Professional Values and Awareness Essay

In this assignment I will identify issues that affect the care provided in a home for adults with learning disabilities. Using the â€Å"case study† format I will focus on the interpersonal relationships and identify the underlying factors that influence them, then provide explanations for these by applying established theories. Churton (2000:214) describes a case study as â€Å"a detailed investigation of a single research area†¦Ã¢â‚¬ . The case study will form a unique representation of the individuals involved at the time they were observed. As a single study the outcomes may not be representative of all care homes, but it is reasonable to assume many issues may be similar. As a student I was able to observe both staff and clients in their normal routines. I was accepted as a member of the care team and took part in daily activities. This form of research is described in Giddens (1997:542) as â€Å"Participant observation†. Becker describe the role of the researcher as â€Å"someone who watches the people he is studying to see what situations they ordinarily meet and how they behave in them† (cited in Marsh I. 1996:124), however the by taking on a role within the group that justifies their presence the researcher acts as more than a passive observer and becomes a participant. As a stranger to the group my presence will have affected the behaviour of the clients and studies have shown that the presence of students affects the way that qualified staff work (Reed J & Procter S. 1993:31). My own preconceived ideas of Learning disabilities and the staff and clients previous experience of students will all have contributed to the behaviour I witnessed. On my first day at the placement I was introduced to my mentor (the deputy manager). We discussed the homes basic philosophy and the clients’ disabilities. I was introduced to the nine clients, and the staff approximately 15. During this first meeting my mentor made me feel welcome and allayed some of my fears about the placement. Unfortunately other than two brief conversations this was the only time I worked with her over the six-week placement. The staff are mostly female with only four male staff. They were of all ages and came from a mix of races and religions, some single and others married with children. All of the staff are support workers and most have NVQ level 3 or are currently studying towards it. I found all the staff very friendly and felt welcome, but I also felt a like a ‘spare part’, as the clients were encouraged to do things for themselves, very little intervention was necessary. Record keeping, giving medication and supervising the clients at the many activities they attended were the main tasks. The days soon became very predictable with set activities and â€Å"opportunities† to be achieved. The slowness of the day meant that staff talked a lot, discussing personal matters as well as how they felt about the clients and their jobs. Conversation included issues around the low regard support workers had from the general public and other health care professionals, the quantity of paper work to be completed daily and the emphasis placed on it, little support and understanding from the management, and having to attend college in there own time. My personal performance was influenced most by the lack of a mentor. Without a mentor to shadow I would try to â€Å"latch onto† a member of staff only to find that we were on different activities or were at the end of their shift. My shifts and my mentors were not together, when I asked the manager if I could swap my weekend to the same as my mentors, she told me that there was no need for me to work with my mentor at all. I was left feeling very isolated. The need for student and mentor to work together â€Å"as much as possible† to build successful relationship is highlighted in Baillià ¯Ã‚ ¿Ã‚ ½re’s Study Skills for Nurses (Maslin-Prothero1997:32). Good mentoring is a two-way process requiring willingness from both mentor and mentee to build a collaborative relationship (Ellis et al 1995:121, Ajiboye P. 2000:11). Formal mentoring is relatively new to nursing (Maslin-Prothero 1997:51), and is closely related to Project 2000 (Salvage J.1999:14). The ENB define mentors as â€Å"an appropriately qualified and experienced first-level nurse/midwife/health visitor who by example guides assists and supports the student in learning new skills, adopting new behaviour and acquiring new attitudes† (as cited in Quinn F. 1995:188). Mentorship has existed for centuries with references dating back to Greek mythology (Ellis R. et al 1995:109), and it is widely used for career development in business, where mentors are â€Å"role models, talent developers and door openers†(Tyson S. & Jackson T. 1992:121). There are several theories on how mentoring works, most emphasise the mentor as a facilitator allowing the student to experiment while ensuring the safety of the patient/clients, and providing a â€Å"developmental bridge between theory and practice† (Ellis R. et al 1995:109). Communication and interpersonal skills are the foundations