Chapter Summaries
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This chapter sets out to provide a framework of knowledge about your learning, sufficient to enable you to take control of the challenges it represents. As adult learners, we come to formal courses from a wide variety of backgrounds. Some of us work full time, others work part time and others study full time, or, more often, have to split our attention between work and home. It is usual for adult learning to take place alongside other activities. Few of us have the luxury of being able to study as long as we want each day, uninterrupted by other responsibilities. As important as the management of our learning and our time is the challenge of learning itself. We need to equip ourselves for learning by understanding more about what these mean and how we prefer to meet them. This chapter suggests ways in which we can anticipate these challenges. It also offers a means of exploring the learning style which comes most easily to us.
This chapter covers the main areas of study skills on which you need to draw in order to pursue the course. These include making time to study, using learning resources effectively, make the most of lectures and seminar groups, carrying out a written assignment and making sense of feedback.
The chapter is more than just a sequence of exercises and tips, however, and it needs to be. The challenges of adult learning at this level are many and in professional courses they touch our personal as well as our professional selves.
This chapter presents a brief historical introduction to the health and social services. There is a need to be very selective and to highlight certain aspects - for instance, the persistence of the reformed Elizabethan Poor Law, only abolished in 1930. More recently, a wave of legislation in the 1940s accompanied the setting up of what has become known as the Welfare State. More recently, major reorganisations of both the National Health Service and the social services have preceded the so-called mixed economy of welfare which has developed from the 1990s.
The sociological perspectives which are the focus of this chapter highlight divisions and inequalities in society. In particular, there are persistent areas of discrimination, associated with racism, sexism and disablism. Over and above this, violence, especially 'domestic' violence or criminal violence in the home is a continuing problem. This chapter can be used as the starting point for wider reflections on other aspects of inequalities, such as poverty and geographical and social class divisions between people. These have consequences for the work of health and social care agencies, in the particular areas where they are located.
This chapter deals with the personal values which pervade our thoughts and actions and alongside these the professional values inherent in our health and social care practice.
Reflection on these values highlights the reality that differences in our values may coincide with the diversity of cultures and beliefs in society, perhaps related to ethnic and religious diversity.
The basis for this chapter is the complex and detailed subjects of anatomy and physiology, which could occupy a large book in themselves and not exhaust the subject.
Our limited goal is to provide enough information to enable health and social care practitioners to acquire familiarity with aspects of human functioning which have a bearing on the lives of people with whom they work on a day to day basis. This should enable them to have a basic knowledge and understanding of the challenges facing people with illnesses, conditions (see Chapter 25) and impairments (see Chapter 14).
This chapter deals with the ways in which different perspectives and approaches in psychology contribute to aspects of relevance to health and social care. It is important that psychology is not just seen as a list of references on research into different aspects. This chapter concentrates on psychological perspectives and their contribution to different aspects of health and social care. The different viewpoints they bring to bear on the subject matter of people's lives are as important as their content in particular areas.
This chapter tackles the much-discussed topic of human growth and development, using an example to illustrate an exercise which a person can carry out. It then examines human development, maturity and ageing through four different perspectives and discusses the main implications of these for practice.
This chapter takes the two linked areas of abuse of adults and criminal violence in the home and gives each of them attention in its own right. This enables the association between them to be clear. At the same time, the chapter pursues the process of responding to adult abuse and details how safeguarding procedures actually function, using an example from practice.
There is a close correspondence between the topic of this chapter and the preceding one, although child and adult safeguarding have different policy options attached and are dealt with somewhat differently by practitioners.
This chapter emphasises the history of scandals and inquiries, which has played a prominent part in the organisational changes to children's services since the Children Act 2004.
The chapter details the way legal and organisational structures are applied in procedures for processing and acting on child abuse and protection situations and monitoring them subsequently. It concludes by discussing what direct work with abused children involves.
The chapter examines the linked areas of risks and safety, showing how each is perceived and responded to quite differently, according to three different writers: Maslow, King and Brearley. In the process, the chapter deals with how risk and safety are managed in delivering health and social care services. Finally the chapter examines some practice issues raised by risk management in health and social care.
