Learning from Practice Placement

Introduction

Through the practice learning opportunity (PLO), it is possible to develop proper understanding about own learning activities by sharing own experience and knowledge. It is crucial for me for developing own learning (Aspinwall-Roberts, 2012). This learning process helps me a lot, where I know what to expect in a real-world scenario and how to progress about it. By improving my areas where I lacked, I will be able to be more effective in the next time, where I can perform better. In this context, I was placed at a mental health homeless agency, where I got the opportunity to put into practice of the theoretical aspects of my studies. During my time there, I have exposed to a number of scenarios, where I had the scope for applying my theoretical knowledge and understanding of the best practices in social work. For the purpose of this essay, I focus on sharing my interesting experience that I had with a service user, while on this placement, which entails assessment and planning of the service user individualised care to improve my abilities to work with other service providers and deliver quality care to the service users. In order to comply with confidentiality laws, the service user hereby will be referred to as Mr H and the agency as Transform. I will also adhere to maintain confidentiality of all the persons involved throughout this essay (SSSC 2016).

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Preparing and gathering assessment

The agency that I worked for mainly provides housing support for homeless people, who are affected by physical or mental health issues. It also offers counselling, shelter and employment opportunities to its service users. The organisation understands that, the people with such needs are vulnerable and face a lot of challenges in their everyday lives (Care Inspectorate, 2012). Hence, the organisation aims to build a community, where they can assist those who are vulnerable to better cope with their challenges and aspects of everyday life that these people struggle with as well as help them to integrate well back into the community. My role on placement is to entail undertaking assessments of the service users’ needs to be able to support them in meeting needs identified. I had the privilege to be the part of a nomination board meeting, while I was on placement, where the members of the board had to deliberate and choose one of the referrals presented to them. The board members presented at the meeting were a social worker, my senior support worker and the head of residential services of the agency. I was there to represent the staff and be part of the decision-making process.

Coulshed and Orme (2012), (cited in Milner, Myers and O’Byrne, 2015), defined an assessment as an ongoing process that aims to understand people and their interaction with their environment. Additionally, it is considered as a process that requires the service user’s involvement and forms as the basis for the practitioner to plan what need to be done in order to either maintain, improve or bring change in a person’s life (Coulshed and Orme, 2012). Kemshall (1998), (cited in Milner, Myer and O’Byrne, 2015) also argued that, an assessment is about using professional judgement to understand a situation or circumstance of a service user as well as identifying the risks involved. From these definitions, assessing Mr H required me to understand his needs and applying my professional knowledge and judgement to develop a support plan for meeting his identified needs. According to Wilson et al., (2011), a practitioner should begin an assessment process before interacting with his or her service user. My assessment began prior to my meeting face-to-face with Mr H, where I concentrate on developing effective communication with the service users in order to acknowledge his needs and preferences in overcoming his issues in his life.

I started gathering information about Mr. H by reading through his referrals available to me to get general insights about the nature and extent of the problems that he was suffering from. Considering this concept, I started reading through the agency’s assessment forms to familiarise myself with the questions and topics that would be discussed with Mr H. I read other assessments that some of my senior colleagues had completed and discussed with some of them to improve my knowledge about the framework and know what was expected from me. As per the theory of social work, it is necessary to have successful patient assessment or understanding the perspectives of the patients and fulfilling the needs and preferences of the service users by developing effective care plan. In this regard it is my duty to develop effective patient’s assessment program, where I can diagnose the patient and interact with Mr. H, in order to understand his preferences so that I can identify the problems in his life and develop suitable planning for supporting him with proper treatment and care.

