvers the robotic arms to perform the surgeries. Using the da Vinci eliminates the natural hand tremor that surgeons have through the software in the computer system created specifically for that function.

“’Penelope’ has been developed at Columbia University by general surgeon Dr. Michael Treat with funding from the US Army’s Telemedicine and Technology Research Center, in Fort Detrick, MD” (Schimpff, 2013, p. 1). Penelope is not currently in use but is a promising robot on the health care horizon. Dr. Michael Treat created Penelope to replace the current surgical assistant that hands the surgeon instruments during surgery. Penelope is equipped with electromagnetic grippers that allows for picking up the instruments the surgeon needs. Penelope arranges the instruments for the procedure, recognizes voice commands, and verbally can respond back to the surgeon. Pharmacy robots

Pharmacy robots currently are in use for dispensing medications. The uses are beneficial to the entire hospital staff by reducing medication errors, orders are entered in by the physicians using computerized physician order entry (CPOE), and charging the cost of the medication to the patients account. The ROBOT-RX is currently in use in 34 states around the country. “The ROBOT-Rx® automated medication dispensing system prevents medication errors, reduces pharmacy labor, and lowers drug inventory. The hospital pharmacy robot automates medication storage, selection, return, restock, and crediting functions for 90 percent or more of a hospital’s daily medication volume” (“ROBOT-RX,” 2013, p. 1). Telemedicine robots

Remote Presence Virtual + Independent Telemedicine Assistant (RP-VITA) is used to assist physicians who are not on-site when a critical patient is admitted to the hospital. The robot is used to connect the off-site physician to the bedside of the patient to assess the patient and give orders to the staff for tests and medications needed for immediate care. Especially useful in the immediate care of stroke patients in the emergency department when time is crucial for the delivery of medicines. If the physician is off-site or across the hospital helping other patients, the RP-VITA allows for faster face-to-face response between the physician and the patient. References

Improves patient safety and process efficiency with robotic medication dispensing. (2013). Retrieved from Schimpff, S. C. (2013). Robotics can revolutionize the delivery of medical care. Retrieved from

Customer Satisfaction and Quality Care

What started out as a community hospital has grew over the past 50 years into a healthcare organization comprising of seven distinct units helping 300,000 people every year. Such development and growth has been motivated by one reason taking care of the people that call Houston County and nearby peoples home. Houston Medical Center is a typical hospital in Warner Robins, GA, and has 237 beds. The most recent statistics study reveals that 67,439 patients stopped at the hospital’s emergency room, there were 14,179 patients admitted to admissions 1,987 inpatient surgeries and 9,816 outpatient surgeries.

While the additional facts of the quality care report the requirements of the hospital, physician, and customer, the patient’s demand to be heard is overcome by a measurement of satisfaction. Frequently, the information collected from the surveys is beneficial for the hospital to measure itself and its accomplishment in keeping a minimum standard of care and sustaining the customer’s needs. 33 Studies have shown that each patient who is dissatisfied will inform up to ten other people of this dissatisfaction (Sitzia & Wood 1997). For instance let’s say with the information given on the percentage of dissatisfaction of patients not being explained what the medicine is they are taking that patient could say that he was given the wrong medication because you have not told him the medication he is taking.

I am quite sure this type of dissatisfaction could lead to a lawsuit. Three barriers that existed at Houston Medical Center were the time they had to wait to receive help, explanation of medicine not given before given to patient to take, and the rooms and bathrooms were not as clean as they should be. These three barriers could have a huge significance on the facility. These barriers I am sure impacted the customer satisfaction at Houston Medical Center. The barriers affected whether or not the patient would return to the center due to the facility not being clean, poor communication, and the wait time. All these factors would make a patient skeptical about returning to the center. One tool Houston Medical Center could have used to study a process barrier related to customer-satisfaction would be the Pareto diagrams or charts. This tool could be used to monitor when the bathrooms were cleaned, patient arrival time and wait time, and also to record the medication given to the patient allowing the nurse to at the time of giving medication to explain what the medication is for.

Sitzia J, Wood N. Patient satisfaction: A review of issues and concepts. Social Science & Medicine. 1997; 45:1829–1843.

Manage health and social care practice

Outcome based practice refers to the actual impacts, effects and or end results of services / interventions on an individual’s life. Its effectiveness is not measured by numbers/figures or financial strategies it is measured by the positive outcome that is achieved. It isn’t about what is required to be done but what is actually achieved as the result that matters. Outcome based practice is centred on results for people in the following areas: gains in health, mobility and skills, prevention of deterioration, increases in confidence, engagement and feeling they are in control and finally changes in behaviour. It is assessed and planned starting with the end result / goal and then planning how the goal is to be achieved. Outcome based practice is about investing rather than funding or purchasing and leads to a very different kind of relationship with programme or service providers.

It means that providers have autonomy and are expected to innovate the objectives and plans etc. It doesn’t just require the input of one or two people, all team members are valued and are required to contribute to the achievement of outcomes. All outcomes will be measured as part of service/programme evaluation. There are different ways to approach outcome based practice following different models or systems and frameworks, including: Outcomes into Practice initiated by the Social Policy Research Unit (SPRU) in the University of York, a Results Based Accountability model, the Logic Model and Outcomes Management. Outcomes into Practice (SPRU): is very much service oriented and is mainly used for adults and older people’s services, for carers and people with learning disabilities.

It is user-centred and promotes value of users determining their own outcomes. It provides autonomy and flexibility for service providers ensuring that they are responding to the ever changing needs and preference of their service users. This model / framework identifies three categories of outcomes: process, change and maintenance. It has both positive and negative features and is very useful for: all involved are focusing on achieving the same identified outcomes, involving service users in decisions about their own care and ensuring that they have control, finding out what works for all involved, enabling staff to use their initiative and feel valued.

Some of the disadvantages to this process include: the actual measuring of outcomes and although ‘bite-sized’ outcomes contribute to more strategic goals the higher outcomes are difficult to plan and be effective. Results-Based Accountability: this is extremely well worked out system and adopts an “ends (results) to means approach. It also presents itself as simple and easily implemented with a ‘talk to action’ method. This system is able to discriminate between Population Accountability and Performance Accountability. Performance accountability is based on three key questions: How much did we do? How well did we do it? And is anyone better off as a result?. It requires a need for baseline assessments / predictions in order to monitor and evaluate.

The advantages to this process includes: it being adaptable to different services and interventions, it provides very strategic outcomes and in the UK is being used for Every Child Matters outcomes and actually measuring outcomes is more achievable. Some of the disadvantages to this method include: funding issues, commissioning relationships as organisations appear to be quite insular when implementing outcomes, individual outcomes/person-centred working and although the actual concept is simple the detail is complex.

Logic model adopts a visual description of interventions and or programmes. It provides a way of understanding the connections between resources (inputs), activities, intended outcomes and the impact of outcomes. This method allows for short term, medium term and long term impact of outcomes to be planned and monitored, a bit like a ‘road map’ towards the outcome required. Although this method is not very precise but it does portray a picture to stakeholders about the aspects they think are important. Advantages to this process include: it helps systemise and organise a programme, it provides a useful primary planning tool, it illustrates the concept and strategy of programme for stakeholders and other organisations, evaluation of outcomes is fairly easy and straightforward and it can be easily augmented to fit differing situations.

Disadvantages to this process include: planning and management of ongoing interventions and service provision. Outcome Management assumes a “results matter” style and this provides the driving force behind it. This means that goals need to be quantified on the outset as ‘what gets measured gets done’. This method also provides a performance measuring tool and milestones provide opportunities to take stock and make adjustment. This process challenges conventional thinking and provide the opportunity for job descriptions to provide a pathway to enthusiasm and energy rather than just being about compliance. This method takes on an evaluation is important, but learning is even more important outlook and believes that the way forward is to invest in order to get results.

Advantages to this process include: it is very supportive of innovation, challenges conventional ways of doing things making people “think outside of the box” and is used a lot in substance abuse programmes where results are easy to measure. Disadvantages to this measure include: more complex outcomes are more difficult to plan, assess and monitor and individual focus can be lost. Outcome based practice is proving to a very valued and evidence based practice which suggests that positive outcomes are more likely to be achieved when this process is followed. Legislation and frameworks also encourage the process as a “best practice” method and evidence strongly backs this up. No matter how small or big a goal it, when adapted using the outcome based process the individual and their care team are all away of the end result which they want to achieve there for the outcome is much more likely to be achieved than if for an example 1 person has set a goal without following this process and involving the individual and key people in their lives.

Dementia Care

Dementia is the term used to describe the symptoms that occur when the brain is affected (damaged) by certain diseases and conditions (e.g. a stroke), including Alzheimer’s disease. As this is a progressive disease, symptoms can be slowed down, but not cured and will always, gradually get worse. Regardless of the cause of the dementia, as it is the brain cells that are dying, some of the person’s abilities and functions of day to day life will progressively become more difficult.

There are five areas of the brain that can be affected by dementia: 1. The Frontal Lobe, affecting behaviour (personal & social), interpretation (not able to problem solve or focus on single tasks), movement and feeling and the inability to express themselves clearly. 2. The Parietal Lobe, affecting language, the inability to name specific items , read or write , special awareness, knocking into things, issues with hand eye coordination and recognition of anything familiar (words/faces). 3. The Temporal Lobe, which affects memory, usually short term loss of events/people, speech and identifying items and hearing. 4. The Occipital Lobe affecting sight, making reading and writing more difficult, struggling to identify colours and occasionally experiencing hallucinations.

The Cerebellum which affects balance, posture and movement. This is turn makes it difficult to walk, reach and grab things, possibly experiencing slurred speech too. It can be extremely difficult for Dementia to be diagnosed correctly, as there are several similar symptoms found within depression, delirium and old age. Someone with depression could be suffering with memory problems, problematic sleeping patterns, and loss of interest in social activities, all of which are common within Alzheimer’s disease. Similarly, being in a confused state, disruptive thoughts and behaviour, sudden changes in perception and mood could be classed as delirium not just dementia.

When looking at age related memory impairments, some of the natural changes that can occur include forgetfulness/short term memory loss or difficulties learning new skills, again, potentially nothing related to dementia. Within Health and Social Care there are models which provide the framework for which health and social care needs and ideas for care and support can be developed and implemented. Two of the most important of these models are “Medical” and “Social”. Medical – In which dementia is seen as a clinical syndrome that is an impairment of the mind of which nothing can be done to help the person suffering with the condition. It focusses specifically on the disease and the treatment of the disease rather than the person and sees the impairment as the problem.

This model seeks to create dependency on others, restrict a person’s choice, disempower, devalue and reinforce stereotypes. Social – Is the direct opposite of the medical model and is totally focussed on the individual with the disease and tries to ensure that the sufferer’s skills, capabilities and achievements are retained. It tries to understand the emotions and behaviours of the person with dementia through learning about their history and background. This can then ensure that the care and support they receive, is appropriate to their needs. Dementia should be seen as a disability, as in accordance with the Equality Act 2010 a person has a disability if: They have a physical or mental impairment.

The impairment has a substantial and long term adverse effect on their ability to perform normal day to day activities. Dementia in its entirety is disabling due to the damage to the person’s brain, preventing them from being able to carry out daily tasks that they were once capable of, including communicating, personal care and maintaining relationships. The four most common types of dementia and their signs and symptoms are: Alzheimer’s disease – the most common form, destroys brain cells and nerves which disrupt the transmitters carrying messages to the brain, making it difficult to maintain the ability to speak, think, remember and make decisions. In the early stages, the person may be slightly forgetful with words or objects, but will get progressively worse, forgetting faces/names of familiar people/items, become more confused, experience mood swings, have continence issues and have difficulty eating and drinking.

They will be completely dependent on others. Vascular Dementia – where brain cells become damaged following insufficient blood supply usually triggered from a series of mini strokes within the brain cells, which affect the person’s speech, coordination, language and memory. This form of dementia progresses in stages, with periods of lucidity followed by a rapid decline with certain functions. Most common problem areas are concentration and communication. Memory loss generally occurs a lot a further on, so the likelihood of frustration and depression is more common as the person is more aware of their declining health. Dementia with Lewy bodies – this is similar to Alzheimer’s in as much as it is caused by degeneration and death of the nerve cells in the brain, but the reason for this is due to protein deposits in the nerve cells which then obstruct the chemical messages sent to the brain.

This will affect the person’s attention/concentration, language, memory and the ability to reason and judge distances. This is also a progressive form and commonly could be spotted through noticing a person experiencing muscle stiffness or shuffling when walking, trembling of the limbs or issues with spatial awareness, sudden inability to plan activities in advance, potentially even hallucinating. Fronto-temporal Dementia – caused by damage to the frontal lobe possibly also the temporal areas of the brain, sometimes associated with motor neurone disease or possibly a genetic hereditary condition. This affects a person’s behaviour, language and emotional responses. Their memory usually stays intact in the initial stages which can be distressing for them.

As this predominantly affects behaviour and personality, initial signs could include sudden changes in either of these areas, for example having been shy and quiet for years suddenly being overly confident and loud, possibly even rude in their behaviour. Loss of inhabitations especially in public places, the need to suddenly undress in public. Sudden signs of compulsive rituals with daily tasks, possibly becoming easily distracted or aggressive. It has been identified that there may be certain factors that can put people at a risk of developing any of form of dementia. These are: Age – As possible as it is to develop dementia at any age, the risk is higher in those aged 65 – 80. Gender – Women are at higher risk of developing Alzheimer’s due to the lack of oestrogen in the body following the menopause, even if they have been on HRT.

However men are at a higher risk of developing vascular dementia as they are more likely to have suffered with high blood pressure and heart disease. Genetics – the risk is increased if any family members have suffered with the disease. Medical History – certain medical conditions can increase the risk, such as multiple sclerosis, HIV, high blood pressure, high cholesterol and diabetes. Environmental and Lifestyle Factors – A poor diet, lack of exercise and smoking are all high risk factors due to their links with heart disease and lack of oxygen to the brain cells. Certain sports can also be high risk, boxing for example, due to the continuous blows to the brain, which slowly damage the cells. There are currently over 800,000 people in the UK who suffer with dementia in one form or another, of these approx. 62% suffer with Alzheimer’s disease, approx. 17% suffer with vascular dementia, approx. 10% have a mixed form, approx.

4% have dementia with Lewy-bodies, approx. 2% suffer with fronto-temporal dementia, 2% with Parkinson’s dementia and 3% from rarer causes. Even though people living with varying types of dementia show similar signs and symptoms, they will all experience dementia in different ways due to having different personalities, states of health, life experiences and varying degrees of neurological impairment. Alzheimer’s is a gradually progressive form, with the first signs including forgetfulness of recent events, repetition, confusion eventually leading to the inability of being able to perform the simplest of everyday tasks. This can result in a loss of interest and lack of initiative to try to do things for themselves which can cause irritability and depression. Vascular dementia is progressive in a step like manner with bouts of worsening being followed by periods of stabilisation.

Due to only certain parts of the brain being affected the individual is more likely to aware of their declining health making them more prone to depression. Fronto-temporal dementia suffers are not so forgetful as those with Alzheimer’s as their memory tends to be less affected, the changes are seen more in their personality and behaviour. Lewy body suffers have their brain’s function interrupted in such a way that it affects their memory, concentration and speech and so can also be misdiagnosed as Parkinson’s disease due to the tremors, difficulties with speech and slowness of movement that accompany it. Age within dementia can cause serious difficulties within families, as more than 17,000 sufferers in the UK currently are under the age of 65, whereas this is commonly seen as only a disease experienced within the older generation.

With a younger sufferer, depression is more likely as their needs are different; they are more likely to have a younger, reliant family, a mortgage/other financial commitments and have been working when diagnosed. The family may also have problems getting a confirmed diagnosis due to not being aware of the symptoms or where to go to for help and support. Sufferers who already have a disability may also struggle to get diagnosed due difficulties in communicating the change in their abilities; they are also more likely to develop dementia at an earlier age. Sometimes their physical health can be greatly affected by the symptoms of dementia, for example if suffering with a visual impairment; they can become more disorientated in unfamiliar situation which could then affect their balance, coordination and mobility.

