In the United States of America, many Americans are left in an ill or dangerous health condition due to their inaccessibility to needed health services. The issues with healthcare access for Americans are due to factors such as: the cost, geographic issues, short doctor office hours, transportation difficulties, and limited education about healthcare facilities. In order to resolve the issue of inaccessible healthcare in America, these factors must be examined and reformed to better the health of millions of Americans.

Facts

The main contributing factor to the inaccessibility to healthcare in America is the cost. According to Bloom (2019), the average annual cost of health care for an American was $9,596 in 2012, then $10,345 in 2016. As a result of these high costs for healthcare, 16.3 percent of the American population lacked health insurance for the entire year in 2010 (Schneider, 2014, p. 465). Of the 16.3 percent of uninsured Americans, 80 percent live in families headed by workers who cannot afford insurance because of the high premiums (Schneider, 2014, p. 465). Sixteen percent of uninsured citizens is very bad for America, considering “a study published in 2009 found that people without health insurance had a 40 percent higher risk of death than those with private insurance, leading to 45,000 deaths each year” (Schneider, 2014, p. 465). The second contributing factor to the inaccessibility to healthcare is geographic issues. Every American does not live within a city where doctors and hospitals are easily accessible. According to Heath (2018), “As many as 57 million Americans currently live in a rural area, according to the American Hospital Association. These individuals face a litany of challenges, ranging from where they live to having enough doctors to provide care.” “The patient-to-primary care physician ratio in rural areas is 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas, according to statistics from the National Rural Health Association” (Heath, 2018). Geography puts many Americans living in rural areas at a disadvantage, because, unlike urban areas, there aren’t many doctors who provide care in rural areas. Another contributing factor to the inaccessibility to healthcare is limited doctor office hours. The normal doctor office is typically open from 8 a.m. to 6 p.m., however, there are many Americans who must work and are not available between those hours. The fourth contributing factor to the inaccessibility to healthcare is transportation. According to Heath, “Per AHA statistics, approximately 3.5 million patients go without care because they cannot access transportation to their providers” (2018). Not every American who needs medical attention has the ability or option to drive whether it be due to a disability or financial reasons, so unfortunately, they tend not to go see a doctor for proper health services. The last contributing factor to the inaccessibility to healthcare in America is limited education about healthcare facilities. According to Heath, “A February 2017 survey from CityMD showed that patients largely don’t know where they should receive care for various different symptoms. When presented with different scenarios…only 46 percent of respondents correctly selected urgent care as the appropriate choice for a scenario in which a child is presenting with 104-degree fever, shivering, and coughing” (2018). Limited education about healthcare facilities causes inaccessibility to healthcare, because if one is not educated on the functions of different healthcare facilities, they more than likely will not know where to go in the time of medical need.

Examples

An example of healthcare being inaccessible due to cost is a blue-collar worker who use to be medically insured through their employer, however, they are currently uninsured. Before monthly premiums for insurance began to rise the worker was insured through their employer. Unfortunately, for the employer, the monthly premiums began rising in proportion to wages, and it became too expensive to provide health insurance for employees and their families. As a result of expensive premiums, the employer cut back their coverage which required the employee to pay a larger share of the premiums, higher deductibles, and higher copayments. Therefore, the blue-collar worker is no longer insured, because they could not afford higher payments for insurance. An example of healthcare being inaccessible due to geography is an elderly woman who lives in a rural area, and she is due for a blood test. However, there has been a recent shortage of clinics within her area and the nearest health care provider is located forty-five minutes away in the city. The elderly woman does not feel comfortable driving such a long distance, so she decides not to go see a doctor because it is too long of a trip. An example of healthcare being inaccessible to due to limited doctor hours is a single mother with two kids who works full time. The mother and her two kids may be in need for their routine physical exam, however, the doctor in the area is only open Monday-Friday from 8 a.m. to 5 p.m. Unfortunately, the mother cannot schedule a time to be examined, because she works 8 a.m. to 6 p.m. Monday-Friday and she cannot afford to miss work. Due to the mother’s long work schedule and the doctor’s limited hours, her two kids and herself never go to get a routine physical exam. An example of healthcare being inaccessible due to transportation difficulties is a woman suffering from a flare up of severe arthritis, and she needs her medication. The woman lives alone, and she cannot drive due to her arthritis, therefore, she has no way of retrieving medication to treat her condition. Lastly, an example of healthcare being inaccessible due to limited education on healthcare facilities is a parent whose child has had abdominal cramping, a reduced appetite, and feeling fatigued for a week. Instead of taking the child to the emergency care, the parent decided to take the child to a pharmacy clinic. After the clinic recommends for the child to be taken to a hospital, the hospital informs the parent that the child has been diagnosed with Crohn’s disease. In this situation, had the parent been educated enough about healthcare facilities, they would’ve known to take their child to the hospital instead of a clinic.

Discussion

Accessibility to healthcare is very important, because it impacts the health of millions of Americans. If millions of Americans cannot access healthcare services, then the health of the country decreases as the mortality rate increases; the challenges that many Americans face when accessing healthcare should be addressed to be reformed. Fortunately, of the issues already discussed there have been efforts made to correct them. To help patients become educated on which type of ailments can be treated at a healthcare facility, “clinician offices and hospitals can display this information in their own facilities and offer patient education materials” (Heath, 2018). In instances where patients cannot reach a doctor due to the limited hours available, “some organizations are utilizing health IT and connected health to allow patients to seek medical advice without needing to come into the office” (Health, 2018). Some health organizations are using a program called Telehealth, which “allows a patient to receive medical treatment without being beholden to an office schedule that does not fit the patient’s needs” (Heath, 2018). Other than using health IT programs, some health facilities have changed their hours of operation to better fit the needs of their patients. In efforts to reform the issues of healthcare inaccessibility due to geographic issues, some healthcare facilities have begun using telemedicine which “allows patients to use their own computers or smartphones to video call with a provider…keeping patients from having to travel great distances to receive intensive or specialized care” (Heath, 2018). Lastly, to overcome transportation barriers that challenge access to healthcare “rideshare giants Uber and Lyft announced plans to close care gaps arising from medical transportation woes” (Heath, 2018). Patients can benefit from healthcare facilities partnering with companies like Uber and Lyft, because they will always have a way of transportation for medical reasons.

