The Role of Nurses in Combating Childhood Obesity

Introduction

Obesity is a complex disorder among the individuals involving an excessive body fat which in turn increases the risk of diseases and health problems such as health diseases, diabetes and high blood pressure and it is calculated by BMI rate of the children through dividing the weight of the child in kilogram by height in meter square (NHS, 2019). The aim of the study is to identify the issue of child obesity and assess the factors influencing health and role of the nurses to support the individuals who are suffering from obesity. It has been that, in the UK, the numbers of child obesity is increasing at a rapid rate due to life style of the children, eating habits and lack of activities in the daily life. According o the data of national Child Measurement Program (NCMP), 9.6% child, aged from 4 to 5 are obese and 13% are overweight. As per the chart below, there is also high numbers of children who are suffering aged between 6 to 16 years, suffering from obesity. One in ten children is obese by age 5 and one in five by age 11. It has been that, 10% boys and 9% girls are obese in England, where the children are aged 4 and 5 years. Additionally, obesity is increasing among the children and there are 22% boys and 18% girls who are suffering from obesity where the age of this group of boys and girls are between 10 to 16 years (Smith, K.B. and Smith, M.S., 2016; NHS, 2019).

Exploring factors influencing health

The factors affecting the health of the children in England are environment and socio economic condition which have crucial impacts on the life style of the individuals. The first factor is environment where it is necessary for the children to get suitable environment for brought up and there are many children in the UK who are deprived of getting proper environment to stay healthy. Home environment and support from the parents are necessary for the child to reshape their activities and lead a normal life. However, in the recent era of globalisation, the parents are busy in their professional career and it is difficult for them to provide suitable environment and take care of their children in the UK (El-Behadli et al., 2015). Hereby, there is lack of primary care and poor parenting which influence such issue of child obesity. Recently, people are engaged with their personal and professional world in the UK and there is lack of primary care and neighbourhoods and community resources for which the children cannot get suitable environment for brought up.

Physical environment of the children is also important for the children where they can get proper support from family members, friends and neighbours but recently there is lack of support from the family members rather the parents empower child care at home for taking care of their children which is also another influential factor for such problem of obesity among the children (Hoffman et al., 2018). The teenagers recently are also engaged with their education and they lack to get involvement in daily activities and social inclusion for which they are also deprived of getting proper environment during their childhoods. Lack of school and institutional policies further influence child obesity where the children lacks to participate in exercising and daily activities, sports and others for which they become sufferer of the problem of child obesity due to high weight and lack of activities in daily life. Hereby, environment plays a crucial role in enhancing the activities and exercise in daily life of the children and mitigate the problem of obesity through providing suitable environment. Moreover, unhealthy eating habit also contributes in child obesity where the children are attracted to fast food and carbonated drinks stores beside their school (NHS, 2018).

Social economic factors are also important to provide proper guidelines to the children and give them effective care. Education of the parents as well as developing proper program for the children to raise awareness about child obesity is necessary, but recently there is lack of school program and parenting education regarding child care for which there is increasing numbers of children who are suffering from child obesity. Additionally, income, housing and areas of residence also matter in developing the children and providing hem better care. Lack of proper financial position and poor child care the reason that influences child obesity. Additional, in the recent era of globalisation, life style of the parents and children is playing crucial role in influencing the health issue of child obesity where there is busy schedule of life and high intake of junk foods even among the teenagers and children in the UK, which further has adverse impacts on the health condition of the children. Hereby, the lifestyle of lack of diet, poor concern about healthy eating as well as high intake of junk foods and lack of physical activities further leads the children towards the problem of child obesity.

The food preferences of the parents and children are also changing and there is lack of concern about healthy life style which further influences the teenagers and children to consume more junk foods and carbonated drinks that raise the numbers of children suffering from obesity in the UK (Tucker, and Lanningham-Foster, 2015). Hereby, both the environmental and social economic factors are important that influence health among the children. It has direct impacts on the wider society where there is high chance of heart diseases, body pain, inactivity among the children and high blood pressure and diabetes among the children in the UK. There are huge numbers of children who are suffering from child obesity and it is difficult for them to take active part in school program and social activities and sports and these further raises the chance of inactivity among the children.

