Nursing and Social Work Skills - Essay Example

The needs of the patient are the primary objective when considering a plan of care for the continuation of good health and well-being. The important aspect of anti-discriminatory practice is that of autonomy – respect for the person and self-determination (Dougherty & Lister, 2004). In this essay, I will illustrate how I worked and established a working relationship with service user TJ during my 100-day statutory placement at a primary care community for people with learning disabilities and mental health problems. I will consider the interactions and interventions embarked upon with the patient by critically analyzing my work practice by linking theory to practice. My work with this patient involved helping and supporting him to develop new skills and more importantly to lower his aggression towards others in the day centre. The assignment will look at the rationale for utilizing a holistic philosophy of care and employing an anti-discriminatory and anti-oppressive practice in nursing. I will also discuss how I developed this close relationship. This essay will be divided into five sections. The first section will discuss the description of the work. The second section will analyze how the relationship was established. The third section will identify the anticipated and actual barriers in the relationship. The fourth section will discuss in depth how the relationship was brought to a close. Reflecting upon my interactions with the patient I will analyze the influence of the reflective process. Following guidelines from the NMC (2008) Code of Professional Conduct and the GSCC (2002) Codes of Practice, the names of the patients have been changed to ensure confidentiality. The placement will remain unidentified and referred to as Edwardian Day Centre. The final section will provide an evaluation of my success (if any) in establishing the relationship with TJ. The essay will then be concluded. The Nursing and Midwifery Council (2008) stated that registered nurses must deliver safe and effective care and also maintain professional competence by ensuring that their skills and knowledge remain current. In addition, The General Social care Council (2004) also stated that Registered Social Care workers are required to support students and facilitate effective development of their knowledge and skills base. In order to identify a patient, a nurse must provide background information (Elliss, et al, 2003). TJ is of British origin, age fifty-five year, and male who has a mild learning disability. TJ is a pleasant, polite, and courteous man that enjoys being helpful and active. TJ also suffers from Obsessive Compulsive Disorder (OCD). Calvert & Palmer (2003) explains obsessions to be ‘thoughts, images, or impulses that occur over and over again and feel out of our control’. He stated that it is an obsession that is usually accompanied by uncomfortable feelings of doubt, fear, and disgust such as common obsessions which include: harming self or others; losing control or aggressive urges; intrusive sexual thoughts or urges. Yet his OCD has made TJ to exhibit a number of serious incidents resulting in anxiety and aggression in college. His anxiety is usually provoked by his sister at home and at his previous college where they both attend. In view of this, TJ had to leave his previous college, Willow Woods, to come to Edwardian. The Edwardian Day Centre that TJ attends provides developmental training for people with learning disabilities in the age range of 18 and older in order that they can live more independently in the community. Edwardian Day Centre considers its members (aged 18-65) as students rather than service users as this prevents labelling (Cynthia, 2004). The Day Centre currently enrols 20 students with mild, moderate, or severe learning disabilities who access the day services either in full or as part time. On many occasions, TJ has exhibited outbursts of aggression towards others resulting in very serious incidents. His outbursts occurred suddenly and can be largely triggered by others not acting in his accord. Such situations make him physically aggressive. In the Edwardian, there were only two male workers; TJ doesn’t get along with male workers, causing difficulty for intensive works. Therefore, I was allocated as an intensive worker to support him to develop new skills that would benefit him in his life. The aim of the engagement with TJ was to establish, build, and sustain a relationship with him. The purpose of this was to have a mutual relationship that would benefit TJ as his aggression had to be lowered so that newer relations can be formed. Another aim was to teach him skills such as sharing and working with others, and helping him with his OCD and improving coping mechanisms (Baillie, 2005). The Unit Manager stated to me that TJ much preferred to work with females as he perceives them to be friendlier, patient, and caring; he has worked with females in the past and has always enjoyed his sessions with them. Before beginning work with TJ, I sought his consent. I respected him as an individual, which means that I looked at all the different elements that made up TJ as a whole, as well as how I was going to deliver a patient centre care and a care that would be well dignified. Siviter (2004) outlines that holism and holistic care look at the patient as a whole person, with unique and individual needs and circumstances. Holism ensures the nurse to see more than just the reason the patients are in care. It encourages them to look at the way the patients feel and what is important to them. It focuses on their spiritual, emotional, physiological, psychological, and cultural needs (Beauchamp, & Childress, 2009).  