Developing Inclusion and Independence for a Person with Disabilities

1. Explain the meaning of centrality

This is the ability of an individual being in the centre of his/her care provision.

1. Explain the importance of recognising the centrality of an individual rather than the disability

It is important one recognises the individuality of a person to help improvement their self-confidence and self-esteem and to make ascertain that the individual in question is not labelled. Labelling individuals with disability would potentially influence persons view about their disabilities as opposed to who they really are, human beings first before their disabilities.  Looking at individuals disabilities become limiting, it blinds individuals from harnessing the strengths and true potentials of individuals.  Centrality therefore enables people especially professionals to recognise people first before their disabilities.

Define person centred care

Providing care through the eyes of the patient or the service user taking into accounts their specific needs are and exactly your opportunity is providing to that individual and the expected outcomes for the benefit of the user could simply be classified as person centred care. “To see through the eyes of the patient and understand patients’ expectations, perceptions, and experiences, rather than just seeing through our professional eyes could describe person centeredness the best. …however Stewart (2000) defines person centred care as : exploring the disease and illness experience; understanding the whole person; finding common ground regarding management; incorporating prevention and health promotion; enhancing the doctor-patient relationship and ‘being realistic’ about personal limitations and resources.

Patient-centred communication in primary care, Stewart (2000)

1. Explain the importance of person centred care. Give examples from your practice

The importance of person centred care is many however I would attempt to discuss it with a particular service user in mind. For the sake of anonymity, I would call this service user as B. B lives in the outskirts of a town; however he has become prone to falls and minor accidents at his home of residence. After his discharge from hospital it became apparent that the trips and falls would continue to happen as B lives on his own. The local authority Social Worker decided it would be better for him to move into a care home. As there was little the L/A could do at that stage of B’s life. After family and professionals met and discussed the above with B, it was agreed that B moved closer to a reliable access to health care provision. Because B had lived all his life in the town in question. It was agreed that B didn’t have to move away from his friends, family and loved ones. But most importantly, B has become known to his local health professionals and his social worker within the adult team of the L/A in particular.  For continuity of care and smooth transitions to his new environment, B agreed with both his family and professionals to supported accommodation closer to his previous place of abode. Throughout the discussions with professionals and family members, clear communications and information without the use of any medical jargons or the use of technical words was used to bring the message home to B. B was fully involved in the decision making and B was accorded greater respect with his preferences as far as the provision of care is concerned.  In addition to the above, Mead and Bower has propounded “carers remain sensitive to services user’s preferences for information and shared decision-making and responding appropriately to the above and the fostering of therapeutic alliance – developing common therapeutic goals and enhancing the professional bond between carer and patient. Carers or care providers become aware of the influence of the personal qualities on the patient or service user is also paramount to the healing of the above”. (Mead and Bower 2000)

1. Compare the different outcomes that may occur between focusing on individuals’ strengths rather than needs only

Focusing on an individual’s needs as a practitioner could be limiting to a service user as compared to their strengths. When one concentrates on needs, professionals do well to satisfy what they ought to provide. Focusing on the strength of an individual is cooperation between the service user and the professionals involved with his/her care. This is an opportunity for the both to work together to determine an outcome that draws on the person's strengths and assets.  “it concerns itself principally with the quality of the relationship that develops between those providing and being supported, as well as the elements that the person seeking support brings to the process”  (Duncan and Hubble, 2000).

Focussing on the “needs” of the services user limits professionals to the notion the individual they providing support for needs help because they have a problem. This set them apart from others who are thought about as not having problems. So instead of identifying the problem and looking for an expert to fix the identified problem, service users are given the opportunity to participate, take control and learn what works best for their particular challenge as opposed to waiting for professionals to fix it.

1. Describe the term physical disability ( give two examples)

Any condition that affects a person’s mobility, physical capacity, stamina and or dexterity could be referred to as physical disability. Among the above may include brain or spinal cord injuries, epilepsy, hearing and visual impairments, cerebral palsy, and respiratory disorders.

