Understanding Specific Needs- Assignment 1 This assignment on understanding specific needs will look into the perceptions that people have of health, disability, illness and behaviour in a health and social care context. It will also look into and explain how attitudes towards individuals with specific needs and perceptions of those needs change over time and differ between cultures. I will then analyse how legislation, society, culture and social policy interact to influence attitudes toward and service development for individuals with specific needs.
The World Health Organisation (WHO, 1946) describes health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Concepts related to health and social care that have been adapted to define health and disease in individuals include disability, illness, impairment, sickness and behaviour to name a few. These concepts may be misused by individuals who don’t actually understand the term.
In order to be a competent and professional health and social care practitioner it is extremely important to understand the correct definition and have the correct perceptions of health, disability and wellbeing, if not, we may end up offending individuals in our care without meaning too. It is hard to find a correct definition for ‘impairment’ and ‘disability’ but WHO describes impairment as ‘any loss or abnormality of psychological, physiological, or anatomical structure or function’- an example of this would include someone who has suffered from a stroke and as a result loses function of one side of their body.
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They then go on to describe disability as ‘any restriction or lack (resulting from an impairment) of ability to perform an activity in the matter or within the range considered normal for a human being’ followed by an example of ‘limited functioning of leg leads to inability to walk’. When it comes to illness, disease and sickness it is sometimes hard to differentiate between the three. Although they are quite closely related to one another they do each mean different things. Jones, 1994 described disease as a specific condition of ill health in a patient.
Illness is about how you feel- it is related to disease in that you may have a particular disease but still feel well. Some people believe that if a person is ill they have a disease but this however is not always the case- a disease is a physical change or abnormality in the human body. A relevant example to highlight the difference between a disease and illness would be HIV and some forms of cancer- sufferers can live everyday relatively normal without feeling ill or sick while taking the correct medication.
Most diseases will affect our behaviour if diagnosed- most obvious behaviour change could be feeling down in the dumps/ sad about the impact the disease may have on your own day to day life. However, it doesn’t have to be a problem- some people may be diagnosed with a disease, be optimistic and look at the ‘problems’ it poses but then be motivated to change those problems. Disease is the most likely out of the terms that would be most commonly used in health and social care as it is noticeable and certain whereas illness and sickness are feelings. A person has a disability if he has a physical or mental impairment which has a substantial long-term adverse effect on his ability to carry out normal day-to-day activities”. – (Disability Discrimination Act 1995) I previously touched briefly on disability and WHO’s definition, however I have become more and more aware of disability and those who suffer from a disability within my own placement work in the college helping out and assisting the students who have learning disabilities, therefore I can relate more to it.
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I agree with the above definition as the students in my placement, although a lot older than me; can’t complete the tasks that I take for granted everyday as well as us who don’t have a disability. I feel that by the college offering classes and providing facilities for those who have a disability is very positive and from having firsthand experience I feel that the staff do a very positive and great job with the students. There is also a door to door service available for those who are in wheelchair due to problems with their mobility- this bus collects students from their door and brings then directly to the college.
This is also positive as in the past this was not available. In general I feel that discrimination against those who suffer from a disability is getting better- examples of this include ramps for wheel chair accessibility onto buses and trains which was not available in the past. I feel like we as a society are talking a step in the right direction in bringing equality to all including those who have a disability. According to Wolfensburger, 1972, the social roles perceptions of people with learning disabilities include subhuman, sick, menace, object of dread and object of ridule.
The social model of disability says that disability is caused by the way society is organised, rather than by a person’s impairment or difference. It looks at ways of removing barriers that restrict life choices for disabled people. When barriers are removed, disabled people can be independent and equal in society, with choice and control over their own lives. The medical model of disability says people are disabled by their impairments or differences. Under the medical model, these impairments or differences should be ‘fixed’ or changed by medical and other treatments, even when the impairment or difference does not cause pain or illness.
The medical model looks at what is ‘wrong’ with the person and not what the person needs. It creates low expectations and leads to people losing independence, choice and control in their own lives. An example of both models in action would be a wheelchair user wants to get into a building with a step at the entrance. Under a social model solution, a ramp would be added to the entrance so that the wheelchair user is free to go into the building immediately. Using the medical model, there are very few solutions to help wheelchair users to climb stairs, which excludes them from many essential and leisure activities.
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Each models have their individual strengths and weaknesses however I do feel that the one that I agree with most is the social model- I believe that the mind is a powerful thing, and thinking positively and pushing ourselves to reach our full potential is extremely important in how we develop- I believe that by the social model encouraging independence of those who are disabled they are doing exactly this. In saying this I of course still understand the importance of the medical side and its importance in disability.
