Caring for People with Dementia - Assignment Example

EVALUATE SUPPORT SERVICES FOR DEMENTIA IN NOTTINGHAM Support Services available for Dementia Nottingham has been one of the pilot cities in whichthe Mental Health Foundation of UK's project for, "Dementia Advice and Support Services" has been launched. Thus the city's dementia affected population has been positively benefited by this project, indirectly contributing to the overall social and health capital in the city. The scheme has been providing assistance to over 300 people and teams of home care workers, psychiatric nurses and occupational therapists have been specifically tasked and trained for this purpose. It is popularly known as the JackDawe Service. The key services provided by the project include the following:- (a) Information. (b) Advice. (c) Support. (d) Volunteer Befriending. (e) Access in existing services. (f) Relief for the carers. (g) Support to the user at home. (h) Advocacy and legal advice. (i) Counseling The target population of these services includes not only the users but also their families and the carers by providing them necessary skills for coping with the pressures of sustaining assistance to the user. Appraisal of Services During appraisal of services it was noticed that while there were a wide range of services which could have been covered, the scope of appraisal was limited to key issues which affect the user, the family and the carer. Thus appraisal of services has been carried out with reference to four principle skills befriending, informing, advising and coping skills for carers. A common factor observed while appraisal of all these services was the lack of suitable metrics for assessing efficacy of each scheme which militated against their optimum administration. It was also considered that a total understanding of the issue of consequence to a limited number of the population could possibly be a majoritarian one and thus may not be totally congruent with the needs of the users. (Payne, 1997). Befriending. Befriending is a key issue for users. These services alone make the relationship and friendship fun for all the participants, the user as well as the friend. The availability of befriending services was seen to be limited and these were restricted in numbers and their commitment as well as ability to provide succor to the users. Informing. Information should overcome the key encumbrance of dementia that it seemingly does not have a medical cure. Information services have been adequately provided for in the area. These have in many cases covered the individual needs as well as general user needs thereby catering for essential information on benefits available, support and care services as well as treatment that can be provided. However there is also a need for access to information for the carers which was seen to be inadequate. Thus while generally the focus of information is on users, it is also essential for carers. As also while information on benefits was available in adequate quantum; accessibility to legal information was poor. Advice. There was adequate material for provision of early advice and guidance to the user. Diagnosis was however seen to be a grey area as some reluctance was observed from a number of practitioners to diagnose dementia and subject people to special treatment. This key deficiency needs to be overcome with greater awareness in general practitioners. On the other hand some patients were also extremely reluctant to take advice in the initial stages. The reasons were seen to be varied including acceptance of a personal inadequacy and possible stigma attached to the condition. Provision of advice was seen to be particularly weak in this area. However the dilemma of the advisors was also well appreciated, as advice cannot be intrusive in nature as it would then be counter productive. Skills for Coping by Carers. The skills provided for copers should ensure greater confidence and enhance their skills for management of the user preferably at home. The carer should understand that his needs are not the same as the user but at the same time are linked with the user. Primary issue for carers includes counseling and support. This considerably enhances the ability of carers to cope with the trying circumstances that they face. This is an important facet Imparting skills to carers is a key to any program which is considered beneficial to the users. These services were available however their practical utility to the carers has been mixed. The institutional mechanisms for effective imparting of training in coping skills through these services were found to be limited and there is certainly greater scope in this sphere. Accessibility to People While overall the access to the community has been seen to be adequate, those living on the fringes and minorities have had limited access to all the services. Thus extension of these to those on the margins such as women and ethnically diverse people would need consideration. Befriending. Befriending has been one of the key services which have been devised for providing succor to the user. However accessibility of volunteer befrienders to the users has been low as their numbers are limited, those who are available are inadequately trained to provide consistent assistance to the users. Thus accessibility of this aspect remained limited, though it is the most ideal and economical service that can be provided to the patients. The most important types of befrienders are volunteers who themselves have been carers; this has been found most wanting. An increase in the level of voluntary befriending needs some consideration. The availability of such a service when an individual goes into residential care is also suspect and not many such instances had come to notice. Information. While adequate information is available, there were inadequate details at the point where it was most needed. There was also a question of ease of access in some cases and the need for a friendlier computer interface. Advice. Accessibility