BTEC Level 3 National Health and Social CA - Mary Whitehouse

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Text © Neil Moonie, Peter Lawrence, Carolyn Aldworth, Beryl Stretch, Mary Whitehouse, Marilyn Billingham, Hilary Talman
Print edition first published 2010
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10 9 8 7
eBook edition first published 2014

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This does not mean that the material is essential to achieve any Edexcel qualification, nor does it mean that it is the only suitable
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Contents
About your BTEC Level 3 National National Health and Social Care vi
Unit Credit value Unit title Author Page
1 10 Developing effective communication in health and Neil Moonie 1

social care
2 10 Equality, diversity and rights in health and social care Peter Lawrence 45
3 10 Health, safety and security in health and social care Carolyn Aldworth 85
4 10 Development through the life stages Neil Moonie 129
5 10 Anatomy and physiology for health Beryl Stretch 175

and social care
6 20 Personal and professional development in health Mary Whitehouse 239

and social care
7 5 Sociological perspectives for health and social care Marilyn Billingham 301
8 5 Psychological perspectives for health and social care Hilary Talman 335
21 10 Nutrition for health and social care Carolyn Aldworth 367
22 15 Research methodology for health and social care Mary Whitehouse 405
Legislation grid 459
Glossary 467
Index 475
iii
Acknowledgements
We are grateful to the following for permission to reproduce copyright material:
Figures
Office for National Statistics for Figure 2.2 ‘Unemployment rates of men: by ethnic group, 2004’ from The Annual Population Survey; Figure 3.2
‘Deaths related to MRSA in England and Wales 1993–2008’, Crown © copyright; Pearson Education, Inc. for Figure 6.3 ‘Kolb’s experiential learning
cycle’ from Experiential Learning: Experience as a Source of Learning & Development by David, A. Kolb, p.21, copyright © 1984, Prentice Hall;
British Library for Figure 7.4 from the Report on Social Insurance and Allied Services by Sir William Beveridge, 1941, copyright © British Library Board,
BS Ref 1/1942-43 vi.119 Cmnd 6404; Figure 7.6 ‘Expectation of life at birth by sex’, Figure 7.7 ‘Prevalence of cardiovascular disease by household
income and sex’, and Figure 7.8 ‘Unemployment rates of men by ethnic group from Social Trends 2006, Vol. 36, HMSO; and extracts Social Trends
2009, Vol. 39, HMSO. Crown © Copyright; Figure 8.8 ‘Maslow’s hierarchy of needs’ from Motivation and Personality, 3rd edition by Abraham H.
Maslow, Robert D. Frager and James Fadiman, copyright © 1987, Prentice Hall. Reprinted with the permission of Pearson Education, Inc., Upper
Saddle River, NJ; and Health Protection Agency for Figure 22.8 ‘Line graph showing changes in annual incidence of measles in England and Wales
over a 10 year period’ taken from data in the tables between 1998 and 2008 on www.hpa.org.uk/, data courtesy of Health Protection Agency.
Table
Peter Honey Publications Ltd for Table 6.1 ‘Honey and Mumford’s learning styles theory’ from The Manual of Learning Styles by Honey, P.,
Mumford, A., 1985, copyright © Peter Honey, Education Development International; Food Standards Agency for Table 21.4 ‘Selenium and zinc:
functions, sources and characteristics’, adapted from Food Standards Agency, www.eatwell.gov.uk.
Text
Office of Public Sector Information for extracts on p.54, The Human Rights Act of 2000; p.102, Health and Safety at Work Act 1974; p.103, Manual
Handling Operations Regulations 1992; and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995; p.104
Management of Health and Safety at Work Regulations 1999; and Control of Substances Hazardous to Health (COSHH) 2002. © Crown copyright
2002 – 2008; Office for National Statistics for Equality and Human Rights Commission for extracts on pp. 66, 70 from Equality and Human
Rights Commission Publication Scheme, February 2009, www.equalityhumanrights.com copyright © Equality and Human Rights Commission;
The Nursing and Midwifery Council for their Code of Professional Conduct www.nmc-uk.org on pp.73, 263. Reproduced with permission; Extracts
on pp.151, 155, 156, 158 from Social Trends, 2004, Vol. 34, and 2009, Vol 39 HMSO; Pearson Education, Inc. for an extract on p.244 from
Experiential Learning: Experience as a Source of Learning & Development by David, A. Kolb, p.21, copyright © 1984, Prentice Hall; British
Library for an extract on p.318 from the Report on Social Insurance and Allied Services by Sir William Beveridge, 1941, copyright © British Library
Board, BS Ref 1/1942-43 vi.119 Cmnd 6404; and Child Poverty Action Group for facts and details on p. 323 from www.cpag.org.uk/povertyfacts,
copyright © Child Poverty Action Group;
In some instances we have been unable to trace the owners of copyright material, and we would appreciate any information that would enable
us to do so.
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v
BTEC’s own resources
About your BTEC Level 3 National

Health and Social Care book
Choosing to study for a BTEC Level 3 National Health and Social Care qualification is a great decision to
make for lots of reasons. It is an area to work in which gives many varied opportunities for you to make a
difference to people’s lives in a positive way. At the same time you are gaining skills that you can transfer to
other professions later. Working in the health and social care professions can also take you to different parts
of the country and overseas. The opportunities are endless.
Your BTEC Level 3 National in Health and Social Care is a vocational or work-related qualification. This
doesn’t mean that it will give you all the skills you need to do a job, but it does mean that you’ll have the
opportunity to gain specific knowledge, understanding and skills that are relevant to your chosen subject or
area of work.
What will you be doing?

The qualification is structured into mandatory units (ones that you must do) and optional units (ones
that you can choose to do). How many units you do and which ones you cover depend on the type of
qualification you are working towards.
Qualifications Credits from Credits from Total credits

mandatory units optional units
Edexcel BTEC Level 3 Certificate in Health and 10 10 specialist 30
Social Care 10 optional
Edexcel BTEC Level 3 Subsidiary Diploma in 30 30 60
Health and Social Care
Edexcel BTEC Level 3 Diploma in Health and 80 40 120
Social Care
Social Care (Social Care)
Social Care (Health Sciences)
Social Care (Health Studies)
Edexcel BTEC Level 3 Extended Diploma in 80 100 180
Health and Social Care
Health and Social Care (Social Care)
Health and Social Care (Health Studies)
Health and Social Care (Health Sciences)
You may have chosen a general health and social care qualification or you may be following a more
specialist route, and the units you study will reflect this. Whatever your choice, you will need to complete a
mix of mandatory units and optional units.
vi
Introduction
The table below shows how each unit in the book fits into each qualification.
Unit title Mandatory Optional
Unit 1 Developing effective All levels

communication in health and
social care
Unit 2 Equality, diversity and All levels except Certificate Specialist optional unit for
rights in health and social care Certificate
Unit 3 Health, safety and All levels except Certificate Specialist optional unit for
security in health and social Certificate
care
Unit 4 Development through All Diplomas Certificate H&SC

the life stages All Extended Diplomas Subsidiary Diploma H&SC
Unit 5 Anatomy and physiology All Diplomas Certificate H&SC

for health and social care All Extended Diplomas Subsidiary Diploma H&SC
Unit 6 Personal and All Diplomas

professional development in All Extended Diplomas
health and social care
Unit 7 Sociological perspectives Diploma H&SC Certificate H&SC

for health and social care All Extended Diplomas Subsidiary Diploma H&SC
Diploma H&SC (SC)
Diploma H&SC (HSt)
Diploma H&SC (HSc)
Unit 8 Psychological Diploma H&SC Certificate H&SC

perspectives for health and All Extended Diplomas Subsidiary Diploma H&SC
social care Diploma H&SC (SC)
Diploma H&SC (HSt)
Diploma H&SC (HSc)
Unit 21 Nutrition for health and Certificate H&SC

social care Subsidiary Diploma H&SC
All Diplomas
All Extended Diplomas
Unit 22 Research methodology All Diplomas

for health and social care All Extended Diplomas
vii
How to use this book

This book is designed to help you through your BTEC
Level 3 National Health and Social Care course. It is
specifically designed to support you when you are
studying for the BTEC Level 3 National qualifications.
The book is divided into 10 units to reflect the units in
the specification. To make your learning easier we have Credit value: 10
divided each unit into a series of topics each related to

the learning outcomes and content of the qualification.
This book also contains many features that will help you
3
use your skills and knowledge in work-related situations
and assist you in getting the most from your course.
Health, safety
We also provide a second book (Book 2) which gives you
and security
an additional nine units for study and you will find details
This unit introduces you to health, safety and security issues in health and social
of this either from your tutor or at www.pearsonfe.co.uk/ care settings. In the UK health and safety is taken extremely seriously, and we
take it for granted that our workplaces will be safe. However, as a practitioner
you will have to consider what risks exist, and be able to plan a safe environment.
btecH&SC. You will need to know what the law requires you to do, and how to carry it out. If
you become a manager of a setting, you must make sure that everything possible
has been done to keep your staff and the people you care for safe, and that you
can prove you have done so.
To be good at health and safety, you need to be creative and innovative, and be able to think
ahead and remain calm in an emergency. You will gain a thorough understanding of potential
hazards. You will also learn how legislation, policies and procedures work to reduce risk, and the
consequences of not following them, both for your safety and your career! You will learn about
the health, safety and security responsibilities of employees and employers, and their relevance to
you as a student. Finally you will learn how to deal with all sorts of incidents and emergencies that
could occur in health and social care settings.
Learning outcomes
After completing this unit you should:
1 understand potential hazards in health and social care
2 know how legislation, policies and procedures promote health, safety and
security in health and social care settings
3 be able to implement a risk assessment
4 understand priorities and responses in dealing with incidents and emergencies.
Introduction 85
These introductions give you a snapshot of what to

expect from each unit – and what you should be aiming
for by the time you finish it! BTEC’s own resources
Assessment and grading criteria

This table shows you what you must do in order to achieve a pass, merit or distinction grade,
and where you can find activities in this book to help you.
Assessment and grading To achieve a pass grade, the

evidence must show that you are
able to:
To achieve a merit grade, the
evidence must show that, in
addition to the pass criteria, you are
able to:
To achieve a distinction grade,
the evidence must show that, in
addition to the pass and merit
criteria, you are able to:
criteria
P1 Explain potential hazards and the
harm that may arise from each in a
health or social care setting.
See Assessment activity 3.1,
page 97
This table explains what you must do to achieve P2 Outline how legislation, policies
and procedures relating to health,
safety and security influence health
M1 Describe how health and safety
legislation, policies and procedures
promote the safety of individuals in
each of the assessment criteria for each unit. For

and social care settings. a health or social care setting.
See Assessment activity 3.2, See Assessment activity 3.2,
page 112 page 112
each assessment criterion, shown by the grade

P3 Carry out a risk assessment in a M2 Assess the hazards identified in the D1 Make recommendations in relation
health or social care setting. health or social care setting. to identified hazards to minimise
See Assessment activity 3.3, See Assessment activity 3.3, the risks to the service user group.
page 118 page 118 See Assessment activity 3.3,
button P1 , there is an assessment activity. P4 Explain possible priorities and M3 Discuss health, safety or security
page 118
D2 Justify responses to a particular

responses when dealing with two concerns arising from a specific incident or emergency in a health
particular incidents or emergencies incident or emergency in a health or social care setting.
in a health or social care setting. or social care setting. See Assessment activity 3.4,
See Assessment activity 3.4, See Assessment activity 3.4, page 126
page 126 page 126
86
03-BTEC_National_H&SC-Unit 3-ccc.indd 86 17/06/2010 08:29
viii
Introduction
Assessment
Your tutor will set assignments throughout your
Unit 7 Sociological perspectives for health and social care
course for you to complete. These may take the How you will be assessed
This unit will be assessed by internal assignments that will be marked by the staff at your
form of research, presentations, written work or centre. It may be subject to sampling by your centre’s external verifier as part of Edexcel’s
on-going quality assurance procedures. The assignments will be designed to allow you to
show your understanding of the unit learning outcomes. These directly relate to what you
research assignments. The important thing is that you should know and be able to do after completing this unit.
Your assignments could be in the form of:
• presentations
evidence your skills and knowledge to date. • written assignments
• case studies
• essays.
Guidance is included throughout this unit to help you prepare and present your work.
Sam, 18 years old

I’ve been on placement at a hostel for homeless young people for
six weeks so far. Many of the residents at the hostel have very sad
life stories. Few of them have any family support. Some have been
in care. They have come from poor areas, where unemployment
and crime are high and drugs are easily available. They all seem
to have had very deprived childhoods. Has this all led to the hostel
Stuck for ideas? Daunted by your first assignment?

being their home?
I think of Joe. He was brought up by his grandparents, who were retired and on a
very low income. He never knew his dad, and his mum had a drug habit. When he left
school he also left home. After that he lived with friends, sometimes in hostels and
These learners have all been through it before… often on the streets. He has been in hospital at various times with chronic bronchitis,
pneumonia and hypothermia. His diet has been very poor – sometimes eating from
rubbish bins. He hasn’t ever worked. He often seems very depressed. He doesn’t seem
to talk to anyone very much. His personal hygiene is poor and his self-esteem is low.
This unit helped me to see that guys like Joe are homeless partly because they haven’t
yet had much of a chance in life. Poverty, little family support, poor housing and poor
health seem to have led them to this.
Overresources
BTEC’s own to you!
1 Which parts of this unit do you think you will find most interesting?
2 Which other units do you think are linked with the issues covered in this unit?
1.5 Learning 3opportunities Unit 6 Personal a
you might only apply it later. Your formal learning in
Which parts of this unit will help you better understand the homeless young
college may enable you to reflect differently on an
people at the hostel?
Opportunities to apply the Kolb experiential learning
experience from your past so you might now have
cycle to learn something new, or to increase your
a better understanding of why you received the
understanding, can happen at any time. This might be
treatment you did when you were ill as a child. In this
during formal learning in the classroom, supported by
instance, the reflection forms part of the reflective
a tutor, or on a placement, supported by a supervisor 303
observation and active conceptualisation part of
research. T
Reflect
mentor. Everyday experience can also prompt
the cycle. Opportunities for learning can also come
reflection – for example, being a patient yourself or
observing an incident in the street as a passer-by.
from experiences in paid employment or voluntary
work, where you might gain experience of using and
that everyo
How do you think your preferred learning style
You might apply the Kolb theory soon after an active
experience, perhaps after a classroom discussion or
developing your communication skills while working
with customers in a shop or a restaurant.
about befo
might influence your skills for learning? assignmen
Activities Assessment activity
What could
learning?
you 6.1do to help develop your skills for
P1 M1 D1
Research i
There are different types of activities for you to do: Produce a piece of writing that explains influences on M1 Sketch a timeline to help collect your thoughts
you will ne
the personal learning process of different individuals. about the factors that have influenced your
in all units
Assessment activities are suggestions for tasks Include an assessment of how different influences in
your life have affected your own learning. Consider
influences on the development of your knowledge
learning from your childhood, school, work
and other life experiences. You could put
the significant events and experiences (e.g. need a ba
that you might do as part of your assignment and You will use functional skills throughout the course and
and understanding, skills and abilities. Present your
assessment as a personal statement and include a
starting school, moving home) on top of the
line and their effects below the line. Use the obtain info
timeline as a tool to help you construct your
specialist
curriculum vitae.
support may involve one-to-one teaching successful
will help you develop your knowledge, skills and Evaluate how the personal learning and development personal statement. Research how to present a
curriculum vitae.
from a specialist tutor as well D1asBefore
of health and social care workers can benefit others.
class sessions
you prepare forfor D1, you
your evaluation
useful for y
understanding. Grading tips clearly explain what Grading tips
English,
P1 For P1, youmathematical
should consider a wide rangeandof
could carry out some research about PPD and
ICT itstalk
skills.
benefits inAdditional
health and social care.study
You should
observatio
influences that may affect people’s learning to staff at your placement about how their
you need to do in order to achieve a pass, merit or skills and (those skills you need to complete
not just the factors that have influenced a course of
learning and career backgrounds have helped
them in their work. You could also consider how
study
your own learning. Remember to explain the
successfully) to prepare you
possible effects of the influences, applying the you have used your own learning throughout
for
so farhigher
to help others.education
Observati
distinction grade. theories discussed in this section. your life
Much of w
are explored in Unit 46 Academic literacy in the health
and social care sectors. through in
Functional skills PLTS
Independent enquirer: Your exploration of the
what is go
English: Producing extended writing and
communicating your ideas effectively and concisely
will allow you to demonstrate your English skills.
factors that influence your own learning and that of
others will demonstrate your ability to explore issues
few practic
Activity 5: Checking your own
ICT: Using word processing skills.
and analyse and evaluate relevant information as an
independent enquirer. out yourse
learning online observe ot
communic
Are your individual learning plan and the records activities a
There are also suggestions for activities that will 254 of what you have achieved so far available to you an importa
give you a broader grasp of the sector, stretch your online at your school or college? If so, it probably may be pe
means that your school or college has its own such a sett
imagination and deepen your skills. intranet or virtual learning environment. ICT is an
related to
increasingly important tool for study. Becoming
familiar with the way it can help you would be health.
valuable preparation for study in higher education.
Ask yourself the following questions about your own
online learning information: Reflec
1 How often do you use it? Why are
2 Do you find it useful? settings
3 Could you make more or better use of it to What ro
support your studies? services
What do
about in
ix
Research skills Questioni
social care?
Being aware of your preferred learning style means
1 How could the learning experience be altered to
that you can select an approach when planning your
BTEC’s
study own
activitiesresources
and personal development that fits
improve the individual’s learning?
2 What would have affected your learning in a
your style. However, in working life, being able to similar situation to your peer?
An overview of learning
adopt a range of different learning styles according to Before you qualify as a professional, learning from
Personal, learning and

the circumstances can make you more flexible and less
Learning is a process by which we acquire knowledge,
dependent on a single learning style.
experience is called personal and professional
PLTS
development (PPD) but learning after qualifying is
skills and an understanding of abstract concepts.
thinkingSome
skills
peoplestarts
Learning nowwith
consider that learningasstyles
early experiences haveand
an infant
called continuing professional development (CPD).
Independent enquirer: Processing observed
You will come across both terms in this unit.
lesscontinues
effect on through
an individual’s ability to learn than was information on complex subjects concisely and clearly
Throughout your BTEC Level 3 formal schooling
National Healthand and
academic
will allow you to demonstrate your independent
previously
study orthought.
training. You will need to complete specialist
Social Care course, there
training are lots
to acquire theof opportunities
knowledge and skillsto
for work Reflect
enquiry skills.
develop your
246 personal, learningnurse
as a care assistant, andorthinking skills.
social worker, for example. Workers in health and social care are required
Look out for theseTheasprocess is summarised in Figure 6.1 (on the next
you progress. to undertake CPD. Why do you think this is
page). Learning also continues informally throughout necessary? Unit 4 Development through the life stages
life, and most health and social care workers expect to
support the learning of other staff as a routine aspect As an older adolescent or adult, you will learn
FunctionalActivity
skills5: Discussing
of their work. Workers may also need to support
individuals to learn new information or skills.
from formal study but you will also learn from your
Functional
experience skills
of daily life (jobs you have had, your home
It’s important that you have
adolescence good English, maths
Health and social care workers are expected to take life, etc.). You will have
English: In discussing the innate
changes abilities that you are
in social
and ICT skills – you
active never
steps toknow when
develop theiryou’ll need
learning appropriately born with, suchyou
development, as will
having a good
develop your singing
speakingvoice,
and or
Fiftythe
for years agoc adolescence
specifi care they do. was
Thisoften seenhelp
unit will as ayou to:
them, and employers will be looking for evidence
time of ‘storm and stress’ where young people
listeningskills
practical skills you
and skills
haveofacquired,
presentingsuch
arguments and
as learning
• understand how you learn to listening
play a to others.
musical Recording your
instrument conclusions
through willOften
practice.
that you’ve got these skills too. find themselves in conflict with
would automatically developblends
your writing
•(or understand
rebel against) their
what parents
you and older
have learned people.
from your formal learning skillsskills.
with theory – driving a car
Organise a discussion with other
study and life experiences to datecourse members involves practical skills and knowledge of the Highway
to decide how far this idea is still true today and Code. Figure 6.1 shows how these three different
• set goals for your personal development during the
what may have changed since the 1960s. Record
yourcourse
conclusions for incorporation into information
Emotional
areas overlap. development
As you go through the course, you will
•sheets
planonforlifespan development and implement The way we understand and feel about ourselves and
development.
your personal
Key terms the plan other people develops as we grow older. Some key
Key terms
features of emotional development associated with life
Technical words •and monitor
phrasesyour progress
are easyagainst the plan,
to spot, andamending it stages
Personal
are and out
set professional
in Tabledevelopment
4.6. (PPD) –
as learning proceeds Learning acquired from experience before qualifying as a
definitions are included. The terms and definitions
• reﬂect on the progress of your learning and professional.
are also in theTable
glossary
4.6:
at the back
development
Key featureson
of the
of the
national
emotional
book.
programme,
development Continuing professional development (CPD) – Learning
especially with regard to your career aspirations. acquired after qualifying as a professional.
Life stage Emotional development
Infancy 0–3 Attachment
242
years Bowlby (1953) argued that infants have an in-built need to form an attachment with a carer.
The quality of this attachment may affect emotional development for the rest of the child’s life.
Ainsworth et al (1978) and Marris (1996) argue that the quality of our early attachment influences
the assumptions we make about our self and others. Infants who are securely attached will
WorkSpace grow up with the emotional resources needed to cope with uncertainty in life. Infants who are
Nurse practitioner
insecurely attached may have a reduced ability to cope with stress and major life events.
Case studies provide snapshots of real workplace Yasmin is the nurse practitioner
Childhood
issues, and show Understanding
how the skills self and others
and knowledge
at a busy GP’s surgery in a northern town. The
practice has a lot of elderly patients and Yasmin runs regular
‘well man’ and ‘well woman’ clinics for the over-sixties. Among
4–9 years Children use their imagination to begin to understand the social roles that other people play. the couples who come to her clinics are the Tattons and the
you develop during your course canbegin

Children helptoyou in a ‘me’ – an idea of self. Relationships with other family members may
imagine
Bensons, and she has got to know them quite well over the years.
Mr and Mrs Tatton both worked as solicitors and had a very good
income all their working lives. They were able to save and now
your career. influence how a child feels valued – a sense of self-worth. The way a child gets on with teachers have a very good occupational pension. They have a beautiful
home by the sea, and they play tennis and golf all year.
and friends may influence their self-confidence. The child might develop a permanent sense of They go on holiday abroad most winters and have
their grandchildren to stay every summer.
There are also mini-case studies

confithroughout the
dence or a sense of failure and inferiority.
book to help you relate
Adolescenceideas and concepts
Identity to real They just don’t seem to age, and hardly ever come to the surgery
for treatment. Their daughter Sally married John Benson, the Bensons’
life issues and situations.

eldest son, and John and Sally settled down in London.
10–18 years During adolescence this sense of self continues to develop. An adolescent needs to develop a The Bensons have lived very different lives. Mr Benson was a miner and was made
redundant in the 1970s. He managed to get other work but the jobs were all poorly paid. He
secure sense of identity. Identity theory was first proposed bypension.
now has to rely on his state Erikson
Mrs Benson has(1963). Aall person
worked part-time her life in unskilledneeds
jobs. She doesn’t have a works pension and she never paid into the state pension scheme.
a clear understanding of identity in order to feel secure when working with other people or
They still live in the three-bedroomed council house they moved into when they got married.
It is damp and difficult to heat. In the winter they have to choose between eating well and
in order to make a loving sexual attachment. This may beon holiday

a stressful time asareself-esteem may
keeping warm. They do manage to get away for a week in the summer but they have
never been abroad. Some would say that they rather proud and will
not accept financial help from their grown-up children. Mr Benson has angina
depend on the development of identity. and Mrs Benson has suffered from asthma for about ten years. They
both attend the surgery frequently so Yasmin tends to see
them every few weeks.
Adulthood Intimacy Think about it!

19–65 years Erikson argued that the key task of early adulthood was
1 List thelearning to cope
factors that might contribute with
to and detract from theemotional
health and well-being of the
Tattons and the Bensons.
attachment to a sexual partner. This may involve not2 being
What services too self-centred
will be available orlives?
to each couple in their later defensive and not
3 Are there additional services that might be available to the Tattons?
becoming emotionally isolated. 4 How have changes in the family made it more difficult for children to look after their ageing
parents? What are the implications for families, social services and government finances?
Staying involved 5 There is evidence that people in socio-economic class 1 have a greater life expectancy
than those in socio-economic class 8. Using the Internet or other sources, check the current
Later on adults may face a risk of emotional ‘stagnation’ when they lose interest
statistics for life expectancy by socio-economic class.
6 Which factors mentioned in the case study could indicate that thein social
life expectancy issues.
of the
two couples might be different?
According to Erikson, the developmental task is to stay emotionally involved with social life. 325
Older Making sense of your life
adulthood Erikson argued that older people need to develop a secure sense of self that enables them to
x 65+ years cope with the physical changes associated with ageing and death. People who fail to make
sense of their life might experience emotional despair.
Introduction
Did you know? Did you know?

Fascinating facts, figures and information are given, Aseptic technique is the method used to keep the
providing you with additional information relating patient or individual as free from contamination
as possible. It is used to prevent micro-organisms
to the ideas and concepts covered.
entering the body, which could cause infection. You
need to use sterile equipment and fluids during
invasive medical and nursing procedures, including
wound dressings and catheterisation and during
operations.
Reflect Reflect
These are opportunities for individual reflection on, Reflect on your thoughts on homophobia and be
or group discussions about, your experiences in a honest! Then reflect on how your thoughts may
influence you when you are working with and
health and social care context. They will widen your supporting people in health and social care. This is
understanding and help you reflect on issues that personal to you, unless you want to discuss it openly.
impact on health and social care.
Further reading and resources Resources and

further reading
Useful websites
Braille www.brailleplus.net
British Sign Language www.bda.org.uk
Recommended books, journals and websites to Argyle, M. (1972) The Psychology of Interpersonal
Behaviour, second ed. Harmondsworth: Pelican Makaton www.makaton.org
Signs and finger spelling alphabet
develop your knowledge on the subjects covered in Burnard, P. (1996) Acquiring Interpersonal Skills,
second ed. London: Chapman & Hall www.british-sign.co.uk
and at www.royaldeaf.org.uk
Burnard, P., Morrison, P. (1997) Caring and
each unit. Communicating Basingstoke and London:
Macmillan Press Ltd
Engebretson, J. (2003) ‘Caring presence: a case
study’ in Communication, Relationships and Care
Robb, M., Barrett, S., Komaromy, C., Rogers, A. (eds)
London & New York: OU & Routledge
Pinker, S. (1994) The Language Instinct
Harmondsworth: Penguin
Tuckman, B. (1965) ‘Development Sequence in Small
Groups’, Psychological Bulletin, Vol. 63, No. 6
xi
Just checking
Just checking 1
2
3
Define the following key terms: socialisation, culture, norms, ethnicity, social role and social class.
Provide a definition for the following sociological perspectives: functionalism, Marxism, feminism,
postmodernism, interactionism, collectivism and the New Right.
Explain the following concepts of health: negative concept, positive concept and the holistic
When you see this sort of activity, take stock! These 4

concepts of health.
Explain the biomedical model of health and the socio-medical model of health.
5 Identify and give examples of three main sources of statistical information about trends in health
quick activities and questions are there to check 6

7
and illness.
Why may statistical evidence be unreliable as a measure of the nation’s health?
Identify five social groups who, according to research, have a higher level of illness than the
your knowledge. You can use them to see how

population as a whole.
much progress you’ve made or as a revision tool.
Assignment tips
1 The sociological terms introduced at the beginning of the unit (such as socialisation, culture, social
Edexcel’s assignment tips

class, gender and ethnicity) should be used in class discussion of sociological issues and in your written
assignment tasks.
2 To achieve the pass grade in this unit, you are required to explain ideas and issues, such as different
sociological perspectives, different sociological approaches to health and ill-health, and trends in
health and illness among different social groups. Explanations require more detail than a definition
At the end of each chapter, you’ll find hints and tips to or a description. In this case, the grades can be achieved by using appropriate examples to illustrate
the concepts introduced. As a rule, you should devote one or two paragraphs to each sociological
perspective or approach that you are explaining.
help you get the best mark you can, such as the best 3 To achieve merit grade, you are required in M1 to assess the biomedical and socio-medical models of
health described in P2 . When assessing ideas you are should consider the strengths and weaknesses
of the approaches or ideas, in this case the two models of health. M2 requires you to discuss trends of
websites to go to, checklists to help you remember health and illness in two different social groups e.g. gender, social class or ethnic group. This requires
you to develop further and in more detail two of the groups introduced in P3 , presenting clearly the
evidence for the patterns and trends explained. You may, further, refer to the difficulties in defining
processes and really useful facts and figures.

health and to issues relating to the reliability of statistical data. Ensure that you use the sociological
terminology accurately and appropriately when considering these topics.
4 To achieve the distinction grade for this unit, you are required, in addition to meeting all other grading
criteria, to evaluate patterns and trends in health and illness among two social groupings. Draw on the
evidence presented earlier, in particular commenting on the strengths and weaknesses of the evidence,
and in the final paragraph present your conclusion.
334
Have you read your BTEC Level 3 National Study

Skills Guide? It’s full of advice on study skills,
putting your assignments together and making
the most of being a BTEC Health and Social Care
student.
Ask your tutor about extra materials to help you

through your course. We also provide Student
Book 2 which gives you even more units for your
study. The Tutor Resource Pack which accompanies
this book contains interesting videos, activities,
presentations and information about the Health and
Social Care sector.
Your book is just part of the exciting resources from

Edexcel to help you succeed in your BTEC course.
Visit:
• www.edexcel.com/BTEC or
• www.pearsonfe.co.uk/BTEC 2010
xii
Credit value: 10
1
Developing
effective
communication in
health and social
care
This unit is designed to help you develop your communication skills.
You will explore ways of overcoming barriers to communication and
develop your own skills in one-to-one and group interactions.
In order to work with people you must be good at communicating with them.
Effective communication requires advanced practical skills in much the same way as
driving a car does. Driving a car involves responding to changes in the road ahead,
as well as responding to other road users. Effective communication in care involves
being sensitive to feedback from others. Sometimes the people you meet may be
happy but often they may feel sad, afraid, upset or anxious. You need to be able to
recognise and respond appropriately to many different emotional situations. Different
contexts will require you to communicate in different ways. Skilled communication
requires you to make decisions as to what response would be most effective in the
situation you find yourself in. Effective communication involves much more than just
giving or receiving information.
Learning outcomes
1 understand effective communication and interpersonal interaction in health
and social care
2 understand factors that influence communication and interpersonal interaction
in health and social care environments
3 understand ways to overcome barriers in a health and social care environment
4 be able to communicate and interact effectively in a health or care
environment.
1

To achieve a pass grade, the To achieve a merit grade, the To achieve a distinction grade,
evidence must show that you are evidence must show that, in the evidence must show that, in
able to: addition to the pass criteria, you are addition to the pass and merit
able to: criteria, you are able to:
P1 Explain the role of effective M1 Assess the role of effective

communication and interpersonal communication and interpersonal
interaction in a health and social interaction in health and social
care context. care with a reference to theories of
See Assessment activity 1.1, communication.
page 17 See Assessment activity 1.2,
page 21
P2 Discuss theories of communication. D1 Evaluate strategies used in health
See Assessment activity 1.2, and social care environments to
page 21 overcome barriers to effective
communication and interpersonal
P3 Explain factors that may influence M2 Review strategies used in health interactions.
communication and interpersonal and social care environments to See Assessment activity 1.4,
interactions in health and social overcome barriers to effective page 40
care environments. communication and interpersonal
See Assessment activity 1.3, interactions.
page 40
P4 Explain strategies used in health
and social care environments to
overcome barriers to effective
communication and interpersonal
interactions.
page 40
P5 Participate in a one-to-one M3 Assess your communication and D2 Evaluate factors that influence the
interaction in a health and social interpersonal skills in relation to effectiveness of each interaction.
care context. each interaction. See Assessment activity 1.5,
page 42 page 42
P6 Participate in a group interaction in

a health and social care context.
page 42
2
Unit 1 Developing effective communication in health and social care
How you will be assessed

You will need to produce written evidence of examples of the role of communication and
interpersonal interaction in health and social care. You will also need to explain theories
of one-to-one and group communication. You will need to demonstrate your own skills
both in one-to-one and in group interaction situations. Varied assessment tasks are
included throughout this unit to help you prepare your work.
Daniel, 17 years old

This is a very practical unit. Although there’s quite a lot of theory, I
found that I ‘sort of knew’ some of the ideas, although I had never
put them into words before.
The great thing about studying this unit is that it enables you to
explain what’s going on in one-to-one and group situations. The
unit changes the way you understand conversations and the way
people behave when they are in groups. Whenever I see people talking,
I start to work out what their body language might mean. I now realise that there are
special communication skills that you can use in care work. Sometimes the way you say
something can be more important than what you say. There are a lot of barriers in care
situations that can stop people from understanding each other. But the unit explains
ways of overcoming these problems.
The assignment work is all very practical. To begin with, I had to set up a logbook to
record examples of the theory we were studying. We had to study practical examples
of the communication cycle and group formation. I went on to explore barriers to
communication and how to overcome barriers. I found my supervisor at my practice
placement was very helpful in getting me to understand how to overcome barriers.
Finally, I had to explore my own skills in one-to-one communication and group
situations. I tried analysing several situations that I had experienced before going on to
complete my final assignment work.
Over to you!
1 Why is skilled communication so important in health and social care work?
2 Do you think effective group or effective one-to-one communication will be the
hardest to demonstrate?
3 What part of the practical work for this unit do you think will be most enjoyable?
3
1 Understanding effective communication

and interpersonal interaction in health and social
care
Changing the way you communicate

Get
Imagine that you have to interview people in a youth club in a distant city as part of
started a project. You do not know the members of this club. The members speak English
but they are very different from your friends in your local area. The people you are
interviewing don’t have to answer your questions.
How would you act to get these people to like you and listen to you?
The way you communicate with other people always depends on the situation
or the context you find yourself in. You will have developed effective ways of
communicating and interacting with your friends. But if you find yourself in a
different context you will need to be able to change the way you act in order to get
a good response from people.
1.1 Contexts of communication Reflect