The most recent model in relation to disability is the affirmative model and it is all about celebrating diversity. In 2000, John Swain and Sally French came up with the idea for the new model. They believed that yes the social model was great from promoting independence and equality however with this, people were still going to see disabled people as a personal tragedy and feel sympathetic towards them and therefore they would never be treated equal to those without a disability. So the Affirmative Model was initially proposed as a counter to this personal tragedy narrative of impairment.
It is expressed in the voices of people who say, ‘Deafness is normal for me. I wouldn’t want to be other than Deaf. ‘ Or, ‘I’ve been blind since birth. Why would I want to change? This is who I am. ‘ Or, ‘I have learning difficulties. I have Down’s Syndrome but I don’t ‘suffer’ from Down’s Syndrome. This is who I am as a person. This is me. ‘ It encourages disabled people to be happy in the people that they are and in my opinion they should do exactly this. We as health and social care workers must be advocates to the disabled in our society.
We must speak out and act persuasively on behalf of anyone in our cares rights and just in general should speak up for everyone’s rights. We must do so because of legislative requirements, our code of practice and care value base but most of all because we feel it is right to do so. Although, as mentioned above, Northern Ireland as a society is becoming more and more aware and accommodating to the needs of the disabled it has been quite a long time coming in comparison to other countries, Sweden being a prime example.
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There is a huge difference in how disabled people are treated here and how they are treated in Sweden. Sweden follow the Nordic Model which has characteristics such as welfare funded by high taxes (around 35%), universal welfare rights, high level of public/state interventions and political consensus and shared culture and belief. Benefits come from using the Nordic model and have helped Sweden in becoming the well thought of country it is today. For example, carers in Sweden can be off work for as long as they need and still be paid- they receive great benefits.
It is a society focused on everyone which helps in the support of vulnerable people who are in need of help. Sweden has higher levels of social satisfaction and well being. They are great at negotiating issues and coming to agreements- there are very little strikes, protests and walk outs. In Sweden profit is not the most important focus- commitment to society is. They were also ahead of us in Northern Ireland in making significant decisions- one of these being the Grunewald’s 4 phases of care ervices which was introduced in 1974. The first phase in Grunewald’s phases of caring is diagnostic stage and ultimately identifying the problem. The next phase looks at the specialisation of the problem- this seen the need for a ‘specialist’ institution caring for people. The third phase of care services was differentiation which appreciated that one service was not enough and could not meet the need holistically therefore the development of multi disciplinary models was introduced.
The final stage of Grunewald’s phases of caring was decentralisation- this ensured the integration of services and use of ‘ordinary’ facilities. This highlights just how quick and early Sweden were in discovering that those who had a disability in their country needed to be treated with equality and needed to be able to do the things that everyone else could do. The next part of the assignment will look into the development of community care in Northern Ireland which will then enable me to make fair comparisons between it and Sweden. Community care is not a new concept. The term however means different things to different people. This paper uses the term to mean care outside hospital’. Community care is in relation to those who previously lived in long stay institutions now live in and are cared for in the community. It ensures that those living in the community who need care, for example, older people, people with mental illness, learning/ physical disability and those suffering from addiction, victims of abuse, homeless etc are facilitated to remain in the community.
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It is provided by three sectors; statutory sector which is the government/ Trusts, independent sector which is separate from the government and include voluntary organisations as well as private organisations and finally informal sector which is unpaid carers including relatives, friends neighbours etc. ‘Ever since the Health Service had been created, and indeed for long before it, the long stay services in hospitals for the mentally ill and elderly and handicapped had been a disgrace to a humane society. Glennerster (2000) P113 The 1960’s is when things started to change in relation to institutional care. Reductions in admission led the government to conclude that demand was not high, this alongside criticisms of institutional care from Barbara Robb’s book ‘Sans Everything’ as well as Geoffrey Howe’s critical inquiry into care at Ely Hospital for people with learning disabilities gave the government the recognition that things were not right however there were no solutions made in this decade. The next ecade, the 1970’s, presented better services debate on the agenda as well as beginnings of health service reform which was looking promising, however economic constraints led to not a whole lot of improvements being carried out. In the 1980’s much of the same negotiations took and things began to improve such as adult commission- making a reality of community care, cost of supplementary benefit spending on private residential and nursing care as well as Griffiths report on Community Care; Agenda for Action.
