BSc (Hons.) Health and Social Care Lecture 2

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Transcript BSc (Hons.) Health and Social Care Lecture 2

Admiral Nurse Standards: an
overview and application of
‘values based practice’
Ian McGonagle
School of Health and Social Care
University of Lincoln
Admiral Nurse Competences
1. Therapeutic role
2. Sharing information about dementia and carer
issues
3. Advanced assessment skills
4. Prioritising work
5. Preventative work and health promotion
6. Ethical and person-centred care
7. Balancing the needs of the carer and the person
with dementia
8. Promoting best practice
Admiral Nurse Standards
S1. Access -Outcome:
Admiral Nurses provide clear, local guidelines on access to their services, which follow the
principles of choice, equity and responsiveness.
S2: Referral - Outcome
Referrals to Admiral Nurses are responded to in accordance with locally agreed referral
criteria which are targeted to promote, protect and improve the health and well being of the
population served.
S3: Assessment - Outcome
Carers and/or people with dementia, who meet the locally agreed criteria for referral, receive
assessment of their psychological, physical, spiritual, cultural and social care needs.
S4: Interventions - Outcome
Carers and/or people with dementia are offered evidence based interventions that provide
health care benefits and meet their individual needs.
S5: Working in Partnership - Outcomes
Care is provided in partnership with carers, stakeholders and /or people with dementia,
respecting their diverse needs, preferences and choices.
S6: Governance - Outcome
Admiral Nurse practice is governed by systems, which ensure that; probity, quality
assurance, quality improvement and client safety are central components to all activities.
Components of supervision (adapted)
Practice dilemmas, standards
and accountability
Normative
Reflective on practice
and learning from experience
Formative
Personal refreshment,
management of stress
Restorative
A supervision alliance model (Proctor 2001) in Cutcliffe, Butterworth & Proctor (eds)
Fundamental Themes in Clinical Supervision London Routledge
What do we mean by ‘Values’?
• People have varied value systems and
hold them in a different hierarchy
– Music – Classical; Hip-Hop; Rock; Indie; Soul
– Architecture – Gothic; Modern;
– Food – Indian; English; French; Italian; Thai
– Wine – French; New World; German;
Portuguese
– Cars – VW; Audi; Ford;
– Holiday – UK; France; Americas; Europe; Asia
(Different)
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Values continued..
Honesty Reliability Truthful Kind Fair Considerate Respectful Resourceful -
Are Values…
• Eternal – Core beliefs?
• Ideals of behaviour?
• Touchstones or aspirations?
• Depends who you ask
– Think about the Mid Staff enquiry or the Health Ombudsman’s
work on 10 stories of care of older people – how do we square
nursing (and other professionals) practice and values?
• It would seem that values vary from..
– Person to person
– Place to place and
– time to time
Values are not fixed and are subject to change over time
Values Based Practice
• Values are everywhere
• Values are more than acting ethically
(although this is important)
• VBP is concerned with everything of value
of those concerned with Health and Social
care
VBP
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Ethical principles
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Justice
Best interests
Do no harm
Autonomy
But also – Wishes/desires/beliefs/ideals/needs/fulfilment/well-being
Values are Action Guiding (but they do not determine our actions – open to
dissonance)
They are unique preferences, concerns and expectations and VBP is
the ability to integrate values into the best possible decisions
Values based practice is
‘balanced decision making’
‘Leadership is about making decisions; not any
decision, but the right one’
Dalai Lama
Health and Social care practice..
• ..is always value driven (but often not explicitly stated)
• Universal Values? – the right to life;
freedom from torture or degrading
treatment
• Diversity of values and difference: gender;
sexuality; identity; culture; religion; politics
• In this view, VBP is messy – so how do we
observe or seek to create the order?
Balanced decision making
within a framework
of shared values
Point
Partnership
Process
Two feet principle
Squeaky wheel principle
Person-centred practice
Awareness
Reasoning
Science driven principle
Multidisciplinary teamwork
Knowledge
Communication
Mutual respect for
differences of values
Premise
From Fulford, Peile & Carroll (2012)
Essential values-based practice: clinical stories linking science with people.
CUP. Cambridge
An example
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Mary is an 78 year old woman who is currently on a hospital ward suffering with a
major chest infection. Additionally Mary has been suffering with a dementia for the
past 7 years.
Usually Mary is cared for at home by her daughter Sally and this has been the case
since Mary was first diagnosed with dementia.
There are two other children, James and Roberta and none of the children are
particularly close. Roberta has not spoken with her mother for the past 15 years
following a disagreement about her lifestyle and choice of partner.
Sally is supported at home by an admiral nurse who also maintains contact with
James and Roberta.
A care conference has been requested by James to discuss immediate and future
care options for Mary. He is very concerned not to “prolong her suffering any longer
than necessary” and is insistent that a ‘Do Not Resuscitate’ order be made.
Sally (his sister) became a ‘born-again’ Christian 10 years ago and is a strong
advocate of the sanctity of life and wishes her mother to receive any intervention that
will maintain her life.
The care team are equally (but silently) split on the same issues as Sally and James.
The majority of the team (particularly the consultant and the medical team) favour
the position advocated by James
Admiral Nurse Standards
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S1. Access -Outcome:
Admiral Nurses provide clear, local guidelines on access to their services, which follow
the principles of choice, equity and responsiveness.
S2: Referral - Outcome
Referrals to Admiral Nurses are responded to in accordance with locally agreed
referral criteria which are targeted to promote, protect and improve the health and well
being of the population served
S3: Assessment - Outcome
Carers and/or people with dementia, who meet the locally agreed criteria for referral,
receive assessment of their psychological, physical, spiritual, cultural and social care
needs.
S4: Interventions - Outcome
Carers and/or people with dementia are offered evidence based interventions that
provide health care benefits and meet their individual needs.
S5: Working in Partnership - Outcomes
Care is provided in partnership with carers, stakeholders and /or people with
dementia, respecting their diverse needs, preferences and choices.
S6: Governance - Outcome
Admiral Nurse practice is governed by systems, which ensure that; probity, quality
assurance, quality improvement and client safety are central components to all
activities.
In the end everything will be ok
If it is not ok, then it is not the end
Ian McGonagle
[email protected]