In general, people with little knowledge of an illness, such as dementia, can be very negative towards those suffering with it, which can have an extremely detrimental effect on those with the illness. The most common harmful attitudes/actions are: To disempower – to not allow the person to carry out a task they are capable of or to make them feel worthless or incompetent. To patronise – to treat them in an insensitive manner; speak to them a low grade term as if they are a small child. To ignore – to not meet their evident needs or to speak to others that are present as if that person is not there.

To mock – to tease or humiliate at their expense, due to actions beyond their control. To be intimidating – to be overpowering causing fear and anxiety. To treat as if an object – not speak to or move the person as if they are human, just an inanimate object. To Outpace – to rush the person when performing tasks or making decisions resulting in them feeling pressured to do/say things when not ready/able to do so. Therefore the more knowledge provided to all, the better understood and helped a person with dementia can be.

Strength based approach towards client care

Below is an overview of a strength based approach towards client care and in accordance to domain 2 management of nursing care, competency 2.3 of Nursing Council of New Zealand, confidentiality and anonymity was maintained at all times. The assessment was commenced upon gaining verbal consent from the client with reference to The Health and Disability Rights Act (Ministry of Justice, 2004).

Mr Y is an elderly man who is now residing at a rest home was diagnosed with hypertension, meningitis, epilepsy, type 2 diabetes and korsakoffs dementia due to prolonged alcohol dependency (Ambrose, 2001). Mr Y is a person with a very delightful personality and is not fussed about anything. However hesitates to be the first one to start conversation. He starts to talk if the second person begins communication. He is independent with almost all activities of daily life however is supervised by staff as Mr Y is susceptible to wandering mostly in the afternoon so more care is provided accordingly.

The client has no nutritional complications and has three medium sized meals in a day. He has no bladder and bowel difficulties and therefore needs no incontinence products, neither in the day nor during the night. Mr Y has no sleep disturbances nevertheless exhibits some degree of anxiety and agitation at some point which is when he wants to be with his family. Mr Y has no family support as his sister who was the only support has moved abroad.

The clients change in behaviour is controlled by diversional therapies which includes activities with regards to his strengths and psychosocial activities. The client is well orientated to time people and places. A strengths based approach provides a new perception of potentials rather than complications, options rather than constraints and wellness rather than ill health and once this is seen, achievement can occur (Rapp & Goscha, 2006). Therefore with the advantage of the assessment various strengths of the client were identified.

Mr y is known to have a very pleasant voice and therefore sings very well. He is also a very talented guitar player and used to be part of the music club during his young days. Additionally Mr Y has a very intact long term memory as he was able to recognise his friends from his teen age days as well as he was reminiscing his memories from childhood during the interview. He enjoys spending time with everyone regardless of nationality and is very easy to get along with. Mr Y is always willing to take part in all activities such as playing bingo, card games, pool etc. but needs to be invited for the games by someone.

He is always willing to help with work for instance bbq, shopping and many other things if and whenever he is able to. The client was a very sporty and active person and used to play football in the league. The greatest strength of Mr Y is that he is still able to walk around and perform all his activities of daily life which keeps him physically and mentally fit.

This also slows down the progression of his declining physical and mental health (Faulkner, Taylor,2005). Conversely the client also displays feelings of being alienated and isolated which needs to be considered as studies of clients’ experiences of mental health services provide indication that being understood and listened to in a considerate and sensitive way ratifies their humanity and provides anticipation for their future (Shattell, Mc Allister, & Hogan, 2006).

The full assessment was carried out in compliance to all the competencies of domain 3- interpersonal relationship of nursing council of New Zealand. Firstly, researching about korsakoffs dementia and its effects on the patient before carrying out the assessment allowed attaining knowledge on a broader perspective. It also aided in critical thinking and client evaluation which limited assumptions and gave more meaning and understanding to the findings. After gaining consent from the registered nurse patient folder was accessed for clients past history and current health situation.

This provided a brief overview of the client and presented a definite baseline to commence with the assessment. Interpersonal relationships are the relations between two or more people. Skilful management of interpersonal relationships is critical to psychiatric-mental health nursing (Arnold & Boggs, 2007). Similarly, with Mr Y a therapeutic interpersonal relationship was established and maintained with regards to competency 3.1 of Nursing Council of New Zealand.

Primarily, to build up a therapeutic rapport with the client therapeutic use of ‘self’ was used as an essential tool to initiate a strong nurse-client relationship as suggested by Fourie (2005). It was made sure to focus on self-awareness including professional detachment and understanding of personal emotions, beliefs and values. Self-disclosure was used as a strategy to make the client feel comfortable as the client found himself in a mutual conversation and not in a state of being interrogated. It was noticed that after the assessor shared her own life experience with Mr Y he felt at ease and open up disclosing his personal information without hesitation.

The therapeutic use of self also lowers the anxiety level of the client and forms a positive link between the efficacy of the nurse-client relationship and improved outcomes for client with mental illness (Howegego, 2003). It is likewise important that the therapeutic bond which is developed is maintained throughout the clients’ time of care. Therefore to maintain a therapeutic relationship with the client empathy, appropriate body language and proper communication skills were used.

During the communication with the client it was made sure to be present with Mr Y physically, emotionally and cognitively which enables one to understand the clients subjective experience, thoughts and feelings as much as possible. Additionally with reference to competency 3.3 of Nursing Council of New Zealand effective communication was carried out with the client. It was achieved through use of non-verbal cues such as maintaining an eye contact during conversation however avoiding a fixed gaze or stare. As proposed by Stein-Parbury (2005) appropriate body language was also used for instance it was ensured to sit down at the level of the client not too far or too close to him, apposite facial expression which tells the client that the assessor is genuinely interested in whatever he is saying and eluding things such as raising eyebrows, putting hands on hips while standing etc.

Congruence between verbal message and body language is very crucial to maintain a therapeutic relationship (Raydon, 2005). Client’s full attention was gained before initiating verbal communication. As mentioned by Rimondi (2010) open ended questions asked during interviews gives the client more opportunity to speak more disclosing more information at a deeper level. Use of open ended questions incorporated with active listening skills and appropriate body language helped to maintain a therapeutic bond with the client. Use of open ended question also allows to adhere with competency 3.2 which speaks of partnering with the client .

These strategies enabled a more person centered approach developed by Dr Thomas Kitwood (Warchol, 2006) which takes into account the standpoint of the person with dementia. Person cantered planning incorporated with a strength based approach was used during this assessment which provides a way of listening to and working with the person, their ideas and aspirations in partnership. This strategy works with respect to competency 3.2 of Nursing Council of New Zealand which states about practising nursing in a negotiated partnership with the client where and when possible. Mr Y was always ensured that he is being respected, listened to and is treated as an individual (Hupcey & Miller, 2006).

In accordance to competency 3.3 it is very essential to employ appropriate language to the context for example during the assessment reflective listening such as echoing client communication was used to redirect the content and feelings back to the client (Stickly & Freshwater, 2006). Paraphrasing was also a technique used to confirm the client that the assessor has heard and understood the clients subjective experience and perception. This allows the client to have trust and faith in the assessor and feels safe in their care (Stein-Parbury, 2005). For example the client mentioned “I feel really happy to be with family. I feel more energetic”. To paraphrase it was said that “that’s nice you feel more comfortable and happy with your family being around”.

This indicates that the client was actively listened to. As mentioned in the strengths assessment, Mr Y enjoys music and singing and is a very good guitar player. There is a guitar at the facility which is given to the client most of the time and he plays it. This was seen to be a good way to uplift his mood as it appeared to encourage Mr Y in reminiscing his past memories as an independent person (Perkins, 2004). Subjective data was also gained while taking him for a walk in the afternoon as mentioned in his strengths assessment.

This makes the client feel involved in the day to day conversation as normal people. Mr Y has a very strong connection with his traditional cultural beliefs and values. As suggested by Wepa (2005) cultural safety is one of the most vital aspects to consider while working with this client. A good therapeutic relationship was maintained by having enhanced responsiveness to Mr Y’s cultural and spiritual needs (Ramsden, 2002). For instance engaging in the context of what is Tapu (forbidden) that is avoided touching his head and actively listened to when he spoke about his cultural norms.

The client was always greeted in his own mother tongue which made him feel special. Mr Y was always treated with respect, dignity, genuineness and honesty. This was interwoven with trained empathy to enhance the therapeutic relationship and trust (Welch 2005). Additionally to maintain the therapeutic bond with the client nurses coming from a different cultural background should be culturally competent to ensure that Mr Y feels culturally safe in their care which again enhances trust in Mr Y for care provider (Daly, Speedy & Jackson, 2009). Nurses should avoid being judgmental.

Working in accordance to competency 3.2 Nursing Council of New Zealand, it was ensured not to advice against the client undertaking a particular activity, but instead work with the person to explore the advantages, disadvantages, required steps and possible concerns of an action so the client can make an informed choice (Elder, Evans& Nizette, 2009). This way health professionals are able to help the patient to achieve their desired goal. Mr Y like any other individual has goals which he aspires to achieve.

Firstly, knowing that he has a deteriorating health he aims to stay independent with his activities of daily life for as long as possible. With reference to competency 3.2 of nursing council of New Zealand nurses role is to practice partnering with the client and helping him to be physically and mentally fit.

This can be done by considering Mr Y’s strengths from the past and present (refer to strengths assessments). The client used to be a very active and sport loving person therefore involving him in more indoor games such as pool, bowling and any other games of his interest is a good way of keeping him entertained as well as active. Asking him what he prefers will keep him involved and interacted. Since Mr Y enjoys going out for afternoon walk the nurses should include this in his care plan so that he could be taken out for walks accordingly. As recommended by Kopelman, Thomson Marshall and Guirenni (2009) clients with korsakoffs dementia has damaged brain cells which affects cognitive, physical and social functioning of the client.

Mental health nurses have the responsibility to ensure that the diet of Mr Y includes thiamine and other metabolites such as magnesium (parenteral, oral) to improve the metabolic pathway in the brain and in manufacturing energy in cells. It is very important for nurses to consider the underlying cause of Mr Y’s declining health which is his chronic alcohol dependency. Therefore abstinence from alcohol is the cornerstone for his rehabilitation and is the most judicious intervention to slow down the effects of his dementia and to achieve his goal of being independent for as long as possible.

As mentioned in the overview of Mr Y in the earlier paragraph the client exhibits some form of anxiety and wandering. Nurses together with other health professionals should encourage Mr Y to participate in the diversional therapies provided by the facility including activities with regards to his strengths. Focusing on strength based activities helps people to overcome current difficulties refraining from a pessimistic world view to an optimistic one which instils hope. Nurses should always avoid to impose their own ideas but should work in partnership with the client to explore ways which works for Mr Y (Elder, Evans& Nizette, 2009).

Mr Y must be promoted with psychosocial activities such as always to be provided a safe environment and to be given encouragement. For instance Mr Y should be encouraged to play guitar for all the residence in the facility. This will remind him of the days when he used to play on stage and he would feel motivated and worthwhile therefore will be able to control his anxiety to some extent by keeping himself engaged with meaningful work and be diverted from distressing thoughts (Elder, Evans& Nizette, 2009). To avoid Mr Y wandering to places nurses should consider the use of arrows indicating the way to the lounge, dining room toilets etc.

This helps Mr Y to find his way independently without confusion (Kopelman, Thomson, Marshall and Guirenni, 2009). Secondly, Mr Y would prefer to be an active member of the facility and avoid being isolated. As mentioned above Mr Y hesitates to start conversation therefore if not approached by anyone he tends to isolate himself in his room. Though nurses have a very busy profession they should be responsible to ensure that Mr Y is informed about all activities held at the facility. As suggested by Faulkner and Taylor (2005) exercise is a good way to deal with social isolation and since the client is said to be a sporty person it would be reasonably easy to include physical exercise in his care plan.

It is also advisable to involve Mr Y in group activities rather than individualised intervention such as group singing competions, watching TV in the lounge with other residents, playing pool in groups, sharing past life experience within groups etc. these psychosocial group activities will allow the client to developing more new friendships hence reducing loneliness and give him enough confidence to openly start communication with people (Routasalo, Tilvis, Kautiainen & Pitkala, 2009).

To conclude it can be said that strengths based care proposes that every person has talents, goals confidence and aspirations regardless of their mental status. However any approach towards client care is helpful if commenced after build-up of a strong interpersonal nurse-client relationship. Therefore it is important for nurses and all other health care professionals to focus on strengths of the person instead of the pathology when treating them. Strength based care encourages the client, provides self-confidence and instils a hope which helps them to thrive towards better health.

Health and social care


A Comparative Investigation into Teenage Pregnancy in Wales and England

BTEC Level 3 Diploma Public Services





Investigation Findings & Analysis





Title for Investigation
Comparative study of teenage pregnancy in Wales and England
What do I want to find out about during my investigation?
Teenage pregnancy in Wales and England to see which one has the higher rates of teenage pregnancy and comparing them. I will find statistics and graphs such as charts, graphs etc. I will use government sites to get an accurate study and I will also use reports from the internet, both for Wales and England Effects of teenage pregnancy within the society in both Wales and England How different the societies deal with teenage pregnancy and its conception. What will the Welsh and England government need to reduce teenage pregnancy. Where will I find the information?

To complete this individual investigation I will use secondary and primary research. I will use secondary research to improve my understanding of the subject. Internet – gather information to start off with and compare my information. Statistics to get data which is correct.

Books – Go to the Library and look for the relevant books to get information. Newspapers – Local ‘Merthyr Express’ and see the headlines of the paper and show statistics, Questionnaires – Create questionnaires to hand out with relevant questions so I can have their opinions. How am I going to present my completed investigation?

I will present my investigation as a 2000-2500 report using Microsoft Word. I will structure my report using sub headings which will make it easier to read. I will also use graphs, pictures and charts. Planning

I will also use images to enhance my text. I will draft and proof read my document throughout. What help will I need and from whom?
I will need help from my tutor for guidance and feedback on my drafts. I will need assistance from the public by filling in my questionnaires. I also will need IT assistance to present my findings.

What I need to do
IOLP Target
Completed On
Find out how to pass Investigation
Tutor supported me with my investigation and provided guideline sheets; I didn’t have any difficulties with this. Mind map a subject to investigate
I had some difficulties with some ideas and expanding on them, tutor helped me overcome this. Learn how to research effectively
Searched effectively throughout the internet, books and articles but needed help to be shown what options were available. Plan what is required
I found it easy to collect the information but found it difficult to combine this information to create this investigation. Look for Information (secondary research)
I didn’t find any difficulties with this as it is my own research. Decide on the key question(s) and presentation format
I didn’t have many difficulties with this, only from which format I needed to use. Carry out secondary research on Wales
This part was different because a lot of the work I needed was irrelevant for this moment in time. Not enough up to date information on Wales. Carry out secondary research on another country
This also was difficult as my chosen country; England was linked with Wales so the information was very similar. Prepare a questionnaire (or other methods) for primary research 3
I found this part easy and interesting to find out everyone’s different view. Carry out primary research
No support needed with this.
Collate & Analyse information from primary research
Difficulties with how to analyse the results and information into a conclusion. Start putting the information together to answer the question 1,2,3
II found this interesting gathering all the information
Hand in first draft
I found this hard to get this in on time due to poor managing skills with trying to put all the valid information together Discuss the draft with your tutor and reflect on your progress 1
I have reflected on my weaknesses throughout this investigation and I have solved these Make any necessary amendments to investigation
I have amended any improvements to my investigation
Complete and hand in Investigation
Handed in later than planned but this enabled me to do more work and effort


“Teenage pregnancy is “contagious” between sisters”
(Researchers in the UK and Norway have claimed)

This investigation will compare teenage pregnancy. Focusing on the rising of teenage pregnancies throughout England and Wales. I have chosen to compare Wales and England because both countries have been known for high teenage pregnancy. This will be shown a variety of evidence within this investigation. I will focus on Merthyr Tydfil within Wales as it is known for a higher population of girls with teenage pregnancy as shown on BBC News in 2010.

The picture above shows research done shows that teenage pregnancy is an increasing problem and becoming “contagious” Research has showed “Sisters generally spend more time together than schoolmates or friends and so sisters are likely to be influenced by the behaviour of their siblings,” the report said. Jules Hillier, the Deputy Chief Executive of the charity Brook, said: “There are links between low aspirations; deprivation and teenage pregnancy, but there are also a whole range of measures that need to be in place to reduce teenage pregnancy rates such as comprehensive sex and relationships education and easy access to sexual health services.”

