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B991 Health And Social Care Question: 1. How can the hospital environment impact on staff and people who use services?  2. What might be the impact on people of a transition from living in their own home to living in a care home?  3. Describe at is meant by unacceptable care practices, and discuss why it might develop in the workplace.  4. What are the different forms of accountability in health and social care practice and how can they contribute to the provision of effective and safe care?  Answer: 1. The hospital environment is an important operational tool that influences the way care is provided to the patients by the health staffs. It not only has an impact on the patients, but, also has implications on the hospital staffs. The well-being and productivity of the hospital staffs are affected by the hospital environment (Ryman et al. 2015). The job satisfaction and motivation has a direct impact on the patient outcomes. The strengthening of the working environment with optimum level of job satisfaction among the staffs improve patient care and satisfaction and in providing the patient-centered care. The stress and fatigue that prevails among the healthcare staffs threatens patient safety and decrease in the effectiveness of the delivery of care. An unsupportive hospital environment has an impact on the hospital staffs as it increases the chances of medication errors, staff dissatisfaction and results in absenteeism, turnover and burnout among the healthcare staffs. Nurses are the most essential elements in delivering care to the patients and in improving patient safety. A physical working environment also has an impact on the hospital staffs like noise, odor, light, safety which may be associated with the positive or negative influence on the nurses and healthcare professionals perceiving stress, job dissatisfaction and intention to change jobs. A psychological strenuous and stressful environment has an impact on the healthcare professionals which intend them to leave job and leads to turnover. This shows that a healthy environment has direct implications on the working of the healthcare professionals in the hospital especially the nurses (Hamdan et al. 2016). Apart from hospital staffs, hospital environment also have an impact on the patients who avail the healthcare services. The equipment, technology and the physical environment has an impact on the health and safety of the patients under the provision of care. The stress prevailing among the healthcare professionals directly affect the effectiveness of the delivery of care and health outcomes of the patients under their care provision. The environmental factors like natural environment, artwork display and attainment of the specific needs of the patient have an influence on the psychological and physical health of the patients (Kirwan et al. 2013). The hospital environment has an impact on the patient satisfaction. The physical environment ailing with the behavior and delivery of care of the staffs affects patient satisfaction, recovery and duration of hospital stay. A healthy environment not only promotes patient healing, but, also prevents patient falls, medical errors and hospital-acquired infections. The healthy patient relationships with the healthcare professionals and caregivers, policies involving patient-centered care and good physical environment improve patient satisfaction and quality of care delivered to them. A clean, calm and easy to navigate hospital layouts are crucial for the patients’ comfort and in creating a calm atmosphere for fast recovery and satisfaction. The nursing and physician support along with caring environment reduces the patient stress and anxiety that directly affect the health outcomes and recovery of the patients. A healthy hospital environment is one of the important aspects for the recovery of the patients who are availing the healthcare services (Schoenfeld et al. 2016). 2. A total institution is a workplace and residence where a large number of people who are similar are situated in a place and are cut from the wider society for a particular period of time. They live together in a formal and enclosed administered round of life (Hamre 2016). This concept is associated with sociologist, Erving Goffman in 1961. According to Goffman, total institution is divided into five types based on the type of people living together in the institution and intended function that the institution performs. The characteristics of the institutions are that it is intended to take care of the people who are incapable of taking care of themselves or are intended to provide house to the people who are a threat to the society or intended to provide services to the people like protection in the larger society. Despite of the intended purposes, the characteristics of the total institutions have some parameters in common. According to Goffman, the institutions are involved in the kind of separation from the society. In a total institution, there is no interaction with the different kinds of people and involvement in activities. This concept is called totalizing aspect of the institutions as given by Goffman. Total institutions are also intended to take care of the people who pose danger to the community and are sequestered, but, not being the immediate issue. They are also intended to provide establishments such as retreats which offer training stations for the people who are religious (Borowski 2013). There are five different types of people living in the total institutions. These five types have an impact on the people staying in the institutions. The impact of total institutions on the people who have spent their