One-to-one communication Imagine a care worker in a day centre for older
people walking around and sharply asking
When you start a conversation with someone you each person: ‘You want tea or coffee?’ Without
don’t know well, you should always try to create the any other conversation, this behaviour would
right kind of feeling. It is important to create a positive probably come across as ‘mechanical’. The care
emotional atmosphere before you go on to discuss worker would just be carrying out a practical task
complicated issues or give people information. The – getting fluid into the bodies of these people.
However, some older people might find this
other person needs to feel relaxed and happy to talk to
behaviour disrespectful, and others might find it
you. Very often people will start with a greeting such as cold and unfriendly.
‘Good morning’. You can help other people to relax by
How would you offer a choice of drinks to people
showing that you are friendly and relaxed.
in a warm and friendly way?
1. Greeting 2. Conversation
or warm-up 3. Farewells or
or information
winding-down
exchange
Fig 1.1: Interaction often involves a three-stage process
4
Once you have created a good feeling, you can move about to finish speaking they usually signal this by
on to the business – the things you want to talk about. lowering their voice tone, slowing their pace of talking
When it is time to finish the conversation, you want to and looking around at other people in the group.
leave the other person with the right kind of emotions The next person to talk knows that it is their turn by
so you might say something like ‘See you soon’ to watching the eyes of other group members. If people
show that you value them. Formal conversations often fail to notice these patterns then too many people may
follow a three-stage model, with an emotional ‘warm- try to speak at the same time. If everybody is talking
up stage’ at the beginning, a ‘business’ or ‘exchange then nobody is listening!
of information’ stage in the middle, and a ‘winding
Can everybody see each other clearly?
down stage’ at the end.
If people sit in a circle then everyone can see everyone
Group communication else’s face. This is very important because positive
Taking part in a group discussion involves the same group feeling and successful turn-taking often depend
issues as one-to-one communication as well as some on people being able to understand the messages in
additional issues. other people’s faces. If people sit behind each other
or in rows, then some of the group cannot see others’
How does it feel to be in the group?
faces. Bad seating or standing positions can make
Group discussion only works well if people want to group communication harder.
be involved. Sometimes people feel threatened if
they have to speak within a formal group of people,
or they might stay quiet because they are worried Activity 1: Record eye
about other people’s reactions. It is important that the contact and turn-taking in
group has the right emotional atmosphere. People group discussion
in groups often use humour or other friendly ways
of behaving to create the right group feeling, which Get together with five or six colleagues and agree
encourages people to talk. Creating the right group on a current news topic that you would all enjoy
discussing for four or five minutes. One of you
atmosphere involves ‘maintaining’ the group so this
should use a camcorder to record the eye contact
aspect of group communication is often called group and speech of other group members. Analyse your
maintenance. recording and work out how good people were at
Is there a group leader? taking turns in group discussion.
Some groups, such as team meetings or classroom

discussions, have a leader or chairperson. Having a
leader is very useful because the leader can encourage
PLTS
people to express their ideas and help them to take
Independent enquirer: This activity will help you
turns when talking. Group leaders often encourage
demonstrate that you can analyse and evaluate
people to focus on a particular task within a group.
information, judging its relevance and value. The
Have you prepared what you are going to say? activity may also help to develop team working and
participation skills.
When talking in a formal group you will need to think
through your points before sharing them with the
whole group. Because of this extra preparation, talking
Informal communication
to a group can feel very different from talking in a one-
We often use informal communication when we know
to-one situation.
people well – for example, with friends and family.
Are you good at taking turns? Some friends or family members may use terms that
Group communication fails if everybody speaks at other people would not understand. Local groups
the same time. It is harder to work out who should from particular places might also have their own ways
be speaking in a group discussion than in a one-to- of speaking. For example, some people in southern
one conversation. The skill of taking turns involves England might say things like ‘Hiya, mate. How’s it
identifying the following pattern. When a person is goin’?’ If you belong to this group, you will appreciate
5
this as a warm, friendly greeting. But different groups interpret this as not being treated seriously, or ‘not
of people use different informal language so it can being respected’.
sometimes be hard to understand the informal So is there a correct way to speak to people when
communication of people from different social groups. you first introduce yourself? After all, if you are too
Formal communication formal you may come across as pretentious or ‘posh’.
Usually care workers will adjust the way they speak in
Health and social care work often involves formal
order to communicate respect for different ‘speech
communication. For example, if you went to a local
communities’.
authority social services reception desk you might
expect to be greeted with the phrase ‘Good morning. Communication between colleagues
How can I help you?’ This formal communication Family and friends know you well and will usually
is understood by a wide range of people. Formal understand you, even if you communicate poorly or
communication also shows respect for others. very informally. Communicating with people at work is
The degree of formality or informality is called the different because:
language ‘register’.
• It is important that care workers communicate
Imagine going to the reception desk and being respect for each other. Colleagues who do not show
greeted with the phrase ‘What you after then?’ Some respect for each other may fail to show respect to
people might actually prefer such an informal greeting. the people who use care services.
It might put them at ease, making them feel that the
• You may often have to greet colleagues by asking
other person is like them. But in many situations, such
if they are well and spend time on ‘warm-up talk’ in
informal language could make people feel that they
order to show that you value them.
are not being respected. Being ‘after something’ could
be a ‘put down’; you might assume that you are being • You will need to demonstrate that you are a good
seen as a scrounger. So it is often risky to use informal listener and can remember details of conversations
language unless you are sure that other people expect with your colleagues.
you to do so. If you are treated informally, you may • Colleagues have to develop trust in each other. It
is important to demonstrate that you respect the
Hiya, confidentiality of conversation with colleagues.
I’m ’ere to assess • Work settings may have their own social
some geezer who lives
’ere – that you? expectations about the correct way to communicate
thoughts and feelings. These may differ from social
expectations when communicating with your friends
and family.
Although communication between colleagues may
often be informal it is important that care workers use
skilled communication in order to develop respect and
trust.
PLTS
Independent enquirer: The following activity will
help you demonstrate that you can identify questions to
answer, and explore issues from different perspectives.
Creative thinker: You may also be able to demonstrate
that you can connect your own and other people’s
experiences in inventive ways.
Fig 1.2: Informality can be seen as a sign of disrespect
6
well aware of the need to translate technical language

Activity 2: Formal and into everyday language when they work with people
informal communication from other professions or people who use services.
It is important that professionals check that they are
Get together with a small group of colleagues
and imagine an introductory meeting between not being misunderstood (see section 2 on the role of
a student and a care manager as part of a work feedback).
practice placement. One person should act as the
manager and another as the student. Work out Communication with professionals
how the manager would welcome the student and When people who use services communicate with
explain the work of the care centre. Then work out professionals there is always a risk of misunderstanding
what questions the student should ask. After you between people from different language communities.
have performed this simulation or role-play, two
It is important that people check that they are being
other students should undertake exactly the same
task, but this time they should pretend that they are understood correctly. Professional health and social
close friends chatting about the situation. care staff need to check their understanding of issues
with people who are communicating with them.
The whole group should then discuss the
differences between these two simulations. Multi-agency working
Health and social care professionals often have to
communicate with colleagues who work for different
organisations. For example, a home care organiser
Functional skills
might have to communicate not only with people who
English: Your discussion activity may also contribute use services and care workers but also with community
towards English speaking and listening skills. nurses, GPs’ surgeries, hospital services, occupational
therapists, voluntary groups, day care groups and
Communication between professional people many other organisations. It is important not to assume
that people from different agencies will understand
and people using services
Professional people, such as doctors and nurses, often
work within their own specialised language community. Key term
A language community is a community of people that Language community – A social community of people
has developed its own special words, phrases, social that has its own special ways of using language in order to
expectations and ways of interacting that set it apart communicate between group members.
from other groups of people. Professionals are usually
Case study: Amber

The following conversation took place between 1 If Amber had spoken to her colleagues
members of the same family: like this, would they have assumed that Amber
respected and valued them?
Mother: How was your day at work?
2 Can you explain why a conversation like this
Amber: OK, didn’t do much, walked about a bit. might be acceptable within a family context but
Have to learn where everything is – like. not within a work context?
Mother: Did you enjoy it there? 3 Can you explain how Amber should change her
Amber: Suppose it was all right. I had to listen comments if she was describing her first day at
to a guy going on about stuff but it was boring. work to a professional colleague?
Might be better tomorrow. I am going to ‘do’ the
residents tomorrow – they should be more fun!
7
the same terminology. Formal communication may

help to convey respect and avoid misunderstandings
Reflect
when interacting with unfamiliar professionals in other No one has ever written a rule book defining how
agencies. health and social care workers should behave in
all the different contexts listed above. One of the
Multi-professional working reasons this has not been attempted is that every
interaction involves a feedback cycle (see section
Professionals from different backgrounds often have
2 in this unit). There may not be a single correct
to work together in order to assess and meet the way of handling each interaction.
needs of people who use services. Multi-professional
working happens when many different professionals
work together. Communication will often need to be
formal and carefully planned in order to avoid barriers
to understanding.
Table 1.1: Degrees of formality in different contexts

Context Degree of formality Key issues
Between colleagues Often informal. Must demonstrate respect for each
other.
Between professionals and people Usually informal. Professionals must adapt their
using services language (not use technical terms or
jargon) in order to be understood.
With professionals People using services may Professionals must take
communicate informally. responsibility for checking their
Professionals may respond formally. understanding.
Multi-agency working Usually formal – unless workers Important not to make assumptions
know each other well. or use technical terminology.
Multi-professional working Usually formal – may need formal Different professional people must
planning to produce ‘agendas’ for be careful to check that they are
business. understood.
Case study: Karen

Karen is a home care worker. ‘She makes you feel special – not just one of
Here are some statements the crowd.’
that people have made about ‘She is very kind and considerate. There aren’t very
the way she works: many people like her – it’s a sort of magical touch –
‘I always feel better when she you feel different when she is around.’
visits – she always smiles and Karen has excellent interpersonal skills – a ‘magical
cheers me up if I feel down.’ touch’. Karen’s skills enrich her own life and the lives
‘She makes you feel important of other people.
– she always listens to you, 1 Why do some people get on so well with other
even when she is very busy.’ people?
‘She is so easy to talk to – she takes an interest in 2 What makes someone good at interpersonal
you. She is never ‘bossy’ or ‘posh’ – she’s like one of work?
my family’.
8
1.2 Forms of communication 1.3 Types of interpersonal

Communication between people enables us to interaction
exchange ideas and information but it involves
much more than simply passing on information to Speech
others. Communication helps people to feel safe, to Different localities, ethnic groups, professions and work
form relationships and to develop self-esteem. Poor cultures all have their own special words, phrases and
communication can make an individual feel vulnerable, speech patterns. These localities and groups may be
worthless or emotionally threatened. referred to as different speech communities. Some
There are many different types of communication as people may feel threatened or excluded by the kind of
shown in Fig. 1.3 below. language they encounter in these speech communities.
However, just using formal language will not solve
this problem. The technical terminology used by care
Activity 3: Communicating workers (often called jargon) can also create barriers for
emotion people who are not a part of that ‘speech community’.
When people from different geographical areas use
Get together with a small group of colleagues and different words and pronounce words differently they
discuss the relative importance of all the different are often using a different dialect. Some social groups
types of communication in Fig. 1.3 when you try use slang – non-standard words that are understood
to communicate emotions such as feeling happy
by other members of a speech community but which
or sad. Discuss whether or not spoken words are
usually the best way to communicate emotion. cannot usually be found in a dictionary.
Key terms
Jargon – Words used by a particular profession or group that
are hard for others to understand.
PLTS Dialect – Words and their pronunciation, which are specific to
Creative thinker: This activity will help you a geographical community. For example, people who live in
demonstrate that you can generate ideas and explore the north west of England might use a different dialect from
possibilities. Londoners.
Independent enquirer: The activity may also lead you Slang – Informal words and phrases that are not usually found
to identify questions and problems to resolve. in standard dictionaries but which are used within specific
social groups and communities.
Artwork, paintings,
photographs,
sculptures, architecture,
One-to-one spoken Unspoken ornaments and other
Text messaging using
communication communication using objects communicate
mobile phones
between individuals facial expressions messages and
emotions
Music and drama Communication

have been called the using information
language of emotion. Types of technology, e.g.
Mime and drama communication emails and other
provide powerful ways technological aids to
of communicating communication
Braille communication
Spoken (oral) using raised marks
communication within Written The use of signed
communication (visual) languages on paper that can be
groups of people touched
Fig 1.3: Forms of communication
9
Case study: Professional jargon

The following conversation involves speech from for guidance that must be followed by all
different speech communities. PCTs to result in a national assessment process
supported by a checklist tool, decision support
Relative: If my mother needed care who would pay
tool, and fast track tool which are used to provide
for it?
clarity, transparency and consistency in the
Professional: Well the national framework for NHS decision-making process for eligibility.
continuing health care and NHS funded nursing 1 Can you work out what the professional is talking
care provides principles and processes for an about?
assessment process that will establish eligibility for
NHS continuing health care. 2 Can you see how technical and legal terminology
can exclude people?
Relative: So the NHS would pay for care?
3 Will the relative feel helped and respected by
Professional: No, as I said, the framework provides such a technical answer?
Did you know?

Non-verbal communication
Within a few seconds of meeting an individual you will
Teenagers can be thought of as a speech community usually be able to tell what they are feeling. You will
with their own slang. Lucy Tobin has published a book know whether the person is tired, happy, angry, sad,
called Pimp your vocab, which acts as a dictionary for
frightened – even before they say anything. You can
‘teek people’ – people who are outside the teenage
speech community. This ‘teenglish dictionary’ enables
usually guess what a person feels by studying their
others to understand teenage terminology. non-verbal communication.
Many people think the book is great fun, but some Non-verbal means ‘without words’, so non-verbal
critics argue that adolescent language changes so communication refers to the messages that we send
rapidly that it is hard to keep up to date and to be without using words. We send these messages using
sensitive to local variations. our eyes, the tone of our voice, our facial expression,
our hands and arms, gestures with our hands and arms,
First language the angle of our head, the way we sit or stand (known
The author and psychologist Steven Pinker (1994) as body posture) and the tension in our muscles.
estimated that there may be about 600 languages Posture
in the world that are spoken by more than 100,000
The way you sit or stand can send messages. Sitting
people. There are many more minority languages.
with crossed arms can mean ‘I’m not taking any notice’.
Some people grow up in multilingual communities,
Leaning back can send the message that you are
where they learn several languages from birth. But
relaxed or bored. Leaning forward can show interest or
many people in the UK have grown up using only one
intense involvement.
language to think and communicate. People who learn
a second language later in life often find that they
cannot communicate their thoughts as effectively as
they might have done using their first language. The
first language that people have learned to think in
usually becomes their preferred language.
Key term
First language – The first language that a person learns to
speak is often the language that they will think in. Working Person 2 Person 1
with later languages can be difficult, as mental translation
between languages may be required. Fig 1.4: You can see that person 2 is rejecting what person 1 is
communicating
10
The way you move

As well as posture, your body movements will
communicate messages. For example, the way you
walk, move your head, sit, cross your legs and so
on will send messages about whether you are tired,
happy, sad, or bored.
Facing other people
The way in which you face other people can also
communicate emotional messages. Standing or sitting
face-to-face may send a message that you are being
formal or angry. A slight angle can create a more
relaxed and friendly feeling.
Fig 1.5: Square-on orientation can communicate aggression Can you see how a person’s emotions
can often be interpreted from their facial
expression?
Gestures
Gestures are hand and arm movements that can
help us to understand what a person is saying.
Facial expression
Some gestures carry a common meaning in most
communities in the UK. Your face often indicates your emotional state. When a
person is sad they may signal this emotion by looking
down – there may be tension in their face and their
mouth will be closed. The muscles in the person’s
shoulders are likely to be relaxed but their face and
neck may show tension. A happy person will have
‘wide eyes’ that make contact with you – and they will
probably smile. When people are excited they move
their arms and hands to signal this.
We can guess another person’s feelings and thoughts
by looking at their eyes, using eye-to-eye contact. Our
eyes get wider when we are excited, attracted to, or
interested in someone else. A fixed stare may send the
message that someone is angry. In European culture,
looking away is often interpreted as being bored or
Fig 1.6: Common gestures for ‘good’ and ‘perfect’ not interested.
11
Most people can recognise emotions in the non-verbal touch, or gesture in a way that allows another person
behaviour of others. You will also need to understand to refuse your touch, before proceeding.
how your own non-verbal behaviour may influence People may also look at, or feel, the degree of muscle
other people. tension that you show when you communicate with
Touch them. The tension in your feet, hands and fingers can
tell others how relaxed or tense you are. If someone
Touch is another way of communicating without words.
is very tense their shoulders might stiffen, their face
Touching another person can send messages of care,
muscles might tighten and they might sit or stand
affection, power over them or sexual interest. The
rigidly. A tense person may have a firmly closed mouth,
social setting and a person’s body language will usually
with lips and jaws clenched tight, and they might
help you to understand what their touch might mean.
breathe quickly.
But touch can easily be misinterpreted. You might try
to comfort someone by holding their hand but they Silence
may interpret this touch as an attempt to dominate.
One definition of friends is ‘people who can sit
Sometimes it can be a good idea to ask if you may
together and feel comfortable in silence’. Sometimes
a pause in conversation can make people feel
embarrassed – it looks as if you weren’t listening or
Case study: Tonya you weren’t interested. Sometimes a silent pause can
Tonya is 15 years old and attends meetings
mean ‘let’s think’ or ‘I need time to think’. Silent pauses
of a youth group. She often sits with her arms can be OK, as long as non-verbal messages that show
crossed and her head turned away, looking out of respect and interest are given. Silence doesn’t always
the window. She avoids making eye contact with stop the conversation.
people who are speaking to the group. When
asked if she feels OK, she does make eye contact, Voice tone
changes her body posture and says she is happy to When you speak to other people, your tone of voice
be in the group.
is important. If you talk quickly in a loud voice with a
1 What messages would crossed arms and fixed tone, people may think you are angry. A calm,
avoidance of eye contact normally send?
slow voice with a varying tone may send a message of
2 How many reasons can you think of to explain being friendly.
why someone might sit with their arms crossed,
looking out of the window, while other people Proximity
are speaking?
The space between people can sometimes show how
3 How can you find out what an individual’s body
friendly or ‘intimate’ the conversation is. Different
language means?
cultures have different customs regarding the space
between people when they are talking.
In Britain there are expectations or ‘norms’ as to how
close you should be when you talk to others. When
.
talking to strangers we usually keep ‘an arm’s length’
apart. The ritual of shaking hands indicates that you
have been introduced – you may come closer. When
you are friendly with someone you may accept them
being closer to you. Relatives and partners might not
be restricted at all in how close they can come.
Proximity is a very important issue in health and care
work. Many people have a sense of personal space.
A care worker who assumes it is fine to enter the
personal space of a person who uses services, without
asking or explaining why, may be seen as dominating
Fig 1.7: Gestures and words give a person the option of
refusing touch or aggressive.
12
Reflective listening • checking your understanding with the person who

We can often understand other people’s emotions just was speaking to you.
by watching their non-verbal communication. However, We can learn about people who are different from
we can’t always understand someone’s thoughts us by checking our understanding of what we have
without good listening skills. heard. Checking understanding can involve listening to
Listening skills involve hearing another person’s what the other person says and then asking questions.
words, then thinking about what their words mean, Reflection may also involve putting what a person has
then thinking about how to reply to the other person. just said into our own words (paraphrasing) and saying
Sometimes this process is called ‘active listening’ and it back to them, to check that we have understood
sometimes ‘reflective listening.’ The word ‘reflective’ what they were saying.
is used because the person’s conversation is reflected When we listen to complicated details of other
back (like the reflection in a mirror) in order to check people’s lives, we often begin to form mental pictures
understanding. As well as remembering what a person based on what they tell us. The skill of listening
says, good listeners will make sure that their non-verbal involves checking these mental pictures. Good
behaviour shows interest. listening involves thinking about what we hear while
Skilled listening involves: we are listening and checking our understanding as
the conversation goes along – we reflect on the other
• looking interested and communicating that you are
person’s ideas.
ready to listen
Good listening can feel like really hard work. Instead
• hearing what is said to you of just being around when people speak, we have to
• remembering what was said to you, together with build an understanding of the people we communicate
non-verbal messages with.
Message sent
Message is ‘reflected’
back like an image
in a mirror
Personal space
Close relationships
Fig 1.9: Why is it important to see our understanding reflected
Personal space
with friends back to us?
Public space
Fig 1.8: There are different expectations about personal space
13
Case study: Sarah

Sarah is unemployed and is looking for work in a • Repeating what was said, e.g. ‘You never
specialised field. She looks worried and says ‘I don’t get a job offer.’
know what to do. I keep looking for work and going Parroting some phrases back to a person may
for interviews but I never get a job offer.’ Given that sound mechanical. The person might say: ‘That’s
you know nothing about the kind of job she is looking what I just said – didn’t you hear me?’
for, how can you respond in a skilled way? Consider • Reflecting the other person’s message, e.g. ‘It must
some of the possibilities below: be worrying when you can’t get a job.’
• Try to be reassuring, e.g. ‘I’m sure you will get a job This shows that you have listened and it may be
eventually.’ seen as an invitation to keep talking. Being able to
Unless you are an expert with detailed knowledge talk to someone who is actively involved may make
of the job market, reassurance is likely to sound the other person feel that they are being taken
false. You may come across as trying to avoid the seriously.
topic or trick the person. 1 What is the difference between saying things such
• Offer advice, e.g. ‘Why don’t you see a careers as ‘Why don’t you see an adviser’ or ‘I’m sure you
adviser?’ will get a job eventually’ and just saying ‘I don’t
Receiving unwanted advice can sometimes be very want to talk to you about it’?
irritating. The person may have already thought of 2 Can you explain the difference between just
seeing an adviser. You might come across as trying repeating or parroting the words you have heard
to sound clever and superior to Sarah. You might and the idea of reflective listening?
be seen as trying to avoid the issue, i.e. ‘This is all I
can think to say, please don’t talk to me about this 3 Why might another person feel that you care
any more.’ about them because you can reflect back what
they have said?
1.4 Communication and language community should be identified as ‘culturally Deaf’ by

using a capital ‘D’ for Deaf. This emphasises that ‘Deaf’
needs and preferences people use another language system, as opposed to
Spoken and written English are not the preferred ‘Deaf’ people who are perceived to be impaired.
system of communication for everyone. The first (or Further details of BSL can be found at
main) language of many Deaf people may be a signed www.bda.org.uk
language. People who are registered blind may use Details of signs and a finger spelling alphabet
Braille, as opposed to written text, in order to read can be found at www.british-sign.co.uk and at
information. www.royaldeaf.org.uk
British Sign Language Makaton

British Sign Language is a language in its own right Makaton is a system for developing language that
– not simply a signed version of spoken English. The uses speech, signs and symbols to help people with
British Deaf Association explains that British Sign learning difficulties to communicate and to develop
Language is the first or preferred language of many their language skills. People who communicate using
Deaf people in the United Kingdom. The British Deaf Makaton may speak a word and perform a sign using
Association also explains that BSL was recognised as hands and body language. There is a large range of
an official British language in 2003 and the Association symbols to help people with learning difficulties to
campaigns for the right of Deaf people to be educated recognise an idea or to communicate with others.
in BSL and to access information and services Further information on Makaton can be found at
through BSL. Many Deaf people argue that the Deaf www.makaton.org
14
Activity 4: Research Written communication

people’s understanding There is a Chinese saying that ‘the faintest ink is
stronger than the strongest memory’! Written records
of BSL are essential for communicating formal information
Do people understand what British Sign Language that needs to be reviewed at a future date. When
is? Plan a short series of questions and ask people people remember conversations they have had, they
who are not studying this course if they have will probably miss out or change some details. Written
ever heard of British Sign Language and what statements are much more permanent and, if they are
kind of language it might be? You may find that
accurate when they are written, they may be useful
the majority of people think that BSL is a way of
signing English words – in other words that to later on.
sign in BSL you would first have to know English.
Only a few people might understand that BSL is
Pictures and objects of reference
a separate language developed within the Deaf Paintings, photographs, sculptures, architecture,
community. Discuss what consequences your ornaments and other household objects can
research might have for both Deaf and hearing communicate messages and emotions to people.
people. People often take photographs or buy souvenirs to
remind them of happy experiences and emotions.
Sometimes an object – such as a cuddly toy – can
PLTS symbolise important personal issues and provide a
source of meaning and comfort for an individual.
demonstrate that you can plan and carry out research
and appreciate its consequences.
Key term
Object of reference – An object of reference is a physical
Braille object or picture that has become associated with an activity,
Braille (a system of raised marks that can be felt person or other special meaning.
with the fingers) provides a means of written
communication, based on the sense of touch, for
people who have limited vision. The communication Objects can sometimes be used to communicate
system known as Braille was first published by Louis with people who do not use much signed or spoken
Braille, a blind 20-year-old, in 1829. This system is now language. A child or adult with a learning disability
widely used, for reading and writing, by people who might understand that a cup stands for ‘would you like
cannot see written script. a drink’. An object like a spoon tied to a card might
Modern computer software can translate written communicate that it is time for dinner when the spoon
material into Braille, which can be printed out using is presented. A person without language might use
special printers. Further details on Braille can be found a patch of cloth to communicate that they wish to
at www.brailleplus.net sit in a favourite chair covered in that type of cloth.
Sometimes a person might learn a symbol, perhaps
Use of signs and symbols a symbol like a horseshoe that can be used to label
Gestures made with hands or arms, written symbols possessions or identify his or her room.
or diagrams (such as traffic signs) all communicate
Finger spelling
messages to people.
People who use a signed language, such as British
Sign Language, also use finger spelling. Finger spelling
enables signers to spell out words that do not have
a general sign, or words that may be misunderstood
such as the names of people and places.
Fig 1.10: What meanings do these signs communicate?
15
speech into writing. Some electronic communication

Reflect systems can be activated by air pressure, so that a
Imagine that you had to spell every word in person can communicate via an oral tube connected
a phone conversation – it would take a long
to computerised equipment. At a simpler level, aids
time and the conversation would not be very
such as flash cards or picture books can also improve
enjoyable. For this reason, people who use
signed languages do not generally use finger communication with people who do not use a spoken
spelling to communicate, other than for specific or signed language. Text messaging, using a mobile
terms. phone, provides an effective way of staying in touch for
many people. For people with a hearing disability, text
messaging may provide a major form of communication.
Communication passports
Communication passports are usually small personalised
books containing straightforward practical information
about a person and their style of communication. Did you know?
The passport may help health and care workers to
In August 2009 a Roman Catholic Archbishop, Vincent
understand the needs of a person with communication
Nichols, was reported as saying that ‘too much
difficulties. Communication passports often include exclusive use of electronic information dehumanises
photographs or drawings that may help care workers what is a very, very important part of community life
to gain a better understanding of the person who owns and living together... We’re losing social skills, the
the passport. They are put together by working with human interaction skills, how to read a person’s mood,
the person with communication difficulties and his or to read their body language.’
her carers; the person tells their own story of their likes, How far do you think email and text messages may
dislikes and communication styles. spoil or improve relationships between people?
Technological aids to communication

Information technology offers a wide range of facilities When you send text messages to friends, do you
to help with communication. It is possible to provide use symbols and shortened words that would not be
enlarged visual displays or voice description for acceptable in more formal academic work? If you send
people with visual impairment. Electronic aids – such emails, do you use abbreviations, symbols and special
as the minicom for people with a hearing disability terms or do you only use formal English? Do you think
or voice typing for people with dyslexia – can turn it should be acceptable to use ‘texting’ symbols and
abbreviations for academic work? How formal should
English be?
Human aids to communication

Think about the way children communicate
Many people have specific communication needs. It
through play using objects
may be important to employ an interpreter if a person
uses a different language such as BSL. Some carers
learn to use communication systems, such as Makaton,
in order to help them communicate with people.
If you are communicating with a person with a hearing
impairment you should make sure that the person
can see your face clearly so that they can see your
expressions and the way your lips move. Sometimes
people use clues from facial expression and lip
movement to interpret what you might be saying. It
is also important to speak in a clear, normal voice. If
you raise your voice, your face and lips will become
distorted. A person with a hearing impairment may
realise that you are shouting and may assume that you
16
are angry! It is also important to try and speak in an No one can learn every possible system of cultural
environment with little background noise. variation in non-verbal behaviour but it is possible
If people have limited vision, it may be important to learn about the ones that are used by the people
to use language to describe issues that a sighted you are with! You can do this by first noticing and
person might take for granted, such as non-verbal remembering what others do – in other words, what
communication or the context of certain comments. non-verbal messages they are sending. The next step
Touch may be an important aspect of communication. is to make a guess as to what messages the person is
For instance, some registered blind people can work trying to give you. Finally, check your understanding
out what you look like if they can touch your face in (your guesses) with the person. This involves reflective
order to build an understanding of your features. listening and thinking carefully about the person’s
responses.
It is always important to choose the right style of
language in order to communicate with people from
different language communities.
Key term
Variation between cultures Cultural variation – Communication is always influenced
Skilled carers use a range of conversational techniques by cultural systems of meaning. Different cultures interpret
when working with others. These include being verbal and non-verbal communication behaviours as having
sensitive to variations in culture. different meanings.
Culture means the history, customs and ways of

behaving that people learn as they grow up. People Care workers must be careful not to assume that
from different regions of Britain use different statements and signs always have the same meaning.
expressions. Non-verbal signs vary from culture to Cultural differences and different settings can alter
culture. White middle-class people often expect what things mean. A vast range of meanings can be
people to ‘look them in the eye’ while talking. If a given to any type of eye contact, facial expression,
person looks down or away a lot, they think it is a sign posture or gesture. Every culture, and even small
that the person may be dishonest, or perhaps sad groups of people, can develop their own system of
or depressed. In some other cultures – for example, meanings. Care workers have to respect differences
among some black communities – looking down or but it is impossible to learn all the possible meanings
away when talking is a sign of respect. that phrases, words and signs may have.
Assessment activity 1.1 P1
Explain, using examples you have observed, the role the anonymity of individuals and any details
of communication and interpersonal interactions in that might enable individuals or settings to be
health and social care. identified.
Grading tip Consider what is meant by ‘effective’ when

discussing communication and interpersonal
P1 Maintain a logbook to record notes of interactions in health and social care.
interactions you have observed in class role
plays, informally with your peers, with others at Consider formal and informal communication,
work and in school/college or in public spaces differences between different language
and particularly in health and social care settings communities and cultures and the role of verbal
when visiting or in placements. Note behaviours, and non-verbal communication in interpersonal
non-verbal communication skills and how the interactions.
communication cycle is/is not demonstrated. Include examples of different language needs
Remember that your notes should maintain and preferences in your explanation.
17
2 Understand factors that influence communication

and interpersonal interaction in health and social
care environments
2.1 Theories of communication
The communication cycle Key term
Communication cycle – Most important communication in
Effective communication involves a two-way process in care work involves a cycle of building understanding using an
which each person tries to understand the viewpoint active process of reflecting on, and checking out, what the
of the other person. Communication is a cycle other person is trying to communicate.
because when two people communicate they need to
check that their ideas have been understood. Good
communication involves the process of checking One way of looking at this cycle might be:
understanding, using reflective or active listening.
1 An idea occurs: You have an idea that you want to
Michael Argyle (1972) argued that interpersonal communicate.
communication was a skill that could be learned and
2 Message coded: You think through how you are
developed in much the same way as learning to drive
going to say what you are thinking. You put your
a car. Argyle emphasised the importance of feedback
thoughts into language or into some other code
in skilled activities. When you drive a car you have
such as sign language.
to change your behaviour depending on what is
3 Message sent: You speak, or perhaps you sign or
happening on the road. Driving involves a constant
write, or send your message in some other way.
cycle of watching what is happening, working out how
to respond, making responses and then repeating this 4 Message received: The other person has to sense
cycle until you reach your destination. your message – they hear your words or see your
symbols.
According to Argyle, skilled interpersonal interaction
(social skills) involves a cycle in which you have 5 Message decoded: The other person has to
to translate or ‘decode’ what other people are interpret or ‘decode’ your message (i.e. what you
communicating and constantly adapt your own have said). This is not always easy, as the other
behaviour in order to communicate effectively. person will make assumptions about your words
Verbal and non-verbal communication is not always and body language.
straightforward. The communication cycle involves a 6 Message understood: If all goes well then your
kind of code that has to be translated. You have to work ideas will be understood but this does not always
out what another person’s behaviour really means. happen first time!
2. Message coded 4. Message perceived
1. Ideas
occur
3. Message sent 5. Message
decoded
6. Feedback –
what was
understood
Fig 1.11: What are the stages in the communication cycle?
18
Case study: Karen

Karen is talking to Jasmin, In this brief example, there is no helpful advice or
whose partner has died. information that Karen can offer. Karen is careful to
reflect back what Jasmin has said. This results in a
Jasmin: I can’t believe it.
communication cycle in which Jasmin can begin to
I don’t know how I’m going
share her feelings.
to cope on my own, I can’t
sleep or eat. 1 Can you explain why it is so important for care
workers to say back what they understand?
Karen: You must feel awful,
it must have been a terrible 2 What might have happened if Karen had
shock. responded with ‘Don’t worry, you’ll feel better as
time goes by’?
Jasmin: I’ll say it was – I just feel so anxious. I know I
won’t be able to cope. 3 How can understanding the communication
cycle help care professionals to develop skilled
Karen: Can you tell me a little about your life communication?
together?
through a process of group formation. Many groups

Activity 5: Observe the may experience some sort of struggle before people
communication cycle unite and communicate effectively. One of the best-
known theorists to explain group formation stages is
Work in a small group and plan how to record the
speech and faces of two people talking. Agree on Tuckman (1965). Tuckman suggested that most groups
a topic of conversation and record pairs of people go through a process involving four stages. These are:
talking to each other for up to five minutes. Analyse 1 forming
your recordings in terms of the six stages of the
communication cycle.
2 storming
3 norming
4 performing.
The first stage (forming) refers to people meeting for
PLTS the first time and sharing information. The second
Independent enquirer: This activity may help you stage (storming) involves tension, struggle and
demonstrate that you can analyse and evaluate sometimes arguments about the way the group might
information. function. The third stage (norming) sees the group
coming together and consciously or unconsciously
agreeing on their group values. Once they have
Functional skills established common expectations and values, the
group will reach the fourth stage of being an effectively
ICT: Discussing this activity may help you demonstrate performing group.
that you can evaluate the selection and use of ICT
tools and facilities used to present information.
Key term
Group values – Group members need to share a common
Tuckman’s stages of group interaction system of beliefs or values in order for the group to
Communication in groups can also be influenced by communicate and perform effectively. You may be able to
the degree to which people feel they belong together. identify these values when you watch a group at work.
When people first meet in a group they often go
19
Day centre team leader
Pinewoods
is a day centre for adult people
with learning disabilities. Jenna is the team leader
for a new group of care workers who have only been working
together for the past two weeks. They have regular team meetings
and this is an extract from their third meeting in which they are
discussing the activities that they lead with day centre members.
Jenna: Let’s talk about the cookery sessions. I think that members are
really enjoying learning to cook.
Carly: Maybe, but I worry about what we’re doing. We don’t
watch people carefully enough. For example, Drew nearly
burned himself last Tuesday because nobody was
watching what he was doing.
André: Yes, but he didn’t burn

himself and he is learning to become independent. I
think it’s important to let people take risks. I could never have become
independent if my parents hadn’t let me take risks!
Deja: So it’s all right for Drew to burn himself, is it? Is that what you’re saying?
Shanice: I can’t believe you just said that! André is talking about the importance of independence
and you turn that round to saying he doesn’t care about people burning themselves. That’s not what he
said – you didn’t listen!
Deja: Now you listen to me! What I am saying is that we don’t take safety seriously enough. These people
are vulnerable, they can hurt themselves if we don’t take proper care.
Jenna: OK, we all know that both safety and independence are central to our work here. So why are
we talking as if we can’t have both?
Deja: Well, I agree that both are important, but safety comes first as far as I’m concerned.
Shanice: Well I don’t think things are that simple. It is possible to concentrate
too much on safety and then we might stop people from reaching their
potential of independence. It’s a matter of getting the
balance right.
Think about it!