Health promotional strategy

One of the major health promotional strategies in the UK is ‘Strengthen community action’ through which the health acre providers try to raise concern among the social communities across the UK and provide proper information and care for strengthening the community action. Through this strategy, the health care professionals can create social captaining as well as promote the policies of being healthy through regular exercise and healthy eating habits (Hubbs-Tait et al., 016). Arranging social campaigning is effective to retain the community members and raise their awareness about child obesity so that they can take active actions to provide suitable environment to their children. Educational program for parenting is necessary for improving community action where the parents can learn how to care their children and provide proper food and nutrition for the development of their health (Lobstein et al., 2015). Additionally, behavioural changes are necessary where there is high trend of eating junk food, which needs to be change through this strategy of community action and in this regard, the health care providers share their information through social media post as in the recent era of digitalisation, people like to be updated with latest news and information through social media.

It is also one of the effective ways to raise awareness and develop community action for supporting the parents and providing proper care plan and advice to care their children so that the health issue of child obesity can be resolved (Flint, Hudson and Lavallee, 2016). The government of the UK takes initiative to label the food for the children as well as raise concern in reducing the sugar content in the child’s food. Moreover, implementing the strategy of BMI rate calculation ain the school as well as the government ensures that, there are many outdoor activities in the school where the teachers motivate the children to tale active part in the activities (World health Organisation, 2019).

Role of nurse in chosen health issue

The nurses are playing crucial role in supporting the children to mitigate their health issue of obesity and in this regard, there are three types of nurses who are efficient to support the children and their family members to resolve the existing health issue in the UK (Freemark, 2018). The role of the learning disability nurses are to enhance communication among the children, increase social inclusion and consider the service user’s vulnerability in the society so that every children can have proper access of the health care and support from the nurses (Temple and Oliver, 2017). The learning disability nurses are well acknowledged in developing person centred approach where they try to empower the children and acknowledge their actual needs and preferences so that they can develop effective care plan for them to mitigate the health issue of obesity. In order to resolve the issue of obesity among the children, it is necessary for the nurses to develop proper diet charts so that the children can develop healthy eating habit and avoid junk foods and carbonated drinks (Flint, Hudson and Lavallee, 2015). This in turn helps them to resolve the issue of obesity. Apart from that, the nurses in learning disability are also responsible for increasing social inclusion among the children and in this regard they are responsible for arranging social programs and improve the involvement of the children in taking active part and mitigating their problems (World health Organisation, 2019).

On the other hand, child nursing is difficult where the nurses are responsible for taking care of the children efficiently with proper treatment, medication and monitoring their health condition and in this regard the nurses are also responsible for understanding child psychology to handle them and cooperate with them for better care (Agha, M. and Agha, R., 2017). In this regard, the child care nurses have the duty for successful development of child’s physical and mental health. The nurses are also playing crucial role in education of the children where they care about the children and develop proper care plan in order to provide supportive environment to them. In this regard, the nurses are trying to provide proper activities, engagement in sport and other exercise in daily life to the children so that the issue of obesity can be mitigated among the children. Apart from that, the adult nurses are also responsible to educate the parents and provide supportive environment so that they also can follow healthy lifestyle and care their children successfully. Hereby, the nurses in this field are trying to develop family centred care to provide proper information and share they guidance so that the parenting of the children can be developed (Williams et al., 2018).

Promoting healthy lifestyle among the family is possible where the adult nurses are playing crucial role in supporting the parents and other family members for taking care of their children and give them suitable environment so that the children can also have healthy living style, healthy eating habit and engagement with exercise and social activities (Smith, K.B. and Smith, M.S., 2016). Hereby, all the nurses are responsible for supporting the children and their family members with proper treatment, guidance and diet so that the health issue of obesity among the children can be mitigated. The child nurses are mainly responsible to support the children so that the children can get proper environment to live a healthy lifestyle ad get involved in the daily activities, sports and exercise that will stay the children active. The nurses are also playing crucial role in develop proper environment and encourage the family members to follow healthy life style, maintain the habit of healthy eating with proper diet chart as well as activities in daily life so that the children can be concerned about their health and avoid eating junk foods and carbonated drinks (World health Organisation, 2019).

Conclusion

It can be concluded that, the health issue of child obesity is increasing in the UK and the healthcare professional and nurses are playing crucial role in creating supportive environment to provide proper care to the family members so that they can care their children and contribute positively in healthy living activities. The health promotional strategy of strengthening the community action in the UK is beneficial in his context to resolve the issue of obesity among the children where the health care professionals raise concern and keep motivating the parents and children for healthy eating habits and raising involvement in daily activities and exercise. The nurses also support the children with proper care and motivate them for taking active part in school program and social activities for maximising their wellbeing.

Reference List

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El-Behadli, A.F., Sharp, C., Hughes, S.O., Obasi, E.M. and Nicklas, T.A., 2015. Maternal depression, stress and feeding styles: towards a framework for theory and research in child obesity. British journal of nutrition, 113(S1), pp.S55-S71.

