Table of Contents
Social care can be defined as the function of agent change, which is the main goal of social care. The goal of social care is to strengthen the ability of practitioners to handle their duties, responsibilities and challenges they encounter in life and encourage the environmental improvements according to the needs of other people. The change agent needs to initially understand the system of the client in a comprehensive way. Scientific knowledge is also noteworthy as a basic instrument in handling the situations. This includes the use of models, theories and approaches. Theoretic and knowledgeable approaches help in understanding the dimensions of social care and the elements of the client system in influencing the point, tool and nature of an intervention. This makes the theoretic preferences be a crucial intervention measure in the practice of social care as well as theory (Beckett & Maynard, 2005).
a) Construction and meaning of care
The reality of the client system is the key in practicing social care. It has the truth about the entire world as that is dependent on the individual’s thoughts, beliefs and perceptions, an aspect, which is called social constructionism. This feature significantly contributes to the social care by influencing participation, self-determination, individualization, the client system, social justice and human rights as illustrated in Appendix 1. The approach of care construction puts much emphasis on the processes and activities that have been involved in trying to accomplish the change successfully (Dean and Rhodes, 1998).
Construction of social care or social constructionism lay on the belief that reality if constructed socially with the language emphasis is a crucial way of interpreting individual experiences. Reality remains unknown except for the individual perceptions and interpretations of reality. Dean and Rhodes (1998) stated that discoveries of the real world are made from hypotheses building and testing in which the individual who is involved remains neutral. Construction of care emphasizes on individual values and interests that are entangled with the observations of the real world.
There are two terms that are commonly confused, i.e. constructivism and social constructionism, although they share several similarities. Both elements perceive reality in connection to the social context and social interaction rather than on observations and complete objectivity that are yet to be discovered. Constructionism focuses on the development of knowledge and its social aspects. It also describes individuals who have schemas or cognitive structures that are vital to this process. It portrays these cognitive structures to be of social origin rather than from the concrete human organism. Social constructivism involves culture and history in influencing the social construction of reality of the self-system. Both of these elements also emphasize the reality as a function of social construction using language, social discourse and dialogue. Social construction also refers to health in regards how it varies from one society to another. Gender ethnicity class determines the experience of reality, religion and education construct of the society in the UK (Appendix 1). Health, disability, and illness are also factors of social construction. Some critics argue that people surrounding an individual usually influence an individual’s perception of a symptom that is worth attention from a health professional such as a doctor. Cultural background is also an influential factor of the reasoning of a patient in seeking medical assistance. For example, a good number of Italians seek medical help, because disease symptoms interfere with personal relationships. Irish citizens are likely to develop disease symptoms because of the pressure to seek help from the surrounding people while Anglo-Saxons seek medical assistance when the developing symptoms interfere with their work (Haynes, 1998).
In social or health care, there are several definitions of illness and health, which varies widely in different cultural backgrounds. For example, the social view of illness in the middle ages saw epilepsy as a violent possession of divine forces, as compared to current times, where the cause of epilepsy is due to an abnormal neurological condition from damages to the brain. This explains the change of views and perceptions that occur over time. Most people cannot distinguish between illness and disease and generalize them to the same meaning by accepting personal explanation of illness. There are different definitions of health, some being positive while others are negative. The positive definitions describe health as physical fitness and emotional stability, and the ability to cope with life. Negative definition does not link health and illness like not having a problematic back pains and being disease free. The definition of health given by WHO (World Health Organization) is a state or function of absolute physical, social and mental wellbeing, and not just a state of disease absence and infirmity. Variations in the definitions of health imply that sociologists must perceive health and illness to be socially constructed. This means that the definitions are derived from the functioning of the body, and that culture defines and distinguishes the state of being healthy or unhealthy (Dean and Rhodes, 1998).
In the social construction of health, there are two main approaches known as the social model and medical model. The medical model focuses on the medical profession that views the body system as a machine and stresses on physical disease treatment. The medical model does not include the mental or social complications in a proper way and thus perceived to be negative. It also emphasized that the key characteristics of the medical model developed in the eighteenth and nineteenth centuries and then dominated in the twentieth century in North America. Domination of the medical model was also reported to dominate medical practices and the attitudes of the society towards health in the UK, in the twentieth century (Appendix 1). It is extremely essential that the healthcare professional dealing with patients from diverse cultural backgrounds in order to understand their patients’ beliefs on the causes of illnesses and the treatment regimes that they consider being most acceptable and effective (Franklin, 1995).
On the other hand, the social model of health emphasizes how the society defines views illness and explores an individual's perceptions rather that figuring out what could be wrong. The social model focuses on the lay definitions of health and considers factors such as lifestyle, diet and housing to strongly affect health of an individual. Currently, health professionals have begun to acknowledge that health is profoundly affected by social factors like lifestyle and stress and that good health is a function of disease absence. The medical model views disability as an illness and advocates for the adaptation of the affected individuals in the construction and organisation of the society. It also sees a disabled person to be entirely dependent on society and justifies the exclusion of the disabled people from the society. The social model, on the other hand, views disability as being socially constructed and refers to the way that people with disabilities have to face restrictions from the society. Negative effects can prop up from the society if education, building and transport systems do not consider the disabled people.
