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There are three pro-formas covering Resources material from Block 4. These are articles from Parker and Lawton; Lee-Treweek and Lawler.

There are two pro-formas for each article. One is blank and the other gives you a ‘sample answer’.

Pro-forma on key points related to Parker and Lawton’s ‘Procedures and the Professional’ (K101 Resources p.100-109)



|Question | |

|Headings: what is the article about (main |. |

|themes) | |

|What research was undertaken? By whom? | |

|What are the main points about Procedures and| |

|Protocols? | |

|Things change very rapidly in Health and | |

|Social Care - how valid are these points in | |

|2020? | |

|How can I use this article in the TMA? | |

| |

Completed Pro-forma on key points related to Parker and Lawton’s ‘Procedures and the Professional’ (K101 Resources p.100-109)



|Question | |

|Headings: what is the article about (main |Research study undertaken in late 1990s. |

|themes) |Looking at the extent to which 1) Procedures are enabling in Health and Social Care 2) Disabling|

| |3) Differences amongst Practitioners |

| | |

| |There’s also a historical and international perspective in terms of how Procedures and Protocols|

| |have emerged in the field of Health and Social Care in recent years. |

|What research was undertaken? By whom? |The authors undertook the research, through what are termed ‘focus groups’. |

| | |

| |These are groups of interviewees who answer the interviewers’ questions in group situations |

| | |

| |Twenty four focus groups were scheduled and run across three hospitals. In |

| |total, 126 health care professionals participated in the study. This sample |

| |consisted of 33 senior managers, 46 nurses, midwives or technicians, 18 Resources |

| |100 senior nurses, five ward managers, nine consultants, six registrars, eight |

| |junior doctors and one senior theatre technician. |

| | |

| |They were asked to discuss a series of questions |

|What are the main points about Procedures and|There are several protocols that have a role in training staff new to the Trust. It was also |

|Protocols? |suggested that protocols are |

| |needed to define correct practice (15), to provide support when challenging |

| |the practice of a colleague (6), to support the extension of the nurse’s role |

| |(6), to help the group function effectively as a team (6) and to change the |

| |practice of some of the older members of staff (4). (p.102) |

| | |

| |It was suggested that protocols should be made available and referred to when necessary. In this|

| |sense they were perceived as an aid to practice rather than a prescription of practice. (p.103) |

| | |

| |Differences between approach of medical and nursing staff. Nurses might undertake procedures in |

| |a different manner. Both doctors and nurses recognised that |

| |medical staff are much more likely to ‘do their own thing’ whereas nurses |

| |adhere much more strictly to the protocols in place. (p.103). Different training and working |

| |cultures etc. |

| | |

| |In terms of ‘usefulness’, some scepticism – can stifle Professional practice, prevent progress |

| |in terms of treatment etc and in some cases lead to the wrong treatment being given. |

|Things change very rapidly in Health and |To answer that question in truly accurate way – you would need to (as far as possible) ask the |

|Social Care - how valid are these points in |same questions to the same people. |

|2020? | |

| |Key point is that the principles of ‘proceduralisation’ are in many respects similar in 2020 to |

| |1999. |

| | |

| |The key difference is that ‘cost-effectiveness’ and ‘efficiency’ would now be significant |

| |drivers related to procedures and protocols in Health and Social Care. |

| | |

| |One other difference is that ‘unqualified’ staff are now carrying out much more in the way of |

| |clinical interventions – catheterisation, venepuncture etc. |

|How can I use this article in the TMA? |Make sure that you read the Assignment question carefully. Read the article several times. |

| |Then when making notes, suggested heading: How useful are protocols/guidelines to Health and |

| |Social Care practitioners? |

| | |

| |Aim for 150-250 words focussed on in what ways are they useful and not useful in relation to |

| |Health and Social Care |

| |

Pro-forma on key points related to 14 Body care and learning to do for others - Jocalyn Lawler – taken from Jocalyn Lawler (1991) Behind the Screens: Nursing, Somology and the Problem of the Body. Melbourne: Churchill, pp. 117–133 (abridged)



|Question | |

|Headings: what is the article about (main | |

|themes). | |

| | |

|What is somology? | |

|What research was undertaken? By whom? | |

|What are the main points about Intimate Care | |

|in the article? | |

|Lawler’s article was written in 1991. | |

|What has changed since then in relation to | |

|intimate care? | |

| | |

|In what respects is it still relevant? | |

|How can I use this article in the TMA? |. |

| |

Pro-forma on key points related to 14 Body care and learning to do for others - Jocalyn Lawler – taken from Jocalyn Lawler (1991) Behind the Screens: Nursing, Somology and the Problem of the Body. Melbourne: Churchill, pp. 117–133 (abridged)



|Question | |

|Headings: what is the article about (main |Lawler notes at the beginning that Nursing Care requires ‘touching every part of the human body |

|themes). |that is touchable’. This includes part of the body that have sexual significance. |

| | |

|What is somology? |Student nurses are required to find ways of managing such interactions, which can generate |

| |anxiety, taking into account the ‘gendered’ nature of bodies. |

| | |

| |Lawler’s argument is that intimate care – in her work referring principally to the external |

| |parts of the body is about seeing people naked. This can be a real challenge for nurses who are|

| |new to Care. This challenge is increased by the relative lack of attention in Nurse training to|

| |managing emotions and intimate care. |

| | |

| |Somology is the science of Nursing – especially the body. |

|What research was undertaken? By whom? |Lawler interviewed Nurses and Student Nurses in Australia in the early 1990s. She also includes|

