Case Study On Critical Reflection Of Learning On Placement

The mentioned case study is regarding an elderly female of 70-year-old Bangladeshi who will be referred to as Mrs Z to maintain her privacy and ensure the confidentiality of her personal information. She has a steady carer who comes each day to assist her to wash and dress as she is unable to do these activities after knee replacement which has limited her mobility. She is found to go shopping with the family on a wheelchair as due to the knee replacement she cannot walk long distances. It is reported that she feels pain in the legs and unable to make free movement if she sits for long. Mrs Z lives with her daughter, son-in-law and two grand-children who usually work from 9-5 that results the service user to remain alone at home for most of the time. However, this lonely feeling is not accepted by her and she feels extremely depressed, helpless and isolated at home.

Mrs Z has lost her husband most recently and has been mourning his death since then but avoided to share the grief with her family or reminisce about her husband or share information about their relationship with the family. This is because she feels that the family members are too much busy within their personal life which is going to make them ignore her feelings. Thus, she avoided reciprocating her feelings towards them about how she feels about her husband. However, her daughter asked me after Mrs Z's participation in the day care centre to ensure she does not sit for long and walks around the centre often as continuous sitting make her feel pain in the legs. This indicates that her family are quite concerned with her health situation as her daughter properly identified the key activities to be done for Mrs Z to ensure her better health.

Mrs Z was referred to the day care centre so that concerns raised can be investigated and accordingly care plan can be developed. As a part of 70-day placement for my social training and being in the team for “Better Together” project, I was allocated to take care of Mrs Z so that she can share her feelings, cope with her morning for husband’s death and resolve issues with mobility and depression. The care aims to maintain continuity and consistency of support for Mrs Z by ensuring her human rights and dignity is properly abided while focussing on her well-being.

The key role as a social worker in this condition is that I develop a trusting relationship with Mrs Z to help her share feelings regarding husband’s death so that she can feel relieved of her mourning situation, arrange activities to improve her mobility and build support that resolves her depression as well as feeling of isolation. It is found that Mrs Z attends the day care centre for 2 days and an extra day for each week under the "Better Together" program. The involvement to care for Mrs Z assisted me to develop an insight into the life of the service user which in turn helped me establish a close relationship with her where she can freely share her emotions regarding her husband and family as well as her other needs. The HCPC guidance and PCF standards provided me with a base on which I can intervene and utilise theories of social work to direct the changes and uphold the well-being of the service user.

I initiated the care services by introducing myself as my role to Mrs Z where I mentioned her she is required to attend the day care centre for three days a week. In the first few sessions, I assessed her mental and physical health as well as executed risk assessment to identify the risk to be faced as well as needs and her capacity to control health in regard to the present condition. This indicates that I have been able to undertake need, risk and capacity assessment of service users to respond appropriately (SOP1.3). The SOP 4.1 informs social worker is required to assess the severity and nature of the problem and the situation to use knowledge and experience to deal with the condition (HCPC, 2018). In case of Mrs Z, I assessed that her issue with mobility is severe which is evident as her daughter also reported sitting for longer time leads her mother to experience pain in the knees and she is incapable to make free movement as she uses wheelchair to move long distance. This assessment led me to deal with the condition by arranging at least two mobility activities to be done by Mrs Z on each day while she visits the day care centre.

During interaction with Mrs Z, I found that she is still mourning the death of her husband and unable to get over the situation due to lack of attention, support and love from the family members. She also lacked self-esteem and feel strongly depressed as well as isolated from her current family because they have no time to interact with her to help her share and cope with the emotions regarding her husband's death. This has led her to avoid sharing her condition with the family. I executed a needs assessment for the purpose by using Maslow's hierarchy of needs model. As mentioned by Henwood et al. (2015), Maslow’s hierarchy of needs mentions that physiological and safety needs are basic, belongingness and self-esteem are psychological needs and self-actualisation needs are self-fulfilment needs to be met for an individual to make them live a happy and satisfied life. The physiological needs are the food, water, warmth and rest whereas safety needs are security of the individual (Shih et al. 2019). Mrs Z’s family already fulfils her physiological needs by providing her place to live, food when hungry, wash and dress properly and others. The safety needs of Mrs Z are also fulfilled by the family members as they do not cause any harm or abuse to her as well as has ensured she remains secured by informing to concerned carers about the way she is to be properly supported at home and day care centre.

The belongingness needs are referred to intimate relationship and friendship whereas self-esteem needs are prestige and accomplishment feeling (Rasskazova et al. 2016). In the case of Mrs Z, her belongings needs are not fulfilled because her family members do not offer her enough love when required. This is evident as her daughter and other family members often leave her alone at home even after the death of Mrs Z's husband and hardly talks with her to help her share previous experiences during childhood, adulthood and marriage with husband her cope with the mourning of husband’s death and led a normal life. It has led Mrs Z to feel low self-esteem as she experience lack of value and support from family and feeling of not belonging with them, in turn, making her feel isolated and extremely depressed about her. The self-actualisation needs are helping one achieve their full potential and include in creative activities (Fergeus et al. 2019). This need is fulfilled by me which is evident because to improve Mrs Z’s mobility I have tried to arrange swimming lessons for her which she desires and is interested in doing.

After executing needs assessment, I used Bowlby's Attachment theory to understand her relationship with family members. The Bowlby’s Attachment theory informs that children come into the world being pre-programmed to develop an attachment with their caregivers as this is going to help them survive (Van Rosmalen et al. 2016). The idea was explored by Hazan and Shaver who informed that the relationship between infants and caregivers share various similar features with adult relationship formed with their partners. They mentioned that if the adult relationship with the partners is attachment relationship then they way the relationship works is similar to the way infant-caregiver relationship executes (Fraley, 2019). This theoretical principle highlighted me that Mrs Z feels isolated and depressed as well as is unable to cope with the mourning of her husband's death because of inconsistent and unpredictable care pattern from her daughter who is presently her only support.