Social or health care construction is closely linked to the mission and value system of the discipline and profession of social care. Social carers often try to inquire the dominant structures of knowledge in understanding the impacts of history and culture. Factors such as economics, ethics, politics and ideology determine the way how social carers understand the needs of different people as proposed in Appendix 1. These models may enable the social carer in constructing the problem, and the means of addressing the impacts on the rendered services (Witkin, 1999).
b) Ethics and ethical practice
Ethics and ethical practice are the study of the human conduct. It is a branch of philosophy influenced by questions regarding the meaning of life. It connects to perceptions about life, and if they originate from religion or philosophy, as well as their effects on the human conduct. There are several theories that have been raised on ethics and ethical practices such as Kantian, Utilitarianism and Virtue ethics. The most widespread ethical theory is the Utilitarianism theory, which is based on the utility principle. This principle states that, in a situation concerning an ethical choice, an individual should opt for the choice that results in the greatest happiness for most people affected as an intervention may result to either good or bad. John Stuart Mill opposed the critics of the utilitarianism theory by stating that there are qualitative differences in pleasures and that proper education or information results into the appreciation of good deeds (Thompson, 1999).
An ethical theory of universal principles (Kantian theory) has been developed that focuses on the view of rationality in enabling people to understand their duties and the relationship of these duties in enlightening the world. For example, if everyone lied than no one will be able to distinguish what is truthful and false. People need to be respected as being self directing and autonomous, despite the growing interest of the society in technology, which acts to reduce the interactions of individuals, thus putting pressure on the society to become more universal and less autonomous (Hinmann, 2003). The Kantian theory remains a basis of social care and is the most dominant in relation to the ethics of social care. Members of the society need to be treated equally, with equal measure of respect (Banks, 2006).
Human qualities form the foundation of virtue ethics are based on the approach that is installed and expressed in ethical choices. These human qualities include honesty, courage and kindness of an individual. It is evident that the values of social care should emphasize on the need of clarifying individual values of social carers. This result from the assumption that personal values of a social carer affects significant influence on the clients’ views, the strategies and frameworks of interventions, and the outlines of the outcomes (Beckett & Maynard, 2005).
Ethics and ethical practices are evident in Appendix 2, as the social carer may have maternal feelings towards the client. These individual values or feeling can pose challenges to the case, especially if they conflict with the policies or laws of the agency (Reamer, 2006). However, effective social carers must instil virtue theory by focusing in their character traits, which will assist in ignoring the possibility of individual determination of ethical choices over other options (Parott, 2006).
The General Social Care Council GSCC (2002) points out the required standards of professional conduct practice for social carers, which are stated in the Codes of Practice. The set criterion is applicable as a guide to ethical practices and clearly defines the ethical conduct standards that need to be met by the social carers. They are also encouraged to improve all possible areas by evaluating their own practice. The organisations’ values contained in Code 3 are specific to families and children. The social carers need to encourage the independence of the service user, and protect them from harm or danger.
Beckett & Maynard (2005) also implies the wishes and needs of the client verses the wishes and needs of the caregiver or parent. For instance, in Appendix 2, the issue of personal values may come up as the social carer may have the same opinions and views as Jane’s parent. The social carer may, therefore, suggest that Jane should agree to follow the rightful procedures in dealing with the bullies, such as reporting them to the necessary authorities, as well as follow the measures of dealing with the stigma in order to progress smoothly with her academic work. However, the social carer may base her decision on Legislation such as the Children Act, 1989, s.1, whereby the welfare of the client is paramount. This is because the social carers have the tasks and services as outlined in the policies and laws (Brayne & Carr, 2005).
It is evident that social carers are faced with challenges of having to perform their duties in line with the laws while giving priority to their work load, and serving the best interests and rights of the service user, as well as the society in the most acceptable and ethical way. From an ethical point of view, the social carer is required to take on the responsibilities for actions that they have control and must be able to account for these to behave in a truly professional manner (Banks, 2006). Therefore, the ethical content of reflection is outlined by avoiding oppressive practice; to work in an anti-oppressive manner requires social carers to be, in a mode of continuous, critical reflection. This involves stepping out of one’s practice and measuring it against ethical principles of anti-oppressive social care (Parrott, 2006).
