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Employment Based Learning

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Submitted By ka867
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BSC (HONS) PUBLIC HEALTH
OMED 1204
MO1
EMPLOYMENT BASED LEARNING

COURSE DEADLINE: 09:05: 2013
WORD COUNT: 2047

The developed world talks of a demographic time bomb in the 21st century as the proportion of people aged over 65 in the UK rose from 15% to 17% from 1985-2010, an increase of 1.7m people, and is projected to reach 23% by 2035, according to the office of national statistics (ONS 2012). Of most significance for the social care system is the growth in the number of people aged over 85, which doubled from 690,000 in 1985 to 1.4m in 2010 and is set to reach 3.6m, or 5% of the population, by 2035( ONS 2012). This made it necessary for the government to launch the National Service Frame work (NSF) for older people(2001) which contained eight standards relating to older people’s services covering the full range of care older people need. The standards embody fundamental principles ensuring care is based on clinical need, not age, and that services treat older people as individuals, promoting their quality of life, independence, dignity and their right to make choices about their own care. This essay aims to explore how guidelines and policies are implemented in a residential care home in London to promote the well-being of the elderly and also further investigate the specific risk factors concerning the health and well-being of the elderly.
Well-being has become an important focus for health and social policy in general, and in relation to older people in particular (Reed et al 2004). Well-being as a phenomenon involves more than happiness and health as it explores all aspects that give meaning to life and a feeling that life is fulfilling and worthwhile. It encompasses aspects of physical, emotional, social, financial and spiritual well-being (Reed et al 2004). Just like all human beings well-being affects all aspects of old age but mainly their health, making it a vital aspect that needs to be worked upon at all times. Well-being has been linked to ideas about ‘active ageing’ (The National Framework for Older People DH, 2001) as well as independence (Opportunity Age DWP, 2005). The connection between well-being and independence was reinforced in the social care Green Paper, Independence, Well-Being and Choice: Our vision for the future of adult social care in England (DH 2005b). The experience I had while working as a volunteer public health student at a local residential home in London increased my practical skills on promoting health and well-being of the elderly based on guidelines and policies as I was able to incorporate theory into practice by linking policies and guidelines with the daily activities done. The home had services predominantly aimed at people aged 70 and above, but consideration was made for people below that age depending on their individual circumstances. The home offers a range of services to enable older people to get the best out of life by offering warm, safe and friendly environment, where people can maintain their independence if they wish but have access to support when they need it.
My role as a volunteer public health student at a local residential home in London involved a range of roles that covered aspects of meeting or maintaining healthcare needs (for example, eye, hearing and foot care) nutrition (for example, healthy eating), personal care (for example laundry, keeping warm) staying active and increasing daily mobility of the elderly while putting safety in consideration.
1:0 Implementations of policies and guidelines aiming to promote well-being of the elderly
The Department of Health (DH 2011) published daily physical activity guidelines for older adults aged 65+ where the requirements were that older adults were active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more as Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. The home was able to implement this on a daily basis as among the activities that I performed was enhancing daily physical activity where I worked in collaboration with Physiotherapists, registered exercise professionals and fitness instructors to deliver exercise programmes appropriate for older people. Daily activities involved offering tailored exercise and physical activity programmes, that involved a range of mixed exercise programmes of moderate intensity (for example, dancing, walking) ,strength and resistance exercise, especially for frail older people and simple toning and stretching exercises. The elderly were informed of the benefits of regular physical activity of at least 30 minutes a day on 5 days each week or more depending on older people’s mobility and capacity. The approach of tailored exercise programmes also lines with the British Heart Foundation (2007) guidelines for the elderly which the home maintains on a regular basis.
The maintenance of physical activity in later life is central to improving physical and emotional health (Naidoo and Wills 2000). Regular exercise has beneficial effects on general health, mobility and independence, and is associated with a reduced risk of depression and related benefits for mental wellbeing, such as reduced anxiety and enhanced mood and self-esteem (DH 2005c). Physical health and mental health, in turn, also have an impact on older people’s economic circumstances and on their ability to participate in society (Marmot et al 2003, Naidoo and Wills 2009).
The National Institute for Clinical Excellence (NICE 2008) Public health policy on improving the care of the elderly in primary care and residential care where one of the recommendations were for health professionals were required to Invite regular feedback from the elderly about services provided and use it to inform the content of the sessions and to gauge levels of motivation. This was so much implemented as the care home manager and supervisor stressed the importance of Inviting regular feedback from the elderly. As such, it was a necessity that health care staff collected feedback from service users which was all documented for managerial use. The Service feedback can also be used to evaluate or redesign services to meet the needs of older people (NICE 2008).Evaluation is an important aspect of health promotion as it enables the ability to judge the worth of an activity (Sidell and Douglas 2012, Elwes and Simnet 2005).
