FOUNDATION DEGREE IN HEALTH AND SOCIALCARE
PRINCIPALS OF CARE
Management of risk and protection of vulnerable individuals in health and social care.
INTRODUCTION
This report is about the potential risk to an elderly person living alone, and the implementation of a risk assessment using a legal framework. Also those risks are assessed using the organisational policies and guidelines available to all care agencies to help protect and minimise risks which may be encountered by a vulnerable client group. The report also highlights the need for multi-disciplinary care agencies to uphold the importance of and implement principles of good care practice when considering the management of risks exposed to an individual and their differing needs within our society.
THE DILEMMA
Mrs B is an elderly lady who has been living alone within her own home. She has no relatives and has been adamant that she can care for herself. It is known that Mrs B has refused help in the past by various care services due to lack of trust and sees their involvement as an intrusion on her private life. Mrs B however. Unfortunately fell down her stairs and was admitted to hospital with a fractured femur, during a routine admission assessment of her care plan, it was observed and documented that Mrs B was considerably underweight and her clothing and general hygiene was unkempt. It was clear from this assessment that Mrs B had been seriously neglecting her own needs and this in itself is a risk of covert self abuse, and consequently could have resulted in her death. During her long stay in hospital Mrs B stated that she wished to return home and continue to care for herself.
MANAGEMENT OF RISK CONDERING PRINCIPALS OF CARE
Mrs B clearly needs a risk assessment with her care plan. A named nurse would be allocated to Mrs B on her arrival to the ward. (The role of the nurse is to consider the risks to. The client, other service users, the wider community, implicit in codes of practice (e.g. ukcc 1922,a b, Maxine Holt 2002) Her needs would be addressed by informed discussion with Mrs B and with her consent and active contribution of the assessment to establish her care plan. It is important that all interactions with Mrs B by hospital staff adhere to the principals of good care practice. Ensuring that Mrs B’s individual rights to confidentiality, choice, dignity, respect, autonomy, cultural, and equity are considered when any plans, programmes of her care plan are implemented. Firstly it should be made clear to Mrs B that she has the right to refuse, and that she understands that her care and discharge plan is implemented in confidence as described within the organisational confidentiality policy. On admission to hospital Mrs B would be observed and an assessment of her needs would be documented ensuring all people connected to her care plan adhere to a continuity of care which is best suited to Mrs B. All nurses allocated to her care plan should deliver the care plan in an informed way, ensuring that all documentation is documented appropriately under the organisational guidelines and with reference to the Data Protection Act 1998. The named nurse assigned to Mrs B would involve various agencies to come and assess the needs of Mrs B with her consent. Any contact or involvement with Mrs B should be with the knowledge and presence off the person allocated to Mrs B. A multi disciplinary team would contribute and work together to ensure Mrs B’s choice to return home is paramount with regard to her rehabilitation and discharge plan. The care plan will be guided by the organisationals specific procedures and guidelines which will be held within the work area , protocols need to be adhered to i.e. alerting concerns to a senior person, also documenting and reporting any concerns or changes, with regards to her health or circumstances. Also allocation of services as required investigating any concerns and the coordination of information, deciding in an informed way how to proceed, and monitoring the client’s case whilst gathering information. This individual balancing act that multi-disciplinary teams encounter when considering the resources to manage the risks is a risky business in its self and leaves agencies uncertain of the intervention and how best to manage and seek to minimise the risks exposed to this client group.
(“The protective action of others can create many risks to the life and wellbeing as those they are aimed at preventing”) Nursing Older People, October 2003 Volume 15 issue 7.)
Abuse can take place in many different contexts and it is important we do not exploit a vulnerable persons civil rights. Mrs B clearly had mistrust with other people becoming involved in her life. Therefore when and how to intervene builds on the concept of significant harm introduced in the Children’s Act. When making an assessment of an individual many factors need to be considered. For example the extent of vulnerability and risk of repeated acts that meet the criteria of the Community Care Act 1990. To ignore the assessment of older people can be an example of ageism in its own right, contributing to an elderly person feeling disempowered.
“Elderly people need to be active participants rather than active recipients. The task is not to look after, but to motivate, empower and promote self-esteem.” Hughes, 1995, Thursz et al.
RISK ANALAYSIS.
An adult protection policy will identify and help support Mrs B’s decisions for her care and help her to understand risks and benefits exposed and available to her.
RISK ACTION PLAN.
1. Community social worker to help coordinate services and develop a relationship with Mrs B.
2. Physiotherapy to aid with mobility. Enable Mrs B to cope safely with basic care needs. Also with consultation of other care workers occupational therapist can contribute to the possible adaptations that might be required within the home.
3. Dietician to help with dietary advice.
4. Support agencies to offer care call, bathing help, meals on wheels also considers the isolation needs that might be encountered with regard to her mental health as well as her physical needs.
5. Security systems to protect from theft, and physical abuse, and other environmental variables
The management of the above will be implemented with clear guidelines and the coordination of multi agency workers, working together to deliver a programme of care in the best interest of Mrs B’s needs and individual choices. It is clear that for older people there exists a climate of (often unsubstantiated) perceived risk on one hand, and a presumed right of statuary agencies to intervene on the other. Choice and self determination are affected by economic and social factors as well as physical and mental health. This means the elderly are in themselves at risk of being referred to services. Extreme caution should be placed in the hands of all agencies when considering the management of risks within this client group, and other vulnerable service users, i.e. children, disabled. Also a danger of active discrimination may prevail without intent.
DEFINITION OF ABUSE.
(Abuse is a violation of an individuals, human and civil right’s by any other or person or persons. Department of health no secrets section 2 page 9.)
LEGISLATION AND ORGANISATIONAL POLICIES AND GUIDELINES.
Laws are needed to protect all people from abuse, exploitation, and acts as an advocate to govern their needs and rights, which ensures that all people are treated equally. Vulnerable people are exposed to many infringements of their rights as an individual. Mrs B needed the input of various care agencies. These agencies require guidelines and support. Appropriate training and the protection of policies and legislation to protect the risks of a care worker and a framework where help, can best manage the needs of Mrs B. Multi agency workers need to realise that every patient they care for gives them the opportunity to act as the clients advocate, ensuring the best protection of client and colleagues. Also that all risks have been minimised using the resources available and knowledge to avoid legal redress.
VARIOUS POLICIES TO GUIDE THE CARE AGENCY AND PROTECT WHEN CONSIDERING THE MANAGEMENT OF RISKS.
“No Secrets” guidance under section 7 of the local authority social services act 1970.
Modernising social services 1998. (Government white paper).
Children’s act 1989.
Criminal justice act 1992.
Mental Health Act 1959/1983.
N.H.S Community Care Act 1990.
Department of health (Seeking Consent) guidelines.
Stockport all agency adult protection policy.
Leaving hospital: elderly people and their discharge to community care: Report to the Department of Health. London; HMSO (Neill, June Williams, Jenny (1992)
Department of Health (2001 National service framework for older people. London: Department of Health.
Elaine Davidson. Student No:0305638.
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