Making judgements

Since Mr H was a divorced man and had very little contact with any other relatives, it was obvious that he was suffering from loneliness. In such cases, people may feel stressed and would therefore engage in activities that they believe could relieve them. His chain smoking here could be explained by the systems theory. Mr H could manage his finances but whenever he experienced crisis, he asked others for money or even stole it. These are moments of crisis where a person needs to adapt. The residents here only know these two ways to avoid these crises and thus demonstrate the aforementioned behaviour. In the supported housing facility, he was enjoying a lot more freedom and flexibility than he used to have in the hospital. Though there were support staffs to assist him in day to day activities, he still had the right to make choices for himself. It was important that his rights were respected, and he could do things if those activities did not put himself or anybody else into danger. It was one of my responsibilities to ensure that he realised some of his actions were not appropriate. According to the rational choice theory, a person takes only those actions that are rational to him (Tudor, 2013). That was why I had to understand his logics behind each of those abnormal actions portrayed by him during all these years. Informed by these theories, I investigated the areas mentioned and made sure the resident received the best possible support while he was at Transform.

As per the assessment, the initial referral from both his social worker and GP outlined extensively the nature of Mr H’s conditions. He was receiving 24-hour care and supervision in a locked ward environment due to how aggressive he could be and did not go out of the ward unsupervised. He could manage most self-care and domestic tasks but sometimes required prompting. The service user can be impaired temporarily, have conditions diagnosed as mild cognitive impairment, suffer from illness creating progressive impairment, or simply have lower levels of ability to learn or remember (as with any mental retardation condition) that will remain constant throughout life as he had a cognitive impairment that was not going to improve. As per the medical model, the physicians, doctors, nurses and the care professionals try to diagnose the service user in order to identify the actual diseases that the patients is suffering from, where proper care plan and treatment are developed in order to treat the patients with proper medication and treatment (Congress, and McAuliffe, 2006; Coulshed and Orme, 2012). In the medical model, the doctors, GPs, social workers, surgeons, occupational therapist and other health care professionals are involved in order to deliver high quality treatment and care. In this regard, Mr H’s continues stay in the hospital did not make any change to his situation. For this reason, the clinical team concluded he had reached a stage, where he could return to the community thus his referral to the agency.

Hereby, the medical model was not working for Mr H despite several attempts, so it was considered that the social model which enables integration back into the community and socialise with other service users and neighbours would be beneficial for him. In this context, the social model is effective to treat the patients where the care professionals try to fulfil the aspiration and social needs of the people by improving the engagement of the service users with the social communities as a whole. In this regard, as per the social model, the care professionals try to identify the psychological needs of the patient including the requirement of food, shelter and water, requirement of love and respect, self actualisation needs and self esteem where it is possible to assess the patients on the perspective of their emotional needs (Wilson et al., 2011). In this regard, I as a social worker try to concentrate on social development model, where I focus on improving my skill and abilities to support the patient with proper counselling process, enhancing communication and interaction as well as provide respect to each of the patients at the care home. For example, I also try to encourage the individual Mr. H, and cooperate with him in order to acknowledge his needs and try to build string relationship so that he feels comfortable to share his perception and develop effective care plan by empowering him properly.

In this regard, under the social model, the relationship model based practice is one of the effective practices which help the other service providers to take care of the patients and build strong relationship with them for providing them better care and support. Currently, there has been a move to see the relationship-based model back into practice. My initial meeting with Mr. H was not effective. Our conversation was based on questioning model of assessment whereby I focused on getting the task done by ensuring that I got answers for all the questions on the framework. According to Graybeal (2011), “learning to ask questions that open up possibilities is an art form that requires practice”. This is effective for me to develop strong binding with the service user and show respect and integrity so that the patient can rely on me for getting support and care. Hereby, the social model of social work practice is effective for me to develop my own understanding and knowledge to support the individual with better care and practice (Tudor, 2013). Additionally, I had to earn his trust by being honest with him about the purpose of the assessment, so I applied exchange model of assessment for sharing of ideas and views with him considering him as an expert of his situation. In this regard, as per the theory and practice of social work, exchanging the information between the social worker and the service user is necessary, where sharing information is necessary for the service providers and also for the service users to concentrate on developing proper care plan by using latest treatment and care (Turney, 2012).