Summary

In conclusion, many Americans face challenges that restrict them from accessing healthcare services. The common challenges that cause inaccessibility to healthcare are the cost, geographic issues, limited doctor office hours, transportation difficulties, and limited education about healthcare facilities. If these problems are not brought to the attention of our country’s healthcare providers, then there will not be any reform to our country’s healthcare access. If there is no change done to allow better access to healthcare, it will result in more Americans having deteriorating health conditions and illnesses. Fortunately, there has been efforts made to reform challenges such as geographic issues, limited doctor office hours, transportation difficulties, and limited education about healthcare facilities. Many healthcare organizations have begun to expand their health IT programs, and partner with rideshare companies to give more Americans easier access to healthcare. Health IT programs, such as Telehealth and Telemedicine, allow patients to access healthcare services via electronic device at any time of the day. Rideshare companies, such as Uber and Lyft, have partnered with health organizations to offer patients a reliable way of transportation to receive health services. Healthcare access should not be taken lightly, because the easier patients can access health services, then the easier it is to prevent diseases and promote better health.

References

• Clark, J. (2014). Do the solutions for global health lie in healthcare? BMJ: British Medical Journal, 349. Retrieved from https://www.jstor.org/stable/26517292
• Hooper, C. (2008). Adding Insult to Injury: The Healthcare Brain Drain. Journal of Medical Ethics, 34(9), 684-687. Retrieved from http://www.jstor.org/stable/27720175
• Heath, S. (2018, June 28). Top Challenges Impacting Patient Access to Healthcare. Retrieved from https://patientengagementhit.com/news/top-challenges-impacting-patient-access-to-healthcare
• Lack of Health Care is a Waste of Human Capital: 5 Ways to Achieve Universal Health Coverage By 2030. (2018, December 7). Retrieved from https://www.worldbank.org/en/news/immersive-story/2018/12/07/lack-of-health-care-is-a-waste-of-human-capital-5-ways-to-achieve-universal-health-coverage-by-2030
• Schneider, M.-J. (2014). Introduction to public health. Burlington, MA: Jones & Bartlett Learning.
• Bloom, E. (2019, October 14). Here’s how much the average American spends on health care. Retrieved from https://www.cnbc.com/2017/06/23/heres-how-much-the-average-american-spends-on-health-care.html
• Chokshi, D., & Kesselheim, A. (2008). Rethinking Global Access to Vaccines. BMJ: BritishMedical Journal, 336(7647), 750-753. Retrieved from http://www.jstor.org/stable/20509392

This critical evaluation will be going into depth on whether or not social media increases the risk of mental health issues in teenagers and young adults negatively, and whether or not there is a wide range of academic sources that are up-to-date and comprehensive of the research subject. Therefore, it is seen through immense and thorough research that it can be supported that social media has a moderately negative impact on the emotional and mental wellbeing of adolescence and young adults alike.  Nevertheless, there is still many arguments taken on both sides of the spectrum, all attempting to support their stance with relevant information that gives way to important and necessary interpretations and understandings of this topic. Mental illness is something that affects everyone, even though this evaluation is only looking into the effects of social media and mental health in young adults and teenagers, it is still something that touches the lives of everyone in society. Therefore, social media does increase the risk of mental health problems.

Many studies have delved into the topic of social media platforms and their impact on mental health. Many correlations of this subject has been continuously researched over the years since social media was first introduced into society and the world. Many different studies have shown the links between social networking sites (SNS) and their effect (whether they are arguing positively or negatively against this topic) on the mental health of young adults and teenagers. SNS is a platform to which many people around the world are able to connect and generate relationships via the internet and social connections (Seabrook, Kern, Rickard, 2016). The main types of SNS is Facebook, Twitter and Instagram, with more than 70% of adolescence and young adults using these sites (Jelenchick, Eickhoff, Moreno, 2012). Seabrook, Kern and Rickards 2016, have put forward the consideration that social networking could actually be supportive while also enabling social interaction, but also could have the opposite effect, and create issues that could lead to negative effects on mental health (Seabrook, Kern, Rickard, 2016). Therefore, some social aspects of social media can have a poor effect on mental health, which is highly seen in adolescence and young adults. This source suggests that if social media effects poorly on the user it is just indicative to their use of it and it isn’t the platform as a whole, going as far as suggesting that social media in fact protects users against mental health issues such as depression and anxiety that will be looked at into more depth further on. Even though this source isn’t supportive of the main argument, it does give an important counter-view of it. Social media use is forever increasing among society as a whole, and through many studies, including Lin, Sidani, Shensa et al., (2016) research that showed that in American young adults, increased social media use was in fact significantly associated with depression (Lin, Sidani, Shensa et al., 2016). There is also a phenomenon called “Facebook Depression” that has neither been rebutted or supported that SNS like Facebook cause depression (Jelenchick, Eickhoff, Moreno, 2012). Therefore, many published studies that draw into the association of SNS and mental health have yielded mixed reviews over the years. However, consistent findings were obtained despite different samples and methods of peoples’ research into this topic. This is indicative of a robust finding that supports the notion that social media affects mental health.