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The 1990’s saw the introduction of The NHS and Community Care Act 1990 as well as People First; Community Care in Northern Ireland for the 1990’s. After going through this timeline of the development of community care in Northern Ireland it is quite obvious that Sweden move a whole lot faster in developing their country for those in need. I feel like this is possibly down to the relationship between the public and the government in Sweden- they seem to have a good system and seem united in most decisions.
As well as this their society focuses on everyone in the society, they support vulnerable people who are in need of help and this I feel needs improved in Northern Ireland. Although there have been many improvements from previous years it is quite obvious that we still lag very far behind not only Sweden but England and Wales as well. “Severe challenging behaviour refers to behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities. Emerson et al (1987) In our lifetime, most of us will come across instances of challenging behaviour, particularly those who work in health and social care environments. Behaviours that people find challenging can put people’s safety at risk, disrupt home life as well as stop a person taking part in everyday, ordinary social, educational and leisurely activities. Challenging behaviour can affect a person’s development and their ability to learn. Problems are often caused as much by the way a person is supported – or not supported – as by their disabilities.
People often behave in a ‘challenging’ way if they have problems understanding what’s happening around them or communicating what they want or need. The Alzheimer Society explained that ‘In many cases, challenging behaviours have meaning – the challenge is to figure out the significance, so that the behaviour can be managed, controlled or diverted’- this part of the assignment will look at the potential impact that challenging behaviour may have on health and social care organisations as well as analysing the strategies for working with challenging behaviours associated with specific needs.
Challenging behaviour is often seen in people with conditions that affect communication and the brain, such as learning disabilities or dementia. Communication is the main way we interact and express our needs, likes and dislikes. If communication is a problem then it can be very frustrating for the person involved and may result in challenging behaviour. If this behaviour leads to a desired outcome, it may be repeated again and again. We as carers must be able to deal appropriately and effectively with challenging behaviour as we will more than likely face it in our career lifetime.
As professionals we should determine whether the behaviour is challenging or safe for the person- it may be a problem for someone else which doesn’t trouble the individual at all. For example, if being in a large group of people makes the person you care for feel anxious and makes them become agitated, you could arrange for them to be in a smaller group or have one-to-one support- this will trigger challenging behaviour for some people but not everyone. In order to help deal with the behaviour we must try to understand the cause and why the person is behaving this way.
We can start doing this by figuring out what has happened just before the behaviour, looking for any triggers, as well as determining what happened after the incident- it is extremely important to remember not to make assumptions as to what the cause of the behaviour is as this may bring on further challenging behaviour. Simple explanations can be the cause of challenging behaviour such as boredom and frustration as well as changes in routine, sometimes the behaviour is caused simply for a way to get attention.
We must try to find the suitable solutions to meet the person’s needs and must be prepared to try different approaches in order to find the correct one. It is important to remember that challenging behaviour can usually be managed with good support and that teaching new communication skills is key in reducing the behaviour. If you as a carer are finding it hard to cope with the behaviour of the person you look after, you can ask your GP to refer you to a specialist with knowledge of challenging behaviour.
The specialist will want to know what situations or people trigger the behaviour, what the early warning signs are, and what happens after the event. As well as this, there are organisations set up in order to cope with dealing with challenging behaviour, for example, many organisations for people with learning disabilities or dementia have strategies for coping with challenging behaviour. Some of these organisations also provide opportunities for carers to connect with other people in a similar situation including through family linking schemes.
Similarly, family of the person with challenging behaviour can be affected by it and also need help and support. They most likely will be suffering from high levels of stress and often have emotional or physical problems of their own- they should seek help from a specialist, for example a ‘behaviour support team’ or they could alternatively speak to someone who is in a similar situation and therefore understanding of their own circumstances.
Another option would be to seek comfort in speaking to a family counselling and support service. Physical Intervention can, sometimes, come along with challenging behaviour however this should only ever happen if needs be. Physical intervention can include restraints such as arm splints or helmets but again should only ever be implemented as a last resort. If they are employed, it should be with clear guidelines on their use, and alongside a range of other ways of supporting the person with their behaviour.
This should be recorded and regularly reviewed with a clear aim of eliminating their use. However, before any healthcare professional carries out any sort of physical intervention they should receive the correct training- this will not only teach them how to carry out the intervention properly ensuring the safety of themselves as well as the patient but also it will ensure that the carer has confidence in doing so.
Overall it is quite obvious the importance that communication has in carers dealing with challenging behaviour, if we can communicate with our patients effectively as well as identifying the cause of the problem challenging behaviour will be kept to a minimal. Those suffering from Attention Deficit Hyperactivity Disorder (ADHD) are prone to experiencing challenging behaviour. Part of this assignment is to look at and evaluate a case study based on a school boy, Michael, who because of ADHD IS having trouble in school.