The policy and legal context of community care leads into a discussion of the main content of community care practice. Its diversity is illustrated, as the major services are explored. A number of practice issues are discussed. It is clear from the way the chapter is written that community care has undergone a major transformation since the late 1980s and the beginnings of the contracting out of services by local authorities. During the 1990s, internal markets were created in health and social services for the commissioning, purchase and provision of services and local authorities largely withdrew from directly providing services.
Since 2000, there has been increasing concern to standardise the eligibility criteria and charging practices, attempts have continued to improve joint working between health and social care agencies and there has been an increase in the take up of direct payments to enable people with community care needs to employ their own carers or personal assistants. Domiciliary care, intermediate care and continuing care have expanded, making the heading of community care seem somewhat outmoded.
This chapter uses illustrations from practice to show firstly how ageism affects people's lives adversely and secondly the practicalities of a care and an empowerment model of working with older people.
This chapter deals with three main kinds of physical impairment for which society disables people - loss of mobility, loss of sight and loss of hearing. It refers briefly to the different implications of an individual/medical model of disability and a social model respectively. It is clear that the social model enables us to view critically the ways in which societies disable people and exclude them.
The chapter continues by examining the nature of the three forms of physical impairment and some of the ways of working with them.
Many people experiencing learning disabilities have been locked away in institutions in the past and the conditions in some of these have been appalling. Scandals, public inquiries and research into them have combined to improve the treatment of people with learning disabilities from the last 30 years of the twentieth century. The chapter uses practice illustration to show how the treatment of people has become more positive.
Part of the reason for these improvements has not been at the initiative of the professionals, but through the success of the disability movement in self-advocacy for the rights of disabled people.
This chapter begins with a brief reference to different categories and models of mental health problems. It reviews different kinds of mental health resources and treatments. Finally, it illustrates one of these - the 'recovery perspective'. This is interesting, in that it is based on an approach well outside the control of the medical model of mental illness, since ones aim is to enable the person to manage symptoms and assume a normal role in society, rather than to be labelled as sick
and unable to return to normal life because all the symptoms have not disappeared. The chapter shows how mental health problems may be dealt with in a way which empowers people who use health and social care services.
The revolution in the way children's services are organised, taking place between 2004 and 2008, is one aspect of the policy and legal context set in this chapter. It goes on to survey briefly the range of children's services and concludes by referring to some of the main issues encountered in work with children. It is clear from the direction of the discussion in this chapter that, for instance, in the framework for assessment of children in need and their families, children's work cannot be carried out in isolation from the family and the parents of the child. Also, much work with children is joint work, involving collaboration across the health and social care agencies.
This chapter is set in the context of the laws which have governed drug usage and medicines in the UK since the early 1970s. This leads directly into the question of how drugs and medicines are defined and how dangerous certain illegal drugs are deemed to be. It becomes clear that some of these areas are matters of opinion rather than objective facts. However, at a basic level the author does maintain the distinction between systemic and topical drugs. The chapter concludes by discussing the ingredients of a well-managed drug regime.
This is a very full chapter, in that it examines some of the key medical and social problems arising from the main social and medical problems associated with alcohol, drug, smoking and dietary disorders such as anorexia nervosa and bulimia some of the main approaches to working with people who abuse different substances.
The tension between welfare and justice approaches to work with young offenders is introduced in this chapter, which uses a practice example to illustrate of the process of work with a young offender. The chapter shows how different practice interventions are implemented, following the assessment and planning stages. It also highlights how tensions arise in practice, for instance, in the area of confidentiality.
The primary focus of this chapter is upon the different constituents which make up a person’s diet. It explores the notion of good nutrition and how this contributes to good health and well being. It goes on to discuss the importance of nutrition in health and social care work.
This chapter deals with the reasons why hand hygiene is so important in health and social care work. It deals in detail with the practicalities of the dangers to hygiene and the contribution effective hand washing makes to countering those dangers.