Teenage Pregnancy is defined as ‘Pregnancy by a female, age 13 to 19, which is understood to occur in a girl who hasn’t completed her core education—secondary school—has few or no marketable skills, is financially dependent upon her parents and/or continues to live at home and is mentally immature’ –

This investigation aims to find out:
Trends of teenage pregnancy rates in Wales
Trends of teenage pregnancy rates in England
What the each country doing to deal with the problem?
How this problem affects society?


For my secondary research I looked at internet resources. I chose to research
information on pregnancy rates in Wales and England and how it affects the society. The main sites which I used to research Wales are: (I used newspaper articles to read about teenage pregnancy in Wales and England and the statistics of it) (This website was used to find out information on teenage pregnancy in Merthyr Tydfil) (This helped me with the statistics of Wales and England) The main sites which I used to research England are:

For my primary research I created questionnaires on teenage pregnancy and involved questions which helped me with my investigation by finding out about the opinions of the people of Merthyr Tydfil. The questionnaire was a good way to find out relevant information in order to help me with my topic.



In 2008, Merthyr Tydfil had the highest rate of teenage pregnancy between 15-17 year old girls in Wales and England. The average for Wales was 40.6. The second highest figure in Wales is another valleys district, Rhondda Cynon Taff, with 59.2. Rates of pregnancy in teenagers up to 16 years old dipped to 7.5 per 1,000 girls ages 13-15, five years ago. But in 2007 the rate has risen once more to 8.5.

ngland-wales-map) Teenage pregnancy affects the society because it brings a social poverty stereotype to the town they live in and it brings a lot of stress to the family. This may be because a lot of the time the child may be given to the parent as they have to look after the child. This can cause a lot of stress to the family. Also, some families can’t get used to the long term change to an unwanted baby.

As the map shows Merthyr Tydfil no longer has the tag of the highest teenage pregnancy in Wales. Merthyr Tydfil had a rate of 73.3 conceptions per 1,000 women aged 15-17 in 2008, which fell to 60.7 in 2009. This now puts it behind Blackpool (67.4), Manchester (67.2), Hull (64), Southwark (63.2), Nottingham (61.5) and Stoke-on-Trent (61.1). This graph shows the higher rates of England and the low rate of Merthyr Tydfil compared to the other places.

Nicola John, Director of Public Health for Cwm Taff Health Board, said: “We are delighted to see that the teenage conception rate for under-18s has decreased in Merthyr Tydfil.” They created a scheme “condom card scheme” which was intended to make it clear to young people “why it is so important to take responsibility for their own sexual health by exploring the wider consequences of a sexual relationship”, this scheme has proven to be successful due to the big drop of pregnancies.

Their scheme is to increase the availability of condoms to young people in Merthyr Tydfil by reducing the barriers of financial cost and access, to increase the uptake of condoms among young men, to increase the level of awareness and understanding young people have towards sexually transmitted infections and sexual health and to develop and enhance the skills of staff working with young people in the area of sexual health and well-being.

( This table shows the statistics of teenage pregnancy in different authorities in Wales This table shows Monmouthshire has lowest rate of 2009 with a rate of 20.7 and Merthyr is still the highest in Wales with a rate of 60.7 which suggests that richer area have less teenage pregnancy and more deprived have more. It also shows that rates have dropped a lot in Merthyr and RCT from 61.3 to 46.6 in for RCT and from 75.3 to 60.7 for Merthyr. Wales total dropped a lot too from 45.5 in 2001 to 40.1 in 2009. The graph below shows that teenage pregnancy has fallen by 4%, however, it is still incredibly high.


Primary Research
From my primary research I have found out that over half of the public that answered my questionnaires believed that they didn’t receive enough education and information on sexual intercourse and the effects of unprotected sex. Through my findings, the majority of the older public said they did receive enough information this questions whether the government has neglected its responsibility to educate teenagers on sex? This suggests that some people blame the Government for this problem in Wales and feel like the government should organise an educational group on teenage pregnancy. For example, they should increase the sexual education throughout schools. Half of the people questioned agreed that teenage pregnancy is not acceptable and that in most cases, young girls and boys fail to communicate with one another to make a decision and don’t seek help. From my secondary research

I have found out that there are some key factors that are somewhat responsible for teenage pregnancy rates in Wales. These include young girls having low expectations of education and good employment. Parents that are not educating their children about sex and themselves have experienced teenage pregnancy, they trend follows through. BBC news health claims (2011) claims that sisters have an effect on each other; more girls are more likely to experience teenage pregnancy if an older sister has also got a child at a young age. They claim that this effect was experienced if the sisters were of a similar age and from a poorer background. The following table show the research findings from FPA in 2010 showing the conception rate by two different age ranges. It shows the biggest problem is with 16-18 years group but the rate has dropped from 2000 to 2007 but still high. Also the under 16 years rate did start to decline but has increased again since 2004 which is very worrying. Also abortion rates were up for both age groups.

Under-18 conception in Wales
Conception rate
Number of conceptions
Percentage leading to legal abortion

Under-16 conceptions in Wales
Conception rate
Number of conceptions
Percentage leading to legal abortion



My secondary research shows that teenage pregnancy rates across the UK have decreased leaving them at the lowest level since the early 1960s. However, the number of teenage girls choosing to abort unwanted pregnancies has risen over the past decade. Julie Bentley Chief Executive of the Family Planning Association said that “the success brought about by today’s figures revealing we’re seeing the lowest teenage pregnancy in England and Wales for 30 years is down to a dedicated strategy in England with a tried and tested formula of sex and relationships education, contraception and information
services and local services working together”. This may be due to other studies showing that the numbers of older women between the ages of 40 and over are now having babies. (The Guardian)

( Photograph: Tatjana Alvegard/Getty Images

The teen pregnancy rate in England and Wales has reached its lowest since 1969, new data shows. Figures from the Office for National Statistics show conceptions in under-18s fell to 34,633 in 2010 compared with 38,259 in 2009, a drop of 9.5% in England and the UK. Pregnancies in under-16s also went down – by 6.8% to 6,674 in total from 7,158 the previous year. Following a report from the Social Exclusion Unit 1998, the Teenage Pregnancy Unit was set up with a ten year strategy and action plan was implemented. The target was to halve the under 18 conception rate by 2010 and to bring a decline in the rate of conceptions to under 16s. The aim was to increase the participation of teenage parents in education, employment or training to reduce their long-term risk of social exclusion.

An Independent Advisory Group on teenage pregnancy was established in 2002 to provide advice to the Government and monitor overall success of the 7th strategy. Guidance was published in 2006 to support more effective local implementation of the strategy. Between 1998 and 2007 the teenage conception rate fell by 10.7 per cent in under 18s and by 6.4 per cent in under 16s. When looking at England only, statistics the FPA in 2010 reported that conception rates had dropped for both age groups in 10 years. Also abortions have increased. Under-18 conceptions in England

Number of conceptions
Conception rate
Percentage leading to legal abortion
38, 750
Under-16 conceptions in England
Number of conceptions
Conception rate
Percentage leading to legal abortion
I have decided to study teenage pregnancy, as it is a growing problem within society. Throughout this investigation I have found out how the rate of teenage pregnancy has increased and decreased throughout Wales and England but it is currently the lowest it’s been since 1969, however, the rate of aborting children has raised. Studies show that older women are now expecting babies later on after they have gained a good career and capable of looking after a child and are in stable relationships, that won’t affect the life of the child.

3 million according to last population census in 2001
In 2001, the population of the United Kingdom was recorded at just under 59 million people Under-18 conception
44.9 (2009)
40.5 (2008)
Under -16 conception
8.5 (2007)
7.8 (2008)
Total teenage conception
Cwm Taff Health Board created the “condom scheme” to help prevent the risks of sexuality transmitted diseases and to make the awareness that condoms are now more openly available. This scheme was proven to work as the rate of pregnancies dropped. England created a scheme in going to schools and local information services and informing people on sexual health and

Hnc health and social care

There are many theories that tend to explain different aspects in human development. According to Encarta Encyclopedia, 2006, these are system of assumptions based on limited information or knowledge, devised to analyze, predict, or otherwise explain the nature or behavior of a specified set of phenomena. In line with the definition, theories remain as conjectures explaining certain occurrences, but never will it attain the grounds earned by laws and principles as universal truths.

In Developmental Psychology, theories govern the existence of human growth. Considering the case stated earlier, does it imply that the learning gained in studying this field is not reliable? Not at all.

In medicine, when a person developed sickness, doctors try to find its root cause. There are many possible answers as to how and why it was acquired, might be through his/her family’s history, his/her lifestyle and his/her environment. If that’s the situation, would that person hesitate to seek wellness? Likewise, developmental theories offer several answers which unlock the depths of human behavior by studying the causalities of different experiences throughout the life span of a person.

It can be quoted from Maurice Merleau-Ponty that every object is the mirror of all other objects. Correspondingly, developmental theories are rooted in different schools of thoughts such as Behaviorism, Gestalt, Humanism, Cognitivism and Psychoanalysis. Using it as their main ingredient, these schools of thoughts presented development in various ways — thus, in different perspectives.

Jean Piaget, Erik Erikson and Lawrence Kohlberg are some of theorists who ventured in the field of Psychology, specifically in human development. Consequently, using Thomas’s standard of judgment, this paper aims to weigh, compare and evaluate the assumptions and claims of these proponents.

Piaget, a cognitivist and pioneer of the Cognitive Development Theory, focused on the cognitive aspect of human development. He gave a detailed picture of how thinking is processed among individuals, concluding that the difference between adults’ and children’s thinking is qualitative and not quantitative. He asserted that development occurs in distinct, measurable, and observable stages. Additionally, he made an assumption that developmental growth is independent of experience and based on a universal characteristic. Piaget’s theory assumes that development is unidirectional with all children reaching each stage at approximately at the same age.

Kohlberg, an Ameican psychologist, tried to expand the theory of morality that Piaget gave briefly. He assumes that there are 3 levels of morality that each individual faces — Preconventional, Conventional, Post Conventional— that are then subdivided in stages. According to him, children in middle childhood, begin to perceive themselves as responsible to others because of the importance of getting along and of being a good citizen.

They seek to act appropriately because people matter to them, not just to avoid punishment. Children’s developing psychological understanding heightens their sensitivity to human needs and contributes to empathy for others. Whereas a preschooler may sympathize with another but not know what to do, older children are more likely to assist a classmate who is attacked by a bully or to raise money to help children in a developing country.

Erikson’s Psychosocial Theory of Development traces its roots to Freud’s Psychosexual Theory. He believes that his theory would patch what Freud was unable of discussing. He studied groups of Native American children to help formulate his theories. These studies enabled him to correlate personality growth with parental and societal values. His first book, Childhood and Society (1950), became a classic in the field. As he continued his clinical work with young people, Erikson developed the concept of the “identity crisis,” an inevitable conflict that accompanies the growth of a sense of identity in late adolescence.

Using case studies that were in descriptive methods, Piaget strengthened his works to cite reliable facts about the real world in children. It can be reflected upon his presentation of the mental growth—from sensorimotor stage, to preoperational stage, then to concrete operational stage and lastly, to formal operational stage— where several features and characteristics were keenly monitored and recorded.

In Kohlberg’s theory of Moral Development, he emphasized what could be the current state of morality that a person has if he/she is in that age. In the last activity performed, it was found that the preconventional children depends their action to the possible outcome, might be, if there would be a punishment or a reward. This proves that the theory is reliable.

Erikson different from any other theorists, he comprehensively investigated upon the development of an infant to the old age. These are the Trust vs. Mistrust, Autonomy vs. Shame and Doubt, Initiative vs. Guilt, Industry vs. Inferiority, Identity vs. Role Confusion, Intimacy vs. Isolation, Generativity vs. Absorption and lastly Integrity vs. Despair. His theory explains that in every stage, a positive or a negative attitude might be developed in an individual. When used to local setting as mainframe, the result can also be the same, though there is inevitable variability among personalities.

Most of their assumptions in development of children are simple, very tangible. As to Piaget’s findings regarding the concept of conservation, egocentrism, schema formation and some other features he had recorded, applying it in the local setting will be easy. Differently from Freud, there is no hidden element, (i.e., the id,) that would entail controversy. As to Kohlberg, his works were anchored as that of Piaget’s, therefore his works were also simple and can be clearly understandable. Erikson although, theory is psychoanalytically founded, showed clearness among his theory as well as Kohlberg. Their theories enable many to relate easily.

However, with a belief that development is unidirectional and that the biological development drives the movement from one cognitive stage to the next, Piaget showed no proof that the thinking process expressed on a former stage would predict the cognition in the latter stage and vice versa. But perhaps, the thought of having mental growth as universal to every individual with respect to the stages that Piaget constructed may tell what the next cognitive feature a person can express.

In Kohlberg’s theory, he assumed that one might not attain the next stage remaining to show manifestations of the former. His work doesn’t predict what would happen in the future, actually, if a person would arrive or not arrive to the next level is already an uncertainty.

Different to Erikson, where he believed that the attitudes such as trust, initiative, intimacy and the like that had developed in a certain stage would have an effect in the future. For example, he asserted that if an individual has a positive outlook in life and maintains hope though facing unexpected events in life, that individual when he/she was an infant might had been taken good care of and had developed trust with the maternal person.

Furthermore, many educators and parents base their strategies with Piaget’s perspective. In rearing a child, he contributed largely to the field of language and education. In the development of language, his assumptions of Language Acquisition Device (LAD) as innate in infancy were widely appreciated. Therefore, educational implications were fleshed out from his theory considering what could be the best possible approach in enabling children to unleash their potentials. Regarding Kohlberg, his theory is widely used as basis on how to face moral dilemmas that occur in a life span of every individual, particularly in child’s life. Erikson’s stages of ritualization are also considered on how a person would handle decisions and priorities in life.

As to the internal consistency in the theory, the mental characteristics and features manifesting on a specific stage and their gradual change are thoroughly explained. For example, the realism and animism, both occurring in the preoperational stage, he cleared out that their existence are inversely related. Consistency can also be inferred in the whole theory. Even though he compared his work to Freud’s and Spinoza’s, Piaget remained intact with the perception that he was holding. It was never mixed. These can also be observed to Kohlberg and Erikson’s theories. Their terminologies, concepts and perception didn’t shift.

Several convincing ideas can be presented by Piaget to support his theory. In relation to the last activity performed by the class which was the observation of early childhood, he asserted that preoperational children display certain characteristics such as transductive reasoning, irreversibility, artificialism and centering. When tested, it was amazing to see that the findings gained by Piaget and the findings gained by the section have great resemblance to each. Same thing happens in their findings, when Kohlberg was used as a mainframe.

Despite this occurrence, some of Piaget’s ideas have been supported through more correlational and experimental methodologies, some portions of the theory when compared to other researches, give a result that the data from similar cross-sectional studies do not support the assertion that all individuals will automatically move to the next cognitive stage as they biologically mature. Indeed, this implies an unproven assumption that is somehow disconfirmable. As to Kohlberg and Erikson, some of their finding doesn’t match with the current researches done.

As mentioned earlier, Piaget’s perception didn’t only enrich the field of psychology but rather shared some insights in language, education and morality. His work is collaborative — it can build another and it can rebuild itself. Example of ‘building another’ is Vygotsky’s Socio-cultural Theory and Kohlberg’s Moral Development Theory. These two gained grounds in psychology by the strengths of Piaget. Vygotsky criticized Piaget’s assumptions and later on was able to make a theory and Kohlberg, because of inspiration in Piaget’s work, tried to expand some aspects that he found lacking in the Cognitive Development Theory. As to ‘rebuilding itself’, up until now, Neo-Piagetians continually improve the theory made by their lead proponent. Although rooted from another’s works, Erikson and Kohlberg established theories on their own that may stand coequal with the others. As of today, their works are being taught and learnt by many.

Piaget led to forming a theory when he asked his two children to express their beliefs in a particular situation. Since he is the founder of Cognitivism, his work possesses novelty. As long as it is in relation to cognition and comprehension, this theory may provide the answer about the different phenomena encountered by individuals in a certain point of time. This is also true in Kohlberg’s and Erikson’s theories— as long as morality and psychosocial aspects of growth are concerned, their theories can provide the answer.

