The principle of ethics in care and support for the care of disabled individuals focuses on ensuring the protection of the individual human dignity and ensuring conservation of principles such as justice, non-maleficence, beneficence, autonomy, fidelity, and veracity (Park and Nam2019). The ethical principles thus act as a moral compass in the branch of philosophy that ensure effective support and care (Hanes et al. 2019). One of the primary aspects of ensuring the application of these ethical principles is associated with the conservation of individual rights, and this is even more crucial in the context of people with disabilities as they often get discriminated against and are impacted by the discriminatory behaviour of the society (Fritz and Sewell-Roberts 2020). In this paper, the case of Martha Jayaseker will be assessed. Martha has cerebral palsy and needs assistance with going to bed, for which her carer visits by seven in the evening even after multiple reminders and complaints of their need by ten in the night. This paper will thus assess this situation in the context of freedom, rights, and responsibilities in the process of care with an evidence-based approach. A discussion based on the individual needs of Martha will be outlined in this paper in context with the role of the care support worker. Further, this paper will also explore the ethical principles and their impacts in the given case and outline how the application of effective communication and critical interpersonal skills would have helped improve the overall care outcomes for Martha.
Understanding needs of Martha Jayasekera and role of care worker
Cerebral Palsy is identified as a group of disorders that impact the posture and movement in the muscle tones. The disease is caused by damage in the developing brain during the development years of the child (Gulati and Sondhi 2018). The signs and symptoms are observable in the pre-school years. These include impaired movements and exaggerated reflexes. Individuals can also include floppiness and unusual practices in the affected individuals. Affected individuals may also need assistance in accomplishing the tasks of daily life like swallowing food walking, and sleeping. Individuals may also develop intellectual disabilities (Gbonjubola et al. 2021). In terms of speech and eating, individuals may have problems in speaking and have delayed speech development. In addition, they may face problems in chewing, eating, sucking. The development complications include delay in reaching the milestones for motor skills and delayed growth (ELgohary et al. 2021). Allied complications may include frequent incidences of seizures and difficulty in hearing. The individuals may also face problems in vision and have abnormal eye movements. The complications that impact the affected individuals include contracture, risk of malnourishment, and mental health problems (Kadivar et al. 2018). Individuals may also have a greater risk for heart and lung diseases. Cerebral Palsy has been classified into three primary types. These include stiff muscles (spasticity), uncontrollable movements (dyskinesia), and poor coordination and balance (ataxia) (Barkoudah and Armsby 2018).
In the given case, the primary care needs for Martha include assistance with daily living, wheelchair support, and assistance with getting out of bed and dressing. Martha also needs assistance for washing and support for getting into the bed. For an individual like Martha, special care needs can include support for getting organised and staying informed for holistic care and support. In the given case, Martha receives assistance from a care service provider. However, her care provider comes before the requested time, which results in Martha sleeping and moving to bed earlier than what she wants. According to the national standards for people with disabilities in the United Kingdom, the focus should be based on ensuring transparency, integrity, and honesty (Deeming 2019). The purpose of this is to ensure that quality and safe care is promoted and improved quality of living is enhanced. Competence in care is one of the essential elements that direct the care in conjunction with the person-centred approach (Fritz and Sewell-Roberts 2020). A support worker should also identify the strengths and limitations of the clients and focus on their needs, goals, and emotional and support needs to ensure holistic development (Ekman et al. 2020).
A care worker should align and focus on providing care in consideration of ethical principles and professional standards. These include respecting the individuals and focussing on holistic care needs that include psychological, emotional and physical care support (Bennett and Rosner 2019). Human dignity and respect for autonomy are one of the primary ethical principles that need to be taken into consideration in the process of care. Human dignity is a fundamental human right and has been identified in the legislation of UK government that identifies “fundamental rights and freedoms that everyone in the UK is entitled to” (Human Rights Act 1998)
It is an unethical and poor duty of care on behalf of the carer. The principle of duty of care is defined as a legal and moral obligation to ensure the safety and well-being of individuals (Kadivar et al. 2018). A disability support worker has the primary duty of care for an individual with a disability as well as the community to ensure support and to provide a competent environment. For the duty of care, it is essential to focus on high quality and safe care and support (Gómez-Vírseda et al. 2020). In addition, the individual has to ensure that dignified care is provided and the independence of the individual is promoted (World Health Organization 2021). In the given case, the duty of care for Martha is being ignored at several levels. First, it is the responsibility of the carer to ensure acknowledgement of the care needs of Martha. Going to bed early is against the wish of Martha and is imposed by the carer itself. This results in poor acknowledgement of the choices and preferences Martha. This is also a breach of the principle of autonomy of Martha. Autonomy of the patient asserts that the patint has a fundamental right to take decisions for themselves and direct their process of care by taking active decisions (Gómez-Vírseda et al. 2020. In addition, the care that is provided fails to acknowledge and understand the importance of independence. Independence is a fundamental right of every individual (Berghs et al. 2019). It is the primary responsibility of the carer to ensure that the care service provider enhances and promotes independence in the individual. For individuals with disabilities promotion of independence is critical. This helps in boosting the confidence and the self-esteem of the individuals in the process of care. It also empowers them and helps in improving their quality of life (Ellis 2019). In the given case, Martha seeks to care for going to bed and is a working individual. Her care needs to be designated in consideration of her daily tasks and activities, and thus, in consideration of the same, she wishes to go to bed by ten in the night. However, when she is put to bed by seven by the care worker against her autonomy and need, it may result in restricting her primary duty of care and support.
