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Essay: Reflective account: working with children placed in residential services due to complex health needs

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Reflective Account
My Workplace
Currently I work with Capability Scotland at Stanmore House Residential Bungalows. Typically, I work with children aged between 5-19 who have been placed in residential services due to complex health needs and parents may have opted to place their child within a residential service or they have been placed with us by Social Services for several different factors. Stanmore also provide respite for Adults with disabilities and on occasions I work with these service users as well. Stanmore is committed to a Getting it Right For Every Child (GIRFEC 2006) approach and focuses on maintaining the well-being outcomes for each individual young person. GIRFEC is based on children’s rights and its principles reflect ‘United Nations Convention on the Rights of the Child’(UNCRC) and parental rights under the European Convention on Human Rights’ (ECHR). The principles and values of GIRFEC are Child focused, based on understanding of the wellbeing of the child and their current situation, focuses on tackling needs early and requires joined up working. Within my workplace these principles and values play a key role in how we look after our service users.
Day to day the work I do within Stanmore is very child focused and based on the individual needs of each child that uses the service. Before even beginning employment with Capability it is essential that each staff member attends Mealtime assistance and Safer Assistance training. The mealtime assistance training helped me to gain knowledge on the difficulties (dysphagia) that many of the service users I work with have with eating drinking and swallowing, allowed me to be able to identify the signs of choking and aspiration and gain skills in the appropriate way to help assist my service user at mealtimes. Capability have Policies and procedures in Dysphasia Management in place under this policy I must ensure the service user has mealtime assistance guidelines in place and that I follow them when supporting them with eating or drinking. I must also inform my line manager should any concerns arise regarding the service users support needs. An example of when I might do this is when my service user in question has started struggling with the consistency of a food and is consistently showing signs of swallowing difficulty at this time. This would then lead to the line management passing on the information to Speech and Language therapy for it to be assessed further. Lastly, I have a responsibility to report any incidents of choking or potential aspiration to my line manager which will then be recorded through the Accident and Incident Reporting process.
Safer Assistance training attended consisted of gaining the skills and knowledge to handle people and objects safely to avoid injury to both the service user and me. This is very important within my workplace as on an everyday basis I have to safely assist service users from one place to another due to their complex health needs the majority of the service users I support are wheelchair bound and cannot safely get themselves from for example bed into their wheelchair or vice versa and rely on myself and other staff members to ensure that this is done safely and complies with the legislation regarding this, the main one being ‘Manual Handling Operations Regulations 1992’ where I must “make full and proper use of systems provided.” I also have a duty under the ‘Health and Safety at Work Act 1974’ to ensure that “I take reasonable care for the health and safety of myself and of other persons who may be affected by my actions, to comply with employers instructions, to not interfere or misuse any equipment provided for health and safety and to report any unsafe conditions or practices.”
At work I do both mealtime assistance and safer assistance daily. Before completing any of these tasks, I have to look at the service users care plan in the first instance in order to better understand the needs and preferences of the individual these are very important as all the information that is needed for looking after the service user is within the care plan as well as consent forms stating the care that is to be provided to the child these can be found in a locked filing cabinet within the office area of the bungalow this is in line with Capabilities Confidentiality Policy 2.2.1 – Customers must be assured that any information relating to them, or the services they receive, will be managed in accordance with the Data Protection Act 1998 legislation. I will find within this the guidelines set out by speech and language therapy for mealtime assistance and will also find the service users SARA which gives me details of their risk assessment when moving them in order to do it safely and adhering to the plan in place. On a daily basis these can also be found within my service users red bag that hangs on the back of their wheelchair and goes everywhere with them so that before any manoeuvre can take place they can be looked at and it tells staff which colours of the sling should be used with the hoist to ensure the service user is hoisted in a safe and effective position for the place they are being moved to. Sometimes a service user may have to have a different positioning of the sling to hoist them for a sitting position than going to a lying down position this is all dependant on the service user in question.
Generally, on a day to day basis I do many different duties some which are necessary to maintaining the general health of the service user and other activities for enjoyment, for the service users to realise potential and promote equality and diversity for each individual child in line with Scottish Social Services Councils codes of practice 1.1-1.5.
