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Significant life events have different effects on individuals even if they experience the same event. The death of a spouse may cause the surviving spouse, of one couple, to become withdrawn and fall into depression, while the surviving spouse of another couple may consider ‘life is not promised’ and make and complete a bucket list. Significant life events encapsulate the various life course or life stages of all individuals, beginning from conception, to birth through to death. The gestation period could be considered a non-significant life event, but with the advance of medicine and foetuses undergoing operations in womb, significant life events can be charted from any time after conception (Kolata, 1988).
During the life course, there is a mixture of predictable and unpredictable significant life events the majority of people are expected to experience. Predictable events include attending school, at least until the age of 16, employment and retirement. Unpredictable events or experiences include being diagnosed with an illness/condition which prevents the predictable, such as having a fulfilling and rewarding retirement, from occurring, such as being diagnosed with stage 4 cancer very soon after retiring (Lewis, 2013). In essence, any notable event affecting life plans become significant with respect to the way in which the person, experiencing the event, responds. Drawing on a positive approach to the situation could assist the individual with ‘coping’ with the event, while the converse, a negative approach, is true and the situation can either become, or appear to become, worse.
This report seeks to shed light on the importance of health and social care support for individuals experiencing notable life changing events, and how health and social care encourages the functioning of a strong and supportive community. Therefore, this report seeks to address not only how individuals react/respond to significant life events but how groups within which operate, responds to their responses and how groups can provide for support for their members experiencing a significant life event ranging from, death of a child; unwanted redundancy; unwanted pregnancy; age related conditions; unexpected terminal medical condition through to an accident with life changing results (Williams, 1999). Analysis will also address how one person’s significant life events may impact on the lives and actions of others such as family members and/or carers. Following the two analytical sections, organisational policies and procedures which are in place to provide support experiencing a major life changing event will be evaluated.
AC 1.2 Analyse possible group responses to significant life events that occur to one of its members
A significant life event, such as the death of a spouse of before either spouse has retired from work, can evoke various responses from the various groups within which the surviving spouse exists. In a work group, other than the expected and received condolences, team members may ‘take up the slack’ of the bereaved person not working efficiently and at full capacity. Others may swap shifts to accommodate the bereaved person’s change in lifestyle, as in having to take a child to school first before arriving at work when this was not the case before. These various responses may resonate either sympathy or empathy; sorrow for the person’s loss, or ‘experiencing’ the person’s loss owing to having experienced the loss of a spouse too.
Overall, the members of any group can be family members and/or friends; institutional personal such as colleagues; care workers or other health professionals; health and social care services users; informal carers or life partnerships. It is even possible that groups can comprise of people who would not usually interact with each other, as in a group offering a parent support in a child protection case so that members could be from the legal sector, the police family liaison team, various professionals from the health and social care sector, and a supporting family member. Group responses, to significant life events that occur to one of its members, can be analysed as varying from uplifting and cordial, indecisive and unhelpful through to demotivating and hostile; this is irrespective of the group comprising of individuals who may ‘have had similar experiences. For example, an informal ‘self-help’ support group of parents, who have experienced the death of a child, may be comprised of some individuals who may not be so supportive of a parent whose child death arose from his/her neglect or carelessness, if their child died from an unforeseen illness. Thus, while some of the responses could be cordial and helpful, other responses could be outright hostile; the latter being because the ‘careless’ parent is perceived as not being as loving and/or protective of his/her child as those who had spent many days/months ‘watching’ their children die.
Notably, more often than not, purposefully designed organisational systems and procedures are in place in health and social care establishments, for the very purpose of ensuring that service users, and individuals in general too, who experience significant or critical life events have access to a service which offer a quality matching those of national, and local, service standards. However, although ‘rules’ of service care are ‘implemented’ they do not account for ‘human’ reaction, hence the range of responses possible within a group, professional, informal or otherwise, with respect to an individual experiencing a critical life event.
Concern, anger, sympathy depression and/or counselling are all possible group responses to the death of a group member’s ‘loved one’, for example:
- Concern for the individual experiencing the bereavement; anxious to know how that individual will cope/continue to function without the presence of that ‘loved one’ as could be the case of a mother experiencing the death of a child. Children are not supposed to die before parents so there will be concern as to how that mother will respond to the loss. Practical concern may reveal itself in people offering to cook, clean the environment, or just offer a ‘listening ear’.