I accessed his file with him so that I would have knowledge and gain an understanding of his physical and mental health assessment needs, as well as identifying previous multidisciplinary input in relation to his OCD. Daley (2001) emphasizes that an assessment completed in partnership with a person should be used as a system of social support, which offers choices to the user. I introduced myself to TJ and asked him how he wished to be supported. This is an important part of the nurse and client relationship, in as much as when two people are offering their names to each other they are respectively also offering themselves, which indicates an openness and readiness to talk and share with each other (Quinney ,2006). I spoke to him calmly, taking his learning disability into consideration. I explained to him that I intended to establish, build, and sustain a relationship with him and find ways to lower his episodes of aggression towards others. Once he was fully informed, I asked whether it was acceptable to work with him. He gave me his consent by smiling and nodding down at me, which was positive (NMC, 2008). According to Heyward and Ramsdale (2008), consent is private genetic information about a person that should generally not be obtained, held, or communicated without that person’s free and informed consent. Elliss, Gates and Kenworthy (2003) stated that good communication is fundamental to effective nursing practice. Communication is defined by Thompson (2005) as listening, reading, speaking, and writing, and in the health care setting these are generally listening and giving information to our patients. By doing so, I was adopting the NMC (2008), which stated that “you must treat people kindly and considerately” and “you must listen to the people in your care and respond to their concerns and preferences”. Human Right’s Act (1998) Article 14 explains that every person should be treated equally without any discrimination on any ground (HMSO). When engaging with TJ, I took into consideration his disability and respected his rights to make his choice to work with me and to be involved in his care. During the time spent with TJ, I assessed that he was interested in painting. This was the first stage of the nursing process, in which data about TJ’s health and social needs and status is collected (Dougherty & Lister, 2004). This made me plan the initial contact with him in such environments which he enjoyed. TJ was given a two-day project in which he had to draw and paint the things he enjoyed doing the most in his life. I felt that supporting his project would act as a foundation for establishing our relationship and aid him to be comfortable. Furthermore, this gave him an opportunity to find out more about me as well and to gain confidence in me. For example, I disclosed to him that I am also a student like him, so he shouldn’t worry to make mistakes as we can learn from them. I often repeat to TJ what we had just discussed, which is called paraphrasing and summarising. These are the equivalent of non-verbal positive postures, which sends out the message to say “I am listening to you” (Thompson, 2002). Although most of my communication with TJ was verbal, I also used activities like soft music, art, and little makaton to communicate with him. I used body language too as physical presence can affect the care given. For this, I utilized Egan’s (1982) acronym, S.O.L.E.R., in which I Sat facing TJ squarely, with an Open posture, Leaning towards him, making Eye contact, and Relaxing myself to illustrate active listening and participation in the discussion (Egan, 2007). While sitting down and interacting with him I made sure that I was at the same height as him, which would ensure client centered care as it recognizes his equality in the nurse-patient relationship (Astin, et al, 2006). Furthermore, other skills I utilised were also awareness, observational skills, goal setting skills, and interviewing skills as to have one to one sessions with TJ each week. These enhanced a particular type of skill in him. At times he would need constant motivation and positive interaction as he often found it difficult to express his feelings and thoughts (Department Of Health, 2001). While working with TJ I was able to understand why he behaves as he does, and more importantly what triggers him to act like this. By educating myself, I read around his files, engaged with his previous health care worker, his family, day centre manager and his previous day centre. Even though I was not a trained therapist or consultant, I was able to understand and help him reduce the cycle he was getting himself involved with. According to Rogers (1994, pg. 136), the facilitative aspect of the relationship is empathetic understanding. This means that the therapist senses accurately the feelings and personal meaning that the client is experiencing and communicates this acceptant understanding to the client (Gross et al, 1998). An example of a successful task we worked on was during week 9 in which TJ took part in gardening. The aim of this task was to enable him to work with other students in order to achieve a common goal (Evans R, 2001). This was a hands-on approach task which involved working with other students and supporting them. I expected outbursts of aggression due to the high temperature and other factors of that day, but to my relief he fully engaged in this task by helping and supporting other students. While engaging in the activities, I used lower arousal as a method of intervention to help him perform in the presence of others, such as heightened self-awareness or increased self-monitoring (Calvert & Palmer, 2003). I set task-centred work with him as to review his performance and identify the areas of his difficulty and find ways to assist him so that he would not set up to fail (Gale & Oakley-Browne, 2000). Another formal meeting was arranged again which aimed at empowering him as to gain control over his life, his ability to make decisions, and taking control by allowing him to continue making an informed choice to work with me during the 100 days of the project. TJ could change his mind, which he had the right to do at anytime (Horner, 2005). The GSCC (2002) code’s practice 1.3 supports this in which the social care worker must support the service user’s rights to control their lives and make informed choices about the services they receive. By giving TJ a choice I was helping him to increase his capacity as an individual and enabling him to gain power of decision and action over his life. A key principle of the law is that every adult has the right to make their own decisions and is assumed to have the capacity to do so unless it is established otherwise (Nicol, et al, 2004). In TJ’s case, that was not the case as he understood every involvement, reaction, and rationale behind his support. For example, if it was vice versa, as may be he does not understand, then it is my role to make sure I collaborated, encouraged, and worked closely him with other multi-disciplinary factors that are involved in his care and his family. This will not take away his right as it will encourage self-advocacy as a patient speaking up for themselves and asserting their rights is considered ethical