Necessary duties as an employee that I do continually throughout the day are things like personal care. This consists of many different duties for example changing pads, showering, dressing, brushing teeth, hair care, medication, stoma care and generally just everything that needs to be assisted with that promotes the health and wellbeing of the service user. During this time, it is very important to respect the service user’s dignity and privacy in all aspects of their care so that they feel as comfortable as is possible with the care provided to them. This would be in line with Capabilities Confidentiality Policy 1.7.4 which states “Dignity- we believe that everyone should be treated with an experience and sense of dignity in all aspects of their life, in a way which actively promotes and never undermines their sense of identity and self-respect.” An example of this is when I change the services users pad I make sure they are in either their own personal space or the bathroom the door is closed, any blinds are closed and any visual monitors (in own room) necessary for the individual is turned off so no one that may come into the bungalow will be able to see. I would wear the necessary protective clothing like an apron and gloves to ensure infection control regulations are being met and that it’s done in a dignified manner. Before doing all of that I communicate with the service user so that they know what is going on. With non-verbal service users at times they may communicate using facial expressions and vocalising and will often communicate vocally if they are uncomfortable. Telling them what is happening beforehand helps them to understand what is going on and they are happy for you to support them with personal care. By doing all of this I am following the codes of practice by Scottish Social Services Council claus 1.4 respecting and maintaining the dignity and privacy of the service users.
A lot of the service users I look after require help and support with regards to medication administration as they are unable to do this on their own, I must dispense and administer their medication. This is in line with ‘The Medicines Act 1968, The Health and Safety at Work Act 1974, The Data Protection Act 1998, the Adults with Incapacity (Scotland) Act 2000,’ and many others. These are in place to safeguard the welfare of both children and adults in relation to the administration of medication. Some of the children I look after within the bungalow receive their medication through a Gastrostomy site on their stomach by use of an enteral feeding tube as they are unable to have anything by mouth. This can be for different reasons as some service users may only receive medication by this method but can eat food normally by mouth whereas others are nil by mouth. Training had to be undertaken in order to do both duties as well. I had to be taught the correct procedure to do this in line with appropriate infection control guidelines set out by the local NHS board and nominated staff nurse chosen to implement it within the workplace according to Capabilities Infection Control Policy 1.0 and 2.0. Children and adults with a gastrostomy will mostly receive both their medication and all necessary nutrition in the way of milk feeds through the gastrostomy site and I must follow the enteral feeding regime put in place by the dietician responsible for the child or adult within the service. We currently have one child within the bungalow that receives their medication covertly. Appropriate paperwork and legislation in line with the ‘Adults with Incapacity Act 2000,’ a certificate of incapax was obtained through outside health and legal professionals in order for the service user to have their medication put into their food in the morning and evening, so as to be sure that she receives it correctly as she would otherwise spit it out. Whilst giving a service user either medication or a feed through gastrostomy or with any other assistance it is important for me that I explain exactly what I am doing beforehand. I also reassure the service user if they are showing signs of distress or dislike getting medication as this helps calm them and distracts them from getting upset in any way or in some instances trying to pull at the feeding tube in their stomach as some of the children like to have a little pull at their gastrostomy site when it’s in view of them. During this time reassurance and distraction techniques help avoid any problems that may arise if they were to pull at the gastrostomy site or feeding tube.
As well as these duties we also prepare the young person’s meals (where applicable), this requires appropriate food hygiene training where the relevant legislation (The Food Safety Act 1990) and guidelines from local authorities and the food standards agency must be followed by law. Within the bungalow when on duty I must all meals from breakfast until supper time. When cooking a meal, I always use a food probe to ensure the correct temperature as well as check fridge and freezer temperatures and record this information on appropriate paperwork. I am responsible as well for making sure that food is thrown away at used by date and to follow infection control procedures for cleaning equipment and surfaces and that appropriate protective clothing is being worn for such tasks. At the beginning of each week a menu is written for the week. The service user gets to choose any food they may want by either verbal communication or through photos or pec cards. This is in line with the Scottish Social Services Council codes of practice for employees’ section 1.2 which states that “workers must respect and, where appropriate promote the views and wishes of people who use services and carers.” There is also room for change, as often the young person may change their mind, which I am happy to oblige to. This ensures they have choice. I do this in line with Capabilities Confidentiality Policy 1.4 vision “Capability is here for disabled people and strives to be a major ally in supporting disabled people to achieve full equality and to have dignity, choice and autonomy in their lives.”
