I will also be looking at the way front line staff can promote Dignity, Choice, Relationships and Contributing and the importance for a person with ID to be able to experience all of them. For this assignment I will carry out some primary research, this will involve an interview with a member of a multi – disciplinary team. During my work placement in St John of Gods Drumcar I hope to see a multi – disciplinary team at first hand and get a better understanding of the work they do and how they meet the holistic needs of a person with ID.
Dignity “Dignity is being treated as a human being. It is about being treated as an individual and with respect. ” Royal College of Nursing (2013) Dignity should be shown to all people but especially to those who are in a care setting regardless of their physical or intellectual ability. When people are treated with dignity they feel as if they are in control and feel valued and confident to make decisions for themselves. Dignity for people with learning disabilities often involves what other people may take for granted.
This is why it is important to promote dignity for people with ID. There are many ways to promote dignity but here a just a few; Always address the individual about their care and not their family ie talking to the mother instead of the client. Treat every individual the same, and with respect. If you are an adult, you should be treated as an adult. Always find out what people can do for themselves and not do it for them. Do not make assumptions about the person. You need to take time to establish what their abilities are and what support they need. Choice
“Living ‘a good life’ means that one is able to determine the course of one’s own life and have the opportunity to create an existence based on one’s own dreams, visions, wishes and needs”. Holm, Holst, Balch Olsen, and Perlt, 1996 Individuals with ID should be allowed to make choices on how they wished to be cared for. Some people may wish to live independently and get jobs, be integrated into society, and some people may choose to live in residential care, either way they should have the right to choose. Having a choice also gives a feeling of control over their own lives.
Being able to choose ones own clothes for example or having the choice of what food to eat. People with ID should have the right to make the same choices as everybody else. Choices we take for granted or choices we may see as trivial may be a big decision for a person with ID. How a person with ID wishes to be treated medically should also be taken into consideration. Relationships – Building relationships are an important part of everybody’s life and people with Intellectual Disabilities are no different. People with ID should be encouraged to build relationships.
Having a relationship with someone apart from somebody who is family or a paid member of staff will give a person with ID a great feeling of self worth and a feeling that they are cared about and loved. Being able to have network of friends for support is very important. Having a life outside of a care facility could eventually lead to independent living. Contributing – Having the ability to make a contribution to society is an important element in building self – esteem and self – confidence. The focus was always on what people with ID were incapable of doing and not focusing on what they can do.
It should not be assumed that people with ID can not make a contribution to society, they should be given the same opportunities as everybody else. This should include; Education & Training, Community Services, Social Welfare, Job Opportunities, Housing. Many people with ID have part of full time jobs one such place providing jobs to people with ID is L’Arche workshops and coffee shops. The L’Arche ethos is “A foundational belief of L’Arche is that central to every person is the need to feel useful. To have a sense of purpose.
To feel part of, and contribute to, a larger association of people. ” http://www. larche. ie/Workshops. aspx Facilities & Support Available For People With An Intellectual Disability There are very different types and levels of ID this will therefore determine the type of support that person will require. For some people with minor disabilities staying at home or going to a day centre for some training or learning new skills could prove to be enough. Some people might have a slightly more severe disability and might require more professional support.
This support can come in various ways either through residential homes where the client would live in a medical model of care and have all their needs met by staff nurses, RPA’s ( residential programme assistants ) doctors, and many different therapists. They may also live in community housing where they would live in a social model of care. This would involve having house parents instead of staff nurses and where carers are there to assist the resident instead of doing everything for them like they would in a residential home.
In a community home residents have more freedom to make decisions for themselves for example what kind of food do they want, where to buy their clothes, where to go on day trips all of these self made choices are all examples of living in a social model. Some people may have the opportunity to live in Independent or Semi-Independent housing. This can be determined by finding out what the individuals needs are and giving them the training to be able to live independently.
While many people with ID live independently they will always need support from either social workers or from a previous residential home from where they might have moved from. One such place is Sunbeam House Services which provide care for people with all levels of disability with its main ethos being to provide people with the necessary skills to live full and satisfying lives as equal citizens of their local communities. http://www. sunbeam. ie/ Some families might only require respite or temporary care.