- Anger arising from a cultural perspective from not showing emotion irrespective of the significant event of the death of a child, for example. In the older British generation public displays of emotion was not acceptable, and throughout the WWII the slogan ‘Be Calm’ was popular underlying the stoic white British approach of not showing emotion in the face of hardship and/or pain; the phrase ‘a stiff upper lip’ is also associated with the British at that time (Hislop, 2012). Should the group comprise of mostly white British it could be that sympathy, analysed below, is not a forth coming response, rather anger at the show of ‘weakness’ in response to a significant life event.
- Sympathy arising from the group’s ability to understand, or at least sorrow for, the pain of that member experiencing a critical life event. This particular response could because at least one person in the group has experienced a similar event, as in also the loss of a child for example, or simply because another human being is in pain so there is an expression or feeling of sorrow for the distress of another person.
- Depression arising from the thought of one’s own possible mortality or the possibility mortality of one’s loves one. Irrespective of the group’s social and/or physical make up, be they aged and healthy, young and sick or just young, someone else’s death can cause them to consider their own demise. An Obsessive morbid focus on one’s own death, or the possible death of a loved one can lead to depression within a group (Ghadirian, 1983).
- Counselling from the senior members of a family/close friends group. Senior members, owing to their own life experiences could provide an informal style of counselling drawing on their own experiences or the experience of their peers. Emotional support provided in this counselling format may demonstrate to the person experiencing the significant event that he/she too will survive the experience of that event.
Group responses are different, because circumstances vary, and because more so individuals in the group are different. Irrespective of the ‘signed up code of conduct’ individuals may not always react as expected; some police offers may not remain stoic during the investigation of a child abuse case, while others will be totally impassive in their line of duty. Individuals are different, and as such their reactions to life’s many varying situations are variable too, although there could be common responses to common situations, as in bereavement, redundancy, terminal diagnosis, wedding preparations or university graduation. Social, emotional, ethnic and physical differences also impact the way in which a group responds to one of its members’ experiencing a significant life event as observed above.
AC1.3 Analyse the impact for others in health and social care when an individual experiences significant life events (AC 1.3) using effective judgement in arriving at your conclusion (M1)
Childbirth is a significant life event common to all cultures, but the birth of the child can cause different reactions amongst various groups associated with the mother. For example:
- If the child is healthy and the mother is happy then family members and/or friends, community nursing/midwife team and health visitor team are the main groups involved in this event.
- If the child is healthy but the mother is unhappy in addition to the three afore mentioned groups the community mental health team and/or social worker team may be involved.
The latter example may give a greater insight to the impact for others in health and social care when an individual experiences significant life events. For whatever reason a mother may be unhappy after childbirth, if the situation is not addressed by support/intervention then the outcome for a positive relationship between mother and child, and mother and other family members etc may be in jeopardy. In health and social care the professional approach is necessary to prevent ‘natural’ emotions from impeding the ‘correction’ of a secondary significant life event, that of the mother being unhappy after the birth of the child in the transition to being ‘a mother’. In years gone by, the ‘natural’ approach to such a secondary event would range from ‘there, there it will be alright’, ‘pull yourself together you are a mother now’ through to ‘let me take the baby for you’ – this meaning a physical separation for mother and child if a family member, such as an aunt, for example took the child to live with her while the mother ‘recovered’. However, in recent years health and social care teams have evidence that not pacifying or admonishing the mother, or separating mother and child is the way forward in addressing post-natal behaviour (National Health Service, 2016a). Health and social care professionals which include the mother’s GP, hospital psychiatrist, health visitors and social workers work together to produce a care plan for the mother, be it at home or at a mother and baby unit as appropriate. Notably, the professional team is likely to work closely with significant family members, first to apprise them of the situation from a medical perspective and then to elicit information from them to form a comprehensive ‘picture’ of the patient pre and post childbirth, if this information is not forth coming from the mother or addition information is needed (National Health Service, 2016a).
The impact for the professional team would be to ensure that services provided by individual professional teams are synthesised so that all ‘bases’ are covered to address the mother’s need for professional support during this significant life event; support could include antidepressant medication prescribed initially by a hospital psychiatrist and continued by GP as appropriate, and/or psychologist led ‘talking therapy’ such as Cognitive Behaviour Therapy and Interpersonal Therapy (Centre of Perinatal Excellence, 2014). Although, the professionals ‘will be doing their jobs’, it is not without possibility that they may have to suppress their ‘natural’ reactions to the reaction of another experiencing a significant life event for which ‘most people would be overjoyed’. They will recognise that this secondary significant life event, postnatal depression, can arise from mental health issues during the pregnancy, a lack of family support, or even that the birth itself sent the depression in motion (National Health Service, 2016a), and work together to provide the necessary support.