Mental illness has been recognised as one of the most leading factors in disability today, and that social media can be used to actually detect depression and anxiety, as well as cause it to intensify or even help manage it (Choundry, Ganon, Counts, Horvitz, 2013). One study even delves into how gender can also change the way SNS affects one’s mental health, with the constituting factor of age. It is seen in this study that females have a higher prevalence of mental health issues and mental distress brought from social media platforms (Kawachi, Berkman, 2001). However, as it is seen in many of the relevant sources, more research has to be brought into actually answering the question at hand.Shaw and Gant (2004) conducted a research study on whether or not the internet had negative impacts on users. Their results suggested that the internet could very well be seen to have negative impacts and implications to its users (Shaw, Gant, 2004). Their research pointed out that internet use was positively linked with dwindling relationships between the family members that were apart of this study (Shaw, Gant, 2004). Stress that seemed to be daily, loneliness and depression were all positively identified and also linked to a higher level of internet usage, while they controlled for other variables in the research (Shaw, Gant, 2004). The information and data taken from this research journal shows that internet usage and social media does reflect badly on one’s mental health. However, their research also suggested and showed that none of the results gathered from this experiment were strong enough to actually suggest that internet was the only categorical factor pertaining to the diminishing mental health of the participants (Shaw, Gant, 2004). This is suggestive that of the data collected from this study didn’t fully support the argument at hand. Kraut, et al., (1998) conducted a study that significantly supported our stance on this topic. It showed how greater use of the internet, and social medial could be associated with the declines in participants’ communication with others, as well as, declines seen socially, and also increases in their depression and loneliness (Kraut, et al., 1998). Seeing as this is quite an older study, this suggests that the findings in this papers hypothesis could be moderately different now. Primack, (2017) has even suggested that depression and anxiety can be associated with an increased use of SNS, however, with the independent roles of using multiple platforms is still unclear (Primack, 2017). Therefore, this shows that there is a gap in literature, as well as a contradiction that social media negatively affects mental health by suggesting that it is, but also not being completely of it causing mental health problems to be more apparent and worse in a way.

There has been a lot of research and knowledge put into the many analyses and/or experiments that have been done to understand this subject. There texts all seemed to attempt to answer the question with relevant and new information gathered. However, there seems to be a very biased notion that social media affects teenagers and young adults either negatively or in no way at all. Whether or not this is the case, there is not much research that suggests otherwise. Many of the research that had been conducted in these cases had hypotheses suggesting that social media had no negative effects and that it actually helps with mental illness. There is a lot of published research reports that are suggestive of the fact that there is in fact a positive relationship between social media and mental health, and after conducting their experiments or analyses they in fact go on to suggest that there is either no relationship or that there is a negative relationship between the two. However, what is truly the case is that it is highly suggested as well as supported that social media negatively impacts a person’s mental health, especially in high regards to depression, anxiety, self-esteem and perceived loneliness. It was also seen that the evidence to support either opinion came with extensive research and was persuasive, even if findings were contradictory to stated beliefs. However, irrespective of the suggested belief and direction of a researcher’s findings between social media use and mental illness, these findings should be shown to public practitioners and others, as it is important for them to understand the link between the two (Lin, Sidani, Shensa et al., 2016), as untreated depression and other mental health disorders have become a serious problem in today’s society, and every bit of information about topics such as these are useful (Nambisan, Luo, Kapoor, et al., 2015). Therefore, research on whether social media increases mental health problems should continue on, to really be able to determine whether or not this is a serious risk factor for the health of teenagers and young adults around the world.

Therefore, through much research it has been highly suggestive of the fact that social media does have a detrimental effect on the mental health of teenagers and young adults alike. However, more research should continue to be conducted into this topic to find the extend of this problem. Mental health is a serious issue in today’s society, and measures need to continue to be taken to help support the people in need of help. Therefore, founded through current and qualified research, social media platforms negatively impact young adults and teenagers today.

References

• Shaw, L. H., & Gant, L. M. (2004). In defense of the Internet: The relationship between Internet communication and depression, loneliness, self-esteem, and perceived social support.
  
  Internet Research, 28
  
  (3).
• Kraut, R., Petterson, M., Lundmark, V., et al. (1998). Internet paradox: a social technology that reduces social involvement and psychological well-being.
  
  American Psychologist
  
  53:1017-1031.
• Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barret, E. L., Sidani, J. E., COlditz, J. B., & James, A. E. (2017). USe of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among US young adults.
  
  Computers in human behaviour, 69
  
  , 1-9.
• Seabrook, E. M., Kern, M. L., & Rickard, N. S. (2016). Social networking sites, depression, and anxiety: a systematic review.
  
  JMIR mental health, 3
  
  (4)
  
  .
  
• Lin, L. Y., Sidani, J. E., Shensa, A., Radovic, A., Miller, E., Colditz, J. B., … & Primack, B. A. (2016). Association between social media use and depression among US young adults.
  
  Depression and anxiety, 33
  
  (4), 323-331.
• De Choudhury, M., Gamon, M., Counts, S., & Horvitz, E. (2013, June). Predicting depression via social media.
  
  In Seventh international AAAI conference on weblogs and social media
  
  .
• Nambisan, P., Luo, Z., Kapoor, A., Patrick, T. B., & Cisler, R. A. (2015, January). Social media, big data, and public health informatics: Ruminating behavior of depression revealed through twitter.
  