The UK Food Standards Agency developed nutrient and food based guidance for residential care homes where emphasis was laid on the provision of healthy balanced diet for the elderly which also correlates with the government initiative of change4life campaign that lays guidelines on eating well and living longer(FSA 2007). Implementation of this policy at the home was quite evident as I was personally given the role of working with the nutritionist in promoting healthy eating, ensuring provision of balanced diet to all residents and further stress the importance of ample rest and regular drinking of water to avoid dehydration. The nutritional needs of the elderly were fully met and encouragement of independence however as a health promoter I felt that greater enhancement of respect and dignity would have had further impact on the well-being of the elderly. This would have been done through regular enhancement of effective communication skills to engage with the elderly and their families. With this therefore conclusions were that the Dignity at Work and the NHS Spiritual Care Policy, 2009 was not fully implemented.
The care home had a comprehensive policy to ensure that the elderly were kept warm at all times especially during the cold winters as the elderly are typically more vulnerable to cold weather due to the fact that their skin’s protective abilities, bone strength and body’s ability to regulate temperature all weaken with age and are therefore at increased risk of developing blood clots in cold temperatures (Allen 2008). All health care staff ensured that the home was warm enough and continuously used rooms had heating concentrated. I was personally involved in encouraging the elderly to keep warm by taking regular cups of tea, encouraging them to eat their food warm and wearing warm clothing especially if going out.
1.1: Investigation of specific risk factors concerning the health and well-being of the elderly
Falls are a major cause of disability and the leading cause of mortality resulting from injury in people aged above 75 in the UK (Scuffham and Chaplin 2002 ,Cryer 2001) Therefore, the prevention and management of falls in older people is a key Government target in reducing morbidity and mortality (NICE 2004). This is outlined in the National Service Framework (NSF 2001) for England, standard six for older people.
The care home policies as implemented by the manager at the residential home ensured that risk factors relating to falls of the elderly are minimised by implementing safety assessments and facilitated the elimination of hazards and had a range of safety devices installed. All health care staff including me had an education programme highlighting the importance of health and safety in the home.
Additionally, In order to prevent injuries it was a requirement and in the staff manual that hazardous manual handling operations are avoided by all health care staff and use of lifting, handling and assisting aids wherever practicable was implemented. The manager carried out a sufficient assessment of manual handling operations regularly which indicated the application of the manual handling operations regulation 1992.
Biological hazards were prevented as there were adequate procedures laid down for the safe handling, segregation, storage, spillage control and disposal to reduce the risk from such hazards to a minimum. This was in line with the COSHH 2002 regulations.
Floors, corridors and stairs were kept free from obstructions at all times and were well lit. Stairs had handrails on both sides and Spillages were cleared up immediately. It was a home policy and in the staff manual that Warning signs be displayed during cleaning to warn residents of potentially slippery surfaces.
Although most falls result in no serious injury, approximately 5 per cent of older people in community dwelling settings who fall in a given year experience a fracture or require hospitalisation (Rubenstein et al. 2001). It is therefore a vital aspect that risk factors resulting in falls are monitored regularly and this was always given priority at the home.
Beattie(1991) offers a structural analysis of a range of health promotion approaches(Naidoo and Wills 2009) that range from authoritative (topdown and expert led) to negotiated(bottom up and valuing individual autonomy). Much health promotion work involving advice and information is determined and led by practitioners. As we can see throughout the essay, most of the work at the residential home was authoritative falling under the legislative action for health where by most interventions at the home were led by health care staff but intended to protect the elderly.
Various Engagements at the residential home enabled me to evaluate my skills so as to be able to determine professional development. Achieving this was done through the use of Kolb(1984) learning cycle frame work theory that examines the link between education ,work and personal development were perception and processing are acknowledged as the two learning actions which relate to the four dimensions of the education cycle; Concrete experience, Reflective observation, Abstract conceptualisation and active experimentation(Dixon1999).In line with the theory, I was able to increase my knowledge through observations of the various activities carried out known as concrete experience and later processed the information using a range of activities that included feeding the elderly together with other health care assistants. The accommodator aspect in Kolb’s theory was the most learning style I felt engaged in as perceived knowledge was gained through advice given to the elderly to keep warm and healthy, feeding and actively engaging with the elderly during the physical exercise programmes (Dixon 1999).
In conclusion therefore, it can be seen that the care home worked largely to meet the policies and guidelines to promote the well-being of older people and also emphasised the need to implement the specific risk factors concerning the health and well-being of the elderly. Overall however, although working as a volunteer student was somewhat challenging, it was also very rewarding because it increased my awareness, knowledge and skills and gave me the ability to incorporate theory into practice that at the moment I feel confident that when the future takes be to the field soon, I will have the ability to take up assignments with in my profession as a public health and health promotion professional.