life in these institutions is sociological investigation. They use the sociological perspective and become curios to ask questions that is based on systemic and direct observation. Sociological perspective is being used by the total institution that has an impact on the behavior of the people residing there and establishment of connections with the society as a whole. It has an impact where the people look into the connections that are formed between the individual people behavior and the society structures where they live in (Ammannagari et al. 2016). Typically, the total institution has an impact on the people where the people tend to think that the society is just natural. The aspects of the life are conducted at a common place with large batch of people where the people are treated in a similar manner and have doing the same thing at the same time. The activities that the people perform are scheduled by explicit formal rules and operated by the officials. Finally, these activities are being arranged and brought together in a rational single plan that is designated to fulfill the institution’s official aims. The impact on the people is good or bad depending on the behavior of the officials and working of the institutions and its officials. The special care that are provided affect them in away where they are able to establish their connection with the society (de Moya-Anegón, López-Illescas and Moed 2014). 3. Unacceptable care practices encompass the unmet requirements of the patients which are clinically irrelevant and medically unnecessary. These practices greatly define the quality of care that has a detrimental effect on the working environment and endangers the patient safety and satisfaction (Hoben et al. 2016). The unqualified healthcare professionals provide unreliable care to the patient that increases the patient dissatisfaction and increases the chances of medical errors. The tampering of the patient’s documents, disclosure of the patient’s personal information and practices that involve harming of the patient putting their life in danger. When the healthcare professionals are not performing their ethical code of conduct, professional code of conduct and are performing beyond their professional limits. The healthcare professionals are not working towards the interests of the patients and do not act with competence, integrity and respect with their clients and patients. The unacceptable care practices also include the non-adherence to the profession where they are not able to complete their professional competence. It also includes the unsafe and incompetent manner and not working in accordance with the professional practice of medical ethics. It also consists of the disrespecting of the culture and beliefs of the clients and patients and disclosing of the personal information. The delivery of impartial and inappropriate information to the patients with distrust is also some of the unacceptable care practices that endanger the patients’ life and the quality of care provided to them (Wise 2014). The healthcare professionals, especially the nurses work in stressful environment while dealing with different kinds of patients in the clinical setting. It poses a feeling of stress, job dissatisfaction and intention to change jobs that leads to turnover and burnout. In addition, these stressful factors lead to unacceptable care practices that have a direct effect on the patient safety and satisfaction (Harris et al. 2014). The nurse to patient ratio is less that leads to stressful situations among the nurses and healthcare professionals and results in medical errors and patient harm. The tiring shift work, workloads, complicated care and patient’s death are some of the reasons that affect the physical and mental well-being of the nurses and healthcare professionals that affect the patient safety and negative health outcomes. In order to meet the requirements of the patients with specific needs also pose a workload on the nurses and healthcare professionals along with working within their set of moral and ethics. The irregular timetable and the dealing with the specific healthcare needs of the patients and clients have an effect on the job satisfaction of the healthcare professionals posing a direct threat to the patients and making them vulnerable to unethical and unacceptable care practices.  Due to increase in the complicity of care and new technologies coming up, the healthcare professionals are unable to meet the requirements due to lack of skill and knowledge and so are intended to perform unacceptable care practices to get away from the burden of workload hampering patient safety and well-being (Gandra and Ellison III 2014). 4. Accountability is an important aspect in the professional practice in the health and social care. The procedures and the practices performed by the health and social care workers are the responsibility of them and they are held accountable for their actions (Schoenfeld et al. 2016). There are three essential components in accountability. The loci of the accountability, domains of accountability and the procedures of the accountability are the main framework of accountability in healthcare system. The role of accountability is important in the health and social care as it encompasses the caring of the people. The people who are accountable and to whom they are accountable are the forms of accountability in the health and social care and the doing of the work according to the agreed plan of care. The health and social care workers are accountable to the patients or clients who are under their provision of care along with the healthcare team comprising of the colleagues and the seniors. They have a duty of