1. Describe congenital disability (give two examples)

Congenital disability is a term used to describe disability which is identified at birth of a child.  These may include, learning disabilities, head injuries and many more. 

1. Describe acquired disability

Acquired disability is the term used to describe disability that develops/ come about during an individual’s lifetime. This may as a result of an accident or illness.  Among such disabilities include the following; head trauma, spinal injuries, loss of vision, loss of hearing, injured / loss of limbs. Illness and health related: post stroke, post-traumatic stress, Multiple Sclerosis, Arthritis, Motor Neurone Disease and a range of mental illnesses.

1. Describe neurological disability (give two examples)

Neurological disabilities are diseases of the brain, spine and the nerves that connect them. There are many disabilities of the nervous system, such as brain tumours, epilepsy, Parkinson's disease and stroke as well as less familiar ones such as frontotemporal dementia. disability.wa.gov.au

1. Compare a congenital disability with a neurological disability

Congenital disability is the disability that exist at birth for example mental or physical traits, anomalies, malformations, or diseases, which may be either hereditary or due to an influence occurring during gestation up to the moment of birth. Neurological disability on the other hand is a disorder of the nervous system. This is structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. “example include paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain and altered levels of consciousness”. Farlex 2012

 Explain the term progressive in terms of disability

Progressive disability is the disability that gradually develops. Common examples of progressive disabilities include muscular dystrophy, multiple sclerosis, Alzheimer's disease, and types of vision and hearing loss that get worse over time. A progressive condition is one that gets worse over time.

Part 2

1. Explain the emotional impact of a progressive disability on an individual and family

The challenges facing family members and an individual with progressive disabilities are numerous. Often family members become carers, financiers, holiday makers, to mention but a few. On the positive side it can broaden their horizons, increase family members’ awareness of their inner strength, enhance family cohesion, and encourage connections to community. On the other hand, the time and financial costs, physical and emotional demands, and logistical complexities associated with caring for a disabled child/adult can have far-reaching effects. Impact of a progressive disability is likely dependant on the type of condition and its severity, as well as the physical, emotional, and financial ability of the family and the resources that are available.

Caring for a disabled family member may increase the stress levels of families. Notably their mental and physical health would be stressed significantly. Progressive disability could also impact on the family’s available finances for an appropriate and affordable child care, decisions about work, education and or training.  As a result, could impact on family member’s emotional wellbeing, often it is associated with guilt, blame, or reduced self-esteem. Subsequently other aspects of family functioning could be neglected or sidled. All of these potential effects could have repercussions for the quality of the relationship between family members, their living arrangements, and future relationships and family structure.

1. Compare the different impacts that congenital and progressive disabilities can have on the individual and their family

An individual with the above condition have a variety of challenges. Among the challenges include body esteem.  “Body esteem refers to the overall positive or negative evaluation of the body” Mayer O.  Eisenberg J (1988). There are a number of authors who have argued that the bodies of people with physical disabilities are viewed negatively in our society. Stone (1995) argued that disability is perceived to be a condition to be avoided as much as possible. Our society values bodily characteristics that people with physical disabilities are less likely to possess, including physical fitness, sporting attainment and the ‘body beautiful,’ as it is represented in the media. One would expect that these attitudes and values would influence how people with physical disabilities feel about their own bodies. Furthermore, when a person with a physical disability faces the reality of being unable to match up with the ‘ideal’ body, his or her body esteem would be expected to suffer. Lawrence (1991) suggested that an impaired physique can be extremely frustrating and discouraging to the individual’s emotional stability and that this is likely to lead to unpleasant and unrelenting emotional tension. This is likely to involve poor body image and low body esteem in people with physical disabilities.

1. Describe the environmental and social barriers that can have a disabling effect on an individual with a disability

Nearly everyone faces hardships and difficulties at one time or another. But for people with disabilities, barriers can be more frequent and have greater impact. The World Health Organization (WHO) describes barriers as being more than just physical obstacles. Here is the WHO definition of barriers:

“Factors in a person’s environment that, through their absence or presence, limit functioning and create disability.