After a brief survey of policy and legislation relating to hygiene this chapter, written by a general practitioner who has specialised in lecturing on this topic, discusses the contribution it makes, at the centre of good health and social care, to infection prevention and control. The chapter continues with a survey of the main types of infection and the groups of patients and people who use health and social care services who are particularly prone to them. Finally, the chapter goes into some detail about the contribution to good hygiene of the different precautions and types of protective equipment.
This chapter deals with the important contribution which people’s bladder and bowel function makes to health. It devotes most of its space to examining in turn the main factors which can lead to urinary incontinence and constipation. It proceeds to an examination of how urinary incontinence and constipation can be managed. Throughout, the chapter is making the point that incontinence and constipation are not just physical conditions with medical signs and symptoms. They have psychological and social consequences and can lead a person to be excluded and isolated and to lose confidence in meeting other people. The alternative, as the author argues, is to make the most of the research knowledge and practice expertise available and develop ways of managing incontinence in particular, so that the person can return to living a normal life.
This chapter takes a general view of the basic signs of disease and ill-health in a person. It is not possible for this brief survey to provide anything like a complete, let alone comprehensive, view of the topic. However, in a rapid tour of the body, it refers to some of the main examples of conditions and diseases which could be responsible for ill health among the largest groups of people who use health and social care services. The chapter points out the dangers of ill-informed attempts to diagnose.
This chapter deals with the nature of acute and chronic pain and shows how it is not easy to define what pain is, because that definition depends partly on how people experience it. This creates similar difficulties when it comes to assessing pain, which feed through into the management of pain.
We deal in this chapter with different kinds of wounds and the current state of knowledge from research concerning how best wounds should be managed. The chapter goes on to give details of how health and social care workers should respond to and manage wounds.
A single case illustration is used in this chapter to take the reader through the process of palliative care. This enables us to see what exactly palliative care means and how multi-disciplinary work happens in practice. It also highlights the process of the work and identifies some of the main issues likely to arise. Finally, the chapter points out how good palliative care should make the transition to bereavement work.
This chapter discusses generally what is meant by 'process' in health and social care practice. It goes through some of the differences in the way processes are dealt with in different professions in health and social care. It gives an outline of the different stages involved in the process of health and social care practice.
Assessment is the basic building block of the care process. Much space is devoted to diagnosis and assessment in the health and social care services. This is understandable for a faulty diagnosis can be fatal. In health and social care, all the countries of the UK have moved towards a common, single process of assessment which all practitioners are meant to have accepted. This does not always work smoothly, but the theory is that people who use health and social care services will only be assessed by one process, involving all the necessary practitioners, who will then compile a single assessment statement, working with the person using services. Within this general framework, this chapter discusses different aspects, including three different models of assessment. It also refers to the impressively comprehensive, three-sided framework used to assess children in need and their families.
This chapter follows the sequence established in the previous one. We see illustrations of what is involved in health and social care planning and how a good plan is developed and written up. As the task is carried out, we see how issues arising in the planning process are dealt with. Particular attention is drawn to the issues of determining eligibility for services and, of course, charging policy and practice relates to this. Also, we discuss direct payments. The government is working to encourage a higher take up of direct payments and they form an important component of care plans.
We focus in this chapter on what is meant by implementation and intervention in health and social care. We then refer briefly to the range of methods of intervention which may be used (many of which are outlined in Part VI of this book). The chapter goes through the implementation process and highlights some of the issues arising in practice.
This chapter deals with the different but closely related activities of 'review' and 'evaluation' in health and social care. It distinguishes the function of review, which takes place repeatedly at regular intervals on the way, from evaluation, which tends to occur at the end of the process.
The emphasis in this chapter is on making the distinction between the everyday meanings of ‘reflective’ and ‘critical’ and their use in health and social care. Practice illustration is used to show how critical reflection takes place, noting the stages involved and also the importance of supervision of the critical, reflective practitioner.
There are several Resource Files around this chapter which expand on different aspects. We deal in this chapter with what is meant by research and the main different approaches to research, in terms of quantitative and qualitative methodologies.