Changing Landscape of Health Care

Unless you have been living on another planet somewhere, the changes in health care taking place in this country have become hard to ignore. With all the debate over recent health care reform, it is sometimes difficult to know who is right, and who is wrong. How can there be such a wide gap in opinion on “Obama care”? How are these reforms changing the landscape in health care, and how are we to survive these changes? To begin, let’s look at how all these changes began.

The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act was passed in the senate on December 24, 2009. It passed in the house on March 21, 2010, and was signed into law by President Obama on March 23rd, 2010. It was then upheld in the Supreme Court on June 28, 2012, and the landscape of health care has been changing ever since. Few would argue that health care reform was needed, as the cost of health care had been out of control for some time in this country. However, many in the health industry feel that although the intent may have been honorable, the repercussions of reform-compliance is wreaking havoc in the health care industry and may lead to even further problems.

The Trickledown Effect

Most of the issues surrounding the changing landscape of health care are a direct result of health care reform. Changes in legislation have produced a trickledown effect, beginning with the small rural hospitals. For example, one such opinion is expressed by Dr. Scott Litten in a blog on the website Physicians Practice, where he states:

While the intent of the ACA was good, the aftershocks [of the passage of The Affordable Care Act] are changing the very way we practice medicine. Small hospitals in rural areas will be the first ones to enact changes. Reimbursements are not increasing and the new penalties that hospitals across the nation face for readmissions within 30 days, the decreasing numbers of actual admissions, and the increasing numbers of outpatient observation admissions are forcing all facilities to lay off personnel and decrease services provided. Coupling this with the fact that fewer patients are coming to doctor’s offices for services produces a very steep decline in revenue. (Litten, 2013).

According to Dr. Litten, this decline in revenue is just the tip of the iceberg. Businesses are facing a similar problem. Insurance premiums are rising, forcing employers to pass this cost on to the employee, making it more expensive each time they receive health services. This in turn discourages trips to the doctor’s office, and the cycle is repeated. Contributing to this decline, Medicaid also has been slow to increases coverage, forcing many practices to no longer accept Medicaid patients. Dr. Litten believes the changes practices are facing have produced a perfect storm for our healthcare industry. And to top it all off, the sluggish economy is causing everyone to cut back on regular spending, which has a trickledown effect on medical practices and hospitals alike. He further sees no change in these effects in the near future, and believes physicians will continue to struggle with how to provide quality health care with less resources.

The Wide Gap in Opinion

Prior to the passage of the Affordable Care Act, most Americans would have agreed health care reform was needed in this country. However, the wide gap in opinion on whether “Obama care” is a good or bad thing seems to center on how this legislation may lead to an even greater problem: government controlled health care. One anonymous physician blogger put it this way: “The Affordable Care Act was nothing more than a huge power grab by the government, the Executive branch in particular. All of the resulting chaos is planned, which will ultimately force out private insurance and thereby establish a single payer system (government) with physicians becoming part of the public service union. When that comes to pass, I’ll retire or maybe set up a “boutique” practice working 2-3 hours/day; 2-3 days/week for the patients who can afford it. My selfish concern is: who will be there to take care of me when I need it? Fortunately, I will be in a position to pay for a concierge doctor. Welcome to British style medicine. (Anonymous, 2013).

Even advocates of “Obama care” express concern that nothing in it addressed malpractice costs and tort reform, economic price feedback loops, or increased responsibility on behalf of the consumer. Another blogger states “It, [The Affordable Care Act] means more people are eligible for subsidized coverage which will add to the long term deficit issues and healthcare costs unless other changes are made.” (Litten, 2013). These issues, along with others that may arise before full implementation of The Affordable Care Act are realized, will need to be addressed if we are indeed to be successful in attaining affordable health care for all Americans.

Adapting to Change

How are we as an industry and a people to survive these changes? Mark Twain once said “It’s not progress that I mind, it’s the change I don’t like,” and the same can be said of the health care industry. People in general are opposed to change, especially when they do not have a good understanding of the issues. But “Obama care” is here to stay, and understanding the intent, specific benefits, and potential for positive reform is the first step in adapting to these changes. We have the ability to research and investigate the many options available to us as both consumers and providers of health care. Knowing what health care reform means on a personal level as well as a business level will not only help us understand and adapt to health care reform, but we may also find that there are many way this reform may indeed work to our benefit in the long run.


Litten, S. J. (2013, May 24). Health Care Reform is Changing the Landscape in Medicine. Retrieved from Physician Practice Web site:

Holistic care approaches used in healthcare

The objective of this assignment is to evaluate Holistic care approaches used in healthcare within the acute care setting specifically relating to the role of Assistant Practitioners.

Holistic care takes into consideration an individual’s psychological, sociological and mental health needs. Using a holistic approach to care enhances the experience for my patients and families (Erickson 2007). The Nursing and Midwifery Council (2010) defines holistic medicine as a system of comprehensive or total patient care that considers the physical, emotional, social, economic and spiritual needs of the person, taking into consideration a person as a whole. Over the past few decades the focus of medical care has shifted from treatment of a disease and or injury to treatment of a patient (Henning, 2013).

Holism has a long history derived from a Greek-indo -European root holos or hale, meaning whole, healthy, healing, holy and the act of caring (Auyang,1999). The first published literature in relation to holistic care was produced by Florence Nightingale in her book Notes on Nursing, which described the work of nurses as putting patients in the best condition for nature to act upon them (Nightingale, F 1969). However the concept of holism was first defined by polymath Jan Smuts in 1927, as the tendency in nature to form wholes that are greater than the sum of the parts through creative evolution (Smuts. 1927).

Different theories on holism have been widely supported and promoted in healthcare since the 1960’s, when Florence Nightingale first identified the importance of treating patients individually, as opposed to solely treating the illness (Dossey & Keegan 2009). However this concept is new in Emergency medicine, and has been derived from the recent conflict in Afghanistan. The Army pain management task force published best practice based on a holistic, multidisciplinary, integrative approach to care (Schoolmaker, 2009). The Nursing Midwifery council (2008) states that all nurses must practice in a holistic, non-judgemental, caring and sensitive manner.

Throughout this assignment the names of patients, and family members have been substituted to comply with the Data Protection Act (1998) in order to safeguard their identities and ensure confidentiality is maintained as per NHS Policy (2012). Mr. T attended the Emergency Department (ED) after taking a poly-pharmaceutical overdose and collapsing sustaining superficial lacerations to his arms and face. Mr. T was an unkempt gentleman of middle age who was wearing soiled clothes and looked malnourished.

Mr. T was known to have some minor learning difficulties and was a frequent attendee to the ED, due to his long extensive history of alcohol and illicit drug abuse. Regular attendees to the ED often suffer from alcohol and or substance misuse, where homeless and socially disengaged (Cherpitel C 1995). Little & Watson (1996) found that frequent attendees to the ED where at risk of bias care, because they often did not adhere to medical advice or except support resulting in frustration amongst staff during busy times.

Pirmohamed (2000) published figures stating that the majority of alcohol-related ED patients are 18–60 years of age, and about 20% of these involve a serious health problem due to long-term alcohol and drug misuse. Blenkiron (2000) identified that 15-25% of suicides and deliberate self-harm is associated with prolonged alcohol misuse, a battle Mr. T had been fighting against for several years. Mr. T had been using cannabis from a young age which studies have indicated an increased risk of self-harm and suicide attempts, (Beautrais, 1999). Cannabis has also been well documented to contribute to psychiatric and depressive disorders (Andereasson, et al 2002) & (Moore, 2007).

Abraham Maslow (1908-1970) was a humanistic psychologist who developed his theory, ‘the hierarchy of needs’ (1943) a five stage model of motivational needs often depicted as a pyramid. The five stages are divided into; Psychological, safety, social, esteem and self-actualization. He believed that the lower levels of the pyramid have to be satisfied before a person could move up. Each stage was further defined stating the lowest level was what every human required to survive such as food, shelter, water, sex, air, clothing, to the top being the pinnacle of each person’s potential in life who is able to pursue inner talent, creativity and fulfillment (McLeod, 2007). At this point Mr. T was barley functioning at the lowest level as he was unable to meet his basic nutritional needs and lacked warm clean clothing or shelter. Lack of food can affect a person’s mood, behavior and brain function, (Pessoa, 2008). I provided Mr. T with food and clean warm clothing, in order to assist with some of Mr. T’s basic humanistic psychological needs, as advocated by Maslow (1943) alongside his medical treatment, demonstrating a comprehensive holistic approach to care.

Rutledge (2011) another psychologist disagreed with Maslow’s theory and developed her own theory Maslow Rewired, stating none of these needs starting with basic survival on up, are possible without social connection and collaboration, and that humans require community, Love and the feeling of belonging before harvesting the ability to survive, although this is very much more associated with the 21st century. However substantive evidence has accumulated over the past few decades showing that social ties and social support are positively and casually related to mental health, physical health and longevity (Berkman, 1995). However Mr. T had no relatives other than his brother, who was estranged due to Mr. T’s extensive alcohol abuse. He was disengaged from services, refused social support and often did not adhere to medical advice.

The tablets and quantities Mr. T had taken did not require any immediate treatment likewise the lacerations to his arms and face required minimal intervention, however Holistic nursing as advocated by Dossey & Keegan (2009) treats the entire patient. Therefore as a holistic practitioner I investigated Mr. T’s Psychological issues through gentle discussion whilst a colleague dressed his wounds and administered medication to reduce the effects of alcohol withdrawal, thus assisting with Mr. T’s Physical effects which in turn will assist with his psychological needs. Alcohol is a drug with complex behavioural effects that can be pleasurable when consumed in moderation but can be unpleasant when misused, (Swift, 1999).

Mr. T was initially withdrawn and reluctant to discuss his mental health problems, however through gentle questioning whilst undertaking basic tasks, a skill often used by nurses as indicted by Berg et al (2007). Mr. T started to disclose information in relation to his psychological behaviour. Whilst discussing such issues with Mr. T it is important to maintain good eye contact and engage in a moderate amount of social touch, as this is perceived by patients as a more empathetic clinician (Montague 2013). A similar approach is advocated by, McCann & McKenna (1993) whilst Bamford – Wade & Kimble (2013) promote compassionate listening in addition to touch when dealing with patients in crisis. Therefore it was essential to speak slowly and use appropriate body and facial language to demonstrate empathy and understanding to the patient. Throughout the discussion non-verbal listening skills are respectfully used. Egan (1994) offers the acronym ‘SOLER’, an approach used in counselling which stands for; S – Sit square

O – Open Posture
L – Lean slightly forward
E – Eye contact
R – Relax

However according to Stickley (2011) the school of nursing and midwifery has introduced a new model to student nurses, the Acronym SURETY, which stands for;

S – Sit at an angle
U – Uncross legs
R – Relax
E – Eye contact
T – Touch
Y – Your intuition

This approach subsequently adds in ‘touch’ as advocated by McCann & McKenna (1993) along with your intuition. A nurse’s intuition is not a new concept and studies have been carried out since 1978, (Gerrity 1987) however it is a skill widely associated with experience (Hams 2000). Intuition has been acknowledged by clinicians and scholars as a vital component of clinical judgment and decision making (Rew 2007). Mr. T responded well to this approach of communication.

Carl Rogers (1961), another humanistic psychologist developed the theory Core conditions which is the basic attitudes that councillors should display in order to show acceptance of the client and valuing them as a human being, and include Congruence, empathy and respect. Like Rutledge’s (2011) approach, Rogers (1959) believed everyone needs to feel loved, valued and unconditional regard, to achieve Maslow’s findings that all humans aim to ‘self-actualize’ and fulfill their potential (1961). During the assessment it is essential to communicate effectively, minimise barriers such as using medical terminology in discussion as advocated by, Minardi & Riley (2007). Physicians frequently use medical words during consultations leading to ‘jargon’ that is potentially misunderstood thus impairing effective communication (Blackman & Sahebjalal 2014)

Good communication skills allow patients and relatives alike to express their concerns and needs, subsequently building trust between them and the healthcare professional, demonstrating a two way circle of communication, identified as the most effective method by Schramm (1954). The Johari Window is a model created by Luft & Ingham (1995) and used by healthcare professionals whilst communicating with patients, that encourages self-awareness and understanding of others, ensuring practitioners are aware of their own beliefs, principles, attitudes and strengths in order to help their patients.

There are some barriers to providing effective communication, as the ED is a very busy loud environment which can hinder effective communication and possibly result in communication overload Woloshynowych et al (2007). However by simply taking a patient or relative away from these areas and into a quiet room, communication barriers can be minimised.

Mr. T responded well to the approaches used, and had not spoken of his feelings or depression for a long time. Mr. T explained that he had lived with his mother up to the age of twelve when she passed away following a lifetime of alcohol abuse and that this was the only life he knew. Psychologist Albert Bandura believed children imitate behaviors witnessed as they grow up which was illustrated in the experiment ‘The Bobo Doll’, (McCleod 2007).

Since becoming reliant on drugs and alcohol Mr. T’s mental state had significantly deteriorated thus exacerbating his addiction and leading to unemployment and subsequently homelessness. Due to the fact Mr. T was disengaged from services and had no family support he was feeling increasingly isolated and unloved thus amplifying Rogers. C (1961) theory OF “Core Conditions” however Mr. T was reluctant to change. DiClemente & Prochaska (1998) developed the “Transtheoretical Model of Change” which is primarily associated with addiction and the willingness to change. The five stages of this are; 1. Precontemplation – Unwillingness to change

2. Contemplation – Consideration of change
3. Preparation – Commitment to change
4. Action – modification of behaviour takes place
5. Maintenance – lifelong avoidance of relapse

Mr. T was currently at the precontemplation phase and unwilling to make changes to his current circumstances. Due to increasing pressure from NHS targets, Emergency practitioners have a very limited amount of time to address such varied and extensive issues due to all patients needing to be transferred or discharged within four hours of arrival. As strong advocates of holistic practice the department strives to ensure all patients are treated holistically and provided with the relevant knowledge and support required to address and manage their problems.

Mr. T was referred to the mental health team for further assessment of his psychological needs assisted with housing, and referred to the Alcohol and Drug Misuse Team in order to address his addictions. These services work in both the interests of staff and patients providing support to patients with complex alcohol and drug dependence in order to reduce the number of attendances to the ED and help to reduce care costs. The home office published data relating to alcoholism which showed the cost to the NHS is in excess of £3.5 billion annually (Government’s Alcohol Strategy 2012). Layard (2005) concurs with these statistics stating that ‘Mental Health’ is our biggest social problem.

In conclusion a Holistic approach to care considers the physical, emotional, social, economic and spiritual needs of a patient taking in to account a person as a whole not only treating the physical and medical needs of a patient. It is evident that treating patients as a whole and not the presenting complaint alone is key to providing effective healthcare for the patient and can result in fewer admissions and reduce pressure on resources. The evidence provided in this assignment has shown that the emergency department uses all resources available, working as a multi-disciplinary team to assess and treat patients with complex mental health needs and drug and alcohol dependencies fairly without passing judgement.

Effective communication plays a vital part in effective treatment of a patient although there is potential for communication to be hindered. The communicative approaches used proved favourable with Mr. T and enabled the practitioner to gain the relevant information required. The psychological approaches used with Mr. T proved effective and by treating Mr. T in a holistic manner contributed to the effective management of his care. Based on the research and evidence published holistic care significantly improves patient outcomes leading to greater patient satisfaction and contribute to reducing healthcare costs which will subsequently assist in providing a longer sustainable national health service.

Palliative Care and Hospice Care: The Principles and Goals They Set

The principles of palliative care and hospice care have similar goals that may often come together in an effort of providing the best care for a patient. Palliative care is holistic care of an individual with a chronic life debilitating condition whereas hospice care is for those with a terminal condition who have been diagnosed with 6 months or less to live. Palliative care usually will begin prior to the hospice care and continues to be joined with hospice care. “It is important to note that the prognosis-based distinction between palliative care (eligibility based on need, no prognostic restriction) and hospice (eligibility based on a prognosis of living less than six months) is unique to the United States, whereas in other countries the terms palliative care and hospice are largely synonymous”(1) “The Institute of Medicine ([IOM], 2003) defined palliative care as the total active care of the body, mind, and spirit. The aim of palliative care is to prevent or lessen the severity of pain and other symptoms, and to achieve the best quality of life” (IOM, 2003, p.2) throughout the course of any life –threatening or life-limiting healthcare condition.” (2)

In providing palliative care to an individual the possibility of curing the illness still exists. The patient is made as comfortable as possible but has not been given a time frame for death. An “Interdisciplinary palliative care teams assess and treat symptoms, support decision making and help match treatments to informed patient and family goals, mobilize practical aid for patients and their family caregivers, identify community resources to ensure a safe and secure living environment, and promote collaborative, and seamless models of care across a range of care settings (i.e., hospital, home, and nursing home).”(1) Palliative care begins when an individual’s quality of life has decreased because of their disease process and the prognostic restriction is not available. With hospice care, the illness is terminal. The interdisciplinary team will also assess the patient but will not seek a cure for the condition. Their goal now is care and comfort with the emphasis being comfort. “Hospice is a movement that offers palliative care to terminally ill patients; this type of care eases pain and suffering and helps a patient die with dignity but does not attempt to cure illness. This care may take place at home or in the hospital.

