Challenges Faced By Health and Social Care Professionals - Term Paper Example

Challenges Faced By Health and Social Care Professionals When They Attempt To Adopt A More Enabling Approach' To Rehabilitation Student’s Name: Instructor’s Name: Course Code and Name: University: Date of Submission: Challenges Faced By Health and Social Care Professionals When They Attempt To Adopt A More Enabling Approach' To Rehabilitation Introduction The World Health Organization (2006) states that many neurological disorders and conditions affect an individual's functioning and restrict his/her participation in social activities. As a consequence of the above, current thinking advocates the adoption of a 'more enabling approach' to rehabilitation to address this perceived restricted participation. Behavior is the product of cognitive processes and also the key to improving the processes. The behavior that a patient who is undergoing cognitive rehabilitation exhibits impacts their own mental status for the better. Enabling approaches refer to those that incorporate participation in social activities with the aim of improving overall functioning of the patient through their continued engagement. Once this behavior is reinforced within the individual’s cognitive processes through neurological rehabilitation that integrates an enabling approach, it becomes easier for them to function socially within the society once more. Behavior science is a one of the most fragmented fields with more than a hundred theories explaining the different behaviors that people have in different situations (Robinson 2011, p. 4-14). The role of theories in a change program such as neurological rehabilitation is of great importance for people to understand to that they know when, where, in what situation and which theory to apply. Health science is popular for basing behavioral programs on theoretical perspectives and approaches (Bach-y-Rita 1989, p. 162). Since each theory describes some fragment of what human beings experience, it is important to choose the right and most effective theory for the situation. An enabling approach describes a situation where rehabilitation is approached from within the patient in that the change that is required should start from within the patient (Robinson 2011, p. 4-14). The power of perception is acknowledged by this approach and the stronger a patient feels about a certain treatment approach; the higher the chances are that it will succeed. Physiotherapy has been around for years and in looking for easy to make it more applicable and effective in cases where the patient is affected neurologically; an enabling approach offers the best chance of success. Neurological problems often leave the patient feeling hopeless as they cannot be part of the things that had molded their personalities. For this reason, an enabling approach is one that will empower the individual in more ways than just the physical. Physical empowerment coupled with psychological empowerment is what an enabling approach gives a patient. Critical examination of complexities of adoption Most of the available research has been focusing on using technological and scientific developments to pinpoint the areas of the brain that are in need of reorganization in the case of neuro-rehabilitation. This focuses on treatments that concentrate on methods that will make the patient’s physical state better. An enabling approach encompasses these approaches with a motivational and self assuring approach that results in the patient taking the required steps on their own so that they have the best chance of getting better (Anderson & Lough 1986, p. 74-82). The approaches that are described are made to appeal to the patient. One of the theories of enabling approaches in rehabilitation that has been put across by Robinson (2011) is an integrated theory that triggers behavior change (p. 4-14). This theory came to be referred to as 5 doors and it was conceptualized by integrating relevant parts of other theories. The theories that are within it include diffusion of innovations, self efficacy, social learning theory, social influence theory, self-discrepancy theory, self-determination theory and risk perception theories. The integration of these diverse concepts was not a simple task as they had to be coherent in terms of their ideologies. However, the ideas were amalgamated in a effective way that allows for their application to behavior change programs. The end result was an integrated theory that is a lens to how things can be changed by healthcare officials especially in the field of neuro-rehabilitation. According to the theory, there are five conditions that need to be present for the theory to have an effective and lasting effect when it is applied and for its principle to be fulfilled. The principle that needs to be adhered to is that in order for a behavior to be achieved in a sustained adoption, the five conditions that have been specified by the theory have to be present in the lives of those who will act to implement the change (Motano & Spitzer 2009, p. 37-61). The 5 doors theory bases its conceptualizations on the technological, physical and social environments of human beings. The theory is not just about changing people’s attitudes, knowledge and beliefs but also about enabling the relationships that these people have with others and modifying their existing social and technological contexts (Robinson 2011, p. 4-14). The five conditions that have to be present are desirability where the health or social care professional has to ensure that the behavior that is meant to be adopted answers the requirements of the patient especially their frustrations like having more autonomy in their functioning, being on time or learning to do things on time, for respect, for security, for better health and for predictability (Robinson 2011, p. 4-14). Desirability speaks to the patients need to answer a want that they have. In order for the patient to adopt or take a different approach in getting better, they have to want the results that the adoption will lead to and they also have to want to adopt the new behavior. In many of the discourses that have been held about changing behavior, the input of people themselves and what they need or want is rarely taken in to consideration. Most of the time, an assumption is made that the message will be enough to convince the person to make the change that is needed (Siggeirsdóttir et al 2004, p. 3-4). This is often true but only in the short term sand since an enabling approach needs to be done over a longer period of time, it is important to ensure that the approaches used in convincing the patient and interested parties to adopt the behavior are strong enough to maintain the behavior in the long term. This meant that event he families and other influential people in the patient’s life need to be convinced as they play