care towards the patients under their provision as their actions can cause harm to the patients and they are held responsible for their actions. The health and social care workers are legally accountable to their patients or clients for any kind of medical errors and if they are unable to meet the needs of them. They are also accountable to their employers as they have to work within their professional limits and deliver their duties in a safe and effective manner. Their activities greatly contribute to the provision of effective and safe care (Van Bogaert et al. 2014). When the health and social care workers work in an ethical and safe manner, they are able to provide safe and effective duty of care. They have to be clear in their duties and have to provide the right training and actions that they carry out their duties in an efficient and safe manner. They have to work within their professional boundaries and make their roles clear within the professional code of conduct (Shamian et al. 2016). They have to work within the agreed protocols that act as safe guide towards the care delivery also ensures safe and efficient delivery of care. They have to ensure that they would provide adequate support to the patients and clients along with supervision and ample of support. They have to work in their professional conduct so that they are able to develop their professional role and provide efficient delivery of care. They should perform their activities in an ethical manner so that they are legally accountable for their actions. They have to work in making the delegations clear so that they are able to comply with the professional code of conduct and work in accordance with the professional practice. They should comply with the code of professional conduct and ethics in the organization where they work and seek help from the supervisors and managers so that they are able to provide care in a safe and efficient manner (Robinson et al. 2015). References: Ammannagari, N., Javvaji, C., Danchaivijitr, P. and George, S., 2016. We evaluated the efficacy and safety of low-dose estramustine phosphate (EMP) in Japanese patients with castration-resistant prostate cancer (CRPC). The present study was a single-arm, nonrandomized prospective study in which all patients received EMP orally twice daily for a total dose of 280 mg/day. A total of 31 patients with CRPC were enrolled from December 2009 to December 2012 at 5 institutions… Clinical Genitourinary Cancer, 14(1), pp.e123-e125. Borowski, A., 2013. Ethical problems in study of total institutions. International Letters of Social and Humanistic Sciences, 1, pp.14-18. de Moya-Anegón, F., López-Illescas, C. and Moed, H.F., 2014. How to interpret the position of private sector institutions in bibliometric rankings of research institutions. Scientometrics, 98(1), pp.283-298. Gandra, S. and Ellison III, R.T., 2014. Modern trends in infection control practices in intensive care units. Journal of intensive care medicine, 29(6), pp.311-326. Hamdan, A.B., AlShammary, S., Tamani, J.C., Peethambaran, S., Hussein, M. and AlHarbi, M., 2016. The impact of creating a child-friendly hospital environment in pediatric cancer patients and their families in comprehensive cancer center at King Fahad medical city. Current Pediatric Research, 20(1). Hamre, B., 2016. Dispositive–as an methodological tool–in the historical understanding of total institutions and the forming of subjects. In Foucault at 90. Harris, B., Eyles, J., Penn-Kekana, L., Fried, J., Nyathela, H., Thomas, L. and Goudge, J., 2014. Bringing justice to unacceptable health care services? Street-level reflections from urban South Africa. International Journal of Transitional Justice, 8(1), pp.141-161. Hoben, M., Chamberlain, S.A., Knopp-Sihota, J.A., Poss, J.W., Thompson, G.N. and Estabrooks, C.A., 2016. Impact of symptoms and care practices on nursing home residents at the end of life: A rating by front-line care providers. Journal of the American Medical Directors Association, 17(2), pp.155-161. Kirwan, M., Matthews, A. and Scott, P.A., 2013. The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. International journal of nursing studies, 50(2), pp.253-263. Robinson, J., Gott, M., Gardiner, C. and Ingleton, C., 2015. The impact of the environment on patient experiences of hospital admissions in palliative care. BMJ Supportive & Palliative Care, pp.bmjspcare-2015. Ryman, S., Bell, A.F., Walton, K.L. and Jenkins, E., 2015. Exploring the impact of two different food and beverage packaging conditions on the dietary intakes of older adults in a simulated hospital environment. Schoenfeld, A.J., Zhang, D., Walley, K.C., Bono, C.M. and Harris, M.B., 2016. The influence of race and hospital environment on the care of patients with cervical spine fractures. The Spine Journal, 16(5), pp.602-607. Schoenfeld, A.J., Zhang, D., Walley, K.C., Bono, C.M. and Harris, M.B., 2016. The influence of race and hospital environment on the care of patients with cervical spine fractures. The Spine Journal, 16(5), pp.602-607. Shamian, J., Kerr, M.S., Laschinger, H.K.S. and Thomson, D., 2016. A hospital-level analysis of the work environment and workforce health indicators for registered nurses in Ontario’s acute-care hospitals. Canadian Journal of Nursing Research Archive, 33(4). Van Bogaert, P., Timmermans, O., Weeks, S.M., van Heusden, D., Wouters, K. and Franck, E., 2014. Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey. International journal of nursing studies, 51(8), pp.1123-1134. Wise, J., 2014. Regulator calls time on” unacceptable care” in hospitals and care homes in England. BMJ: British Medical Journal (Online), 349.

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