Some larger communities have a separate facility devoted to hospice care.”(3) With hospice care the individual and family have accepted the imminence of death with a six month period and the care the patient will receive will be based on making sure the patient is comfortable at all times. The facilities that provide hospice care are successful because the dignity and comfort of individual and critically important to both the patient and their family. Hospice care gives support to not only the patient but also to the family during this difficult time. This process of beginning hospice care is often delayed by the patient and patient family because it is makes the phase of dying a reality. Hospice confirms that there is not a cure available for a loved one and makes death more of a reality. Hospice also makes this last phase of dying more acceptable, and provides the spiritual comfort for the patient and their family.

Hospice care is not just patient based care, it is family based care. In discussing palliative care versus hospice care we can ascertain that “palliative care may be appropriate for anyone with a chronic progressive disease when symptom management becomes a challenge.”, but hospice care is palliative care for the terminally ill. The difference in these two types of care and the phase of death an individual is currently experiencing meaning the prognosis of death. “Hospice care is appropriate when patients and their families decide to forgo curative therapies in order to focus on maximizing comfort and quality of life, when curative treatments are no longer beneficial, when the burdens of these treatments outweigh their benefits, or when patients are entering the last weeks or months of life”(1)

Bonebrake, D., Call, K., Culver, C., & Ward-Smith, P. (2010, June). Clinically differentiating palliative care and hospice. Clinical Journal of Oncology Nursing, 14(3), 273+. Retrieved from Kincaid, L., & Labell, L. (2011). Death and Dying: Hospice . Human Growth and Development (Third Edition ed., ). Jacksonville: Florida State College. Meier, D. (2011). Increased access to palliative care and hospice services: opportunities to improve value in health care. The Milbank Quarterly, 89(3), 343-380.

The role of the health and social care worker

1.1 Explain how a working relationship is different from a personal relationship: Working relations: Working relations are based on formal policies and procedures and also by contract of employment. I have to work to care standards on daily basis and support everyday living of my residents, for example dressing, eating , bathing, activities and personal hygiene. All residents have different needs and I work to meet their needs. Personal relationship: Personal relationship are outside the work place with family, friends, neighbours, etc. Personal must not influence my work with residents.

1.2 The care assistant role is to give assistance and support to residents , as the individual care plan states. When I work with residents I make sure that they are safe nad able to make decisions about their wishes, preferences in day to day activities. When working I have contact with doctors, district nurses, social workers, family and friends of residents. This is to make sure that the individual residents needs are met fully. All my contacts and observations I write record.

2.1 Describe why it is importand to adhere to the agreed scope of the job role. As a care assistant my rolr is to get to know my residents their history, interests, and what kind of support they need to ensure their well being. I am responsible for delivery of service according to care standard, policies and procedures. It is my duty to communicate with my seniors to make sure that all the individual residents needs are met.

2.2 Access full and up to date details of agreed ways of working. In the care plan I can read what are the needs of my residents and what support is needed everyday. I record everything about my work with residents, any changes in their physical state, behavior, who came to see them professionally or privately. This is to make sure that all the carers have access to the information and act accordingly.

2.3 Implement agreed ways of working.
The care plan sets my duties. Policies and procedures are there to be observed and followed. My role is to communicate with my seniors about anything which can ensure the well being of the resident.

3.1 Explain why it is important to work in partnership with others. To ensure continuality of good care team work is very important. Members of the team must communicate to each other any revelant information about residents. This is to be recorded in the care plan, risk assessment, daily and night written reports, verbal handovers from shift to shift.

3.3 Idntify skills and approaches needed for resolving conflicts. In my opinion it is very important, undestanding and patience. When trying to resolve conflict we must listen to both sides. That should be done when the sides are separated. By listening we help them resolve their problems. Experience, relevant training and assistance of fellow care workers gives us the tools to deal with conflict.

Handling of information in social care settings

Legislation that relates to recording, storage and sharing of information in social care are as follows Data protection act 1998. This is how information about individuals is used. This covers eight principles under which personal data must be protected and collected. DPA says that service user information must be confidential and can only be accessed with their consent. Service users must know what records are being kept and why the data is kept. Freedom of information act 200 The Freedom of Information Act gives individuals the right to ask organisations all the information they have about them… There are some that might be withheld to protect various interest which if that is the case, the individual must be aware of it. Information about individuals will be handled under the Data Protection Act… Health and social care act 2008

Codes of practice include
General Social Care Council (GSCC) which produces the Codes of Practice for social care Workers.
Walsingham’s policy’s and procedures

1. It is important to have secure systems for recording and storing information in a health and social care setting so that individuals and staff’s private information will be protected from unauthorised viewing. It is to comply with the legislation; it is the right of individuals and staff for their private information to be protected. To ensure information is accessible for those who need to know, it is important. To protect confidentiality, it is important to have secure systems for recording and storing information in a health and social caresetting. It is important to have secure systems for recording and storing information in a health and social care setting to prevent identity theft.

To maintain the rights of individuals, it is important to have secure systems for recording and storing information in a health andsocial care setting. Information about individuals and staff in my place of work is protected from unauthorised persons. I only pass individualinformation on with their permission but if the information is going to pose a risk then I will pass it on to the manager immediately.’ All recordings must be clear accurate, recorded as soon as possible including, time, date in black ink only and any errors shown by putting a clear line through and putting your initials to identify error.

Through induction and other training, guidance, information and advice about handling information is obtained. Through the company’s policies and procedures, information and advice about handling information is accessed like keeping people we support information confidential. Through colleagues and individuals, guidance, advice and information about data protection is accessed. Through the code of practice like the General Social Care Council (GSCC) which produces the Codes of Practice for social care workers, I gained guidance, advice and information about handling information. Through this course, I gained guidance, advice and information about handling information, I accessed guidance, advice and information about handling information.

For example I should make the person I support if possible aware before I access their care plan. Also through surfing the internet, I accessed guidance, advice and information about handling information. We practice person centred approaches in my place of work which involves service users virtually in everything that has to do with them including their care plan updating, like documenting any changes in their health and well-being, their achievements, the outcome of their health appointments, support required, completed and uncompleted activities, etc. when the person we support is deemed not to have capacity support is then given from family members and keyworkers and outside agency’s.

‘When there are concerns over the recording, storing or sharing of information I ensure I talk to my colleagues or senior member of staff like my line manager or supervisor and ensure I record it. If the information has to do with a service user’s privacy, I must obtain consent from the service user before passing the information on except when the information poses a risk to the service user if not passed if not passed on for example in the case of abuse… For instance in a case of bruises being observed and the service user refuses to say anything and does not want it to be discussed; although it is the right of the service user not to disclose this, I will make my manager aware of it because of the risk involved but Ensure it remains confidential reporting.

One example I know of is when one of the service users whilst she was being supported told a staff member that she would soon be getting engaged to her boyfriend. This was recorded and shared only with the right people because in this situation the service user may be at risk from abuse.

Reason for Pursuing Graduation degree in Heath care Administration

Each individual has his own reason for pursuing a graduate degree. Professionally, a graduate degree shows that the person has the motivation, ambition, and dedication to improve and thus strive to obtain a position in which s/he can apply and expand his/her knowledge base. The choice to seek additional education after investing four years in an undergraduate degree shows commitment to learning and recognition of self-worth.

I chose to pursue a Master’s degree because; I believe that obtaining a graduate degree will definitely make me more marketable in the corporate world. But my main goal is to broaden my horizon beyond the technical world, unlock career aspirations otherwise blocked, and enhance problem-solving and decision-making skills which lead me to do some excellent research base work in future.

I am writing this statement in support of my application to study towards the Master of Health Care Administration degree at Worcester State University (WSU). Here the question is why am I pursuing my graduate degree in HCA/Public Health while I did my graduation/ under graduation from Statistics? My answer is, I want to expand my career level in a broad way by opening some more windows and I believe, the public health will be a good choice for one of them. A Healthcare Administration Degree can be utilized in just about any healthcare related occupation, ranging from hospital CEO, to health insurance manager(who need experience of statistics), to public health official(need statistics), to management consultant, health care analysis(need statistics) and more. Getting this degree under my belt now will ensure that I have a plethora of career options later on.

I think health care and statistics are just like cousins. In today’s world we are faced with situations everyday where statistics can be applied. Statistics can be used to determine the potential outcome of thousands of things where the human mind alone wouldn’t be able to. For example-

Researchers employ scientific methods to gather data on human population samples.

The health care industry benefits from knowing consumer market characteristics such as age, sex, race, income and disabilities. These demographic statistics can predict the types of services that people are using and the level of care that is affordable to them.

Health care administrators refer statistics on service utilization to apply for grant funding and to justify budget expenditures to their governing boards.

Quantitative research guides health care decision makers with statistics–numerical data collected from measurements or observation that describe the characteristics of specific population samples.

Descriptive statistics summarize the utility, efficacy and costs of medical goods and services. Increasingly, health care organizations employ statistical analysis to measure their performance outcomes.

Hospitals and other large provider service organizations implement data-driven, continuous quality improvement programs to maximize efficiency.

Government health and human service agencies gauge the overall health and well-being of populations with statistical information.

Moreover, Public Service Leaders work behind the scenes at hospitals and other healthcare facilities to make sure that patients have access to quality health services. They are trained to manage the financial aspects of hospital administration which include creating and managing budgets, conducting financial forecasting exercises to project future growth and expenditures and overseeing the day to day tracking of accounting data. Some of these healthcare business professionals are involved in public service but at a more strategic level as they work to guide policy making decisions for both government agencies and private healthcare service providers.

Students pursuing graduate degrees in Healthcare Administration usually are interested in promoting quality healthcare to everyone not only from inside the hospital base as doctor but from the outside in different necessary way. A graduate level Health Administration degree programs are usually filled with courses pertaining to quantitative analysis, probability and statistics and hypotheses testing. So, I believe Students who have interests in learning how to correctly design research studies, applying statistical models using the latest healthcare software tools and interpreting data to contribute to improve healthcare services do well in graduate level health administration coursework.

Analysis of Contemporary Health Care Issues

US health care expenditures have been rising quickly over the past few years; it has risen more than the national financial system. Nonetheless a number of citizens in the US still lack appropriate health care. If the truth be told, health care expenditures are going to continue to increase; in addition numerous individuals will possibly have to make difficult choices pertaining to their health care. Our health system has grave problems that require reform, through reforming, there is optimism that there will be an increase in affordable health care and high-quality of care for America.

Medicaid, Medicare and private sector insurances are all going through trials and tribulations because of spending. Obama Cares purpose is to put consumers back in charge of their health care and aid in driving down the cost of spending in health care. The reform will also strive to put forward a delivery system that operates better for all involved thereby decreasing organizational burdens and assisting in the collaboration towards improved care. If the reform is successful, it will lead to measureable improvements in care outcomes, and in the health of the American general public overall. Non-profit/Profit

While non-profit organizations dominate the delivery of health services, there are more than a few for-profit organizations that remain affected by health care spending as well. By having Obama Care in place, non-profit and profit organizations can possibly see an increase by way of earnings and consumers. The CEO of See Change Health; Martin Watson, made a statement that said “without health reform, we figured we would get to the $800 million mark (in earnings) by 2016.

With health reform, it looks like we’ll hit $1.5 billion by 2016.” (Kennedy, K. 2012). Although undeniable, numerous for-profit organizations may gain as a result of the reform, non-profit organizations may perhaps thrive also. In 2014, guarantors cannot profit by means of rejecting coverage any longer, consequently they will be more motivated to keep people healthy. (Kennedy, K, 2012). Due to the continuous changes by health care reform to the current system, everyone could benefit from sustaining spending. Financial Management Staff

The Financial management staff is accountable for acquiring and effectually making use of the resources required for operating efficiently. The first step the staff should take is to assess and develop economic proficiency of the present setup in addition to preparation for the outlook of future operations. Financial management staffs must plan, obtain and use funds to yield the complete benefits of the efficiency and assessment of its project. The next focus should be on long-term investments decisions, like new accommodations and machinery, and also how to obtain funds needed to purchase the necessities essential to sustain operation.

Contract management is another responsibility. “Health services establishments have to negotiate, monitor, and sign contracts with managed care organizations and third-party payers.” (Halvorson, G.C. 2005). Since costs is excessive, there is hopefulness that the reform act can aid the pecuniary staffs to maintain or lessen their expenditures thru generating rudimentary regulations and standards. Rules and Regulations

There are numerous rules and regulations the financial management staff must address pertaining to national health care spending. Their aim should be improved care, ensuring more healthy individuals and societies, all the while making sure affordable care is available for individuals, while lowering or sustaining health care spending. “Making quality care more affordable for individuals, families, employers and governments by developing and spreading new health care delivery models is key.” (National Strategy, 2011). Financial management must come up with proposals that will nurture new ideas, devices or processes to promote and lessen costs; The Affordable Care Act has provisions that will help financial management deal with simplification.

By having extra electronic processing and less form-filling, it will eliminate the need to spend money on check printing, phone calls, and postage charges. Simplification and synchronization is needed for administrative. National health care spending is a heated issue; however there is a single entity that all agree upon and that is there needs to be cut backs or the maintaining of current expenses. The current reform will help decrease the percentage of Americans who are without coverage. An vigilant observation on healthcare spending is needed, at the rate its going now thing don’t look too good financially for anyone when it comes to healthcare.

Department of Health & Human Services. (2011). National Strategy for Quality Improvement in Healthcare. Washington, DC: U.S. Government Printing Office. Halvorson, G. C. (2005). Healthcare Tipping Points. Healthcare Financial Management (March): 74-80. Kennedy, K. (2012). Healthcare Law’s Impact on Businesses Varies. Retrieved from: Woolhandler, S., & Himmelstein, D. (2011). Healthcare Reform 2.0 Social Research, 78 (3), 719-730

Promote Communication in Health, Social Care or Children’s and Young People’s Settings

Communication is a central part of everyday life for most people and is particularly important when you work in a care setting. Communication means making contact with others and being understood. We all communicate continuously, through a two-way process of sending and receiving messages. These messages can be: verbal communication, using spoken or written words. Non-verbal communication, using body language such as gestures, eye-contact and touch. People communicate to make new relationships. The ability to communicate well is a key skill that enables you to work effectively with others. Working in a care setting means working in a team.

A team with members who communicate well with each other is a strong team. When you work in a care setting an important part is to enabling individuals to express themselves and understand the communication of others. There are many different influences that affect communication such as their culture, ethnicity, nationality and any particular needs. When you are communicating with others the content of the message needs to be clear, but it also needs to be said in a clear way. There is no one combination of factors that provides the ideal way to communicate a message. However effecting Communication methods include: Non-verbal communication: eye contact, touch, physical gestures, body language, behavior. Verbal communication: vocabulary, linguistic tone, pitch.

Services may include: translation services, interpreting services, speech and language, services advocacy services. It is important to respond an appropriately to an individual’s reactions when communicating, this includes: verbal responses (tone, pitch, silence), non- verbal responses (body language, facial expressions, eye contact), emotional state, signs that information has been understood. Communication is all about sharing with one another and yet each person communicates slightly differently according to their different backgrounds and experiences. Cultural differences refer to a variety of different influences, such as family background, peer group religion and ethnicity. These all play a part in shaping the way a person views the world and responds to it. Cultural differences are revealed by particular attitudes, values and practices, all of which have a bearing on how a person communicates and understands the communication of others. Barriers to effective communication can be:

health problems or medical condition
sensory impairment
effects of alcohol or drugs
learning disabilities
emotional and behavioural difficulties
cultural differences.