Difficulties that he has include listening in class, completing homework’s, shouting out inappropriately during class as well as talking during class – with this said it is obvious that he struggles with understanding the social constraints of the classroom. However one point from the case study that I feel is relevant and important to remember is that Michael attends a grammar school with a 1950’s style ethos which does suggest that the school is outdates and therefore may not accommodate correctly to those suffering from ADHD.
After reading the case study, my class group devised a communication chart and came to the conclusion that Michael is simply trying to communicate but he may be misunderstood because of his ADHD- we believe that he may have little to no friends and that he may not be able to cope with the demand of work and therefore is falling behind all because of his disability, all of which would be extremely frustrating. It is evident that support is needed, not only in school but also at home from his family.
This could include a recording device to help record homework such as a homework diary. Also I feel that it would be beneficial for the school teachers as well as pupils to become aware and be given more knowledge as to what ADHD actually is and its impact on those who suffer from its lives, obviously without pin pointing Michael- this would reduce stigma and people labelling Michael as a ‘problem child’. PIES is vital in the development of anyone and is particularly important for those with specific needs such as Michael.
When looking at the physical aspect I feel that physical activity in after school sports would be beneficial in Michaels development- not only would this keep him physically healthy but it would also ensure his social needs improve as he would be interacting and making new friends with other students. As well as this Michael should have a set routine at home, for example getting the correct amount of sleep and eating a health balanced diet. Intellectually it is obvious that improvements need to happen if Michael is to prosper in school.
I feel that it is vitally important that he gets one to one attention from a teaching assistant- this way he could seek help from the teaching assistant by asking him/her questions rather than shouting out loud and interrupting the class. The school could also contribute by changing their teaching style by making it more up to date and interactive to suit all students, including Michael. Finally, as mentioned previously, extra support at home would be beneficial and effective communication between Michael’s parent and teachers would help develop his intellectual needs.
Emotional support will help in Michael’s development in school. A school counsellor could be provided to help him with his transition from Primary school, in which the case study points out he had no problems, to secondary school where there are obvious problems. Another idea could be that the school could develop different methods of dealing with challenging behaviour rather than strict punishment, for example they could calmly speak to Michael and try to understand the problems that he may be having. Finally, in terms of Michael’s social development it would appear he has very little friends in school.
As mentioned above, taking part in extracurricular activities could help develop Michael socially and would result in him making friends. After assessing the case study it is extremely obvious that the main implementation for Michael should be a person centred approach and under the Children (NI) Order 1995 Michael is entitled to receive this. “Put simply, person-centred planning is a way of discovering what people want, the support they need and how they can get it. It is evidence-based practice that assists people in leading an independent and inclusive life.
Person-centred planning is both an empowering philosophy and a set of tools for change, at an individual, a team and an organisational level. It shifts power from professionals to people who use services. ” http://www. dh. gov. /documents/digitalasset/dh_115249. pdf- accessed on 1/5/13. The school should recognise and be aware of Michael’s own needs and problems that he may have and they should accommodate these otherwise Michael could find the help he needs elsewhere.
It should implement person centred thinking tools such as ‘The Doughnut’ which is particularly relevant to Michael as it helps promote independence by identifying responsibilities and avoiding the tendency to treat people with specific needs differently from everybody else which is exactly what Michael would not want. A good idea would also be for the school and Michael’s family to come together every month and assess how things are progressing, stating what’s working and what needs improved further.
Person centred approaches bring a number of positive outcomes as they are a targeted intervention and they manage challenging behaviour through prevention- they should definitely be implemented in Michael’s case. After looking at challenging behaviour, the strategies and tools that can help cope with it and how to deal with people suffering from it as health and social care professionals, I feel that above all, communication is the most important aspect. If we can communicate effectively we should be able to solve any problems. Like everything in Health and Social care partnership and working together makes things go a lot smoother.
Person centred approaches are also very important in those who have challenging behaviour’s development. Risk management also helps especially having a plan in the event of an emergency. Understanding Specific Needs- Assignment 2 One condition that can bring about challenging behaviour, as well as ADHD, is dementia. In order to care for those who have dementia, we as carers must have a better understanding of what the disease is and what it involves. According to the Alzheimers Disease International 2010, there are 7. 7 million new cases of dementia each year- highlighting the severity of the condition.