There is a significant difference, by the way, between what we mean when we say ‘method’ and ‘methodology’. Briefly, research ‘methodology’ implies that we are going to discuss the choice of research approach, which includes consideration of the theoretical aspects and arguments about the advantages and disadvantages of different perspectives such as qualitative and quantitative ‘methodologies’. Research ‘methods’ on the other hand refers simply to our listing of the methods we will use – interviews, questionnaires and so on.
This chapter now goes on to discuss the different ‘methods’ of research and some of the complications, including ethical issues and how certain procedures deal with these, in places such as universities where research happens.
We offer a definition of quality assurance in this chapter and set a policy and legal context for the many measures being taken to assure quality in health and social care. We show how the different components of quality assurance, such as inspections, operate. Finally, we discuss how shortcomings in quality may be dealt with and in particular how complaints and whistle blowing contribute to quality assurance.
This chapter refers briefly to the different meanings of 'theory' and the meaning of 'practice'. It devotes space to showing how the integration of theory and practice may be understood and how it can be demonstrated.
This chapter deals with different models of, and approaches to, health promotion. It highlights the contrast between medical and social approaches. The latter tend to highlight such aspects as disadvantage and health which inequalities affect the health of people. The reverse side of health promotion is the barriers to health and well-being. Health promotion does raise issues for health and social care practice, because there is a tension between the pressures from the mass media and the advertisers of so-called ‘junk food’ and the research evidence on what constitutes a healthy lifestyle.
The major, significant shift which has grown in momentum since the early 1990s towards greater patient and public involvement in health and social care is the focus of this chapter. The government emphasises the importance of putting the patient and the service user and carer at the heart of the process of providing services. The chapter distinguishes between the broad range of ways in which people may be involved – from tokenism (where the gestures are made but there is no meaningful participation) and the more significant level of participation by health and social care service users and carers, where they can actually influence decisions about services.
Chapter 40
This chapter deals with the meaning of empowerment and advocacy. It continues with a discussion of how they may be used in practice. It refers to working in partnership, to ‘emancipation’ and outlines different forms of advocacy. Finally, it uses examples to show how empowerment and advocacy work in practice and to illustrate the stages of empowerment.
This chapter explores the different models and theoretical bases for understanding communication. It shows how, once the study of communication moved away from mechanical and mathematical models and became rooted in the social sciences, it started to make progress. Psychology and sociology made a particular contribution to our understanding of what makes for good communication. What we are discussing really is the study of how people interact, rather than how one person sends a message and another person responds. Also, there is more to communication than words. People’s body language and facial expression convey much.
The focus of this chapter is a very important cluster of theories, approaches and techniques which are much used by a range of practitioners in health and social care services. In the library, books and journal articles on cognitive behavioural therapy can be found on both the health and nursing shelves and the social work, social care and adult and young offender shelves, which says a lot about its wide applications. This chapter reviews the main theoretical reference points and features of cognitive behavioural work, noting the psychological theories that inform it. Using a practice example, we go through the typical process of cognitive behavioural therapy.
The huge and ever expanding number of therapeutic approaches cannot be represented adequately in this brief chapter, which deals with a number of very different therapeutic approaches to working with health and social care users and carers. The particular focus of many therapies has been shaped by their basis in psychoanalytic and psychodynamic theories of the personality and human development. Family therapy, for example, can be a focus which brings together psychiatrists, psychologists, social workers, nurses, healthcare assistants and care staff in a multi-disciplinary setting. The chapter refers to brief therapy, therapeutic communities, therapeutic groupwork and the expressive therapies. It also indicates some of the ways in which the main therapeutic approaches can be used, using the particular example of photography therapy – which I as the editor of this book hadn’t heard of until a few years ago – with a very startling illustration of its power in work with a person with a learning disability.
Systems theory, which is the basis for the approaches discussed in this chapter, is an off-putting title, but really works quite simply. The idea, outlined here, is that the practitioner identifies the problem and possible resources for dealing with it, in the different systems, or groups, networks and settings, to which the person relates. Within them, hopefully, are some of the resources the person can draw on for support. Quite quickly, a set of potential sources of help are combined into a plan which will enable the person to move forward. This chapter gives illustrations to show how systems approaches work in practice. In present day practice which is so dependent on multi-professional and multi-disciplinary activity, systems thinking is very appropriate. However, we do offer in the chapter some critical comments about the limitations of systems approaches.