In a similar vein, family members create their own care plan to assist and support the mother experiencing postnatal depression; the medical term which encapsulates the term ‘baby blues’ which in pass years was dismissed as a passing phase which was not in need of professional intervention. Family members, especially those closest, such as the father may also require support to cope with the mother not being able to cope. The impact of significant life events, such as childbirth as being discussed, is not always clear cut and direct, in that only the person, the mother, experiencing the event is affected by it, and the impact of the event only applies to her. The affect and impact of significant events can be quite far reaching. In the case of postnatal depression, the father may feel grief for the mother’s condition, as well as his own in that instead of the event being joyous he is now feeling ‘sadness’ because of the mother’s ‘sadness’, and the ripple of sadness can become bigger impacting on the lives of others, directly or indirectly (WebMD, 2017).
Further, and in general to the above, team members can experience many various significant life events ranging from ill-health (be it terminal, seasonal or a ‘one off’), disciplinary action for an ‘unintended’ action or offense, unexpected redundancy, forced redundancy or witnessing a traumatic event whether in the course of duty or off duty. If a significant event is such as to cause emotional trauma to a member of a team the repercussions can be such that it affects the dynamics, cordiality and cohesiveness of the team.
Work load can increase for team members if the individual experiencing the significant event has to take time off work, makes avoidable mistakes while on duty, and operates in such a way as to become a liability to the team. In turn, the impact on the other team members can be seen in and analysed as anger, resentment, and uncooperative or empathetic behaviour; these behaviours may be in response to increased workload, and even if workload has not increased it may consider that the person experiencing this critical life event is getting special treatment or that the employer is callous in its response to this persons situation. The impact of another’s critical life event has the ‘ability’ to reveal hidden traits amongst group members, traits that even the person exhibiting aware that he or she had such a trait or traits; traits such as intolerance, limited or no sympathy, empathy, sympathy not time-bound, compassion fatigue, unforgiveness, ability to take on more responsibility, and others.
In effect, a team member’s significant life event could be the precursor to a pivotal and significant change within and for the group. Policies pertaining to such a specific crisis may be put in place so as to be able to address any future such events, and/or existing policies could be strengthened; policies that cover how and when counselling should be implemented for example, and which management tier should be able to initiate the policy. Within the final analysis, of the impact for others in health and social care when an individual experiences significant life events, the whole team could possibly benefit if lessons are learned from the impact of one member’s situation on the functioning of the group.
AC 2.1 Evaluate the effectiveness of organisational policies and procedures in supporting individuals and their social networks affected by significant life events (AC 2.1) arriving at justifiable conclusions based on syntheses of a range of ideas and opinions (D1).
Organisational policies and procedures for supporting individuals and their social networks affected by significant life events are there to enable to continue to function effectively, and provide the care and attention, and the level of quality, to which service users are entitled and to which they have become accustomed, if the individual is a colleague. They are there too, if the individual is a service user to ensure that changes in their circumstances can be recorded and that his or her care plan can be adjusted, if appropriate and/or necessary, to reflect a new dimension in the life of the service users arising from the effect of a significant life event which was not in existence at the time of the initial care plan and admission to the health care service, be it in the home of the individual or at the institution where he or she now resides.
For organisational policies and procedures to be effective in supporting individuals and their social network affected by significant life events, they should apply to both the psychological and physical wellbeing of those affected, be they service users, family members and/or friends of the service users, carers, groups associated/working within, with or for the organisation, and others in various capacities interacting with the organisation. Significant life events, can be different for different people, so that a fire in the building, in which no one dies or is hurt, may not particularly bother one individual, but may traumatise another such that being in a closed environment becomes traumatic, so there may be no exact definition of significant event but the organisation must be prepared to deal with those experiencing trauma however the significant event arises and/or whatever it is. Therefore effective policies and procedures include, but not exclusive to, the following factors:
- Awareness that there is not a ‘one size fit all’ natural response to significant life events, and be aware of the various ways in which a ‘natural response’ may be manifested.
