Key Ideas
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We deal in this chapter with a number of linked topics around the fundamental question as to why good nutrition is important to maintaining health and well-being. The chapter deals in turn with understanding how nutrition contributes to good health, valuing nutrition in health and social care and the growing professional awareness of nutrition.
This is set in the context of research, for instance, as carried out by the King’s Fund in 1992, on the relatedness of dietary deficiencies to people’s speed of recovery following illness. There has also been research demonstrating that malnourishment is common for people in care settings such as hospitals (McWhirter and Pennington, 1994).
The chapter continues by examining the contribution of nutrition to good health. The elements of good nutrition include fats, proteins, carbohydrates, vitamins and minerals. Other factors associated with good health include some of the factors hinted at in Chapter 3 when inequalities in health were referred to, notably age and income, physical activity, health status, cognitive development and cultural and religious preferences.
We acknowledge in this chapter that people’s dietary requirements change through the lifespan. Their metabolism changes as they age. Also, particular conditions such as high blood pressure and diabetes affect the desirable diet. People who are unwell may need help with eating and drinking.
Chapter 22 Hand Hygiene in General Infection Prevention and Control
It might seem bizarre to include a brief chapter on what might be dismissed as hand washing in a book about professional aspects of health and social care. However, we have not one but two chapters, in sequence, one on the narrower aspects and the other (Chapter 23) on the broader topic of infection control. The reason is all around us, in the appalling statistics on the incidence of morbidity (illness) and mortality (death) from infections patients and residents have acquired in health and social care facilities. So the author begins this chapter by discussing why hand hygiene is vital and makes no apology for going through the elements of hand hygiene.
The chapter notes that risks come from many sources of infection: other patients; external sources; shaking hands; touching door handles, work surfaces and clothes and bedding.
The author mentions the infection MRSA - Methicillin-resistant Staphylococcus aureus and refers to other types of infection, including transient (micro-) organisms, which are likely to be loosely attached to skin, are most often associated with healthcare associated infections and can be easily removed by washing.
Regular hand washing reduces risk of cross-infection and this entails not just tokenistic rinses but thorough washing for sufficient time with adequate antibacterial wipes or antiseptics.
Chapter 23 General Infection Prevention and Control
Policies relating to infection prevention are referred to early in this chapter, including the Health and Safety at Work Act 1974 and Managing Health and Safety at Work Regulations 1999. From 2000 there has been increasing pressure on NHS Trusts and government to reduce infections and deaths acquired through NHS facilities. The Health Protection Agency (HPA) set up 2005 and the DoH published guidelines in 2000 entitled The Management and Control of Hospital Infections.
The chapter continues by examining factors increasing recorded infections. Five to ten per cent of hospital patients in UK acquire healthcare associated infections. The increase is because of greater awareness, advances in medical therapy and technology, more primary and community care, longer life expectancy, increases in invasive products and immuno-suppressant therapy.
Finally, the chapter examines how precautions and protective equipment contribute to good
Hygiene, including: identifying 'carriers' of disease; attention to good hygiene; universal precautions; barrier nursing; reverse barrier nursing; personal protective clothing; cleaning; disinfection, sterilisation and avoiding needle stick injuries.
Chapter 24 Promoting a Healthy Bladder and Bowel
This chapter puts forward messages of great relevance to health and social care practitioners.
It is concerned to emphasise the positives of health promotion rather than focusing exclusively on incontinence, as though nothing can be done about it. The contrary is the case. Measures can be taken to educate incontinence sufferers and many who work with them, bringing them to a more positive frame of mind.
The chapter moves to consider the contribution of the bladder and bowel to health, the causes of urinary incontinence and constipation and ways to manage urinary incontinence and constipation. First, it is undeniable that bladder or bowel problems can have major effects on a person’s lifestyle, as well as affecting general health and well-being. The social, psychological and hygiene consequences of incontinence may result in withdrawal from friends, family and partner. These consequences can affect people at any age.
Second, turning to the causes of urinary incontinence and constipation, these are potentially many:
Urinary incontinence may be caused by the bladder or other parts of the body not working properly. The person’s medical history is relevant here, regarding conditions such as multiple sclerosis, which can contribute to incontinence. Then there may be an inability to cope with demands on the bladder because of mobility problems. It is true also that constipation is a widespread problem, being experienced regularly by about 3m people in UK. It particularly affects those with certain chronic conditions, who are taking more than 5 medications a day, who are residential or nursing home residents and who have low fluid or fibre intake.
As far as managing urinary incontinence and constipation are concerned, government guidance points out that everyone has the right to assessment of continence problems (DoH 2000
Good Practice for Continence Services). There is a need to increase the appropriate fluid intake; avoid constipation by encouraging increased mobility and improving toileting techniques.
Chapter 25 Illnesses and Conditions: Signs and Symptoms
In this chapter, we deal with understanding the basic signs of disease and ill-health. There is a need at the start to be clear about our reasons for doing this and the limitations of this chapter. Our purpose is so that health and social care workers will have a baseline of knowledge to draw on when they work with people. We should be aware of the dangers of using a little knowledge to draw conclusions and diagnose people’s conditions and illnesses.
We distinguish between illnesses and diseases, such as acute infections, will pass from the body once 'cured' and chronic conditions, which may remain and can only be controlled or managed. Decisions about a person’s general health or ill-health are not necessarily based purely on tests and objective measures, but involve qualitative judgements about a person's holistic (overall) well-being.
