4. 1 Compare models of reflective practice
Jenny Moon (1999) Model of Reflection used a common sense thought process which looks at what the outcome is to be achieved and how this can be achieved when this achievement is not clear. She stated that there were five stages in learning, her Map of learning, these involved Notice, getting to know what you are trying to achieve. Making sense to look at the whole outcome and how important this is for the person. Making meaning through which relationships are determined and new ideas are utilised to solve and promote the outcome. Working with meaning which develops these new ideas into actions and understanding which then leads to transform learning as this planning is implemented and utilised for the person to achieve their outcomes. Kolb 1975 described the concepts of experiential learning. It mainly looks at using reflection to help understand what has been done and how this can then be improved. His model looks at the situation once it has occurred, reflecting on what you did and the impact of this, then using these skills in a different situation. This then leads to development and the knowledge is continuously applied and builds on the learner’s experiences and knowledge. This leads to developing knowledge around how we work and what doesn’t work. Gibbs 1988 developed Kolb’s reflective model and used discussion around the actions to improve and develop the staff. He broke this down into stages of debriefing, description of what happened, what you did. Then feelings, how did you feel, what were your reactions. Evaluation, what went well or what didn’t, think about the outcomes of the action taken. Analysis, what happened, how was the experience, was it what you expected. Conclusion, general, how did it go, was there anything specific that impacted on the actions, and conclusions, specific, what was it about the situation that led to the outcome. He then developed the reflection of the experience through personal action plans, used to look at how and why you might change your actions next time. What have you learnt and how are you going to use this information in the future. Johns 1995 model of reflection looks at using a supervisor or mentor to discuss the actions with, this allows for learning to take place quickly. He highlighted the need to use experienced knowledge and develop the staff members ability to use new information and learning in practice. For this to occur reflection needs to look at how the staff member feels the experience went (looking in) and how the experience was carried out. (looking out). He looked at the staff member analysing the aesthetic, personal, ethical, empirical and reflexive elements of any situation.
1.2 Critically review approaches to outcome based practice
There are several models used to achieve outcomes for clients, these all have the same aim of supporting and developing the client’s skills and actions to achieve their desired goals. The models include the Logic Model. This is the most widely used model in outcome-based practice and outlines the aims and goals of the person, it also outlines the actions put into place to achieve these aims. The logic model looks at the resources required, a plan of the actions to be taken and the progress towards the achievement. The action planning is then amended to continue to achieve the goal. The Outcome funding framework looks at achieving outcomes by setting targets towards the ultimate objectives, to progress the client towards achievement. It promotes setting steps towards achieving the aims which allows for ongoing reviews of the progress and can be adapted if these steps are not achieved. It breaks down the actions required to achieve an objective and promotes the gradual achievement of the goal. Results based accountability looks at the objectives and then works backwards to determine how they can be achieved. This works well in our practice for some of the goals of the clients as their goal is to develop independence, and we can promote this through the questions involved in results-based accountability of what you want, how will we know it has been achieved and what will it take to get there. We use this model in collaboration with other models to assist the clients to achieve their aims and objectives. The model targeting outcomes of programmes is based on a series of steps to plan, implement and evaluate the progress of the client. It looks at the questions of why have a programme in the first place, how it should be carried out and how is it going to be implemented, what and how are the benefits achieved.
1.3 Analyse the effect of legislation and policy on outcome based practice
Legislation around outcome-based practice developed from the NHS and Community Care Act 1990, which advocated that local authorities have a duty to carry out individual assessments on people requiring community care services. This assessment determined whether the person was eligible for services and their needs for services and what they wanted to achieve. The Valuing people 2001 white paper and valuing people a strategy for change advocated Rights, Independence, Choice and Inclusion for people requiring services to support them. This has since been followed up with the Care Standards Act 2000, The Health and social care Act all advocating outcome-based practice for the development of care for people. The Care Act 2014 has also ensured that the needs of the clients are put first and that the clients should We also work within the CQC regulations which advocate individualised care planning, looking at the needs, beliefs preferences of the client determine what their objectives and aims are and assessments should be developed to achieve these under the Essential standards of care.
The Mental capacity act 2005 and deprivation of liberty safeguards 2006, means we must acknowledge a person’s rights to take risks and to have capacity to make their own decisions, we must promote their best interests where capacity has been assessed as lacking and continue to promote their goals and preferred outcomes within this. The Equality act 2010, also ensures that we work to promote the rights and choices of the client’s , makes sure they can access services and are supported in the best way for them to achieve outcomes and to prevent discrimination because of their conditions.
1.1 Identify operational objectives within own area of responsibility
My main responsibility is to provide a service, which meets the needs of the service user’s whilst managing and providing the resources within the financial boundaries of the service. This must be done whilst meeting the standards and regulations set out by the CQC, government policies local authority guidelines and our codes of practice. I need to understand the market, the demographics of the area and the aims and objectives of the service. I need to be able to resource the appropriate staff and ensure good quality assurance measures are in place to promote a high standard of care.