Flint, S.W., Hudson, J. and Lavallee, D., 2015. UK adults’ implicit and explicit attitudes towards obesity: a cross-sectional study. BMC obesity, 2(1), p.31.

Flint, S.W., Hudson, J. and Lavallee, D., 2016. The portrayal of obesity in UK national newspapers. Stigma and Health, 1(1), p.16.

Freemark, M. S., 2018. Pediatric obesity: Etiology, pathogenesis and treatment. London: Humana Press.

Hoffman, J., Frerichs, L., Story, M., Jones, J., Gaskin, K., Apple, A., Skinner, A. and Armstrong, S., 2018. An integrated clinic-community partnership for child obesity treatment: A randomized pilot trial. Pediatrics, 141(1), p.e20171444.

Hubbs-Tait, L., Kimble, A., Hingle, M., Novotny, R. and Fiese, B., 2016. Systematic review of child obesity prevention and treatment trials addressing parenting. The FASEB Journal, 30(1_supplement), pp.1155-6.

Lobstein, T., Jackson-Leach, R., Moodie, M.L., Hall, K.D., Gortmaker, S.L., Swinburn, B.A., James, W.P.T., Wang, Y. and McPherson, K., 2015. Child and adolescent obesity: part of a bigger picture. The Lancet, 385(9986), pp.2510-2520.

Smith, K.B. and Smith, M.S., 2016. Obesity statistics. Primary care: clinics in office practice, 43(1), pp.121-135.

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Tucker, S. and Lanningham-Foster, L.M., 2015. Nurse-led school-based child obesity prevention. The Journal of School Nursing, 31(6), pp.450-466.

Williams, R., Alexander, G., Armstrong, I., Baker, A., Bhala, N., Camps-Walsh, G., Cramp, M.E., De Lusignan, S., Day, N., Dhawan, A. and Dillon, J., 2018. Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK. The Lancet, 391(10125), pp.1097-1107.

Organisational structural analysis

According to Martin et al (2015), the grouping of several diverging care facilities for the purpose of specific treatment service provisioning towards assisting the psychologically ill patients could constitute the core structure of a mental healthcare treatment centre. These medical centres are structured for the purpose of providing treatment involving specified psychological health issues such as addiction and depression.

In this context, these are the general institutions which also could provide particularly specialised treatment facilities for a range of psychological ailments such as suicidal perceptive ideations, Substance Abuse Addition, Post Traumatic Stress Disorder (PTSD), anxiety disorders, behavioural disorders and others. In this context, the selection of the psychiatric facility of Nightingale Hospital has been premised upon the purpose to shed effective analytical gaze on the overview of management and leadership roles and the organisational structure within the health segment of significance. The psychiatric care centre is located at Marylebone, Lisson Grove, London, United Kingdom (nightingalehospital.co.uk, 2019).

Barr and Dowding (2019) have observed in this respect that development of effective healthcare leadership compliments within this healthcare organisation is premised upon the establishment of the direction to the care professionals working within the Nightingale Hospital and to ensure that these employees could be made to retain their commitment towards this particular direction. This necessitates the utilisation of proper vision, ideas and leadership elements to inspire the care professionals to enhance the scope of their services. On the other hand, Rycroft-Malone et al (2015) have specified that the management structure of the healthcare organisations such as the Nightingale Hospital, primarily pertain to the social discipline of controlling the human institutional involvement and the associated behaviour. This process is a dynamic one. However, Gould (2016) has observed that the nature of management within such a healthcare centre is primarily contingent upon the work processes, policies and work cultural values of the institution. This leads to the determination of the structure of this organisation to be a traditionally hierarchical bureaucratic format which overtly emphasises on the clarification of roles, designations and commands and setting of the most explicit measure of accountability regarding the exhibited care performance by the staff of the hospital.

Simonetx (2015) has further divided the managerial responsibilities of the Nightingale Hospital into three segments, namely the Informational, Interpersonal and Decisional responsibilities. The Informational could be further subdivided into monitoring (searching and acquisition of care service information), distribution of information (communication and dissemination of necessary instructions and data to the deserving recipients within the organisational structure) and public relationship management (providing accurate information to the patients and their representatives). Interpersonal could be subdivided into segments such as operational representation (completion of legal and social duties), training responsibilities and contact establishment with the external regulatory authorities such as the CQC, the NHS and the HCPC. The Decisional responsibilities could be subdivided into identification of new scopes of improvement and project management operations, management of conflicts and resolving the operational impediments which could arise during the discourse of operations and finally resource allocation. In this context, Davies and Challis (2018) have stated that the external environment and the organisational responsibility scenario influence the managerial roles related to the organisation.