| |numerous references to academic studies in order to support her ideas. This includes a |

| |reference to Arlie Hochschild’s concept of ‘Emotion Management’ (p.84). |

|What are the main points about Intimate Care |Touching people’s through washing is an uncomfortable experience – especially for staff new to |

|in the article? |nursing |

| |This creates an anxiety, which is increased by the fact that Nursing Education tends to focus on|

| |the procedural elements of the task |

| |Nurses are encouraged to ‘shut out’ their emotions when providing care. This limits their |

| |ability to be able to empathise with service users, who themselves may find receiving intimate |

| |care to be anxiety-provoking |

| |There is a ‘language problem’ in terms of how Nurses communicate with patients in relation to |

| |intimate care, though this in many cases has a ‘class dimension’ to it in relation to being |

| |‘comfortable’ with language. |

| | |

| |Lawler’s concluding points summarise her argument very effectively: |

| | |

| |Becoming socialized as a nurse, however, |

| |means taking on a new way of looking at the body and learning to ‘do for’.It requires unlearning|

| |ways of viewing the body. Such unlearning is necessitated by ‘the problem of the body’ and by |

| |the extent to which nursing and illness are disruptive of social order and normal rules do not |

| |always apply. [ … ] There is also no professional jargon that can be used to describe body |

| |functions which would make it possible to sanitize things people regard as dirty. [ … ] In the |

| |absence of discourse and socially acceptable language, some nursing functions are located |

| |outside socially condoned and accepted practices – they are dealt with by their absence and the |

| |silence which surrounds them. |

| | |

| |(p.88) |

| | |

|Lawler’s article was written in 1991. |Popular culture has become much more ‘sexualised’; For example, on daytime TV, celebrities/TV |

|What has changed since then in relation to |presenters will discuss their body and the sexual aspects of their bodies more openly in the UK |

|intimate care? |without the need for ‘humour’ as a ‘veneer’ to hide behind. |

| | |

|In what respects is it still relevant? |(In the 1950s, these conversations were generally conducted through innuendo – ‘Carry On’ films |

| |were the key exemplar) |

| | |

| |In the early 2000s, TV series such as ‘No Angels’ (C4) opened up ‘Nursing’ and Nurses in their |

| |‘private lives’ in a way that hadn’t been seen on British TV before. |

| | |

| |Within culture as a whole there is more talk of bodies but also (in part) as a result of |

| |mass/social media, more ‘body shaming’ that takes place. |

| | |

| |Similarly, the boundaries of ‘Intimate Care’ and sexualised bodies were dramatized in Pedro |

| |Almodovar’s ‘Habla Con Ella’ (2000). |

|How can I use this article in the TMA? |The theme of rigidity in Procedures and how this can create anxiety for staff is one that is |

| |relevant to the TMA – a brief 100 words would add a very relevant angle to your Assignment. |

| |

Pro-forma on: Bedroom abuse: the hidden work in a nursing home - Geraldine Lee-Treweek (Resources 13)

Originally published in Generations Review (March 1994), vol. 4, no. 1, pp. 2–4 (abridged).



|Question | |

|Headings: what is the article about (main |Lee-Treweek’s article is a case study from the early 1990s, written about an abusive care |

|themes). |environment in which residents were systematically mocked, humiliated and abused in public. |

| | |

| |Her first point is that in the Nursing Home, the most private ‘spaces’ were managed by untrained|

| |Nursing Auxilaries, were told that the main objective was to enable the so-named ‘presentable |

| |patient’ as a criterion for doing their job effectively. |

| | |

| |She indicates how this, and its associated lack of staff training led to a culture of abuse. |

| |There is an implicit connection to Stanley Milgram’s emblematic Psychology study ‘Obedience to |

| |Authority’ and Willliam Golding’s novel: ‘Lord of the Flies’. |

| | |

| |Its also about how staff with no adequate training become disempowered and that is dramatized |

| |through various abusive practices – all of which contribute to what is ‘de-personalisation’ in |

| |relation to the residents. This is essentially about the processes through which vulnerable |

| |people are deprived of their humanity and Human Rights as a result of a weakness |

|What research was undertaken? By whom? |This is not actually clear, though likely research by Lee-Treweek was undertaken in relation to|

| |former staff and residents |

|What is Lee-Treweek’s main argument here? |‘Bedroom Work’ in Nursing Homes carries significant risks as 1) it is a private space 2) some |

| |staff know nothing about Dementia or Professional boundaries 3) If there is not a culture of |

| |education/training and supervision, then the risk is that behaviour towards vulnerable people |

| |(eg Dementia sufferers) will de-generate into abuse in an ‘atavistic’ manner in which cruelty is|

| |the only means that staff have to relate to clients whilst managing the anxieties that are |

| |generated by the level of distress that the clients that they are working with express. |

|What theoretical ideas does she draw on and |Lee-Treweek draws on the ideas of Erving Goffman. He is mentioned in Block 2 in relation to |

|why? |Lennox Castle and arguably one of the most influential Sociological theorists of all time. |

| |(You’ll find his ideas everywhere within Health and Social Care). The citations in her article |

| |are from his (1959) work: ‘The Presentation of Self in Everyday Life’. |

|How can I use this article in the TMA? |.This a case study that dramatizes what can happen when policies and procedures do not exist or |

| |are not followed within a workplace environment. Certainly relevant in terms of establishing |

| |why policies and procedures matter. |

| |

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