These include aspects such as:

• A physical environment that is not accessible.
• Lack of relevant assistive technology (assistive, adaptive, and rehabilitative devices)
• Negative attitudes of people towards disability.

Services, systems and policies that are either non-existent or that hinder the involvement of all people with a health condition in all areas of life.”

World Health Organization 2012

Often there are multiple barriers that can make it extremely difficult or even impossible for people with disabilities to function. Here are three most common barriers. Often, more than one barrier occurs at a time. See below described barriers faced by people with disabilities: 

Attitudinal barriers

This is the most basic but yet may contribute to other barriers. For example, some people may not be aware that difficulties in getting to or into a place can limit a person with a disability from participating in everyday life and common daily activities. Examples of attitudinal barriers include:

Stereotyping: People sometimes stereotype those with disabilities, assuming their quality of life is poor or that they are unhealthy because of their impairments.

Stigma: Prejudice and discrimination: Within society, these attitudes may come from people’s ideas related to disability—People may see disability as a personal tragedy, as something that needs to be cured or prevented, as a punishment for wrongdoing, or as an indication of the lack of ability to behave as expected in society.

Physical barriers

Physical barriers are structural obstacles in natural or manmade environments that prevent or block mobility (moving around in the environment) or access. Examples of physical barriers include:

Steps and curbs that block a person with mobility impairment from entering a building or using a sidewalk.

Mammography equipment that requires a woman with mobility impairment to stand; and

Absence of a weight scale that accommodates wheelchairs or others who have difficulty stepping up.

Social Barriers

Social barriers are related to the conditions in which people are born, grow, live, learn, work and age – or social determinants of health – that can contribute to decreased functioning among people with disabilities. Here are examples of social barriers:

• People with disabilities are far less likely to be employed. In 2017, 35.5% of people with disabilities, ages 18 to 64 years, were employed, while 76.5% of people without disabilities were employed, about double that of people with disabilities.
• Adults age 18 years and older with disabilities are less likely to have completed high school compared to their peers without disabilities (22.3% compared to 10.1%).
• People with disabilities are more likely to have income of less than $15,000 compared to people without disabilities (22.3% compare to 7.3%).
• Children with disabilities are almost four times more likely to experience violence than children without disabilities.

1. Analyse the socio-economic effects of physical disability on an individual

Socioeconomic challenges facing a person with physical disability are rather unique and challenging as compared to their counterparts who may not have any physical disabilities. Key challenges include the following:

Emotional well-being:

A person with physical disabilities emotional well-being is often short-lived as they soon bombarded with another challenge.

In view of the above challenges, they are clobbered with bouts of depression. To many a disabled person, they often saddled with sadness as their standard of life is always near to impossible.  In spite of the above challenges, persons with disabilities develop resilience in their personal resources knowing that if it had to be done mostly they would have to rise up to the occasion. They are more often than not optimistic about their future. “Lack of optimism often leads to intense depression”. Developed resilience enable the disabled individual to deal with life’s difficulties.

World Health Organization, International classification of functioning, disability and health. Geneva: 2001, WHO. p. 214.

1. Describe how legislation has changed society in relation to physical disability

People with accredited impairments have existed throughout history and have had a presence in all societies (Stiker, 2001). Recent estimates suggest that there are around 8.2 million disabled people in Britain and 500 million worldwide. Moreover, these figures are set to rise dramatically over the coming decades both in the rich ‘developed’ nations of the minority world and in the poorer ‘developing’ countries of the majority world (IDF, 1998). In rich and poor countries alike, disabled people are among the poorest of the poor (Coleridge, 1993; Stone, 1999; WHO, 2001). All  of which raises a number of issues for those engaged in policy making at all levels and in all countries. Perhaps unsurprisingly then, following its politicisation in the 1960s by disability activists and disability organisations, disability has become an increasingly important issue for politicians and policy makers at both the national and international levels. Many national governments now have some form of anti-discrimination law or policy to secure the equal rights of disabled people. Early examples include Britain’s 1970 Chronically Sick and Disabled Person’s Act.  The above promoted the importance of improved environmental access and the development of more comprehensive services for disabled people. But while the former was fairly wide-ranging in scope, it failed to locate the exclusion of disabled people from the mainstream of community life within the context of discrimination. The law prohibited discrimination against disabled people in governments funded programmes (Oliver and Barnes, 1998).