As a worker and support provider, the focus should be on conserving the values of social justice and promoting holistic care for Martha (Ryan 2020). However, in this case, the problem is also associated with the lack of concern for the dignity of Martha, making it a violation of her primary human right and is also a breach of the ethical and professional conduct of the care support provider. Treatment of individuals with a disability with dignity is associated with making the individuals feel included in society and make them feel valued and respected (Matiti and Baillie 2020). The care worker of Martha asserts that she is occupied and cannot work till late. This is a violation of the right to dignity. where the values and the desires of Martha are being placed secondary to the individual needs of the care service providers. The focus should be on prioritising the care by the support service providers and finding alternative interventions to ensure safety for working in the region of residence of Martha (Berghs 2019).
Therefore, in this case, multiple ethical considerations have been breached. These include poor support and lack of adherence to professional standards for duty of care, breach of autonomy and disregard for dignity for Martha.
Role of communication and interpersonal skills for the best care possible for Martha Jayasekera
Effective communication is one of the primary skills that are essential for a care support worker when working with an individual with a disability (Pound et al. 2018). Due to a lack of effective communication skills, it will not be possible for the carers to develop therapeutic communication and support for the individuals (Fritz and Sewell-Roberts 2020). The role of the carer is to focus on providing effective communication to promote holistic care and support by building therapeutic relationships with the client (Nguyen et al. 2019). The communication needs that are essential include the development of verbal communication and non-verbal communication. In addition, the focus should be based on active listening and self-awareness (Purnell 2018). It is also important to focus on the provision of support and care through reflective practice and ensuring holistic support to provide improved care for individuals with a disability (Nguyen et al. 2019). Communication thus helps in the development of a therapeutic relationship between the carer and the individual and promotes the building of a mutual relationship with trust and rapport (Agaronnik et al. 2019).
In the given case, the communication between the support provider and Martha has been compromised, resulting in poor support and care. When the care support provider asserts that she cannot prioritise the care needs of Martha and refuses to acknowledge the requested change in timings, a poor relationship is developed. This approach is disrespectful and should not be practised when providing care, and is indicative of incompetency (Kadivar et al. 2018).
In the given case, effective communication should be based on a focus on the assertions of Martha. Active listening is one of the primary components of effective communication and needs to be taken into consideration to understand the individual needs of people. The worker should communicate her concerns with Martha, and an active resolution should be identified for the situation through shared decision making. Shared decision making ensures active participation of the individual in the process of care and also ensure consideration of perspectives (Fritz and Sewell-Roberts 2020). One of the primary approaches in supportive care is to ensure furthering of responses (Agaronnik et al. 2019). Furthering response of Martha would have assisted in finding an improved resolution of the concern so that the concern regarding timings could be managed. The care for communication should be based on consideration with the seven C’s of communication that includes clarity, correctness, courtesy, consciousness, consideration, concreteness, and completeness (Bennett and Rosner 2019). The same should be ensured in the provision of care for Martha.
In conjunction with communication, a disability support worker requires a range of skills that help them in ensuring person-centred care and support. The personal skills and approaches that a disability support worker should have include patience and an understanding approach towards clients (Bennett and Rosner 2019). In addition, the worker should be supportive and caring in nature. Another skill needed for the individuals who work as support service providers includes a commitment to rights and ensuring the conservation of dignity of the individuals. This includes the promotion of independence and enhancing the abilities of the individuals (Agaronnik et al. 2019).
A worker should be able to accept responsibility and must work efficiently by conserving the ethical principles and the rights of the individuals. Adults like Martha that live with cerebral palsy require individualised and multi-disciplinary care and support. As a care worker for an adult with cerebral palsy, the focus should be on ensuring that the physical activity of the individuals is promoted and the sedentary lifestyle of the individuals is minimised (Gbonjubola et al. 2021). This is crucial as it can help in reducing the risk of cardiovascular and metabolic risks to which the affected individuals are at a greater vulnerability (Gulati and Sondhi 2018). In the given case, this is directly harmed in the case of Martha, where she is being put to bed earlier than required. Hence, this not only impacts the psychological well-being of Martha where her mental well-being is impacted, but also, harm may be implicated on her physical well-being. In addition, strength building activities and exercises should be promoted, and smarter nutritional choices should be promoted. It is also the responsibility of the individual to track the progress of the affected individual and promote undertaking lifestyle adjustments for improved well-being (Bennett and Rosner 2019). Hence, systematic support and approach are needed for holistic support that was missing in the case of provision of care provided to Martha.