Use of supervision in the assessment

There are several issues during the working practice with the service users where the service providers face difficulties to diagnose and acknowledge the actual needs and preferences of the service users. Without having in depth information about the patients and lack of understanding bout the actual health issues and personal preferences, the service providers cannot develop proper care plan. In this regard, I was aware that my cultural background and life experience might conflict with the assessment process. I then used supervision with practice educator and coordinator to address this conflict and to be provided appropriate way of carrying on with the task. Fenton (2016) advised that, the social workers should seek opinions and assistances from likeminded colleagues or professionals, if they want to improve their practice. Hereby, there are different issues such as language gap, lack of communication and cooperation as well as poor interaction and cultural differences which are serious problems in the workplace, where it negatively hampers the activities of the service providers (Pohjola and Korhonen, 2014; Smith, 2014). Here I also face the difficulties to develop conversation with the patients due to lack of communication skill, where I also fail to cooperate with the service providers and also Mr. H. which deteriorate the chance of delivering high quality service to the individuals. I face problems in working with other and empowering the patient in the care plan, as I am not efficient to interact and build strong relationship with the patient due to cultural differences and lack of interaction.

It is necessary for the service workers to develop personal and professionals knowledge so that it is possible to fulfil the job role of the workers in the organisational context (Parker, 2007). Through this study, it is possible to share my experience during my working process and utilise the existing practice and heath car process to create values for the service users (Ward, Turney, and Ruch, 2010). In this regard, in order to develop patient centred care, it is necessary to follow the guidelines and legislations of Care Quality Commission, where managing transparency and accountability, patient empowerment, improving quality of care, providing the service creatively by suing latest technology and treatment, managing health and safety of the service users and workers, respecting each other, far treatment and care, managing communication and cooperation are effective guidelines, which are contributing factors in delivering quality care to the service users (Scottish Social Services Council, 2016; Scottish Social Services Council News, 2016).

In this case scenario, I have acknowledged that, he opened up and trusted me because I engaged with him throughout the process by listening to his views and opinions and by not being judgemental. This approach made Mr H comfortable in my presence and even gave me his permission to seek any further information from staff, CPN, family members and any other authorised bodies that could help to build a strong support plan for him. According to the Code of Practice 2.2, social workers are expected to be honest, open to their service users and communicate with them in an appropriate and straight forward way without using any jargons for the understanding of each other (Scottish Social Services Council, 2016). However, it is argued that being friendly to service user is important, however, being friendly does not mean to be the service user’s friend (Ward, Turney and Ruch, 2010).

The agency’s monitoring tool called ‘Better Futures’ was used for assessing our service users. The framework is supported by a web-based recording system that uses easy-to-follow reporting tools as compared to other systems that are complicated and difficult to understand and operate (Care Inspectorate, 2012). This helps those using support services to identify goals and chart their progress towards independent living and means that organisations can track outcomes – a feature which is equally beneficial for providers and their funders (Pohjola and Korhonen, 2014). The tool is believed to be effective in achieving five most important goals - accommodation, health, safety and security, social and economic wellbeing and employment (Scottish Housing News, 2016; Milner, Myers and O'Byrne, 2015). Achieving these goals is crucial in providing that support. While I used the tool, I was careful in following the procedures and reviewed the previous experiences of the agency to develop a better understanding about it. In this regard, I try to utilise the accommodations as well as organisational resources and capabilities in order to improve welfare of the patients and in this regard, I also try to empower the patient in the organisation in order to involve them in developing the care pan so that Mr. H can share his perceptions and personal preferences during the treatment and care process.