1. Analyse the improvements legislation has made for the individual with a disability. Look at your own environment (work place), is it accessible for individuals, families and staff? What does legislation and regulations say about ramps and doorways? Review your policy does it reflect this?

If the chronically sick and the disabled persons Act 1970 is the keystone of disability welfare law in the UK, then the foundation stone is the National Assistance Act, 1948. The 1948 Act establishes the basic qualifications of a person as disabled for the purpose of social need and places a duty of care on the local authority/government entities to make provision for residential care. In contrast, the 1970 Act requires Local authorities to address and provide for the needs and care of disabled persons in the community. This is the statutory framework which establishes the right of a disabled citizen to an assessment of their needs and subsequently to lead to the provision of practical assistance, such as help in the home, access to recreational facilities. Domestic adaptations and equipment, and other essentials. However this does little to address the twin objectives of the modern disability movement: independent living and civil rights.

In April 1997, an advance was made by way of giving disabled people the right to choose and pay for their own support. This came in the form of Community Care Direct Payment Act 1996 also the Community care Direct Payments Regulations 1997. This statute enables local to a degree, therefore, this new enactment represents a small move towards the ideals of independent living in which disabled people seek to gain greater control over their lives. This was subsequently enshrined into under the Equality Act 2010. which defines disability as “if one has a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities”. Equality Act 2010

1. Discuss at length the impact a physical disability can have on individual life choices. Use examples where possible. How do you ensure service users are supported to make choices and decisions?

The impact of physical disabilities on an individual’s life choices could be daunting. It could impact on their normal day-to-day activities:

• taking longer with everyday tasks like getting dressed, going to the toilet or preparing meals because of pain, if you didn’t take your painkillers
• finding it difficult to go out on your own because of a phobia, physical restriction or learning disability
• being unable to concentrate on watching TV or reading a newspaper because of mental health issues
• finding it difficult to talk to people and avoiding socialising because you have Asperger’s Syndrome and can’t always understand what people mean
• having seizures which cause you to lose awareness of your surroundings

Example of the above include the following, CD id bed ridden because he is at the last stages of prostate cancer and he has epilepsy which causes him to have seizures. It has a substantial and adverse effect on his ability to carry out normal day-to-day activities, for example he can’t go out on his own because he’s likely to fall down. CD requires a carer with him at all times due to the aforementioned risks that CD faces in his daily live.

1. Explain how attitudes can have a positive or negative effect on the perception of disability

Pervasive social and cultural norms, standards, and expectations often lead to the creation of negative attitudes toward the disabled population. Among the frequently mentioned contributing factors are:

• Emphasis on concepts such as "body beautiful," "body whole," youth, health, athletic prowess, personal appearance, and wholeness. These highly stressed societal standards are often institutionalized into cultural customs, which are to be conformed to by members of society.
•  Emphasis on personal productiveness and achievement. Individuals in most Western countries are judged on the basis of their ability to be socially and economically competitive.
• Prevailing socioeconomic level. The importance of socioeconomic factors in creating an atmosphere within which attitudes toward individuals with disabilities are often nourished was emphasized by Salios-Rothschild. 69  The level of societal development Gordan and Friesen44), the rate of unemployment, beliefs concerning the origins of poverty, and the importance attached to the nation's welfare economy and security are all contributing factors affecting attitudes toward people with disabilities.
• (4) Society’s delineation of the "sick role" phenomenon. Whereas the occupant of the "sick role" is exempt from normal societal obligations and responsibilities, the length of a disabled person's remaining in this role is associated with negative attitudes.
• The status degradation attached to disability. The social deviance and inferred stigma of having, a physical disability bears heavily on society's attitudes

The way other people act towards disabled people can have a huge impact on how they may view themselves and their role in society. An occasional moment of rudeness or being ignored may be a minor inconvenience or annoyance. But the more it happens, the more the impact adds up.