  In 2015 48th Hawaii International Conference on System Sciences
  
  (pp. 2906-2913). IEEE.
• Jelenchick, L. A., Eickhoff, J. C., & Moreno, M. A. (2013). “Facebook depression?” Social networking site use and depression in older adolescents.
  
  Journal of Adolescent Health, 52
  
  (1), 128-130.

Introduction

The first FETAC Level 5 Assignment in Care Skills module requires that learners produce an assignment on the care of a confused person. This confusion can be the result of any number of causes – from an illness such as dementia or Alzheimer’s disease or the long term use or an abuse of drugs and /or alcohol. The assignment must be completed answering very specific points (as outlined in the table of contents). This assignment was compiled using various methodologies including:

• Classroom lectures and feedback sessions
• Class notes and Manual, hard copy manuals and books
• One to one sessions with Work Experience Skills Coach
• Previous life experience of caring for an ill family member
• Online research and library research

For the purpose of this assignment the author has decided to highlight one particular client who is in the Nursing Home in which the author is completing her work experience module. The clients name has been changed in order to respect her rights to privacy and dignity.

The client in this example has been diagnosed with Stage 4 Lung Cancer (T4, N3) which denotes that she suffers from a malignant tumour which has invaded the oesophagus, epicardium, pleural cavity, T5 and T6 vertebrae with Metastasis to the supraclavicular lymph node. She also suffers from osteoarthritis of L2-L5 and S1-S5, Type 2 Diabetes and Psoriasis.

She is currently on a variety of medications which are listed in her Care Plan, along with creams and ointments for the Psoriasis. Presently she suffers from severe bouts of confusion as a result of her pain medications and needs constant monitoring and care. In conjunction with her family, and a multi-disciplinary team Catherine has decided to move to a Nursing Home where she will receive the type of holistic care she requires. Catherine has also documented her specific wishes regarding her death and funeral arrangements and all of which has to be respected by all involved, the details are listed in her Care Plan along with the emergency contact details if her condition should suddenly decline.

INDIVIDUAL NEEDS ASSESSMENT

Initial assessment of Catherine’s needs using the Logan Roper Tierney model of assessment an individualised, client-centred holistic approach to Catherine’s care has been devised.

Physical

Catherine loves the outdoors and she should be encouraged to continue this through gardening – taking her out for walks, especially during spells of confusion. Ensure she has her walking stick and bring the wheelchair as she gets breathless very easily.

Shower rails and chair must be available in her room and always ensure that the non-slip mat is on the ground. When she is confused she forgets how to wash herself properly and will need assistance.

Intellectual

Catherine loves to read and complete quizzes and cross words – these are very good for stimulation and they should be made available to her in her room and in the day room.

The news and primetime are two of her favourite programs – ensure that they are on the TV in her room and the day room.

Diversional therapy of card games and jigsaws are great for completing when she is confused.

Emotional

As a result of the illness and her pending death Catherine can become depressed – she must be encouraged, made feel wanted loved, needed and always try to support her decision to move into the nursing home

Social/Spiritual

Socially, Catherine has a lot of friends with whom she plays cards – they are going to come visit her once a week to continue this tradition, the other residents should be encouraged to join in also as it will help integrate her more. Her large family of 8 children and 63 grand-children/great-grand-children/great-great grand-children all visit her when she is at home and will continue to do so. It is amazing the Catherine remembers all their names and dates of birth – during spells of confusion though she does tend to forget them a little.

Catherine is very religious and attends mass every Sunday when she is well – the angelus must be said at 12pm and 6pm and the rosary at 9pm.

Identify the level of assistance required

Catherine has very low level needs when she is not confused. She needs help sitting up in the bed and cannot use the remote control as her fingers are very badly damaged from the arthritis and as such will need assistance getting out of bed. She cannot manage small buttons when dressing and most days she just wears t-shirts but on Sundays she wishes to wear a blouse going to mass and will need assistance with that. Catherine dose not wear dentures and is on a chopped diet for now, she can manage to use cutlery but prefers to use a spoon. When she is confused she forgets when to eat and sometimes forgets that she has eaten so she will need monitoring when eating rather than assistance.

MAINTAINING A SAFE ENVIRONMENT

During confused spells Catherine likes to walk and as such walkways will have to be completely compliant with the Health and Safety Regulations for care as set out by the Health and Safety Authority. (HSA.ie, 2014) It would also be a good intervention to ensure that her walking aid is always within arm’s reach and that her shoes/slippers have rubber soles and are well maintained.

For showering, the shower stool must be readily available and ensure that the hand rails are well maintained. The toilet in her room has a raised toilet seat and rail which must be cleaned and maintained regularly. Catherine will also use a commode, but when she is confused does not realise where she is when trying to urinate therefore she should be encouraged to go to the bathroom to protect her dignity.

When going on outings with her family Catherine’s wheelchair must accompany her always and kept well maintained and ensure the wheels are pumped.

PROMOTE CLIENT INVOLVEMENT IN SOCIAL EVENTS AND THERAPIES

Catherine likes to play cards therefore she would enjoy it as part of the available diversional therapies. The HCA can have table quizzes added to the curriculum of activities by the activities co coordinator and help her participate by writing the answers to the questions and holding the cards – when she is confused one to one games such as Patience or Snap are very helpful.

