The study is the reflective essay which will critically reflect my experience and knowledge on placement by centring on a particular case study and deliberating distinct literature that has informed my practice.Reflective practice is considered as the core concept in the sector of social work. It is probably one of the eminent theoretical viewpoints across the whole practical professions of health and social care. In the words of Ruch (2000) reflection has the main pathway for learning, therefore, critical reflections are needed by social work students to questions their practice and to bring about good practice.
This essay is segmented into various sections; initially, I will highlight the overview of the placement settings and association strength-based model of evaluation. Next, I will demonstrate the legislation and the applied theory. After that, I will demonstrate the case study and the work undertaken by myself. In the end, I will present a reflection on my work with the client and a justifiable conclusion of the entire study. Also, I will maintain the confidentiality of my client, social amenities, client family and other experts involved in this case however the client will be stated to as KT.The placement setting will also remain unnamed and will be referred to as adult social services or council. However, I will also demonstrate an outline of the placement setting and the administration context.
My placement was based on the local authority, adult social care services. The main role is to provides support to grownups around 18 years old and above with elongated term communal care requirements(Kitwood 1998). This comprises ofvariable physical wellbeing and psychological health disorders, advanced broad-minded conditions for the risk assessment, for example, Motor Neuron Disease, Brain Injury, Learning Difficulties, Dementia, etc with a primary physical incapacity or psychological health illness. The work undertaken by grown-up social caretakers and the complex team comprises ofup keepinggrown-ups in the necessity of attention and care and who are less able to protect themselves due to age illness, physical disability or mental health issues.
The entire team is guided with the legislative outline which is comprised of various acts such as care act, human rights act, mental capacity act and so on. The Care Act 2014 updates and unites numerous preceding laws on grown-uphealth care in England into one act in order todeliver a comprehensible approach to grown-up social care(Miller and Rollnick 2012).Apart from this, Mental Capacity Act (2005) delivers a lawfulagenda for evaluating mental dimensions and then building the best decisions when a patient (aged 18+) is measured not to have the ability (Mandelstam, 2017). Apart from this, there are various other acts which are guided to the team.
As per the case study, KT is well known to social services a few years and he has been a self –funded until his referral following the depletion of his savings. Due to these reasons, KT case was allocated to me to conduct an assessment under the Care Act (2014) and to carry out a mental capacity assessment(Teater 2014). KT was stated in the referral that he cannot make an informed decision and he has appointed his son as his lasting power of attorney.
KT is 96 years of age living with unspecified Dementia and prostate cancer that has significantly impaired his memory and reduced his mobility. Further medical history is recurrent chest infection that has to result in him has consequences on and off the end of life, long-term pubic catheter, Arthritis and a history of urinary retention about prostate problems(Department of Health 2009). He resides in a permanent nursing care home. Before that, His son stated that KT lived in his accommodation with his deceased wife who had been supportive of him until she passed away.
Thereafter, KT was unable to cope on his own and he moved to his son's house. Since then, he had been supportive of his dad care but due to increase in care, he was unable to manage his father care needs and he decided to move him to a nursing home where his needs can be met. However, KT does not have capacity at the time he was transferred into the care home(Miller and Rollnick 2009). His communication is inconsistent, and he was unable to communicate his views and wishes. His son, who he had appointed for power of attorney, makes decisions on his behalf.
Teater (2014) recognizes theory is a crucial element in an exercise that guides the method through which social workforces’sight and approach persons, assembly and communities. An adult who has dementia disorder are likely to experience difficulties to speak, think and make a decision. As KT suffered from dementia disease which has impacted his reminiscence, it, therefore, originates as no amazement that he is showing comparable problems and ability to remember things.
One of the concepts applied by social workers working with the vulnerable adult living with dementia is personhood model. This concept considered whether someone is considered as a person or non-person(Legislation.gov.uk. 2014). It is highly important in dementia care and social worker with older people to be aware of this concept while working with older people. Therefore, it is essential to recognise my understanding of personhood which can help enable me to understand oppression and person-centred practice as a method of anti-oppressive practice.