In this context, the organisational working architecture has been identified to be McGuire (2016) of a traditional hierarchical nature where the apex controlling organisation is the Board of Administration. Under this particular apex organisation, four different divisional segments have been formulated to serve different care and administrative responsibilities. These are the Therapeutic services, the Information Services, the Diagnostic Services and the Support Services. The Therapeutic Services include the OPDs, the Nursing services, the therapeutic operations involving an extensive range of different psychiatric conditions amongst adults such as ADHD, Bipolar Disorder, Addiction of Substance Abuse, Depression, PTSD, Paranoia, Schizophrenia and Obsessive Compulsive Disorder. Further, the Information Services of the Nightingale Hospital involve admission and registration of the patients, billing, records compilation, hospital log maintenance and official data preservation. The Diagnostic Services of the hospital involve operations concerning the laboratories, infirmary and neurology sections. Finally, the Support Services involve transportation and maintenance sections concerning the different segments of the Therapeutic and Diagnostic Service departments.

Roles and responsibilities of external agencies

According to Glover-Thomas (2018), the Nightingale psychiatry and mental health facility is regulated by the designated body of the General Medical Council (GMC). The registration authority of the organisation is the Care Quality Commission (CQC) and the psychiatrists are individually registered by the GMC. Mehta (2019) have specified that the statutory regulatory authority of Health and Care Professions Council (HCPC) is central to the control of the health professionals of the hospital. This is primarily a standards and quality maintaining authority with the purpose of proficiency management. Further, the overarching authority which sets the benchmark of the professional standards management within the Nightingale psychiatry centre is the Professional Standards Authority for Health and Social Care (PSA). Under the auspices of the PSA, the HCPC operates as the designated regulatory body.

According to the research of Shaw and Middleton (2016) the public taxation structure funded health systems previously under operation within the UK has experienced considerable change in the form of increasing regulatory and supervisory roles of the successive national governments under which the state authorities have increasingly resorted to introducing market based management and incentive structures. These structures have been based upon the measurable effectiveness of the explicit performance of care facilities such as the Nightingale Hospital. In this context, Ferlie et al (2016) have commented that the strategic policies of the state and the associated budgetary considerations are presided upon by the Department of Health (DoH) and the NHS takes the responsibility to administer the same at the local and regional levels through the Clinical Commissioning Groups (CCGs) which are mostly statutory institutions.

According to Williams and Dickinson (2016) prior to the year 2013, the majority of the delegated responsibility of 85% of the annual £95.6 billion budgetary provisions of the NHS had been entitled to the Primary Care Trusts, however, the CCGs acquired this responsibility accordingly. In this context, Campbell et al (2008) have outlined that there have been three criteria on the basis of which the changes in the NHS operational structure had been instituted. These had been the stimulation of incentives which could be sustained by even the private healthcare organisations such as the Nightingale Hospital through the enhancement in the organisational performance in terms of clinical services improvement, the centralised assessment of such performance against the standards set by the NHS in spite of according greater autonomy to the private health operators such as the Nightingale psychiatric centre and the institution of a stringent model of standardisation and regulation implementation.

Individual functions

This is particularly significant since the hospital provides a dynamic care service regarding the apparently volatile care scenario involving psychiatric patients and elderly personnel suffering from effects of social seclusion and young personnel affected by addiction of substance abuse. Billings and De Weger (2015) have outlined that leveraging on personal capabilities and inspiring others to meet the care requirements have been central to healthcare process leadership. From a comprehensive standpoint, it could be observed that inspiration would be the commonest element in the differential leadership factors involving divergent operational discourses and the healthcare organisational leadership elements have to be comprehensively goal oriented though the leadership prospects are non-material from a tangibility perspective.

In this context, Almeda et al (2019) have particularised the fact that current healthcare organisations such as the one under consideration are increasingly experiencing the necessity to reinvent the organisational leadership and managerial perspectives. The underlying catalysts have been expanding expectations from the mental health services and the new fields of psychological complications which have emerged. The leaders and managerial personnel are increasingly experiencing particular situations where previous rules of operations could not be applied and development of executive competencies has become paramount in terms of significance so as to maintain accurate decision formulation processes.