The discussion informs that the lack of sufficient warmth and love from the daughter and lack of time to take care and interact with Mrs Z to listen to her needs is creating hindrance for the service user to distance herself from the family and find barrier to stop morning her husband’s death. Therefore, as a service provider, I developed ways to boost the self-esteem of Mrs Z by providing her with basic necessities as per her culture and social needs. This is evident as I arrange small talk session with her to help her share childhood, adulthood and marriage memories with her husband as well as arranged session for retro-Bollywood movies and music as she is from Asian background where this nature of movies are preferred to be watched by adults. This act helped me to abide by HCPC standard 5 which indicates the social workers to respect the cultural diversity of the individuals (HCPC, 2018). It is evident as I arranged retro-Bollywood movies for her which is accepted in their culture to be watched.

I used the Four Stages of Grief theory to understand at what stage of grief Mrs Z is presently at so that I can use skills and knowledge to improve her life to cope with bereavement. The Bowlby and Parkes through Four Stages of Grief theory inform that shock and numbness is the first phase in which the person sense the loss is unreal and is unable to accept the reality. The second stage is yearning and searching where the individuals are actually able to be aware of the void made in their life due to death of the other person leading them to understand the future they previously thought is unable to be achieved. It makes individual who has lost a dear one search for comfort for filling the void that has been created (Jacobs, 2016). The third stage is despair and disorganisation where one has accepted that the person died is not going to come back making them hopeless and despair. The fourth stage is re-organisation and recovery where the person who lost their dear one has accepted the condition and has started to reorganise their life to live normally (Nakajima, 2018).

The Bowlby and Parkes theory-informed that Mrs Z is presently at the second stage of grief as she is already aware of the death of her husband but could not accept the void created through his loss. She is found to have wish of sharing and reminiscing with her husband to have constant reminders of him. In order to help her get through the stage, I arranged movie session for her and arranged continuous talking session so that she can be helped to fulfil the void created by sharing her emotions to progress to recover from the mourning state. This act helped me to abide by SOP 13.4 and 14.4 where it is informed that social workers are to use theoretical and evidence-based practice to draw upon proper skills and knowledge to identify the actions to be achieved for improving life opportunities of the service users (HCPC, 2018).

The Erikson’s Stage of Psychological Development theory was used by me to understand the psychodynamic growth and dimension of Mrs Z according to her age for planning effective care for her. Erikson's theory informs that people above the age of 65 and until death have a psychological condition where they fight between ego integrity versus despair (Robinson et al. 2017). This means that in case an individual is aware that they are living an unproductive life they become dissatisfied and develop despair, depression and hopelessness. The theoretical principle was used to analyse Mrs Z psychological stage where I identified that loss of her husband, inability to move freely and execute daily activities without support due to her knee replacement and lack of time of her family members to interact with her to fill the void created made her feel dissatisfied with life. It led her to feel depressed and despair to live. This theory made me aware that Mrs Z is to be made productive life so that her depression and despair can be resolved. Thus, I tried to arrange swimming lesson for her to increase her mobility and arranged at least two activities to be performed to increase her mobility as well as closely interacted with her and arranged retro-Bollywood movies to be watched as per her preference to keep her engaged and productive in life and to resolve her grief, despair and depression.

The information is drawn from the attachment theory, Erikson’s theory and Bowlby and Parkes Grief theory because combination of the three theories provided me platform to explain the relationship between Mrs Z and her family members. I recognised that Mrs Z is to be provided support to improve her self-esteem and get her to overcome grief as well as the mourning of her dead husband by listening to her needs and helping her involve in activities to remain engaged. I held various talking session for Mrs Z and arranged retro-Bollywood movies to be watched at the centre. In order to improve her mobility, I arranged at least two activities to be performed in the day care centre and arranged swimming session for her. After evaluating the effectiveness of the intervention implemented by me, other professionals in the centre reviewed that Mrs Z has improved greatly as she mourns less about her husband’s death and easily communicates with others as well as engage in activities to improve her mobility.

During working with Mrs Z, the things which went well was that I was able to offer independent advocacy to the service user in taking their decision regarding care, in turn, assisting me to deliver satisfactory as per the needs and demands of the person. It helped me to abide by domain 1 of PCF where autonomy to the patients to take care decision is to be provided (BASW, 2017). I was able to maintain the privacy of Mrs Z by not revealing any personal information of her during the assessment. This helped me to abide by value and ethics domain of PCF which informs that privacy of service users within and outside the society and family is to be maintained (BASW, 2017). The other thing which went is that I was able to effectively communicate with Mrs Z as well as her family to understand the way care is to be planned which eventually helped me to develop a positive carer-service user relationship with Mrs Z making her to easily share her feeling and needs to be fulfilled to ensure satisfactory care. The challenge experienced while caring for Mrs Z was that I struggled to develop an effective relationship between her and the family members. This is because the distance created between her and the family due to lack of time being spent to care for her cannot be resolved. In future, I am going to improve this condition by informing the family members about the way they can share their limited time with Mrs Z to make her feel included and cared in the family. Further, I would ask them the way they can arrange activities within the house so that Mrs Z does not feel alone or isolated as well as show respect towards her husband which would resolve her loneliness and depression.

The needs assessment executed for Mrs Z by using Maslow's model informed the specific needs that are unfulfilled for Mrs Z. In addition, by drawing information on Attachment theory, Erikson's theory and Bowlby's theory I have improved my ability to understand the support to be tailored for Mrs Z to help her cope with the mourning of her husband, resolve her isolation and depression and improve her mobility.

References

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