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Autonomy Within Professional Practice
I am currently on placement at a Learning Disability Centre in the North of England, which has been open since 174.
The centre aims to support 10 people who have moderate to severe learning disabilities, current ages ranging from nineteen to seventy six years of age. The centre has a number of well-established partnerships with a wide variety of agencies and organisations, which enhances service delivery offering a more varied and inclusive service. Help with essay on Autonomy
The centre aims to support people to play a full and active roll within their local community, through the provision of a programme of activities. This is achieved by using a key worker system and a person centred approach.
This encourages multi-disciplinary teams working, supporting and developing individual service users.
(Halton Borough Council 000)
Each person has their own person centred plan (see appendix 1) and timetable relating to daily activities within structured aims and objectives for example participating in a drama activity can enhance communication skills, which promotes confidence in voicing issues and enhances independence.
The centres philosophy is that every one has the right to experiences, which encourages choice, opportunities and personal development. Both present and future service provision is based firmly on the government's white paper 'Valuing People'.
According to Halton Borough Council they concur that central to this day centre's philosophy of encouraging choice, opportunities and personal development is the involvement of people in all stages of the decision making process regarding their services.
www.halton-borough.go.uk
Within the centre staff are required to follow the Social Care Conduct of Practice when working with Service Uses. The code of practice outlines procedures and policies that are to be implemented within the professional practice (see appendix )
(Halton Borough Council 00)
For this assignment I have chosen to focus on a principles and theories of ethics.
The word ethics has several meanings for example can be related to as what is 'ought to be' or used to refer to as customs and beliefs of a particular group as in a religious ethics, physicians ethics, or nurse ethics. .
(Fry 14)
Ethics are related to theories for example 'classical theories' imply a rich historical tradition and concern with good life or how to achieve the good life e.g. hedonism and stoicism. 'Modern theories are applied ethical conduct in order to find the meaning of terms and statements that appear in theories e.g. naturalism, emotivism and intuitionism
(Fry 14)
All theories of ethics contain one or more ethical principles (ethics in nursing practice). (Fry 14)
Beauchamp & Childress state that ethical principles are guides to moral decision-making and moral action, and centre in the formation of moral judgements in professional practice. (Beauchamp & Childress 18)
Related ethical principles that relate to health profession are beneficence, justice, autonomy, veracity, and fidelity.
I have chosen to focus upon autonomy, as this is a debateable ongoing issue within this professional practice.
Autonomy is. 1. independence or freedom, as of the will or ones actions the autonomy of the individual.
. the condition of being autonomous; self-government, or the right of self-government; independence
www.factmonster.co.uk
The centre focuses on the principle autonomy but elements of 'intilarism' are experienced.
Intilarism is the recognition of a persons right to be his own unique individuality, but the health care profession ignores frequently autonomous wishes.
Paternalism is adopted rather than informed consent (Husted&Husted11)
To follow is a reflection on examples of positive and negative autonomy that Service users experience within the centre daily and try to explain what type of support is available and how this effects the delivery of care for the individual.
The centre has a Journalism group, which gets together twice a week; the group has become involved in a number of projects that enable Service Users to exercise their choice. They felt an important segment in anyone's daily schedule is in choosing a meal. They identified that there are situations that can make it difficult in for Service Users to choose their own meal from the canteen for example not being able to see over the counter due to physical height restriction, wheelchair restrictions and disability impairments i.e. reading menus.
To overcome this the journalism group became heavily involved in using digital cameras and computers to display all the daily menus the canteen provides.
Each day a service User was responsible to ask the kitchen staff what the day's choices are so they can display the large pictures on the menu display. This assists people in the queue to decide what they want. The photos are easily removable to show to staff or for people who are unable to queue in the canteen, or require extra help in their decision-making, also they are portable enough to show a person in the comfort of their own room.
This activity has made it possible and desirable to identify valued activities through which a person can move towards an informed future. It has promoted self-initiative, independence and a rewarding feeling of gratification for the Service Users who took part in this exercise. It has promoted more freedom of choice, independence for other Service Users accessing the canteen.
A few Service Users demonstrated negative examples of autonomy, at meal times. When communicating with them they voiced their opinions stating, they never wanted to bring packed lunches daily, parents made them. Reasons behind this were down to them being over weight and made to stick to a low fat controlled diet or for financial reasons
Financially Service Uses receive disability benefits, which include money for meal times. The canteen is subsidised, it's all down to parents controlling their finances that takes away their right to choice.
As for diet they only have to be few pounds over weight and they are put on a diet by parents and the multi-disciplinary team. This is seen as a threat to their health and well-being. They are monitored on their daily consumption by care staff.
I experienced one gentleman only being allowed a treat on a Friday afternoon. If we were to put on a few pounds or excess weight it should be are decision if we were to diet or not, we could be advised of health implications but it would still be our decision.
This not only takes away choice but also implies that these people don't have the mentality to make decisions regarding their health for themselves.
(Rumbold 000)
John O'Brien states that 'choice is the experience of autonomy in both small, everyday matters (e.g. what to eat or what to wear) and in large, life-defining matters (e.g., with whom to live or what sort of work to do). Personal choice defines and expresses individual identity. Without focused effort to increase available options and provide support for decision making, people with severe handicaps will be passive and without voice or the ability to escape undesirable situations.'
(O'Brien 181)
A key policy in Community Care legislation is that of involving service users in service planning and delivery. Training and support for service users speaking up for themselves and expressing views is of paramount importance if the user's voice is to be heard. (Department of Health 000))
One attempt at involving service users and encouraging them to express their views and having a say in how they would like their day service to develop is by allowing them to interview prospective staff.
