Case 13- SAP Flashcards
Medical model of disability
Any restriction or lack of ability to perform an activity within the range considered normal for a human being. It is impairment defined as any loss or abnormality of psychological, physiological or anatomical structure or function.
Social model of disability
The disadvantage or restriction or activity caused by a contemporary social organisation which does not account for people with disability or impairment. This excludes them from participating in mainstream social activities. People with impairment are discriminated against.
Functional model of disability
The outcome of the interaction between a person with an impairment and the environment and attitude barriers he or she may face. The outcome of impairment, limitations and restriction on participating in activities.
Safeguarding
Protecting vulnerable adults or children from abuse or neglect
When do we use safeguarding
Safeguarding is both meeting the needs of vulnerable patients as part of ordinary care and recognition of vulnerable adults who are at risk of significant harm and require interventions from adult protection teams.
What defines someone as vulnerable according to the safeguarding vulnerable groups act 2006
- Anyone aged 18 or over who is a recipient of any form of health care.
- This fails to recognise the context, not everyone who needs healthcare is vulnerable.
Current definition of someone who is vulnerable
- Has needs for care and support.
- Is experiencing, or is at risk of, abuse or neglect.
- Is unable to protect themselves against abuse of neglect due to their care needs.
Groups of people at increased risk of vulnerability
- Older people
- Individuals with mental disorders e.g. dementia
- A person with a learning disability
- Unpaid carers
- With sensory/physical disability
- Severe physical illness
- Homeless person
- Living with someone who abuses drugs/ alcohol
Types of abuse
Institutional, financial, sexual, discriminatory, modern slavery, neglect, Psychological, physical and self neglect.
The six safeguarding principals
1) Empowerment
2) Protection
3) Partnership
4) Accountability and transparency
5) Proportionality
6) Prevention
The 6 safeguarding principals- Empowerment
- Respect patient dignity and privacy
* Support them in caring for themselves and making their own decisions
The 6 safeguarding principals- Protection
- Identify those who might be at risk
- Adults have the right to live in safety, free from abuse and neglect
- Taking prompt action if you think safety/dignity/comfort is being compromised
The 6 safeguarding principals- Partnership
- Follow the law and guidance relevant to work
- Adult should participate in decisions
- Professionals should work together to support and protect
The 6 safeguarding principals- Accountability and transparency
- Being able to explain, clarify and justify your actions
- Being honest and open in your explanations/ communications
- Make legal and factual records of what you did and why
The 6 safeguarding principals- Proportionality
- Treat information as confidential
- Disclose minimum info necessary
- Handle patient info lawfully
The 6 safeguarding principals- Prevention
Take action before harm occurs
Stepwise approach at safeguarding
- Prevention- establish if someone is at risk or experiencing abuse.
- Assessment- ensure patient is safe and deal with immediate medical needs.
- Capacity- ask consent to share information.
- Identifying services- seek advice and identify strategies that may help.
- Consensual approach- work with patients and give ongoing support
- Safeguarding- cascade as appropriate with safeguarding teams
Self-neglect indicators
- Poor personal hygiene
- Lack of food
- Malnutrition / dehydration
- Neglecting household maintenance
- Hoarding
- Non-compliance with health services
Safeguarding- When to share information about a patient without their consent
- When a person lacks the mental capacity to make the decision
- When a crime could be prevented
- When the abuser has care and support needs too so is also at risk
- Staff are implicated
- A serious crime has been committed
Signs of Institutional abuse
- Insufficient staff resulting in poor care
- Inappropriate use of restraint
- Lack of respect for dignity and privacy
- Discouraging visits
- Not considering a persons cultural/religious needs
- Misuse of medication
- Not offering choice
- Not providing adequate food/drink, or assistance with eating
Challenges people with learning disabilities can encounter when accessing healthcare
- Patient factors e.g. anxiety, fear, distrust, dislike of unfamiliar places, lack of understanding, lack of ability to express oneself
- Doctor factors e.g. diagnostic overshadowing - assuming the illness is due to the LD, difficulties examining the patient, inexperience with LDs
- Carer factors e.g. fatigue, anxiety, guilt
- Organisational factors e.g. time and experience of doctor, hospital environment not LD friendly
How can communication problems arise when consulting a person with learning disabilities
- Patient isn’t able to express themselves properly.