1 Using Tuckman’s theory, can you identify which stage of group formation this group is at?
2 Can you identify different norms that are being argued about in the group?
3 Can you identify the different ‘sides’ being taken in the discussion and how Jenna is starting to use
her group leader role to get the team to focus on common values?
4 If this group is to succeed in working they will have to share common ‘norms’. Can you guess on
what norms the group might eventually agree?
5 If you were in Jenna’s position, how would you lead the conversation on from Shanice’s last
comment in order to reach the ‘norming stage’ of team working?
20
Assessment activity 1.2 P2 M1
Using examples from your experience, discuss Participation in a series of group tasks with
theories of communication. This assessment could be the same group of individuals over a period
integrated with Assessment Activity 1.1. of several weeks and an analysis of how your
For M1, you should also include an assessment of the work with each other changes over time could
role of effective communication and interpersonal provide useful understanding of Tuckman’s
interaction in health and social care. theory. This could involve group work in class
with your peers or how you settle into working
Grading tips with a group of individuals in a work experience
placement or any employment.
P2 Consider how communication theory helps to
explain effective communication in health and M1 Integrate your assessment by using the
social care contexts. examples explained for P1 and discussed in P2.
Consider one-to-one and group interactions, The assessment should consider strengths
formal and informal communication, different and weaknesses of communication and
types of communication and different forms of interpersonal interactions you have observed
interpersonal interaction in your discussion. in relation to theories relating to the
communication cycle and group formation
Reviews of filmed class role-plays in which
you and your peers have participated would Remember to consider a range of health
be helpful to gain understanding of the and social care contexts, different forms
communication cycle. of communication and different types of
interpersonal interaction in your assessment.
2.2 Environmental factors that Activity 6: Plan a good

influence communication environment for group
It is very hard to hear what someone is saying if there communication
is a lot of background noise. It is also very difficult
Get together with a group of colleagues and make
to make sense of other people’s facial expressions
a list of what an ideal environment for videoing a
if you can’t see their faces properly due to poor group discussion would involve. Work out what
lighting. Rooms with awkward seating positions might practical changes you may be able to introduce
mean that a group of people cannot see each other into your own working environment.
comfortably. People sometimes feel uncomfortable if
they are trying to communicate with a person who is PLTS
too close or at a distance. A room that is too hot, stuffy
Creative thinker: This activity will help you
or cold may inhibit communication if it makes people
demonstrate that you can generate ideas and explore
feel tired or stressed. possibilities and perhaps try out alternatives.
The environment also plays an important role in the
effectiveness of communication aids. For instance,
hearing aids will amplify background noise as well as
2.3 Barriers to communication
A barrier blocks things and stops them ‘getting
the voice of the speaker. A noisy environment may
through’. There are different types of communication
therefore be difficult and unpleasant for someone who
barrier that stop communication from being effective.
is using a hearing aid. Good lighting will be critical for
Three types are shown in Table 1.2 on page 22.
someone who supports their understanding of speech
with lip reading. Time limits on how long you can use a Where the first and second types of barriers exist, it
room can also interfere with communication. will usually be obvious that communication has failed.
However, distorted understanding is not always easy
to identify. Skilled use of the communication cycle may
help you to check what has been understood or what
communication barriers may exist. 21
Table 1.2: Communication barriers
Type of barrier Examples

1 Communication is not Not responding to language needs or preferences. Not understanding sensory
received impairment or disability.
Examples: Speaking to a Deaf person who uses a signed language. The sounds are
not received.
Environmental barriers:
Background noise can stop you from hearing a message. You can’t receive full
non‑verbal communication if you can’t see a person’s face or body.
2 Communication is received A person using slang, jargon or complex technical terminology can be heard, but
but not understood their message may not be understood.
3 Understanding is distorted A wide range of emotional and psychological factors can act as barriers, resulting
in distorted understanding of communication.
Key term
Communication barrier – Anything that stops the
development of understanding when people interact.
Fig 1.12: Consider why barriers can mean that no information Fig 1.13: How can psychological factors create communication
is communicated barriers by distorting perception of a message?
22
Case study: Karen

Interviewer: Some people who need care have ‘Can you remember what I told you?’
problems with understanding and memory. How do If I did that, the person might feel I was treating
you know if a person has understood what you are them like a child. So instead I asked them about
talking about? what they would be doing on the day that I had
changed from. They said that I would be coming
Karen: It’s not easy but sometimes you can tell from
to see them – and that was wrong – and so I was
a person’s face. When a person looks puzzled, or
able to remind them of the change. One way
if they don’t respond, then you know you’ve got to
of preventing misunderstanding is to just keep
try and explain something in a different way.
somebody talking.
But some people will nod 1 Can you explain why Karen does not like to ask
and smile although they direct questions such as ‘What did I just tell you?’
haven’t really understood or ‘When am I coming next then?’
you. So I try to keep
the conversation going 2 Can you think of some reasons why people
and find a way to check might nod and smile as if they understand, even
understanding. For example, if they don’t understand what you have tried to
I had to explain I would communicate?
come on a different day. 3 In the example above, how is Karen using the
Now, I couldn’t ask the communication cycle?
person a direct question like
Types of communication: difficult, complex or Reflect

sensitive What can you say to a person who is upset and
Some communication between people is simply crying because they can’t cope, following the
about sharing or ‘transmitting’ information. For death of their partner?
example, someone might want to know what number
bus to catch, or they might ask for a drink of water.
should focus on emotional needs, rather than giving
Sometimes communication will be complex. For
out information.
example, a relative may want to know about funding
arrangements for care. A communication about Engebretson (2003) uses the idea of a caring presence
funding might involve a great deal of complex to explain what is needed in these situations. Creating
information. In this situation it would be important a caring presence is about sharing an understanding
to check what the relative already knew, and whether of the feelings that other people may be experiencing.
or not the individual understood the information you Sometimes simply being with a person who is lonely,
were providing. anxious or depressed can provide comfort. If you
believe that your carer understands your needs and
A great deal of communication in care work involves
is concerned about you, then just knowing that they
building an understanding of another person and
are near you can help you to feel supported. Non-
providing emotional support. Burnard and Morrison
verbal communication may sometimes communicate
(1997) argue that caring and communicating are
emotions and feelings more effectively than words.
inseparably linked. Communication that involves
emotional issues is often experienced as being difficult
or sensitive.
There is no advice or information that is likely to be Key term
very useful to a person who is overwhelmed by grief, Caring presence – Being open to the experience of another
but many people do want someone to be with them. person through a ‘two-way’ encounter with that person.
Communication in this difficult or sensitive situation
23
If you can support people just by the way you are

‘present with them’ this may be because you are
Key terms
developing empathy with them.
Empathy – The ability to develop a deep level of
Empathy understanding of another person’s experience.
Communication disability – Difference that may create
Empathy involves a caring attitude where someone
barriers between people with different systems of
can see beyond his or her own assumptions about communication.
the world and can imagine the thoughts and feelings Sensory impairment – Damage to sense organs such as eyes
of someone else. A professional care worker who and ears.
can empathise will be able to imagine the emotions
associated with the pain and grief that another person
However, in this case, the disability is a social issue (to
is experiencing.
do with needing an interpreter), rather than a sensory
impairment issue.
Did you know? Barriers associated with personality, self-

Empathy is often regarded as a skill that can be esteem, anxiety and depression
developed through training but Carl Rogers, a famous Sometimes care workers can create their own barriers
counsellor, argued that empathy was a state of being. because they feel stressed by the emotional needs
This means that you have to experience your self of the people they work with. Listening to others can
and other people in a special empathetic way. In
involve hearing about frightening and depressing
Rogers’ view you couldn’t simply use empathy as a
communication tool or technique – you had to ‘live’ situations. Carers sometimes stop listening in order
empathy. to avoid painful emotions. Tiredness, lack of time or a
desire to avoid emotional stress can create a barrier to
providing caring communication.
Language needs/preferences Building an understanding of another person and
Most people will have a preferred first language. And establishing a ‘caring presence’ can be very difficult
this preferred language will sometimes be obvious when their personality or self-esteem needs create a
to you. But language needs go beyond the choice of barrier. Many people who are depressed or anxious
a preferred language. Different communities use a experience negative thoughts that ‘just come to them’.
given language in different ways. People use different Attempting to understand these thoughts and feelings
degrees of formality and informality, depending on the can feel like trying to find a way through a brick wall. It
context. For example, people may use jargon, dialect may feel as if there is an emotional barrier preventing
or slang to communicate effectively with people in the person from experiencing any positive emotions.
their own speech community. These differences can The case study on the next page illustrates this type of
create barriers to understanding. situation.
Sensory impairment and disability The carer in the case study opposite is not ‘just
talking’ – she is trying to steer the conversation
A sensory impairment means that a person’s senses
round to positive memories. The worker is using
do not work effectively. Impairments create the first
her understanding of Liam’s past to try and lead the
kind of communication barrier, where information is
conversation around the barrier of negative and
not fully received.
depressed thoughts. If the worker is successful, the
Disability is not the same as impairment. Some people conversation might lead to Liam having positive
experiencing barriers because of their difference thoughts and feelings and increasing his level of self-
may have a communication disability. For example, esteem.
a ‘Deaf’ person, whose preferred language is BSL,
experiences no problems communicating with another Asking questions
person who is good at signing with BSL. This person Talking through difficult, complex or sensitive issues
may not be able to communicate with people who will involve the verbal skills of asking open questions
use spoken English without the aid of an interpreter. and using probes and prompts within the conversation.
24
Case study: Liam

Liam: You can’t possibly understand what it feels Carer: So when you ran your own taxi business
like to be me. Absolutely everything is wrong with you were on top of everything – nothing could get
my life, I’ve got no reason to be alive and you can’t you down?
help me – what’s the point of talking?
Liam: Yeah – but I’ve got health problems now, I’m
Carer: But perhaps I could be useful if I knew more finished, that time is all gone.
about your life?
Carer: Yes, I know it feels terrible, but tell me about
Liam: What do you want to know? I’ve got no the good times. You dealt with problems then. I’d
money, no job, no future, no one cares about me – like to understand how you made it all work back
there’s no point in going on. then.
Carer: Right, so it feels really terrible, really bad, but Read the information on probes and prompts below
was there a time before things went wrong – a time and answer the following questions.
when you were happy? 1 Can you identify how the carer has used
Liam: Yes, a few years back everything was good – questions, probes and prompts in order to keep
but now I feel even more miserable because you the conversation going?
are reminding me of how much I’ve lost! 2 Can you explain how the carer may have
There is no simple way of removing this emotional used reflective listening in order to build an
barrier but some skilled workers might try to keep understanding of Liam’s situation?
the conversation going so that they could continue 3 Can you explain the importance of building an
to learn about the person. It might be possible to understanding of another person during a difficult
positively influence the person’s self-esteem as the and sensitive interaction?
conversation continues.
• Open questions: These cannot be answered with a Barriers associated with assumptions
yes or no response – they require a person to think
Building an understanding of other people’s needs
about their answer. Open questions are likely to
takes time and effort. Jumping to conclusions and
involve a complex communication cycle in order to
making assumptions can save mental effort and time,
discuss issues. They include questions such as ‘How
but assumptions may cause us to misinterpret what
would you describe your quality of life?’
another person is trying to communicate. For example,
• Probes: These are very short questions such as ‘Can you might believe that you don’t need to listen to a
you tell me more?’ Probes are used to dig deeper person because you already know what their needs
into the person’s answer – they probe or investigate are. But care workers who use the communication
what the other person has just said. cycle are less likely to make assumptions because they
• Prompts: These are short questions, which you check their understanding. Assumptions can create a
offer to the other person in order to prompt them barrier because people stop listening and checking
to answer. Prompts are questions such as ‘Would their understanding of other people’s communication.
you do it again?’ Some people make assumptions that people who
Barriers associated with aggression and have a disability are damaged ‘normal’ people. When
disabled people are seen in this way, they might
submissiveness be pitied or ignored. People with communication
When a person experiences strong emotions or
their self-esteem is threatened, that person may
become aggressive or withdrawn, creating barriers to
communication.
Key term
Assumption – An idea that people think is true or correct
See pages 30–33 for further information on aggression without bothering to check.
and submissiveness.
25
differences are sometimes assumed to be mentally Barriers associated with cultural variation
impaired. Older people are sometimes seen as
Culture refers to the different customs and
demented or confused if they do not answer questions
assumptions that communities of people adopt.
quickly, correctly and clearly. If care workers do not
Different ethnic and religious groups may have
bother to check their assumptions about people, these
different cultures, but different age, occupational
assumptions can turn into prejudices. And a prejudice
and geographical groups also make different cultural
or pre-judgement can result in discrimination.
assumptions.
Barriers associated with values and belief Words and non-verbal communication can be
systems interpreted differently depending on the context
and on the culture of the person using them. For
People have different belief systems – about what is
example, the word ‘hot’ can have different meanings
important in life and how people should live their lives.
depending on the context in which it is used and the
Values are the principles that we think of as being
culture of the person using it. In a formal context,
important or valuable, in terms of how we live our lives.
‘hot’ refers to having a high temperature. But in other
speech communities an object might be ‘hot’ if it has
Key terms been ‘stolen’ or if it is perceived as ‘very desirable’.
A hot person might be very good at something, or
Belief systems – The assumptions we use to make sense of
our lives. Our belief systems often include our values. be someone who is overcome with sexual desire! If
Values – What we think of as being important or valuable in
communication is interpreted only from a fixed cultural
terms of how we live our lives. standpoint, serious misunderstandings can arise. To
make sense of spoken and non-verbal language, you
need to understand the context of the interaction and
When people have different belief systems and the intentions of the person communicating.
values it is easy for them to misinterpret one another’s
intentions when attempting to communicate. Like
assumptions, belief systems and values can therefore Reflect
create barriers to understanding. It is important to Think of some words that can mean different
try to learn about other people’s beliefs and values things depending on the cultural context in
in order to make sense of what they are trying to which they are used. ‘Chilling’ is one example.
communicate.
Fig 1.14: Why does learning about other people’s beliefs help to avoid barriers to
communication?
26
An example of a non-verbal cultural variation might If you cannot control and make decisions about your
be the hand gesture in which the palm is held up and own life you may fail to develop, or you might lose
facing forward. In Britain this means ‘Stop, don’t do your sense of being a worthwhile person. If care
that’, whereas in Greece it can mean ‘You are dirt’ and workers control and manipulate you, your self-esteem
is considered a very offensive gesture. Why do the may be damaged.
same physical movements have different meanings? Care workers should seek to empower people who
One explanation could be that the British version of use services. Empowerment means giving power to
the palm-and-fingers gesture means, ‘I arrest you, you others. People who use services should be empowered
must not do it’, whereas the Greek interpretation goes to believe that they can make their own choices and
back to medieval times when criminals had dirt rubbed take control of their lives.
in their faces to show how much people despised
them.
It is important not to make assumptions about non- Key terms
verbal messages – they should always be checked. Empowerment – This enables a person who uses services to
Non-verbal messages can mean different things make choices and take control of their own life.
depending on the circumstances of the people who Power – In the context of interpersonal behaviour, ‘power’
are sending them. means the ability to influence and control what other people
do.
Case study: Gerard In order to empower others, care workers need to

Gerard is a tall, muscular, middle-aged man understand and value each person’s unique story.
who regularly talks to staff about his son’s care. Care workers must support the people they work
He prefers to stand squarely face-to-face and with, in taking control of important decisions. Care
speaks quickly, using a loud voice. Staff say that
workers must also carry out their work on the basis that
they feel uncomfortable talking to Gerard because
he sometimes ‘stares at you’ with a fixed gaze. everyone is of equal status. The care worker does not
Staff say ‘He is in your face’ because they feel that have higher status than people who use services.
he stands too close to them. Some staff think that
Gerard is aggressive and demanding because of
the way he acts.
Fixed eye contact
1 Can you identify how ‘cultural variation’ might
be important when trying to understand this Difference in height
situation?
2 Can you think of possibilities, other than being Inappropriate use of touch
demanding and aggressive, that might explain
Worker ignores feedback
the non-verbal behaviours described above?
3 How could you check what certain non-verbal
behaviours might mean during a conversation?
Use and abuse of power

The General Social Care Council (GSCC) Code of
Practice for Social Care Workers (2002) requires all
workers to respect individuality and support people
who use services to control their own lives. However,
there is always a danger that, if a care worker is short of
Fig 1.15: How do these non-verbal messages express power
time, they will seek to control people who use services. and domination?
It is an abuse of power if care workers deliberately
control and manipulate others.
27
Barriers associated with the effects of understood and also in distorted interpretations of the
message. Alcohol and drug abuse can therefore create
alcohol/drugs
all the barriers to communication shown in Figure 1.16
Alcohol and drugs can influence a person’s ability to on page 29. People with a distorted perception of
send clear verbal and non-verbal messages. Drugs that other people’s communication may be more likely to
affect the functioning of the central nervous system become frustrated or aggressive.
can easily result in messages not being received or
Case study: Karen

Interviewer: Why do a lot of meeting people and getting to know them.
people worry about having care I value everyone I work with; I think of them as
services? important. I am interested in their lives and I listen
Karen: Some people are afraid to what they tell me. I think values – what you
that you will come in and take believe in – are at the heart of how you work with
control of their lives, boss them people.
about, and make them feel stupid. Interviewer: So do you really need theories like
Interviewer: But care work is all about giving power to reflective listening and the communication cycle to
people who use services, making sure people are in be a good carer?
control of their own lives – so why do people worry? Karen: These ideas can help you to be more
Karen: Well, I am always short of time and it is sensitive and to understand what might be going
tempting to just take over and do everything my on. But care work is really about values, attitudes
way to get it done quickly. It’s easy to think you and feelings. Technical knowledge on its own,
know best – but if you make that assumption, you without the right values, isn't enough if you want
upset people and make them feel powerless. to enjoy caring for others and if they are going to
enjoy working with you.
Interviewer: Don’t some people like to sit back and
let you be in control? 1 Why should care workers not aim to control the
lives of the people they work with?
Karen: Some people say, ‘You do what you like,
buy me whatever you think I need – I don’t care.’ 2 Why does Karen try to encourage people to make
But that is a problem too. Sometimes people lose choices, even if they appear not to want to?
control of their lives and give up – they become 3 Can you explain what is meant by power in the
‘helpless’. They want you to make all the decisions context of interpersonal behaviour?
– have all the power. I still try to encourage them to 4 Can you identify what values Karen uses when she
make choices. talks to people who use care services?
Interviewer: There is so much to think about when 5 What does Karen mean when she says ‘If you’ve
you are working with people. How do you manage? got the right attitude then you tend to say and do
Karen: You have to have the right attitude – it’s a the right things anyway’?
sort of feeling. If you’ve got the right attitude you 6 Explain why Karen thinks technical knowledge,
tend to say and do the right things anyway. I enjoy without the right values, isn’t enough?
Again, use the examples used in Grading tip

the previous assessment activities
to explain the factors that influence P3 Integrate the evidence for this task with that for assessment
communication and interpersonal Activities 1.1 and 1.2.
interactions. Consider both positive and negative influences.
Consider one-to-one and group interactions, different forms of
communication and different types of interpersonal interaction.
28
3 Understand ways to overcome barriers in a health

and social care environment
3.1 Communication and national standards, codes of practice and legislation.
People who use services may be seen as having the
interpersonal interaction following rights.
Staff training Confidentiality
Many skills, such as communicating effectively with Confidentiality is an important right for all people who
anxious, depressed or aggressive people, cannot be use services because:
developed simply by obtaining information. Instead, • People may feel confident about sharing
people often develop their skills by reflecting on their information if they know that their care worker won’t
own practice experience and discussing thoughts and pass things on. They may not trust a carer if the
experiences with colleagues. Formal training courses carer does not keep information to themselves.
usually provide opportunities to practise important
• Keeping information confidential demonstrates
skills as well as theories about how to overcome
respect for people who use services. A lack of
communication barriers.
confidentiality may threaten people’s self-esteem.
Assessment of need and using preferred • A professional service, which maintains respect
methods of communication for individuals, must keep private information
confidential – in the same way that medical
It is important to build an understanding of the needs
practitioners and lawyers have always maintained
of people you work with in health and social care.
confidentiality.
Very often, people will make their preferred method
of communication obvious. Sometimes a professional • There are legal requirements (data protection) to
social work or medical assessment may be needed in keep personal records confidential.
order to clarify the person’s needs and their preferred • A person’s safety may be put at risk if details of
method of communication. their property and habits are shared publicly. For
example, if your home was empty and other people
Promoting rights knew where you kept your money, someone might
As well as general human rights, people who use be tempted to break in.
services have a range of rights that are established in
To be treated as an To be treated To be protected

individual in a dignified way from danger or harm
To be cared for in a
A service way that meets their
To be respected user’s rights needs and takes
account of choices
To be allowed access To be treated equally To be able to

To be given privacy to information about and not discriminated communicate using their
themselves against preferred method
Fig 1.16: What are the rights of people who use services?
29
Assertiveness To be assertive, a person usually has to:

Fear and aggression are two basic emotions that we • understand the situation they are in (including facts,
all experience. When we feel stressed, it is easy to details and other people’s perceptions)
give in to our basic emotions and be either submissive • be able to control personal emotions and stay calm
or aggressive. Assertion is an advanced skill, which • be able to act assertively, using the right non-verbal
involves controlling the basic emotions that usually behaviour
prompt you to run away or fight. It involves a mental
• be able to communicate assertively, using the right
attitude whereby you try to negotiate, and try to solve
words and statements.
problems rather than give in to emotional impulses.
Some of the emotions, attitudes and behaviours
During an argument, an aggressive person might
involved in assertion are summarised in Table 1.3 on
insist that they are right and other people are wrong.
page 31.
They will want to win, while others lose. The opposite
of aggression is submission. A submissive person Staying calm and in control of your emotions,
accepts that they will lose, get told off, or be put down displaying respect for others, using reflective listening
emotionally. Assertive behaviour is different from both and building an understanding of another person’s
these responses. In an argument, an assertive person viewpoint are all part of being assertive. Assertion
will try to find an answer that means no one has to lose is the skill of being able to understand another
or be ‘put down’. Assertion is a skill that helps create person’s viewpoint, while being able to help them to
‘win-win’ situations. understand your viewpoint. Assertion skills create a
situation where negotiation is possible.
Assertion does involve a special kind of attitude. You
are going to stick up for yourself – but you are not
Key term trying to dominate or get power over other people.
Assertion – Assertion is different from both submission and
You are trying to reach the best outcome for everyone.
aggression. It involves being able to negotiate a solution to a
problem.
It is very easy to be aggressive – it is in our ‘animal
nature’ to attack people who cause us problems.
Case study: Justin and Tyler

The manager of a care centre has asked that either 1 With a submissive response, Tyler will get
Justin or Tyler should stay for an extra half-hour at what he wants and Justin will lose. But what are
the end of their shift to complete some paper work. the likely consequences for their ability to work
Neither Justin nor Tyler want to do this work, so Justin together in the future?
could argue, using: 2 Justin will not necessarily win using aggression.
Aggression: Don’t think I’m going to do it. I need to Both people could become trapped in a cycle of
get away early and you’re not going to stand in my aggressive responses. If one person does force
way. I don’t care what you say – either you do it or the other to give in, will they be able to trust each
nobody does. other later?
Assertion: Look – neither of us wants to stay late, 3 Assertion is the most skilful response. Can you
but one of us has to stay. Let’s work out a fair way identify the skills that Justin would need in order
to decide which of us stays. to make this approach work?
Submission: I didn’t really want to stay late, but if

you don’t want to stay, then I suppose I’ll have to.
30
Table 1.3: Differences between aggressive, assertive and submissive behaviours

Aggressive behaviour Assertive behaviour Submissive behaviour
Main emotions Anger Control of own behaviour Fear – wanting to please
Attitudes Trying to win Trying to create a situation in Accepting that you will lose
Wanting your own way which everyone wins Letting others dominate
Making demands Negotiating with others Agreeing with others
Trying to solve problems
Behaviours Not listening to other people Listening to other points of Not putting your own views
Putting other people down view across
Shouting or talking very Showing respect for others Withdrawing or showing fear
loudly Keeping a clear, calm voice Speaking quietly or not
speaking at all
Body language Fixed eye contact, tense Varied eye contact, relaxed Looking down, not looking
muscles, waving of hands and face muscles, looking ‘in at others, looking frightened,
arms, looking angry control’, keeping hands and tense muscles
arms at your side
Case study: Karen

Interviewer: You must people to talk to you. You have to show that
have to deal with some rude you’re not going to try and dominate or threaten
and aggressive people? them. But you can’t let yourself be pushed around
either. When people cross the line, I will talk
Karen: Yes, the first thing I
firmly about how they make me feel, and what the
do is to think to myself ‘stay
consequences might be for them. Services can be
calm – don’t feel threatened’.
withdrawn from really offensive people. Usually
Very often people are rude
I think you get respect if you can put yourself in
or aggressive because
other people’s shoes, but if you also stick up for
they feel threatened. They
yourself.
are upset that you are in
their home – they want to control you, to make 1 Do you think Karen has good assertiveness skills?
themselves feel safe. For many people the only way 2 If Karen did behave aggressively towards people
they know to defend themselves is to get angry. who use services, what would be the risks for her
Thinking this way helps me to stay calm. and the people she works with?
Interviewer: That’s a wonderful attitude – but don’t 3 Why does Karen believe it is important to ‘put
people take advantage of you if you think like that? herself in other people’s shoes’?
Karen: No, you have to have the right attitude,
you have to be patient, stay calm and try to get
31
Defusing aggression and staying confident When people become aggressive, care workers are
likely to feel threatened. We all have a natural, animal
People do not always plan or choose to be aggressive.
response to run away or fight when we feel threatened.
In health and social care contexts, a great deal
An unskilled response is to fight aggression with
of aggression is caused by stress, often because
your own aggression – to ‘get your own back’ on
people feel powerless and out of control. Aggression
someone who is threatening you. Within health and
sometimes results from frustration; aggression can be a
social care, this is wrong because it can increase the
last-ditch emotional response when a person feels that
level of aggression or violence in someone who is
he or she is losing control.
stressed. A care worker could be injured in a violent
outburst. Alternatively, your aggression could punish a
Reflect person so that he or she gives up and withdraws from
Have you ever seen a person shouting or contact with you or your services. Being aggressive
swearing at a computer, or hitting the keyboard towards a person who is vulnerable will increase his
because the machine was not doing what they or her problems and could result in helplessness and
wanted? Do they really think the computer will be depression.
impressed?
People can become frustrated when they cannot
control events, and aggressive behaviour is a
natural emotional response.
Key term
Helplessness – People can give up and become helpless
when they learn that they cannot control or influence
Activity 7: Discussing sources important personal events. Helpless people can become
of stress withdrawn and depressed.
Get together with a small group of colleagues and

make a list of some of the stresses that people
who receive care services might experience. Think
about situations in which people may feel that they Table 1.4: Skills for defusing aggression
are out of control. Think about ways in which illness 1 Stay calm Show that you are not going to
or pain might create stress. Think about barriers to
become aggressive. Avoid a tense
understanding and how these might create stress.
body posture, a tense face or
Work out ways in which care workers could prevent clenched fists. Avoid fixed, staring
the stresses from resulting in aggression. eye contact. Breathe normally.
2 Communicate Use your listening skills to show
respect that you are taking the other
person seriously. Use non-verbal
PLTS skills to communicate respect.
3 Create trust Try to meet the other person’s
demonstrate that you can identify questions to answer,
and consider the influence of circumstances on events.
self-esteem needs. Try to make
the other person feel valued and
important, without agreeing to
When people feel stressed, emotions and tension everything they say.
often build up. Just one little misunderstanding can 4 Try to solve You can only discuss issues or
be enough to cause this tension to explode into an problems problems in detail after the other
aggressive outburst. When a person becomes angry person responds to your listening
they may decide that it is someone else’s fault that and calming behaviour. You will
they have been made to be aggressive. Sometimes a note that the other person’s
person will have multiple aggressive outbursts as they non-verbal behaviour shows less
tension.
struggle with their emotions.
32
Care workers are likely to break professional codes Building relationships and appropriate verbal
of conduct if they allow themselves to become
and non-verbal communication
aggressive. Instead it is vital that care workers learn the
Building relationships with people who use care services
skills needed to defuse aggression.
involves skilled listening, together with appropriate
It is not easy to stay calm if someone is threatening
verbal and non-verbal communication. It may be
you. You will need to feel confident that you know
important to use warm, friendly non-verbal behaviour
how to work with the other person. If you have
that expresses interest in another person such as:
already established a sense of trust, it may be easier
• making effective eye contact (varied and
to cope with their aggression than with aggressive
appropriate contact with another person’s eyes)
behaviour from a stranger. You will need to be sensitive
about possible misunderstandings and barriers to • adopting a relaxed and calm body posture
understanding when you start to work with an angry • smiling – looking friendly rather than ‘cold’ or frozen
person. You must avoid any spark that could light the in expression
fuse leading to an angry explosion. • using hand movements and gestures that show
All the skills of recognising and overcoming barriers interest
to communication will be useful in helping you to • nodding your head slightly while talking to
avoid triggering aggression. Reflective listening skills communicate messages such as ‘I see,’ or ‘I
are vital in order to make the other person feel understand,’ or ‘I agree’
valued. • using an appropriate gentle tone of voice.
Case study: Bill and Tony

Bill is a resident in a care home, who has been Tony (serious, sincere but calm): No Bill, honest,
diagnosed with dementia. Tony is a care worker who I would never spy on you. We had a long talk
knows Bill well. Bill will sit for long periods of time and yesterday and I really enjoyed hearing about all the
then become agitated. While sitting in his chair he has things you used to get up to. I was really interested
started to shout angrily at other residents. – you’ve lived an exciting life. I was wondering
whether you might have time to tell me a few more
Bill (very angry): You lot can get out of here, I don’t
stories?
want you round here anymore.
Bill (calmer tone of voice): Well, what about all these
Tony (calm and gentle tone of voice): Hello Bill, I
people in here?
am going to bring some coffee around in a minute.
Would you like a cup? Tony (expressing genuine interest): We could leave
them for the moment – tell me more about your
Bill (raising his fist): You can get out of here too. Go
time in South America.
on, get off or I’ll have you!
Bill (calm): Not sure I can remember, what were we
Tony (stepping back and lowering his head in a non-
talking about?
threatening way): Bill, you remember me. You told
me about your time in the Merchant Navy back in 1 What might have happened if Tony had
the fifties. confronted Bill and told him to stop shouting at
Bill (still angry): Don’t remember you – you weren’t the other residents?
there! 2 Can you explain how Tony showed respect and
Tony (calm, gentle, serious): No – but you told me created trust?
all about your time on the Sea Princess. How you 3 Why did Tony avoid talking about the other
went to South America, how you met your first wife. residents?
Bill (less angry but accusing tone): How do you know 4 How did Tony use his personal knowledge of Bill
all that about me? Have you been spying on me? to help defuse aggression?
33
Appropriate environment Table 1.5: Aspects of communication that increase self-esteem
The following ideas can help to reduce communication

Appropriate non- • Smiling
barriers in the environment: verbal behaviour • Relaxed body posture
• Improve the lighting. • Looking interested
• Reduce any noise. • Being calm
• Move to a quieter or better-lit room. Appropriate • Using correct level of

• Work with smaller groups to see and hear more communication formality
• Using language appropriate
easily.
to speech community
• Organise any seating so that people can see and • Using appropriate preferred
hear each other. language
• Using technological aids
Meeting self-esteem needs and maintaining
an appropriate attitude Listening skills • Using reflective listening
• Having an appropriate
People who use services are often vulnerable. Many attitude and valuing other
vulnerable people do not have the emotional security people
that comes from a high level of self-esteem. If a • Being willing to build an
person feels dominated or threatened he or she may understanding of another
develop low self-esteem. If children don’t feel valued, person’s views
they may not develop self-esteem. Adults who do not
feel valued may have difficulty in maintaining a high
level of self-esteem.
Your communication with people in care settings Key term
should involve understanding and responding to their Self-esteem – This is how you value or feel about yourself.
emotional needs.
Case study: Karen

Interviewer: You talk about about some of the good things in the news –
having the right attitude and soaps and things like that! I try to create a happy
‘putting yourself in other atmosphere because that can sometimes make a
people’s shoes’ but doesn’t person feel included and valued and increase their
that often make you feel sad self-esteem.
and depressed?
Interviewer: So just talking through positive things
Karen: No, you can in your life might make life seem more worthwhile –
understand how someone you value yourself more.
might feel without becoming
Karen: Yes, thinking over the good things is often a
overwhelmed. I always try to
way to increase self-esteem.
leave feeling happy or at least a little bit happier
than when I arrived. 1 What is self-esteem?
Interviewer: So how do you do that? 2 Why would talking about positive past life
experiences help some people to increase their
Karen: Well, keep people talking – most people self-esteem?
have some happy memories. I try to get them to
talk about some of the good things. I try to get a 3 How is Karen likely to know if she has been
positive feeling going. Sometimes, if it feels right, successful in making an individual feel happier
I mention happy things in my life or else talk about after working with them?
34
Whether you work with children, older people or

people with health needs, or physical or learning
3.2 Aids to communication
disabilities, it is always possible to think of ways to help Human aids
increase another person’s self-esteem. There are several services that may assist people
to communicate or help to remove the barriers to
effective communication.
Advocates
Sometimes, when people have a very serious learning
Case study: Karen disability or illness (such as dementia) it is not possible
to communicate with them. In such situations, care
Interviewer: You
services will often employ an advocate. An advocate
talked about creating
‘positive feelings’ – is is someone who speaks for someone else. A lawyer
there any more to this, speaking for a ‘client’ in a courtroom is working as an
other than just talking advocate for that person. In care work, a volunteer
about positive past might try to get to know someone who has dementia
experiences? or a learning disability. The volunteer tries to
Karen: Well, sometimes understand and then communicate the person’s needs
it’s little things that make and wants. Advocates should be independent of the
people feel good. First, staff team and therefore able to argue for people’s
you have to make the
right relationship. I think it’s important to be
rights without being influenced by what is the easiest
cheerful. I always think this is ‘their time’. I have or cheapest thing to do.
to be cheerful for them – and very often when
I come out from a visit being cheerful with that
person has made me feel better too. Then I Key term
always try to remember the little details from a Advocate – Someone who speaks for someone else.
previous visit. I think people often feel valued
if you remember things about them. It always
helps to give people a choice about how they Advocacy is not straightforward; volunteers may not
want work done, what products they want and so
always understand the feelings and needs of the
on. I think people need to feel in control of their
lives in order to maintain a sense of self-esteem. people for whom they are advocating. Some people
Then I think it’s important to listen to people. If argue that it would be better if people who use
people listen to you then you matter, don’t you? services could be trained and supported to argue their
If people cut you short – well, then, perhaps own case. Helping people to argue their own case is
you’re not worth much. called self-advocacy.
1 What verbal and non-verbal behaviours might
help to create a cheerful atmosphere?
Interpreters, translators and signers
2 Why does choice have anything to do with self- Interpreters are people who communicate meaning
esteem? from one language to another. This includes
3 Why is listening to people linked to self- interpreting between spoken and signed languages
esteem? such as English and British Sign Language. When an
interpreter works with people, they become part of a
communication cycle with that person.
Translators are people who change recorded material
from one language to another. Translating and
interpreting involve communicating meaning between
different languages. Translating and interpreting are
not just technical acts of changing the words from
one system to another. Many languages do not have
simple equivalence between words. Interpreters and
35
translators have to grasp the meaning of a message Interpreters may be professional people who are
(decode the message) and find a way of expressing it employed by social services or health authorities in
in a different language system. This is rarely easy, even order to communicate with people who use different
for professional translators. spoken or signed languages. They may also be friends
or family members who have sufficient language
ability to be able to explain messages in different
Activity 8: Exploring ICT circumstances.
translations When people do not use English as their first
language, they may experience difficulty accessing
Use an automatic language translation system to health or care services, unless they are supported by
translate a website that is written in a language
translators and interpreters. People who use signed
other than English. You may find examples
of confusing or even funny mistakes that the languages may also need assistance from interpreters
system makes. Compare your results with your and translators – see page 14 for further details of
colleagues’ research and discuss the problems signed languages.
that can arise when words are simply changed to
another language without any input from a human
translator. Mentors
Mentors are usually people who are highly
experienced in a particular job or activity; they advise
others who are new to the activity or less experienced.
Functional skills Mentors need effective communication skills, coupled
ICT: This activity may help you demonstrate ICT skills with some ability to explain issues and provide
associated with presenting information and English: guidance. If a person is referred to as a mentor, it
skills associated with reading and understanding text. might be assumed that they will provide guidance
based on their experience and knowledge of an issue.
Table 1.6: Important issues in interpretation
Knowledge of the A professional interpreter may be able to explain details of legislation or procedures
subject matter for claiming benefit because they understand the issues. If a relative or friend is acting
as an interpreter, they will have to make sense of the technical details before they can
communicate clearly.
Trust People must have confidence in their interpreter. Some people may find it hard to trust
a member from a different community. Many women may not feel safe and confident
discussing personal issues using a male interpreter. The issue may not be about the
interpreter’s language competence, but about the interpreter’s ability to understand and
correctly convey what a person wants to say.
Social and cultural The choice of an interpreter must support the self-esteem needs of people who need to
values access interpretation services. Many people may feel that it is inappropriate to discuss
personal details using an interpreter of the opposite sex. Some Deaf people do not feel
confident using interpreters who have not experienced deafness themselves.
Confidentiality Confidentiality is a right. Professional interpreters are likely to offer guarantees of
confidentiality. Using a relative or volunteer may not necessarily provide people with the
same guarantee of confidentiality.
Appropriate attitude A professional interpreter is likely to offer advanced interpersonal skills, which include
the ability not to judge what is being said. Volunteers, relatives and friends may have
language competence, but these people may not be able to interpret without involving
their own values, attitudes and beliefs.
36
operator hears the reply and types what is said so that