Individual rights underpinning health and social care

In this context, the rights of the individuals which underpin the psychiatric practices of the Nightingale Hospital are enshrined in the Human Rights Act (1998) (Article 3, 5 and 8). According to Cowell (2017), the Article 3 specifies the Prohibition of degrading and inhuman treatment of the patients under treatment at the hospital facility. This entails the retention of healthy environment within the hospital wards where presence of detrimental atmosphere such as overcrowding, violence, dearth of proper sanitation facilities, improper arrangement of privacy and lack of proper ventilation could be avoided.

The Article 5(Section 1) outlines the right of the patients to have proper security and liberty in the manner of prohibiting the deprivation of individuals or groups of individuals of their liberty except in cases of lawful detention in the care facility under the established observation that the detained person/personnel are of unsound psychological conditions. Furthermore, the Section 4 of Article 5 establishes that every person who has been detained and deprived of his/her liberty is entitled to initiate the legal proceedings under which the legal justification of the detention within the mental care facility has to be decided upon by the court of law with prompt release ordered if such justification could be legally proven to be null and void.

Evaluation of the significance of such rights

The research of Barber, Brown and Martin (2016) has enumerated the requirement of ensuring the proper and careful enactment of executive competencies through the application of a range of differential support principles within the working architecture of the Nightingale Hospital. This gains further significance from the perspective that the hospital also provides considerable facilities of de-addiction from substance abuse practices. Williams (2017) have categorised the necessary support principles in the form of equal care provisioning prospects, accessibility facilitation from a universal approach and providing multiplicity of psychological and psychiatric care options for patients with critical ailments such as high levels of addition, suicidal tendencies and ADHD. Such principles of support are paramount in their significance in terms of enabling the most sophisticated care service provisioning to the most diverse category of patients in terms of their ethnic, cultural, financial and age based lineages.

McLaughlin, Leigh and Worsley (2015) have emphasised on the significance of the theoretical perspective application within the sector of mental healthcare of UK in the form of the basis on which all of the clinical practices are conceived. The ultimate policy formulation of any healthcare institution such as the Nightingale Hospital depends upon the utilisation of general theoretical models so as to properly comply with the existing legislative structures of control. Apart from these considerations, the theoretical models also assist in the development of proper leadership compliments within the working structure of any such healthcare organisation and provide effective guidance for future management process development as well. To this effect, the care principles observed at the UK are primarily formulated on the Humanistic Theory. According to Graham et al (2016) this highlights the significance of effective communication between patients and care providers through a person centred approach to maintain rights and dignity of the patients.

Task 2

According to nightingalehospital.co.uk (2019), the organisational structure of the Nightingale Hospital pertains to the traditional bureaucratic and hierarchical administrative configuration. This primarily involves a top-down approach for the purpose of innovation, quality and effectiveness maintenance. This is also meant to ensure that the responsibilities delegated by the NHS, through the Clinical Commissioning Groups (CCGs), which, also involve the budgetary responsibilities. The central aspects of such an organisational structure involving the apex Administration Board and the subsequent multiplicity of service divisions (Therapeutic, Information Services, Diagnostic Services and Support Services) are the formalisation of the legal framework, formulation of mechanisms through which integrated care could be imparted and the management of functional processes of psychiatric care. According to Morrison-Valfre (2016) another critical aspect has been the systems networking structure within the organisation under consideration through which formulation of effective interdisciplinary care structures has been achieved.

According to Care Quality Commission (2013), Care Quality Commission (CQC) monitors the mental and adult care services of the hospital under the purview of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014(Amended). According to Care Quality Commission (2012) the applied regulations are the Regulation 8 (General Services), Regulation 9 (Person Centric Care Management), Regulation 10 (Maintaining the fundamental standards of respect and dignity of patients), Regulation 11 (Consent necessity), Regulation 12 (Safety of Care), Regulation 13 (Fundamental standards of safeguarding from abuse), Regulation 14 (Hydration and nutritional necessity management), Regulation 15 (Equipment and premises maintenance), Regulation 16 (Complaints registration), Regulation 17 (Governance needs), Regulation 18 (Staff management) and Regulation 20A (Assessment and reporting of displayed performance).

Apart from these, Barber, Brown and Martin (2016) have determined the Care Quality Commission (Registration) Regulations 2009 is utilised to exert further control through the enlistment of regulations involving Regulation 12 (Statement of Operational Purpose), Regulation 13 (Finances), Regulation 14 (Absence Notification), Regulation 15 (Notification of changes), Regulation 16 (Mortification of psychiatric service subscriber), Regulation 17 (Extended) (Notification of mortification and unauthorised absence of any patient who could have been liable to be detained or had been detained under the regulations of the Mental Health Act, 1983), Regulation 18 (Notification of serious incidents), Regulation 19 (Payments) and Regulation 22A (Commission notification form). According to Delgadillo et al (2016) the underlying purpose of such regulations is to ensure that promotion of the best of the practices and excellence in care progression could be maintained.