Catherine is quite a sociable person and will have loads of visitors – they will help to integrate her with the other residents and they play cards, tell stories, Irish dancing and play music some days she wishes not to have any visitors or participate in activities – in order to keep her from this depression the HCA could encourage her to attend the card game or maybe say some prayers with her as her strong beliefs will help to alleviate the depression. Catherine has refused to attend the Cuisle Centre in Portlaoise which has numerous activities and therapies available to cancer sufferers. The HCA could bring her more information on the services provided and explain what they are in detail and answer any questions she may have in order to encourage her to attend. They offer a Gardening Therapy workshop each week which would really benefit her along with the CranioSacral therapy and Holistic Massage would be beneficial for her also and she should be encouraged to go by bringing her down to the centre and having a talk with other clients that attend. (Cuisle Centre, Cancer Support Centre Laois, Cancer Support Portlaoise, 2014)

MOBILITY INDLUDING FALLS AND PRESSURE AREA CARE

FALLS

The results from the Morse Falls Assessment in Catherine’s Care Plan show that on non-confused days she is at low risk, but during spells of confusion she is moderate risk and as such – should be encouraged to walk around more during lucid days and be accompanied outdoors for short walks if her breathing allows – allow her to push the wheelchair for a while will help and support her. The activities co-ordinator has a great curriculum for mobility and Catherine should be encouraged to participate in order to help keep her arms active.

PRESURE AREA CARE

As Catherine suffers from Psoriasis she is even more susceptible to pressure sore development. Her skin should be cared for as per her prescribed treatment – creams and lotions to be applied daily. At the moment she is fairly mobile and does not remain in the one spot for too long – if she suffers bad pain during the day she tends to stay in bed and will need assistance turning and should be encouraged to do so – a second HCA may be needed for this as she has had two hip replacements which have to be cared for also – a hoist may be needed on occasion. Gel cushions should be used when she is playing cards with friends as she could be in the one position for hours, to break this she should be encouraged to get up and walk around every hour – even if for a few minutes.

EFFECTIVE VERBAL AND WRITTEN COMMUNICATION WITH CLIENT AND HEALTHCARE TEAM

Catherine has to attend various appointments for scans and pain medication updates. Any new developments need to be explained in full to her so she can make an informed decision as to what course of action she wants to pursue. Catherine must be kept informed at all times of any changes in her condition and has requested that she be told first so she can decide whether to tell her family. She has stated during meetings regarding her funeral wishes but may want to change these so ensure any changes are documented.

All daily charts are to be kept updated immediately and inform the staff nurse of any noted changes in her condition at handover. As her cancer is rapid and fast progressing Catherine’s condition can and will change on a daily basis therefore food and fluid charts are vital. At the moment she is normal on the M.U.S.T scale, but as she tends not to eat when in pain this has to be carefully monitored and reported if she is refusing food or fluids.

ASSIST CLIENT WITH ACTIVITIES OF DAILY LIVING

Mobility Assistance

Catherine needs assistance when getting in and out of bed. She can sometimes sit up on her own but during spells of confusion she forgets how to stand up and should be encouraged and supported to do it herself as long as possible without the aid of a hoist. She may also need assistance getting in and out of the shower and needs her hair to be washed as she can no longer raise her arms above elbow height.

If the weather if favourable Catherine likes to go outside – she should be accompanied and ensure her wheelchair is in good working order. Allow her to walk as much as she can pushing the wheelchair but ensure she does not get too tired – encourage her to get into the wheelchair and continue until she wishes to return.

Catherine’s pain medication is prescribed by the GP and monitored by the Palliative Care team. She has certain pain killers that are available to her without the nurses supervision – please record when and what she is taking and report it back to the nurse for monitoring.

At the moment Catherine is normal on the M.U.S.T scale and we have to endeavour to keep her that way – she is on a chopped diet but needs to be monitored as the tumour is pressing on her oesophagus – it could cause a choking hazard – any noted changes to her swallow must be reported back to the nurse for further investigation by the MDT. When she is confused Catherine needs assistance eating as she forgets how to use the cutlery.

PROMOTE THE RIGHTS OF THE CLIENT TO DIGNITY, PRIVACY, INDEPENDENCE, POSITIVE SELF IMAGE

As Catherine is very self-conscious about her body – every effort must be made to give her as much privacy as possible when dressing and showering. She will need assistance dressing on occasion especially when she is confused as she gets the order of clothing mixed up. The HCA can discuss her wishes with her and come to an arrangement regarding the assistance she requires.

Catherine is very independent and likes to take her own medications and feed herself. She has expressed her wishes numerous times to all her family and multidisciplinary team regarding her funeral wishes and insists that she not be left alone from now on and even when she passes she does not want to be alone until she is buried with her husband.

Catherine needs to feel in control of the disease and wants to be informed if there is any changes being made to her medications or if the multidisciplinary team think that she is declining in any way regardless of the news make sure she is kept informed and involved in all decisions – it is best practice to inform Catherine first and let her decide when and how much information he and the rest of the family is to be told.

BIBLIOGRAPHY

http://www.upledgerclinic.com/conditions_symptoms.html

http://www.cuislecentre.com/therapies/

http://www.ahrq.gov/legacy/research/ltc/fallpxtoolkit/fallpxtool3h.htm

http://www.clinicaloncologyonline.net/article/S0936-6555(08)00451-2/abstract

http://www.nurse2nurse.ie/Upload/NA6762article.pdf

http://www.ncbi.nlm.nih.gov/pubmed/19059769

http://www.patient.co.uk/doctor/end-of-life-care-pro

REFERENCES

Cuisle Centre, Cancer Support Centre Laois, Cancer Support Portlaoise, (2014). Therapies – Cuisle Centre, Cancer Support Centre Laois, Cancer Support Portlaoise. [online] Available at:

http://www.cuislecentre.com/therapies/

[Accessed 19 Dec. 2014].

Knott, D. (2014). End of Life Care | Doctor | Patient.co.uk. [online] Patient.co.uk. Available at:

http://www.patient.co.uk/doctor/end-of-life-care-pro

[Accessed 15 Dec. 2014].