For many disabled people, this will sound all too familiar. Whether it is outright hostility, or seemingly minor incidents that add up to a hostile atmosphere, prejudice remains a common occurrence. Negative attitudes from others can be one of the biggest barriers to disabled people living life the way they want, and more needs to be done to tackle them.

Part 3

1. Explain the importance of independence and exclusion

When a disabled person  feels they can accomplish tasks for example getting in and out of bed makes them feel more independence . Example is when one of our client who is unable to use his right hand felt very satisfied,  self- worth and empowered when I encouraged him to use his left to brush his teeth and wash his face. Something that he had never done before. He did that with difficulties at the beginning but was able to overcome the difficulties.

1. Analyse ways to promote independence and inclusion, use examples from practice.

Going out to work and make friends also make disabled people feel inclusive and part of society. Giving them chance to make choices and supporting them with decision making makes them feel independent and inclusive in the society. Taking my MG (Service user) to the job centre to look for work made him fell independent. I allowed him to speak to the advisor and supported with the interview.

1. Explain the importance of individuals having control and choices. How do you ensure this happens

Choosing what to wear in the morning can make the whole difference in the giving the disabled person self-esteem. It makes the disabled person feel he or she is part of the society. Health-wise it promotes good mental well being. Because he is given a choice it makes him fell he is in control. It also helps the support worker to tailor the service user’s care needs which in turn promotes person centred care.

Examples of how this can be promoted is by asking a client what he wants to do for the day and support him to go through. Also when it comes to providing meals you can ask what he wants to eat. Give him few choices to choose from if need be.  

1. Describe positive risk taking

Positive risk taking is where one analyses a situation and makes a decision to take action where the outcome is perceived to be way more positive as compared to not taking that action. It is therefore  important to research and analyse and put assessment tools in place to ensure that positive risk taking generates successful results.

1. Analyse the importance of positive risk taking for individuals with a physical disability

Positive risk taking is importance for the disabled person because it encourages them to do things or take actions and achieve goal they would not have been able to achieve. And it is about growing the self-esteem of the individual after the accomplishment. After accomplishing that goal it more of who this individual has grown to become as opposed to what task was performed.

1. Explain how to encourage individuals to take positive risks while remaining safe. Give examples from your practice

Risk assessment should be done whenever any task is going to be completed by the service user. This is to guarantee the level of safety for that activity. Where possible the service user can be involved in coming up with the safety rules before the activity is performed in this way apart from the confidence he will gain he will feel he had a choice and feel a sense of independence and inclusiveness.

1. Explain how you challenge stereotype and discriminatory attitudes?

One should be courageous and deal with it face to face with the individual when it happens so that it does not happen again. If one is unable to do that it can be reported to the manager or the relevant authority as soon as possible. If is in a work environment company policy procedure should be followed so that action can be taken.

Bibliography

• Patient-centred communication in primary care, Stewart (2000)
• Ben-Tovim D, Walker K: Body image, disfigurement and disability. J Psychosom Res 39:283-291, 1995.
• Cohen, J. (1988). The t test for means. In J. Cohen (Ed.), Statistical power analysis for the behavioral sciences (2nd ed., pp. 19–74). Hillsdale, NJ, USA: Lawrence Erlbaum
• Garden FH: Incidence of sexual dysfunction in neurologic disability. Sex Disabil 9: 39-47, 1991.
• www.southernhealth.nhs.uk
• Lawrence B: Self-concept formation and physical handicap: some educational implication for integration. Disabil Handicap Soc 6:139-146, 1991.
• World Health Organization, International classification of functioning, disability and health. Geneva:2001, WHO. p. 214.
• Source: World Health Organization; available at
• www.who.int/mediacentre/news/notes/2012/child_disabilities_violence_20120712/en/
• www.disability.wa.gov.au/understanding-disability1/understanding-disability/what-is-disability
• Mayer O.  Eisenberg J (1988).
• Medical Dictionary for the Health Professions and Nursing -  Farlex 2012
• World Health Organization, International classification of functioning, disability and health. Geneva:2001, WHO. p. 214.