It was necessary to speak with his family members and previous social worker. However, I had to gain consent from the patient to do so as was proposed by Tudor (2013) (Health Direct, 2018). I was able to build rapport with Mr H and he allowed me to contact them. Upon probing, Mr H also expressed his need of staff assistance for performing his day to day activities. Though he was not staying in a hospital anymore, he still needed supervision of GP. In view of this, I assisted him to register with a GP and getting necessary guidance for his care. This helps me to empower the individual and develop patient centred care where the patient can feel valued and empowered well in developing the care plan for the maximisation of the wellbeing of the individual. It was one of my responsibilities to ensure that he realised some of his actions were not appropriate. According to the rational choice theory, a person takes only those actions that are rational to him (Tudor, 2013; Graybeal, 2001). That was why I had to understand his logics behind each of those abnormal actions portrayed by him during all these years. Informed by these theories, I investigated the areas mentioned and made sure the resident received the best possible support while he was at Transform. This provides me a scope to handle the person with respect and integrity and here I also focus on building string relationship with Mr. H through developing trust and loyalty. Hereby, I try to develop patient centred care though improving cooperation and communication with the patients and I also try to follow the health care rules and legislations to provide quality care by managing transparency, proper patient empowerment, protect the personalise data, delivering the best quality treatment and support through counselling and medications, respecting the patient, managing fairness at the care home (Data Protection Act, 2018; Congress and McAuliffe, 2006).

Conclusion and Recommendation

During this practice, I was able to identify my areas of strengths and weaknesses. I had a good amount of knowledge about social work practices before being placed at Transform. This was due to the fact that I studied different theories and reviewed practices related to social work. This made it easier for me to adjust to the environment of the agency very early. I found it difficult in the beginning to properly communicate with Mr H, and thus my communication and negotiation skills needs to be improved as the time progressed. This happened mainly because I put significant effort in understanding the inner world of the new resident. My effort was not only beneficial for me but also for the agency as they got to use my findings for further intervention if needed. I properly used the assessment tool provided by the agency to conduct the initial assessment which had been confirmed by the regular assessments, conducted by the other support staffs.

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During this time, I was careful and tried to respect the standard values and ethics of a social worker every time I tried to interact with Mr H. Special attention was given towards making sure that he did not feel oppressed by any actions taken by me. There were few instances, when I was faced with challenges such as cultural differences, language gap, poor communication and non-cooperation which hamper my work practice and I face difficulties in working with other staff and also with the service user. First of all, getting Mr H to open up was difficult. He denied all his actions which I came to know from the others. Getting his consent for taking any necessary actions was another uphill task. To recover from this, I might need to review all the relevant laws and legislations in this regard, where I try to gather more knowledge and understanding as well as follow the social wok practice and rule in order to develop patient centred care for maximising the values of the social communities as a whole.

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References

Aspinwall-Roberts, E. (2012). Assessment in social work with adults. Maidenhead: Open University Press.

Congress, E. and McAuliffe, D. (2006). Social work ethics. International Social Work, 49(2), pp.151-164.

Coulshed, V. and Orme, J. (2012). Social Work Practice. 5th ed. Basingstoke: Palgrave Macmillan

Graybeal, C (2001) Strengths-based social work assessment: Transforming the dominant paradigm’ Families in Society, Volume 82, Number 3, pp233-42

Milner, J., Myers, S. and O'Byrne, P. (2015). Assessment in Social Work. 4th ed. London: Palgrave.

Parker, J. (2007). Developing Effective Practice Learning for Tomorrow's Social Workers. Social Work Education, 26(8), pp.763-779.

Pohjola, P. and Korhonen, S. (2014). Social work as knowledge work: knowledge practices and multi-professional collaboration. Nordic Social Work Research, 4(sup1), pp.26-43.

Smith, S. (2014). Ethics and Values in Social Work. Ethics and Social Welfare, 8(4), pp.423-424

Tudor, R. (2013). Community Practice: Theories and Skills for Social Workers (3rd ed.). Australian Social Work, 66(4), pp.607-608.

Turney, D. (2012) A relationship-based approach to engaging involuntary clients: the contribution of recognition theory. Child & family social work journal, vol. 17, pp.149-159.

Ward, A., Turney, D. and Ruch, G. (2010). Relationship-Based Social Work: Getting to the Heart of Practice. London: Jessica Kingsley.

Wilson, K. Ruch, G. Lymbery, M. and Cooper, A. (2011). Social Work, An Introduction to contemporary practice. 2nd ed. Gosport. Pearson Educated Limited

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