According to Veitch (2017), the Mental Health Act (Amended) 2007 has been considerably inspired by the development of the Human Rights Act (1998). The drafting of the laws associated with mental health has been guided by the necessity to maintain a delicate balance in between protection of the public interest and ensuring of rights of individual patients. According to Dawson (2015) the white paper issued by the Department of Health (2000) under the nomenclature of Reforming Mental Health Act (Section 1 & 2), clarified that the necessity to formulate new legal regulations for the purpose of the protection of the rights of individuals in the health centres was paramount and this necessitated the amendment of the Mental Health Act (1983). This had culminated in the introduction of the respective legal safeguards into the Mental Health Act (2007), inspired by Human Rights Act 1998. According to Sampson et al (2016), the changes involve that patients could file for legal remedies such as damage claims through the UK courts when their rights could have been infringed upon. Hotzy et al (2018) have highlighted that the Human Rights Act 1998 (Section 3) does specify that the UK courts are obliged to interpret the provisions of the Mental Health Act (1983) in the manner which could be compatible to the stipulations of the International Human Rights Convention. Furthermore, the public authorities including the private healthcare organisations such as the Nightingale Hospital, individual general practitioners, trusts and public health authorities, psychiatrists and hospital managers, are obliged under the Section 8 of the MHA (1983) to desist from infringing the promulgations of the human rights convention. Such infringements could make the perpetrators liable for legal actions and court proceedings such as remedial injunctions against such unlawful activities. De Luc (2018) has considered these legal safeguards to be of significance in psychiatric practices since the mental illnesses make it obligatory often, for the practitioners and psychiatrists, to take their patients into protective detention.

In case of the Nightingale Hospital, as per the provisions of Section 5(4) of the Mental Health Act (1983), the nursing staff could restrict the personal liberty of movement of the patient until the doctor in charge of the care services or the nominated or delegated care professionals could formulate any decision regarding the detention of the patient under the provisions of Section 5(2). However, the duration of such preventive detention is not more than 6 hours. According to Nyttingnes, Ruud and Rugkåsa (2016), the doctors and other psychiatric healthcare professionals could determine to detain a patient for 72 hours under the provisions of Section 5(2) and prior to the completion of such a detention period, it would be obligatory for the hospital administrative authority to arrive at a decision regarding the whether to continue or discontinue the detention as per the guidelines of the MHA.

The impact of codes of practices and legislative regulations on the mental care services provided by Nightingale Hospital has been varied. One significant development has been the increment in the involvement of patient representatives. This has been a development towards greater patient centric approaches where an informal, operational partnership could be established in between the patients (especially those who require overcoming their addiction of substance abuse or bouts of depression). Thus, the impact of psychiatric care, provided at the individual levels, has been strengthened further. Furthermore, the impact of regulations and legislative policies has manifested itself through the implementation of greater accountability on part of the psychological treatment service providers. The research of Bensonn, Thistlethwaite and Moore (2018) has enumerated that the direction of the care policy formulation and execution of the same have considerably shifted the executive model of health services provisioning from the previously prevalent reactive approach to the proactive and patient centric approach. This has been particularly effective in terms of the avoidance of social exclusion aspect which has been a significant problem for various types of mental patients such as those undergoing de-addiction treatments.

As has been observed by McLean (2016), as per the provisions of the Human Rights Act (1998) Section 6(1), it is always considered to be unlawful for the care professionals of any health facility, including the public authorities of the NHS Trusts and the private psychiatrists, to treat the mental health patients in any manner which could be in contravention to the International Human Rights Convention. However, from a legal perspective, under the Section 6(2a) of the same act, if any previous legislation could have been in place which could have dictated such actions, then, the care professionals be exempted from the charges of contravening the human rights convention.

In this context, Hall et al (2018) have brought forth the case of Herczegfalvy v Austria (1993) to outline one of the external influences on the governmental decisions to formulate the various sections of the Mental Health Act (2007). This aforementioned case had outlined the incident when a convicted person had been transferred to a psychiatric hospital situated at Austria from a prison where the patient had suffered a collapse after a prolonged hunger strike. At the hospital, force feeding was applied on the patient apart from keeping him in a solitary confinement of the hospital. Further, the patient had been handcuffed to his bed and was forcefully administered neuroleptics. Ponce et al (2016) had stated that the International Human Rights Commission had initially considered that the treatment of the patient had been degrading and inhuman given the excessive utilisation of force and thus was in contravention to the stipulations of Article 3 which had contributed considerably to the degradation suffered by the patient.