Respite or temporary care may involve providing alternative family or institutional care for a person with a disability in order to enable the carer to take a short break, a holiday or a rest. Schemes of respite care are sometimes called ‘Breakaway’ or ‘Friendship’ schemes. Respite care may be based in the community or in an institution for example St Mary’s Drumcar. There are also many services available for young children with ID. This may come in the form of a special needs assistant in class or even going to a special needs school.
Children with ID are now not automatically sent to special needs school. They have the opportunity to be assessed and then get to go to mainstream school and be educated along with their peers with the help from a SNA, this gives them a better chance of being able to live more independently in later life. The Role Of The Multi-Disciplinary Team I will now explore the role of the multi-disciplinary team caring for a person with Down Syndrome and how a person with Down Syndrome is assessed so that they have proper access to the services that they might require.
Parents of children with Down Syndrome have 3 choices when it comes to getting the best education for their child. Before making this decision the child will need to be assessed to identify their needs and to make sure that they get their specific needs met, they can then choose one of the following to give their child the best chance of getting an education Mainstream school Special class or unit within a mainstream school Special school In a persons early life they need to be assessed to see the level of care they need. This involves having medical and developmental assessment.
This will determine if the person has any other underlying disability along with having Down Syndrome for example a heart defect or a hearing impairment which would determine the level of independence that person can have. They would also need to have a Psychological assessment done to evaluate the level at which the child is able to understand new tasks and their ability to learn this will be very important when it comes to deciding the type of school to send the child. These assessments are also important to establish the type of services that person will require when they get older.
Front Line Staff “Front-line staff are social care employees who work directly with service users, including volunteers, students, ancillary staff and practitioners”. https://www. nsasocialcare. co. uk/careship/front-line-staff The front line staff who deal with people with ID include some of the following, they are also know as the Multi-Disciplinary team, according to HSE. ie Nurses Social Worker Doctors Dietician Psychologist Behaviour Therapist Occupational Therapist Art & Music Therapist Speech & Language Therapist Pharmacist
While carrying out my primary research in a residential home I discovered Nurses play a vital role in the care provided to a person with Down Syndrome . Whilst on placement I spoke to a staff nurse who told me that the residents depend a lot on them for food, medicine, intimate care and even for simple things like company. In St Mary’s Drumcar the role of the nurse is a vital one, she or he is in charge of their unit and responsible for all the clients in that unit. They must see that every client gets their medication, they will also supervise over the RPA’s and make sure the residents get the best quality of care.
They also have a part to play when it comes to ensuring that the clients are getting exercise, fresh air and any other form of stimulation that is available. The nurses must also record any changes or incidents involving the client and they must also keep up to date with hospital visits or treatments that the client may require. Another member of the Multi-disciplinary team is the Physiotherapist and in a large residential care setting like St Mary’s Drumcar a Physiotherapist would also have a Physiotherapist nurse assigned to them.
St Mary’s have over 150 live in clients, with a lot of them requiring either daily or weekly treatment. One such client I observed required daily treatment. The physiotherapist visits him every morning and spends 15- 20 minutes performing chest therapy. This is performed to help the client in removing the build up of mucus on his chest which he is not able to remove himself. The therapy involves hitting the client firmly but gently with a cupped hand on his chest and back from top to bottom, this will then loosen any mucus and help him breath easily. If this was not performed the client would be susceptible to chronic bronchitis.
The physiotherapist will perform this on another 10 clients that day and this has to be done every day along with other treatments. Occupational Therapy deals with promoting clients’ health and well-being, through occupation. This means helping a client do what they can do for themselves in their every day life. Occupational Therapy is client-centred and works to enable people to do certain activities which are important to them. They achieve this by helping clients to do things that will enhance their ability to participate in activities and this may include modifying their surroundings.
According to Intellectual. ie, the Occupational Therapists will ask the question, “Why does this person have difficulties managing his or her daily activities, and what can we adapt to make it possible for him or her to manage better and how will this then impact his or her health and well-being? ”. Following an assessment, the occupational therapist liaises with the client, family members and other members of the Multi-disciplinary team in order to develop a holistic treatment plan. Without this vital communication within the team the client may not get the right treatment that they may require.