practice. Again, he will still have the same right as to refuse interventions and it is vital that professionals respect this right, despite their wish to resolve potentially abusive situations (Banks, 2006). I informed TJ that anything he says to me will not be shared with others in the day centre unless it is life threatening to him or others (Bank, 2004). This was in the remit of the organisation’s confidentiality policy which coincides with the NMC (2008) and GSCC (2004) codes of practise 2.3 in which health and social care workers must respect confidential information. The United Kingdom Central Council for Nursing, Midwifery and Health Visiting code states that the nurse must protect all confidential information related to patients that are obtained during the course of professional practice and that disclosures should be made only with the consent of the patient. Unauthorised disclosure may lead nurses to be disciplined by their professional body. Patients have a right to expect that information about them will be held in confidence, as confidentiality is central to trust developed between the nurse and patient. The nurse must ensure that from the beginning of the care being given, the patient is aware that some information may be disclosed to third parties who are involved in the provision of their care. If disclosure is necessary, then the information should be disclosed on a ‘need to know’ basis (Burnard & Chapman, 2003). Everything I did with TJ was based on holistic care, person centred planning, and in line with the four principles of Valuing People, which are rights, inclusion, choice, and independence, as well as in a non-oppressive manner by allowing him to work at his own pace (DOH, 2006). Before offering feedback, I considered barriers that could affect the intent of my message and worked out strategies to get round them. I ensured that when assessing TJ that realistic goals and clear learning objectives were set. I also encouraged him to question me on things he did not understand. As TJ has a mild learning disability with OCD, I anticipated that I would find it difficult to communicate with him because his OCD was a hindrance to my goal as I had no experience and lacked the knowledge of working with people with OCD. Due to his OCD, I was not afraid to work with him as I feel that I could read wider around his needs and work among other health care workers and be guided in MDT. The NMC (2004:9) stated that, “you must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those actions in which you are competent.” I also anticipated that race could be a potential barrier as I am a young African female and he is a white middle aged man. Since I was the only African female in Edwardian I thought that he may not want to work with me. As a professional, I had no doubts on how far I would be able to assist him, thinking that he may not want to work with me as the staff working there were quite different from me. This became my dilemma for a short period, battling inside whether I will be me or not. Moreover, I understood and acknowledged that my cultural and religious values and beliefs at times can determine my core ethical beliefs and therefore my behavior. This experience made me aware of the importance of valuing diversity, not just with TJ and the staff but to appreciate all clients/environment regardless of any diversity they are associated with. I have highlighted the growing importance of respecting diversity within healthcare and how putting prejudice aside can enable equality for those who I will care for now and throughout my career. I will seek to always practice integrity, honesty, and morality when dealing with others (Beauchamp & Childress 2009). Closure is an emotional component in any nursing, social worker/ client relationship. Consequently, I was aware that my time with TJ was limited and I did not want him to get to attach to me. As a professional, I am to act professional at all times and maintain my professional boundaries (NMC,2008). Evaluating my relationship with TJ, I feel that I was able to influence TJ positively within professional social work ethics and nursing value as the aims and objectives set out met his goals. If we could not meet the targets, we would both review it together(Burnard & Chapman, 2003). Towards closure, I did not observe any incidence of aggressive behaviour in TJ except that I was told one day by my supervisor that he had hit another service user because he sat on the same chair that I usually sit on. I could not figure out why he did it. The unit manager told that he has been telling everyone on that day to stay away as it was my chair. For that moment, I felt special, yet at the same time I was not happy with the fact that he had to hit another service user. I feel that this incident illustrates that maybe he had become too dependent, which is something I would have to work on with him. Therefore, I recognised the need for more distance in our relationship as to be taking time off in-between the sessions and allowing him to work with others. It was necessary for me to reflect on my work practice continually while working with TJ. In conclusion, nursing and social workers as agents of change attempt to alleviate inequalities and oppression within societies and therefore need to be aware of the values underlying their work by referring to the code of ethics (Beauchamp & Childress, 2009). By adopting values and anti-oppressive practice such as advocacy, nurses and social workers will be able to make informed decisions in addressing aspects that relate to the provision of services to individuals who may have differing needs. Being involved with TJ taught me a lot about people with OCD and of the services available for them. It made me realize the importance of consulting with his previous care worker, unit manager, and his family, and being able to admit my limitations in the application of knowledge in terms of risk assessment and theories and stepping aside to reflect, as it is easy to get emotionally involved and overlook important things. I learned that advocacy and empowerment are very important for people like TJ as it gives him control over his life and protects him from harm (NMC,2008). Reflecting back on my placement on this unit, I believe it has added to my knowledge, increased my confidence, helped me to prepare for future roles, be more thoughtful, and be patient when formulating interventions that may have a huge impact on patients’ lives. Read More