of advice to users was limited by scope, type and timing. Thus while most primary care advice was availably in plenty, advice on legal and advocacy issues was limited as the personnel with this knowledge were not available in the required numbers in a small segment of the population even though Nottingham is a large city. Similarly the timing of advice was not found to be the most appropriate, this was significant from the point of view of the need for its provision as early as practicable to enable effective addressing of the problem in its initial stage for better response. Skills for Copers. The availability of services of skills for copers was not at the desired level. While there was a general awareness of its necessity, this was not followed up to include all its dimensions which could provide full scale support to the copers for their mental and physical well being. A holistic approach is thus felt essential which could combine all these issues as information, advice and befriending, to assist copers. In some cases there was adequate awareness of the need to cater for skill development and coping in carers which also had led to denial. Benefit to Service Users The evaluation of the services provided and their impact on the user has conclusively established that the provision of information, assistance, social communication in the form of befriending and support provided by the program has been of considerable significance to the users. While there have been some individual cases of exception, these are very limited in number and could thus be discounted. The benefit was observed to be greater for those people who had the advantage of such interventions at an early stage. Thus it is essential that practitioners who suspect a user's affliction denoting symptoms of dementia could well be advised to recommend early interventions. The impact of a holistic approach to interventions involving the family, carer, user and support from the general environment was also considered significant in partaking benefits of the services provided. Finally the commitment of the carer and the family more than any other issue was the key determinant of whether the program benefited the participant or not. Maximum benefit was observed from continuous volunteer befriending though this service has been seen to be limited than others. There is thus a need identified to enlarge the group of people who are keen to undertake this highly challenging task in the field of social work. This alone will assist those amongst us, who feel estranged, a discomfiture in diverse emotions as indicated by Rogers (2004) are provided the confidence to cope with the challenges of living through the trauma of reduced perception of social realities. The other key issue that emerged during the evaluation was the role of society at large to decide on provision of benefits to a user who is not willing to seek them. Thus a user who is wishing to discontinue services for reasons of perceived incompatibility would pose a dilemma to the service providers as cessation of service would have grave implications especially when the user is not aware of the full implications of such a request. As also it is seen that there is a wide variation between a theoretical model and its practical application. (Schon, 2005). Thus those practitioners who have been able to creatively adopt the theoretical model to practical utility for providing succor to the user have been the most successful. REPORT : AN EVALUATION OF A PRACTITIONER'S VIEWS OF THE IMPORTANCE OF TRUST AND MUTUAL RESPECT IN THE SOCIAL CARE PROFESSION. Preliminary Considerations. The key issue to be identified in the practitioner was his ability to understand that dementia is not a lunacy related affliction but a natural human condition arising out of peculiar biological processes related to aging. A consideration of this aspect of dementia was primary for the carer and the obvious start point of the questionnaire. Though the practitioner selected was fulfilling this criterion of commitment to the cause of the user, it was considered important that the researcher verify this issue and hence the first few questions were designed to seek answers to the same. (See Question 1 to 3, Questionnaire, Appendix). Impact of Trust, Honesty and Integrity. The next aspect to be reviewed was the impact of trust, honesty and integrity on the person affected by dementia and awareness of the practitioner of this facet. (Question 3 and 4, see Appendix). There is reasonable clarity in the effect of dementia affecting practical implementation of the spirit of integrity, honesty and trust. Dementia results in a loss of memory which creates confusion in the mind of the person. This will greatly affect the concepts of honesty, integrity and trust for a person who will always insist that a particular statement has not been made by him, that he has never been told about a thing and that he was being cheated in some way or the other. The problems of memory also result in speech deficiencies. The practitioner displayed a very good understanding of this issue and also denoted the manner in which these deficiencies were to be overcome. Non insistence on pursuance of ones point be it a matter of routine nature or bigger issues was the key to avoiding a confrontation with the user as per the practitioner. There is no point in insisting to the user that he is wrong or has forgotten a thing. It is in fact highly detrimental as per the practitioner to raise issues of integrity and honesty with the user as these concepts are many times diffused and in any case his own deficiencies will never be accepted by the person affected. Repeated encounters of confrontation on these issues would lead to a total loss of trust which should be avoided. The key to building trust as per the practitioner was a successful relationship which did not depend on a feeling of righteousness, for this many times a momentary sacrifice of the truth would be essential and has to be taken from a practical point of