Case study: Jasu the Deaf person can read the typed message.
Jasu is 10 years old. Her father does not Loop systems
speak English although Jasu has grown up to
A loop system enables people who use hearing aids
be multilingual. Jasu’s father is in poor health and
needs to explain his problems to a health worker. to hear sounds more clearly. A cable surrounds a given
area such as a public area, room or even a car. Sound
If Jasu had to interpret her father’s problems in
from a TV, microphone or music system can then
English:
be amplified into the loop. People with appropriate
1 How might she be affected emotionally while
hearing aids can switch their aid to a special setting,
explaining her father’s illness to someone she
does not know? enabling them to hear the amplified signal from the
loop.
2 Would Jasu be likely to find the right
terminology to explain complex health issues Voice-activated software
to a professional?
Voice-activated software enables a person to use
3 Why might the services of a professional speech commands to get their computer to perform a
interpreter be more appropriate in this
situation?
What qualities do you think a befriender

should have?
Befrienders
Befrienders seek to create a supportive relationship
with others. A befriender will have good
communication skills that enable them to listen to, and
build an understanding of, another person’s views and
feelings. A befriender will work ‘as if’ he or she was a
friend. Befrienders will not be assumed to have any
particular professional knowledge.
Technological aids
Hearing aids
Hearing aids are battery-powered electronic devices
with small microphones to pick up and increase the
volume of sound received by a person. Hearing aids
will often amplify background sounds as well as the
voice or other signal that the person wants to hear.
For this reason, a hearing aid will not always work
effectively in a noisy environment.
Text phones, relay systems and minicoms
Text phones and minicoms have a small screen and a
keyboard to enable messages to be typed. The reply
can then be seen on the screen. The Royal National
Institute for Deaf People (RNID) operates a text relay
service, whereby an operator can enable conversations
between speech phones used by hearing people and
text phones used by people who may be Deaf or hard
of hearing. A person can text their message to the
operator, who will read it to the hearing person. The
37
variety of tasks. Some people use speech recognition

software to type messages without using a computer Activity 9: Discussing
keyboard and this facility is particularly useful for barriers to communication
people with dyslexia, who may find it harder to
Think of particular examples of barriers to
communicate using typing or writing.
communication (perhaps taken from the
table opposite) and discuss the strengths and
PLTS weaknesses of different strategies to overcome
them. Your discussion activities may help you to
Independent enquirer: This discussion and thinking work out some reasoned arguments for using
activity may help you demonstrate that you can particular strategies within your work
support conclusions, using reasoned arguments and placement.
evidence.
Case study: Gloria

Gloria grew up in the Caribbean and came to the UK and that trying to communicate with her is a
60 years ago. She now lives in a residential care home waste of time. Gloria sometimes becomes distressed
because she has developed some memory loss and because she is lonely and there is no one to talk to.
disorientation associated with Alzheimer’s disease.
Gloria also has some hearing loss and uses a hearing 1 Can you list the barriers to communication that
aid. Gloria’s first language is English but care workers Gloria is experiencing?
sometimes have difficulty understanding her speech. 2 Can you list ideas for overcoming these barriers?
Sometimes Gloria will talk about places and events 3 How could you use communication skills in order
from the past that care staff have difficulty identifying to increase Gloria’s self-esteem?
with. Some care staff think that Gloria is ‘confused’
Table 1.7: Ideas for reducing barriers to communication where people have a disability
Visual • Use language to describe things.

disability • Assist people to touch things (e.g. they might want to touch your face to recognise you).
• Explain details that sighted people might take for granted.
• Check what people can see (many registered blind people can see shapes, or tell light from
dark).
• Check glasses, other aids and equipment.
Hearing • Don’t shout. Use normal clear speech and make sure your face is visible for people who can
disability lip-read.
• Show pictures or write messages.
• Learn to sign (for people who use signed languages).
• Ask for help from, or employ, a communicator or interpreter for signed languages.
• Check that hearing aids and equipment are working.
Physical and • Increase your knowledge of disabilities.
intellectual • Use pictures and signs as well as clear, simple speech.
disabilities • Be calm and patient.
• Set up group meetings where people can share interests.
• Check that people do not become isolated.
• Use advocates – independent people who can spend time building an understanding of the
needs of specific individuals to assist with communication work.
38
Table 1.8: Strategies for overcoming communication barriers
Type of barrier Possible strategies
Communication that involves Use listening skills/skilled use of the communication cycle. Develop a ‘caring
difficult, complex or sensitive presence’. Professional workers may develop empathy.
issues
Unmet language needs or Assessment of needs. Staff training to enable assessment of need. Use of
preferences preferred language. Training to learn to communicate using different languages
or systems.
Sensory impairment Use human or technological aids to compensate for impairment.
Disabilities See Table 1.7 on page 38 for strategies.
Communication involving Use listening skills/skilled use of the communication cycle. Try to make the other
personality or self-esteem person feel valued. Develop a ‘caring presence’. Use open questions, keep the
needs, or anxiety or depression conversation going. Avoid focusing on/discussing emotionally negative issues.
Aggression/submissiveness Stay calm, show respect. Use skills associated with assertion and defusing
aggression (see pages 30–33).
Assumptions, values or beliefs Use listening skills/skilled use of the communication cycle to detect barriers. Use
reflective learning skills to question own values, beliefs or assumptions. Staff
training to develop reflective learning skills.
Jargon Use listening skills/skilled use of the communication cycle to detect barriers. Use
appropriate language for other people.
Cultural variations Use listening skills/skilled use of the communication cycle to detect barriers and
check your understanding. Learn about the cultural variations among people
you work with. Staff training to learn about cultural variations. Avoid making
assumptions about people who are different. Consider involving advocates who
will represent the best interests of others.
Abuse of power Try to empower others. Reflect on and question own assumptions. Avoid
behaviours aimed at controlling or manipulating other people.
Alcohol or drugs Stay calm, show respect. Use appropriate non-verbal behaviour, avoid making
demands. Assess risk of assault.
39
Assessment activity 1.4 P4 M2 D1
Using examples from class activities, your placement A strategy is a plan of how things are
or visits to health and social care environments, intended to be done but actual practice may not
explain how barriers to effective communication and be the same. Comparison of what is intended
interpersonal interaction may be overcome in health and what actually happens could be helpful.
and social care. For M2, review these strategies against
M2 Consider strengths and weaknesses of observed
best practice in communication and interpersonal interactions and communication practice and
interactions, particularly in relation to overcoming compare these with theories.
barriers. For the D1 evaluation, you will need to include
judgements about the effectiveness of different In preparation for the assessment, take part in
strategies for overcoming barriers to communication role-plays designed to simulate possible barriers
and support these with suitable explanations using to communication and discuss in class the
theories of communication and comparisons between effectiveness of how they were overcome.
different health and social care environments. D1 An evaluation requires both a judgement to be
made eg whether something is or is not effective
Grading tips in overcoming barriers and a justification or
P4 Use examples already explained and discussed explanation of how this judgement has been
in the previous three assessment activities, plus reached.
others as appropriate, to explain the strategies Your evaluations should include references to
used. relevant published sources in addition to your
Continue to use the notes in your logbook as a log book evidence or understanding gained
source of examples to illustrate points you make. from this book.
4 Be able to communicate and interact effectively in a

health or care environment
4.1 Contexts 4.2 Communication skills and
You will practise interactions and discuss their effectiveness
effectiveness before you present evidence of your own
To begin with, you might demonstrate your
practical work. To begin with, you might watch videos
communication skills using role-play or simulation.
or film clips of interpersonal interactions. You should
In role-play you have to behave in such a way that
practise identifying and describing different behaviours
other people can – at least temporarily – believe in
that you have seen and/or heard in recorded material.
the character you are portraying. Simulation does not
As you become more confident, you can role-play or
require you to use acting skills or portray a character.
simulate communicating in various contexts including:
If you simulate a conversation, you simply say (or sign)
formal; one-to-one; group; with people using services;
the appropriate responses. You do not expect people
with professionals/colleagues.
observing your behaviour to perceive you as anyone
This section of the unit is about your own skills in but yourself. Both simulation and role-play involve
communicating in interpersonal interactions. It is your thinking through appropriate responses but role-play
opportunity to demonstrate your ability to apply what involves a greater level of acting skill.
you have learned from the unit.
To demonstrate your communication skills, you will
need to cover verbal and non-verbal skills such as
listening and responding, tone, pace, language,
appropriate environment, proximity, clarifying or
repeating, questioning, responding to difficult
situations and defusing anger.
40
Table 1.9: Checklist for analysing communication and interpersonal interaction
One-to-one interaction • How did you start and finish your interaction? Did you try to meet the person’s
emotional needs?
• Could you identify a communication cycle involving feedback on your understanding
of the other person’s ideas?
Group interaction • Were you able to take effective turns in speaking?
• Could you identify group values and/or purposes within the group?
• Was there a group leader? How was the interaction managed?
Context • Who was involved in the interaction? People who use services? Professionals?
Colleagues? What role did you play?
Verbal listening and • How effective was your use of language, pace of speech and level of formality? Was
responding skills there any use of specialist language? How far did you encourage others to talk?
Non-verbal listening • How appropriate was your voice tone, posture, facial expression, eye contact and
and responding skills proximity?
Reflective listening • How did you use reflective listening and the communication cycle? Can you identify
skills examples of clarifying your understanding or repeating important ideas?
Questioning skills • Did you keep the conversation going using open questions? Can you identify probes
and prompts that you used?
Environment • Did the environment create any barriers? Could everybody see and hear each other
clearly?
Barriers • What barriers did you detect? Were there any barriers to interpreting communication,
such as language differences?
• Were there any barriers to understanding, such as cultural differences, assumptions
values or beliefs?
Difficult situations • Did you act in a calm and respectful way? What skills did you use to interact with
people with strong emotions?
Defusing anger • Were you able to act in an appropriate, calm and respectful way? Were you able to
avoid triggering aggression? Were you able to use assertive skills appropriately?
41
4.3 Effectiveness
PLTS
You should demonstrate effective communication in Self-manager: This activity will enable you to
both group and one-to-one situations including an demonstrate your ability to organise your own time and
awareness of the needs and preferences of others, resources.
interpersonal skills, attitudes, overcoming barriers, Reflective learner: This task will enable you to
adjusting interactions, and your own assertiveness. demonstrate the ability to assess yourself and review
progress. You may evaluate your experience and
The checklist in the table below may be useful as a
learning and communicate what you have learned in
starting point for assessing role-plays and recordings
different ways.
of real interactions.
Assessment activity 1.5 P5 P6

P2 M2
M3 D2
For P5 take part in a one-to-one interaction. For are not in placement, you may need to visit the
P6 take part in an interaction with a small group of environment in advance to better understand
individuals in a health and social care environment. At the context and likely influences so you can
least one of the interactions should be with individuals take these into account when preparing for the
using services although one could involve a specific interactions. The interaction may be focused on
interaction with a professional in the environment a specific activity eg a creative activity or other
relating to an important aspect of care. care task and your preparation would include
For both interactions produce evidence to appropriate planning for this activity as well as
demonstrate your role in each interaction. This should the communication skills you will use.
include a witness testimony from a professional in the Your contributions to the interactions do not
environment who has been present whilst you have necessarily need to be transcribed but your
carried out the interactions. You should also provide evidence should consider the skills you used,
your own account of each interaction. influences and context of the interactions
For M3 you will need to include a detailed description and you should demonstrate respect for the
of the skills you used in the interactions and how rights and confidentiality of the individuals
these related to the context of each interaction and involved in all records/notes you do make of the
the responses made by the individuals involved. For interactions and in your assignment evidence.
both interactions, you should explain how and why M3 To achieve a merit grade, you must reflect on
you applied theory, took account of influences on the your own communication and interpersonal
interactions and minimised or overcame any barriers. skills and provide an analysis, preferably
For D2 the account of the interactions should also including your strengths and weaknesses within
include an evaluation of each and of the skills you each interaction. This reflection should cover
used. both one-to-one and group interactions. You
could discuss the notes you have made on your
Grading tips one-to-one and group observations with your
P5 P6 Gain written consent to carry out the supervisor or tutor to help you develop the
interactions from a suitable professional in the ability to analyse your own interpersonal skills.
health and social care environment and include D2 At this level, you need to go further and
this in your assignment. evaluate the quality of your communication
Both interactions need to be specific planned and interpersonal skills in one-to-one and
activities for the purpose of the assessment group interactions. Your evaluation will involve
and you should obtain confirmation from your a more in-depth discussion of the factors that
tutor that the plans are appropriate before have influenced the effectiveness of your own
carrying out the interactions. It is not possible interaction. Emphasise your good points and
to achieve these criteria from casual, ongoing also those skills which you find difficult and
day-to-day interactions in a placement. If you need to practise more often.
42
Resources and further Useful websites

reading Braille www.brailleplus.net
British Sign Language www.bda.org.uk
Argyle, M. (1972) The Psychology of Interpersonal
Behaviour, second ed. Harmondsworth: Pelican Makaton www.makaton.org
Burnard, P. (1996) Acquiring Interpersonal Skills, Signs and finger spelling alphabet
second ed. London: Chapman & Hall www.british-sign.co.uk
and at www.royaldeaf.org.uk
Burnard, P., Morrison, P. (1997) Caring and
Communicating Basingstoke and London:
Macmillan Press Ltd
Engebretson, J. (2003) ‘Caring presence: a case
study’ in Communication, Relationships and Care
Robb, M., Barrett, S., Komaromy, C., Rogers, A. (eds)
London & New York: OU & Routledge
Pinker, S. (1994) The Language Instinct
Tuckman, B. (1965) ‘Development Sequence in Small
Groups’, Psychological Bulletin, Vol. 63, No. 6
43
Just checking
1 Why is tone of voice categorised as a non-verbal rather than a verbal issue?
2 Is it true that effective, caring, communication can be defined as ‘clear, concise transmission of
information between people’?
3 What is reflective listening and why is it important?
4 Rachel says, ‘I never let anyone else win an argument with me – I always get my own way!’ Is it
correct to describe Rachel’s attitude as being assertive?
5 If you met a person who said, ‘I can’t hear you, I need to put my glasses on’ what sense could you
make of this communication?
6 Is it possible for a person who has no knowledge of the English language to be able to sign using
British Sign Language?
7 What problems might arise if a relative (with the necessary language skills) acts in place of a
professional translator?
Assignment tips
1 Before you start to make logbook records you might like to state how you will record details of
conversations and other interactions. You could include a statement about how you will respect
confidentiality, respect the rights of others, and show respect for other people. You must also be
sure that if you take notes about people who use services your note-taking will not create any
misunderstandings or cause any stress to these people.
2 Use video recording of role-plays or simulations to help you identify how theories of communication
work before attempting to analyse workplace interactions.
3 A range of potential barriers and misunderstandings can influence communication in care settings. Very
often there will be a number of issues that are relevant to any particular observation you have noted.
4 Use role-play and simulation followed by discussion to help you develop skills for reviewing and
evaluating strategies to overcome barriers.
5 It may be a good idea to record a practice one-to-one and group interaction and discuss your
performance with colleagues, supervisors and/or tutors before undertaking the observation that you use
for your assignment. If you practise taking notes and discussing the quality of your interaction you may
pick up some good ideas that you can incorporate in your final assignment.
6 When you make notes about a one-to-one or group interaction you should make your notes
immediately after the conversation or meeting. These notes will help you describe your interactions at
a later date. You will not be able to remember everything that you said or did, or that other people did.
You should aim to recall some of the key things you said and to remember the responses others made.
You should also make notes about some of the non-verbal behaviours you saw in others as well as your
own non-verbal behaviour.
44
Credit value: 10
2 Equality, diversity
and rights in
health and social
care
This unit introduces you to equality, diversity and rights in the health and social
care sector. You need to be aware of these issues because you will be faced with
them on a daily basis. This is one of the most important units on the course and it
is essential that you understand the regulations regarding equality, diversity and
rights.
You need to know how to help a person who is being victimised and how to help the person inflicting
such discrimination so they do not do it again. By doing this, you will ensure that you and others
deliver a respectful and dignified service to everybody using and working in health and social care.
You have a huge responsibility to yourself and others to ensure that this happens. It is also very
important to be aware of your own thoughts and prejudices. (Yes, everybody has them!) This will
enable you to understand your own thought processes in a mature way, and not let them get in the
way of your day-to-day tasks. It will also make you aware of your own rights and help to ensure that
no one discriminates against you, which is also extremely important.
Learning outcomes
1 understand concepts of equality, diversity and rights in relation to health and social
care
2 know discriminatory practices in health and social care
3 understand how national initiatives promote anti-discriminatory practice
4 know how anti-discriminatory practice is promoted in health and social care settings.
45

This table shows you what you must do in order to achieve a pass, merit or distinction grade, and
where you can find activities in this book to help you.
P1 Explain the concepts of equality,

diversity and rights in relation to
page 70
P2 Describe discriminatory practice in M1 Assess the effects on those using

health and social care the service of three different
See Assessment activity 2.1, discriminatory practices in health
page 70 and social care settings
P3 Describe the potential effects of page 70
discriminatory practice on those
who use health or social care
services
page 70
P4 Explain how national initiatives M2 Assess the influence of a recent D1 Evaluate the success of a recent
promote anti-discriminatory national policy initiative promoting initiative to promote anti-
practice anti-discriminatory practice discriminatory practice
See Assessment activity 2.2, See Assessment activity 2.2, See Assessment activity 2.2,
page 82 page 82 page 82
P5 Describe how anti-discriminatory M3 Discuss difficulties that may D2 Justify ways of overcoming
practice is promoted in health and arise when implementing anti- difficulties that may arise when
social care settings discriminatory practice in health implementing anti-discriminatory
See Assessment activity 2.2, and social care settings practices in health and social
page 82 See Assessment activity 2.2, care settings
page 82
46
Unit 2 Equality, diversity and rights in health and social care

You will need to produce written evidence of examples of the effects of discrimination
within health and social care. You will also have to explain recent national initiatives to
promote anti-discriminatory practices. You will need to demonstrate your own skills both
in one-to-one and group interaction situations. Varied assessment tasks are included
throughout this unit to help you prepare your work.
Lola, 18 years old

For me this was one of the most interesting and useful units on
the course. I realised soon after starting how important this was
going to be for my future in health and social care. I have been
aware of discrimination for a long time, as I studied it before and
also witnessed it personally, as well as hearing my family talking
about it.
After a class discussion about discrimination with myself and other
students getting really involved in the subject, we carried out research with different
groups researching a topic. My group found the equality and human rights website a
great source of information, and with guidance from our tutor we were able to give an
interesting presentation. The other groups also presented good topics and this gave us
a good starting point for the unit.
We then had to look at different health and social care settings and see what effect
discrimination had on people using them, and how this could negatively affect their
health. The research and findings were quite shocking and I remember talking to
my family about it, and it made it clear to me how important it is to get this right.
My research also included the law and what I needed to know about it, especially
before I started my work experience. Overall, this unit was intense but interesting and
I really enjoyed researching it. This was reflected in my mark – I’m glad to say I got a
distinction.
Over to you!
1 Why do you think this unit is so important?
2 What topic do you think you will find the most difficult and why?
3 Do you think discrimination happens in health and social care and why?
47
1 Understand concepts of equality, diversity and

rights in relation to health and social care
Diversity – a personal view

Get
A very good starting point is to look at yourself, your family or friends.
started
First answer the questions below on your own:
• What are the nationalities of your family or friends?
• What music do you like?
• What is your favourite food?
• What languages can you or your family/friends speak?
• What and how do you celebrate in your culture?
Now get together in a group selected by your tutor to discuss the range of different
responses to these questions, then report back to the other groups.
Discuss as a whole class how you can each benefit from knowing about the
differences raised in the last exercise.
Finally, consider the question: what does your culture mean to you?
Working in the health and social care sector, equality, You also need to recognise when individuals are being
diversity and rights are at the core of everything you treated unfairly, to challenge such mistreatment, and
will be doing. These terms embrace all individuals help those being mistreated and those causing the
using the health and care sectors and every person mistreatment. This not only applies to people in your
working within them. It is essential that people working care but also if you witness someone being treated
within health and social care recognise the need to unfairly at any time.
treat every individual equally no matter what their Diversity should be recognised and celebrated
gender, race, beliefs, sexuality, age, disability, ethnicity, and it is important to support individuals’ diversity
sexual orientation, education, language, background when working out health and care plans, as well as
or skin colour. recognising any particular needs they may have as
individuals. By doing this, the people in your care will
Key terms feel valued and respected and will feel that they are
being treated with dignity. All these things will help
Equality – Being equal, especially in rights, status or
opportunities. All individuals should be treated equally, them feel more positive about their time in your care.
and there are laws in place to ensure that this happens. In
accordance with the law, organisations have equality policies
to ensure that everyone is treated equally.
Diversity – Diversity means accepting and respecting
differences. This means that everyone is recognised as being
different and their difference is valued and respected. Reflect
Rights – Rights are legal entitlements. For example, an Look at the words ‘equality’, ‘diversity’ and
individual has a right to live in society without being abused ‘rights’ again and think about how they will
or intimidated because of their gender, sexuality, race, skin impact on your career in health and social care.
colour, beliefs or culture.
48
1.1 The benefits of diversity Table 2.1: Waves of immigration to Britain in the
nineteenth and twentieth centuries
Britain is a truly multicultural society with a huge variety
of people from different backgrounds who live and Time Main groups of immigrants
work all over the country. The table below gives some 1800s Jewish arrivals from Russia/Poland;
indication of Britain’s diversity and an idea of when the people from rural Ireland
main groups of immigrants came to Britain. 1948–50s Caribbean people (invited to help
The largest immigrant groups live in and around rebuild post-war Britain)
London, with other groups concentrated in industrial 1950s–60s Asians from India, Pakistan and
centres in Yorkshire, the Midlands and the rest of the Bangladesh
South-East.
1970s East African Asians and Vietnamese
In total, 6.5 per cent of the British population consists
of ethnic minorities. The British population is made up 1980s Eastern European refugees from
of the following ethnic groups: former Yugoslavia and other war torn
states
• White – 53,074,000 (includes Irish, Polish, Italian, etc)
• Black Caribbean – 490,000 Source: www.britishcouncil.org/languageassistant/
What do you think are the benefits

of diversity?
49
• Black African – 376,000

• Black other – 308,000 The arts Social
cohesion
• Indian – 930,000
• Pakistani – 663,000
• Bangladeshi – 268,000 Cultural Social and
Language
enrichment cultural benefits
• Chinese – 137,000
• Other Asian – 209,000 (includes Vietnamese,
Malaysian, Thai)
Tolerance Education Food
• Other – 424,000 (people who did not think they
fitted the above categories)
Fig 2.1: The social and cultural benefits of diversity
Source: British Council, 2009
Therefore people working within health and social may intrigue as well as educate people about other
care and the people who use the services provided will cultures. Museums and exhibitions also give an
come from diverse backgrounds and bring with them understanding of cultures from around the world, past
a wide range of behaviours and beliefs. Everyone is an and present. Plays and other theatrical performances
individual and expects to be valued for who they are can bring an experience of contemporary world
and what they bring with them to a diverse country culture. All these things can help us understand and
such as Britain. appreciate ‘difference’. With knowledge from the arts,
Diversity should benefit all of us, with people valuing a person working in health and social care can develop
each other and experiencing a strong bond with a deeper understanding of diversity.
others from different backgrounds. Unfortunately this
is sometimes not the case. Some people may fear
something they know nothing about and discriminate Reflect
against those from different backgrounds. These Discuss in a group how the arts have enriched
people may use health and social care services your life.
themselves at some times in their lives and you need to
be aware of any unfair and unwarranted discrimination
Diet
from them. They usually act out of ignorance and may
cause upset and offence. However, they still need to Another good reason to enjoy a multicultural society
be treated fairly and this will undoubtedly test you. is its food. In a recent survey in Britain the Chinese
Fortunately this problem only seems to arise with a dish Chow Mein was voted the favourite food, with
small number of people. Some, however, may be in a Indian food being the other main choice. In fact
vulnerable mental state and again these individuals will these two foods accounted for 70 per cent of food
need care and support, just as other individuals do. choices according to the market leader in consumer
survey analysis Mintel. Mexican food was extremely
Britain has passed laws to help bring together the
popular and stir-fries were considered a very healthy
many diverse groups in our country so that we, as a
option. Only 6 per cent of the 1000 people questioned
nation, can celebrate our multicultural society.
admitted to never eating ethnic food.
Social and cultural benefits of diversity
The benefits of diversity affect our whole lives as well Did you know?
as the health and social care sector, as Fig 2.1 shows. It is also interesting to know that diet is linked to
The arts social class. A British Heart Foundation food survey in
2006 found that 50 per cent more people in the highest
The arts provide a valuable way of bringing diversity income bracket ate five portions of fruit and vegetables
to a wide audience. For example, films made in a day more than people in the lowest income bracket.
other countries can demonstrate culture from around Source: www.heartstats.org
the world in a form that is easy to understand and
50
This information is very important for the health and development of online services, there is a wealth of
social care profession, as individual tastes have to be information in most spoken languages. Information
taken into account when planning a person’s diet. is also available in sign language, and the visually
More and more people are enjoying a diet with herbs impaired can use specialised software, which speaks to
and spices. This is partly due to our multicultural the viewer. Most websites now have an ‘accessibility’
society and also because more people are travelling option for people who cannot read the text.
to other countries and tasting different types of food People who can speak languages other than English
and drink. A person’s diet also needs to be tailored to are highly sought after in health and social care
their health requirements. For example, diabetics and because many of those using the services may
some older people may need to exclude certain foods. not speak English. Interpretation is seen as a new
Likewise, a person’s religious beliefs may mean that career in the health service, so speaking another
halal meat is a requirement. Asking people about their language is clearly beneficial for health and social care
food likes and dislikes, and what they can and cannot professionals.
eat, is all part of considering and respecting their
diversity. Reflect
If you know of someone who cannot speak
Reflect English and has used health and social care
services, ask them how they managed to
Think about the food you like and what sort of
communicate.
meals you would like if you were in a health and
social care environment.
PLTS
Education Independent enquirer: By exploring
Education has seen big developments over recent communication from a different perspective, you
can show independent enquiry skills.
years with diverse cultures being explored and
valued within the curriculum. Schools and colleges
now include studies in a wide range of cultures and Tolerance
languages. The education system has also benefited Tolerance is a very important quality to have when
from people from different backgrounds reaching working in health and social care. You may come across
management positions and making positive changes in people you do not get on with or who have different
relation to diversity. views from you. This is life and has to be accepted;
The inclusion of equality, diversity and rights training after all, we are all individuals. You have to be mature
in the health and social care profession has increased and professional when working with colleagues and
and has become an important part of the professional helping people, even though you may sometimes not
training programme. The Royal College of General feel you want to be. Difference has to be accepted
Practitioners, for instance, places great importance on – even more in health and social care than in other
the promotion of equality and diversity in GP training. occupations.
All organisations are required by law to train their Social cohesion
staff in equality, diversity and rights, usually under the This could be better described as community
equal opportunities framework. This is usually done cohesion, where a community (social group) sticks
in the induction programme. In-service training is also
regularly given on equality, diversity and rights for all
Britain’s workforce. Education is an important tool in Key terms
helping to get rid of ignorance about diversity. Tolerance – The ability or willingness to tolerate the
existence of opinions or behaviour that you dislike or
Language disagree with.
Learning another language can be very beneficial for Halal – Religiously acceptable according to Muslim law. Food
health professionals. It can give them the chance to prepared in a way prescribed by Muslim law.
work abroad as well as learn something new. With the
51
together (cohesion). You may know of a close health and social care profession, new techniques,
community and may live in one. This may be formed equipment and software developments are being
for a number of reasons, such as ethnicity. Belonging shared all round the world. This all means that people
to a community is very important to human behaviour, are benefiting from diversity.
as it provides a safe and understanding environment,
Employment and expertise
and a group that sticks together.
Many organisations, including the health and
In times of crisis (such as the ‘big freeze’ in December
social care services, have come to realise that
2009, when people said on the news that strangers
their customers are from a wide range of diverse
were helping each other cope with the icy conditions),
backgrounds and it is therefore important that their
strong bonds are formed between individuals.
workforce also reflects this.
Social cohesion can be strengthened under such
Organisations have also realised that by positively
circumstances; if you experience a difficult situation
encouraging potential employees to apply for jobs
with other people, you feel a common bond because
they increase the chance of getting the right person,
you are the only ones who have experienced it at first
which they may not have done otherwise.
hand.
The Race Relations (Amendment) Act 2000 promoted
Health and social care team members need to form
race equality, equality of opportunity and good race
this type of bond. Working in diverse teams requires
relations in public bodies including the health and
each member to respect all the others in the team and
care service. This has helped to build an appropriate
to value each person as an individual. Without this,
diverse workforce.
the team will operate ineffectively and eventually fall
apart, causing major difficulties for the people using
the service. 1.2 Terminology
When working in the health and social care
Activity 1: Supporting a profession you must know and understand how to
member of staff use appropriate terminology with regard to equality
and diversity. Words like empowerment, diversity,
Discuss in a small group how you would support stereotyping must be used in the right context.
a member of your team who has been racially
Without this knowledge you will find it difficult to
abused by a person using your service.
communicate in a diverse workforce and you may find
yourself in an embarrassing situation if you use the
words incorrectly.
Cultural enrichment
On the following pages are key words and terms that
All the social and cultural benefits described above you will need to understand for this unit.
will bring about cultural enrichment through diversity,
which will improve life for everyone, both those who Activity 2: Developing your
work in health and social care and those who use the
services provided.
own glossary
You may wish to develop your own glossary of
The economic benefits of diversity terms used within the health and social care
The economic benefits of diversity to Britain can be professions. Get a small notebook or keep a file on
seen everywhere, from the clothes we wear and the your computer and keep adding new terms as you
foods we eat to the people who work here. The many come across them.
diverse shops (ranging from big names on the high
street to small independent manufacturers and those
who sell their products on the Internet) all add up to PLTS
a richly varied community. Imports and exports now Self-manager: Organising your time to develop
make this a global community. All of these aspects health and social care resources, such as a glossary
underline the importance of diversity to the economic of terms, will help you demonstrate self-management
well-being of Britain and the world. In relation to the skills.
52
Care home assistant
Lamiley studied the BTEC Health and Social Care

course and found work as a care home assistant at a local care
home. The home didn’t have a great reputation but it was nearby,
which was convenient for Lamiley, so she was pleased to get the job.
The residents in the care home were all in their seventies and eighties,
and Lamiley noticed that there were a few who were Indian or
Pakistani, a couple of them were black, one was Chinese, and the
other fifteen were white.
Lamiley: When I started work, I soon found out

why the home didn’t have a great reputation. During the day
there was no stimulus for the people in the home. They were washed
in the morning and then just plonked in front of the television. They were
then pushed in their chairs or walked to the main eating room and given lunch,
which consisted of a white bread sandwich with lettuce, cheese and pickle and a
cup of tea. They were then taken back to the television lounge again for the rest of the
afternoon.
At teatime they were given a meal of what I was told was breaded turkey escalopes,
mashed potato, cabbage and gravy, followed by rhubarb and custard. When I asked
one of the carers about the food they said it was nutritious and typical of the meals
that were served. The carers hardly talked to the residents while they fed
them. After the meal the residents had another cup of tea before being
returned to their bedrooms for the night at about 5.30 pm.
Think about it!