Previously dementia was viewed as an inevitable part of the ageing process and individuals who had it were characterised as ‘senile old people who have lost their mind’. Many still hold on to this view and as a result individuals often go misdiagnosed by professionals, individuals and families (Berr et al, 2005).
However as time has went on it has become more recognised as a mental health condition, given the medical definition of ‘Dementia is the insidious onset and progression of cognitive and/or behavioural symptoms that constitute a departure from the individual’s customary way of thinking and/or behaving. Wicklund and Weintruab 2005. As a result of this more research into the condition has been carried out. Dementia is not classified as a disease but rather a symptom, it indicates that the brain is not functioning ‘normally’ but researchers can not specify the cause or source of the ‘malfunction’. Dementia affects individuals independence and as a result their daily living as well as social relationships. Their personality can change and their memory lost. Their emotional responsiveness changes alongside their language, reasoning, judgement and ability to communicate all of which can be very hard for loved ones to come to terms with.
Alzheimer’s Scotland 2003 stress that being diagnosed with dementia is not ‘the end of the road’ and while it brings great changes and challenges ‘there’s still a whole world to enjoy’. A lot of individuals suffering from dementia, depending on the severity, live in care settings simply because they can become difficult for family members alone to look after. In my own experience of working in a care home I know too well about the care that those with dementia need. As carers it is important that we promote as much independence on those with dementia.
It is important to help them remain as fit and healthy as possible- both mentally and physically. In my own care home we would fulfil this by simply taking residents for walks around the garden ensuring that they get some fresh air and aren’t just sitting in their chair all day. All principles of practice still apply for dementia individuals, we should respect their dignity when washing, respect their privacy by knocking their door before entering as well as respecting their personal style and identity when dressing them- this is reassuring for family member when visiting.
As dementia develops, it can cause behaviour changes that can be confusing, irritating or difficult for others to deal with, leaving carers and family members feeling stressed, irritable or helpless. By learning to understand the meaning behind the actions, it can be easier to stay calm and deal effectively with the challenges that arise. Examples of changes in behaviour include asking the same question over and over again- in this case we should try encouraging the individual to find the answer for themselves and also ensure that we are patient and understanding.
One example that is relevant to me and probably others working in a care home is residents repeatedly asking to go home; in this case we should be extremely understanding and reassure them that they are in a safe place and loved. As a result of looking after loved ones with dementia, we can sometimes neglect ourselves and it can become emotionally and physically draining. Pinquart and Sorenson (2004) suggest that the impact of caring for a person with dementia is greater than caring for a physically frail elder due to a number of challenges specific to caring for a person with dementia.
Dementia results in an increased need for supervision which in turn can result in the carer becoming isolated and having no time for their own spare time activities. In making recommendations for inventions to support carers of people with dementia, the National Institute for Clinical Excellence and the Social Care Institute for Excellence (NICE- SCIE) took into account the findings from the research literature. The most successful interventions are tailored and multi- component, including for example: – Individual or group psycho- education – Peer support groups with other carers Training courses about dementia, services and benefits, and communication and problem solving in the care of people with dementia – Involvement of other family members All of this highlights the importance of information on dementia and how important education on dementia is for carers. Counselling sessions have also proved valuable for carers of those with dementia. Mittelman et al (1995, 1996, 2005) set up individual and family counselling, support groups and access to long term telephone support. Content would include learning techniques for managing behaviour or promoting better communication between concerned family members.
There has been no formal replication of the model in the UK but the service offered by Admiral Nurses is similar in that they provide long term, carer focused support. It is obvious that in the past dementia has been perceived wrong by the public, however with more and more research and exposure as to what the condition actually is and how it affects those who have it I feel that people have begun to realise just how serious it is as well as just how much it changes not only the lives of those suffering from it but also their loved ones as well as their carers.
In order to continue with this progress I feel it is extremely important for future nurses, carers and people in general to be fed information on what dementia is, how it can affect us and how we can cope with the condition in our daily lives, for example by providing more support services for carers and families in need. Bibliography World Health Organisation 1946 & 1984 cited in L Ewles & I Simnet [2003] “Promoting Health – A Practical Guide” 5th Ed London, Balliere Tindall – L Jones [1994] “The Social Context of Health and Health Work” London Macmillan – http://www. disabilityartsonline. org. uk/affirmative-model-of-disability- accessed on 1/5/13 – http://www. scope. org. uk/about-us/our-brand/talking-about-disability/social-model-disability- accessed on 1/5/13 – Grunewald [1974] The Mentally Retarded in Sweden” Swedish Institute, Stockholm – CCETSW, Conn, L. and