The necessary duties within my workplace are essential in ensuring the health and wellbeing of each service user but it is equally important to ensure each person is treated based on individual need and to actively encourage them and use my imagination to improve their everyday life. I do this by making activity plans for each service user within the bungalow for the week ahead and they are tailored to the individual interests of the child. An example of this is that one girl who we will call Neve has a wide range of interests and once one activity has been done, she generally isn’t keen to do it again for a long time, so we are continually using our imagination to think of new things that she will be keen to take part in. We as a team recognised that there were certain activities and through the help of personally speaking with her parent found that she really enjoys swimming on a continuous basis. Due to this I have been shown what to do for her to access the pool with myself and have also had the relevant first aid training if any problems occur. She also enjoys baking and is encouraged to add and mix ingredients herself. She really enjoys these activities and actively takes part in them. These are just a small glimpse of things we do with her and the other children, as we also have pamper nights, bungalow discos, and many other activities. I do these in line with the Scottish Social Services Council codes of practice for employees code 3, to “promote the independence of people who use the services while protecting them, as far as possible, from danger and harm.”
At Stanmore residential bungalows we work as part of a multidisciplinary team and work closely with Stanmore House school where we have access to, Speech and Language therapists, Occupations therapists, a Dietician, Physical therapists, as well as a 24 hour Nursing team who provide support to staff and service users to ensure that the principles of GIRFEC, that Capability is based on work together in the best interests and wellbeing of the service user. Due to having such relationships with many different agencies and teams we must share information on the individuals with these teams in line with Capabilities Confidentiality Policy 2.1; Confidentiality is a method of working which ensures that use of personal information is controlled and limited to the purpose for which it is disclosed and 2.2.1; customers must be assured that any information relating to them, or the services they receive, will be managed in accordance with the data protection legislation (Data Protection Act 1998.) Although these policies must be adhered to there are instances in which it may be necessary to share this information to safeguard and promote the welfare and rights of the service user. One instance may be if there is a concern regarding Child and Adult protection, in which case it is not my job to decide on any action regarding information provided. My job is to fill out a record/incident form about the information I personally know, and I would pass this on to management or team leader in the first instance if the Child and Adult Protection officer/coordinator was unavailable.
An example to support this would be that one of my service users who I will call Angela came back smelling really bad and wasn’t getting the appropriate personal care at visits home, she also had a couple of bruises, one at the top of her leg and the other on her shoulder. In the first instance I called the duty nurse, who came and checked Angela over and went on to write out a body map. I also recorded my findings and the circumstances that Angela was just back from her overnight at home and that no marks were noted before leaving for home. After writing the incident form I then tried to contact the Child and Adult Protection coordinator with the information, but she was out of office, so I passed the information on to my team leader due to previously recorded concerns of neglect at home. After the information was received by the Child and Adult Protection coordinator the next part of the process was out with my control. I only heard any more information when it was passed on to staff that Angela had to be checked for marks and ensure any relevant information is passed on straight away after any overnights until the issue was resolved and that management had concluded that there was no sign of a Protection issue and that Angela was in fact safe whilst at home. During this process it had come to my attention that whilst in contact with Angela’s mum that her home carer services for Angela had been stopped and that no one was coming in anymore to support her with Angela when she was staying there her mum was very upfront about the situation and that she was struggling having to cope on her own. This gives me as a Support Worker some insight into maybe why there were some issues at home and in the end Angela’s mum was given back the help that she needed in order to provide better care for Angela whilst she was there.
Most of the time outside agencies like Social Work are also involved in the welfare of the service users and they play a key role in helping the families of the individual gain access to our services and communicate with management and team leaders on a regular basis regarding the service user. Occasionally I must attend meetings with them to discuss the individual in question and to talk about any changes regarding them that may affect the care and wellbeing of that child/adult. In most cases the team leader deals with contact from outside agencies and implements any changes that must be passed on to staff and carried out for the care of the service user.
To conclude, daily the work I do is continually changing in order to provide the best care for the service user. I continually work in line with the Scottish Social Services Councils code of practice 6 which states that “As a social service worker, I am accountable for the quality of my work and will take responsibility for maintaining and improving my knowledge and skills.” Currently I am doing this by taking on the role of keyworker to one of the service users and will gain knowledge and skills in this area and hope that it will help me improve my practice even more and give me a better understanding of what this role entails by attending a workshop all about a key working to get me started.

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