on which a successful relationship is built and are therefore essential skills in a mentor (Ellis R. et al 1995:121). However the mentor themselves may be the most important factor. A mentor is a role model good or bad. Hopefully the student will witness a high standard of practice and set their own standards similarly. But when the standard is low it depends on the students’ knowledge of the theory as to whether they choose to imitate the mentor or apply their own higher standard. Bandura (cited in Ellis R. et al 1995:116) describes this process as Social Learning Theory, a three-stage process. Stage 1 Observational Learning: Imitating a good role model Stage 2 Inhibitory/Disinhibitory Effects: bad practice rejected or imitated Stage 3 Eliciting Effect: good practices learned and core knowledge improved. The break down of the mentor mentee relationship on my placement may have been for variety of reasons, poor communication, unrealistic expectations or time constraints. Supernumerary students have time to observe and reflect, but mentors may have an already busy schedule and supervising students can become just another pressure (Reed J. & Procter S. 1993:36). Students in this environment may find themselves being used as â€Å"another pair of hands† (Ajiboye P. 2000:11). Many texts cite good leadership of the manager as vital to forming an atmosphere conducive to learning (Quinn F. 1995:182). A good manager will find time to inspire staff to enthusiastically provide high quality care (Grohar-Murray 1997:125). In the philosophy of care/service values of the placement it states that â€Å"we have a well trained staff who have achieved a NVQ in care or are working towards it† (not referenced to protect confidentiality). However the staff studying the NVQ had to attend college in there own time. This caused resentment towards the management as the staff felt that the qualification was for the company’s benefit, but at their expense. Tappen (1995:69) recognises that by allocating staff time to attend lectures or college days without them incurring financial penalties the outlook is changed from just gaining a ‘paper qualification’ to ‘an opportunity’ to develop skills and increase personal knowledge. Encouraging staff to develop new skills is a great motivator. Motivation has been described as â€Å"the oil that keeps the machinery turning† (Dell T. 1988:59) and is a key element in many leader/management theories. Many motivation theories are based around the concept of fulfilling needs. Maslow (1968 cited in Hogston R. & Simpson P. 1999:295/303) devised a hierarchy with seven levels, the first level are basic physical needs such as food and water progressing up to more psychological needs of self fulfilment. Individuals climb the pyramid a step at a time motivated by fulfilment at the previous level (see appendix 1). Kafka (1986 cited in Tappen 1995:304) offers five basic factors for motivation, Economic security, Control, Recognition, Personal self-worth and Belonging. But unlike Maslow the five may be placed in any order, as one person may be motivated more by the need to belong than the need for money (see appendix 2). Self-esteem/worth and belonging are needs common to both Maslow and Kafka. If managers boost self-esteem by acknowledging good practice and recognising achievements they enhance the feeling of belonging. Without feedback staff often feel overlooked and isolated. To be constructive feedback should contain both positive and negative elements and be based on observed behaviour, given objectively it can highlight areas that need strengthening and increase motivation. Kron (1981 cited in Tappen R. 1995:420) described this â€Å"positive feed back† as a â€Å"psychological paycheque†. The need to belong affects students, when they are included in procedures, and given opportunities to express opinions and don’t feel â€Å"in the way† they become part of the team. Being accepted boosts self-esteem and motivates learning (Oliver R & Endersby C. 1994:94) Dell statement that â€Å"people work harder for recognition than for money†(Dell T. 1988:59) is supported by a study of the affect of incentives such as pay increases and shorter hours. When each incentive was implemented productivity was found to increase. When the incentives were removed and working conditions returned to normal it was expected that the productivity would fall. In fact productivity rose â€Å"to the highest levels ever†. Mayo’s conclusion was that being in the study had caused the group to bond (belong) and that the interest (recognition) showed by researchers had encouraged the workers to achieve the level they believed the researchers expected of them (Mayo E. 1933 cited in Barratt M. & Mottershead A. 1999:74). If the security of â€Å"belonging† is absent self-esteem deteriorates which can lead to an â€Å"increase in complaints and fatigue†¦and absenteeism is likely to rise†(Barratt M.