Since Martha lives alone, her dependency on the care service provider is enhanced directly. The same should be acknowledged and should be taken into consideration by Martha. It is the primary responsibility of support workers to ensure that the individual they are caring for feels valued and respected (Kadivar et al. 2018).
Comprehensive care support can range from understanding the personal needs of the individual and delivering those in a professionally competent manner. If this is followed, improved satisfaction and care outcomes are achieved (Gbonjubola et al. 2021). These result in enhancement of quality of the lives of the individuals and also promote the building of a therapeutic relationship between the carer and the individual seeking support (Agaronnik et al. 2019). Therefore, use of therapeutic communication skills that acknowledge the individual needs of Martha and acknowledge her decisions in life should be respected and the decisions based on the same should be acknowledged. This will promote holistic care and conservation of freedoms and rights of Martha.
Conclusion
This paper summarises the case of Martha, a twenty-five-year-old individual who has cerebral Palsy. Martha seeks assistance in her daily living needs, like being put to bed. However, she has not been getting the required support for the same. Martha has requested that she wishes to be put to bed by ten in the night. However, she is put to bed by seven. This is thus one of the major concerns where this is associated with unprofessional and unethical care practices. As a care support worker, it is the primary responsibility of the care service providers to ensure respecting the care needs of people and develop actions in alignment with the same. Therefore, this presents a case of breach of autonomy for Martha as well as of the dignity of Martha.
This paper assesses the situation in the context of freedom, rights, and responsibilities in the process of care with an evidence-based approach. A discussion based on the individual needs of Martha has been outlined in this paper in context with the role of the care support worker. In conjunction, this paper has also explored the ethical principles and their impacts in the given case and outlines how the application of effective communication and critical interpersonal skills can help in improving the overall care outcomes for Martha. Through this analysis, it can be concluded that if focussed care and support is provided to Martha and effective communication is ensured with active engagement and shared decision making, the care outcomes could be improved.
Introduction
The ideas of dignity and respect have been identified as the primary human right (Ikuenobe 2018). It is associated with the focus on ensuring that the individuals are included in the community. It can help them feel valued in society. The case study of Martha was one of the key learning that helped me in shaping my understanding of dignity and respect in the context of disabled individuals in the community. This reflection will apply the Kolb’s model of reflection.
What?
In the given case, a conflict was posted in the discussion. Martha is dependent on the support of a carer to get her to bed. However, in the case of Martha, it has been observed that the carer does not acknowledge her request and asks her to sleep by seven when Martha wishes to sleep by ten. This case indicates how the wish of Martha has been ignored by the carer and indicates a lack of respect and poor conservation of dignity of Martha. As a carer, the primary responsibility of the carer is to focus on the needs of the person seeking care. However, with this behaviour, the needs of the disabled individual, Martha, have been regarded as secondary, and the personal priorities have been taken into consideration.
So what?
As I reflect on this case, I was able to understand that it is essential to focus on the needs of the client. This ensures that the individual feels respected and their opinions are valued. This is also important for one as when an individual works as a support provider, they understand the context of the decisions, communicate efficiently and deliver suitable care needs (McGinley et al. 2021). When disabled individual is discredited and their needs are ignored, they may feel devalued, and this may impact their self-esteem. Hence, such practices need to be discouraged and are also against the ethical and professional conduct of ethical practices (Camoni et al. 2020).
Now What?
Through this assessment, I have been able to develop an understanding of the suitable care approaches and the importance of communication in care and support. I have also been able to develop an understanding of required interpersonal skills that can help me shape my practice and advance as a competent professional in future. I have also been able to develop knowledge of communication skills like active listening and the application of a person-centred approach when providing care. I will apply this in future by focussing on shared decision making and ensuring active participation of the individuals involved in care and collection of frequent assessments and feedback for improvement (Ziss 2022).
Conclusion
I have been able to reflect on how the idea of dignity and respect is crucial when providing support to individuals with disabilities. Through this learning, I have been informed of the suitable practice and importance of acknowledgement of dignity and respect for individuals like Martha. This will help me improve my competencies and develop a more empathetic and informed practice for support and care. Hence, through this, I will ensure that I am able to provide competent service and contribute to improving the outcomes of individuals I work with in future.
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