However, the ruling of the European Court had earlier specified that in case of specific emergencies where the patient could be considered to be in active danger of harming himself/herself or could suffer further degradation of health or even death if the condition of the patient is left untreated, then, the necessary actions to restore the health of the patient could be considered to be therapeutic requirement. In such cases, the treatment meted out to the patient could not be regarding as either degrading or inhuman. Thus, regarding the Herczegfalvy v Austria (1993) case, the European Court had provided the verdict that the medical necessity dictated the apparently violent treatment provided to the patient under consideration and thus, the infringement of Article 3 had not taken place.

Finally, it could be considered that such codes of practices have been critical to determine an acceptable resolution of the fundamental question which remains regarding the justification of any hard handed treatment of patients at risk concerning their mental illness under the pretext of ensuring their health and security. This has been the source of the dilemma of operations for psychiatrists at the Nightingale Hospital. This has been exacerbated by the fact that many of the patients admitted into the hospital to undergo de-addiction from substance abuse propensities have been strenuously defying the administration of essential medical procedures. These aspects have been continuous sources of challenges for the care professionals. Thus, DeRidder et al (2016) have averred that such challenges have been the source of the development of the practice of obtaining second opinions from experienced senior psychiatrists. Thus, interdisciplinary teamwork has become invaluable.

Task 3

According to Beaussier et al (2016) the emphasis is required to be concentrated on the influence of the NHS administrative and corrective activities in relation to the implementation of the regulations stipulated by the DoH which have been enshrined into Mental Health Act (MHA) (2007). Concerning the facilities of care provided by the Nightingale Hospital and regarding the entire mental healthcare industry, the appointment of the reviewers of the MHA has been of prime significance. Such reviewers are selected from an extensive and variegated range of backgrounds and generally including doctors to lawyers. These reviewers are entitled to act in independent capacity from the respective care providing services such as the hospitals.

Davidson et al (2016) have researched that these reviewers could visit the patients interned within the Nightingale Hospital with prior notification and could meet the patients in private to determine their state of affairs and learn about their experiences as well. Apart from such direct interventionist approaches regarding the patients who could have been undergoing treatment for de-addiction from substance abuse practices, the MHA reviewers could as well review the cases of the patients who could have been discharged from the hospital under consideration on community treatment orders by the professionals.

The review service is oriented towards the performance of a host of different responsibilities such as learning about the issues which could exist in terms of proper adherence to the governmental guidelines and in conjunction with the previously mentioned Human Rights Act (1998), raising the concerns demonstrated by the patients and learnt from the visitations of the hospital wards to the ward managers, assist the patients concerned to voice their complaints through the proper administrative channels and file appropriate reports about the ward conditions to the proper authorities. However, the reviewers are not legally entitled to discharge any of the patients, arrange for the transfer or leave of the patients and provide any legal advice on behalf of the patient representatives.

According to Orthwein (2017), the application of proper care principles for the addiction relief purposes of the mental health patients undergoing treatment at the Nightingale Hospital should be concerned to be the primary impact of social value based attitudes. One such impact of the social values could be acknowledged to be the equality management in the care provisioning structure, the ensuring of the availability of universal mental healthcare access to the deserving patients and the maintenance of appropriate financial options through which individuals from every background could access such healthcare regardless of the ethnic, racial or class divisions.

Apart from this, another impact of person centred care principle and social value has been the formulation of the rights of the patients under the legal stipulations of the Mental Health Act (2007) and the Mental Capacity Act (2005). One such outcome of this impact has been the efforts instituted at the hospital under consideration to protect the patients from self-inflicted and externally induced harms. This social value has been reflective of the fact that mental care patients such as those affected by behavioural disorders or extensive substance abuse tendencies often experience considerable financial and physical difficulties apart from their psychological tribulations. Such difficulties often result in vulnerabilities on part of the patients involving potential harm and the practices of social and psychological safeguarding of such patients thus become critical. Gould (2016) has thus specified that the current policy mandates by the NHS have been particular regarding ensuring obligatory adherence of the healthcare professionals to the most stringent procedures of prevention of both abuse and negligence of patients. This reflects the aspect of accountability enforcement on part of the national health authorities of the UK over the existing care providers. Other social values include the protection of the confidentiality of clients as well as empowering the patients to retain their primary human rights so as to ensure that psychologically vulnerable mental patients could not be abused in the care facilities.