I had previously worked as a social carer in the UK. I will therefore, draw a personal reflection on my past experience, in relation to the case study, in Appendix 2, that I was personally involved when I was a social carer. From Jane’s case, I noted that the greatest challenge that social carers face is ethical dilemmas that come up because of risk assessment and confidentiality. Confidentiality is a key factor in creating and maintaining an effective relationship and connection with the client. From the case study in Appendix 2, utilitarian may justify the need to respect the confidentiality rights of the client in order to achieve their protection from danger or harm (Reamer, 2006). Consequently, a key feature in social care is the risk, which is responsible in identifying the influence or occurrence of a potential hazard. However, there are challenges in risk assessment, because it focuses on making judgments on the prediction of future possibilities of a change in the behaviour of a client or occurrence of the unknown. A social carer must therefore, protect clients, if a necessity arises in the quest of ensuring their protection and safety.
I noted (in Appendix 2) that initially Jane opted to live in a state of denial as even her elder brothers never cared about what she was going through, or try to protect her from the bullies. The decision to this situation would simply not be a personal choice, because the expectations of the agency and the stipulated guidelines need to be followed in dealing with the situation, while also respect the confidentiality rights of the client and maintain effective communication with the client (Becket & Maynard 2005).
Effective working relationships and partnerships encounter barriers such as multi- agency rivalry, which generates difficulties and undesirable consequences. This calls for a measure to establish strong working relationships in order to ensure successful and effective partnerships service users and the concerned agencies, by ensuring respect and recognition of the strengths of the expertise (Adams, Dominelli & Payne, 2005). Social carers need to work in collaboration with other organisations besides their own agency, and be aware of their duties and responsibilities as well as the negative or positive impacts of their work to other social carers. The practitioner needs to uphold a self-critical approach in their responsibilities as well as evaluate their work and reflect on the decisions they have to make (Adams, Dominelli & Payne 2005).
Differences in values and ethics may also generate challenges such as social carers having different priorities, pressures, objectives, concerns, constraints, expectations and legal obligation. These differences may create difficulties in working of multidisciplinary partnerships, and result into oppressive and discriminatory practice, because of mistrust, tension and poor communication (Dalrymple & Burke, 2006). Social carers also need to be aware of disadvantaged social groups, and be keen on the challenges, such as discrimination, as an important factor of anti-oppressive practice. This practice demands a positive approach when handling such vulnerable groups that exist in the society (Parrott, 2006).
Another risk or challenge that is connected to the case study in Appendix 2 is in regards to Jane’s age and state of self-denial, which led her into negative thoughts of contemplating to commit suicide. The social carer will, therefore, be required to encourage the client on the importance of continuing to live, and the possibility of overcoming all her tribulation by adopting effective strategies. This is in line with the utilitarianism theory, which also emphasizes on the happiness of the service users, or what is necessary for the general welfare of the client (Thompson, 1999). On the other hand, Kant was critical of the approach defined by the utilitarian by explaining that in the instance that the client decides to commit suicide, then that would signify the sacrifice of one person for the sake of the others, if there was a chance of expressing the benefits of harm to one individual over the other beneficiaries (Beckett & Maynard, 2005).
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Presenting an ethical argument involves the aspects of right and wrong evaluations and decisions; therefore, the social carer must clearly define the basis of making any claims as well the values and ethics involved. Failure of the practitioner to follow this principle may result in the lack of appreciation of different opinions and conclusions from other professional, on the rights and wrongs of the issue. This illustration explains that an issue is seen as trivial to one individual may be pertinent to another person (Thompson, 1999).
A reflection on the ethical principles and practices on Appendix 2 showed that I did respect Jane as an individual with the capability and rights to make her own decisions, to encourage her self-determination and ability to offer support (Kantian). Utilitarian considerations are also evident in Jane’s case, as recognize the concerns of the possibility of developing stress and depression, or even negative thoughts of life due to living in self denial. I also did show the sense of fairness, trust, and honesty by supporting Jane throughout the case (Virtue ethics).
Social care reflects on the different values and ethics supported by different people, even at the basic level of social construction. The professionals in the field of social care may even have to reason and make decisions in a critical way in lie with their own values. Western (2006) suggests that in social care, there is no clear distinction between decisions and answers that are right or wrong to an ethical dilemma. This calls for ethically justifiable and skilled judgments, and the selection of the best and ethically acceptable course of action. However, sometimes the matter at hand tends to be extremely complex an ethical issue that can prove to be difficult for the concerned social carer to resolve. In such instances, the practitioner or social carer should seek assistance or guidance from the senior, management, or other professional agencies.
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Professional integrity and ethical courage should be maintained by social carers, as well as moral strength in order to achieve effective analysis of the situation, and their pledge to respect the confidentiality rights of the clients despite any pressures from other social carers (Banks, 2006). Partnership is also beneficial in maintaining an effective communication and a productive relationship with the service user. It is essential for the professionals involved in social care to maintain these positive relationships, as they are indispensable in offering a range of options for the service user, enabling positive results for the individuals actively involved in the case (Thompson, 2007). Resolving the dilemmas of social care also requires social carers to be aware of the standards of practice that make up sound behaviour practice, as well as understand the principles stipulated in the codes of ethics and practice.