References
Allen J (2008) Older people and wellbeing; London: Institute for Public Policy Research.
Age Concern England and Mental Health Foundation (2004) Literature and policy review for the joint inquiry into mental health and wellbeing in later life. Available from: www.mhilli.org/documents/Litandpolicyreview-Execsummary.pdf
British Heart Foundation, National Centre for Physical Activity and Health(2007) Guidelines on the promotion of physical activity with older people. London: British Heart Foundation.
Cryer C (2001) What works to prevent accidental injury amongst older people, London: Health Development Agency
Department of Health (2001) National service framework for older people: London: Department of Health
Department of Health (2005b) Securing better mental health as part of active ageing London: Department of Health.
Department of Health (2005c) Choosing activity: a physical activity action plan. London: Department of Health.
Dixon N M (1999) The organisational learning cycle: how we can learn collectively 2nd edition: Gower Publishing ltd
Elwes L and Simnet I (2005) Promoting Health;Apractical guide 5th edition Baillire Tindall
Food Standards Agency (2007) Guidance on food served to older people in residential care (online) last accessed on 23.04.2013 at http://www.food.gov.uk/multimedia/pdfs/olderresident.pdf
Marmot M, Banks J, Blundell R, (eds) (2003) English longitudinal study on ageing. Health, wealth and lifestyles of the older population in England London: Institute for Fiscal Studies.
Naidoo J and Wills J (2009) Foundations for health promotion 2nd edition; Braillere Tindall
NICE (2008) Occupational therapy interventions and physical activity interventions to promote the mental well-being of older people in primary care and residential care: NICE PH guidance16 (online) last accessed 14.04.2013 athttp://www.nice.org.uk/nicemedia/pdf/PH16Guidance.pdf
NICE (2004) Clinical practice guidelines for assessment and prevention of falls in older people; improving practice; improving care (online) last accessed 14.04.2013 at http://www.nice.org.uk/nicemedia/live/10956/29585/29585.pdf
Offices of the Deputy Prime Minister (2006) A sure start to later life: ending inequalities for older people: A Social Exclusion Unit final report. London: Office of the Deputy Prime Minister.
Personal Social Services Research Unit (2006) Control, well-being and the meaning of home in care homes and extra care housing Research summary (online) last accessed 12.04.2013 at www.pssru.ac.uk/pdf/rs038.pdf
Reed J, Stanley D, and Clarke C (2004) Health and Well-being and Older people:The Policy Press
Rubenstein LZ, Josephson KR, Trueblood PR, Loy S,Harker JO,
Pietruszka FM (2000) Effects of a group exercise programon strength,mobility, and falls among fall-prone elderly men,Journals of Gerontology 55(6):317-21.
Sidell M and Douglas J(2012) Using evidence to plan and evaluate public health intervensions In Jones L and Douglas J Public health;Bluiding Innovative practice: Sage publications
Scuffham P, Chaplin S (2002) The incidence and costs of accidental falls in the UK. Final Report, York: York Health Economic Form Consortium.The University of York.

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