To avoid barriers during communication we can use technological aids, human aids, use of age-appropriate vocabulary, staff training, improving environment, reducing distractions. When a misunderstanding is unavoidable it is important to have a range of methods to clarify the situation and improve communication, such as: adapt your message, change the environment, ask for feedback, allow time, repeating, apologise. There is a range of support available to enable effective communication. Importantly, individuals need to be informed about these services and should be able to access them. For example: local authorities and services such as the NHS, education and children and families services, third sector organisations,

interpreting service,
translation service,
national charities.

Work in a care setting you will regularly deal with information to do with the children or young people in your care and their families. Some of this is personal and private. Confidentiality refers to the need to handle personal and private information in ways that are appropriate, safe and professional and meet legal requirements. A great deal of information will pass around place of work through conversations, hand-over reports, letters, written reports and emails. We need to deal appropriately with confidential information of various types when working in a care setting. If we are unsure whether information is confidential in nature ask a senior member, NIC, unit leader or management. There are some situations when confidentiality needs to be breached to report information to a higher authority. The disclosure of private and personal information should only take place when: – withholding the information is likely to threaten the safety and wellbeing of others – a crime has been, or is likely to be, committed.

It is our responsibility to check the policy and procedure in our place of work about disclosure of confidential information, in order to be clear about how to act and who to contact should the need arise.

1.2. Explain how communication affects relationships in the work setting.

I need to build relationships with clients that I work with, their families and colleagues to enable to work effectively. Relationships and communication skills are closely linked, as good communication will help to build good relationships. Relationships are influenced by the way we communicate this not only includes the language we use and how we listen to others but also our body language, gestures and facial expressions. It is important that we find ways to communicate with clients that are new to the setting so that they quickly feel comfortable, settled and feel secure, the early relationship we build with a client also helps build the parents/family confidence and trust in us that we take good care of the child and that the child will enjoy the experience.

3.1 Explain how people from different backgrounds may use and/or interpret communication methods in different ways.

Communication can be slightly different when using it with other people from different backgrounds. Communication can be interpreted in different ways by different people, this is because they may not speak English, if from a different country, or they may not understand you. This is also a barrier to communication. Other people may think that if they’re being listened to, they will express their beliefs and their opinions about life. Different people from other backgrounds may use verbal communication to express what they think, however they could also use non-verbal communication to put their point across. Communication can be used in many ways by using different methods.

Client from different backgrounds can communicate by doing what they like best. Client could use body language and facial expressions to express their needs or what they want to do in the workplace. People from different backgrounds can use communication by being confident. This shows their personality and will help the communication between them and others around. Different backgrounds of different people can cause misunderstandings when using communication. However, they will be able to interpret the communication they’re using by using hand gestures, facial expressions or maybe body language. The personality can also affect the way an individual communicates. For example, if a person is shy he/she may not want to speak clearly and may use a little bit of verbal communication.

4.3. Describe the potential tension between maintaining an individual’s confidentiality and disclosing concerns.

The issue of confidentiality and disclosure is a legal requirement. While confidentiality is highly regarded, disclosures of certain information is vital. Any information disclosed without recourse to the service user must be one that portent anger either to the service user or others. As a care worker, before I pass on any information about any service user to other person(s), I must seek consent from the service user. However, the exception to that rule is that information can be passed on when others have a right and a need to that information.

Anatomy and Physiology for Health and Social Care

Task2: The main tissue types of the body and the role these play in two named organs of the body. P2: Outline the structure of the main tissues of the body

There are many different types of cells in the human body. These cells would not be able to function on their own, they are all part of a large organism that is called – you. The two named organs that I have chosen for this assignment are the intestines and the heart.


All cells group together within the body to form tissue, a collection of similar cells group together to perform a specialized function. There are four primary tissue types in the human body – epithelium, connective tissue, nervous and the muscle tissue.

Epithelial tissue-

This tissue is specialised to cover the whole part of the body lining of all of the internal and external body surfaces, they are packed tightly together to form continuous layers that serve as linings in different parts of the body. Epithelial tissue serves as membranes lining organs and helping to keep the body’s organs separate, in place and protected. Some examples of epithelial tissue are the outer layer of the skin, the inside of the mouth and stomach, and the tissue surrounding the body’s organs. These kinds of tissues can be divided into two groups depending on the number of layers that it has. An Epithelial tissue which is only one cell thick is known as Simple epithelia, if it consists of several layers then it is known as Compound Epithelia.

Epithelial tissue

In the Intestines-

The apical surface of epithelial cells usually have tiny projections called microvilli. These function to increase the surface area. For example, microvilli on intestinal cells increase the surface area open for absorption. Absorption is an important function of epithelial tissue within the intestines. The surface of the small intestine is lined with simple columnar epithelium. This type of epithelium appears as a single layer of tall, column-shaped cells with oblong nuclei. The primary function of this type of epithelium is absorption of nutrients, secretion of digestive juices as well as secretion of mucus by goblet cells. The surface area of the small intestine is increased by outward finger-like extension sand inward indentations, as villi and crypts. Both of these structures are lined with simple columnar epithelium.

In the heart-

The epithelial tissue protects the heart from becoming damaged from the lobes that are in the heart against the lungs; it provides an extra barrier of protection from injuries. Epithelial tissues line all the ducts and glands within the heart and protect it with an exterior membrane.

P2: Outline the structure of the main tissues of the body

The Intestine

P2: Outline the structure of the main tissues of the body

The Heart

Connective tissue-

There are many types of connective tissue that are widely distributed throughout the body that lie beneath the epithelial tissue. This type of tissue does not contain many cells, as they are separated from each other by an intercellular ground substance, (matrix), they are hidden by the cells. It is made up of either liquid, solid, or connective tissue, within the matrix there are many types of connecting fibres, such as collagen and elastic fibres. The function of the connective tissue is to support, bind, cover, protect and give structure to the body. Most types of connective tissue contain fibrous strands of the protein collagen that add strength to connective tissue. Some examples of connective tissue include the inner layers of skin, tendons, ligaments, cartilage, areolar, adipose bone and fat tissue.

In addition to these more recognizable forms of connective tissue, blood is also considered a form of connective tissue. Cartilage tissue is a smooth, firm substance that protects ends of the bones from friction during movement and they can be found at the end of our bones in mobile joints, the front ends of the ribs, also in parts of our nose and ears. Our bone tissues are made of a much harder substance than the cartilage, but they can be worn away by friction. They are tough on the outside, but on the inside they have a sponge-like design that helps to reduce the weight while retaining strength. They are designed to maintain the body’s structure and support the body’s movement and are used to protect weaker tissues, such as the brain, lungs and heart.

P2: Outline the structure of the main tissues of the body

Blood is a specialized bodily fluid in human’s that delivers necessary substances such as, nutrients and oxygen to the cells and transports metabolic waste products away from those same cells. Bones have a rigid structure that constitutes part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a dense type of connective tissue. Cartilage is a flexible connective tissue found in many areas in the body including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs.

It is not as hard and rigid as bone but is stiffer and less flexible than muscle. Areolar tissue is a common type of connective tissue, also referred to as ‘loose connective tissue’. It is strong enough to bind different tissue types together, yet soft enough to provide flexibility and cushioning. Adipose tissue (fatty tissue) it provides insulation and protection of organs, muscle fibres, nerves, and supports blood vessels. It protects us from excessive heat loss or heat increase and also acts as a shock absorber to protect against injury.

In the intestine-

The lumen is the cavity where digested food passes through and from where nutrients are absorbed. Both intestines share a general structure with the whole gut, and are composed of several layers. Going from inside the lumen radially outwards, one passes the mucosa (glandular epithelium and muscularis mucosa), submucosa, muscularis externa (made up of inner circular and outer longitudinal), and lastly serosa. Serosa is made up of loose connective tissue and coated in mucus to prevent friction damage from the intestine rubbing against other tissue. Holding all this in place are the mesenteries which suspend the intestine in the abdominal cavity and stop it being disturbed when a person is physically active.

In the heart-

Connective tissue provides the final pathway for diffusion of nutrients, oxygen, waste and metabolites to and from the cells of the body. All blood vessels are embedded in connective tissue. The only cells which receive their sustenance directly from the blood are the endothelial cells lining the vessels themselves. All of the other cells are supplied via diffusion through intermediary connective tissue. The transport functions of blood and connective tissue cannot be separated. The heart and circulatory system simply facilitate the movement of this travelling tissue. The valves in the heart are also made from connective tissues, they control the amount of blood that is passed through the heart and into the blood stream, and it also helps to reduce the flow back to the heart.

Nervous tissue-

The nervous tissue includes the brain, spinal cord and the nerves throughout the organism, it contains two types of cell they are the neurons and glial cells. Nerve tissue has the ability to generate and conduct electrical signals in the body. These electrical messages are managed by nerve tissue in the brain and transmitted down the spinal cord to the body. The nervous tissue, main function is to carry messages throughout the body, gathering and feeding back information via electronic impulses along specialised cells called neurons. It is like an information speedway, it directs the drive force of the nervous system by sending messages, to ensure that all of the systems are able to work together within the body, this is to maintain that the internal conditions are needed to enable the body to respond to motivation.

In the heart-

The nervous tissue in the heart controls the heart’s main functions. It is controlled by specialised nerves called nodes. A node is a specialised type of tissue that behaves as both muscle and nervous tissue. When nodal tissue contracts (like muscle tissue) it generates nerve impulses (like nervous tissue) that travel throughout the heart wall. The heart has two nodes that are instrumental in cardiac conduction, which is the electrical system that powers the cardiac cycle. These two nodes are the sinoatrial (SA) node and the atrio-ventricular (AV) node. The sinoatrial node, is also referred to as the pacemaker of the heart, it coordinates the heart contractions. It is located in the upper wall of the right atrium, it generates nerve impulses that travel throughout the heart wall causing both of the atria to contract.

The atrio-ventricular node lies on the right side of the partition that divides the atria, near the bottom of the right atrium. When the impulses generated by the SA node reach the AV node, they are delayed for about a tenth of a second. This delay allows the atria to contract, thereby emptying blood into the ventricles. The AV node then sends the impulses down the atrio-ventricular bundle. This bundle of fibres branches off into two bundles and the impulses are carried down the centre of the heart to the left and right ventricles. Btec Level: 3 in Health and Social Care

Nervous Tissue

In the intestine

In order to propel the food into the small intestine, a small electrical impulse is passed down the nerve into the lower part of the stomach to grind the food and it is expelled little by little. Then in order for digested food to pass through the intestine and the electrical impulses tract messages to the brain pass through the spinal cord to the nervous tissue within the intestines which then stimulates the muscle to contract causing the digested food to be passed down through to the rectum to the be excreted.

Muscle tissue-

Muscle tissue is a specialized tissue that is able to conduct electrical impulses and to contract. Muscle tissue contains the specialized proteins actin and myosin that slide past one another to allow movement. Examples of muscle tissue are contained in the muscles throughout your body. There are three types of muscles, they are known as:

Striated (also called voluntary or skeletal muscle), produces movement and maintains posture, contract and relax, applies force to joints and bones, is under voluntary control. Non-striated (also called involuntary, plain or smooth), it protects, controls movement of substance along tubes, not under voluntary control, found in stomach, intestines, bladder, uterus and the eyes. The cardiac muscle (also called involuntary, has four chambers), can only be found in the heart, shares similarities to skeletal muscle, and cannot be controlled. Cardiac muscles are only found in theheart. They are self-contracting, autonomically regulated and continue to contract in rhythmic fashion for the whole life of the organism. Some of the cardiac muscle cells contract without any nervous stimulation.

P2: Outline the structure of the main tissues of the body

Muscle Tissue

P2: Outline the structure of the main tissues of the body

In the heart-

The cardiac muscle has several different unique features. The muscle’s that are present in the cardiac are intercalated discs, which are connected between two adjacent cardiac cells. Intercalated discs help multiple cardiac muscle cells to contract rapidly as a unit. This is important for the heart to function properly. The cardiac muscle can also contract more powerfully when it is stretched slightly. When the ventricles are filled, they are stretched beyond their normal resting capacity. The result is a more powerful contraction, ensuring that the maximum amount of blood can be forced from the ventricles and into the arteries with each stroke. This is most noticeable during exercise, when the heart beats rapidly. This pumps blood around to all the cells in the body, to help to retrieve it and re-oxygenate it and pump it back around.

In the intestine-

The smooth muscle is found in the walls of hollow organs like your intestines and stomach. The muscular walls of the intestines contract to push food through your body and help to break it up, this is an involuntary function.

Stretch B.and Whitehouse M., (2014), Health & Social Care, level 3, 1st edition. Edinburgh Gate, Harlow and Essex.
College notes and hand-outs
Ms Mansell,, Guernsey College FE, unpublished.

Prison Health Care Agency

There are many facets in the health care industry. Examples include hospitals, urgent care centers, physicians’ offices, medical labs, and more. One not really spoken about, is the prison health care system. Prison health care is the medical treatment of inmates in the United States Correctional Facilities (Means & Cochran, 2012) this is according to the report. The National Commission on Correctional Health Care (NCCHC) is a federal agency that oversees the medical needs of prisoners. According to the Bureau of Justice Statistics, “In 2012, the number of admissions to state and federal prison in the United States was 609,800 offenders (Carson & Golinelli, 2013). With these prison inmate statistics, clearly there is a need for health care in the prison system. The NCCHC is a federal agency that was constructed to improve the quality of health care in the prison setting. The NCCHC was founded in the early 1970’s.

The American Medical Association (AMA) executed a study on the conditions of jails. The AMA found “inadequate, disorganized health services, and a lack of national standards” (National Commission on Correctional Health Care, 2013). The National Commission on Correctional Health Care states their mission is to improve the quality of health care in jails, prisons, and juvenile confinement facilities. They support their mission with the help of other national organizations, mirroring the fields of health, and law and corrections, examples include The American Bar Association, The American Medical Association, The Academy of Pediatrics, and The American Dental Association. The NCCHC cannot fulfill its’ mission without the proper structure within the agency. This organization is comprised of accreditation and facility services, health professional certification, education and conferences, standards and guidelines, and a board of directors from supporting organizations. These supporting organizations play a role in helping the NCCHC fulfill its’ mission and roles for the prison health care system.

The board of directors role is ensuring all guidelines are adhered to and assessing the overall direction and strategy of the organization. The NCCHC has many roles and standards for their organization. One of the most important is patient safety. Put in place are patient safety systems to ensure prisoners are receiving proper care. Another role of NCCHC is continuous quality improvement. Continuous quality improvement is the process of requiring each prison facility to complete a process study on inmates needing health care services. “Process studies examine the effectiveness of the health care delivery process. Outcome quality improvement studies examine whether expected outcomes of patient care were achieved” (Rechtine, D., 2008). There must be a review in the event of a patient’s death. Proper procedures must be followed. The NCCHC requires health care professionals to continue their education by completing annual certification classes.

Initial health assessments must be performed on each new inmate within 7 days of arrival to the facility. These health assessments are to be given by board certified and trained registered nurses or midlevel practitioners, followed by a physician’s review. If a prisoner is at risk for suicide, there is a prevention program in place with treatment plans. Any inmate with special needs requires an individualized treatment plan provided by a doctor. The NCCHC has put in place a chronic disease program for inmates, which requires the physicians to document in a patient’s medical chart, making sure they are following the correct disease procedures. The impact that NCCHC have on health care is one that relates to their mission. The mission, role, and impact has a direct association with each other.

Providing quality health care for incarcerated individuals. The commitment to continually improve health care in confinement facilities, to help these correctional facilities in improving their inmate’s health and the communities that they will return to, increase the efficiency of health services delivery, strengthen organizational effectiveness, and reduce the risk of adverse legal judgments (NCCHC, n.d.). “NCCHC offers a broad range of services and resources to help correctional health care systems provide efficient, effective, and high-quality care” (NCCHC, n.d.). An example of the National Commission on Corrective Health Care carrying out a duty is the commitment to treating inmates in a humane manner. The NCCHC, in partnership with supporting organizations, including the American College of Physicians, the American Medical Association, the American Nursing Association, the American Bar Association, the American Psychological Association, the American Psychiatric Association, and the American Public Health Association.

