This essay will discuss the concept of person centred care, why ser-vice users are at the centre of any decisions made. The importance of this when developing a plan of care to an individual with dementia within a community care setting with limited mobility. What the structure of the mutli disciplinary is when involved in delivering a package of care and how the different roles involved contribute to the positive outcomes Principles of care as stated by the Royal College of Nursing (2013) outlines guidelines what service users should expect from the nurs-ing profession, whether you are a nurse, health care assistant, community nurse, a service user, family member. You are given the information of what to expect when you are in contact with any of the services or who actually are providing a service. Within the community sector this is important as it gives carers a guideline on how to deliver the best possible care and how they should conduct themselves when dealing with vulnerable people. The Royal College of nursing (2013) outlines 8 principles of care they consist of; that all health care assistants, nurses treat all service users with dignity, respect, show understanding of the service users needs. To be non judgemental in the care being provided, whilst showing compassion and sensitivity.
All nurses and health care assistants take responsibility for their actions in the care they are providing whilst also being answerable for any action and decision that they take. To manage and assess risk to ensure the safety of the service user and others. To promote the care that is being given putting the service user at the centre of that care, whilst also involving any family members. To ensure that the service user is fully informed of any treatment, to enable them to make an informed choice. All health care assistant and nurses are in the front line for communicating any changes of the service user, recording such things, communicating with other members on the care being provided, whilst maintaining confidentiality. Have up to date knowledge and skills in order to deliver the highest possible level of care to everyone. Work closely with other profes-sionals to ensure that continuity of care is followed to have the best possible outcome for the service user and the staff team. To develop themselves, to encourage and highlight to other professionals the importance of updating knowledge and skills. Many people have different definitions on what Person centred care approaches mean to each individual profession and what their roles involve when implementing person centred care.
The Health Foun-dation 2014 suggests that more person centered care is needed, so that people are supported to make informed decisions about manag-ing their own health and care. In order for this to happen changes in behavior and mindset from patients and clinicians supported by a service that has patients at the heart of it. Policies and practice guidelines need to support patients and clinicians to take on new roles and relationships. Ford 2012 wrote an article on what the value of patient care is this was described as the 6 C’s which stand for care, compassion, com-petence, communication, courage and commitment. Brooker (2007) states that by providing a supportive environment for interaction, whilst taking into account that all human life is mainly grounded by relationships. Within the community environment People suffering from dementia requires and need a fulfilling social environment which enables them to have opportunities for growth within the environment that compensates for their impairments. Brooker focuses on the actual diagnosis and how best to help service user to maintain a social connection within a safe environment with the help of staff who understands their condition.
Whilst the article that Ford had written expands the key points on how professionals should take into consideration and act when looking after people and communicating with them also. Tuchman’s theory (1965) suggests that in order for a positive outcome to happen then 4 stages of process would need to be worked through within a group situation. These stages are forming, storming, norming and performing. Person centred care was first used in relation to people with demen-tia by a Professor called Tim Kitwood who founded the Bradford de-mentia Group in the 1980’s. His aim was to steer away from the medical diagnosis of dementia and to help those living with the ill-ness to live and be treated as an individual. To acknowledge that these people did have a voice even though in the medical eyes they were slowly losing their own mind. He wrote about the Enriched Model (1997) which detailed opportunities to maximise the well being of a person suffering from dementia whilst enhancing their daily living of the other elements that affect the person.
For example people suffering from dementia have many challenges to deal with. They have the gradual memory loss but also lose the interaction with others, communication becomes repetitive and in the past, how to eat, drink, co ordination, coping with mood changes, general daily living skills become more difficult to complete along with depression. Buijssen 2005 suggests that depression is a main factor with dementia due to lots of feelings of helplessness and anxiety which can cause the service user to have challenging out bursts. To enable a person to remain in their home safely and independently other people will be involved. This depends on how advanced the dementia is, otherwise the service user would be placed within a residential or nursing home. Maureen Guirdham (1995) suggests that by practising empathy when communicating with a service user, seeing things from their point of view and not just by a medical point of view can build a positive professional relationship.