1

The concept of reflection in learning is not new. It can be traced back as far as Aristotle’s discussions of ‘practical judgement and moral action’ in his Ethics (Grundy 1982 cited in Boud et al 2005a P11).

In 1933, Dewy stated that there were two kinds of ‘experiential process’ leading to learning. The first process was ‘trial and error’ and the second was that of ‘reflective activity’ which involved the ‘perception of relationships and connections between the parts of the experience.'(Boud et al 2005a P12). He explained reflection as a learning loop, continually feeding back and forth between the experience and the situation. (Boud et al 2005a).

In more recent times (1980’s), reflective practice has been introduced and divided into three core components: ‘Things that happen to a person, the reflective process that learning has occurred and the action that was taken from this new perspective’ (Jasper 2003 p2). These can be summarised as experience-reflection-action cycle (ERA) and is a way that learning from experience can be understood and developed.

Kolb (1984 cited in Jasper 2003) developed an ‘experiential learning cycle’ which has been suggested to be the most effective way of learning from our experiences by linking theory to practice:

Observation-

Something that has happened to you

Or that you have done

Action Reflection –

Reviewing event or experience in your mind

Concept development/theorising-

Understanding what happened

(Kolb’s experiential learning cycle 1984, cited in Jasper 2003 p3)

As illustrated, reflection is an important part of the learning loop. Another significant part of reflection is that the process of learning continues so that the learner changes from ‘Actor to Observer’, from ‘specific involvement to general analytic detachment creating a new experience to reflect and conceptualize at each stage’ (Moon 2005 p25).

It has been suggested that reflection itself can be identified into two types of ways ‘reflection-on-action’ and ‘reflection-in-action’ (Schon 1983). Reflection-in-action is reflecting while doing the action, which occurs subconsciously, instinctively and unconsciously, often seen in the more experienced practitioner who can monitor and adapt their practice simultaneously. Reflecting-on-action involves thinking about action after it has occurred, often seen in novice practitioners who need to step back and think about the situation over in their minds. (Finaly 2004)

Another style of reflection is Gibbs reflective cycle. It has characteristics of all other strategies/

frameworks for reflection

that have been developed. However, Gibbs cycle stops at the stage of action and therefore does not provide a way to close the cycle or move to reflective practice in terms of taking action (Jasper 2003). This is because Gibbs framework had its foundations from an education context as opposed to a practice one:

Description

(what happened)

Action plan

Feelings

(if it arose again (what were you what would you do) thinking and feeling)

Reflective cycle

Conclusion

Evaluation

(What else could (what was good you have done) & bad)

Description

(what do you make of the situation)

Gibbs reflective cycle (1988, cited in Jasper 2003 p77)

Chris

Johns model of structured reflection

was developed in the 1990’s. It has gone through many changes and the 1994 version is the easiest to use when beginning reflective practice. Johns says that the model:

‘consists of a series of questions which aim to tune the practitioner into her experiences in a structured and meaningful way. It emerged as a natural sequence through which practitioners explored their experience in supervision’ (Jasper 2003 p84).

The focus of John’s model is about making us aware of the knowledge that we use in practice. This is taken as a core question, which is explored through five cue questions, that are further divided into detailed questions: ‘description of the experience, reflection, influencing factors, could I have dealt with the situation better and learning’ (Jasper 2003 p85). The framework is presented in appendix one.

Many people have defined reflection, Johns (2009 p3) defined reflection as ‘Learning through our everyday experiences towards realising ones vision of desirable practice as a lived reality. It is a critical and reflexive process of self-inquiry and transformation of being and becoming the practitioner you desire to be’.

Furthermore, Boud et al (2005a p18) suggested that ‘reflection is a form of response of the learner to experience’. Where experience is the response of a person to a situation or event e.g. feelings, thoughts, actions and finishes at the time or immediately thereafter. The situation or event could be a course or an unplanned reason in daily life. It could be influenced by something external or an internal or evolve from discomfort.

Reid (1993 p305) proposes that reflection is ‘a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice’

There are many positive uses to reflecting on practice. Johns (2009 p15) suggests that the positive uses of reflection ‘encourages the expression, acceptance and understanding of feelings’ .He suggests that feelings of negativity can be looked into and turned into positive ones in order to understand future situations and learn new ways of responding. Furthermore he suggests that reflection is ’empowering’, which in the end will lead to desirable practice.

Boud et al (2005b p11) suggested that In the case of reflecting on learning, firstly only ‘learners themselves can learn and only they can reflect on their own experiences’. Boud et al suggest that teachers can support reflection, but only have access to thoughts and feelings by what individuals decide to reveal about themselves. Therefore the learner is in total control.

Secondly, reflection is a ‘purposeful activity directed toward a goal and lastly the reflective process where both feelings and thoughts are interconnected and interactive. Negative feelings, can form major barriers toward learning’. Positive feelings and emotions can improve the learning process, keeping the learner on the task and providing a stimulus for new learning. (Boud et al 2005b p11)

Reflection can be used to support occupational therapy (O.T) principles and values, continuous professional development (C.P.D), ethical, legal and professional codes of conducts/standards of practice and it has suggested to be a ‘core process competent, essential to O.T practice’ (Bossers et al 1999 p116).