& Mottershead A. 1999:73). Lack of appreciation and support are two of the ten factors cited by Tappen (1995:455) that contribute to ‘burnout’. As the â€Å"most caring and most highly committed are often the ones most prone to burnout† (Eisenstat & Felner cited in Crawford J. 1990:48) it’s frequently linked to health care. Burnout is defined as, (Kozier B et al 2000:1387). † an overwhelming feeling that can lead to physical and emotional depletion, a negative attitude and self concept, and feelings of helplessness and hopelessness† There are many methods to prevent burnout. One of these I observed, and have been guilty of my self, is the ability to suddenly become deaf. For example one client would continually ask for a ‘cup of tea’, to which staff would respond ‘you’ve just had one’ and the client would reply ‘I’ve just had one’ and walk away. But if the frequency of requests increased or they interrupted another activity staff would often pretend not to hear, they would ovoid eye contact and turn away. By ignoring the client it extended the periods between acknowledged requests. For the same reason this client was always last to receive his cup of tea when it was being made for the group. This coping mechanism ‘denial’ is one of many established ways to deal with stress (Kenworthy N. 1996:91). In denial you reject the thing that is unacceptable choosing to believe it isn’t there. Denial is very similar to ‘repression’ where although aware of the feelings you block them out, Tappen suggest that this can leave the caregiver with a â€Å"vague sense of unease† towards the client. Having denied hearing the request staff would then repress their guilt, leaving them with an uneasy feeling towards the client. This practice while not acceptable, had no long-term affects on the client as he would simply ask again a few minutes later, however if all requests where dealt with in the same way it could become harmful to the client (Tappen R. 1995:11). Another behaviour I witnessed was the reliance on PRN medication; a different client was very vocal following staff around the home asking questions about her forthcoming blood test. After a couple of failed attempts to reassure her it was decided she needed PRN to clam her down. The staff had coped by rationalising the situation. Rationalisation uses one explanation to cover up a less acceptable one i.e. their reason for giving the medication was to calm the client down. But the real reason was it would stop her bothering them with questions. (Tappen R.1995:11). Often in learning disabilities carers see a client’s failure to behave in an acceptable way or achieve targets as a personal failure (Brown H. Smith H. 1992:95). These failures or ‘client losses’ are another factor that contributes to burnout (Tappen R.1995:455). Other factors often experience by learning disabilities cares also contribute to burnout such as ‘low pay’, ‘discrimination’ and ‘inadequate advancement opportunities’. Learning disabilities are often referred to as â€Å"the Cinderella of the Cinderella services†(Parish C. 2001:13), and as such tend to attract the least skilled workers, who are given a low status even in relationship to carers in other fields (Brown H. & Smith H. 1992:93). Care is traditionally seen as â€Å"women’s work† and therefore â€Å"unskilled and unworthy† (Brown H. & Smith H. 1992:162/166). This is reflected in the fact that care staff are predominately women working part time, earning low levels of pay and having few opportunities to advance their careers (Hudson B. 2000: 88). Care work is rarely undertaken solely for financial gain; often the motives are more altruistic (Dagnan D. 1994:127). A study into staff satisfaction found that â₠¬Å"in spite of low pay† care staff â€Å"found rewards in the close nature of the caring relationship† (Hudson B. 2000:89). Recent government white papers ‘NHS and Community Care Act’ and ‘Valuing People’ aim to enhance the status of learning disabilities by reorganising the way that the service is provided (Beacock C. 2001:23), and â€Å"give those working in social care a new status which fits the work they do† (Hudson B. 2000:99). These proposals may ultimately improve the status of the service, but in the short term the changes are creating more paperwork, require new skills, and are leading to greater job insecurity. These factors are adding to an already stressful job (Hudson B. 2000:96). Studies found that the main causes of stress for care workers were â€Å"the inability to provide service users with what they needed, accountability or responsibility without power, frustration at office politics and uncertainty about the future† (Hudson B. 2000:90). ‘Powerlessness’ and ‘unresponsiveness to client needs’ added to ‘too much paper work’ are more factors that can contribute to burnout (Tappen R. 1995:456). Care staff are under a great deal of pressure, in their daily work they face all of the ten factors that contribute to burnout. This must ultimately have an affect on the way care is provided. I have no doubt that the staff at my placement are genuinely caring people who do their best to provide a high standard of care for their clients. However sometimes the quality of care I witnessed reflected the pressures they were facing. 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