Some professionals at times use their position to influence a service user to see things from the professional point of view; this can cause a barrier to communication because the service user feels that they are not being treated as an individual. That the professional is using a form of blanket suggestion and solution to their problem. Having a common ground of understanding of what it is to be achieved. Initially within the early stages social workers, mental health nurses, general practitioners, speech and language therapists, mobility spe-cialists, and the NHS. Within a community setting district nurses, general practitioners, and at times the emergency services such as the mobile paramedics and ambulance crew are the main sources of the multi disciplinary team that as carers we would normally work alongside with. Jefferies & Chan 2004 describes how multi disciplinary teams work “the main mechanism to ensure truly holistic care for patients and a seamless service for patients throughout their disease trajectory and across the boundaries of primary, secondary and tertiary care.” Carrier & Kendall 1995 also describes how inter disciplinary teams work “implying a willingness to share and indeed give up exclusive claims to specialist knowledge and authority, if the needs of the client can be met more effectively by other professional groups.”
Not all of these will be involved but people with dementia require different specialists at different times of the diagnosis. Almost everyone is registered with a general practitioner. It is the job of the general practitioners to offer high standards of care to all their patients regardless of their health needs. To establish a continuing and long term relationship, with all their patients including those who are vulnerable (Pritchard 2001). More and more General Practitioners (GP’s) are working within an extended team of professionals who they can refer to for advice and guidance. General Practitioner’s are the first people who are approached when a family member are feared to have the onset of dementia. GP’s will refer the person to the mental health team to have an assessment to see if there are any concerns to have (Mental Health Act 2005). Once the assessment has been done and the diagnosis had been confirmed then a social worker with the relevant experience of mental health issues will be assigned to implement further care decisions. A social worker works with people who have been socially isolated or who are experiencing crisis mentally or physically. Their role is to provide support to enable service users to help themselves. They maintain professional relationships with service users, acting as guides, advocates. Social workers work in a variety of settings within a framework of relevant legislation and procedures, supporting individuals, families and groups within the community.
Settings may include the service user’s home or schools, hospitals or the premises of other public sector and voluntary organizations. This could be introducing carers from an agency to help with daily living needs, preparing food (Roper et al 1996) Day centres can be arranged for the person to be able continue interactions with others, by still being around professionals who understands their needs and condition. Dementia tears layer away at a person at each stage of its progression, (Alzheimer’s Society 2014) The World Bank 2011 describes what empowerment means “Em-powerment is the process of increasing the capacity of individuals or groups to make choices and to transform those choices into desired outcomes. Central to this process is actions which both build individ-ual and collective assets, and improves the efficiency and fairness of the organisation and institutional context which govern the use of these assets.” Mental health nurses work with people suffering from various mental health conditions, they also work alongside their family and careers to offer help and support in dealing with their condition.
There work involves helping the patient to recover from their illness or to come to terms with it in order to lead a positive and full life. The nurses may specialize in working with children or older people, or in a specific area such as eating disorders. Mental health nurses often work in multidisciplinary teams, liaising with psychiatrists, psychologists, occupational therapists, GPs, social workers and other health professionals. As a registered mental health nurse (RMN), they may work with pa-tients in a variety of settings including their own homes, community healthcare centre’s, hospital outpatients departments or specialist units, or secure residential units. Even though each professional has a specific area or expertise communication is always a key factor to delivering the best support and care to a service user and their families. District nurses have a crucial role in the primary health care team by visiting people in their own homes. District nurses also deliver care and support for patients and their families. With the differences in roles bought together as one within meetings or communication the process of care is flawless but in the real world this does not always happen.