1 Identify the diversity issues here.
2 What do you think of the food that was given to all
the residents, and how would you go about making
changes?
3 What other changes would you make to their day and
why?
53
Equality • the right to marry and to start a family

To ensure that people have equal rights and • the right not to be discriminated against in respect
opportunities, equality has become an important of these rights and freedoms
focus. By law every organisation must have an equal • the right to peaceful enjoyment of your property
opportunities policy that all employees can see. This • the right to an education
is to ensure that everyone in the organisation has the
• the right to participate in free elections
same choices and opportunities and no one is treated
• the right not to be subjected to the death penalty.
differently.
As you can see, there is a wide range of rights that affect
In health and social care, according to equal
every aspect of a person’s life and which you need to be
opportunities, all individuals must receive the same
aware of when working in health and social care.
high-quality service.
Equity Opportunities
Equity means fairness and justice. In the health and Continuing from equality, equity and rights, everyone
social care sector this means that everyone is entitled working in or using health and social care services
to equal access to any service when needed, and that should have the same opportunities available to
they should get the high-quality care they deserve, no them. These opportunities can range from job
matter where they live or how they live their lives. opportunities to medical treatment. This may involve
you talking to clients, for example, informing them
Diversity about what they are entitled to, or the possible effects
This term is used to describe the differences between of the medication they will be taking, or the medical
individuals. In its positive sense diversity means that all procedure they may be having.
individuals are respected and valued. This means that
you need to be aware that a person’s differences do Difference
not obstruct the way they are cared for by health and
This is related to diversity, whereby each person has
social care services.
to be respected and their differences recognised.
Individuals need to be acknowledged and valued for
Rights who they are. This applies to colleagues within the
Everyone possesses basic human rights and in turn has health and social care profession as well as those using
a responsibility to respect other people’s human rights. the service.
The Human Rights Act of 2000 is explained on the
government website (www.direct.gov.uk), which states
that a person’s human rights are: Discrimination
• the right to life As you have read before, discrimination is unlawful
within Britain. There is legislation to support anyone
• the right to freedom from torture and degrading
who feels they are being discriminated against. There
treatment
are two types of discrimination that you need to be
• the right to freedom from slavery and forced labour aware of.
• the right to liberty
• the right to a fair trial Overt discrimination
• the right not to be punished for something that This is clear discrimination – for example when a
wasn’t a crime when you did it colleague is paid more than you, because of their
gender, even though you are doing the same job with
• the right to respect for private and family life
the same qualifications. It can also be found in the
• the right to freedom of thought, conscience and different treatment one person receives compared
religion, and freedom to express your beliefs with another when there should be no difference at all.
• the right to freedom of expression Unfortunately, this sometimes happens and you have
• the right to freedom of assembly and association to be aware of it and make sure that it is sorted out.
54
Covert discrimination Prejudice

Covert is the opposite to overt, which means the A prejudice is a judgement made about someone
discrimination is hidden and can be harder to without really knowing the facts. You may have
demonstrate. One example would be when people negative thoughts when you see certain people, for
apply for a job. Although one person may have the example if you see a person wearing a ‘hoodie’ or
same experience and qualifications as the other someone who has their hair spiked and with face rings.
applicants they may not be shortlisted because of their However, when you meet them and talk you may find
skin colour, or sexuality. It’s harder to prove that covert they are interesting, friendly people. In the health
discrimination is occurring but cases are regularly and social care profession you may still have these
reported in the newspapers and it still happens. You thoughts (after all, you are only human!), but as with
also need to be aware of covert discrimination against labelling, you need to be aware of your prejudices
people using health and social care services. and be able to control them. Again, if you let your
prejudices interfere with your work in health and social
Stereotyping care the person will not be treated fairly.
Stereotyping is dangerous and discriminatory.
Children usually develop this habit because of what
they learn from adults. Examples of stereotyping could Activity 3: Becoming aware
be: of your own thoughts
• All homeless people don’t want to work.
As part of developing your self-awareness, you
• All overweight people are lazy.
may find it useful to look at your own stereotyping,
• All male nurses are gay. labelling and prejudices. These reflections should
Stereotyping is obviously a dangerous thing to do in be kept private or just kept in your thoughts if
you do not want to write them down. This activity
the health and social care profession, as it leads to
should help you become aware of your own
wrong assumptions and discriminatory practice, which assumptions and how you formed them. Knowing
is illegal and could lead to someone being harmed. this will help you understand why you have them.
This may take a long time, as it’s a sort of self-
Labelling counselling. However, it’s important to know that
Closely related to stereotyping, labelling is another having thoughts of this kind doesn’t make you a
bad person. It’s what you do with them that matters.
discriminatory practice. We all do this, usually without
knowing it, especially when we meet someone for the
first time. In the health and social care profession you
need to be aware of this tendency to label people.
PLTS
Labelling thoughts may come into your head (and
Creative thinker: You can show creative thinking in
everyone has these types of thoughts) but it’s what you
this activity: be honest when questioning your own
do with them that’s important. By becoming aware of assumptions and asking yourself why and how you
your labelling thoughts, you can control them and stop reached those conclusions.
them interfering with your work. Examples of labelling
are:
• fat
• uneducated
Disadvantage
This can cover a wide range of issues. The term
• mean
disadvantage is usually used when discussing
• weak. people from a poor background, but can be
Labelling someone in health and social care, and applied to someone’s difference in a broader sense,
acting on your thoughts, could affect the way you depending on labelling, stereotyping and prejudices.
communicate with or treat them, and hence you could Unfortunately poverty can influence people’s health
end up disrespecting and perhaps harming them in because of poor living conditions. People from a poor
some way. background may also be less educated and have a
55
poorer diet. This can lead to less paid work and keep Vulnerability
families trapped in poverty. These factors will have
People may be vulnerable because of their mental
an impact on the local health services, which may be
state or age. Someone who is frail is vulnerable to the
under more pressure than those in more affluent areas.
cold in winter and perhaps also to high temperatures in
The government has a duty to improve conditions but
the summer. Vulnerable groups (e.g. older people and
poorer areas do exist and you can see the differences
people with diabetes) are offered free flu vaccines in the
when walking around these areas and comparing
winter months. Some people cannot protect themselves
them with ‘richer’ areas. The important point is that in
and are easily abused because of their mental state.
health and social care everyone has a right to the same
Your role is to help and support them, ensure their
treatment and care as everyone else, no matter what
health and safety while in your care, and make sure that
their background.
there is a support network in place when they leave
your care.
Beliefs
Beliefs can be religious, or they can be beliefs about
Abuse
ourselves or what is happening around us. Beliefs Abuse refers to a range of negative behaviours that
can be very powerful and can influence our thoughts can have the potential to harm or damage individuals
about the world and about people we meet. This may in various ways.
impact on the way people are treated in health and Verbal abuse
social care. For instance, you may come across people
This occurs when one person uses words and body
who believe that something harmful will not happen to
language to criticise another person inappropriately.
them. For example, they may believe that smoking will
not give them lung cancer. (‘It happens to other people Psychological abuse
but it won’t happen to me.’) Or you may be supporting Also known as mental abuse or emotional abuse, this
and respecting a family of Jehovah’s Witnesses who occurs when one person controls information that is
do not believe in blood transfusions but have a son available to another person so as to manipulate or
who could live if he received a blood transfusion. (In distort that person’s sense of reality.
this case, there will be legal implications concerning
Physical abuse
the child’s right to life, meaning that the decision may
This occurs when one person uses physical pain or the
be taken away from the parents – see Section 2.4: Loss
threat of physical force to intimidate another person.
of rights.) Or perhaps you could be treating someone
who is in denial concerning their medical condition Sexual abuse
(for example a diabetic, who doesn’t control their diet, This includes any sort of unwanted sexual contact
as they do not believe they have diabetes). These perpetrated on a victim (child or adult) by an abuser.
situations can all be very trying in the health and social
care profession, but respect always has to be shown. Neglect (fail to care for properly)
This occurs when a person fails to provide for the basic
needs (e.g. food, warmth and shelter) of one or more
Values dependants that he or she is responsible for.
People’s values are usually developed as they grow and
are influenced by the adults that they are in contact Hate crimes
with. This socialisation process impacts on how we see Hate crimes include verbal, physical, emotional
ourselves in the world. It can be positive or negative or or sexual abuse aimed at an individual or a group
a mixture of both. For example, someone may decide of people. The abuses may be based on various
to be a vegan because they think animal welfare is characteristics of the people it is aimed at – religion,
very important. In health and social care you will come sexuality or the colour of their skin.
across the psychological values that impact on people. In the health and social care profession you will come
For example, some individuals don’t value their health across abuse on a regular basis. Whether you are
enough and so they become unwell and may require a dealing with the abused or the abuser, you have to
lot of help from health and social care services. remember that both will need support.
56
Interdependence
Did you know?
Interdependence means working within a team, where
Every week in England and Wales one to two children each person’s role is as important as everyone else’s.
will die following cruelty. When working in a multi-disciplined team each person
Source: Office for National Statistics will rely on another, thus ensuring that everyone carries
out their job properly. In this sense, all the team
members depend on each other’s expertise.
Empowerment Racism
This means that someone has control of certain tasks Racism is the abuse of people of a certain race. This
they have been asked to do or over their own lives. could be at organisational level where promotion
Working in health and social care, you will have to benefits one particular race over another, or outright
ensure that people take control of their health and hatred against a person or a group of people of
well-being by empowering them to do so. This will be another race.
done by giving them support and encouragement and According to recent research, black and Asian ethnic
in some cases it will require a lot of patience. Some minority workers have lower pay than their white
vulnerable people may not feel able to take control counterparts, are more likely to be unemployed
of their health and this is why your supportive role and are less likely to be found in the higher ranks of
is so important. Some people may think the health management.
and social care services are too controlling and you
will need to work with colleagues to find strategies
that work in these cases too. Doing this course is
empowering you to work in the health and social care
profession. Unemployment rates of men: by ethnic group, 2004*
Independence 15
Working with people to ensure they have an
Percentage unemployment (%)
independent life, without others telling them what

to do, is vital. It’s empowering people. As a health
10
professional, you work with an individual; you do not
work for them. Helping clients to become independent
in their health and social care is particularly important.
5
Ethnic minorities in the UK, on
average, earn less than white people.
How might racism contribute to this?
0
Black Caribbean
Black African
Bangladeshi
Mixed
Pakistani
Chinese
Indian
White Irish
White British
*January to December. People aged 16 and over.

Source: Annual Population Survey, Office for National Statistics
Fig 2.2: Ethnic minority disadvantage
57
Sexism 1.3 Health and social care settings

This covers a wide range of negative behaviours, In this unit you are asked to explore equality, diversity
including prejudice and discrimination towards other and rights in relation to four key types of health and
people based on their gender. social care setting:
Women are usually the ones who are discriminated • residential care
against, although sometimes it can be men. This can
• day care
relate to unequal pay between men and women doing
• nursing care
the same job, working conditions being different and
unequal chances of promotion. It can also relate to • domiciliary care (home care).
an unequal level of health care based on a person’s
Residential care
gender.
Residential care is where a person leaves their home to
be cared for in a safe and secure home environment.
Did you know? People who use this type of care may not be able to
In Britain, one-third of the families headed by women live on their own and maintain their health but they do
live below the poverty line. not necessarily need nursing care. The residential care
setting caters for the person’s social care needs, which
may include:
Homophobia
• personal care
Homophobia is the fear or hatred of homosexuals
and homosexuality. Individuals who are homophobic • ensuring they take their medicine at the required
fear or hate the fact that others are sexually attracted time
to members of their own sex. This fear can lead to • arranging health visits when needed
behaviour that discriminates against homosexuals and • encouraging independence.
consequently advantages heterosexuals. There are Some residential care settings care for people with the
drives at the moment around the world against lawful same type of attention needs, such as Alzheimer’s or
marriages between people of the same sex, due to physical frailty.
the fear of homosexuals (gays and lesbians) breaking
down the structure of society and the heterosexual
constitution.
An example of this was when a gay college student Activity 4: Residential care
was told by his parents that if he had a gay relationship
they would refuse to help him financially and that he Visit a residential care home and
would have to move out of their home. interview two residents to find out what
they think about being there (both benefits and
disadvantages), and how their independence is
Reflect encouraged. You should also interview a carer to
Reflect on your thoughts on homophobia and be see what type of work they do on a day-to-day
honest! Then reflect on how your thoughts may basis. Analyse your findings.
influence you when you are working with and
supporting people in health and social care. This is
personal to you, unless you want to discuss it openly.
PLTS
Independent enquirer: For this activity, you need
to think of a range of questions that will lead to broader
PLTS responses and give you more in-depth information. This
Creative thinker: Be really honest about will demonstrate independent enquiry skills.
questioning your own assumptions, and think before
you write anything down. This will help you to be more
creative in your responses.
58
Day care Activity 5: Research nursing

This type of care is for people who need care on a
jobs
daily basis but not in a residential home. They still live
in their own home but can access the day care they Research two different nursing jobs in a hospital
require to maintain their health. This may involve: setting, and find out about the qualifications they
require. Look at how these types of nurses work with
• physiotherapy and occupational therapy services
their patients and the main job criteria. If you wish,
• visiting a local community day care centre for social you can research other nursing jobs apart from those
reasons listed above. Prepare a Powerpoint presentation to
• visits to see health care professionals at hospitals. share your information with the class.
The person may also have carers during the day

to help with personal care, if they cannot bathe Functional skills
themselves, for example. Each person is assessed, and
his or her needs are met on an individual basis. ICT: You can demonstrate your ability to develop,
present and communicate information by putting
Nursing care together a clear, interesting Powerpoint presentation.
This is where a person needs more nursing care
because they are ill and/or need specialist health
care. For example, one person may have had a heart
Domiciliary care
attack and be seriously ill, whereas another may be The word domiciliary means ‘at home’ so this is health
going to hospital to have a baby. Nursing care covers and social care carried out at home. This may be the
a wide range of treatment for people of all ages, from person’s choice – for example, if they want to give birth
Great Ormond Street Hospital where they treat sick at home, or a health visitor is calling to check on a
children to mental health nurses based in hospitals, GP person just released from hospital, or a meal service is
practices or within community centres, who may need being provided for people who cannot cook at home,
to treat some very elderly patients. Specialist nursing or a terminally ill person wants to die at home. Again,
staff include: there is a wide range of nursing services available to
suit individual needs.
• practice nurses
• health visitors Activity 6: Research the
• ward nurses specific role of a Macmillan
• occupational health nurses nurse
• midwives
Research the role and responsibilities of a
• school nurses Macmillan nurse in a domiciliary setting.
• mental health nurses
• paediatric nurses.
Each of the above nurses work in different settings, PLTS
with different groups of patients. Independent enquirer: You can demonstrate
your independent enquiry skills by evaluating the
information gathered and analysing its relevance and
value.
59
1.4 Active promotion of equality Activity 7: Promoting the

and individual rights individual’s rights, choices
A good understanding of the key concepts used in and well-being
health and social care is central to all roles within the
Work together in a group to discuss how you can
sector. Health and social care professionals need to promote the rights, choices and well-being of
actively promote equality and the rights of individuals, people in a health and social care setting. You
whether they are working in or using services. The should look at:
word ‘Active’ emphasises the need to ensure that • how to demonstrate equality
action is taken on these issues. • how to show respect
The principles of the care value base • how to take appropriate action to increase
awareness
These seven principles put the individual at the heart
of health and social care provision. These principles • how to challenge stereotypes
form a value base. They are all of equal importance • how to ensure access to services for all
and should form the basis of all your relationships with • how to improve overall quality of service.
clients and colleagues. Using your findings, arrange a display for an open
The seven principles are: evening, explaining how you will ensure rights,
choices and well-being for all those using the
1 the promotion of anti-discriminatory practice setting. You need to think of questions that will
2 the promotion and support of dignity, lead to a broad range of responses. You need
independence and safety to think about situations where things don’t go
according to plan – use ‘what if…’ questions.
3 respect for, and acknowledgement of, personal
Use different sources of information, not just one
beliefs and an individual’s identity website or book. Think of unusual circumstances,
4 the maintenance of confidentiality such as different responses because of religious
beliefs, etc.
5 protection from abuse and harm
6 the promotion of effective communication and
relationships
7 the provision of personalised (individual) care. PLTS
Together, these principles can be broken down into the Independent enquirer: This activity may help you
demonstrate that you can analyse and evaluate
following key concepts:
information.
• inclusivity • participation
• access • honesty and openness
Functional skills
• trust • respect
ICT: You can use your ICT skills to find and select
• confidentiality • safety
information, and research and investigate national
• choice. initiatives to reduce discriminatory practice.
Promoting the rights, choices and well-being

of individuals Anti-discriminatory practice – empowering
If you follow the seven principles of the care values individuals
in your everyday work you will automatically be By remaining true to the underpinning principles
promoting individuals’ rights and choices. This has and values of care practice at all times, you will
been shown to have a positive impact on people’s automatically demonstrate anti-discriminatory practice.
feelings of well-being and their sense of control over
However, actively promoting anti-discriminatory
their lives when they may be at a vulnerable stage.
practice is another thing entirely. You may need
to challenge others who, perhaps inadvertently,
60
discriminate. This can mean challenging colleagues

Courses and
and people using the service about their discriminatory Internet in-house
behaviour. This may be a hard thing to do but you training
need to be prepared to hold on to your care value
base and challenge people if necessary. If you do not,
Journals and Training and Distance
you may be drawn into the discrimination yourself.
magazines development learning
You may need to seek the support of a line manager
or other person that you trust straight away if you
feel that you cannot challenge the discrimination
Work
yourself. Reporting it is in itself challenging the anti- Television Mentoring
shadowing
discriminatory practice.
The health and social care profession can empower its Fig 2.3: Sources of training and development
staff by encouraging them to promote individual rights,
choices and well-being at all times. You can promote
empowerment in the people using the service by Practical implications of confidentiality, e.g.
helping them maintain, regain, or gain independence recording, reporting, storing and sharing of
as far as they are able.
information
Dealing with tensions and contradictions The law and the underpinning values of care practice
In your career in health and social care there will be demand that all health and social care professionals
many tensions and contradictions. There is really maintain people’s confidentiality at all times.
only one way for you to cope with this and that is Confidentiality refers to all information relating to
to use your team of colleagues to support you. By those using health and social care services and the
asking for help in this way situations are dealt with in records associated with them, no matter what format
a professional manner, you will feel supported and those records are in.
good about yourself and it will encourage the team Whenever you are handling information you must:
to work together. If you make use of your colleagues’ • respect people’s wishes and their privacy
skills and guidance and follow high-quality professional
• follow the guidance and procedures of your
standards, you will find it easier to make decisions and
organisation
deal with any tensions that arise.
• comply with the requirements of the law.
When gathering confidential information you must
Did you know?
ensure that:
Many employees feel that poor interpersonal • only information that is needed is collected
relations are a source of stress at work.
• the data is only used for the purpose for which it
was intended
• all records are kept safe and secure
• each workplace has a policy or guidelines for staff
Staff development and training to follow.
Health and social care workers, like all professionals, All this places a huge burden on people concerned
need to keep their training and skills updated so that with the management of these records. For example:
they can keep up with new ideas and new technology • Where can paper-based records be stored?
and procedures. In terms of the underpinning values of • Who should have access to them?
care practice, health and social care workers need to • How can they be kept secure?
be familiar with the new legislation and new terms that
• How long should they be kept?
should be used when working with individuals. Training
can be gained from a variety of sources, as shown in • What kind of information should be recorded?
Fig 2.3. • How often do they need to be updated or reviewed?
61
There are extra concerns for computer-based records • have their choices taken into account and be
such as: protected.
• Who has access to passwords? You have covered the above in the ‘Terminology’
• What happens when the system fails? section (pages 52–58). In this section, we will use
further activities and case studies to gain a deeper
• Who will carry out the necessary training?
understanding of individual rights.
• Who carries out repairs and can they see the
information? The right to be respected
All individuals have the basic human right to be
Activity 8: Confidentiality respected. Demonstrating respect for the individual
is at the core of the health worker’s responsibility.
policy Respect is about preserving a person’s dignity,
Obtain a copy of a confidentiality policy and make core beliefs, choice and privacy, even if someone’s
notes on the contents and how they promote choice of treatment does not match your own. A
individual rights. Discuss this with your tutor. previous example concerned a person with diabetes
not accepting their condition and not taking their
medicine or controlling their diet. These situations can
be very frustrating, as you may feel that it has nothing
PLTS to do with you if the person is severely ill due to them
not accepting their illness but you still have to respect
Independent enquirer: You can use your
independent enquiry skills to analyse the individual choices.
confidentiality policy, evaluate the information and judge To be able to demonstrate respect you should have:
its relevance. What is its value to anti-discrimination and
• good listening and communication skills with the
rights?
individual
• patience
1.5 Individual rights • acceptance of choices.
• and be non-judgemental
Reflect
Re-read the section on ‘Rights’ (page 54) and
keep this in mind as you work through this
Case study: Women’s
section. refuge
Sarah is a support worker in a women’s refuge
where women come to get away from their abusive
In health and social care, rights refer to the partners. Mrs Gee has been in the refuge for a
underpinning principles of care practice. Examples of month after being physically abused for almost
an individual’s rights are to: three years by her partner. One day she tells Sarah
• be respected that she wants to return to her partner.
• be treated equally and not discriminated against 1 What do you think Sarah should say to her?
2 How do you think Mrs Gee is likely to react?
• be treated as an individual
• be treated in a dignified way
• be allowed privacy
• be protected from danger and harm The right to be treated equally and not
• be allowed access to information about themselves discriminated against
• be able to communicate using their preferred Health and social care professionals work with a wide
method of communication and language range of individuals and must take great care that they
• be cared for in a way that meets their needs do not discriminate against anyone.
62
Case study: Language barrier?

Yasmin is a nurse at a busy hospital. When passing 1 How should Yasmin challenge the
by reception she heard the receptionist, who was receptionist in a professional manner?
obviously annoyed, talking on the phone. She was 2 If Yasmin doesn’t feel able to challenge the
saying, ‘Tell your mother that she needs to clearly receptionist herself, what should she do?
understand English before she sets foot in here.
Otherwise she will not understand what she is told,
unless you fly over from Argentina and help her.’
The right to be treated as an individual The right to be allowed privacy

This is central to the underpinning values of care Privacy is another human right, as long as people are
practice. By recognising and valuing difference, you not going to hurt themselves or others. All of us have
can treat all people as individuals. the right to expect that:
• our treatment and care will be kept private
Activity 9: Reflect on your • no information will be passed to people who have
own rights and choices no right to access it (this confirms the right of
confidentiality)
Reflect back on the questions you asked yourself in
• our dignity will be maintained throughout any
the Getting started activity ‘Diversity – a personal
view’ (page 48). If you were going to hospital, write procedures necessary.
down the things that you would like done to ensure Privacy may not be easy to arrange, especially working
that you were treated as an individual with rights in a busy hospital or care centre, but with thought and
and choices. care it can be achieved.
The right to be treated in a dignified way Why is it important to treat people

with respect and allow them privacy?
All individuals deserve to be treated in a manner that
preserves their dignity and sense of self-worth.
Case study: Distressed

person
Dwayne works in a residential care home as a carer.
As he passes Mr Hinkley’s room, the door is open
and Dwayne sees Mr Hinkley lying on his bed
naked. He has soiled the bedclothes and he is in
distress but cannot get out of bed.
1 What should Dwayne do?
2 How could this type of situation be avoided in
future?
63
The right to able to communicate using their

Case study: Patients’
preferred methods of communication and
privacy
language
Jennifer works in a hospital as a rheumatologist. Every individual has a language they prefer to
As she passed the rheumatology reception desk
communicate in. If you went to hospital for treatment,
today, she saw patients’ notes laid out on top of
the desk with people waiting and no staff present. what language would you want to talk in to describe
your concerns and ask about what happens next?
1 What should Jennifer do?
Is English your first language? If it is, think how you
2 What steps should she take to make sure this
would feel if you went to hospital in another country
doesn’t happen again?
where the main language was different from yours.
How would you feel if the staff didn’t speak your
language when you got there? How would you feel if
The right to be protected from danger and they were telling you something serious (you could tell
it was serious by their body language, tone and facial
harm
expression) but you didn’t understand what they were
Everyone working in or using the health and social care
saying? Reflect on this for a while.
sector has the right to be kept safe from danger and
Clearly, it is extremely important to ensure that the
harm. To ensure this happens, all settings should have
right language is used in order to ensure that there is
a health and safety policy that sets out the actions,
good communication between people. However, this
rules and regulations that must be followed to keep
can be a strain on health and social care resources. For
staff and those using the service safe and healthy.
example, a health authority may find it hard to justify
payment for interpreters or translators when there are
other things to do which may seem more important.
Activity 10: Looking at a Under the Discrimination Act, there is a rule entitled
health and safety policy ‘making reasonable adjustments’. This is where an
adjustment has to be made to help someone, as long
Look at a health and safety policy from a residential
as it is reasonable, and in this case providing a means
care setting and discuss with your tutor ‘what
measures must be taken when using lifting of communication would be seen as reasonable. This
equipment’ and ‘what precautions must be taken means that if the hospital did not provide a means of
when taking people out on a trip’. communication the person could take them to court
and sue them.
Health and social care settings can support
communication in other languages by:
• employing staff with different language skills.
The right to be allowed access to information
• employing staff who speaks the local common
about themselves language
In accordance with the Freedom of Information Act,
• buying in the skills of interpreters and translators
and the Data Protection Act, all individuals have the
right to see their health records and any information • communicating in a variety of formats (e.g. pictures,
written about them. This means that if you are Braille, leaflets in different languages)
responsible for a person’s health records you must be • finding out if the person has a family member who
responsible for: can act as an interpreter.
• keeping their records up to date and in order
• being able to find the information quickly and easily The right to be cared for in a way that meets
• enabling colleagues to find information quickly and their needs
easily if you are absent This right includes all those that have been previously
• keeping that person safe and secure. discussed.
64
Reflect The right to have their choices taken into

Imagine that you are a health worker and you
account and be protected
are visiting a new patient for the first time. What The care value base (page 60) refers to choice.
questions should you ask and why? Whether it is selecting a certain hospital, care facility or
form of treatment, people should have choices that are
taken into account by health and social care staff while
PLTS still ensuring that they are protected.
Independent enquirer: You will show independent
enquiry skills when asking questions to extend your
thinking about meeting new people. Think about your
awareness of the concepts of equality, diversity and
rights and the effects of discriminatory practice.
2 Know discriminatory practices in health and social

care
The cause of any discrimination is termed the ‘basis
of discrimination’. For example, a person may be Did you know?
discriminated against on the basis of their diversity. In Recent findings show that workplace discrimination
this section you will be exploring the different bases on allegations regarding sexual orientation were
which discrimination can occur. dominated by claims of bullying and harassment
including name-calling, threats and physical assaults.
2.1 Bases of discrimination Source: ACAS (www.acas.org.uk)
As you have already learned, the bases of

discrimination are:
• culture Culture
• disability A person’s culture is important to them and identifies
who they are in the world. It is developed within the
• age
social group they are raised in, and can change when
• social class they are mature enough to decide for themselves what
• gender culture best suits them.
• sexuality In the health and social care profession, respecting
• health status a person’s culture is important for all concerned. It is
• family status important for the individual because it creates a sense
of support and understanding, promotes their well-
• cognitive ability.
being and can help their health. It is also important to
You may find it hard to believe that anyone working health and social care professionals because they see
in health and social care would discriminate against the benefits of their care value base and this underlines
another person on any of these grounds. Unfortunately the importance of respecting an individual’s culture.
it does happen, but you also need to be aware of
the possibility of discrimination from everyone you Disabilities
encounter when working in health and social care, In health and social care, you will work with and
including those using the services. support people with various disabilities.
As a health and social care professional, it is part of The Disability Discrimination Act (DDA) makes it
your role to understand the bases of discrimination unlawful to discriminate against someone who has
and to champion diversity and the rights of individuals a disability. The act covers employment, access
so that no one suffers because of discrimination. to goods, facilities and services of organisations,
65
education, buying and renting a property and transport Age

services. There has to be full accessibility for anyone
Age discrimination happens ‘when someone is treated
with a disability.
unfavourably because of their age, without justification,
The organisation you work for will be required by law or is harassed or victimised because of their age’.
to have a policy in place regarding disability.
There have been some controversies regarding the
dispensing of certain very expensive drugs to older
Activity 11: International people because of their shorter life expectancy, due to
their age. Some people have argued that the money
Day of Persons with would be better spent on drugs for younger people.
Disabilities However, denying a person a drug due to their age
On 3 December it is the United Nations may open the health service to considerable legal
International Day of Persons with Disabilities. risk, and legal advice needs to be sought first before
1 Carry out research to explore the key issues decisions like this are made.
behind this event – for example, the concepts
of equality, diversity, rights and the effects of
discriminatory practice. Activity 12: For or against
2 Create a display to put up in your school or ageism
college.
According to the NHS, in 2004–2005 £8 billion was
spent on health care for older people compared
to £4.4 billion on families and children. Form
two groups in your class, with the tutor as the
PLTS chairperson, to argue whether the funding is too
Creative thinker: When displaying your work, use high or too low for the care of older people.
your creative thinking skills to come up with a variety
Source: www.ic.nhs.uk
of formats, such as a slide show with music, video/DVD,
display boards, flyers, leaflets and other formats.
PLTS
Independent enquirer: Ask questions to find out
more information, research information from a wide
range of sources. Then question your own and other
Do you think money should be spent people’s assumptions.
treating people for illnesses when
they are near the end of their lives?
Social class
Our social class is apparent from the place where we
live. The higher the class, the better the place is kept
and maintained. This inequality has also infiltrated
health and social care. In the foreword to a Department
of Health publication, Alan Milburn MP, former
Secretary of State for Health, stated that the poor are
far more likely to get cancer than the rich, and their
chances of survival are lower too; the letter carries on
to say that health care is a postcode lottery. However:
‘At the heart of human rights is the belief that
everybody should be treated equally and with
dignity – no matter what their circumstances’.
Source: Equality and Human Rights Commission
(www.equalityhumanrights.com)
66
Gender Case study: Mohammed

A person cannot be discriminated against because of
their gender. Under the Gender Equality Duty 2007, all Mohammed is a support worker in a
organisations, including health and social care services, residential care home for young people with
severe learning difficulties, a few of whom have
cannot discriminate unfairly due to a person’s gender.
complex needs. These individuals suffer from
Equal rights of access, health care and rights must be mental health difficulties and take prescribed
adhered to. medication to control their aggression. There are
quite a few unqualified staff working in the care
home. Mohammed looks after individuals and
helps other support workers when needed.
Activity 13: Research gender Last week he was passing a room with its door
discrimination partially closed and heard a support worker in the
room, who shouldn’t have been there, saying to
Create a questionnaire and ask 25 people whether the resident, ‘If you ever shout like that again I will
they think they have been discriminated against tie you down in the bed for a week without food or
due to their gender. Analyse the results for the water, do you hear me?’
whole class and discuss the findings.
1 What would you have done?
2 How would you have felt and why?
3 What has been witnessed in terms of equality,
diversity and rights?
PLTS 4 Which other areas in the residential care home
Independent enquirer: Exploring issues, events or should be looked at and why?
problems from different perspectives and analysing the
data shows independent enquiry skills.
Family status
This can lead to a variety of discriminations: against
Sexuality gay and/or lesbian parents, single parents, parents
Sexual orientation can refer to a person who is of different genders, parents of different races with
attracted to another person of the same sex (gay and/ mixed-race children and other family groupings.
or lesbian), the opposite sex (heterosexual), or both
sexes (bisexual).
Cognitive ability
Discrimination on the grounds of cognitive ability may
Discrimination against someone due to their sexual
arise because of a brain injury, a learning disability
orientation is against the law. If someone feels
or difficulty, or a person’s social class or education.
discriminated against due to their sexual orientation
It can be easy to discriminate against people with
or feels they are discriminated against they can seek
cognitive disabilities but care must be taken not to
legal help.
do so. Valuing People Now is a government strategy
which aims to improve the lives of people with learning
Health status
disabilities, and those of their families and carers.
Sometimes difficult decisions have to be made
regarding a person’s medical treatment, taking into
account the cost of the treatment, their expected
2.2 Discriminatory practice
quality of life after the treatment and their overall life Discriminatory practice can be shown through the
expectancy. People making these decisions should following behaviours:
always keep questioning their own assumptions • Infringement of rights: not respecting an individual’s
and prejudices, and do their best to balance the rights and not letting them practise their culture.
welfare of individual patients with broader funding This can lead to individuals feeling devalued and
considerations. very sad, which will affect their health.
67
• Covert abuse of power: hidden use of power to • Stereotyping: assumptions made about an
discriminate. This can lead health and social care individual, which could affect their health care.
professionals to treat someone differently from • Labelling: giving people labels, mostly negative
someone else. This means that a person may ones. This is very unprofessional and could lead to
not get the same level of treatment, which may different levels of health and social care being given
jeopardise their health and well-being. to particular individuals.
• Overt abuse of power: openly using power to • Bullying: using one’s power to intimidate another
discriminate. This will have similar outcomes to covert person. There are different forms of bullying, such
abuse of power. However, if a person being treated as physical, written and verbal, all can which lead to
notices that they are being discriminated against, it distress or even mental health issues.
will have a negative impact on their recovery, their
• Abuse: abusive situations can occur due to stress,
health and perhaps even their mental health.
or lack of staff supervision or training, and will
• Prejudice: negative, preconceived ideas about an definitely lead to the abused individual’s health and
individual, arising from a person’s negative ideas mental state deteriorating.
about that individual. This can affect the individual’s
health or social care.
Activity 14: Discriminatory practices

Read the examples below and identify which letter at the bottom of the pile, meaning the
discriminatory practice is shown in each. person wouldn’t be seen until the following week.
Discuss what negative effects they might have on Discriminatory practice 5:
care practice. Laurel is looking for work experience and she visits a
Discriminatory practice 1: nursing care home where older people with mental
During his work experience at a residential care home health issues are looked after. On arrival, she is shown
with several Bengali residents, Nathan is told by his into the main lounge and sees four people eating their
mentor that the menu is only in English, as they don’t lunch. One is shaking uncontrollably, one dribbles
have a person who can write the menu in Bengali. The their drink down their chin, two are looking up at the
residents who can’t read English are unable to make ceiling. Laurel thinks the people she will be looking
choices from the menu and just get what they are after are stupid.
given. Discriminatory practice 6:
Discriminatory practice 2: In a residential care home a carer says to Laurence:
On his work experience in domiciliary care, Andreas is ‘Mrs Sinclair is coming back next week. She is so
in the car with the health visitor who says before the miserable and so overweight.’
next home visit: ‘The next person is Mr Chisholm. I Discriminatory practice 7:
don’t like him so I won’t take as long over him as I did During her work experience, in a day care centre,
with Mrs Henshaw.’ Fatima walks past the supervisor’s office and hears her
Discriminatory practice 3: say to someone: ‘Shut up complaining about the food
Carmen noticed on her work experience in a nursing – it is tasty. And anyway you need to eat less as you
care home that the carers ignored Emily, a person with are too fat and you need to lose weight.’
a bad temper who swore a lot as she was frustrated at Discriminatory practice 8:
being in a home. However, they would make a big fuss While working in a residential care home, Nicola is
over Theo, who was kind and joked a lot. working with a newly qualified care assistant who is
Discriminatory practice 4: obviously under a lot of pressure to change all the bed
While Patricia was on her work experience at a hospital sheets before 11am. The care assistant handles the
she was going through appointment letters sent in by patients while changing the sheets and moves their
local GPs. When she read that one patient was HIV limbs quite roughly so that at times they moan in pain.
positive she thought ‘gay’ and grimaced, and put the
68
2.3 The effects of Restricted opportunities

discriminatory practice in All types of discrimination may lead to a person
not using health and social care provision and this
health and social care can lead to poorer health. The discrimination may
As you have seen, discriminatory practice has very be by individuals, health organisations or even the
negative effects on people being cared for. This government.
section explores these effects in more detail.
Negative behaviours such as aggression or
Marginalisation (treat a person or group as criminality
Negative behaviour, aggression or crime can be
insignificant) partly caused by discrimination. Living in poverty and
This is when people feel they are not part of the experiencing discrimination can affect an individual’s
main group in society. The Journal of Social Work behaviour. People may experience hardship and then
has explored a wide range of discrimination cases take their frustrations out on police, teachers and
involving marginalisation. For example, the April 2009 health and social care professionals. People may take
edition looked at the oppression and marginalisation out their anger on those they see in a position of
of older lesbian, gay men, bisexual and transgendered power and health professionals can find themselves
people in homophobic societies, and in November being verbally or physically attacked. People may
2009 it looked at cases of marginalisation of children have anger management problems and they may take
with HIV/AIDS. In health and social care no one should this out on the health and social care professional.
be marginalised no matter what their background, Drug users may also display negative behaviour while
circumstances, sexual orientation or health status. in care.
Source: www.oxfordjournals.org
Disempowerment (make a person or group Activity 15: Discriminatory

less powerful or confident) practice
Individuals or groups that are discriminated against
by other individuals or more powerful groups will feel You have been asked to deliver a presentation
disempowered. They may be willing to fight against on the effects of a certain type of discriminatory
practice in health and social care. This can be your
this and in some cases will win their case. However,
own choice or your tutor may choose to ensure that
many do not and they lose the will to fight against the different types of discrimination are covered by
discrimination. As a result of this, they may become allocating one to each person (or small group) in
depressed and devalued and disempowered, which in the class.
turn may lead to more health issues.
Low self-esteem and self-identity

Discrimination can lead to people losing their self- Functional skills
worth or self-esteem. Some vulnerable people may ICT: You can demonstrate your ICT skills by
have low self-esteem before they start using health researching and presenting information in ways that
and social care services. A person with low self-esteem are fit for purpose and audience. Make sure the
information you present meets the criteria and is
will experience negative self-identity, which brings a
relevant.
feeling of worthlessness and depression. The health
and social care professional needs to ensure that an
individual’s self-esteem is maintained (if it is high) or
can be raised (if it is low), to help the person cope with
their situation.
69
2.4 Loss of rights A person’s rights are sometimes taken away by force
or power, for example, if someone with psychiatric
Overriding individual rights problems is detained in hospital under the Mental
Health Act 1983 or the Mental Health (Care and
‘There are some specific circumstances when it is
Protection) (Scotland) Act 2003. They can also be
lawful to discriminate in providing health and social
forced to accept treatment. This is done in the patient’s
care.’
best interests, even though they may not want to take
Source: Equality and Human Rights Commission
the medication.
(www.equalityhumanrights.com)
All organisations have to comply with the Human
Rights Act, as previously mentioned. However, there Activity 16: Lawful
are some cases where the Act can work in different discrimination
ways. These include the use of statutory powers and
cases when a person’s rights have to be removed by In groups, allocated by your tutor, research cases
force or power. of lawful discrimination in health and social care.
From your research, produce information posters
Statutory powers are used, for example, when a to be displayed in your school/college.
child is taken away from abusive parents. Although
the parents’ rights are being affected, the child’s
right to health and safety takes precedence even if
the parents objected. This may require a range of
PLTS
services, including social services, the police and
Independent enquirer: Exploring issues, events or
health professionals as well as the legal profession,
problems from different perspectives (e.g. concepts
working together to ensure that the rights of the child of equality, diversity, rights and the effects of
are protected, even at the expense of the rights of the discriminatory practice) will enable you to use your
parents. independent enquiry skills.