a major part in the patient’s attitude (Goldstein, Cohn & Coster 2004, p. 114-120). The essence of desirability is that in order for a person to adopt a new behavior in their lives, they should be convinced that the behavior is will lead to an outcome and the behavior must work towards achieving the result. The other condition is that there should be an enabling context for the enabling approach to be applied. In this case, the technological, institutional, social and physical context should be modified in such a way that they will enable action to be taken. The environment around the patient should be changed appropriately to enable for adoption of the behavior. It is a fact that the environment that a person is in exerts a very major influence on the behavior that the person has (Bowles, Rissel & Bauman 2006, pp. 39). He environment changes a person’s behavior in three ways, one of them is that is shifts the balance of the behaviors that are thought to be more convenient or easier to undertake than others. When a certain behavior is made to look or is actually more difficult than another the other will be given more preference. Behaviors that are complex, unsafe, time consuming and uncertain will be dropped for those that are simpler, certain, quick and easier. The second way is that the environment creates expectations in the mind of the patient through familiarity. The third way is that the environment enhanced herding behavior that in turn leads to the creation of social norms. A third condition is that the behavior should be something that the patient can do or feels that he can do. If the perceived risks of the action are lowered, then the self efficacy of the patient will be built leading to them believing that they can achieve their goal. Changing anything in anyone’s life is a scary experience since it means that the things that a person has grown to be comfortable with may have to be altered for one reason or another. If a person is confident enough that they can handle something, chances are that he or she will achieve their goal (Carr & Shepherd 2000, pp.1-31). They have to be sure or at least have the confidence that they can handle the physical, financial and social requirements and risks of the behavior change. In most cases, these types of activities that accompany physical therapy require commitment as pertains to physical, social and financial needs. Their family needs to be available to help them through and they also have to be willing to go through the physical activities that will eventually result in their recovery (Seabum 2005, p. 396­–399). The most important thing is for the patient to believe that they can meet these requirements and this is what is referred to as self efficacy. Health and social care providers have to come up with ways to reinforce the belief that the patient can attain their goal without loss, embarrassment, injury or humiliation. This part of rehabilitation is often ignored yet it is one of the most important things that need to exist if a patient is to go through rehabilitation effectively. The fourth condition is that should be present is that there should be a buzz in that positive interest in social networks around the patient. As a result, there will be a positive environment that will lead to positive enablement within the patient’s. There is no change in behavior that can happen without conversation and this is the goal of the fourth condition. In addition, conversation is the reference that people often use to determine whether something is true or not. If their peers or most of their peers believe it, then it is most probably true. Therefore, when people are informed that adopting a new behavior will be instrumental in their getting better, they will consult others to learn how many of them believe the assertion to be true. If most of their friends and family believe it, the chances are higher that the patient will adopt a similar belief too (Anderson & Lough 1986, p. 74-82). The people who are most instrumental in creating the positive buzz are the patient’s family. This step is still vital as it lowers the fear of the patient and renews their resolve to participate in the behavior change program (Adams & Drake 2006, p. 87–105). There are three rules that should be remembered when generating a positive buzz. One is that the absence of buzz means that there will be no change. Another is that not all buzz that is around is the same and the focus should be on positive change. The third rule is that buzz and changes happen within networks (Carr & Shepherd 2000, pp.1-31). The fifth condition is that there should be an invitation in that the emotional frame of mind of the patient should be a compelling invitation from an inviter who is credible to the patient. This could be the social or health care worker along with applicable family members. Even if people want something to change in their lives, they still need to be invited to participate in the change. The person who issues the invitation is the most vital part of this condition. Psychosocial factors affecting neuro patients and their families The creation of an enabling environment is a long and time consuming process that may challenge the parties involved (Clark 2007, p. 163–170). The patient or the patient’s family may grow weary and choose to abandon the efforts that they are putting on creating the environments and getting the patient well. Activities that take a long time to learn like the modification of a patient’s contextual system may lead to resistance and this is one of the challenges that health and social care providers have to deal with when trying to come up with an effective enabling approach. Most of the time, when an individual has to change their behavior to embrace an enabling approach in their rehabilitation; their families also have to do the same. If the patient is to change, their family needs to change their behavior in ways that are consistent with the enabling approach. Though this is the right step for the family to take, it is sometimes hard for some of them who do not want to be burdened by the extra work of having to adopt new behaviors themselves and modifying the ones they have like having positive conversations. When families do this, their share of the work falls on the physiotherapist and the change may take longer to have an effect since its positive effects may be getting undone. The tactics in a change program are a challenging task to implement and the support of the patient and their family is needed. These activities take time to implement and supervise they may cause time constraints to the therapist and not all families have faith in the capability of the therapists to hand over the patient. In addition, if these activities are done at home, transport constraints may surface to the therapist and if done in the hospital, they may be so for the patients