The Health Foundation (2013) states that they “See patients as equal partners in planning, developing and assessing care, to make sure it is appropriate for their needs, putting families and patients at the heart of all decisions”. Egan’s (2010) three stage model the skilled helper explains how professionals can help service users to focus their situation. To be able to ask questions and step by step understand the process. The model helps to empower the person and help them to move toward managing their problems and living more effectively. The Egan’s model enables the user to map out what the issues are that require discussion. To explore all possible solutions and what would best benefit the service user. It enables the professionals to have respect, genuineness to the subject and empathy to the service user. If good active listening skills are re-membered then the outcome will be the best that can be given to the service user. Egan’s model however all stages do not always have to be considered they are adapted to the situation that requires re solving. Another element that is considered is the SMART aspect which stands for specific, measurable, achievable, the mutli disciplinary team this is where individual roles are separated in order to fulfil their part of the plan of care for a service user.
The Department of health (2011) outlines specific guidelines when treating someone with Dementia. These guidelines just like the one that the Department of health released and updated in June 2011 are guidelines and are there to help protect vulnerable people. Working within the community I found I was working alongside more people suffering from early stages of dementia and having more insight into how dementia affects the person enabled me to have a better approach to deal with the care that was being provided. 1000 lives plus 2012 that was written by Davies stated that “Seeing the patient’s illness as a continuum between treatment and rehabilitation leads naturally to partnership between organisations. Departments across health and social services co-operate to fulfil the patient’s needs, and the relevant providers need to be working together at all stages of care to properly anticipate the next step, particularly the return home after in-patient care”. This report emphasised that even though Esther arriving at a NHS hospital was ok and the staff where very polite and caring.
The sys-tem still had failures especially when Esther had to wait five and a half hours to be seen and after being in contact with thirty six people professionals and repeatedly repeating information for someone who could not breath caused a lot of distressed. By establishing some of the professionals roles within the multi dis-ciplinary team and how government legislation and guidelines impact on how care is provided. In the community for someone who has dementia and other physical needs how efficient are the multi disciplinary team? Sometimes available equipment is based on budget from local councils, so as availability of professional bodies. A person I looked after in the community had a diagnosis of dementia. Visiting them daily sometimes four times a day assessing their needs and any changes daily was important to maintain their safety within their home. Any personal care, breakfast, dinner, tea and bed time all had to follow a strict routine.
There came a time when this service user was falling a lot so with the reports given by carers to their head office it was decided the social worker should make a visit they managed to get some adaptations put in place. A wheel frame that could be used to carry things on as it had a tray at the top and at the bottom, the social worker also got a waist alarm, similar to the wrist or necklace type alarm that is linked to a call centre. So if this service user fell the belt would activate automatically because the sensor knew it had to be vertical not horizontal. Within the guidelines of the company policy and given the rights of the person to choose to stay at home, every safety measure to reduce risk was taken by all parties. The service user felt at ease with everyday tasks as before they where a problem. The simple things that we take for granted are the things that need to be taken into account for others. (Human rights Act 1998).
Jeremy Hughes, Chief Executive at Alzheimer’s Society said: ‘Today’s announcement shows that by entering your postcode you enter a lottery. Depending on where you live you may be more or less likely to get a timely diagnosis of dementia and access to the support you need. This is simply unacceptable. Wherever you live, you should be entitled to care and support when you have Alz-heimer’s disease or any form of dementia. It is a National Health Service. It is time to stop treating people with dementia as second class citizens.’ (2013) By introducing the appropriate training and having diagnosis’s being given earlier then people will this diagnosis may stop feeling that they are just being a pain to society and that they still have a function within society. The NHS Wales (2010) five year plan included guidelines to em-power the professionals on the front line for example clinical and non clinical staff to lead changes and deliver the highest possible care available.
All these proposals of improving the NHS and the services attached to them is a positive sign for change but as we all know changes can only happen if the funding is available which predominantly involves the tax payers. Some changes that will happen will be making primary care trusts and strategic health authorities abolished and replacing them with one organisation such as the clinical commissioning groups. Who will over sea and involve local authorities in a bigger role to handle budgets. How effective these changes will be to improve the entire system will only be seen in a report that will be released sometime in 2015 as stated in the NHS (2010) five year plan. Main reasoning for continual reviews is to establish a better link to all professions to enable the protection of the vulnerable and to have the sufficient resources to enable action to be taken so that the negative cases that are reported do not happen again.
Courtney from Study Moose
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