Through the standards the NCCHC has set, has persistently declared the components of a policy against mistreatment. “The Standards for Health Services in Prisons (2008) preclude, for example, health staff participation in non-clinically ordered restraint and seclusion, except to monitor health status (P-I-01 Restraint and Seclusion), or in the collection of forensic information (P-I-03 Forensic Information). They require informed consent of the patient for “all examinations, treatments, and procedures” and recognize the patient’s right to refuse treatment (P-I-05 Informed Consent and Right to Refuse), and protect inmates as subjects in human research (P-I-06 Medical and Other Research)” (NCCHC, 2012). “Other standards require medical autonomy in clinical decision making (P-A-03 Medical Autonomy), maintenance of confidentiality of health information (P-H-02 Confidentiality of Health Records), and patient privacy (P-A-09 Privacy of Care).

NCCHC standards require documentation of patients’ health status at each encounter (P-H-04 Management of Health Records), with special attention to the medical and mental health of inmates under close confinement (P-E-09 Segregated Inmates)” (NCCHC. 2012). In regard to health care, the NCCHC has the best standards of care and are the most recognized and accepted. Medical personnel for the prison system must follow the policies and procedures set in each facility. These policies and procedures allow guidance, standardization, and consistency in practices, a nonfulfillment to comply with these rules and regulations places the nurses, patients, and institutions at risk. The NCCHC has the authority to establish that these policies and procedures are followed by all correctional medical personnel. “Policy topics are wide ranging. Applicable laws and standards should be incorporated into institutional policies, procedures and protocols for the correctional nurse.

For example, they should reflect federal and state regulations for reporting public health concerns, conditions of abuse, rape, communicable diseases, trauma, unexpected and expected deaths and care of the mentally ill. Regarding standards, NCCHC standards address topics such as access to care, quality improvement, grievance mechanisms, patient and staff safety, medication services, screening and assessment, patient restraint and much more” (NCCHC, 2012). The NCCHC has a process for accreditation, certification, and authorization. The NCCHC offers a voluntary accreditation health services program. They have offered this program since the 1970’s. The NCCHC has standards in place as a guide for any correctional facility to follow. The process of accreditation involves an external peer review to determine if the correctional institutions can meet the standards in their provision of health services.

“The NCCHC renders a professional judgment and assists in the improvement of services provided” (NCCHC, 2012). NCCHC provides an Opioid Treatment Programs (OTP) for accreditation. OTP accreditation allows OTPs to achieve legally required certification from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the United States Department of Health and Human Services. “The only SAMHSA authorized accrediting body that focuses on corrections, NCCHC has developed standards that are based on federal regulations but tailored for this field” (NCCHC, 2012). The NCCHC has accreditation surveyors that are formed of nurses, experienced doctors, health administrators and other health care professionals who have knowledge of the correctional system.

The survey team reviews any medical records, including policies and procedures, interviewing of staff personnel, and inmates are included, along with touring the facility. There is an exit conference conducted at the end of the survey to talk over the primary outcomes. Specially trained surveyors visit correctional facilities seeking accreditation to measure compliance with NCCHC standards. These individuals share their time and knowledge because they are committed to the cause of improved quality in correctional health care (NCCHC, 2012).

To become an NCCHC surveyor, one must complete 5 years of experience in correctional health care, a CCHP certification (or receiving one in a year), and the drive to participate in preparatory and follow on training. Surveyors must be health care professionals. Examples include, Medical Doctor (MD), Doctor of Optometry (DO), Doctor of Dental Surgery (DDS) Doctor of Dental Medicine (DMD), Nurse Practitioner (NP), Physician Assistant (PA), and Registered Nurse (RN), or have a Master’s degree. The utmost important requirement of a NCCHC surveyor is the need of devotion and obligation to improving the quality of correctional health care.

Carson, A., & Golinelli, D. (2013). Prisoners in 2012: Trends in Admissions
and Releases, 1991-
2012. Retrieved from:
National Commission for Correctional Health Care. (2012). Promoting Excellence in Health Care: About NCCHC. Retrieved from: Rechtine, D. (2008). NCCHC’s New Standards and the Role of the Physician. Retrieved from: ncchcs-new-standards-and-the-role-of-the-physician

U.S. Department of Justice. (2012). About the Bureau of Prisons. Retrieved from:

Principles of safeguarding and protection in health and social care

1.1 Define the following types of abuse:

•Physical abuse involving contact intended to cause feelings of intimidation, injury, or other physical suffering or bodily harm.

•Sexual abuse is the forcing of undesired sexual behaviour by one person upon another.

•Emotional/psychological abuse may involve threats or actions to cause mental or physical harm; humiliation; isolation.

•Financial abuse is the illegal or unauthorised use of a person’s property, money, pension book or other valuables.

•Institutional abuse involves failure of an organisation to provide appropriate and professional individual services to vulnerable people. It can be seen or detected in processes, attitudes and behaviour that amount to discrimination through unwitting prejudice, ignorance, thoughtlessness, stereotyping and rigid systems.

•Self-neglect is a behavioural condition in which an individual neglects to attend to their basic needs, such as personal hygiene, appropriate clothing, feeding, or tending appropriately to any medical conditions they have.

•Neglect is a passive form of abuse in which the perpetrator is responsible to provide care, for someone, who is unable to care for oneself, but fails to provide adequate care to meet their needs. Neglect may include failing to provide sufficient supervision, nourishment, medical care or other needs.

1.2Identify the signs and/or symptoms associated with each type of abuse:

•Physical abuse when you have Bruises, pressure marks, broken bones, abrasions, and burns may indicate physical abuse or neglect.

•Sexual abuse can be bruises around the breasts or genital area, as well as unexplained bleeding around the genital area, pregnancy, STI’s may be signs of sexual abuse.

•Emotional/psychological abuse can be unexplained withdrawal from normal activities, changes in behaviour and unusual depression may be indicators of emotional abuse.

•Financial abuse can be no money, food, clothes. Large withdrawals of money from the bank account, sudden changes in a will, and the sudden disappearance of valuable items may be indications of financial exploitation.

•Institutional abuse can include poor care standards; lack of positive responses to complex needs; rigid routines; inadequate staffing and an insufficient knowledge base within the service; lack of choice, individuality.

•Self neglect can be bedsores, poor hygiene, unsanitary living conditions, and unattended medical needs may be signs of neglect.

•Neglect by others can be failure to take necessary medicines, leaving a burning stove unattended, poor hygiene, confusion, unexplained weight loss, and dehydration may all be signs of self-neglect.

1.3 Describe factors that may contribute to an individual being more vulnerable to abuse: If an individual is not mobile, is confused, has dementia, or is aggressive or challenging then this can increase the risk of abuse as the carer might not know how to deal with this, get frustrated and might take it personally and abuse the individual.

2.1 Explain the actions to take if there are suspicions that an individual is being abused: If I suspected any kind of abuse I will record the facts on appropriate paperwork and let my manager know.

2.2 Explain the actions to take if an individual alleges that they are being abused: If an individual alleges that they are being abused, I will record the detail of all allegations that the individual tells me using the individual’s own words, I will not ask any questions or make any judgements about what I have been told. I will take the allegations seriously and reassure the individual that they are right to tell me as their safety is the most important. I will make sure that I record the date and time when the abuse was report it to the manager.

2.3 Identify ways to ensure that evidence of abuse is preserved: •Record the facts immediately
•Report immediately
•Do not tamper with evidence

3.1 Identify national policies and local systems that relate to safeguarding and protection from abuse: •National policies – Safeguarding Vulnerable Groups Act 2006, the Vetting and Barring Scheme run by the Independent Safeguarding Authority (ISA), Criminal Records Bureau, Human Rights Act 1998. •Local Systems – Safeguarding Adults Boards, Safeguarding policies and procedures for vulnerable adults.’

3.2 Explain the roles of different agencies in safeguarding and protecting individuals from abuse:

Safeguarding Adults Boards Role:
The overall objective of the board is to enhance the quality of life of the vulnerable adults who are at risk of abuse and to progressively improve the services of those in need of protection The Police Role:

Serving the community, respect and protect human dignity and maintain and uphold the human rights of all persons. CRC Role:
We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care.

3.3 Identify reports into serious failures to protect individuals from abuse:

•October 2013: Police have arrested 7 care workers from the Veilstone Care
Home in Bideford in Devon over alleged abuse of people with learning disabilities. •February 2011: Julie Hayden was designated safeguarding champion for the London Borough of Hounslow’s older people’s team at the time the thefts were reported, but failed to follow correct safeguarding procedures in either case.

•August 2012: The serious case review into events at Winterbourne View, near Bristol, comes after 11 ex-staff members admitted offences against patients

3.4 Identify sources of information and advice about own role in safeguarding and protecting individuals from abuse: You can obtain information from Care Quality Commission, Local authority Adult Services Department like Social Services and Independent Safeguarding Authority. Can get advice on own role from my manager, care workers and my company’s policies and procedures on safeguarding from the office.

4.1 Explain how the likelihood of abuse may be reduced by:
Working with person centred values:
Person-centred values include the individuality of the person, the rights of the individual, the individual’s choice, the individual’s privacy, the individual’s independence, the individual’s dignity and the individual being respected. Encouraging active participation:

Active participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient. Promoting choice and rights:

Individuals are supported to make their choices in anything they want like in choosing food or drink, in what to wear, whether to use hot or cold water to bathe. No individual will choose what will hurt him or her therefore abuse is reduced to the minimum. Individuals’ rights are promoted throughout the service. My service user has the right to do anything that they wish to do and if it is what they want as long as it is not dangerous; a risk assessment is then done to stop any abuse happening.

4.2 Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse:

•The complaints procedure gives the complainant the right to be heard and supported to make their views known. An accessible complaints procedure is understandable and easy to use. It sets out clearly how to make a complaint, the steps that will be taken when the complaint is looked into. It also provides flexibility in relation to target response times.

•An accessible complaints procedure resolves complaints more quickly as the complainant feels that they are being listened to and their complaint taken seriously. This sets up an open culture of making sure that abuse will not be tolerated in any form and encourages the complainant to not accept this.

5.1 Describe unsafe practices that may affect the wellbeing of individuals: •Unsanitary conditions can spread infection as cross-contamination can occur and can affect the well-being of the individual and others. •Dirty kitchen surfaces and equipment can spread infections. •Improper hand washing can also pose a risk.

•Staff not recording in care plans about a service user’s wellbeing and health and not monitoring them. •Staff not checking when a service user is ill or unsteady on their feet. •In terms of health and safety not having risk assessments in place when a service user hurts themselves. •leaving a service user on the toilet too long, ignoring or not listening to them.

5.2 Explain the actions to take if unsafe practices have been identified: If I identify unsafe practices, I must follow the whistle-blowing procedure and immediately report to my manager or if it involves my manager then to another appropriate person.

5.3 Describe the action to take if suspected abuse or unsafe practices have been reported but nothing has been done in response: •If suspected abuse or unsafe practices have been reported but nothing has been done in response or if it has to do with my manager then I will report to the next level or manager. •If it has to do with my manager then I will report to management, then to the social worker and safeguarding team and to the care quality commission and even to the police depending on the response I get.

Principles of communication in adult social care settings.

1.1 Identify different reasons why people communicate?
•expressing and sharing ideas, feelings, needs, wishes and preferences •obtaining and receiving information
•getting to know each other

1.2 Explain how effective communication effects all aspects of working in adult social care settings? •service provision
•participation, support and trust
•empathy and shared understanding
•recording and reporting

1.3 Explain why it is important to observe an individual’s reactions when communicating with them

•to understand what an individual is trying to express
•to meet the individual’s needs
•to identify any changes in an individual’s needs
•to enable effective communication

2.1 Explain why it is important to find out an individual’s communication and language needs, wishes and preferences

An individual is someone requiring care or support

Preferences may be based on:

Importance of finding out an individual’s needs, wishes and preferences may include:

to enable effective communication
•to understand what an individual is trying to express
•to understand an individuals’ needs, wishes, beliefs, values and culture •to avoid the individual feeling excluded
•to avoid the individual becoming distressed, frustrated or frightened •to support the individual to be fully involved in their daily life

2.2 Describe a range of communication methods

Communication methods include:

Non-verbal communication:
•written words
•facial expressions
•eye contact
•physical gestures
•body language
•visual aids e.g. flash cards, pictures, symbols

Verbal communication:
•linguistic tone

3.1 Identify barriers to communication

Barriers may include:
•not understanding or being aware of an individual’s needs, wishes, beliefs, values and culture •not making communication aids available or checking they are working

•a noisy environment
•an uncomfortable environment e.g. lighting, temperature •a lack of

•different language, use of jargon

3.2 Describe ways to reduce barriers to communication

Ways to reduce barriers may include:
•understanding and being aware of an individual’s needs, wishes, beliefs, values and culture •supporting individuals to communicate their needs
•avoiding using jargon in written documents and when speaking •speaking slowly and clearly
•ensuring communication aids are available and working properly •showing you are listening and interested
•providing a quiet and private environment
•making sure the environment is comfortable

3.3 Describe ways to check that communication has been understood

Ways to check may include:
•observing the person you are communicating with
•‘reading’ facial expressions and body language
•checking with the individual that they have understood
•asking questions, re-phrasing
•consulting others

3.4 Identify sources of information and support or services to enable more effective communication

Sources of information and support may include:
•individual’s care plan
•individual’s communication profile
•individual’s communication passport
•individual themselves
•key worker
•speech and language therapist
•family or carers

Services may include:
•translation services
•interpreting services
•speech and language services
•advocacy services

4.1 Define the term “confidentiality”

Meaning of confidentiality may include:
•keeping information private and safe
•passing on private information with the individual’s permission •only passing on information to others who have a right to it and need to know it

4.2 Describe ways to maintain confidentiality in day to day communication

Ways of maintaining confidentiality may include:
•keeping written records safe
•not leaving written records in places where others might see •ensuring confidential information is passed on only to others who have a right to it and who need to know it
•password protecting electronic files
•checking the identity of the person before passing on information •not discussing personal information about individuals outside of work •providing a private environment

4.3 Describe situations where information normally considered to be confidential might need to be shared with agreed others

Situations may include:
•when working with others
•when a criminal act has taken place
•when an individual or another person is at risk of danger, harm or abuse •when an individual or another person is being placed in danger, harmed or abused
Agreed others may include:
•social worker
•occupational therapist
•speech and language therapist
•specialist nurse
•dementia care advisor
•family or carers

4.4 Explain how and when to seek advice about confidentiality

How to seek advice may include :
•the organisation’s confidentiality policy
•speaking with the manager

When to seek advice may include when:
•confidential information needs to be shared with agreed others •clarification is needed

Health Care Communications Methods

Health Care Communications Methods

In the health care industry there are several different ways to communicate. We must communicate with the doctors, nurses, care givers, patients and their family, guardian or representative. There are formal and informal ways of communication, as well as verbal and nonverbal ways to communicate. There are advantages and disadvantages to all of these communication choices, and HIPAA of 1996 regulates all of the information and the degree of how it is communicated and to whom it is communicated. There are several different types of communication methods that can be used when transferring information. There is verbal and nonverbal communication. Verbal communication would include things like speaking face to face, or when you are using the telephone, which is another great way to use verbal communication. Some other types of verbal communications would be the telemedicine; this is the clinics adoption of things like voice mail. According to a study done by NIH 50% of communication done in a clinical setting is done face to face while the other 25% is done through email and 25% is done through voice mail. (Tang, 1996). While according to another study 50% of all communications done in a hospital setting is done face to face with the patient themselves (Touissant, 2005).

When you are communicating using nonverbal communication, would be when you are communicating through sign language, eye contact, body language, hand written communication, emails, fax’s and text messaging. With these types of communication there is always room for potential errors to occur, due to typing errors, spelling mistakes and grammatical errors “If information is the lifeblood of healthcare then communications system is the heart that pumps it” (Lang, 1978). The communication process is made up of the people sending and receiving the message. The communication channel is quote the pipe that the message travels on. As the administrator of a small local nursing home I have just received information that a large national group is purchasing our small establishment. This is going to pose several challenges because many of my patients either have trouble communicating, either because of health reasons or the fact they cannot understand, I have a lady that does not speak a bit of English, and she is deaf.

