Why do good care staff - PowerPoint Presentation

Slide1

Why do good care staff do bad things?

A psychological perspective

Robin Davidson

2016Slide2

Good people can do bad things?DoctorsHazel StewartCare staff

Nurses

Tony Blair

Martin

McGuinness

Mother Teresa Slide3
Slide4
Slide5

2009MarHealthcare Commission report

published

Chair

and Chief Exec resign

July

Second

Royal College of Surgeons

report

Public

enquiry (Francis I) announced by new sec of state Andy Burnham

CHAOS KILLS UP TO 1200 IN ONE HOSPITALSlide6

Compassion?At Stafford:Soiled patients unattended

Call bells not answered

Patients being left without food and water

Extremely poor hygiene

Medication not administered properly

Lack of adequate heating

Failure to notice or respond to deteriorating conditions

Failure to listen to, take seriously and respond to concerns of relativesSlide7

Caring culture?At Stafford:

Early warning signs - shabby & dirty environment, unsmiling staff who were distracted by mobile phones, didn't answer buzzers promptly, didn't pick up litter

Isolated '

timewarp

'

Toleration of mediocrity

'Keep your head down'

Bullying

Isolated

'Systems business' put over patients business

Slide8

Run out of townSlide9

The aftermath…Slide10

Elder abusePhysical Abuse—inflicting physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means

.

Sexual Abuse

—non-consensual sexual contact of any kind

.

Neglect

—the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder

.

Exploitation

—the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else's benefit

.Emotional Abuse—inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts, e.g. humiliating, intimidating, or threatening

.Slide11

Frequency of EAKings College studyAlmost

105,000

suspected cases were

reported last year in England and Wales; 28%

increase on the 82,000 from

2011.

More than a quarter of the cases involved someone aged at least 85

.

More than a third of suspected abusers are care workers,

about half of the cases took place in residential care homes. Slide12

I know when things go wrong it can be…..“a training issue”

“a resource issue”

The Daily

M

ail effect

A few bad apples

Incompetent bosses

But still………Slide13

I know NHS and care staff are mainly goodDavis et al (2014) NHS best on access efficiency and equity.

But

p

oor on mortality amenable to medical

care,infant

mortality, some cancer outcomes and

healty

LE at 60.

Kings Fund (2013)

70% public satisfactionBut still Slide14

heres

why

good people do bad things

The Social psychology of group identification.

The psychology of

disgust.

Attachment

representation.

Burnout.

Hubris

syndrome (power corrupts)Slide15

Stanley Milgram – Obedience to Authority

Philip Zimbardo

– Stanford Prison Expt.

Albert Bandura

– Aggression (Bobo Doll)

Solomon Asch

– Conformity (Line Judging)

Muzafer Sherif

–Norms (Robbers’ Cave)

Kitty Genovese

– Bystander Intervention

Jim Jones

– Jonestown Massacre

Social influenceSlide16

Social psychologyPurists say there can be misinterpretation of seminal social psychology experiments

but

is this splitting hairs?

and

c

an anyone rationalize my next slide

Slide17
Slide18

Group

Polarisation

18

A tendency to shift to more extreme positions after group discussion.Slide19

19Slide20

Symptoms of Groupthink

Illusion of invulnerability

Rationalisations

Belief in group’s inherent morality

Rigid stereotyping of outsiders

Sanctions against deviance

Self-censorship of disagreement

Illusion of unanimity (‘we all agree’)

Emergence of

mindguards

(defending the group from counter-

opinon

)Slide21

Characteristics of A Partisan Culture

Bullying / Harassment

Exclusivity

Hierarchical structures

Gradism

Segregation

Demarcation

In-nessSlide22

Eg

WORKPLACE

BULLYING

‘

Persistent, offensive, abusive, intimidating, malicious or insulting behaviour, abuse of power or unfair penal sanctions which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress.

’

Slide23

Bullies?Slide24

The Components of Burnout

Emotional exhaustion

wearing out, depletion of emotional resources, loss of energy, debilitation, fatigue.

Depersonalisation

- Negative, callous, excessively detached towards other people, loss of idealism, irritability.

Reduced personal accomplishment

- reduction in self-confidence, low productivity, poor morale, inability to cope.Slide25

The psychology of power

Hubris syndrome (

O

wen and Davidson 2009).

Acquired personality disorder

Neuropsychological and physical change (or the

life expectancy

of Oscar winners)Slide26

Attachment representationChildhood attachment persists into adulthood.

Cold professional Insecure/dismissing

Chaotic

carer

Insecure/anxious Warm professional Secure/autonomousSlide27

The psychology of disgustWhitby and

Gracias

(

2013)

disgust >

contempt

and

predjudice

The

Georgen interviews (2011)

Disgust mediated by incontinence and confusion Slide28

What can we doIntelligent kindnessSwartz rounds“Some”

F

rancis recommendations

The Reith Lecture

Clear WB motivational assessment and support

But alsoSlide29

Staff support….which is confidential and evidenced based.Slide30

The endBut remember

Most of us try our best, work hard, care for the ill and elderly and try to make a difference.

Davidson 2013