In order to get a full understanding of the clients needs the whole team must communicate with each other. That is why the nurses must keep a record of their daily activity, the physiotherapist must report any changes they might find, the occupational therapist must inform the nurse of what activities might help the client, and all of this communication leads to the client living a more fulfilling life. Evaluation The aim of my assignment was to get a better understanding of the support needed by a person with ID and what facilities are in place to provide that support.
I learned that there are many different types of ID and the severity of disability will determine the level of independence that person will have. During my time on placement in St Mary’s Drumcar, I had many conversations with different members of the Multi-Disciplinary team. I found it interesting to learn that a person with a minor learning disability with the support of a social care worker could happily live independently or semi independent and that many of their former residents now live in the community.
Whereas in the case of one particular client who is in his 60’s and has severe PKU (Phenylketonuria) which was untreated as a child, will require long term residential care, living in a medical model of care, and may never have the ability to live outside St Mary’s. These decisions are normally made by members of the Multi-Disciplinary team. A psychologist will determine a person’s ability to learn or what their state of mind is.
An occupational therapist will determine a client’s ability to live independently or what needs they might require to live life to their full potential and come up with a lifestyle to suit each individual. A social worker will liaise with the medical team and help a client settle in to a social model of care and make sure they get all their entitlements and are coping with living in the community. During my time in St Mary’s Drumcar I discovered that all clients have access to music classes or swimming lessons and they the opportunity to express themselves and have most of their holistic needs met.
Unfortunately during the current economic climate and many services facing cut backs there isn’t always adequate staff to supervise the clients and therefore even though the facilities are there the clients might not always be able to use them. I also learned there are many organisations which promote independence for people with ID. Places like L’Arche or Sunbeam House Services base their ethos on giving people the training and skills needed to live independently and make contributions to their community.
The Education of Persons with Special Educational Needs Act 2004 (EPSEN) makes provision for the education of children with special educational needs in mainstream schools. HIQA was established in May 2007 and are an independent authority responsible for ensuring quality and safety in social care providers for children, older people and people with disabilities in Ireland. Appendices This is a transcript of an interview held with a staff nurse in St Mary’s Drumcar, Dunleer, Co. Louth. I also spoke to a physiotherapist and I will include some of the main points made during this conversation.
Names have been changed to maintain confidentiality. Hi Pauline thank you for agreeing to talk to me. Can you just tell me a bit about youself and how long have you been working here? No problem Clyde only too glad to help. Well I’m a staff nurse here in St Mary’s and havr been for over 16 years. I started here as a carer when I left school really liked it then St Mary’s must have seen something in me and wanted to train me up as a nurse. Exactly what are your duties here and what kind of things do you do here to give the clients a more holistic level of care.
Well we provide all their medical needs, this would include administering medicine making sure they are up to date with their hospital appointment and getting their daily treatments. Our role has changed dramatically over the years we now are responsible for feeding washing and cleaning the units this would of been done by a RPA but with the cut backs there are less RPA’s so we now have to do all the work they would have done. What do you do to stimulate the clients and how do you promote their holistic care?
We have a music teacher who comes in twice a week we also have swimming pool that the clients can use. We also have a music room where the clients can go and play instrument or even listen to music if they want to. Unfortunately we don’t always have enough staff on to accompany some of the clients who are not able to go by themselves, if a client is a wheelchair user or has a visual impairment then they would need either a nurse or a RPA to go with them and its only if a volunteer is about or a student like yourself is around then we have the opportunity to use the facilities.
How long have most of these clients lived here? Most of them have been here most of their lives we stoppedtaking in residential client in the mid-nineties most of our client would be over 50 years old and have been here since their early teens or children. We only have about 150 live in clients we used to have nearly 700 but most of them client now live out in the community. The clients who live her now are the ones who will need extra care to live in the community or will never be able to live in the community and always require a medical model of care.
Ideally I think a mix of a medical and social model of care would be the best option for the clients. Hi Mary exactly what is your role here in Drumcar? Hi Clyde I’m a physiotherapists Nurse and I visit the clients every day and perform many different treatments. What type of treatments would you perform on a typical day? It could range from chest physio to promoting blood circulation a lot of clients spend a lot of time either in bed or sitting so pressure ulcer control is a major issue so we have to encourage and help the clients with their mobility.