P4 M2
P3 M1
A local hospital has sent out a poster to local schools • Part 2: describes discriminatory practices in health
and colleges giving details of a competition to and social care
produce a presentation on: • Part 3: describes the effects discrimination can
‘The concepts, description and effects of have on staff and individuals using health and
discrimination within health and social care’ social care
The poster is to publicise an NHS project to help • Part 4: discusses the effects of three different
break down discrimination within the health service, discriminatory practices on individuals using health
and the winning presentation will be used in staff and social care services
training.
You need to make the presentation interesting, Grading tips
readable and good to look at, and it should help
readers gain an insight into discrimination and its P1 Part 1: It would be beneficial to look at the
effects. benefits of equality, diversity and rights in
society before viewing them in a health and
Organise the presentation into four parts so that: social care context. Do some research on the
• Part 1: explains concepts of equality, diversity and Internet, especially on health-related websites,
rights in relation to health and social care and look for positive quotes on the benefits of
70
Assessment activity 2.1 continued
equality, diversity and rights in society. Then is always better to get human stories if you can,
visit health and social care settings, perhaps as these will convey the effects of discrimination
on a work experience placement, with a more vividly.
questionnaire to find out how equality, diversity M1 Part 4: Here you need to examine the effects
and rights are valued. of three specific discriminatory practices. You
P2 Part 2: This can be done at your placement could follow on from the examples you used
by asking people about known discriminatory for P3 and see what effects discrimination
practices in health and social care. You can also had on the victims, the person causing the
look at health-related websites, read national discrimination, and/or the organisation. You
and local papers, watch the news and read could use the three discriminatory practices
health magazines when searching for examples that you have the most sympathy with. Again,
of discriminatory evidence. remember it is always good to use a human
P3 Part 3: You could use your workplace story to get the point across. You should
experience to find out about this. Research consider the effects of the discriminatory
health-related websites that publish evidence of practices in detail, identifying those that are
the effects, and find quotes, or case studies. It most important.
PLTS Functional skills

Independent enquirer: explore issues, events or ICT: You can demonstrate your ICT skills by
problems from different perspectives, for example retrieving the information you have saved during
concepts of equality, diversity, rights and the effects of your investigation from a folder on your computer,
discriminatory practice. researching a variety of websites and listing them
in your bibliography, bringing together information
to suit content and purpose, and selecting only
information that is suitable for the presentation.
3 Understand how national initiatives promote anti-

discriminatory practice
Up to now, legislation has been mentioned and However, you do need to know of their existence and
examples given. In this section the most important their basic principles. If you are unsure of anything, you
laws are looked at that you will need to be aware of can always ask someone and research the relevant
when working in the health and social care profession. Act yourself.
3.1 Conventions, legislation and Reflect

regulations Reflect on your thoughts about having to know
There is no need to worry, as no one expects you to about all these laws and regulations and discuss
know all the details of every law that promotes these with others.
anti‑discriminatory practice in health and social care.
71
Table 2.2: Key legislation concerning discrimination against people
Law or regulation Areas covered

European Convention This is a European document relating to human rights; it is signed by all
on Human Rights and governments in the European Union, including the UK.
Fundamental Freedoms 1950
Sex Discrimination Act 1975 This is to protect both men and women against discrimination or harassment on
the grounds of gender in employment, education, advertising or in the provision of
housing, goods, services or facilities.
Mental Health Act 1983 The main purpose of this Act is to allow action to be taken, where necessary, to
make sure that people with mental health difficulties or learning difficulties get the
care and treatment they need for their own health or safety, or for the protection of
other people.
Mental Health (Northern This Order provides the legal framework in Northern Ireland for compulsory
Ireland) Order 1986 admission and treatment of patients suffering from mental illness. GPs can be
involved in Mental Health Order assessments in community or hospital settings.
The Convention on the This is issued by UNICEF for the Framework for the Rights of the Child. It protects
Rights of the Child 1989 specific children’s rights in international law. These rights include principles and
standards for the treatment of children worldwide.
The Children Act 1989 This is a UK Act for the protection of the child from significant harm. It ensures that
the child is supported, safe and cared for, by setting standards.
Race Relations (Amendment) This Act protects racial equality and ensures that no person is discriminated against
Act 2000 on the grounds of their race. It promotes good relations between people of
different ethnic backgrounds.
Disability Discrimination Act The Disability Discrimination Act ensures civil rights for people with disabilities and
(DDA) 1995 protects them from any form of discrimination. It encourages organisations and
health authorities to overcome barriers and make reasonable adjustments to ensure
full accessibility.
Human Rights Act 1998 This covers all human rights and ensures that all individuals have rights on their side
and can take legal action against any person or organisation (including health and
social care services) that disrespects their human rights.
Data Protection Act 1998 This Act covers the way information about living identifiable persons is used and
protected. All organisations holding personal data must apply the Act. This is
obviously extremely important in the health and social care sector.
Nursing and Residential Care This applies to nursing and residential care homes. They have to apply to their
Homes Regulations 1984 local council for a licence to operate, which regulates their practices. If the homes
(amended 2002) do not meet the regulations, the council can prosecute them, and, in extreme
circumstances, close them down.
Care Standards Act 2000 This covers the care of individuals in all types of settings, including domiciliary,
fostering and family care, as well as residential and nursing care. Standards have to
be met to ensure the individual is at the centre of the care being given.
The Children Act 2004 This Act provides legislation to improve children’s lives in the broader sense. This
covers all the services that every child accesses, including additional needs. Its aim
is to encourage better services and provision for all aspects of children’s welfare
and health.
72
Table 2.2: Key legislation concerning discrimination against people – contd
Law or regulation Areas covered

Disability Discrimination Act This updated the 1995 DDA and specifically applies to the public sector, to
(DDA) 2005 promote equality of opportunity for people with disabilities and to eliminate
discrimination. It includes people with HIV. It also states that public bodies must
promote disability equality and will have to produce action plans explaining how
they intend to fulfil their duties, and review their progress annually, and that
universities and colleges must make reasonable changes to their premises to
make them more user-friendly for Britain’s students with disabilities. This duty is
anticipatory, meaning that public authorities will have to review all their policies,
practices, procedures and services to make sure they do not discriminate against
people with disabilities and ensure that all their services are planned with their
needs fully considered in advance.
Mental Capacity Act 2005 This Act provides a framework to empower and protect vulnerable people who
are not able to make their own decisions. It states clearly who can take decisions,
in which situations, and how they should go about this. It enables people to plan
ahead for a time when they may lose their mental capacity. People who are placed
under a duty to have regard to this Act include those working in a professional
capacity such as doctors and social workers.
Age Discrimination Act 2006 Since this Act was passed, it has been unlawful for employers and others to
discriminate against a person on the basis of his/her age. This applies to jobs,
promotion, training and employment.
3.2 Codes of practice and charters (written constitutions, written by

the legislative powers of the country)
Codes of conduct established by professional to expect, in the way of support and behaviour, from
health and social care staff. Most health and social care
bodies
professions have a charter or code of practice, which
These codes guide health and social care professionals members have to follow.
on their roles, rights and responsibilities. They also
can help those using the services understand what Below is part of the nurse’s code of conduct:
UNCIL CODE OF
D MIDWIFERY CO
THE NURSING AN CO ND UC T
PROFESSIONAL
nurses and midwives
formance and ethics for
Standards of conduct, per
ing.
h their health and wellbe
ple in you r car e mu st be able to trust you wit
The peo
must:
To justify that trust, you ividuals and respecting
their
peo ple you r firs t con cern, treating them as ind
• make the care of
dignity r care, their
wellbeing of those in you
oth ers to pro tect and promote the health and
• work wit h
the wider community
families and carers, and
all times
d of practice and care at
• provide a high standar r profession.
old the reputation of you
ope n and hon est, act with integrity and uph r practice and
• be ons and omissions in you
ion al, you are per son ally accountable for acti
As a profess
justify your decisions.
must always be able to ional practice or person
al
s relate to your profess
mu st alw ays act law fully, whether those law
You
life.
Source: The Nursing and Midwifery Council

73
using the service what to expect, and if they are not

Activity 17: The nurse’s treated accordingly they have a right to complain. As
code a professional working in health and social care, you
Form groups and discuss your impressions need to be aware of the codes of practice and charters
and understanding of the nurse’s code. and ensure that you are given training about them.
The codes apply to the:
• General Social Care Council in England
Functional skills • Care Council for Wales
• Northern Ireland Social Care Council.
English: You can demonstrate your speaking and
listening skills by contributing to group discussions The codes also apply to everyone working in the
and making effective presentations in a wide range of voluntary, private and statutory sectors.
contexts.
Charters
As we have seen, most organisations have charters that
General Social Care Council inform staff and those using the service about what
The General Social Care Council (www.gscc.org.uk) they can expect. The Care Quality Commission (www.
registers social care workers and regulates their cqc.org.uk), which is the body that regulates standards
conduct and training. People working in social care in health and social care on behalf of the government,
need codes of practice to follow and are judged on will use the relevant charter as a starting point when
them when they are audited. The code also tells those they review an organisation.
Case study: Susan

In 2008 Susan registered with a nursing agency in order open while she went to speak to her manager.
to get work in the nursing profession. The agency said Susan looked inside her file and noticed a fax
they had work for her but needed a suitable reference. headed ‘Confidential’. She looked at the fax. It was
She had worked for her last employer for five years and from her old manager to the agency, telling them that
she had always had a good attendance record, and she had had a gender change. She had asked her last
had good feedback about her work in appraisals. manager not to mention this. In the fax was her former
She waited for the agency to contact her but they name and she was also referred to as ‘him’ as well as
didn’t. When she enquired they told her that they ‘her’. The agency denied that this was why she hadn’t
hadn’t received a reference. She contacted her been notified of any work.
previous manager directly. He sounded anxious that 1 What course of action could Susan take against
she had contacted him and said he would send the her old manager?
reference again. 2 What course of action could Susan take against
After a few more days she went to the agency again. the agency?
The person she spoke to was very cool towards her. At 3 What are Susan’s rights?
one point the person left the office and left Susan’s file
Activity 18: Codes of PLTS

conduct and charters Creative thinker: Ask questions to extend your
creative thinking about concepts of equality, diversity
Discuss why codes of conduct and charters are
and rights and the effects of discriminatory practice.
important to those using services and why they
are important for you as a health and social care
professional.
74
advocate can be a professional worker or a friend

Did you know? or relative. However, the advocate must realise that
Union representatives play a central role in promoting
they are speaking on behalf of the individual and not
equality because of the trust and confidence attached expressing their own view.
to their position. They are the first point of contact
when members want to make a complaint or just to Work practices
talk something over that is worrying them at work. It Health and social care settings must have policies
is important that union reps are seen to support their
and procedures in place and ensure that staff are
members in discrimination complaints.
aware of these – by putting up notices and providing
training. Policies and procedures are no use if health
and social care professionals do not know about them,
3.3 Organisational policies and so workplace training is vital. Health and social care
professionals then have to abide by the policies and
procedures procedures at all times and must ensure that people
Having explored the legal aspects of equality, diversity using the service are aware of them too. If staff fail to
and rights in health and social care, this section comply with these policies and procedures, the result
looks at policies (rules/guidelines) and procedures could be disciplinary action or dismissal.
(how to carry out the rules/guidelines) within
organisations. Managers in health and social care have
Staff development and training
a responsibility to support and guide professionals in A health and social care professional, once fully
their employment to ensure that they observe equality, trained, still has to be kept up to date with changes
diversity and rights. in policies and procedures, as well as legislation
and technology. All these change or are updated as
Positive promotion of individual rights the need arises. Technology changes rapidly, as do
This can be seen in all areas of health and social care procedures – hence the need for continual professional
by looking at noticeboards in the hallways, reception development.
areas or staff rooms. Charters, for example, should be Equality, diversity and rights legislation are also
displayed for people to read, if they wish, in waiting constantly updated and staff must be kept informed of
rooms, canteens or other areas that they pass through. these changes.
Policies and procedures should also be available for
health and social care professionals to read if they Activity 19: Workplace staff
are unsure about anything, or they should at least be development
informed of where the policies and procedures can be
found. When visiting a health and social care setting,
Staff should also receive a handbook when being ask staff about training they have received on
discrimination and how important it has been in their
inducted to a new post or role, and frequent training
work. Bring your findings back and discuss with your
should be given to ensure that all health and social tutor.
care professionals are kept up to date with changes
and reminded of their duty of care.
Advocacy PLTS
This is often needed for people who are too ill or frail Independent enquirer: Exploring issues, events or
to speak for themselves or do not know their rights. problems from different perspectives (e.g. concepts
Also, people who are vulnerable may not be aware of equality, diversity, rights and the effects of
of their rights and they need a person to ensure that discriminatory practice) can enable you to demonstrate
they receive what they are entitled too. A trained your independent enquiry skills.
person will speak on their behalf and this is common

practice within the health and social care sector. The
75
Quality issues Activity 20: Complaints and

Quality is a continuum. It is always changing and their effects
improving as things get reviewed and experience
develops in equality, diversity and rights. A workplace Research the most common complaints received
or organisation must be kept up to date with all by the NHS and then have a group discussion in
changes and ensure that health and social care class to reflect on the most common complaints
professionals deliver the highest-quality service. and how they could affect your work in health and
social care.
A quality manager is sometimes employed in
bigger workplaces to ensure this is the case, or
if the workplace is small a manager will have this
responsibility. Whoever is responsible for quality will decision of an NHS or in the case of care issues
need to ensure that: Social Services body
• policies and procedures are followed • receive compensation if they have been harmed.
• their content is regularly updated to ensure the
highest quality of service Affirmative action
• staff are regularly trained This is sometimes called positive discrimination or
positive action, which means favouring one individual
• the impact of training is monitored by checking
on the improvement of the quality of service at an over another because of their ethnicity. Although
agreed time after the training. this may be seen as discriminatory, it may be legal if
positive discrimination can be proven to benefit the
However, with pressure of work, some things can
local community. For example, a health provider may
get missed, so if you read or hear of something
advertise a post for someone who speaks a certain
new and you are not following it at work, you have a
language, which is local to that area. This can be seen
responsibility to ensure that others know about it.
as benefiting local people by having someone they
Complaint procedures can communicate with when using their local health
All organisations and smaller workplaces must have service, when they find talking about their health in
a complaints procedure by law. These procedures English difficult.
will be inspected when the settings are audited. The Anti-harassment
complaint procedure will vary between organisations
Organisations and workplaces must have a policy in
and workplaces but it needs to follow the same basic
place, by law, which deals with issues of harassment
format.
or bullying, whether it is on grounds of sexuality,
If someone complains, they have the right to: race, ethnicity, gender, beliefs, sexual orientation,
• have their complaint dealt with efficiently marital status or disability. In health and social care,
• have their complaint properly investigated harassment can sometimes occur partly because of
• know the outcome of any investigation into their the stresses of the job but it needs to be sorted out
complaint immediately, as it can cause stress, humiliation and
depression.
• take their complaint to the independent
Parliamentary and Health Service Ombudsman if
they are not satisfied with the way the NHS or, in the
Did you know?
case of care issues, Social Services has dealt with You, as an employee, must take reasonable steps to
their complaint avoid harm from harassment. If you are harassed, you
must take action via the complaints procedure at your
• make a claim for judicial review if they think they
workplace.
have been directly affected by an unlawful act or
76
Confidentiality Human rights

The guidelines on confidentiality are clearly stated Everything mentioned in this unit relates to human
in the Data Protection Act 1998 (one of the acts rights, and human rights are central to the health and
mentioned in Table 2.2). Confidentiality is at the heart social care profession. As an employee within the
of what health and social care professionals do. health and social care sector, you have to be aware
Every organisation or workplace in the health and of human rights issues and know how to report any
social care sector must have a confidentiality policy. incidents that contravene an individual’s human rights.
Confidentiality procedures must be strictly adhered to
in order to protect an individual’s health status from
becoming known by unauthorised people, which could Key term
lead to humiliation or loss of dignity. Confidentiality – Keeping something secret or private.
Examples of times when confidentiality needs to be
broken are when lack of information:
• means that there is a risk of the individual harming
themselves Reflect
• hides abusive or potentially abusive situations Reflect on the following statement: ‘People with
serious mental health problems die on average
• threatens the life of an individual. 10 years younger than other people. This is because
of the greater risk of physical health problems
and poorer access to health care’ (Source: ‘Equal
Treatment – Closing the Gap, the Disability Rights
Commission’s formal investigation into physical health
inequalities, 2007’.
4 Know how anti-discriminatory practice is promoted

in health and social care settings
4.1 The active promotion of anti- The underpinning principles and values of care
practice are built upon ethical principles and put
discriminatory practice the individual at the heart of health and social care
provision.
Ethical principles
There are four key ethical principles that should be
taken into account in the health and social care sector.
Putting the individual at the heart of service
They are:
provision
1 Justice: People must be treated fairly no matter
what their background. To put the individual at the heart of service provision,
the health and social care sector needs to:
2 Autonomy: A person’s choices must be respected.
• provide active support consistent with the beliefs,
3 Beneficence: This involves risks and costs; the
culture and preferences of the individual
health or care professional should act in a way that
benefits the patient. • support individuals in expressing their needs and
preferences
4 Non-maleficence: Any harm caused by a treatment
or intervention should not outweigh the benefits of • empower individuals
that treatment. • promote individuals’ rights, choices and well-being.
77
Activity 21: Supporting and PLTS

empowering a person Independent enquirer: You can demonstrate
independent enquiry skills by asking questions to
When visiting a health and social care setting, find
extend your thinking about concepts of equality,
out from staff how much of their working day is to
diversity and rights and the effects of discriminatory
do with supporting someone (as described in the
practice.
bullet points above) other than medically. Reflect on
the answers you get.
Case study: Carol

Carol is a carer in a nursing home. She looked after as a health care assistant. Her friends spoke of
Mrs Kombo, aged 36, a terminally ill patient with a how she enjoyed seeing people and going to
brain tumour. Because of the tumour, Mrs Kombo was parties. She was well loved and really enjoyed her life
unable to talk while she was in the home and Carol in London, and was looking forward to her new work in
spent little time with her. nursing.
It was only when Mrs Kombo died and Carol was Having attended the funeral, Carol wishes that she had
required to attend her funeral that she found out what spent more time with Mrs Kombo.
an incredible life Mrs Kombo had had. She came to 1 What would you have done differently?
England from Rwanda in 1995 after the genocide,
having seen her two children slaughtered, her husband 2 What difference would this have made to Mrs
taken and never seen again and she herself had been Kombo?
raped. After fleeing to England she started work as a 3 What factors stopped Carol from spending time
cleaner for a large cleaning company in London. She with Mrs Kombo?
learnt to speak English and spent long hours teaching
4 Why is this situation considered a discussion topic
herself and attending ESOL classes at her local
for a unit on equality, diversity and rights?
college. She wanted to become a nurse and when
her English had improved she started her training
Providing active support consistent with • physical support – dressing, personal care
the beliefs, culture and preferences of the • social support
individual • mental health support – coping strategies.
Active support means helping the individual as much Mental health support – coping strategies
as possible and taking their beliefs, culture and
This has to be treated with sensitivity and
preferences into account when making decisions in
thoughtfulness. If someone is identified as needing
health and social care settings. For example, if an
mental health support, the following teams should be
individual you are caring for follows the Muslim faith
available if needed:
you will need to ensure that halal meat is available
on the menu, and they can have an area in which to • social workers
pray if they so wish. Another example is if a person • community mental health nurses
with a learning difficulty comes into a residential care • occupational therapists
setting for respite. You need to ensure that they are • psychiatrists
listened to and that any support they might need
with their reading, socialising or personal care is met
with sensitivity and diligence. They may also need the
support of an advocate. Key term
The main forms of support may be: Advocate – A person who talks, or pleads, on another
person’s behalf, sometimes in court, or for a person who
• advice and guidance – rights cannot defend themselves.
• medical and care planning information
78
• psychologists them in the decisions being made, so that no one

• counsellors takes over on their behalf – even supposedly in their
best interests. The person has to make the choice
• community support workers, such as home helps.
themselves and it is hoped, with all the facts presented
Community mental health teams can take care of
to them, they will. Individuals have a choice and, even
health and social care needs and they will also advise
if they do not make the choice you want them to, you
on coping strategies for the individual. Remember –
still have to respect their decision.
always seek advice and help from professional services.
Promoting individuals’ rights, choices and
well-being
Did you know?
Individual rights can be promoted in many ways. For
One in six people – about 10 million people in the example, help can be offered with language and
UK – are affected by a mental health problem at any communication for those who cannot communicate
one time. effectively due to illness, disabilities or because
Source: The Office for National Statistics they are speakers of another language. A range of
information has to be made available in English and
in other forms, from Braille to pictures and different
languages. When translation is needed for literature,
Supporting individuals to express their needs ensure that a qualified translator is engaged in the
and preferences process. Otherwise, there is a risk that the wrong
This may mean supporting an individual who is Deaf in information will be given out, or the grammar or
expressing their needs and preferences by organising vocabulary will be wrong, making it look silly and the
communication support including British Sign person feel that they are not valued.
Language (BSL) interpreters, Deaf-blind interpreters,
lip-speakers, note-takers and speech-to-text reporters Balancing individual rights with the rights of
(palantypists). Or the person may not be able to speak others
the local language and an interpreter may need to be Balancing an individual’s rights with the rights of others
found. This may be an employee or a friend, a relative may seem daunting but with very good organisational,
or a person from their community – anyone who can negotiating and communication skills it is possible. The
help them express their needs and preferences. All this support of a network of services will also be required,
is essential to keep the person informed about what with everyone working towards a solution for individual
is happening to them and what is going to happen to rights.
them, and to ensure that they can express their needs
and preferences. How can individuals suffering from illness
be helped to express themselves and
Activity 22: Supporting make choices?
needs and preferences

When visiting a health and social care setting, find
out from staff their experiences of supporting the
needs and preferences of those using the service.
Analyse and discuss your findings in a group
tutorial.
Empowering individuals
An individual can be empowered if everything that
needs to be done for their care is explained to them,
and they are asked if they understand what they need.
This gives them control of the service and empowers
79
Dealing with conflicts Below is a list of possible ways in which this can be
achieved:
Dealing with conflicts is crucial in health and social
care. Individuals can become aggressive and tensions • implementation of government policies and
may build up if the care they are receiving doesn’t guidelines at local level by managers and
seem to be helping with their problems. As a health employees
and social care professional, it is important for you to • staff training and development; awareness training
be trained to deal with conflicts. events in continuous professional development
Conflicts can also happen between health and social • challenging work colleagues who demonstrate
care staff when several different services are needed to discriminatory behaviour
care for an individual. When dealing with conflicts, you • challenging inappropriate language
need to be professional and positive. You will require a
• telling a higher authority (either a line manager or a
range of skills, including:
higher local authority) when rules are broken.
• seeing both sides of the argument
• being willing to listen 4.2 Personal beliefs and value
• not taking sides systems
• not sulking and letting things fester We behave as individuals because of our personal
• being good at quick thinking beliefs and value systems. These develop throughout
• looking for solutions and not getting bogged down our lives and make us behave and react in certain ways.
in personal issues. Looking at yourself and how your personal beliefs and
value systems affect you will help you understand how
Activity 23: Role play – other people react.
Dealing with conflicts Influences on culture
In small groups, act out the following: You may have a strong cultural background or perhaps
• A health visitor calls on an individual as part of none at all. It really depends on those around you and
their routine and finds the person anxious and what they did to influence your understanding of your
angry, as they have been waiting for three hours culture as you were growing up. You might also have
for a home visit from their GP.
developed a strong link with your culture when you got
• A social work supervisor intervenes with two older. It will influence the way you communicate with
social workers, neither of whom feel it is their
people. No matter how you feel about your culture, it is
responsibility to look after an individual who’s
worker is off sick.They both have a heavy yours and no one can take it away from you. In the same
workload. way, you must respect the cultures of your colleagues
• A nurse phones the x-ray department about and those using health and social care services.
an urgent case but the person in the x-ray
department is overworked and not helpful.
Influences on beliefs
Your beliefs are either formed by adults that were
• A parent confronts their childminder, as the
parent was told by a friend that they saw their around you during your upbringing, or you may have
nine-month-old baby left outside a shop in a developed your own beliefs later in life. Your beliefs
pushchair in a very distressed state, while the will influence how you feel about yourself and others.
childminder was chatting to the shop assistant. For example, if you were raised with Buddhist beliefs
your understanding and perception of the world will
be different from those who hold other beliefs. In
Identifying and challenging discrimination psychotherapy, our belief system determines how we
In the course of this unit we have discussed a wide think about ourselves. If an individual has a belief system
range of discriminatory behaviour and how this can that says they are no good at things, they may react in a
affect health and social care staff and those using the negative way towards others, and have no confidence in
services. If any discrimination is identified, it has to be themselves. No matter what they are, you must respect
challenged immediately. the beliefs of others and they should respect yours.
80
Past events and social care and you should have a positive attitude
to your own health as well as the health of others.
Past events have a positive or negative influence.
For example, if you experienced something awful in Developing greater self-awareness and
hospital as a child, you may find that as soon as you tolerance of differences
enter or smell a hospital those negative feelings come
In Activity 3 (on page 55) you were asked to keep a
flooding back, and this can make hospital check-ups
record of your thoughts and prejudices as a way of
difficult. Past events have a huge influence on our
becoming more self-aware. It is essential that you
behaviour so you need to be aware of these when
are aware of how you think of yourself and how you
working in health and social care.
treat others and the reasons behind your behaviour.
Socialisation By doing this, you will become more aware of others’
Socialisation is part of our development, which everyone needs and also of your own needs.
goes through. This is how we learn to socialise with Committing to the care value base
others, from playing, having sleepovers and creating
It is essential that you are committed to the care value
friendships to having arguments and coping with
base and that you abide by it in your working life
education. It’s all part of making us the people we are
within health and social care. You need to be honest
and has a big influence on how we live our lives.
with yourself to check that you can do this and follow
Environmental influences the rules that apply. It’s better to decide you cannot
The environment where we were brought up influences do it now, rather than trying but not really committing
us a great deal and money and social class sometimes yourself, as that would be a waste of your time. Not
play a bigger part than we would like. Where you live everybody can work within health and social care and
may affect your access to health care provision. This commit to the care value base. Have a good think and
is obviously not right and when working in health and if you decide you can then that’s great and good luck.
social care you must do your best to provide the same
Careful use of language
level of care, whatever the environment.
Your use of language forms part of the core value base,
Health and well-being which lies at the centre of health and social care. You
Our health and well-being influence the way we need to be aware of people’s language and how you
develop, how we are seen by others, and how we communicate with them, as they need to understand
feel about ourselves. If we are extremely ill during what you are saying. Remember, if someone does
our childhood this could disrupt our education and not understand what you have said it may mean you
also possibly the way we socialise. This may affect our have not explained yourself clearly enough. Always be
career path later on and also how we communicate careful to ensure that you communicate with people
and feel about ourselves. People with disabilities may using their preferred method of communication. (You
not see themselves as having a disability. But they may may need support with this, such as an interpreter.)
feel that others only see them as ‘a disabled person’, You need to know that each person understands what
rather than an individual in their own right. Applying is happening to them and what they need to do to
labels to people is not helpful in health and social care. ensure that their health is properly looked after.
Your own health also needs to be good. Sometimes Your choice of words will affect your relationships with
long hours, stress and a lot of physical work can affect colleagues and those using services so be careful
your health. Keeping healthy is paramount in health about what you say and how you say it.
81
Working within legal, ethical and policy care profession and see what they think. Working in
health and social care is very rewarding and can give
guidelines
you a strong sense of achievement. However, you need
You have seen that there are a lot of regulations to be committed and be able to work within the legal,
and laws to abide by and to follow and this may be ethical and policy guidelines.
worrying you. Talk to others in the health and social
Assessment activity 2.2 P4 P5 M2 M3 D1 D2
You are to produce a booklet that explains how P5 Your description of how anti-discriminatory
recent national initiatives promote anti-discriminatory practice is promoted must be related to health
practices. The work placement officer at college asks and social care settings and should identify all
you to include a description of how anti-discriminatory the relevant features. You could use examples
practice can be promoted in health and social care so from placements.
that the booklet can be given to students before they
go on placement. She requests that the booklet is M2 Consider in detail the different aspects of
suitable for at least three different types of placement the initiative, identifying which are the most
setting. important and relevant.
You have investigated in detail one recent national

M3 You should consider several difficulties that may
arise when implementing anti-discriminatory
policy initiative promoting anti-discriminatory
practice in health and social care settings,
practice and your placement experiences have made
considering how and why any difficulties
you aware of the difficulties that can arise when
encountered might differ in different settings.
implementing anti-discriminatory practice in health
Your research could include questioning health
and social care settings. You therefore decide that
and social care staff in settings and as guest
your booklet will include chapters as follows:
speakers in class. Aim to investigate the views
1 how recent national initiatives have promoted anti- of a range of staff eg in assistant, supervisory,
discriminatory practice support and management roles.
2 how anti-discriminatory practice is promoted in D1 To achieve this criterion you will need to
health and social care settings review the information and bring it together
3 the impact of one recent national policy initiative to form a conclusion as to how successful
that promotes anti-discriminatory practice the chosen initiative has been in promoting
4 difficulties that may arise when implementing anti- anti-discriminatory practice. Your conclusion
discriminatory practice in health and social care should be supported by the evidence you have
settings and how these may be overcome. considered as part of your assessment for M2.
D2 You could extend your questioning of the
Grading tips staff you talk with for M3 to find out how
P4 You will need to explain at least two recent any difficulties they encountered when
initiatives by providing detailed reasons as to implementing anti-discriminatory practice
how and why they promote anti-discriminatory were overcome. You must provide reasons or
practice. You could use examples from everyday examples to support your justification of ways
life and health and social care. to overcome possible difficulties. Remember
this section of the booklet must also be related
to health and social care settings.

Independent enquirer: By exploring communication ICT: You need to use your ICT skills to select and use
from a different perspective, you are showing a variety of sources of information independently
independent enquiry skills. for this assessment. You also need to bring together
information to suit content and purpose when
organising your booklet.
82
Resources and further BBC News http://news.bbc.co.uk

British Council www.educationuk.org
reading British Heart Foundation Statistics
www.heartstats.org
Journals Data Protection Act www.legislation.org.uk
British Journal of Nursing Department for Children, Schools and Families
Child Care www.dcsf.gov.uk
Community Care Department of Health www.dh.gov.uk
Nursing Times Equality and Human Rights Commission
www.equalityhumanrights.com
Books Global Issues www.globalissues.org/
Clements. P. & Spinks, T. (2009) The Equal Healthcare Law www.carelaw.co.uk
Opportunities Handbook: How to Recognise Inclusion.me Ltd (Disability consultation)
Diversity, Encourage Fairness and Promote Anti- www.inclusion.me.uk
discriminatory Practice London: Kogan Page Ltd Kingston Hospital www.kingstonhospital.nhs.uk
Gaine, C. (2010) Equality and Diversity in Social Laterlife.com www.laterlife.com
Work Practice (Transforming Social Work Practice)
MentalHelp.Net www.mentalhelp.net
Exeter: Learning Matters Ltd
National Refugee Integration Forum
Griffin, S. (2008) Inclusion, Equality and Diversity in www.nrif.homeoffice.gov.uk
Working with Children (Professional Development)
NHS Choices www.nhs.uk
Oxford: Heinemann
NHS Employers
Hinshaw, S. P. (2007) The Mark of Shame: Stigma of
www.nhsemployers.org/Pages/home.aspx
Mental Illness and an Agenda for Change Oxford:
Oxford University Press Nursing and Midwifery Council www.nmc-uk.org
Robinson, K. & Jones Diaz, C. (2005) Diversity and Nursing Times www.nursingtimes.net
Difference in Early Childhood Education: Issues for Office for Disability Issues www.ODI.gov.uk
Theory and Practice Maidenhead: Open University Office of Public Sector Information
Press www.opsi.gov.uk/
Siraj-Blatchford, I. & Clarke, P. (2000) Supporting Postgraduate Medical Education and Training
Identity, Diversity and Language in the Early Years www.pmetb.org.uk
(Supporting Early Learning) Maidenhead: Open Safe Workers www.safeworkers.co.uk
University Press Tameside General Hospital
Sivitar, B. (2008) The Student Nurse Handbook www.tamesidehospital.nhs.uk
second ed. London: Bailliere Tindall Terrence Higgins Trust www.tht.org.uk
Thornicroft, G. (2006) Shunned: Discrimination UK Clinical Ethics Network
against people with mental illness Oxford: Oxford www.ethics-network.org.uk
University Press
UK government www.direct.gov.uk
UNICEF UK (Children’s rights) www.unicef.org.uk
Useful websites WHO Guide to Mental and Neurological Health in

Primary Care
About Equal Rights and Opportunities (UK) www. www.mentalneurologicalprimarycare.org
aboutequalopportunities.co.uk
Acas (Advisory, Conciliation and Arbitration Service)
www.acas.org.uk
83
Just checking
1 What are the benefits of diversity in society and the workplace?
2 Describe three discriminatory practices in health and social care.
3 Explain the consequences of the three discriminatory practices described above.
4 Name four national initiatives that promote anti-discriminatory practices in a health and social care
setting.
5 What would you do if you heard or saw someone being discriminatory against:
a another member of staff?
b someone using the service?
6 How are anti-discriminatory practices promoted in a health and social care setting?
7 How successful have new initiatives been in tackling anti-discriminatory practices?
8 What are your responsibilities when working in a health and social care setting with regard to
discrimination?
Assignment tips
1 Ask your tutor for a copy of the unit content sheet, so you can see what you need to include.
2 ‘Describe’ involves saying how and ‘explain’ involves saying why something happens. If you keep using
the word ‘because’ this will lead you towards achieving the higher grades.
3 Talk to the staff at your placement to gain an understanding of how anti-discriminatory practices are
applied in the way care is delivered so you can really see the relevance of what you are learning.
4 Go to the school/college learning centre or to your local library and read journals such as the British
Journal of Nursing, Community Care and Child Care.
5 Visit the Equality and Human Rights Commission website (www.equalityhumanrights.com). It is full of
useful information and case studies on discrimination. Other good sources of information include the
following websites:
• www.direct.gov.uk
• www.dh.gov.uk
• www.nhs.uk
6 Read newspapers and watch the news on television, looking out for any cases of discrimination in health
and social care, then research the case further. This will help you explore the issues more deeply, using
live stories.
7 Talk to friends and family and ask about their personal experiences of discrimination. If they are willing
to share their feelings, you can get a real insight into how it feels to be discriminated against in health
and social care.
84
Credit value: 10
3 Health, safety
and security
in health and
social care
This unit introduces you to health, safety and security issues in health and social
care settings. In the UK health and safety is taken extremely seriously, and we
take it for granted that our workplaces will be safe. However, as a practitioner
you will have to consider what risks exist, and be able to plan a safe environment.
You will need to know what the law requires you to do, and how to carry it out. If
you become a manager of a setting, you must make sure that everything possible
has been done to keep your staff and the people you care for safe, and that you
can prove you have done so.
To be good at health and safety, you need to be creative and innovative, and be able to think
ahead and remain calm in an emergency. You will gain a thorough understanding of potential
hazards. You will also learn how legislation, policies and procedures work to reduce risk, and the
consequences of not following them, both for your safety and your career! You will learn about
the health, safety and security responsibilities of employees and employers, and their relevance to
you as a student. Finally you will learn how to deal with all sorts of incidents and emergencies that
could occur in health and social care settings.
Learning outcomes
1 understand potential hazards in health and social care
2 know how legislation, policies and procedures promote health, safety and
security in health and social care settings
3 be able to implement a risk assessment
4 understand priorities and responses in dealing with incidents and emergencies.
85

P1 Explain potential hazards and the

harm that may arise from each in a
health or social care setting.
page 97
P2 Outline how legislation, policies M1 Describe how health and safety

and procedures relating to health, legislation, policies and procedures
safety and security influence health promote the safety of individuals in
and social care settings. a health or social care setting.
page 112 page 112
P3 Carry out a risk assessment in a M2 Assess the hazards identified in the D1 Make recommendations in relation
health or social care setting. health or social care setting. to identified hazards to minimise
See Assessment activity 3.3, See Assessment activity 3.3, the risks to the service user group.
page 118 page 118 See Assessment activity 3.3,
page 118
P4 Explain possible priorities and M3 Discuss health, safety or security D2 Justify responses to a particular
responses when dealing with two concerns arising from a specific incident or emergency in a health
particular incidents or emergencies incident or emergency in a health or social care setting.
in a health or social care setting. or social care setting. See Assessment activity 3.4,
page 126 page 126
86
Unit 3 Health, safety and security in health and social care

This unit will be internally assessed by your tutor. Varied exercises and activities are
included to help you understand all aspects of health and safety in health and social care
environments, and prepare for the assessment. You will also have the opportunity to work
on some case studies to further your understanding.
Jodie, 17 years old

I knew this was an important unit before I started the course.
My gran nearly died last year. She was in hospital following a car
accident. She had been taking antibiotics for a chest infection and
caught Clostridium difficile. She was so ill and dehydrated. There
were three other people on her ward with the same infection, so it
must have been spread by poor hygiene.
My tutor went through lots of potential hazards in all different care
settings, so when I came to write my report I had loads of ideas.
She really made me realise how health and safety legislation can be used to maintain
standards, and what can happen to care providers who cut corners in health and safety.
It really made me think, if I don’t practise good health and safety it could be my career
on the line!
Carrying out the risk assessment helped me to realise that you can reduce the chance
of mishaps by thinking ahead.
I loved the last task, as we did a first-aid course and discussed all sorts of other crisis
situations. Then we did a role-play, which we videoed.
I got a distinction overall, which made me really proud!
Over to you!
1 Why do you think health and safety is so important in health and social care?
2 How are you going to get to grips with understanding and implementing
legisation?
3 What do you think is the most effective way of approaching the risk assessment?
87
1 Understand potential hazards in health

and social care
What dangers lie beneath?