One significant development in this context has been, as per the opinion of McLaughlin, Leigh and Worsley (2015) that of the broadening of the definition of any psychological disorder in the stipulations of the MHA (2007). This definition pertains to the prospect of considering any behavioural disability or disorder related to the brain to be associated with an absolute psychological anomaly for the affected person, regardless of whether such disability or disorder could be temporary or permanent in nature. The point of emphasis is now completely on the measure of either disturbance or impairment of any mental functioning for the patient for the treatment to commence. This broadening of the definition has also served to make the necessity to clinically typify the patient into any medical category null and void. Psycho-pathological conditions ranging from personality or psychiatric disorders such as Schizophrenia to the addiction to intoxicants such as narcotics could now be considered to be serious psychological ailment for the personnel affected by the same.

One point of interest in this regard has been outlined by Cookson et al (2016) to be that of the apparent absence of any conflict between the expansion of the scope of definitions of the mental disorders and those of the rights of the patients ensured under the International Human Rights Convention. This has been achieved through the verdict of the European Court in the case of Winterwerp vs Netherlands (1979) where the court had not outlined any particular definition of the psychological disorders. The change of the definitions with specific cases and time has been a constant fact regarding the psychiatric management of patients in the UK healthcare industry.

Apart from these, social values of maintenance of the interests of the patients and ensuring the protection of vulnerable patients have culminated in the institution of differential criteria of treatment. Management of behavioural disorders has been the primary concern for the treatment regime without having to impart effective benefits on the patients at the hospital under consideration. Again, this has not been subject to any contravention of the human rights convention or of the judgements which had been delivered by either the European Court or the European Commission. Williams (2017) has brought forth the case of Ashingdane vs UK (1985) for retrograde reference in this context since in this case, the European Court had passed the judgement that it is not necessary for the care facilities to administer any form of treatment while the patient could be subjected to preliminary detention for the purpose of diagnosis and observation of the actual psychological disorder. This had not been challenged under the provisions of Article 5(1e) of the Human Rights Act which prohibits any arbitrary detention of any person suspected to be suffering from any psychological disorder. However, as per the verdict of the Court in the aforementioned case, it is now necessary for every mental care facility such as the Nightingale Hospital to establish logical linkages between the permissibility of deprivation of liberty in the form of detention of the patients and the conditions which could prompt such decisions. This is, in principle, related to the suitability of conditions of treatment administration.

Thus, Wright et al (2016) have specified that the MHA (2007) clearly has outlined the conditions under which any patient could be detained within the care facilities against his/ her consent for a definite period of time. These are the situations when the patient could be irrefutably diagnosed to have psychological disorder, when the ailment could warrant specialised psychiatric treatment, when critical therapeutic benefits could be imparted to the patients and when the protection of others from the potential risks emanating from the patient could be considered to be of prime necessity to successfully manage behavioural disorders.

According to Sharp et al (2015), a range of environmental and personal factors formulate the barriers to access proper care facilities for mental health patients through affecting the process of availability of such facilities. The factors could be categorised into five segments. The initial one is the inability of recognising the symptoms of psychological disorder as well as the unwillingness on part of the patients to accept the diagnosis results. The next is the often prevalent absence of the social and familial networks through which discussion on the behavioural problems could be undertaken and the decision of accessing treatment facilities could be arrived at. The third has been the social stigma which is integral with the prospect of receiving psychiatric treatment in various cultural lineages. This is the arguably the most powerful potential barrier in accessing treatment involving since particular cultural backgrounds could even make it complicated for the coping up mechanisms to work properly for the patients. This could be expanded to include the cultural naivety and abject insensitivity on part of the care providers to understand the experiences of patients. The fourth factor is the financial burden which has to be shouldered to avail the complementary therapies and medications since these are excluded from the purview of the NHS. Finally, the ultimate barrier pertains to the problem of communication which gets caused more often by linguistic barriers. This is exacerbated by the inability of patients to actually voice their problems in explanatory modes (Dockery et al. 2015). This results in additional stress factors and inappropriate treatment availability. In case of the Nightingale Hospital, the removal of all such barriers has not been a success. However, certain factors such as the communication problems have been overcome through better training of the counsellors and psychiatric staff to comprehend the nature of the problems expressed by the patients from differential sources of information such as through consulting the patient representatives. Apart from this, the hospital has been actively attempting to institute medical insurance policies to support the patients with the extra financial burden of medications which they have to endure.

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