My work was more person-centred, outcome-focused; attachment theory and strength-based to help deal with the presented issues and to achieved KT desired outcomes as well as supported the family. According to DOH, (2001) states that person-centred care principles should be the main based for older adult cares which include looking at individual needs, their home life and social life. However, the older adult is more likely to have complexity in their health condition, therefore I understand providing care for KT needs can be challenging. Irrespective of KT health condition, all decisions made around his care and support needs will be the focus on KT desired outcomes and placing him at the centre of the assessment and the care plan.
I acknowledged the complexities of the case. Before making plans for the assessment, I read up previous assessments to know why KT was initially referred to social services and to familiarise myself with his background history. Initially, I wrote a plan before initiating any work and collect all the necessaryinformation and data about the client grounded on the present issue in the circumstance of upkeep and carewants as anoutcome of Dementia disease that causes cognitive impairment. Before the assessment, I contacted KT son and the nursing home to advise them about the visit and book an appointment. KT son gave his consent.
When I contacted the son for the first time to arrange a visit in order to carry out care needs assessment, the response from his son was very sympathetic. The son stated that he wanted his father to end his life with happiness and get full support from the care home but unfortunately, the family are unable to provide for his care needs and KT son was unemployed and unfit to support him that is why they made the referral. My initial response to KT and his family situation was of sympathy and of concerns for his wellbeing and that of his family.
At the start of the assessment, I explained to KT son that I might need to take some notes during the assessment. The assessment I carried out was to assess KT needs and to determine if he meets eligibility criteria to be funded by social services on a permanent placement at a nursing home and ascertain if he is happy to continue living in the care home by applying the Care Act eligibility criteria. I was also aware of my fear, that I must ensure I had all the relevant information from all party's involved in his care to write my report. My anxiety had been heightened by the advice from my colleagues who repeatedly reminded me that family are not always happy to hear negative news about placement, therefore I must always aim to get my report right before going through the panel.
Due to KT cognitive impairment and reduced in mobility at that time the assessment was done in discussion with his son who emphasized four key areas of concern for his dad, namely, nutritional intake, personal hygiene, safe environment, risk of fall, lack of capacity to make informed decision and wandering (Roper et al, 1996). KT has also been assessed as lacking mental capacity around his care and treatment management at the care home.
The son also informed me that his dad desired outcome is to remain in the nursing home in order to receive appropriate support. To address the safeguarding issues around the risk of fall, I further asked the son of any recent history of falls reported by the care home. The son reported that he had a fall a few weeks back which he ended in the hospital. The Care Act itself talks mostly about protecting adult and carers from abuse or neglect rather than about safeguarding them (Mandelstam, 2017). Therefore, asking about safeguarding issues is part of my prepared questions by reviewing the risk with the care home and how to prevent it from reoccurring.
Collaboration with the client and other professionals' involvement can lead to social work success. After the assessment, I asked to see KT take his view but unfortunately, he was unable to communicate his needs and wishes as he depends on the staffs and family to anticipate his care needs(Department of Health 2009). As soon as we entered the KT room, he smiled at his son; this signified a good relationship with son as he was able to recognise his son.
I spoke to the care manager and carer at the nursing home to take their views concerning KT care and support needs. They corroborated KT's son view that he was happy and well settled at the nursing home; with an appropriate level of support being given. I requested for his care plan, medication chart to read through to ascertain that all the information I had been given by KT son and care management were correct. During my interview with the nurse, she described KT as a frail person, possible onset of dementia, struggles to mobilise, can be verbally challenging and forget to change his clothes and wanders in the night. Although this describes some of the things KT can find difficult due to cognitive impairment, it doesn’t describe KT as a person (Thompson 2009).
