The main responsibility for ensuring that care is not poor quality, unsafe or abusive lies with front-line care workers

Care has a significant impact on people’s lives, and good care can help people become more independent and realize their potential. However, poor quality, unsafe or abusive care can harm people or diminish their quality of life. This essay will examine the responsibilities of front-line care workers, and further examine the responsibilities of various other people involved which include the employer, the voluntary organization, the care worker’s line manager, and the service user. Care workers are rarely solely responsible for making care safe and of good quality since they are nearly always operating within a management framework.

The responsibility to provide safe care is shared amongst different parties, each situation is unique and it is not reasonable to generalize and assign the responsibility only to the front-line care worker. This essay will cover many aspects of care where poor quality, unsafe or abusive care situations arise. It will focus on case studies to demonstrate where the responsibility of care lies and these case studies include Elspeth Grant (K101, Unit 17, pp. 14-16) who required care after she broke both her wrists, chest bone and sternum; Rosalie Williams (K101, Unit 17, p. 0) who has severe learning difficulties and displayed challenging behaviour by punching a support worker; and Cedar Court Nursing Home (K101, Unit 17, p. 48) where abusive care becomes normal practice. The essay will use these case studies to argue that it is not the main responsibility of front-line care workers to ensure that care is not poor quality, unsafe or abusive, but that it is a shared responsibility amongst the front-line care worker, management and organisations and the service user.

Front-line care workers deal directly with the service user and are responsible for ensuring that good quality and safe care is provided. Their attitudes and opinions are extremely important and each individual is responsible for respecting peoples’ basic human rights to dignity, freedom and respect. Care workers should be responsible for their own training, maintaining competence, record keeping and confidentiality. In the case study of Elspeth Grant (K101, Unit 17, pp. 4-16), we see that the person sent from the agency provided poor quality care because she did not prepare herself by taking the time to read Elspeth’s records, she did not have suitable training in intimate care, and she was not competent as she had no protective equipment to wash Elspeth properly. It was also the care-worker’s responsibility to handle the situation with emotional control. “Emotional control is part of the nurse’s “professional’ approach, that is learning how to do body care and perform other nursing functions in a manner typical of the occupation. (Lawler, 2008, p. 142).

However, front-line carers are only as good as their management and it is the responsibility of management to conduct effective recruitment processes and employ competent staff. In Elspeth’s case (K101, Unit 17, pp. 14-16), it was the responsibility of the care worker’s agency and supervisor to train the care worker in accordance with the organisation’s guidelines and protocols. At the Somebody Cares agency, a careful programme of induction for new staff is provided. “This includes shadowing an experienced member of staff for a week during which they are shown how to undertake intimate care tasks (K101, Unit 17, p. 7).

The care worker should have spent time observing another care worker and received advice and training with regard to Elspeth’s situation beforehand. Once trained, a supervisor or an experienced member of staff should have accompanied her on her first visit. In addition, if the care worker is not properly prepared she should have taken responsibility for her own training or asked for support. She should not rely on her own initiative and judgment and always ask for help. It is also her responsibility to follow the policy and procedures in place, and to know who she should report to if in difficulty.

The level of care can also become poor if the care worker is overwhelmed by too much work. We can see this is the Elspeth case study (K101, Unit 17, pp. 14-16) where another care worker looking after Elspeth continually arrived late and was always in a rush. It is the care worker’s responsibility to bring the problem to the attention of her supervisor who in turn needs to re-assess the workload and manage time more effectively. Of course, the most important person in the whole care process is the service user and their opinion counts.

Therefore, Elspeth should be responsible for speaking up in a clear and assertive manner, if she is in any doubt about the level of care being received. As we can see from this case study, the responsibility to provide good quality care is shared between the front-line care worker, management and the service user. Poor quality care can come in various forms and one of the most difficult areas of care work where unsafe or abusive care is common, is dealing with challenging behaviour. The issue of challenging behavior is experienced by care workers on a daily basis.

Care workers frequently work alone and within another person’s environment, and can be confronted with values, attitudes and beliefs at odds with their specific training and experience. When working with services users who display challenging behavior, it is the care worker’s responsibility to put the behavior in context and try to understand why the behavior is being displayed. The term “challenging behavior” has replaced older terms such as ‘problem behaviour’ or ‘difficult behaviour’. Lowe and Felce (1995) explain that …….. he change in terminology served to point up the onus on services to understand and help the individual (K101, Unit 17, p. 33) i. e. to shift responsibility for difficult behavior from the service user to the service provider.

Challenging behaviour comes in physical, emotional and psychological forms, and it can demonstrate that a person is distressed, unhappy or in pain. In the case study of Rosalie, (K101, Unit 17, p. 30) one care worker thought that Rosalie has so few ways of communicating that she has to resort to violence (K101, Unit 17, p. 2). It is the care worker’s responsibility to bring challenging behaviour to the attention of management. In turn, management are responsible for providing a safe working environment and managing the institutional and organizational features of Rosalie’s surroundings. Furthermore, they are responsible for conducting risk assessments and setting guidelines and protocols. These guidelines and protocols should be set clearly by management, and centered on relevant research evidence based practice.

It is also management’s responsibility to develop a code of practice for intervention if a difficult situation arises, on how to administer physical intervention safely. Unfortunately, there is always the danger of physical force being used too readily or too harshly and certain care workers may use bullying behaviour to control the service user. This happens when Lauren, a care worker in Cedar Court (K101, Unit 17, p. 48), is concerned about the effect of another care worker’s actions when she locks a patient in the toilet to stop him shouting.

It is Lauren’s responsibility to report the care worker to management and it is management’s responsibility to discipline the care worker involved and to have clear whistle blowing policies in place. Furthermore, they must ensure that this type of abuse does not continue as the workplace could build up a negative culture where bad practice becomes normal. Everyone involved in the care process is accountable for their actions and keeping records is an extremely important aspect of accountability and providing safe care.

Keeping records plays a significant role in making care safe as it ensures that the service user’s medical history is not forgotten, which could prevent inappropriate or dangerous care being provided. If something goes wrong and a care worker does not keep accurate records, they may be made accountable for their actions as there is no written evidence to back up their account. However, it is management’s responsibility to provide suitable processes and record-keeping systems, including clear confidentiality policies.

In the case study of Rosalie (K101, Unit 17, p. 30), if she was referred to a psychologist then her medical records would need to be shared but this information must be shared with her consent, or someone could give this on her behalf. In conclusion, it has been established that care can go wrong in specific cases and the responsibility of ensuring that poor quality, unsafe or abusive care does not lie solely with the front-line care worker. Providing good care is a shared responsibility between the front-line care worker, management and the service user.

Firstly, the front-line care worker is responsible for letting management know that they require training before they provide care, asking for support, keeping good records, sharing confidential information appropriately, and following guidelines and protocols. Secondly, it is the management’s responsibility to provide good recruitment processes, proper induction, training and support, manage workloads effectively and set guidelines and protocols. Finally, it is the service user’s responsibility to speak up, where possible, if there is in any doubt about the level of care being received.

As determined, the responsibility is shared and everyone involved must work as a team to ensure good quality, safe and non abusive care is carried out. This was demonstrated through the case studies of Elspeth, who received poor quality intimate care, Rosalie who presented challenging behaviour for front-line care workers and Cedar Court Nursing Home where bad care became normal practice. Providing care is an extremely complicated area but if the front-line care workers, management and service users work together then poor quality, unsafe or abusive care can be avoided.