- Being cognisance of the vulnerability of those who may have previous similar experiences, if not the same experience, or those who may be close friend/acquaintance of the person(s) experiencing the significant life event.
- Communicating effectively about the situation when it is appropriate, and take note of the form of communication; some information maybe acceptably communicated through a newsletter or bulletin board, for example, while other information is best communicated face-to-face.
- Provision of opportunity for those both directly and indirectly involved to talk about the event, either informally/and or formally (without professional assistance or with professional assistance)
- Recognition and/or be guidance by appropriate professionals as to if a person directly affected from the event should remain in the environment or be moved – naturally such a decision comes with many ‘depends’ which are considered in relation to each specific event.
- Awareness of differences in culture with respect to responding to any significant event, and therefore ‘recognise the importance of respecting a range of responses to disaster, and encouraging that respect’ (Cambridge University, 2017)
- Acceptance that a non-stipulated period of time, which will vary from person to person, may be needed for individuals ‘to come to terms’ with the effect of the significant event, and as such ‘normal’ working practices could be disrupted for that period, or it may be necessary to readdress programmes and schedules so that working practices are not disruptive, as appropriate.
Effective policies and procedures, which respect confidentiality within the law, are based on addressing significant events such as bereavement and the need to access specialist services such as those for sexually transmitted diseases, and paranoia (National Health Service, 2016b). These policies and procedures provide support for family members and friends of the individual, communities/groups, if they are included in supporting the individual experiencing the significant life event, and appropriate health and social care professionals including care workers, in addition to other users of the health and social care service who may be directly affected by the significant life event of the individual. The policies and procedures, observed above, are not exhaustive, however they set the scene for allowing individuals experiencing significant events to express themselves and to feel that they are being supported by the organisation. In addition, those indirectly affected by the event, as it witnessing ‘the car accident’ which caused their colleague’s leg to be amputated, also feel acceptance that their trauma is not mitigated and/or dismissed. Importantly, acknowledgement that individuals from different cultural backgrounds, even though all British by birth for example, can react to significant life events differently and as such be afforded respect for differences.
The effectiveness of policies and procedures can be evaluated in terms their ‘ability’ to support and underpin the development of relationships within which service users are confident to express their concerns and feelings, in the knowledge that there will not be a judgemental response so as to address their needs with professional support and consideration. If it is clear that the relationship is for the sole purpose of addressing the holistic needs of the service user, whether it is a considered norm or not, then the specific role of organisation, as reflected in the ambassadorship of its employees, has been fulfilled; this irrespective of whether the care worker and service user has any choice in the relationship, the onus being on the care worker to provide the service for which he or she is – dignity, confidentiality, respect and the partnership, between the service user and the service provider in their initial contract, promoting independence is adhered to at all time (Sydney TAFE, 2017). If policies and procedures cause a reduction in anxiety, prevents the onset of possible depression, enables those both directly and indirectly affected by the significant life event to resume ‘normal’ life even if this involves formal counselling support, or being a member of an informal support network group, then they can be evaluated as being effective.
AC 2.3 Evaluate the suitability of external sources of support for Mary (AC 2.3) justifying your selection of support mechanisms that are relevant to the client (M2)
There are a number of external agencies which can provide support for various individuals experiencing significant life events. These agencies, both formal and informal, range from National Health Service and alternative support therapies such as counselling and aromatherapy; professionals/specialist within the health and social care sector; faith communities which also provide counselling and support groups in addition to voluntary practical help as required by the individual experiencing a life changing event; specific cultural groups with no religious affiliation; non-cultural, non-religious community groups open to all; the Dementia Association; the Royal National Institute of Blind People (RNIB), through to the Citizen Advice Bureau (CAB) which provide a range of services which include legal and/or financial advice.