The College of Occupational Therapist incorporate the benefits of reflective practice in their learning strategies (McClure 2004). Reflection aids professional practice and the importance of this ensures high standards of care and is shown in documents such as ‘A Vision for the Future’ (Department of Health 1993).This is also shown in the Professional Standards of Practice (2007) which states that O.T’s should maintain high standards of competence of knowledge, skills and behaviour (standard 4 – professional development and lifelong learning and standard 1 – service quality and governance)

Ethically, lifelong learning and professional competence (standard 5.4 and 5.1) state that O.T’s shall continuously maintain high standards of knowledge, skills and behaviour and be responsible for maintaining and developing their personal and professional competence. (College of Occupational Therapists 2005).

Reflection is also an important part of continuous professional development

(Fish & Twinn 1997, cited in Martin & Wheatley 2008) and is now a requirement for registration to practice, as is evidence based practice which is an ‘ethical and professional imperative’ (Duncan 2006 p8).

The O.T Codes of Ethics states that ‘O.T’s shall be responsible for maintaining evidence of their continuing professional development ‘(College of Occupational Therapists Code of Ethics and Professional Conduct 2005, 5.3) therefore, this can be done through reflection. New learning and continuous professional development depend on how skilfully you can reflect on ‘your and others practice, to gain new insights, see new relationships, make new discoveries and make explicit the new learning that occurs’ (Aslop 2004 p114). Any new knowledge learnt from the experience will be saved for future reference for when similar situations arise. (Aslop 2004 p115)

To demonstrate reflective practice, In the following reflective account, I am going to use Johns model of reflective structure (1994) mixed with Gibbs reflective cycle (1988) and will be reflecting-on-action (Schon 1983). I feel both are extremely valuable models and help to express different ideas/feelings in different ways at different points. Other models I could have used are Goodman’s levels of reflection (1984), Bortons development framework (1970) and Fish et al strands of reflection (1991).

A mix of both Gibbs reflective cycle with John’s model of structured reflection, will combine theoretical reflection and practice environment. John’s model is helpful in having cue questions. It provides personal awareness of ‘ourselves, our knowledge and actions’ .It asks ‘what you could do rather than what you will do’ (Jasper 2003 p98). Gibbs reflective cycle provides a good framework for the reflective process e.g. learning by reflecting on an event and usually away from the scene of practice. It encourages a good description of the situation, looks at feelings and the experience, concludes where other options are considered and if the situation arose again, what you would do differently.

The following narrative describes a critical incident that had a significant effect on me which made me stop and think and raised questions. This incident was the role of occupational therapist’s (O.T’s) within social care and the impact of this upon a service user’s journey. The names within this narrative have been changed to protect the innocent.

The role of O.T and Social worker have been combined within social care producing the title ‘Self Directed Support Practitioners’ (SDS practitioners)

Occupational therapy as a new profession is facing new challenges from the introduction of the Health Professions Council. The council want greater integration of health and social care provision and the College of Occupational Therapists is preparing for these changes by seeking to refocus the organisations of the work of the O.T’s by its strategic document ‘ from interface to integration’ (Dimond 2004 P397). Hence the role of an S.D.S practitioner.

Brian was a 60 year old man, who lived in a bungalow on his own; with no outside help e.g. care packages or adaptations. His daughter visited him on regular occasions to take him shopping, to appointments and check on his health. Brian was admitted to hospital due to a fall last year whilst using the toilet. The nearby hospital released him about 2 months ago after he spent a few nights there. His daughter reported that Brian was still having problems with self-care, cooking and general mobility.

An S.D.S practitioner and myself carried out a home visit on Brian. We received a referral from Brian’s daughter regarding his health and ability to perform activities of daily living (ADL’s). Upon assessment of Brian, we found that he used the sink (which seemed to be coming off the wall) to aid standing from the toilet. His mobility was generally good but had difficulties raising and lowing himself in and out of the bath and rising his legs over the lip. He had slight problems in the kitchen due to mild arthritis when opening cans and jars, lifting heavy equipment and gripping cutlery. Brian’s mood and motivation was very low and he seemed angry at life in general. His daughter said she could not cope with looking after Brian anymore and needed help with this. She also seemed very low in mood and appeared stressed.

When we assessed Brian, I was unsure and slightly confused how to assess in an S.D.S way. I was thinking about my O.T values and beliefs and how I could incorporate these within the assessment. This would involve me assessing in a holistic way, promoting independence, empowering and motivating him as well as using activity as a therapeutic tool. I was unsure how to implement social work values as they seemed to clash with my own, for example I found it difficult to establish when it would be appropriate to provide care packages. This made me feel extremely confused and concerned that I was not providing the best service for Brian when carrying out the assessment and going against my professional ethics of respecting autonomy (decision-making of service user), beneficence (benefits of treatment against risks and cost), non maleficence (do no harm) and justice (distributing benefits, risks and costs fairly) (Butler & Creek 2008)

Overall I was trying to achieve independence for Brian with the least amount of equipment and help necessary. When assessing Brian in the bathroom, whilst he was sitting on a bath board and using a grab rail, he managed to lift his legs over the side of the bath and had good sitting balance. His toilet transfers needed support, so we offered a toilet frame to aid this. When assessing his kitchen abilities, Brian struggled to lift heavy pots and pans and filling the kettle. He also had difficulty gripping cutlery and standing for periods of time when preparing food. The S.D.S practitioner suggested meals on wheels to overcome the problems Brian faced in the kitchen.

Throughout the assessment Brian was not very happy and laughed at his capabilities. He became very angry when we suggested that he used the equipment provided and he mentioned that he wanted a ‘wet room’ and ‘why could he not have one of these, as his friends had one fitted not that long ago’. We explained sensitively that funding would not allow this and he was very capable of transferring safely with the equipment in place. This made me think about funding and O.T’s values and beliefs, which in turn made me feel unhappy as Brian could not have something he wanted and personally I can understand how comforting and aesthetically pleasing this would be. However installing a wet room could reduce Brain’s mobility, as he would no longer need to lift legs over the edge of the bath, maintain unsupported sitting balance and therefore would lose those skill. Therefore this idea would go against my O.T and personal beliefs. Also due to funding he was not eligible for such a major adaptation.