Applying strength-based as helped me to know who KT is by conducting motivational interviewing with his son. He described KT as a father, husband, highly skilled engineer for Royal Airforce, clever man, lovely father and a football player. Son also said he enjoyed participating in a chair-based ball game before he turns 50 years. He retired at 59 years old due to his loss in memory. This information gathered helped me to write my report
Effective communication skills are indispensable to any procedure of social work practice (Koprowska, 2014). Throughout my assessment, I listened to KT views and concerns using my active listening skills and ensured I built a good rapport from the first contact with KT son to have a smooth working relationship. A comfortablesituation was enabled in KT nursing home.Effective communication helps to gather important information in order to build a complete image of KT health condition and thesupport needs.
After gathering all information, KT needed to be unable to achieve seven outcomes which signify that he is eligible for care and support needs. These allowed me to produce important evidence for a gooddecisionfinding (Guthrie and Lewis, 2007). All the recognizedwants of KT remainedcombined into his action plan and the suitable interventions were taken. On arrival back to the office, I wrote my assessment based on all the information gathered and send it to my supervisor for authority before sending it to the panel to make their decisions.
I found effective communication very essential and helpful during interaction with the service users. I chose my words carefully when completing the assessment at work to give a clear picture of the service user and the details of the assessment because I realised how I had been guided by the previously recorded information(Heron 2005). The use of social work tools has equipped me with knowledge on how to engage effectively with service user and family for possible outcomes. Person-centred approach and strength-based approach aids in understanding the needs and requirements of KT.
I released the importance of attachment to people living with dementia as they often feel quite alone when they are in strange places like nursing home and hospitals. I noticed KT was smiling as soon he sees his son, entering into his bedroom. This assessment helped me to gain more understanding of working with service users with dementia and remembering that no two individuals living with dementia are the same.
The legislationsthat include all the acts are vital in adult social care as provisionoperators are supposed to acquirecapability until confirmed otherwise. In adult social care, all assessment is based on Care Act principles and Domains to determine if an individual is eligible for care and support. In this entire scenario, my part as a social work student, who needs to ensure that KT got a placement in a nursing home and will able to provide the necessary care and support needs. This learning experience gave me a good insight into understanding individual service users need and support and how to apply the legislation when working professionally.
It is concluded from the study that the entire experience was very amazing and pleasant. I was so much enthusiastic with my role as a social work student, who needs to ensure that KT got a placement in a nursing home and will able to provide the necessary care and support needs.I read up previous assessments to know why KT was initially referred to social services and to familiarise myself with his background history. Initially, I wrote a plan before initiating any work and collect all the necessary information and data about the client grounded on the present issue in the circumstance of upkeep and care wants as an outcome of Dementia disease that causes cognitive impairment.This assessment helped me to gain more understanding of working with service users with dementia and remembering that no two individuals living with dementia are the same. The use of social work tools has equipped me with knowledge on how to engage effectively with service user and family for possible outcomes.
Department of Health (2009) Living Well with Dementia: A National Strategy. The Stationery Office, London.
Guthrie, E. Lewis, S. (2007), Psychiatry. A clinical core text with self-assessment. London: Churchill Livingston.
Heron, B. (2005), Self‐reflection in critical social work practice: subjectivity and the possibilities of resistance. Reflective practice, 6(3), pp.341-351.
Kitwood, T (1998), Toward a theory of dementia care: ethics and interaction, the Journal of Clinical Ethics,9,23–34
Koprowska, J. (2014), Communication & interpersonal skills in social work. London: Sage/Learning Matters.
Legislation.gov.uk. (2014). Care Act of 2014. (Online) available at http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted (accessed 8/4/2020)
Michael Mandelstam. (2017), Care Act 2014. Jessica Kingsley Publishers.
Miller, W.R. and Rollnick, S. (2009), Ten things that Motivational Interviewing is not. Behavioural and Cognitive Psychotherapy, Vol. 37, pp. 129-140.
Roper, N., et al (1996) Using a Model for Nursing. Edinburgh, Churchill Livingstone.
Ruch, G. (2000), Self and social work: towards an integrated model of learning' Journal of social work practice. 14(2) pp. 99-112
Teater, B. (2014), An introduction to applying social work theories and methods. Maidenhead: Open University Press.
Thompson, N. (2009), Understanding Social Work, third edition. Hampshire:Palgrave macmillan.
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