Get
Many dangerous things are dealt with by someone other than ourselves. Divide into
started seven small groups, with each group choosing a different topic from the list below.
Spend ten minutes discussing what hazards potentially exist and what measures
have been taken to reduce risk or remove hazards from our daily lives. Think of the
situation in developing countries.
• Electricity supply • Household waste
• Raw sewage • Water supply
• Traffic • Criminal behaviour
• Building construction
Feed back to the rest of the group and discuss your thoughts.
1.1 Hazards
Hazards potentially exist for staff, visitors and Key terms
individuals, if care is not taken to reduce risk to Hazard – Anything that can cause harm, such as a steep
a minimum. There are health hazards, safety staircase.
hazards and security hazards. However, it would be Risk – Risk is the chance, high or low, that someone will be
unreasonable to remove the opportunity for people harmed by a hazard.
to be able to take risks, if they so wish. A balance is Health hazards – These include incidents leading to illness.
needed, between exposing people to unreasonable Safety hazards – These include incidents leading to personal
risk and over-protecting them to the extent that they injury or damage to equipment or buildings.
cannot identify dangerous situations. Security hazards – These include intruders, theft of property
or information, and individuals either being abducted or
‘Positive Risk Taking is about people taking control leaving without consent.
over their own lives by weighing up the potential
benefits and harms of exercising one choice of
action over another. Positive Risk Taking is not In a residential or day care setting, much is done to
negligent ignorance of the potential risks. ensure that individuals, as well as staff and visitors, are
protected from harm.
Risk is a part of everyone’s everyday life. All people
have the right to take risks.’ Hazards in the physical environment
Source: Herefordshire Council website, 2009 The physical environment includes everything that is
For health and social care workers, the working around you – objects, people, pets, the building, the
environment can include a variety of settings, such as air, and the temperature. It can have a huge impact on
residential and nursing homes, day centres, hospitals, the well-being of staff and individuals.
health centres, schools, nurseries and private homes. Poor ventilation will increase the spread of airborne
Some jobs involve taking clients out, perhaps on infections, such as colds and influenza, so it is
holiday, to the shops, or to an appointment. A important to have fresh air circulating. However,
paramedic’s working environment could be anywhere. people should never be in a draught and should
88
always be warm enough. It is easy to think the Hazards from equipment

temperature is adequate when you are rushing around,
Hazards from equipment could include:
but remember that babies, older people and those
• untidiness, e.g. toys or equipment left in corridors,
with disabilities find it more difficult to maintain their
on stairs or blocking fire exits
body temperature.
• poor maintenance, e.g. frayed wiring or broken
Fumes and smoke should not contaminate the air,
equipment
which should be fresh and clean. Ventilation should
also remove stale air and provide air movement. • unsafe practice, e.g. overloaded sockets or trailing
flexes
Rooms should be centrally heated and it should be
possible to control the temperature in each individual • lack of awareness of hazards, e.g. hot surfaces or
room. moving parts.
Lighting in rooms should be bright enough and If all goes well, you will never witness such hazards in
positioned to enable people to read and enjoy other the workplace, but – because they are seldom seen – it
activities. Emergency lighting, which comes on if there is easy to forget that hazards exist. In this sense, it can
is a power failure, must be provided throughout any be dangerous to protect people too much, including
residential or day care setting. you. To be truly safe, you need to be able to anticipate
and avoid danger.
Poor lighting can be particularly hazardous to older
residents and anyone with poor vision. You should take Equipment must be functioning correctly and fully
special care when looking after people with limited maintained at all times. There should be a schedule for
vision to position them in a well-lit area. It is also checking equipment to ensure that it does not cause
helpful to ensure that there is a good contrast between injuries to staff or individuals. This might include fire-
objects and surroundings, such as a dark door in a fighting equipment, hoists and medical diagnostic
white surround. equipment, such as ECG and x-ray machines. If any of
this equipment is faulty it will not work properly. In the
You can find more information by looking at the
case of diagnostic equipment, this could lead to a false
National Minimum Standards at www.dh.gov.uk
diagnosis.
Computers now play as important a role in the care
industry as they do in any other field of work. The same
attention to health and safety must be paid to their
use as in an office. Incorrect positioning can cause
repetitive strain injury, prolonged exposure to the
screen can put strain on vision, and incorrect sitting
position can lead to orthopaedic problems, such as
back strain or neck pain.
Cord pulls for call systems should be within easy reach
of individuals in any health or social care setting.
Overstretching in itself can cause a fall, and an out-
of-reach cord pull is useless to someone who has
fallen over. Precious time may be lost in coming to the
person’s assistance, during which time their condition
could deteriorate and make the situation much more
serious.
Hazards from infections

If you do not follow procedures correctly you can put
yourself and others at unnecessary risk. Food hygiene
Fig 3.1: Imagine trying to find your way around a busy care must be scrupulous in care settings. Older people
home with poor vision like this and young babies are particularly at risk of serious,
89
and sometimes fatal, complications if they contract

food- borne infections, such as Salmonella, Clostridium Key terms
difficile and E. coli.
MRSA – Short for methicillin-resistant Staphylococcus aureus,
Media coverage of the incidence of MRSA in hospitals sometimes known as a ‘superbug’ because it is resistant to
has highlighted the potentially devastating effects of many antibiotics.
poor personal hygiene practices and over-prescription Organism – A term for any living thing that can exist
of antibiotics. Even the antibiotics that are effective independently, including bacteria and viruses.
against MRSA have to be given in much higher doses
over much longer periods to be successful.
According to the National Statistics website (www. People can become carriers of MRSA by direct contact
statistics.gov.uk), the number of deaths linked to MRSA with the organism. If the bacteria are on the skin then
in the UK rose each year from 1993 to 2006, when they can be spread by touch. If the organism is in the
it peaked at 1,652. However, the number of death nose or the lungs it may be passed on by droplet
certificates mentioning MRSA decreased to 1,593 in spread, by breathing or coughing over someone.
2007 and then decreased further to 1,230 in 2008, a fall If patients are otherwise well, the bacteria often
of 23 per cent. disappear once they leave hospital. Sometimes,
MRSA is often associated with patients in hospitals however, they do not, and this may mean that
but can also be found in the nose or throat, or on precautions need to be used again if the patient has to
the skin of people in the community. It is not usually be readmitted to hospital. As long as other members
necessary to treat MRSA organisms. The organism of the household are healthy, special precautions are
Staphylococcus aureus is found on many people’s skin not required at home.
and does not generally cause major problems. People If MRSA gets inside the body, perhaps into the
who carry MRSA are usually very healthy and are bloodstream through a wound, or into the lungs, it can
considered to be simply carriers of the organism. cause serious infections such as:
Deaths related to MRSA in England and Wales 1993–2008
1800
1600 MRSA mentioned on death certificate
1400
MRSA selected as cause of death
Number of deaths
1200
1000
800
600
400
200
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Fig 3.2: After year-on-year increases in the incidence of MRSA, cases started to fall in 2007 due to a massive improvement in
hygiene standards in hospitals
90
• osteomyelitis (bone marrow infection)

• septicaemia (blood poisoning)
• septic shock (a complication of septicaemia that
causes a fall in blood pressure and organ failure)
• septic arthritis (infection of the joint)
• meningitis (inflammation of the tissues that
surround the brain and spinal cord)
• abscesses anywhere within the body
• endocarditis (infection of the heart lining)
• pneumonia (lung infection).
MRSA bacteria can also cause scalded skin syndrome
and, very occasionally, toxic shock syndrome.
You can find out more about MRSA by looking at the
NHS Direct website (www.nhs.uk) and searching under
‘MRSA infection’.
Hazardous waste
Care workers need to take particular care when
disposing of hazardous waste including soiled
dressings, nappies and incontinence pads. These
Fig 3.3: All sharps, such as needles and scalpel blades, must be
should all be disposed of by depositing them in a safely disposed of in a sharps bin
yellow clinical waste bag. These bags are incinerated,
which will destroy any micro-organisms.
x-rays are all examples of substances found in health
and social care settings.
Key terms Chemicals can cause burns to the throat and
Clinical waste – Waste contaminated with blood or other oesophagus if swallowed in error.
body fluids, which are potentially infectious. Carelessness when administering medication can put
Incontinence – The inability to control the bladder or bowels. individuals at risk. Medication could be given to the
wrong person, or the wrong dose might be given. This
kind of mistake can have devastating consequences.
Did you know? For example, in 2005, two nurses miscalculated the
dose of a drug needed to slow down a baby boy’s
Protective disposable gloves should always be worn heart rate. The baby was given ten times the dose he
when dealing with blood and other body fluids, as should have received, and died.
they could potentially cause infections.
Even when medication is given correctly, there can
be risks. Arthritis tablets can cause stomach ulcers,
sedatives for anxiety can lead to drowsiness and
Syringes and needles can cause needle-stick
increase the risk of falls, and diuretics (water tablets)
injuries (accidental puncture of the skin with a used
can cause incontinence and dehydration.
needle) if they are not disposed of in a sharps box.
There is a small but significant risk of HIV (human You may have noticed that when you have an x-ray the
immunodeficiency virus) and hepatitis B virus being radiographer hides behind a screen or wears a lead
contracted by needle-stick injuries. apron. For patients having an occasional x-ray there is
hardly any risk at all, and even people who have lots
Hazardous substances of x-rays, perhaps following a road traffic accident,
A number of substances used in care settings are are only at a very slight increased risk of developing
hazardous if misused. Cleaning fluids, medications and cancer in later life. However, if hospital staff were
91
not protected from the rays, they would be exposed Staff shortages can result in staff being expected to
to many x-rays every day, so this would put them at work overtime. Care work is physically and mentally
significant risk. demanding, and too much overtime is likely to result
To find out more about hazards associated with x-rays, in staff being unable to perform to the best of their
visit the Health Protection Agency website (www.hpa. ability. Tired staff members are more likely to make
org.uk). mistakes, such as miscalculating drug dosages. They
are also likely to be less alert, and may miss a sign that
Hazardous working conditions someone they are caring for is becoming unwell.
Working conditions include aspects of your job, such Stress is another effect of staff shortages. Stress can
as the hours you work, the staffing levels, and staff show itself in a variety of ways, including anxiety, sleep
relations. problems, digestive disorders, high blood pressure
Despite considerable improvements in the quality of and mood swings. The manager has a duty of care
health and social care as a result of regular inspections, for the staff, and should be aware of the effects on
there are still problems with staff turnover and staff their mental well-being of an excessive work load.
shortages. This can lead to staff rushing their work and Constantly relying on temporary staff from agencies,
not always following procedures properly, which can for example, means that permanent employees have
increase the risk of injuries and accidents. to supervise and direct these staff, who are unfamiliar
The pay rates for early years workers, health and social
care assistants remain low, with workers often only paid
the minimum wage, or just above. While many staff
Key term
Digestive disorders – Conditions affecting the stomach or
work to high standards despite low wages, others may
gut leading to symptoms like nausea (feeling sick), vomiting,
feel undervalued and this can make them less likely diarrhoea, wind and/or bloating.
to follow policies and procedures designed to keep
them, and those they care for, safe. It is also important
to have a suitable mix of staff. For example, it is not
advisable to have a high number of inexperienced staff
and only a few experienced ones.
Have you ever wondered why

radiographers wear lead aprons and
whether you should be worried about your
own health when being x-rayed? Fig 3.4: Stress can have a detrimental effect on the quality of
care given
92
with the routine, layout, and needs of the individuals in 2003 the National Audit office reported that 80,000
the health or social care setting. nurses sustain back injuries at work each year. An
estimated one-third of all reported accidents in
‘Too often people receive care that is patchy and
healthcare settings result from moving and handling,
fragmented, as care homes and home care services
and approximately 40 per cent of all sickness absences
struggle to recruit and retain high quality staff.
in the health service are attributed to moving and
Because of the difficulties with recruiting staff, vital
handling accidents (National Audit Office, 2002–2003).
recruitment checks are often overlooked, placing
people at risk. Social workers remain the poorest- The main hazards linked with handling people are
paid professionals and care workers are getting an that the handler may slip or trip, stand in an awkward
increasingly poor deal.’ position, twist or over-reach, as may the person. Any
of these mistakes could result in a strain, sprain or
‘Vacancy rates in social care are higher than for
fracture for the individual or carer. It could take several
all other employment sectors in England. Around
months or even years to recover fully from such an
one in four residential homes for children, adults
injury. In some cases, permanent disability can result.
and older people do not have, or cannot recruit,
sufficient staff. Shortages of staff have a direct Hazardous security systems
impact on the quality of care.’ To keep staff and individuals safe from intruders, security
Source: Commission for Social Care Inspection, 2005 systems have been fitted in most health, social care and
early years settings. Residential homes usually keep
Hazardous working practices the main door locked, and windows on the ground
Working practices are the jobs you do when caring floor do not open far enough to allow anyone to climb
for people. This can include moving and handling, in or out. However, this could result in crucial time
preparing food, changing nappies, giving injections or being lost in a fire, when rescuers need to gain access
supervising individuals with challenging behaviour. to the building to evacuate anyone who is trapped.
If you do not follow procedures correctly you can put Confidential information held on computers must be
yourself and others at unnecessary risk. password-protected, so it is important that all staff
Despite the Manual Handling Operations Regulations who need to know have access to passwords. Filing
1992 (see page 103), many care workers still suffer cabinets must be kept locked.
injuries related to moving people they care for. In
Fig 3.5: Always plan a lift beforehand to reduce the risk of injury
93
1.2 Harm and abuse care to be trustworthy, but unfortunately this is not
always so. There are many opportunities for a care
Sometimes hazards result from abuse, which could worker to take advantage of the vulnerable people for
be intentional or unintentional. Intentional abuse whom they are caring. There are often times when care
includes deliberately hurting someone, physically or workers are alone with individuals in their homes or in a
emotionally. care setting, and this will give opportunities for theft of
You can imagine the distress that can be caused by money or property. There have even been cases in the
harm or abuse. Psychological effects could include past where care workers have persuaded the people
fear, loss of trust in carers, loss of self-esteem and self- they are caring for to give them money or change
worth. their will. This is, of course, against the law, as well as
You can read more about deliberate abuse later in this being morally wrong. Again, this can lead to enormous
unit. Abuse can also occur unintentionally, when care distress both for individuals and their relatives.
staff do not understand good care practice. Physical Damage to premises can also occur deliberately or
abuse can include rough handling, or ignoring care accidentally. Situations involving deliberate damage
needs leading to individuals falling, being incontinent could include a person becoming aggressive or
or developing pressure ulcers. Poorly trained or wishing to retaliate for some reason. Accidental
stressed staff may not realise that they are not damage would result from carelessness. Whatever
providing adequate care. Infections can be passed on the reason, damaged premises will lead to a great
easily by staff who do not understand the importance deal of disruption. If the building is left in an unusable
of thorough hand-washing or do not put this into condition, temporary premises will have to be found
practice. and property quickly replaced. In addition, records
Poor care practice can be caused by inappropriate may have been lost if they are not held electronically
care planning, where individuals’ needs are not on an external server. This alone could put individuals’
adequately assessed, or the care strategies chosen are welfare at risk.
not effective. This can result in exposure to dangers
such as falls and pressure ulcers. 1.3 Type of setting
People with learning disabilities need careful care Health and social care workers are employed in a
planning to enable them to be as independent as variety of settings, each of which has its own hazards.
possible, but if this is not done thoroughly they could
face many hazards. They may be unable to assess Residential care settings
danger for themselves, and could end up being Care settings where people live are known as
taken advantage of. Those with mental illness can be residential. There are residential settings for older
particularly challenging, especially if their perception people, people with disabilities, and looked-after
of danger is affected, or they are determined to harm children. It is crucial that health and safety is taken
themselves due to their mental state. very seriously in these settings. You need to be sure
Another form of abuse and harm is dishonesty. You that residents can escape in a fire, that they do not put
would expect people working in health and social each other in danger, and that infections don’t spread
when people live close together. It is important to give
residents information about keeping themselves and
their peers safe.
Key terms In some settings people can come and go as they

please. However, in a setting where there are people
Pressure ulcers – These are caused by people sitting, or
lying in the same position for a long time, which reduces the who are confused, or young children, this would be
oxygen supply to the skin and underlying tissue. In serious inappropriate. The risk of road traffic accidents is
cases the tissue dies and turns black. very real in this situation. Anyone who is confused
Hypothermia – A condition in which the body temperature may become disorientated and get lost. In colder
falls below 35ºC, which can lead to death. weather they may develop hypothermia if they are
inadequately dressed or suffer a fall.
94
If people do go out, staff must know that they have left

the building, and they must be able to get back in on
Key terms
their return.
Anaesthetic – Causes unconsciousness during operations.
Hospitals, clinics and surgeries Chemotherapy – Treatment for cancer using drugs.
Health care settings pose many hazards. Those that Hypodermic needles – Used for injections.
are particular to hospitals, clinics and surgeries include Radiotherapy – Treatment for cancer using radiation.
the risk of microbes infecting wounds during or after
surgery; radiation from x-rays and radiotherapy;
controlled drugs, which can be addictive, and Day care settings
chemotherapy drugs that can harm staff administering Day care settings do not tend to have any specific
them unless care is taken. Anaesthetic gases must be hazards, just the normal dangers associated with
carefully administered, and sharps such as scalpels and vulnerable people. The care provided is non-acute and
hypodermic needles need to be disposed of carefully. those cared for are relatively mobile and independent.
Fires can cause particularly difficult problems in health The most likely incidents would be slips and trips, so
and social care settings. Large organisations, such as care must be taken to work tidily and deal with any
hospitals, often divide the building into zones that can hazards straight away. Fire hazards and food hygiene
be separated in case of fire by substantial fire doors, need to be considered, as in all settings.
which automatically close when the alarm sounds. This In winter, staff may need to consider checking whether
removes the need to evacuate anyone who is not in users are safe at home – if they are unable to attend
the immediate vicinity of the fire. It is extremely difficult due to severe weather.
to evacuate very ill patients, some of whom are reliant
on equipment to survive. Those who do have to be Pre-school, childminder and infant school
evacuated can usually be moved into an adjacent zone. settings
This avoids them being exposed to cold weather and These settings should be very safe, as young children
ensures continuing access to electricity and oxygen are not skilled at assessing danger.
supplies.
Babies, toddlers and children are naturally curious,
and this can lead to them into hazardous situations.
Potentially dangerous behaviours include:
• putting objects in the mouth, which could poison or
cause choking
• opening gates, leading to wandering
• opening cupboard doors and drawers, and getting
hold of poisonous substances or sharp objects
• climbing and falling, or becoming stuck and
distressed.
If you are working in a pre-school setting you need
to be constantly vigilant and look out for anything
dangerous. The staff are completely responsible
for ensuring that activities are safe and supervised
properly and they need to take into account any
special needs that children have, such as allergies.
As children develop from toddlers to infants, you can
encourage them to think about danger before starting
an activity, by questioning them about what could
happen if they are not careful.
Fig 3.6: Fire exits must always be kept clear of obstructions
for easy evacuation. Never leave a fire exit like this.
There is more information on risk assessment in
section 2.6 later in this unit.
95
Health and social care student
I am in my second year of the

BTEC National Diploma in Health and Social Care.
I have been attending my final placement at Little Acorns Day
Nursery and they asked me to plan an activity afternoon for the six
children aged 4 to 5 years on the theme of ‘Summer Holidays’. They
will all be leaving for primary school at the end of the summer term.
The nursery is across the road from the beach and I had loads of ideas
buzzing round my head, thinking of picnics, sand, sea, and sun. I
wanted to do something out of the ordinary. My main concern was
how to achieve this without putting any of the children in danger.
Fran, my supervisor, sat down with me to do the risk
assessment. She let me do it and then gave
suggestions to improve it, which I
found a great learning
experience.
I wanted to take them onto the
beach looking at rock pools.
I wrote a letter to all the parents to get their
permission. The day arrived, and we had some very excited
children. Fran let me take charge, but of course she was there in
case I forgot anything, or anything went wrong.
The children really enjoyed themselves. They were so fascinated
by the creatures hidden under the rocks none of them even
thought about wandering off. But I was glad I had thought
of all the possible dangers beforehand, as it made
it less stressful.
Think about it!

1 Identify all the hazards that would exist in a trip of this nature.
2 What is the potential severity of each of the hazards you have identified?
Could they potentially lead to death or serious injury, or are they only likely
to lead to cuts and bruises? Score them according to a scale where 5 is
serious and 1 is minor.
3 How likely is it that these hazards will lead to injury, illness or an incident?
Score the likelihood according to a scale where 5 is very likely and 1 is very
unlikely.
4 Make a list of precautions you would take to reduce the risk of the hazards
causing harm.
96
In this activity, you need to explain potential hazards residents, identify as many hazards as you can for
and the harm that may arise from each in a health or residents, staff and visitors to the home. Include health
social care setting. hazards, safety hazards and security hazards. Explain
Ideally you should base this on a real care setting, the harm that could result from each hazard you have
gathering information through a visit or when on a identified.
placement. If this is not feasible, you could base your
answer on the following scenario. Grading tip
Riverglade House is a small residential care home for P1 ‘Explain’ means state what the hazards are,
ten older people, all of whom have some impairment. the harm that might occur and how or why the
Some have dementia, meaning that they are confused hazards might cause harm.
and forgetful. Some have arthritis, making it difficult To achieve P1, you must provide evidence for
for them to move around independently. Some have at least six hazards, relating the hazards to the
had a stroke, meaning they have poor sensation in the abilities and limitations of the group you are
affected side of their body. basing your answer on.
Riverglade House is a converted Victorian house in You will find it helpful to read the section
large grounds on a main road. following this activity.
Taking into consideration the building, situation and
safety equipment fitted, such as a raised toilet seat)

PLTS but you can’t force people to make changes.
Independent enquirer: Visit a care setting and
Community care workers also need to consider how
investigate actual hazards for the individuals. This will
give you a much better understanding of the topic. to manage security for people who are unable to
get to the door. Years ago it was not uncommon to
Creative thinker: Discuss the hazards with someone
leave front doors unlocked all day, and sometimes
at the setting and incorporate their thoughts and your
own. all night, or to leave a key hanging on a string inside
the letterbox. Obviously neither of these would be
Self-manager: Take the initiative to contact a care
acceptable today. Finding the right balance between
setting yourself to arrange a visit.
security and safety requires careful thought.
Effective participator: Make suggestions to minimise
the risk of harm. Another risk to lone workers (such as home care
assistants, social workers, community nurses, GPs
and health visitors) is their vulnerability to attack by
aggressive clients or by members of the public when
Community settings
out working in the community. Staff are often required
Community settings are potentially among the most to work unsocial hours, including evenings and nights.
hazardous of all care environments, as it is almost Social workers may have to take children into foster
impossible to have much control over health and safety. care, and this is often a highly distressing experience
The health and safety of community care workers for parents, children and social workers. Home care
is given a high priority. For example, moving and staff sometimes visit on foot and may have regular
handling equipment can be provided for use in private patterns of visits, making them vulnerable targets for
houses. Staff have the right to be safe, so they can attack. Workers have to consider their own safety when
refuse to carry out tasks if the necessary equipment, travelling between assignments, particularly at night. In
such as a hoist, is not provided. May 2009 it was announced that community healthcare
People receiving care in their own home may be workers would be issued with security alarms that
offered advice on health and safety (including link directly to a call centre, which can pinpoint each
removing mats, which can be a trip hazard, and having worker’s location.
97
It is good practice to keep individuals in touch with Swimming pools

the outside world by enabling them to visit places
The main hazards at a swimming pool are caused by
such as shops, leisure centres and parks. However,
careless behaviour. Diving in shallow water, fooling
these areas can pose dangers to vulnerable people.
about in the pool and running on wet floors can all
Risk assessments must therefore be done before
lead to head injuries, or even drowning. If you are
embarking on such trips, to raise awareness of the
involved in visits to the swimming pool as a health and
hazards and devise ways of reducing the risk of harm to
social care worker, remember the need for plenty of
both individuals and staff.
supervision.
Roads Public parks
Roads present a major danger, particularly to children.
Although a public park is generally a safe, traffic-free
The Department for Transport website (www.dft.gov.uk)
environment, you may need to consider whether there
gives the following information:
are any potential dangers posed by other park users.
‘The number of children killed or seriously injured in For example, if young people use the park as a safe
2008 was 2,807 (down 9 per cent on 2007). Of those, place to skateboard, this could create a hazard for
1,784 were pedestrians, 6 per cent down on 2007. 124 older people who might be unsteady on their feet.
children died on the roads, 2 per cent higher than in
If working with children, you may take them to a
the previous year, when the lowest ever child fatality
playground. Here you have to be especially careful.
figure of 121 was recorded.’
Local councils are responsible for the maintenance
According to the National Statistics website (www.
of the equipment in public parks. Most equipment
statistics.gov.uk), a total of 215 children died of
is well maintained but unfortunately parks are
accidents in 2003, the only greater cause of death
occasionally targeted by vandals, leaving equipment
being cancer, which led to the deaths of 273 children.
in a dangerous state. You should always check
If taking people with poor mobility out into the equipment before allowing children on. You will need
community, it should be remembered that they will to assess the suitability of the equipment, based on
take longer to cross the road. Those with impaired the developmental stage of the child. The surface
vision need help in deciding when it is safe to cross, under the equipment is usually impact absorbing,
and those who are Deaf do not have the benefit of which means that it cushions a child’s fall. Although
hearing traffic approaching from around a bend, so brain injuries are the main concern, the cushioning
they will need to cross where there is good visibility.
It is important to allow individuals opportunities to
participate in activities with an element of risk, as
long as measures are taken to keep them as safe as
possible, and they are made aware of the risks.
Retail areas
City-centre shopping areas and retail parks are very safe
in physical terms. They are usually wheelchair-friendly,
well lit, with pavements in good repair. However, some
retail areas have signs on the pavement outside shops
to attract shoppers’ attention. These are a hazard
to those with poor eyesight. Those with learning
disabilities and young children may become disoriented
while out in a busy shopping area, losing sight of
their carers. This could cause distress. Unfortunately
busy streets also attract pickpockets, so you need to
Think about why health and safety are much
advise individuals about keeping purses and wallets harder to control in the wider environment.
inaccessible. Zipped or inside pockets are much more
difficult to access than handbags and coat pockets.
98
effect of the surface also reduces the risk of injuries to Sports events for people with disabilities are a great
backs, shoulders, arms and legs. Children sometimes way to raise self-esteem. Organisers have to ensure
underestimate the challenge of the equipment, adequate supervision and first-aid provision. One
climbing up and then being too frightened to get example of an organisation that arranges such events
down, so close supervision is necessary. is CP Sport England and Wales. This is a sports
There is much media coverage on the topic of organisation for people with cerebral palsy, providing
paedophiles. Of course the vast majority of adults are sporting opportunities for individuals of all ages and
perfectly safe, but it is essential that children are kept at all levels, from the recreational right through to
in sight at all times to stop them being approached by Paralympic competition.
strangers, or adults who are prohibited from seeing Beaches
individual children. This supervision is also essential to
A trip to the beach can be very enjoyable, but also
prevent children from wandering off unaccompanied.
very hazardous. Beaches can become very crowded
Unfortunately some parks are frequented by drug on a hot summer day, and it is easy to lose sight of
abusers, who may leave used needles on the ground. children or individuals in your care. It will help if you
This would be extremely hazardous to inquisitive take something distinctive, such as a brightly coloured
young children. Another threat to children in a park parasol, to enable people to spot the group’s base
could be dog faeces. Dog owners have become from a distance. Another hazard is the sea. Some
much more responsible in recent years about clearing beaches shelve steeply into the water, and it is easy to
up after their dogs, but you still need to be vigilant. swim out of your depth quickly. Currents can quickly
Toxicara is a roundworm that can be present in the drag a person out to sea, so you should never let
faeces of dogs that haven’t been wormed. The chances people use floats and lilos in the sea, unless you have
of a child being infected are fairly low, with about two them on a rope and someone holds on.
cases per million population annually. This infection
Another hazard is caused by the tide. It is easy to
can potentially result in total blindness in either one or
become absorbed in looking at rock pools out in the
both eyes, though this is exceptionally rare. However,
bay, not realising the tide is coming in. This can lead
children should be encouraged to use good hygiene
to you becoming trapped. Some rocks will disappear
practices and thoroughly wash their hands after
completely under the water at high tide, so drowning
playing in any area where dogs have been.
is another risk.
Parks are an ideal place to take children to allow them Sunbathing is now known to increase the risk of
to get some exercise. However, accidents do happen skin cancer, so sunscreen is an essential part of your
and a well-equipped first-aid kit should be taken, to equipment if taking children and other individuals to
enable you to deal with insect bites, stings, cuts and the beach for the day.
sprains. You should take a mobile phone and a list of
According to Cancer Research UK, regular use of
parents’ contact numbers for everyone on the trip.
sunscreen reduces the risk of non-melanoma skin
It is important for children to learn to be able to assess
risk for themselves. You can discuss with children what
dangers exist and encourage them to work out what
measures they need to take to keep themselves safe.
Sports grounds
Taking people to events such as football matches
can be very stressful. They can be very crowded and
fans may get very angry if their team isn’t winning.
Individuals might become separated from the group,
or caught up in unruly behaviour, both of which could
be very distressing. You also need to ensure that toilets
How does this photo show that disability
are nearby if anyone is likely to need to visit at short
needn’t be a barrier to participating in sport?
notice.
99
cancer by 78 per cent, and the people who need to supervising to prevent people walking onto the road,
take the most care in the sun: maybe even one worker for every two people.
• have fair skin Train travel can also be quite hazardous, as railway
• have red or blond hair stations may be busy, large and noisy, which some
people find quite intimidating. It is vital to keep
• have blue, green or hazel eyes
individuals away from the platform edge, as trains
• have freckles
passing through can suck people in if they stand too
• tan poorly and burn easily close.
• have large numbers of moles The floors on modern buses can often be lowered to
• have a family history of skin cancer. allow access for wheelchairs and pushchairs, so this
You can find useful advice about protecting yourself is another option. To prevent falls, make sure people
and the people you care for from the sun by looking at sit down before the bus moves off and don’t stand up
the Sunsmart website (www.sunsmart.org.uk). until it has stopped. The driver can be alerted that you
want to get off by pressing the bell.
Did you know? 1.4 Hazards affecting individuals

Getting badly sunburnt before the age of 15 can When dealing with health and safety, it is not just
double your risk of developing skin cancer. the individuals using the services who have to be
considered. Everyone in the setting has to be kept safe
Transport and well, including those who are receiving care, the
staff (including administrators, catering and cleaning
National Statistics (2009) reported that 2946 people
staff) and visitors. Visitors may include relatives, friends,
were killed in road traffic accidents in the UK in 2007,
maintenance engineers and visiting care professionals.
646 of whom were pedestrians. The total number of
road casualties including deaths was about 248,000.
The numbers of deaths and injuries continue to decline 1.5 Hazards affecting users of
as road safety strategies become increasingly effective. health and social care services
Nevertheless, when taking people out on trips you
Each individual using care services faces slightly
need to consider the dangers from travel carefully.
different hazards. Some hazards stem from the
For road travel, ensure that seat belts are always worn,
environment and others from the individuals
and have enough staff to ensure the driver does not
themselves. Table 3.1 briefly outlines particular issues
get distracted. If taking children or vulnerable adults
for different groups.
walking near roads, you need enough care workers
Table 3.1: Factors increasing hazards for different groups
Group Factors increasing risk of hazards