leading to incidences of missing appointment which has a regressive effect on physiotherapy and more on neuro-rehabilitation (Anderson & Lough 1986, p. 74-82). Strategies to be implemented In order for a person to change their behavior based in the environment changing, the environment has to be nudged in that its particulars are altered to have an unconscious psychological issues that will lead to biases that will make the good choices automatically preferable to the bad ones (Bates et al 2006). Nudging has been used in many other fields apart from the healthcare fields like safety. There is a very wide range of contextual interventions that can accelerate behavior changes and ultimately, it comes down to the type of intervention that will be best for particular individuals. While doing so, it is important to keep in mind that the environment is also social as well meaning that the interventions can be made in the social context as well. One of the most powerful social interventions and also a good strategy that can be applied by health and social care professional in neuro-rehabilitation is resolute leadership that will motivate and sustain the patient’s self belief and make I seem like success is possible against all odds that the patient may be facing (Bowles, Rissel & Bauman 2006, pp. 39). Another method that can be used to change the patient’s social environment is to create connections between that person and others because being isolated makes the situation worse. Support groups, leadership programs, mentorship programs, action groups and exercise groups are a good option for their practice and this strategy will help in strengthening their resolve to become better. another strategy that is in line with modern trends are to get them involved with social networks and online communities that will get them interested in getting better (Bowles, Rissel & Bauman 2006, pp. 39). In the planning of a behavior change program, the patient’s entire contextual system needs to be analyzed and modifications made where need be. Technically, anything that will exert a negative or positive influence on certain behavior should be analyzed. Self efficacy can be modeled within individuals through using tactics that help to build it in people. This can be done by giving the patient a freedom of choice of the activities that they wish to participate in thus increasing their autonomy (Adams & Drake 2006, p. 87–105). In addition, the activities that they participate in should be those that increase their familiarity. For instance, the strategies used should include hands on activities of learning that at the same time help in neuro-rehabilitation. In addition, the patient should have clear goals set for them and feedback on their progress communicated. Also, the presence of social proof is important in that their program could be designed as part of a group and in seeing others fulfill their goals successfully, they will be motivated to achieve the same goal. The activities should also be enjoyable and be characteristic of generous social environments. Networks that create a positive buzz should also be used to find out the doubts that people may have about the rehabilitation approach that is being used which in this case is an enabling approach then they should be addressed. True stories about how other people’s lives have been changed using by using an enabling approach is a good strategy (Carr & Shepherd 2000, pp.1-31). Modeling the impact of change within one’s life is a good strategy (Goldstein, Cohn & Coster 2004, p. 114-120). The more things that the inviter has in common with the patient, the better and more effective the invitation will be. Health and social care providers should seek out the best and most appropriate inviter from the information they have about the patient. They should tell the patient exactly what to expect so that they are mentally prepared for what is to come next and build their self-efficacy. In addition, they should communicate to them what they are willing to do for them and call them to action. Conclusion Once the five conditions are present, the patient will be motivated to try out the behavior. Hopefully, the trial goes well and yields successful results which then lead to adoption of the behavior. However, it should be noted that the behavior will only be adopted if the behavior has resulted in a satisfactory result (Mead & Bower 2000, p. 1087–1110). The end result that every health and social care professional hoped is for an enabling approach to be adopted by the patient in neuro-rehabilitation and for the adoption to be sustained. One of the downsides of applying an enabling approach in neuro-rehabilitation is that it needs a lot of commitment from the patient, the patient’s family and the physiotherapist and since the conditions that allow for an effective rehabilitation program to be established within the individual take a lot of time and commitment, it is sometimes a challenge for families and health and social care professionals to commit fully (Goldstein, Cohn & Coster 2004, p. 114-120). The result of slacking is more detrimental to the process and more likely leads to more time constraints as undoing the damage that has been done takes longer. Neuro-rehabilitation presents a challenge to everyone involved but an enabling approach is still among the best things to do. The diagram below summarizes the conditions that are required by the 5 doors theory for it to be successful and effective. Source: Robinson, L 2011, Enabling Change: 5 doors: An integrated theory of behavior change, Creative Commons Attribution, pp. 4-14, References Adams, JR & Drake, RE 2006, Shared decision making and evidence based practice. Community Mental Health Journal, vol. 42, pp. 87–105. Anderson, M & Lough S 1986, A psychological framework for neurorehabilitation. Physiotherapy Practice, vol. 2, pp. 74-82 Bach-y-Rita, P 1989, Theory-Based Rehabilitation, Archive of Physiotherapy Medication and Rehabilitation, vol. 70, no. 2, pp. 162. Bates, P. Gee, H, Klingel, U, et al 2006, Moving to inclusion. Mental Health Today, Bowles, HR, Rissel, C & Bauman, A 2006, Mass community cycling events: Who participates and is their behavior influenced by participation, International Journal of Behavioural Nutrition and Physical Activity, vol. 3, pp. 39 Carr, JH & Shepherd, RB 2000, Movement science foundations for physical therapy in Rehabilitation. 2nd ed, Gaithersburg, Aspen, pp.1-31. Clark, JG, 2007, Patient-Centered Practice: Aligning Professional Ethics with Patient Goals, Seminars in Hearing, vol. 28, pp. 163–170 Goldstein, DN, Cohn, E & Coster, W 2004, Enhancing participation for children with disabilities: application of the ICF enablement framework to pediatric physical therapist practice, pediatric physical therapy, vol. 16, no. 2, pp. 114-120. 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