Although, Mary’s faith is not mentioned, it may be reasonable to assume that her mother may have had some connections to a faith community, based on the recognition that faith is central to many Asian cultures (Carteret, 2011; Le, 2017). Exploring this avenue may ensure Mary’s cooperation as she will feel that a practice observed by her mother is being kept, and she will be familiar with the rituals which may buoy her spirit. If this is not the case, it will not be a wasted exercise; rather it will demonstrate a holistic care approach to Mary’s needs. Within the faith group/community it may be possible to organise for a DBS checked volunteer ESOL teacher to work with Mary so to improve her English and thus enabling her to communicate independently with her cares and support workers such as the social worker. Now doubt, owing to her slurred speech, Mary will be availed the opportunity of working with a speech and language therapist, in addition to the physiotherapy she is receiving. The speech and language therapist working with the volunteer ESOL teacher could make significant changes to the life of Mary in that she will be able to communicate more effectively and this could raise the confidence she needs to attend the social centre. Recognising that Mary also has a hearing impairment, collaboratively working with the charity Action for Hearing Loss, formerly the Royal National Institute for the Deaf (RNID), the speech and language therapist and the volunteer ESOL teacher could produce a programme of exercises and activities to enhance Mary’s overall communication skills so that she can participate in activities at both the day centre and at the care home.
Having been removed from her home to a health and social care institution Mary has other support which can be regarded as external; day centre activities and physiotherapy sessions. Although not clearly stated, it is assumed that the day centre caters for her deafness and lack of English by communicating with her in her ‘mother’ tongue; this should enhance the support Mary receives from the volunteer ESOL teacher from her own faith community, and any Action for Hearing Loss support worker involved in her case. Being able to communicate can be evaluated as suitable, if not essential, ‘to bring Mary out of herself’ and encourage her to socialize and interact with others. This is involvement will undoubtedly assist in counteracting her home experience as long as no one expects an immediate change, recognising that Mary will need considerable time to trust those around her before she can respond in a positive manner.
For improved mobility, the physiotherapy session have been appropriately included in her plan and can be evaluated as suitable and essential for physical well being, in the near future, and her emotional well being in the distance future when she is more mobile and somewhat ‘more’ independent. Finally, and notably, Mary should have access too to another professional health care service, that of counselling. Her experience, after the death of her mother, from the abuse she received from both aunt and uncle may require professional counselling, the time of which it continues being determined by Mary’s progression during and after the sessions. Counselling will involve collaboration with the speech and language therapist and the volunteer ESOL teacher to ensure that the the counsellor can help Mary as much as it professionally possible. It may that through these counselling sessions Mary may be able to develop skills to address her experiences and thereby come to benefit from the experiences/activities at the care home and the day centre.
AC 3.1 Analyse possible organisational responses to the need to support Mary who is experiencing a significant life event.
Possible organisational responses will be best implemented if there is an accurate ‘paper trail’. The manager of the care home is unaware that Mary is not attending the external support systems put in place for her in her initial care plane. Now that the manager is aware a staff retraining programme could be implemented. It may that some of the staff may, in their own way, be ‘protecting’ Mary by empathising with her when she indicates that she does not wish to participate in the external services provided for her, so they ‘cover’ her non attendance by stating that ‘all is well’ in their reports. Training should reiterate that organisational policies and procedures should be adhered and any deviation could result in disciplinary conduct if the deviation is not reported to management in the shortest possible time of the deviation occurring.
Specifically, our policies and procedures as they apply to Mary are varied but comprehensive, to ensure that Mary can receive the maximum benefit of what we have to offer, in conjunction with the activities provided at the day centre, and the physical benefits she will receive from attending the physiotherapy sessions.
Transition periods vary, and Mary’s period of transition from her home of 65 years to a full-time 24 hour institution could take some time as she ‘acclimatises’ to a new environment, so carers have to give her time to adjust as they do with all new residents. Staff would not expect Mary ‘to be happy’ in her new environment, even if she has been removed from an abusive situation, since the she is now in an unfamiliar environment; unfamiliarity could add to the trauma of being moved away from the home she has known for 65 years. Therefore, our policies and procedures will not only accommodate the preceding, but they will take account of the Mary’s response to this traumatic change in her life, recognising that responses vary from individual to individual, as well as with the individual his or herself depending on mood changes, and carers’ attitudes to clients ( Sydney TAFE, 2017). Our policy is to avoid clients isolating themselves, and from the report given by the social worker and the recorded reports at this home it would appear that set policies and procedures are either not effective or not being implemented. Since such a situation has not arisen before the conclusion is that policies and procedures are not being implemented for whatever reason and this must be investigated; carers cannot take it upon themselves to act in a way which is non-beneficial to a client and this practice will be stopped. Mary needs to be around people, and observe how they interact with each other, with the hope that Mary will wish to join the interactions.