- Doctor inexperience of learning disabilities.
- Patient is upset/frustrated, can be the same for carers.
How can we overcome communication problems when consulting a patient with learning disabilities?
- Ask family/friends/careers for information on signs/visual aids etc
- Talk directly to the patient, but bring in the carer when necessary
- Be patient, build rapport and trust
- Adapt the situation - make the patient the last of the day to allow more time
- Dont diagnostic overshadow - not everything is a part of the disability
- Dont make assumptions
- Examine the patient instead of avoiding this due to difficulties in communication
How to adapt communication when safeguarding
- Consider use of aids/diagrams
- Ensure the abuser is not present when discussing issues
- Allow enough time - double appointments/last of the day
- Create a suitable location
- Listen carefully
- Remain calm and don’t show shock or disbelief
- Don’t ask leading questions
- Don’t promise to keep a secret
- Seek consent to share information
- Record individual specific needs and the names of family/carers/supporting professionals
Aims of safeguarding
- Prevent harm and the risk of abuse
- Stop abuse
- Support vulnerable adults with making their own choices
- Raise public awareness
- Improve life of those vulnerable
- Provide information and support in accessible ways
- Address what has caused the abuse or neglect
What can you do to increase capacity of an individual (consent)
- Presumed capacity
- Maximise decision making
- Freedom to make unwise choices
- If no capacity then the decisions made for them are in their best interests
- Least restrictive alternative
- Capacity is decision and time specific.
Steps to determine capacity
- Does the person have an impairment of the mind or brain (if no then presumed capacity). If yes we go to step 2.
- Is the person able to understand the decision they need to make. Understand, retain, use and weight the information relevant to making a decision. Understand the consequences of making or not making the decision. Are they able to communicate the decision (by any means).
If no to any of number 2 then they do not have capacity.
What to do if a person refuses herlp?
- Assess capacity.
- Explore reasons for refusal.
- Encourage them to consider how they could benefit.
- Prompt them to consider the potential consequences of not taking the action.
- Provide information about sources of support.
- Remember the patient may change their mind later.
How to make best interest decisions
- Can the decision be deferred till they regain capacity.
- Take into account past and present wishes and feelings.
- Take into account the beliefs and values of the person where relevant.
- Consider factors that the other person would consider.
Benefits of genetic testing
Leads to early detection of disease
Potential to treat diseases early i.e. Cystic fibrosis
Predict reactions patients may have to treatment
Can promote lifestyle changes to prevent disease
Negatives of genetic testing
1) People who are aware they have passed a gene on will feel guilt, resentment, pressure to share their information, fear
2) People who are aware they’ve gained a gene from a family member will feel resentment, fear, upset
3) Issues with consent from children
4) Discrimination- may not be offered a job etc
5) Negative eugenics- can have racist/stereotypical motives. Websites i.e. ancestry sites can use your genetic data for health/travel insurance
6) Can be offered termination of pregnancy is this selective enhancement
Legal issues with those with disability- Equality act 2010
Extends protection against indirect discrimination to disability
Makes it a duty to make reasonable adjustments for disabled people
Makes it difficult for disabled people to be unfairly screened out when applying for jobs
Describe the spectrum of learning disabilities
Ranges from people who are high functioning, have extreme ability in some areas but may still require some level of support to people who require substantial support
- Difficulties with social communication and interpreting social cues
- Repetitive and restricted patterns of behaviour
- Everyday function is impaired/limited
Levels of learning disabilities
Level 1- requiring support, extreme ability in some area. High function Autism, Asperger’s.
Level 2- requiring substantial support. Mild learning disability, Average IQ.
Level 3- requiring substantial support. Severe learning disability