The outcome of the event was not very good. Brian refused equipment and care packages and became angry. That made me feel sad as I wanted to help Brian, to live an independent life as possible and reduce the dependence upon his daughter. Due to Brian declining the equipment, we had to record and have him sign that he understood the risks of this.

Looking back at the event, I feel maybe I could have convinced Brian further to accept the equipment and care packages suggested. Although the care packages conflicted with my O.T and personal values, as they take away independence, skills and the use of activity as a therapeutic tool; I can see a place for these with extremely impaired individuals. In Brian’s case I would have suggested adapting equipment within the kitchen, such as grips for cutlery, automatic tin openers, a kettle tipper and a perching stool.

The emotions I went through during this experience were anxiety, excitement, and inquisitiveness during the start of the event, followed by sadness toward the end. The most important emotion for me was sadness. I feel that I can learn and grow from this, to tackle the situation differently next time.

To evaluate, the good aspects of the experience was the enormous opportunities for continuous professional development as the role of O.T continues to grow. I also feel my understanding of O.T, social work, clinical reasoning and inter-personal/professional skills have been developed. I also feel more confident if I were ever to be in this situation again to promote and air my values and beliefs.

However, I feel that the role of an S.D.S practitioner causes confusion, loss of role identity and crossing over of professional boundaries. The S.D.S practitioners themselves were not happy with this title and their role which caused problems within multidisciplinary teams.

Although I feel not a lot went well, I believe if I had been more confident to contribute my O.T knowledge it would have aided the situation. The S.D.S. practitioner that I was with managed to balance out the professions well, but I feel provision of adapted equipment should have been encouraged. Her style of reasoning was perhaps due to little knowledge of O.T and herself coming from a social work background.

I am now more prepared for the role of an S.D.S. practitioner. If carried out again I would definitely gain more insight into the values and beliefs of social workers and be more vocal about my O.T ones. I would have tried to encourage Brian to take the equipment and explained more as to why this was important. Perhaps reasoning with him that it was important for him not to lose his existing skills i.e.’ use it or lose it’.

I have learnt that theory; personal, professional standards, values and beliefs, ethics and legal issues often influence practice. I have learnt the importance of reflecting in order to develop myself professionally and personally. My needs in order to develop my professional practice at this stage of my career are huge. I mainly need to develop my knowledge, communication skills, professional skills and clinically reasoning skills. I have also learnt the role which I play within a team and according to Belbins team roles (2010), I am a monitor-evaluator mixed with team worker. This means I try to see all the options and ‘judge accurately, working co-operatively sensitively and diplomatically’ (Belbin 2010).

In general, looking back over the situation, the role of an S.D.S practitioner promotes big ethical issues. In the code of ethics It states that ‘O.T’s can only provided services in which they have been taught to do so’ (5.1) and that ‘O.T’s shall recognise the need for multi-professional collaboration but not undertake work that is deemed to be outside the scope of O.T. ‘ (5.3) (College of Occupational Therapists Code of Ethics and Professional Conduct 2005). Also ethically, are you doing good, doing no harm, promoting autonomy and justice (Butler & Creek 2008) by working in such a manner? Am I affecting the service user’s human rights on freedom of thought, expression or conscience? (article 9 & 10) (Butler & Creek 2008).

Other issues that are concerned with S.D.S practitioner work is when working in such a way there is ‘no team liability’ (every professional is accountable for their own actions and cannot blame the team for negligence which has lead to harm), ‘no defence of inexperience’ (the patient is entitled to the reasonable standard of care whoever provides the treatment), ‘determination of competence’ (carried out by competent colleagues or external assessors), ‘refusal to undertake activities outside scope of competence’ (no O.T should undertake activities which are outside the scope of her professional practice) (Dimond 2004 P112).

To conclude, reflection can identify learning needs, and new learning opportunities. It can illustrate ways in which we learn best, differently and new courses of action toward an event. Reflection can help solve problems supporting personal and professional development and offers an escape from general practice. Reflection shows us the cost of our actions, reveals our competences to others and achievements to ourselves. From observations, reflection lets us build on our theory, helping us to make decisions or resolve doubt and empower or release ourselves as individuals (Jasper 2003).

However, reflective practice has been criticised for its lack of ‘definition, modes of implementation and its unproven benefit’ (Mackintosh 1998 cited in Johns 2009 p22). Platzer et al (2000, cited in Johns 2009 p22) noted that students may be opposed to to reflection that would involve talking about themselves. This was also highlighted by Cotton (2001 cited in Johns 2009 p22) who suggests that reflection becomes a type of ‘surveillance, assessment and control’.

Appendix One

Johns Model of Structured Reflection. Core question – what information do I need in order to learn through this experience?

Cue questions (Jasper 2003)

1. Description of experience

Phenomenon

Casual

Context

Clarifying

2. Reflection

What am I trying to attain

Why did I get involved as I did

What were the cost of my actions for: myself, family, patient, colleagues

Feelings about experiences

Patients feelings

How do I know how the patient felt

3. Influencing factors

Internal influences on decision-making

External influences on decision-making

What knowledge influenced decision making

4. How differently could I have dealt with the situation

Choices available

Consequences of choices

5. learning

Feeling about experiences

The sense made of this experiences thinking of past and future practice

How experience changed my ways of knowing empirics, aesthetics, ethics and personal