Mary may not be able to communicate what has happened, and what is happening, but that does not prevent the staff from being her advocate, and some staff member should have raised the concerns long before the Mary’s social worker spoke to a senior member of staff. When clients can communicate for themselves, all events/actions are investigated to arrive at an amicable conclusion. In our favour, the awareness of Mary’s culture has been taken into consideration with respect to her meals, and the observance of specific holidays/seasons but we acknowledge that more could have been done for Mary by making contact with her local faith community, and possibly arranging for Mary to be accompanied to attend a service or celebration, if it could be ensured that she would not encounter her aunt or her father there. If this is not possible we could contact an adjacent faith community. The situation, Mary’s non-attendance at her physiotherapy sessions and the day care session, has been recorded as a critical incident report. All those responsible for signing off on Mary’s daily care schedule will be required to give a report with respect the conflicting report as provided by Mary’s social work, in line and in keeping with our policies and procedures which are designed to address such unfortunate situations. If it is found that the situation has arisen from non-professional behaviour, as in ‘could not be bothered’ then a disciplinary hearing will ensue, but, and this is the strong suspicion, if it is the case that the staff were trying ‘protect’ or ‘side with’ Mary, if she communicated that she did not feeling like going, or that she just wanted to stay in her room, then this recognisably misguided approach will be addressed through training, and observation by senior members of staff. The suspicion that staff action is misguided loyalty to Mary arises from the fact that Mary’s daily ritual such as being encouraged and supported to brush her teeth; attending to her personal hygiene with support and the effective use of the hoist so that Mary is allowed to shower daily; being given the opportunity to select what she should wear each day; the daily brushing of her hair which brings a smile to her face; respect for her religious festivals especially when specific food is eaten, this food has been provided by the kitchen, and staff ‘checking in on her’ on a regular basis. Hence, the need for staff to be fully aware that Mary must attend the sessions as per her care plan, and if they need assistance in enforcing the agreed plan they must approach a senior member of staff, as they well know
AC 3.3 Make recommendations for improving the support available in Ladybird residential home for Mary and her social networks when affected by significant life events. Demonstrate the ability to make innovative and creative recommendations for improvement
It may be that the staff feel that the policies and procedures are too draconian and/or lack empathy which may be the reason they circumvent them for the benefit of Mary. In this situation only an open and frank discussion can assist Mary’s development if the reality of Mary’s needs is now known, as to being ‘heard about’ from others. That is care workers may ‘pick up vibes’ or have ‘gut feelings’ about Mary’s behaviour as they interact daily with her; their interaction would be far greater in length/duration, and more intimate than that of a social worker’s observation, no matter how good it is. Hence, a recommendation for Mary’s progression, and for those similar to her, would be to reassess Mary’s position every two weeks, for example, as opposed to the standard eight weeks which we allow for, so clients can settle in, and family/and or friends can become accustomed to our working practices. As an aside, family or friends can approach any member of staff with respect to any concerns, and we have a concerns form on site and on our website for completion at any time. However, as we have never had a client like Mary before, with her complex needs and no family and/or friends to support her, upon reflection a two-week period for review should be implemented for Mary, and any other such service users in the future. It is envisaged that the recent recommendation to collaborated with the volunteer ESOL teacher, from her own faith community, and take professional advice from Action on Hearing Loss, that Mary’s overall communication skills will improve so that she will be able to communicate to and with the other service users, both here and at the day unit (Action on Hearing and Loss, 2017). Thus, in the future, for clients like Mary, after their arrival, we will seek future in-depth input from the care staff working with her; the provision will also be there for any staff member to report concerns or updates on Mary before that set period, if Mary’s behaviour, likes or dislikes does not match, or closely match, what is recorded in her care plan.
Working with, and taking advice from, the physiotherapist a further recommendation is to explore what, if appropriate and affordable, assistive technologies (ATs) are available to aid Mary’s mobility and communication. In a recent search for information on ATs we have discovered research on ATs for the deaf (Morrissey, 2008; National Institute on Deafness and Other Communication Disorders, 2017). However, the problem we have at the moment is identifying ATs for the hearing impaired with ESOL which could translate English, and communicate her ‘mother tongue to Mary while Mary’s is addressing the issue of improving her English communication skills. Along with this search, we will contact Action on Hearing and Loss for more professional and specific advice. Further, there is a recommendation to meet with Mary’s physiotherapist and ascertain if there is a suitable piece of AT, or suitable ATs, to assist Mary in her mobility.
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