This chapter gives a brief overview of what counselling and advice-giving are and summarises the three main approaches to counselling discussed here - psychodynamic, humanistic person-centred
and cognitive-behavioural. It continues by exploring the qualities and skills needed in a counsellor. It also discusses some of the major issues affecting the decision as to whether to counsel a person. It is necessary to note that whilst many professions draw on different aspects of counselling knowledge and skills, only people registered with the relevant professional body should publicly advertise themselves as counsellors.
This chapter examines some of the main features of emergency work, crisis intervention and task-centred practice. It is clear that whilst these have some similarities in that they deal with acute problems which are dealt with in the short term, at this point many of the differences between these three approaches emerge. Emergency work is a medically focused approach to responding to situations which threaten the health, well being or life of the patient. Crisis work has a psychodynamic basis and consists of working with a particular problem or issue so that the person can manage it effectively. Task-centred work is concerned mainly with behaviour which can be changed in the short term.
This chapter explores what is meant by partnerships and teams and gives indications of their characteristics. It also explores the nature of management and teamwork and the implications of different styles of team leadership. It considers group dynamics and the ingredients for effective work in teams.
One of the most important tensions arises between the openness required in teamwork and the legal basis for securing information and respecting confidentiality and people’s privacy. The Resource File before this chapter deals with the laws covering data protection and freedom of information.
The basis for this chapter is working through the process of practice with adults in health and social care. It is rooted in the complexities of an actual case, though it starts by considering some of the issues involved in working in partnership. Among other things, it uses a checklist of questions to chart the practice through its main stages of assessment, planning, implementation and review/ evaluation.
This chapter follows a parallel pattern to the previous one, focusing this time on work with children and young people and their families. Although our main task in this book is to explore health and social care practice, it wouldn’t be complete without showing how the workers cross boundaries between different age groups in working with families and also how the theories, approaches and frameworks for practice cross those boundaries. So, this chapter refers briefly to the world of children’s services. It also takes the process of practice through the preliminary stage of beginning the work, before going through assessment, planning, implementation/ intervention and review/ evaluation.
This chapter introduces occupational therapy within the multidisciplinary team. It deals with the practice of the occupational therapist within a health and social care setting and the role of the occupational therapist within the multi-disciplinary team. The particular value of this chapter is to highlight at this later stage of the book how multi-disciplinary working is viewed from another professional group in health and social care. The examples, with their accompanying diagrams, illustrate this particularly clearly.
This chapter concentrates on what is involved in making a good decision and how good decisions are made. It focuses on the actual stages, using an example from practice. The chapter is written in such an open way that it provides a template which can be fitted over absolutely any practice situation in health and social care.
The use of practice examples in this chapter is intended to highlight those aspects of health and social care which have relevance to the needs of children and young people. This chapter uses examples from practice to highlight how the process of practice proceeds through the stages of assessment, planning, implementation and review/evaluation. A number of complexities, tensions and dilemmas are examined on the way.
The approach taken in the previous chapter is repeated here, with practice examples providing the stimulus for considering the stages involved in health and social care work with adults. As the work proceeds, it is apparent that there are a number of practice issues, which the health and social care practitioner has to reflect on and tackle. For example, it is necessary for the practitioner to knowing how to act in response to a complaint or need to protect a vulnerable adult.
This chapter focuses critically on the nature of residential and day services and, read in conjunction with the Resource File which follows, provides a theoretical perspective on residential care in particular. Certain policy changes are referred to and during the chapter the reader is able to work towards establishing the ingredients of good residential care. One direction explored is that of people's rights. An indication of the character of good day services is also given.
The main topics tackled in this chapter include checking out three key questions: Where am I now? Where do I want to go from here? How can I get to where I want to go? It considers the importance of reviewing and evaluating your learning to date, recording your personal and professional development and assessing the work and study you may consider next.
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