view. Recognition of Support. The practitioner highlighted that there was always a recognition of the support that has been provided to the user and he acknowledges it, but not in as many words. (Question 5, Appendix). Many times the recognition is acknowledged in differing emotions rather than words, such as a sense of relief on seeing the practitioner or distress on not interacting with him for a long time. The distress causes high degree of anxiety and some times depression. The realization of dependency can be fostered for building trust, however it should not construe into total enslavement for this will be detrimental in the long term interest of caring for the person. Acceptance of Necessity of Trust. A review of the discussion in the above mentioned paragraphs would have revealed that the practitioner had a deep understanding and belief in the need for building trust with the person under his care. However a direct question related to the same was also included to receive a positive proof or contradiction in the approaches. (Question 6, Appendix). The practitioner responded positively to the question and thus he indicated that he fully supported the concept of necessity of trust in dealing with the user. That it cannot be a mechanistic process and has to come from long term relationship of mutual affection and feeling of caring particularly from the practitioner to the cared. Creating Trust. The key issue however was not just acceptance of the need for trust by the practitioner, but also how much time and energy he had expended in creating trust. (Question 7, Appendix). The responses indicated that the practitioner had undertaken a number of trust building exercises with people under his care. The total numbers indicated were 12 in a career spanning 3 years which is considered adequate commitment on his part towards this essential aspect. The practitioner was also committed to the concept of trust as a medium to provide relief to the persons affected, He had strong beliefs that it was one of the most significant ways in which the user could be benefited and he indicated that trust should be the core of providing care, be it by family, friends or carers. He indicated very strongly that without trust very little could be practically achieved. Process of Trust Building. The process of trust building was the next issue which was considered. (Questions 8 and 9, Appendix). The practitioner underlined that this was a continuous process and not an episodic one. A number of discrete events will add to the trust. There was a problem he had faced in some users where he had to limit his interaction with them for certain periods due to other commitments. However he indicated that fore warning of his absence and likely revival of relationship enabled continuance of trust. He also felt that in case the subjects had not been forewarned, they would have considered his absence as a sign of mistrust and the relationship would have been difficult to revive. Language is considered an important facet of interaction. Not just the language but also the tone and the tenor of the interaction which had an impact and which needed consideration in building trust. Rude and intemperate language by people did not build trust and the users generally tend to avoid further intercourse with those who ill treated them. Trust Building and Mutual Respect. Is trust building a mutual process or is it a one sided interaction. (Question 10, Appendix). As Trevethick (2005) has indicated, there are many problems associated with trust. One issue is that of asymmetry in the mental and coping powers of the administrator and the user. There was thus a scope of possibility of biases creeping in the process. (Trevethick, 2005). This asymmetry may result in lack of mutual respect and the process of trust building failing after a certain time. The practitioner firmly indicated that he was personally benefited from the trust building process and enriched his personal and professional life leading to greater degree of mutual respect between him and the user. Conclusion. The report highlights the commitment of the practitioner to trust as a medium of relief in the context of users of dementia assistance, which supports the hypothesis of importance of trust and mutual respect in the social care profession. References 1. Payne, Malcolm. 1997. Modern Social Work Theory. Second Edn. London Macmillan. P 136. 2. Rogers, Carl R. 2004. On Becoming a Person. London. Constable. P 76. 3. Schon, Donald. 2005. The Reflective Practitioner : How professionals think in action. London. Ashgate. P44. 4. Trevethick, Pamela. 2005. Social Work Skills, A Practice Handbook. Sec Edn. Open University Press. P 232. Appendix QUESTIONNAIRE 1. What are the key symptoms of people affected with dementia 2. How do these symptoms affect the ability to interact with the environment 3. Do the attributes attained due to dementia affect building of trust with the personnel 4. Do personnel affected by dementia have any concept of honesty and integrity 5. Is there a realization in the personnel affected by dementia of the support provided by you or others to them a. If yes, provide how it can lead to building greater trust b. If no, indicate how despite the same greater trust can be build between people interacting with the affected personnel 6. Do you feel the necessity to build trust with the personnel under your care or is it a mechanistic process of treatment 7. Have your attempted to create trust with the people under your care Based on your experience do you feel that trust and mutual respect can be created with personnel suffering from dementia 8. Are there any special considerations of language which must be borne in mind while interacting with people with dementia 9. Is trust building a continuous process or an episodic one Will it survive disengagement for a period of time and then be revived with engagement 10. Can trust building lead to mutual respect If so is the process lasting or is it limited to the period of interaction Read More