
| 8.3a
Issues and strategies for managers |
Good management in this field is based on the following principles:
- A person with
a TBI has the right to choose what is most important to them. Assume
they are competent to do this, unless a guardian
has been appointed as a substitute decision-maker. (Contact
the NSW Guardianship Tribunal and NSW Office of the Public Guardian
or equivalent state offices for further information if needed.)
- Be consistent in approach
-
Set goals according to the client’s issues
- Facilitate
the self-determination of people with TBI to the greatest extent
possible, given their impairments
- Form partnerships with staff and other agencies to achieve client outcomes
- Take a holistic
approach to the client, their family and their community.
A valuable management
resource is the Getting It All Together Kit, designed to enable people
with brain injury to get the most out of their life,
and to help them regain control and accept responsibility. The
Kit provides a framework for clients that include a process of Identifying
the Issues, Tackling the Issues and Making it Work. The Kit is designed for clients to use on their own or with support. The
client decides the issues they wish to work on and the Kit gives
them and their carer/worker a structure to enable this
to happen. It assists the client to regain control of his or her
life and
accept responsibility for what he or she gets out
of life. The accompanying booklet Promoting Independence provides
family and carers/workers with information to assist them in their
work with people with a brain injury and to enable the person to achieve their
goals.
The
managers role is often a juggling of responsibilities as a service provider
to meet the needs of clients and the needs of staff. At times there
is an imbalance in the situation. They key to good management is to
keep these needs balanced so that it works effectively for both staff
and client. At all times the client must remain the focus of what we
do.
This section wil
involve analysing the following case study, and then using it to
determine
the strategies that form the basis of good management practice.
Case study - Jenny
Jenny was involved in a motor vehicle accident when she was 29 years
old. She sustained a severe brain injury, which has left her extremely
cognitively impaired. She has a without prejudice motor vehicle
claim that has not been finalised. Jenny receives the disability
support pension and has received a financial advancement earlier
in her rehabilitation.
Now 32, Jenny has been living by herself with support from her
elderly parents each day for the past 2 years. Due to ill health
her parents
are unable to continue the level of support she requires. Jenny’s
behaviour has become less acceptable and causing her parents extreme
stress. They have requested assistance. Jenny had been discharged from
the Brain Injury Unit and has no continuing rehabilitation goals. She
is unable to work or drive a car.
Jenny has extremely short memory, is unable to do most things without
prompting and guidance, has issues with personal hygiene, refuses
to do housework, can be extremely abusive toward anyone who wants
to help
her and provide support. She became increasingly bored and frustrated
with her circumstances, and became involved with gambling and alcohol
abuse. At these times she can be very disinhibited and sexually
inappropriate, occasionally inviting unknown men into her home.
Staff suspects that
Jenny uses illegal recreational drugs.
Jenny was assessed as being unable to manage her money. The Office
of the Protective Commissioner has this responsibility and she
is constantly asking them for more money. She then gets upset
when they
refuse to
give her the additional money.
Your
agency received this referral a month ago and has been providing
6 hours support per day. The goal is to provide staff to assist
in establishing routines and strategies to assist Jenny to
manage her
independence more effectively without support from her parents.
Staff will also need to help assist Jenny reduce behaviour
outbursts and
not place herself in vulnerable situations. All staff has reported
difficulty working with Jenny and you are finding it difficult
to recruit, there is no formal plan in place and your time
is spent on re-recruiting
staff to work with Jenny.
Managing
staff working with Jenny
Imagine that you
are managing the agency that is providing support to Jenny. Your first
step will be to identify all the issues for staff working with Jenny.
These issues are listed in the first column of the table below.
Secondly, you must
identify strategiesfor dealing with these issues. These are listed in
the second column of the table. These strategies will be based on good
management practices, which are listed in the third column of the table.
| Issues |
Strategies |
Good
management practices |
Jenny
Refuses
to do housework Abusive and
threatening behaviour to staff and others
Problems
with personal hygiene
Gambling
problems, money issues
Disinhibited
behaviour
Drug and alcohol
issues
Other issues Limited
family involvement
No case manager
involved
No clear
direction for staff
|
Goal orientated
plan – achievable
Timetable
of routine activities
Behaviour
management plan – consistent approach, least restrictive
Expenditure
planning – budgets, identified activity costs
Policies
and procedures for staff at risk
Monitoring
and review
|
Consistent
approach to client management
Good communication,
written and verbal,
Clinical
and critical pathways Develop
and foste a team approach
Hold regular
meetings to review and monitor and evaluate plan
Provide inservice
and training to staff
Provide crisis
management, intervention and debriefing
Rotate staff
to prevent burnout and stress
OH&S
issues for staff – safe workplace
Accessible
and user friendly policies and procedures
Recognising
staff stress - disillusionment process and stress
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