The chapter turns now to different parts of the body. Illnesses and conditions can arise in any part of the body and we review these one by one: blood; nervous system; liver, bile, pancreas; rheumatological, musculoskeletal; digestive and gastro-intestinal; urinary and renal; respiratory; cardiovascular; sexually transmitted.
Undoubtedly most pain arises from tissue damage, but the study of pain and its treatment is by no means confined to this. We begin this chapter by discussing what pain is, recognising that whilst some measures of pain exist, in the last resort people’s pain is what they report as a pain. There are so many aspects to pain: physical, psychological, behavioural, emotional and social.
We can distinguish between different types of pain, such as acute and chronic pain. Acute or nociceptive (referring to how brain processes pain) pain, is more likely to be intense; localised; the result of a specific injury or disease, specific to a time. Chronic pain is likely to be, by definition longer term, and most important, less easy to diagnose.
The chapter turns now to how to manage pain, which is most important from the viewpoint of the practitioner. Good assessment is crucial and a good understanding of the physiological causes and mechanisms is essential to effective treatment. On the whole, acute pain responds well to management e.g. by analgesics (pain-controlling drugs). Chronic pain often less easy to treat because its causes are often less clear.
This chapter deals with the different kinds of wounds and healing processes.
At its simplest, a wound is a break in the skin. There can be acute and chronic wounds and they may be superficial, as with a graze, or deep, as with a knife cut. The time wounds take to heal can vary enormously. They rely on the body's natural healing processes and the type of wound and health of the patient could mean a wound takes years or months to heal completely. Healing involves complex processes which we can simplify into the following three stages:
Stage 1: blood clot forms to stop bleeding
Stage 2: inflammation while white corpuscles clean wound
Stage 3: body restores defective tissues
The chapter turns to the treatments of wounds, which, contrary to received wisdom a number of years ago, should be maintained moist, clean, with a non-adherent (sticky) dressing, at room temperature, with the dressing changed not too frequently (up to 7 days) and without letting any gauze or cotton wool touch wound (lest it disturbs delicate healing tissues).
Chapter 28 Palliative Care and Bereavement
This chapter tackles the complex and emotion-provoking topic of palliative care and bereavement work. The author of this chapter decided to present a single multi-disciplinary case study and the editor readily agreed, for two main reasons: firstly, the subject arouses strong emotions because none of us can detach ourselves from the reality we will die and the likelihood that we already have had personal contact with somebody who has received palliative care; secondly, this depth of emotion at the end of a person’s life requires in depth discussion, rather than a superficial ‘tick in the box’ approach. The Resource File Attachment and Loss: Death and Bereavement after this chapter contains some good starting points for studying dying and bereavement in more detail.
We begin with some general statements about what palliative care is. There are three aspects: 1 active total care by multi-professional team when patient's disease no longer responds to curative medicine; 2 control of pain, and other symptoms whilst maintaining that the patient’s social, psychological, spiritual problems are paramount; 3 the goal being to achieve a good quality of life for patients and families throughout the process.
The author makes two further points. Palliative care benefits from a multi-disciplinary approach. Bereavement services are regarded as integral to this approach to palliative care.
The chapter moves on to consider the process of palliative care, summarised in the following list: continuous assessment; planning and implementation; review, reassessment and adjustment to plan; dealing with issues such as the strong emotions of anger and frustration and dealing with deterioration; coping strategies and communication. There must be an ending, but the way the author chooses to conclude the chapter somehow focuses on the positive aspects of death and bereavement as part of further processes of grieving and (eventually perhaps) some healing. This seems to be more helpful and holistic portrayal of the realities of this area of practice than a one-dimensional checklist would provide.
Part IV Working with People
We come now to the five Parts of the book which tackle practice from different viewpoints. This Part takes the basic process of the work. The Introduction to this reminds us that we need to locate this work in its context of laws and values. The Resource File which follows this is based on a very interesting activity. This invites us to explore our own attitudes and values in relation to our work in health and social care.
Chapter 29 Processes of Work with People
We explore in this chapter the general process of health and social care, before launching into the four main aspects of these in the chapters which follow.
The chapter draws attention to the different meanings of 'process', which include the passing of time and the sequence of events.
Four stages of the process are identified in the chapter. There is a general correspondence between the four stages of the nursing process and the social care/ social work process. Assessment and planning, the first two stages, are the same, the two main differences being stages three and four, in the nursing process ‘implementation’ and ‘evaluation’ and in the social work process ‘intervention’ and ‘review’. This chapter and subsequent ones, therefore, describes the four as follows: assessment, planning, implementation/ intervention and review/evaluation.
The chapter refers briefly to the values and principles of working with people. Values include respecting people and responding to diversity of needs. Principles include involving health and social care users, making creative and purposeful decisions, going beyond procedures and exercising continual critical awareness.
We begin this chapter by exploring what we mean by assessment. Four kinds of need have been identified by Bradshaw(1972): normative, felt, expressed, comparative. The general aim of assessment is to make a judgement about a person's circumstances and needs.
Types of assessment include formal/ informal and statutory/ non-statutory assessment. There are three models of assessment: questioning, procedural and exchange.
The chapter refers also to the single assessment process. It discusses what good assessment comprises. It should be systematic and with clear expectations on all the part of all those involved.
There should be a prioritising of health and social care users and carers to ensure they are full participants in this part of the process of planning health and social care. The process should be person-centred, rather than service-led or needs-led.
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