I am responsible for the planning and communicating of the services development, the training of staff and the management of the financial budgets. I mentor the senior staff team and delegate work roles to them as and when required and monitor their roles. I am responsible for the development of the service and the training of staff and upholding the standards of care. Meet CQC standards and maintain the goals of the service. I must also maintain good relationships with relatives, and other external agencies to promote the reputation for the care home in the local community. My responsibility is to maintain levels of satisfaction to both residents and their relatives and comply with legislative requirements and company policy, through effective quality assurance, audits and resolution of complaints.
I am required to maintain an annual operating plan and evaluate and monitor performance targets of the service and to share this information with relevant others. I am responsible for the selection, recruitment, induction, retention and development of staff and their development through supervision and appraisals.
We aim to promote the objectives of the service, and promote the maintenance of independence, choice and the rights of our client’s. We provide a safe and secure environment and activities to stimulate and develop skills and occupy client’s.
I organise and prioritising my own workload to deliver work of high quality that meets agreed objectives. I need to be able to work effectively with other people from both my own, and other organisations. I am also committed to developing my own skills within my role.
I manage day-to-day activities in my service and ensure that I plan activities and promote the achievement of the organisation’s objectives. I must plan and maintain risk assessments within the service and ensure that actions are carried out to minimise these. I have operational plans in place which have relevant risk assessments attached and maintain an emergency plan to limit any risks re unforeseen eventualities. My responsibility covers the whole services running and development, I deal with complaints and safeguarding issues and promote the safety of the client’s which balancing this against the finances and viability of the service, the staffing levels and the requirements of the inspectorate.
1.2 Analyse objectives of own area of responsibility in relation to those of own organisation
My objectives are to provide and maintain a service that meets the needs of the client’s, it must meet the requirements of the inspections CQC and local authority and be robust enough to be viable. I need to ensure that the service develops to meet the increased needs of the client’s and maintain the standards expected of us within our budgets. We must ensure that new legislation and serious events are incorporated into our policies and procedures and that staff have the skills to develop and carry out their roles to the highest standards.
I must also ensure that the building and furniture and equipment is maintained and safe and that replacement of these occurs to ensure that the service is kept up to date and safe for the client’s. I must make sure that policies and procedures are maintained and reviewed, and risk assessments are reviewed and updated as and when required, including the contingency plans in place, which is
updated throughout the year and a copy of which is sent to the local authority for their information and records. I must maintain appropriate staffing numbers and mix of staff for each shift and have contingency plans in place for when required. I must produce reports and evidence the services work and promotion and development annually for the company and complete reports and evidence re CQC, determine the performance indicators re the service and maintain the standards. I maintain the relevant records and ensure that reviews of support plans take place at regular intervals and monitor the systems in place to protect the client’s, staff and others within the building.
I am also responsible for ensuring that the resources are available to enable staff in their roles and that the health and safety of the clients and staff are promoted. I assess the home environment and carry out risk assessments re the activities of client’s they wish to undertake. This reduces the risks of harm for both themselves and others. I promote the safety of the clients and am responsible for contacting the safeguarding board and review meetings to ensure that measures are in place to protect the clients from harm. My objectives involve maintaining a safe and secure service for both clients and staff, updating policies and upholding the values of the company. I ensure that the service meets the standards and legislation we work within and that the records and support plans are kept up to date and relevant.
2.2 Identify support from relevant stakeholders
My services stakeholders include staff, client’s, suppliers, regulators and governing bodies, investors and owners. They are all people who are concerned with or who may be involved in the service on a day-to-day basis. Stakeholder involvement and participation is important in the development of a successful service and the promotion of individual care support. They also support the home with legal advice around recruitment, equality and diversity and safeguarding to ensure our practices meet the standards required.
The NHS and physiotherapy, occupational therapy, dietetics and speech and language therapy teams work together with our staff, to develop specialist support plans based on the service user’s goals. They assist in the provision of aids and appliances and development of safe practices re the client’s.
We work with the Community Mental Health Teams which support us to provide services to client’s experiencing mental health issues and dementia. They give the service specialist advice and support for our clients who have dementia, and for the care staff supporting clients with dementia, or for a service user recently diagnosed with dementia. The specialist memory clinics works with family carers, care home staff, to provide information and develop the understanding and skills re the support these client’s need. The clients determine the service they require as this is tailored to their needs and also impacts on the training needs of the staff team. The assessment of risks is also dependant on the needs of clients and every client is individually assessed re their needs and the risks involved including personal evacuation plans.
We also work with the local authority and social services who assess and refer clients to the service. They will carry out reviews and support us with safeguarding concerns and issues and support re risk assessments and ensure we work within the legal frameworks. Staff are involved as we must ensure they are trained to be able to carry out the care, and also trained in emergency procedures to protect the clients and to ensure that they are aware of the procedures and practices to take in the event of an emergency situation.