This poses a big problem because I will need to get a Spanish speaking person that knows how to use sign language in Spanish. For my patients that do not have any family in the local area I will have to send out written notification to their family members last known address and request the mail to be forwarded. I will try to use any email addresses that the family or guardians have left for us to use in case of an emergency. It is a possibility to use social media like face book and twitter to put out a message regarding the nursing home being sold and the patients being displaced but there is only a limited amount of information we can put on the interned due to the HIPAA and the protected medical health records (duPre, 2005). The information used in the social media sites must be general in nature only, no names or personal information can be released or that would be a violation of the HIPAA privacy act which would come with sanctions and fines that the nursing home cannot afford, especially now, the last thing we need is negative publicity.

With all communication there are advantages and disadvantages, some of the advantages of using social media like face book and twitter would be the fact that you can reach hundreds, thousands even millions of people with only one post on the social media sites. Some of the disadvantages of using social media sites are the restrictions and lack of detail we are able to use when referencing the patients. Some of the family members have not seen their family in several years and it is possible without a name they may not even know that the message would or could pertain to them or their family because it has been so long since they have had any contact with them.

In conclusion there are many different ways to communicate in the health care industry, there are verbal and nonverbal communications, and there are formal and informal ways of communication. We can communicate face to face, over the phone, via email, voice mail, face book and twitter. The HIPAA privacy act of 1996 protects and regulates the way we disclose the protected medical information about our patients. When communicating information over the internet through face book, twitter and other social media sites there are specific protocol that must be followed on order to protect the privacy of our patients protected medical records.

Tang, P.C.,(1996) Clinical information activities in diverse ambulatory care practices. Falls Surp. PubMed . Touissant, P.J. (2005). Supporting communications in health care. Boston, PubMed. duPre, A. (2005). Communicating about health care. Current issues and perspectives (2nd ed.). Boston, McGraw Hill. Hicks, N.J. & Nicols, C.M. (2012). Health industry communication. New media, new method, new message, Burlington, MA: Jones & Bartlett Learning

Engage in personal development in health, social care or children’s and young people’s setting

My duties and responsibilities as a foster carer are many, i must have child A best interests at heart at all times, i provide a safe and stimulating environment for child A to develop to the best of her ability, to keep her safe from harm and abuse. I must make sure all her appointments e,g doctors dentist and language and speech are attended and up to date and recorded.

That child A is taught about personal hygiene and why it is so important to do this daily , where ever she may be living. Be a positive role model for her, show her i am there for her to depend on and what i say i mean and do, help her with her school work giving positive praise for the smallest of tasks. To give her new experiences help her to develop her social skills, give her ways to show how she’s feeling, talk and listen to her about what’s going on, show her that her that she is important , that her views and feelings matter, keep her well informed of what’s happening on her behalf , doing all this and keeping confidentiality.

For me to carry this out to the best of my ability i attend regular training for me to develop the skills i need , also attend meetings with appropriate people e,g social workers, key workers, guardians, teachers and any other professional that has an influence on child A’s life. I also attend a support group that has talks about different issues that may occur and a chance to talk to other foster carers and social workers about any concerns i may have in a confidential setting. I also keep records, daily logs which are kept locked away for confidential reasons, on how child A is doing, and her positive behaviour also any concerns I may have. I also take child A to contact on a few occasions during the week, having a positive relationship with the people child A sees is a positive experience for her.

1.2 This QCF is based on The National Occupational Standards that you are expected to meet in every unit. Explain the expectations about your own work
role as expressed in relevant standards ie Code of Practice, National Minimum Standards, National Occupational Standards.

Health and safety at work act 1974 all electrical equipment working correctly, all gas appliances safe to use, these are to be checked yearly by qualified people. No hazards that can cause slips trips or falls. That all hazardous substances are locked away. All outdoor areas are safe from harm. All vehicles that are used are road worthy. That household hygiene is paramount at all times. That pet are well behaved. That general safety is maintained at all times. Childrens act 2004 , every child matters :- 5 core outcomes, Be healthy:-promote physical, emotional, mental health. Stay safe :- keep them safe from maltreatment , neglect, violence and sexual exploitation , accidental injury and death, bullying and discrimination.

Enjoy and achieve :- support leaning, attendance at school, stretching abilities. Make a positive contribution: – encourage making choices , being involved, promoting good behaviour. Achieve economic well-being :- encourage further education, better lifestyles. Care council for Wales, code of practise for social care workers :- As a foster carer i must protect the rights of child A promote her interests , gain her trust and build her confidence, promote her independence, but keeping her safe at all times. Respect her rights and choices as long as they cause no harm to herself or others. Be accountable for my work, take responsibility for my actions and maintain and improve child A’s knowledge and skills, do any relevant training for me to be able to carry out my role effectively.

2.1 Explain giving three reasons why reflective practice is important in continuously improving the quality of service provided I feel reflective practise is very important within my role as things change all the time, i have to be able to adapt to any given situation and deal with it at that time, by looking back at what you did, will help you to see if you could have dealt with the situation differently, if it occurs again or a similar situation. The environment, age and development, life experiences, training are all factors. Reflective practise helps to improve my quality of care, increases my confidence learning and through experiences, no-one is right all of the time.

2.3 Describe how your own values, belief systems and experiences may affect your working practise. As a adult i cannot remember being told “i love you” being hugged or any signs of affection being given, but i do know i was loved. I have brought into my family hugs whenever wanted or needed or just a hug for no reason, i tell my daughter and child A i love them every day, and i do. (if this is what the child wants).

4.1 Identify 3 sources of support available to you for planning and reviewing your own development. I receive support and encouragement from my QCF assessor, my key worker and the children i work with, within my role and family life.

SHC 31: promote communication in health, social care or children and young peopl’s settings.

Building a positive relationship with colleagues and children is important in the workplace, it helps you and others feel comfortable with their interactions. You will feel happier and supported and supportive towards others. SHARING IDEAS AND THOUGHTS

Sharing ideas and thoughts with others in the team keeps everybody on the same plan of action throughout the day; it is also a fun way to interact with children to ask their ideas and what they think about e.g. books, pictures, the weather and anything else of interest at that present time. EXPRESSING YOUR NEEDS AND FEELINGS

Expressing your needs and feelings is it prevents everybody being confused and helps you and others to understand about any difficult or misunderstood situations. It is also vital to understand children’s needs and feelings so they feel happy, safe and secure. KNOWING YOUR ROLE IN WORKPLACE

It is important to know your role in the workplace because others will know what you are doing throughout the day; people will have other roles to do so all can run smoothly. CREATE BONDS
Creating bonds with colleagues helps everybody trust and believe in each other, creating a positive connection. TO SET UP A ROUTINE
Children fear the unknown and creating routines are a good way of helping children feel safe, comfortable and at ease with school friends and teachers, because routines gives them a sense of security. The nursery will run efficiently on a system of routines. BUILDING CONFIDENCE

Communicating and interacting with others builds your confidence, helping you
overcome any insecurity’s, e.g. if you lack in confidence about reading to a group of children you would start with one child and gradually to a small group of children, reading aloud in private or if you have your own children you could pretend it’s your own children your reading to. TO MEET INDIVIDUAL NEEDS

We need to monitor children on a daily bases, by observing them, recording observations of their interest and using them to plan children’s next steps to suit their individual needs and education plans. TO WORK EFFECTIVLY IN A TEAM

It is important to work well in a team as it enables individuals to focus on one main objective; it also gives all involved to contribute their own ideas which give everyone a sense of belonging. TO SHOW INTEREST

It is vital to listen to children when they are speaking to you, keep eye contact with the child until they have finished and have a answer for them to help them understand why, what and where in answer to their question. LISTENING IS A (TWO WAY PROCESS)

Listening to a child and a child listening to the adult is important because it reduces confusion. A child listening to a person does not always mean they are hearing. Reading aloud to children helps improve their listening skills and more importantly their hearing skills. A child loves you to listen to them, it make them feel self worth when their thoughts are important to you.

Handle information in health and social care setting

Outcome 1 Understand the need for secure handling of information in health and social care

Identify the legislation that relates to the recording, storage and sharing of information in health and social care The Data Protection Act 1998 covers anything relating to a person, medical records, social service records, credit information, local authority information. There are eight enforceable principles:

Personal data shall be processed fairly and lawfully

Adequate, relevant and not excessive
Not kept for longer than necessary
Process in accordance with the data subject rights
Not transferred to countries without adequate protection

The Data protection Act also allows people to see information recorded about them through the Freedom of Information Act 2000, therefore people are allowed to see their social care files, this is important to know when entering information in people’s notes. The ICO Information Commissioner’s Office is responsible for upholding information rights in the public interest.

Explain why it is important to have secure systems for recording and storing information in a health and social care setting Information on Care homes and in house information is valuable and critical to the business of the home. This information must be stored and processed therefore it is essential that Information Security is maintained. The purpose of information security is to preserve:

Confidentiality data is only access by those with the right to see them. Integrity information can be relied upon to be accurate and process correctly. Availability information can be accessed when needed.

Insecure information can lead to violation of an individual’s human civil rights that may results in neglect/or physical, sexual, emotional or financial harm. Manual system of recording information has to secure so they are usually kept in a locked cabinet and may be in a secure room.

Outcome 2

Know how to access support for handling information Describe how to access guidance, information and advice about handling information The first place to look for guidance and advice is the supervisor with regards to information in the work place. If you require information about a person, then that person’s care plan would be ideal. Information about legislation to ensure that you are complying with the law, them the Information Commissioner’s Office is the place to contact.

Explain what actions to be taken when there are concerns over the recording, storing or sharing of information If there is a concern relating to people’s records, the concern should be directed to the manager who is in the position to deal with the concern. For taking a concern further that has not being resolved, the concern needs to be : Put in writing

Be clear about dates, times and the exact nature of the concern Identify the steps that have already been taken and the response Involve trade union or professional organisation for support The steps for resolving concerns:

Discuss with line manager
Record the concerns and take it to a more senior manager
Take it to director or chief executive
Take it to the inspectorate
You are protected from unfair dismissal by an employer through the Public Interest Disclosure Act 1998 if your concern relates to the employer.

Outcome 3

Be able to handle information in accordance with agreed ways of working Keep records that are up to date, complete, accurate and legible Records should provide objective, accurate, current, comprehensive and concise information concerning the condition and care of the client. The records kept should reflect an accurate and up to date picture of somebody’s situation. Records are kept to:

Provide a full assessment of the client’s needs

Provide record of any problems and the actions taken
Provide evidence of care required
Provide a baseline record against which improvement or deterioration may be judged

Records should le after be made as soon as possible after the event providing current information on the care and condition of the person.

Follow agreed ways of working for:
Recording information

Good recording of information supports good practice in a number of ways. Supports effective partnership with users and carers, provides documented evidence and account of the department involvement with an individual, support risk assessment and risk management plans.

The principles for recording:-

Service users and carers are helped to understand the purpose and contents of their case record and are invited to contribute to it. Case records will be kept in accordance with Department of health guidance and legal requirements.

Storing information

A care plan contains valuable information about a person in care and this information has to be stored. All documents are stored according to legal, organisational and ethical standards. Some information can be stored and displayed openly, i.e. menus can be stored in a kitchen. Documents, such as care plans, medication sheets, and employee files need to be stored in locked cupboards in locked rooms to deny access to those who have no right to the information.

Sharing information the home has a general duty in common law to safeguard the sensitive information they hold of individual’s. The home should have a clear policy on the Data Protection Act which staff should adhere to. It is important that staff should pay particular attention to ensuring consent to share information is clearly recorded on file. Where it has been necessary to share information without consent then the justification should be recorded and authorised by the line manager. There are different reasons for sharing personal information without consent:-

Court or tribunal orders

A person’s best interest
Risk to health
Police request
Public interest
Protection to others
Partner agencies providing support.

It is important that you know the policies of the care organisation with regards to confidentiality and the disclosure of information in your workplace. The basic rule is that all information is confidential and cannot be shared with anyone without the consent of the person.

Health and Social Care

Everyone is born into this world by the choice of the parents, no one asked for it. And so we all have no choice into which country we are born, who our parents are, what sex we are, and the colour of our skin. But all of these factors combined give us our culture. It makes us who we are. As we grow older our parents or peers instil us with a set of beliefs, moral and social, and this stays with us up to the age where we are able to think and act independently. Then we are able to change these beliefs to that of our own. This then allows us to have a set of preferences for the way we live our life. What happened in our past we cannot change, and it is from our past that gives us our heritage. Who we are and where we came from. All of these beliefs, culture and heritage are personal to us, make us who we are, they are an everyday important tool in the way we live our lives. Though they are not defined! We can change and we must change in certain environments.

One being the workplace. It is of utmost importance at work that a standard set of rules and beliefs are adhered to, no matter what your culture or heritage. This is to ensure all people are treated fairly and the rules and beliefs are usually along the same lines e.g. treating all people fairly, respect one another etc. In the work place we have colleagues and residents and visitors who all deserve the same amount of dignity and respect and all have the right to go about their business without being influenced on their beliefs by a single other person. By all sticking to the same set of standards and beliefs we can ensure a fair service is provided to all.

However does this mean that when we are in the workplace we can forget our own identities and that of others? No. It means that we have a common set of values that we will all abide by in order to treat all people fairly. For example not treating male residents any different to female residents, offering them the same opportunities. But we must also understand very clearly that each individual has their own set of beliefs, culture and heritage and that we must not discriminate base on this. What we can do is learn to understand this. Embrace it and promote it. It is very easy to believe that our own way of doing thing is correct and anyone different is wrong or inferior. This is due to a lack of understanding of the unknown.

When we start to understand more about the unknown it becomes the known and so is more acceptable to us. So by understanding and respecting the beliefs of others we can learn very much. The whole practise of understanding others and respecting there values is not only essential to provide an equal and comfortable work space. It is the key tool in promoting wellbeing, happiness and a sense of inclusion in our residents and staff. If we all stuck to our own beliefs we would all be alone and feel different from all others. By showing understanding and respect we can learn and respect each other and make for a happier place to be. Assignment 303

In my workplace we use inclusive practise in all areas. Examples of this can be asking individuals what time they would like to be assisted to bed and not assisting all residents at a set time. It could be offering the individual a choice of clothes to wear and not making that choice for them. It could be asking the individual residents what they would like to eat and giving choice. Not giving all residents the same meal. It can be as simple as talking with the residents and not talking over them. Asking them what they want and not asking other staff members. It could be helping the residents access the local library at their convenience and not waiting for the once weekly trip by bus. These are all examples of how inclusive practise helps the residents contribute to the care they receive. This is essential in promoting wellbeing and raising standards of comfort and happiness.

Exclusive practise should not be accepted in the workplace. Examples of this could be having separate lounges and dining rooms for Male and Female residents. Having only activities that favour one gender. e.g. Knitting, flower arranging and card making. And not having an activity that would suit a male resident. It could be only celebrating Christmas in the Christian calendar and not considering those who are of another faith and allowing them to celebrate their own festival too. It could be only providing one option at meal times and not considering those who have another taste. It could be waking all residents up at the same time in order to get your jobs complete and not respecting the individual’s right to choose when they want to wake up. All of these practises hinder the progress of good care and will prevent the individual having a high sense of wellbeing.

Handle Information in Health and Social Care Setting

1.1 The legislation that relates to recording storage and sharing of information known as care plans is the Data Protection Act 1998. There are 8 principles to be followed when gathering data 1) processed fairly and lawfully 2) processed only for 1 or more lawful purpose 3) adequate and relevant 4) accurate and up to date 5) kept for no longer than necessary 6) processed in line with the right of the individual 7) secured against loss or damage 8) not transferred to countries out of EEA. 1.2 It is important to have secure systems for recording and storing information to prevent personal information from being misused. Any information that has been gathered is confidential but written evidence may be required by other professionals on occasions. Also if new staff members arrive they can read the care plans to gain all the information needed.

2.1 I would follow my company’s policies and procedures for guidance and advice about handling information but would also speak to my directors or Human resources office. Information can also be gained from government websites for advice or other professionals. 2.2 If there are concerns over the recording storing or sharing of information i would document and report my concerns and secure all the information immediately.

3.1 Agreed ways of working relates to the company’s and government policies in relation to Care Plans. All documents should be evaluated and reviewed regularly, updated as required, completed and legible so others are able to decipher them. 3.2 Agreed ways of working when

a) Recording information; would be to follow the company’s and government policies to ensure all information gathered is accurate, legible, complete and confidential. b) Storing information; all information that is gathered should be stored in locked filing cabinets that are only accessible to the persons requiring access to information.