In preparing for interviews, clients discussed the need not to ask leading questions and what that meant. Service users discussed about how it would be necessary to ask additional questions to those that were written down.
The service users had to consider ways of rephrasing questions in case they were not clear to the interviewee, or in order to get more information so that a question was answered properly.
In designing the questions the clients had total autonomy in discussing together what they felt were appropriate questions to ask. Having the service users formulate their own questions was probably better than any question that staff would have formulated according to a day service organiser (located at the centre).
For example it was recorded that clients were able to use simple, clear language, there was no ambiguity in the way the questions were formulated.
When clients asked the questions during the interview, questions were very clear and uncluttered no jargon used and no lengthy questions.
From involving service users it was recorded that it changed the culture and the attitudes of the workers and recognised the users expertise.
It also coincided with The NHS Community Care Act 11, which recommends that users should be at the focus of planning, developments and initiatives by collaborating and joint working and consultation with users.
www.halton-borough.gov.uk
The exercise also demonstrated that people with learning disabilities carry less intellectual clutter and so can say and see things in clearer and direct ways.
Another example of the need for autonomy is when service users want opportunities to be able to work. Access to the world of work can be difficult, sometimes daunting.
Halton Supported Employment offer comprehensive services to local employers, in order to create opportunities for people with learning disabilities, to get real paid employment.
www.halton-borough.go.uk/../socialservices/supportedemployment.asp
We take for granted having the ability to sustain employment.
Clients receive initial support for approximately fifteen weeks. On the employment scheme there is an expectancy of initial support being withdrawn after that period.
However it has been identified that there are a number of service users that would like a work placement but would require longer or indefinite support within that placement. However this is not current practice, referrals still not being acted upon.
This obviously causes limitations of choice.
In recent job research and statistical evidence it shows that majority of jobs taken up tend to be 'stacking shelves', Is the firm doing this to please the service or is there a real job already there? It's hard to give an indefinite answer to this question because it can be looked at from numerous angles and be considered by differing attitudes and beliefs.
Traditionally people with learning disabilities have been regarded as objects of pity, objects of charity, misfits and inadequate, these are just a few of the negative perceptions which people have held and still hold today. As a result they have become seen as passive recipients of services. They have been assumed to be incapable of exercising their rights over their own lives, which others take for granted. Often services have developed without consulting the users of it, and decisions have been made for them, mapping out their life opportunities.
(O'Brien, Lyle&Sibblett 18)
The centre has set up a self-advocacy group in reference of the above.
Self-advocacy is 'speaking out for yourself' individually or in groups rather then letting others speak or act upon your behalf. Self-advocacy occurs when people assert their own rights, needs and concerns and assume the duties of full citizenship. Outcomes from theses groups have been proven to dispel the beliefs that people with learning disabilities depend solely on others and can only achieve very little.
(Mencap, 001)
Conclusion
John O'Brien has researched into lifestyle accomplishments within the learning disability environment. He recommends the following five Community Presence, Choice, Competence, Respect, Community Participation
He recommends these accomplishments help us to identify constructive actions that
Will improve the quality of life experiences for a particular individual.
(O'Brien 181)
The centre makes positive contributions towards each individual. From experiences within the centre and in the community, the service users receive a lot of freedom of choice and levels of independence. This is only taken away if it is not seen as beneficial or of a threatening implication towards the service user.
The service users are assessed and identified as individuals, with differing levels of physical and mental abilities, personalities and varying constraints.
The centre is constantly updating and communicating with service users to improve existing levels of standard.
From my work placement I have really enjoyed exploring this new experience that I have not before had the opportunity to be part of. I found the role of the Day Service Organiser to be a rewarding position as the service users showed real gratification when activities and delivery of care was implemented.
The emergence of advocacy movements has had tremendous force in bringing people to express more clearly their rights and entitlements.(Dawson & Whittaker 1)
The day centre's philosophy coincides with the implemented practice in the delivery of care that is received by the service users.
But there are still issues where aspects of choice and decision are taken away from them whether it being subconsciously (in the person's best interest as thought of by the carer or parent, or by the sub-conscious level were the want to be able to provide the autonomy but unable to due to finances reasons or lack of resources.
During this placement, it was not evident that the centre endeavoured to promote 'autonomy' for he people in its care.
Individuals were encouraged to become more independent for example, during an activity developing skills needed to glue and cut. Individuals were given the opportunity to choose activities they were interested in, to involve them making their own timetables.
This research has highlighted the need for more autonomy, valuing the contributions of people with learning disabilities to enable them to gain the confidence and self-esteem to ensure that they are included in the decision-making process.
The centre adheres to the guidelines implemented by the government's white paper 'Valuing People' they reflect on the principles of rights, choice and inclusion and the implications portrayed. They drive their challenges and perceptions through the help of agenise i.e. public, independent sectors and voluntary services. Who try to promote people with learning disabilities to have their voices heard and have wider opportunities for a fulfilling life as part of the local community?
They imply that getting it right for people with learning disabilities will show what can be achieved, within one of the most vulnerable and socially excluded groups in society. (Halton Borough Council 000).
Reference
Beauchamp.,& Childress,J,F.,(18) Principles of Biomedical nd Ed. Oxford University Press, New York.
Dawson,L.,&Whittaker,A.,(1) On one Side The role of the advisor in supporting people with learning disabilities in self advocacy groups, Mencap, Stamford.
Fry,T,S.,(14) Ethics in Nursing Practice rd Ed. Council Of Nurses(RCN) London
Husted,G,L.,&Husted,J,H,.11 Ethical Decision Making. Mosby-Year-Book,Inc.USA.
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