Hospital patients Exposure to infection – medication, surgery, and other treatments often carry
some degree of risk
Older people May be unsteady, or have poor vision, or hearing – reactions often slower.
People with learning disabilities Difficulties with processing information may impair ability to understand
Young people Less experience of assessing hazards – may be subject to peer pressure and
take more risks
Young children and babies Unable to recognise hazards for themselves – co-ordination still developing,
medical conditions can develop very quickly
Those with physical disability Movements can be slow, or jerky – sense of touch may be impaired, mobility
may be reduced
Those with sensory impairment Receive less information to be able to judge risks
Those with mental health problems Symptoms such as hallucinations, delusions and phobias can impair judgement
100
2 Know how legislation, guidelines, policies and

procedures promote health, safety and security
2.1 Legislation and guidelines Key terms
Health and Safety at Work Act 1974 Guideline – A statement of a policy or procedure to help you
to follow regulations.
The UK has one of the lowest accident rates in the
Legislation – A law or group of laws.
world. The Health and Safety at Work Act 1974 is one
of the main reasons for this. Legislation over the last 30 Regulation – A principle, rule or law designed to control
behaviour.
years has helped bring about significant improvements
Liability – Taking responsibility for something.
in health and safety in the workplace (including a
reduction in fatalities of nearly two-thirds since the
act was introduced). Even now, over 200 people are • ensure the workplace is fully insured. Employers’
killed each year at work in the UK and over 150,000 are compulsory liability insurance must be taken out
injured. Two million people suffer from illnesses that and public liability is strongly recommended, in
have been caused, or made worse, by their work. case an incident occurs and the business is found to
be at fault.
Health and safety law applies to employees, the self-
employed, people on work experience, apprentices,
volunteers, mobile workers and home workers. Case study: Hana
The Health and Safety at Work Act 1974 applies to
Hana Chaudry has just started her first
Scotland as well as England, Wales and Northern placement. She has never been on placement
Ireland. before. She is on work experience at Springfields
There are several pieces of legislation and various Day Centre. She has been told that the day
centre caters for young adults with severe physical
guidelines that you have to work within, as a health
disabilities.
and social care worker.
As she enters the building one of the users, Della,
The Health and Safety at Work Act 1974, also referred
asks Hana to help her to go out into the garden.
to as HASAWA or HSW, is the main piece of legislation Hana, being very thoughtful, holds open the door
covering occupational health and safety in the United and Della starts to wheel herself down the ramp
Kingdom. In England, Wales and Northern Ireland into the front garden. Unfortunately one of the
the Health and Safety Executive is responsible for wheels drops over the edge of the ramp, and the
enforcing the Act and a number of other regulations wheelchair tips over, throwing Della out of the
chair.
relating to the working environment. In Scotland this
role is carried out by the Scottish Executive. Hana rushes in to fetch a member of staff. As it is
only her first day, she doesn’t think it could be her
Key requirements fault.
Employers are responsible for the health and safety 1 Is she right?
of employees, workers from other organisations, and
2 Look back at the Health and Safety at Work Act
visitors while they are on the premises. Employers must: 1974 and particularly at the responsibilities of
• carry out a thorough risk assessment before employers and employees. Discuss with other
opening for business, and it should be updated members of your group what measures could
have been taken to prevent this incident, and
regularly
who was responsible.
• ensure that there is a health and safety policy
written for the setting and appoint someone to be
responsible for health and safety
Functional skills
• keep a record of all accidents and incidents
English: You can provide evidence of speaking and
• provide safety equipment, written health and safety
listening skills by contributing to the discussion.
information and training
101
Employees (including yourself when on work • foods are kept at the right temperature
experience, even though you are not paid) also have • cross-contamination is prevented.
responsibilities under the Health and Safety at Work
Health and social care settings need to have a kitchen
Act 1974. You must:
that meets all the requirements of the regulations.
• take reasonable care of your own, and other If you look at the kitchen at your work experience
people’s, health and safety placement you should see that it is run on a
• not deliberately do anything that could jeopardise commercial basis. There will, for example, be separate
someone else’s health or safety. chopping boards for raw and ready-to-eat foods. The
kitchen should be easy to keep clean, with surfaces
Regulations under the Health and Safety at Work
that are smooth (such as stainless steel), without cracks
Act 1974
and crevices where food can accumulate. There should
Over the years since the HASAWA was first passed,
be a separate hand-washing basin; staff cannot use
additional regulations have been added to reflect
the same sink as that used for food preparation. Hand-
changes in practice, technology and understanding.
washing should take place frequently, and especially
These regulations include:
after touching raw meat, and after visiting the toilet.
• Manual Handling Operations Regulations 1992
• Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations (RIDDOR) 1995
• Control of Substances Hazardous to Health
Regulations (COSHH) 2002
Key terms
Unfit for human consumption – Not fit to be eaten.
• Food Safety Act 1990
Notice of Improvement – A legal paper demanding better
• Food Safety (General Food Hygiene) Regulations standards.
1995 Cross-contamination – Microbes being spread from one
• Management of Health and Safety at Work food to another.
Regulations 1999
• Data Protection Act 1998
• Fire Precautions (Workplace) Regulations 1997.
Food Safety Act 1990

The Food Safety Act 1990 gives powers to
environmental health inspectors to inspect food
and seize food unfit for human consumption
and condemn it. Any establishment breaching
food hygiene standards can be served a notice of
improvement, and can, in extreme circumstances, be
closed temporarily or permanently if the practices are
considered to be a health hazard. Businesses can be
prosecuted for breaching standards.
Food Safety (General Food Hygiene)

Regulations 1995
Food Safety (General Food Hygiene) Regulations 1995
aim to prevent cases of food poisoning by stipulating
that:
• food areas are kept clean and good standards of
personal hygiene are maintained
Fig 3.7: Food must be stored correctly and use-by dates must
• foods are cooked thoroughly be adhered to
102
Sometimes the sink will have elbow taps, to prevent • reportable diseases
microbes being transferred back onto the hands when • potentially dangerous occurrences that did not
turning the taps off. lead to injury or disease.
If you are asked to help prepare food at your Reporting this information enables the local council
placement, you must practise good hygiene, and or the HSE to ascertain why, where and how risks
preferably complete a food hygiene certificate. This occur and to investigate serious accidents and near-
should ensure that you understand the risks of poor accidents. They can then advise organisations on how
practice. It is easy for food to become contaminated to prevent or reduce injury, ill-health and damage to
if raw foods, especially meat, comes into contact with property. If at some time in the future you are working
foods which are not going to be cooked, or have in a senior post and an incident occurs, it would be
already been cooked. your responsibility to submit the report.
Anyone who has been suffering from an infection,
such as vomiting and diarrhoea, should not have any
Data Protection Act 1998
dealings with food preparation until they have been The Data Protection Act 1998 relates to personal
free of symptoms for 48 hours. information held in paper and electronic format.
The information held should be relevant and not
Manual Handling Operations Regulations excessive. It should have been obtained for lawful
1992 reasons and should be accurate and current. The
Under these regulations employees should: information should not be held for longer than
• avoid manual handling operations that involve a risk necessary. Information should be protected against
of injury, as far as possible. unauthorised access and accidental destruction.
• assess all manual handling operations that cannot Health and social care services necessarily hold a lot of
be avoided. sensitive information about individuals. It is vital that
this information is only used for legitimate purposes.
• take steps to reduce the risk of injury during those
For example, you may have access to home addresses,
operations that cannot be avoided.
sometimes meaning that properties are empty. An
In order to reduce the risk of injury from manual
individual’s diagnosis is highly confidential. Not
handling you should:
everyone wishes their relatives to know what is wrong
• encourage people to move independently with them. Some information may be embarrassing for
whenever possible people, for example if they are incontinent.
• plan every lift to be as safe as possible Accidental destruction of medical information could
• use lifting aids when people cannot move have very serious consequences, such as loss of
independently or when moving heavy objects information about allergies.
• avoid twisting your body When you are at a work placement you too will have
• avoid lifting from the floor access to some information. You must never disclose
this information to an unauthorised person, such as
• keep the load close to your body
• avoid repetitive lifts.
Reporting of Injuries, Diseases and Key terms

Major injuries – These include fractures (except fingers and
Dangerous Occurrences Regulations toes), dislocations, loss of sight, unconsciousness, poisoning,
(RIDDOR) 1995 and any injury resulting in someone requiring resuscitation.
These regulations require you to report the following Reportable diseases – The reportable diseases most
relevant to health and social care include hepatitis, HIV,
to the local council or the Health and Safety Executive
tuberculosis (TB), and meningitis.
(HSE):
Dangerous occurrences – These include fire, electrical short-
• death or major injuries circuit, needle-stick injury and collapse of lifting equipment.
• an incident leading to someone being absent from Diagnosis – The medical condition a person has.
work for three or more days
103
a member of your family. Be very wary of giving any

information over the telephone; it is usually best to
Activity 1: Planning for a
hand calls over to permanent staff. Do not let callers new resident
pressurise you into disclosing sensitive information.
You are the manager of a residential home and
Even after a person has died, their records cannot be have just been informed that a new person is to be
destroyed. The Department of Health requires records admitted who sometimes has aggressive outbursts.
to be retained for at least eight years after someone Look at a more detailed version of the
has died. Records of treatments given to children and Management of Health and Safety at Work
maternity records must be kept until they are 25 years Regulations 1999. The Health and Safety Executive
of age, unless the child has died, in which case they will leaflet ‘Health and safety regulation … a short
be destroyed eight years after the child’s death. This guide’ would be a good choice.
should give plenty of time for notes to be accessed if What would be your responsibility for planning for
there are any complications later on that could be due this new resident under the Management of Health
to treatments given. and Safety at Work Regulations 1999?
Management of Health and Safety at Work

Regulations 1999
The Management of Health and Safety at Work Functional skills
Regulations clarify what employers are required to English: You could provide evidence of English skills
do to manage the Health and Safety at Work Act. by reading legal and policy documents, and extracting
They apply to every work activity. Employers with relevant information to inform your answer to this
five or more employees need to carry out a full risk activity.
assessment for the organisation.
Employers must:
• make sure that all the health and safety precautions Control of Substances Hazardous to Health
identified by the risk assessment are carried out
(COSHH) 2002
• ensure that competent people are appointed
COSHH requires employers to:
to help put health and safety precautions and
emergency procedures in place • assess the risks posed by hazardous substances
such as body fluids and sharps
• provide clear information and training for
employees. • devise procedures to prevent or control exposure to
hazardous substances
Care Homes Regulations • ensure procedures are followed
Every care home must have a manager, who has • ensure health surveillance is carried out if
a qualification in Leadership and Management in employees are exposed to harmful substances in
Care Services (or Registered Managers Award, which their work, to identify early signs of disease
predates it), or currently be studying for one. This
• prepare plans to deal with accidents, incidents and
person must ensure that all parts of the home to which
emergencies
individuals have access are free from hazards, and that
risks are identified and eliminated so far as possible. • ensure that staff are adequately trained and
supervised.
If the manager feels that an employee is a danger to
anyone, whether due to incompetence or intentionally
causing harm, the manager must suspend the Key terms
employee while investigations are carried out.
Risk assessment – Carried out to anticipate danger and plan
The manager must inform the Care Quality how to reduce the risk of harm occurring.
Commission immediately of any event in the care Care Quality Commission – The independent regulator of
home that endangers the well-being or safety of any health and social care services in England.
individual.
104
A senior manager in a health or social care setting as swine flu), industrial accidents or environmental
would need to consider what substances pose a threat pollution incidents.
to care staff. The main risk to care workers would be
exposure to cleaning chemicals and to body fluids Care Minimum Standards
including blood, urine, faeces, vomit and saliva. National Minimum Standards were published in 2003,
The blood of individuals infected with HIV (human following the Care Standards Act 2000. They form
immunodeficiency virus), hepatitis B or hepatitis the basis for the inspection of care settings, which is
C poses a risk to health care workers and so a risk done by the Care Quality Commission. They include
assessment would be carried out to work out the best information about the standard of care that should be
way to keep staff safe. given, and part of this relates to health and safety.
The person carrying out the risk assessment has to Different versions of National Minimum Standards exist
consider the seriousness of the conditions identified as for each category of care setting:
possible threats to health. • Care homes for older people (65+)
HIV, for example, takes on average nine years • Care homes for adults (18 to 65)
to develop into full-blown AIDS (acquired
• Domiciliary care (home care)
immunodeficiency syndrome) without treatment. Once
AIDS has developed, the person might only expect • Nurses’ agencies
to live for one to two years. However, since better HIV • Adult placement schemes.
treatments have become available, those who take the The National Minimum Standards for older people
medicines as prescribed tend to do very well. explains the minimum acceptable practice in health
For more information on living with HIV, look at and safety when caring for older people. Many settings
www.tht.org.uk. exceed these standards. The care plan should include
Managers should watch staff periodically to ensure that an assessment of individuals’ personal safety and risk.
they are following these procedures properly. Robust procedures should be in place for responding
Any member of staff who is accidentally exposed to to suspicion or evidence of abuse or neglect (including
potential infection must be started on an anti-HIV whistle blowing) to ensure the safety and protection of
drug, such as AZT, which has been found to be 80 per individuals, including passing on concerns to the Care
cent effective in preventing HIV infection. In this case Quality Commission. The environment must be safe for
you would not wait for signs of infection to appear individuals to move around. Staff must receive training
before starting prophylactic (preventative) treatment. in all areas of health and safety. Equipment must be
regularly serviced. Monitoring for sources of infection
Staff must be trained to ensure they know how to keep
should be carried out. Security measures are also vital
themselves safe from harm.
to protect vulnerable people.
(Source: Family Health International, 2001)
Homes must comply with relevant laws and have
Civil Contingencies Act 2004 effective policies and procedures, which should be
This Act relates to the response of public services in a available and in forms that can be easily understood by
major emergency. It gives guidance on anticipation, all who need to understand them (for example, large
assessment, prevention, preparation, response and font for those with visual impairment or easy language
recovery, before, during and after a major threat to public for those with low reading ability). All staff must receive
welfare. The Act would come into use if the situation induction training on safe working practice.
were so serious that public services became unable to
carry out their function without the power of the law
behind them. The law requires emergency services to 2.2 Safeguarding
work together. In order to do this, a plan is already in Legislation, policies and procedures for safeguarding
place, giving a framework to use if an emergency arises, vulnerable groups have made health and social care
so that each service knows what its role will be. staff much more aware of what is regarded as abuse,
Emergencies could include severe flooding, extreme and how to recognise that abuse may have occurred.
weather conditions, a terrorist attack, a pandemic (such These regulations will help you to know what to do if
105
you suspect abuse, or a person tells you that they have individual ratios are met, and this may mean that
been abused. workers have to come in on their day off, or stay on
Procedures are in place to identify people who have shift to meet the requirements. This can increase stress
previously committed offences to reduce the risk on staff. Another option is to bring in agency staff, but,
to vulnerable people, including children and young of course, they will not know individuals, or the routine.
people, older people, those with learning disabilities Premises
and mental illnesses.
Legislation, policies and procedures also influence the
Enhanced disclosures location and type of building considered suitable for
Under the Independent Safeguarding Authority’s use as a care setting. Before a care setting is allowed
(ISA) Vetting and Barring Scheme, which replaced to open, an inspector from CQC will visit to check that
the Protection of Vulnerable Adults (PoVA) scheme in the building is safe and suitable for the people who will
October 2009, all staff (including volunteers) working be using the setting. The location may cause hazards,
with vulnerable people must be checked by the if it is on a busy road or very isolated, for example.
Criminal Records Bureau (CRB). Anyone who works Access to the premises is also important. Visitors will
with children and vulnerable people has to undergo an be arriving and leaving frequently, so the entrance
enhanced disclosure, which will identify any previous must be positioned to allow drivers to see it easily, to
cautions and offences, even if they are spent. This is to give time to indicate that you are turning in, and to see
ensure that they are suitable for the role for which they approaching traffic as you are trying to leave. There
have been appointed, and have not previously harmed must be adequate parking space so the road isn’t
a child or vulnerable adult or placed them at risk of obstructed with cars parked outside.
harm.
Practices
It is a criminal offence for individuals barred by the ISA
When the manager and senior staff are writing
to work, or apply to work, with children or vulnerable
policies and procedures they need to know what
adults. This includes working in the NHS, schools and
the law requires, and make sure that, as long as staff
nurseries, the Prison Service and residential homes
follow procedures, they will not break the law.
for older people and those with learning or physical
disabilities or mental illness. There are many different roles within health and
social care and each has a different responsibility
You probably completed a form at the beginning of
when it comes to health and safety.
your course for the Criminal Records Bureau check.
It is the employer’s responsibility to ensure that this has
been done.
Of course, it will only flag up those who have been
cautioned or committed an offence, not those who
Key terms
Policy – A document explaining the expected standards.
have avoided detection, or who have the potential to
offend but have not yet done so. Procedure – Instructions about how to carry out a particular
task.
Until a clear CRB clearance has been received, care
Responsibility – The duties you are expected to carry out
workers should not be left unattended with individuals. within your job.
2.3 Influences
The requirement to work within the law and meet
minimum standards has a big influence on the way
2.4 Policies and procedures
organisations deliver care. Policies and procedures reflect the unique nature
of individual organisations. Every building is slightly
Staff different, the needs of the people who are being
The standards inform the manager about the minimum cared for differ from one setting to another, and
number of care staff required to provide a satisfactory policies may also reflect the requirements of local
level of care. Managers have to ensure that staff– authorities.
106
Health and safety policies Activity 2: Compare health

Every employer has to produce their own health and
and safety policies and
safety policies and procedures to state how they will
operate under the law. The Health and Safety at Work
procedures
Act 1974 states that organisations must have a health As a group, collect a selection of health and
and safety policy. safety policies and procedures from your work
placements. Compare and discuss the policies
Other policies and procedures, looking for similarities and
Most organisations also have a range of policies and differences.
procedures linked to the regulations discussed earlier.
These should include:
• safeguarding Functional skills
• reporting of accidents English: You could provide evidence of English skills
• disposal of body wastes by reading legal and policy documents, and extracting
• fire evacuation relevant information to inform your discussion in the
above activity.
• security of premises, possessions and individuals
• cleaning
• food safety. procedures should initially be offered further training,
Other policies and procedures are only relevant in but can be disciplined for ignoring health and safety,
certain settings, such as: and could be sacked.
• storage of and dispensing of medicines Managers can have an enormous influence on
• lone working. the quality of care delivered if they show they are
committed to high standards. An enthusiastic manager
Following policies and procedures
can inspire staff to take pride in their work.
Policies should be monitored regularly to ensure that
Unfortunately most policies are long and complex
they are keeping staff, visitors and service users safe.
and include a lot of formal legal jargon. It would be
On starting a new job, employees sign a contract, impossible to include a full policy within this chapter
which will usually include a clause requiring them but Fig 3.8 shows a brief extract.
to follow all policies and procedures. Managers
should enforce this. Staff not working to policies and
2.5 Roles
THE THE Employers and health and safety
BRANCH BRANCH representatives
TRUST TRUST Employers are the company or the statutory body
you work for. The managers of the organisation act
FIRE POLICY FIRE PROCEDURE on behalf of the employers and take responsibility for
STATEMENT STATEMENT the safe operation of the organisation for the benefit
• On discovering a fire, of staff, users and visitors. This means that if there is
The Trust will meet all
raise the alarm by an incident where someone is hurt, or contracts an
statutory requirements breaking the glass in infection, or if security is breached, it is the employer
for fire safety for all the nearest fire point. who will be investigated to ensure that all regulations
buildings for which • Leave the building by were being followed at the time of the incident, and
responsibility is held the nearest fire escape.
that everything practical had been done to keep the
• Assemble at Fire
person safe.
Assembly Point B.
Employers promote health and safety by ensuring
that all necessary policies and procedures are in place
Fig 3.8: Here are examples of the wording of a policy
statement and a short procedure. How do they differ? to meet the legal requirements for health and safety,
107
and that staff follow them. Employers can delegate skilled staff, such as care assistants, youth workers and
responsibility for health and safety to employees, early years workers.
managers, health and safety representatives and the Legislation, policies and procedures influence the
people who use the service. However, they still have to specific training provided for different members of
take ultimate responsibility for health and safety. staff. However, they must all receive health and safety
Every organisation will have a different approach training both at the start of their employment and on
to the management of health and safety. Broadly an ongoing basis.
speaking, someone will be appointed as the health The Care Quality Commission (CQC) and Skills for
and safety representative to oversee health and safety Care expect new recruits to receive training in the
on behalf of the employer, so the employer must be first 12 weeks of employment on the following health
certain that they are capable of carrying out this role. and safety topics, as part of the Common Induction
When appointing someone to the post, a person Standards:
specification should be written to help select suitable • moving and handling
candidates from all those who apply.
• fire safety
Employers have to carry out risk assessments, although
• basic first aid
this may be delegated to a senior member of staff,
such as the health and safety representative. Some • infection control
employers go over and above legal requirements, to • abuse.
benefit the health and safety of employees. This might It is the responsibility of staff providing direct care to
include offering private health insurance or particularly consider the health and safety of their colleagues and
good terms and conditions of employment. This raises those for whom they are caring at all times. It would
the self-esteem of the workforce and encourages be easy for care workers to cut corners. You often
staff to stay. Ensuring that staff are experienced, work behind closed doors with vulnerable people
well-trained and committed to the reputation of the who are not usually in a position to complain if health
organisation will have a positive effect on everyone’s and safety procedures are not followed. It is therefore
health and safety. The employer therefore needs to imperative that you maintain high standards without
ensure that all employees receive the training they supervision.
require. Employees’ responsibilities include reporting incidents
Insurance cover and emergencies, using the equipment provided to
The workplace must be fully insured. Employers’ keep them safe and knowing their own limits. You
Compulsory Liability Insurance must be taken out, in should never try to carry out any task you do not feel
case an incident occurs and the business is found to confident about. Always ask for further training or
be at fault. Should an employee be seriously injured, supervision when needed.
compensation would have to be paid for any loss of A record must be kept of all accidents and incidents.
income or costs incurred as a result of the injury. This is normally achieved by providing an accident
Occasionally workers are so badly injured that they are book, which has to be completed whenever an
unable to work again; this type of insurance ensures accident or injury occurs.
that a person is still able to have a similar standard
of living to that which they had before the accident.
Some people may need long-term treatment (such
as physiotherapy) or special equipment (such as back
Key terms
support) to relieve back pain. All of these items are
Skills for Care – One of the sector skills councils for health
expensive, so it is reasonable to expect compensation. and social care that set standards for good practice in the UK.
The other is Skills for Health.
Employees Common Induction Standards – These standards cover all
There are a wide variety of job roles in the health and the training needed during the first few weeks working in a
social care sector, including professional staff, such as care setting.
nurses, occupational therapists and social workers, and
108
Activity 3: Recording accidents
Figure 3.9 below shows a sample accident form. If you have had an accident, or witnessed one,
complete the form using the actual details. Alternatively, you could make up a scenario.
EXEMPLAR ACCIDENT FORM REVIEW

About the person completing the form: Outcome at review:
Full name: Was the injury (tick if applies) Did the injured person (tick if applies)
Job title: A fatality? Become unconscious?
Signature A major injury? Need resuscitation?
About any witnesses: Serious enough to require Remain in hospital for 24 hours or
Full name: 3 or more days off work? more
Job title/Status Serious enough to require hospital
Signature treatment?
About the injured person: If any of the above ticked, accident must be reported to HSE.
Name:
Home address: Prevention:
What has been done to prevent future similar accidents?
Post code:
Home tel no:
Date of birth: Age:
Gender:
About the accident:
Date of accident: / /
Time of accident: : hrs
Location of accident:
Injury (e.g. fracture)

Part of the body injured:
About the type of accident:
What happened? (tick if applies) Review date: / /
Equipment failure
Slip on wet surface Describe the accident using factual Name of person reviewing accident:
Tripped over object information: Name in full:
Injured while moving something
Fell Job role:
Trapped by something collapsing
Inhaled gas/fumes
Electridc shock
Asphyxiation
Assault
Exposure to fire
Struck by moving object
Other
About prevention of a recurrence:
Can you identify any way the accident could have been prevented?
Date form completed: Review date:
Fig 3.9: A sample accident form
Monitoring working practices

It is the responsibility of senior staff to monitor working
Did you know?
practices by watching staff carrying out procedures Aseptic technique is the method used to keep the
such as hand-washing, moving and handling and patient or individual as free from contamination
aseptic technique. as possible. It is used to prevent micro-organisms
entering the body, which could cause infection. You
It is vital that staff are confident about their abilities need to use sterile equipment and fluids during
and don’t feel threatened by senior staff who are invasive medical and nursing procedures, including
watching them at work. They should also feel able to wound dressings and catheterisation and during
ask for a demonstration and supervision if they are not operations.
confident.
109
Following any health or safety incident, the employer, Local authority

or the health and safety representative, should review
The local authority can provide advice for managers
policies and procedures and consider whether the
in settings owned and run by the council. They also
incident occurred because of any weakness in the
employ community care staff who can provide health
systems in place.
and safety advice to individuals living in their own
homes. Occupational therapists are employed by the
local authority, and can advise on health and safety
Case study: Kendra when assessing people for aids and adaptations to
Kendra Clarke started a new job as manager their home. Those who live in houses owned by the
of Firbanks Residential Home in March 2004. The local authority can have adaptations done by the
previous manager had resigned after an enquiry local authority to allow them to remain in their homes
into the death of a resident following a fall. The despite reduced mobility. The work that is carried
enquiry identified a concern over the number of out must meet safety standards. Sometimes the local
falls that had occurred at the home.
authority will contract out the work, but the authority is
One of Kendra’s first actions was to examine the still ultimately responsible.
accident book. There had been 57 falls in the home
in the previous 12 months. She felt this figure was National Health Service trusts
very high and she set about analysing the reports.
NHS trusts have extensive health and safety
Many of the falls appeared to have occurred when obligations, from the safety of the buildings and staff
residents had been walking unaccompanied around through to ensuring that procedures are carried out
the home. Some had tripped over obstacles, while
as safely as possible. In recent years, hospitals (and
others had simply overbalanced. Kendra decided to
carry out a risk assessment for every resident with even individual consultants) have had their death
respect to their mobility. rates compared. This can give valuable information,
1 Why do you think there had been such a high and may raise important questions if there are large
incidence of falls at Firbanks? discrepancies. Hospitals that are particularly successful,
2 What measures could be put into place to with low death rates, can share good practice with less
reduce falls? successful ones.
3 How do you think the existing staff may have There has been a massive drive to raise hygiene
reacted to Kendra’s appointment? standards in hospitals, and staff have been specifically
4 How could Kendra manage this situation in a employed to develop more effective infection control.
positive way? The NHS Security Management Service is responsible
for the security of NHS staff and property in England.
This includes:
Users of services • protecting NHS staff from violence and abuse
People who use health and social care services • taking appropriate action against those who abuse,
themselves should not do anything that could cause or attempt to abuse, NHS staff
danger to staff or other individuals. For example, • helping to ensure the security of property, facilities,
they cannot demand to be lifted manually, even if equipment and other resources such as drugs.
they are afraid of being lifted by hoist. If they are self-
All NHS trusts have to nominate a director at board
medicating, they must keep their medication safe,
level to take responsibility for security.
and in accordance with the policy on self-medication.
However, not everyone is able to understand health
and safety. Children and those with cognitive
impairment would not be expected to follow health
and safety instructions.
Key term
Staff have the right to refuse to treat people who use
Cognitive impairment – Difficulty in thinking clearly and
threatening behaviour and many hospital emergency logically.
departments have a zero tolerance policy.
110
You can read more about NHS Security Management Medical supplies, such as syringes and needles, should
by looking at www.nhsbsa.nhs.uk and selecting be locked away. A balance has to be reached between
‘security management’. keeping people safe and making supplies accessible in
an emergency.
Scottish Centre for Healthy Working Lives
Some items may have to be stored in the refrigerator,
NHS Scotland provides occupational health and safety
particularly vaccines and liquid medicines.
advice and workplace visits through the Scottish
Centre for Healthy Working Lives. You can visit www. Tidiness is essential when working in a care
healthyworkinglives.com to find out more about health environment, both to prevent falls, and to ensure that
and safety in Scotland. items can be found quickly in an emergency situation.
Other individuals, e.g. visitors, relatives and Making risk assessments and minimising
volunteers risks
All visitors to health and social care settings should
As a student, you are unlikely to be more than an
take responsibility for health and safety. It is common
observer in a formal risk assessment. However, if you
sense to shut doors behind you, report obvious
are on placement and a risk assessment is being
hazards and behave in a sensible and considerate way.
carried out, do take the opportunity to observe. You
may be allowed to do the assessment under the
2.6 Responsibilities supervision of a qualified member of staff, who will
take responsibility for the assessment. You should
Following organisational safety and security
always carry out tasks in the way recommended in the
procedures risk assessment.
It is irrelevant how much is invested in health and
Risk assessments are covered in more detail in section
safety by employers if employees do not follow
3 (pages 113 to 118).
organisational policies and procedures. Employees
cannot claim compensation in the case of an accident Identifying and minimising health, safety and
or incident if they were not following procedures. You security risks
must use equipment provided, attend training, and
When working in a care environment, it is your
adhere to all guidance that has been put in place for
responsibility to identify hazardous situations. If you
your own safety.
notice something dangerous, you must not ignore it.
Safe storage and use of materials and equipment A spillage could cause someone to slip, or, if it is
It is important that employees store and use materials a hazardous substance, it could cause the spread
and equipment as shown in the manufacturer’s of infection. The least you should do is to report
instructions, and according to legislation, policy and the spillage and put up a warning sign. Not all care
guidance. settings have domestic staff on the premises at all
Hazardous substances must be put away in an times, so the responsibility to clean up a spillage may
appropriate place when not in use. For example, fall to care staff. If this is so, you must follow the agreed
flammable materials must not be stored near a heat procedure in the case of a hazardous substance. This
source. involves wearing protective gloves and a disposable
apron. Hands should be washed thoroughly afterwards,
Staff responsible for medication must ensure that the
even when gloves have been worn.
drug cupboard is locked and that the drug trolley is
locked to the wall, when not in use. When people are Objects causing trip hazards or blocking fire exits
self-medicating, medication must be inaccessible to should always be moved.
other residents. In some organisations this is achieved Any faulty equipment must be reported, so accidents
by giving individuals a key to a small medication can be avoided and repairs can be arranged.
cabinet in their room. An alternative solution is to ask If you notice an external door has been left unlocked
them to carry their medication with them in a bag or open, shut it and lock it, but then check whether it
around their waist. was open for a reason.
111
Reporting of and maintaining records of Understanding the limits of your

incidents and emergencies responsibilities
Health and safety incidents and emergencies must be It is vital that you limit your work activities to those you
recorded in writing in case there is an enquiry at a later are trained for, and confident about. If you are under
date. Sometimes the incident can lead to a problem a 18 years of age, you are also restricted under the Care
long time after the incident happened, and you might Standards Act.
not be able to contact the people who were involved
at the time. Records must be completed accurately
and include as much detail as possible. They must be
kept safe for three years.
This task is designed to help you gain a real Grading tips

understanding of the way the law influences rules in P2 ‘Outline’ means that you need to state what
the workplace. must, or must not, be done to comply with the
You will need to outline how legislation, policies and various laws and regulations, and to work within
procedures relating to health, safety and security policies and procedures.
influence health and social care settings. Get copies of some policies and procedures
Describe how health and safety legislation, policies from your placement, pick out particular
and procedures promote the safety of individuals in a statements and describe how they relate to
health or social care setting. promoting health, safety and/or security. Read
through the summaries of the relevant laws and
try to see how the policy or procedure matches
the requirements of the law.
Think about how the consequences of breaking
the law or disobeying policies are an incentive
to work safely. Think about how policies and
procedures clarify safe practice.
M1 ‘Describe’ means write in more depth. The
better the description you give, the more likely
you are to achieve a merit.
PLTS
Independent enquirer: Interview the manager at
your placement to see how s/he uses legislation when
writing or updating policies and procedures.
Creative thinker: Try to write your own policy or
procedure using the summary of a law, this would
provide evidence of your creative thinking.
Self-manager: Organise yourself to complete this task
well and on time.
112
3 Be able to implement a risk assessment

It is the responsibility of the employer to anticipate used in conjunction with frequent changes of position
danger and to put into place measures to reduce risk. to further reduce the risk of these debilitating ulcers
This is done through the process of risk assessment. occurring.
The employer delegates the responsibility of carrying
out risk assessments to appropriate staff. For example, 3.1 Risk assessment
a senior care worker could carry out a risk assessment
on the manual handling of a new resident. It is the Hazard identification
responsibility of the management to ensure that the The first stage of risk assessment involves identifying
senior care worker has the correct training to be able hazards that could cause a risk. This requires you to
to carry out the task. think deeply about the activity you are considering,
A good example of risk assessment in direct care and ‘think the unthinkable’. If you look back at section
involves assessing the risk of an individual developing 1, you will see that hazards can be due to:
pressure ulcers. • the physical environment
Several tools are used to assess the risk of pressure • equipment
ulcers developing. The most frequently-used tool is • infectious substances
the Waterlow score. Factors such as weight, mobility,
• working conditions
skin type and whether the individual is continent all
• working practices
combine to give a score. The higher the score, the
more likely the person is to develop pressure ulcers. • security systems.
Once the risk has been established, it will be decided
how often the individual should have their position
changed. Key terms
There are various types of equipment designed to Continent – Able to control the bladder and bowels.
relieve pressure, usually by spreading the pressure Anti-decubitus mattress – A mattress designed to share the
over a larger surface area. Examples include anti- weight evenly and reduce pressure ulcers.
decubitus mattresses and water beds. These can be
Pressure ulcers are caused by people staying in the same

position for a long time. How do you think the tissue
in people’s bodies is affected when it is compressed
between the bed or chair and the bones?
113
You need to consider each of these that are road, the likelihood that a person would be killed
relevant to the activity, and think about what could or seriously injured is tiny, if you consider how many
theoretically be a hazard. The act of carrying out a risk people cross roads every day compared to the number
assessment really makes you think, because you have of casualties. However, if you were taking children ice
a form to fill in. This prompts you to consider more skating, the likelihood of someone falling over is very
carefully whether the benefits of the activity outweigh high, and therefore the probability of a child sustaining
the risks. an injury is greater when ice skating than crossing the
road.
Potential severity of harm resulting from Critical controls
each hazard Some workplace tasks have control measures in place
When deciding if it is safe to go ahead with an activity, at critical points where something is likely to cause
it is important to decide how serious the potential danger. One example is the food industry, where a
harm would be if things were to go wrong. We do system known as ‘Hazard Analysis and Critical Control
not want to stop individuals from enjoying activities if Point’ (HACCP) is recommended to keep control of
the risk they face is not a serious threat to health and food preparation processes. It involves monitoring
safety. For example, when taking children ice skating, food preparation staff to check that they are following
the worst that could happen on the ice is a broken arm procedures including cleaning preparation surfaces,
or severed finger. checking fridge and freezer temperatures, checking
The worst thing that can happen in any incident is cooked food core temperatures, and monitoring the
that someone dies or is permanently and severely time food is left out at room temperature. Everything
disabled, so if this is a possibility you need to consider is documented so control measures can be proven if
carefully whether the activity could still go ahead as necessary.
long as safety measures were put in place. Of course,
you could get killed or seriously injured crossing the 3.2 Calculating the degree of
road, but you cross roads most days without coming
to harm, so even if the potential severity is this serious,
risk
the activity may still be possible with adequate controls When you consider how likely it is that something will
in place. go wrong and, if it did, how serious it would be, you
should use a scale to grade your decision. The harm
does not necessarily have to be a physical injury; it
Likelihood/probability of each hazard could be psychological damage or harm to property.
causing harm This takes quite a bit of thought, as it is easy to
You also need to consider how likely it is that the worst imagine the chances of harm are much higher than
will happen. Using the same example of crossing a they are in reality.
Table 3.2: Risk likelihood and severity scales
Likelihood Severity
1 Not very likely to happen 1 If it did happen the harm would be minimal and could be dealt with by an
untrained person (e.g. might just need a plaster)
2 1 in 4 (25 per cent) chance 2 Might need to visit a professional for advice or treatment (e.g. might need
stitches)
3 2 in 4 (50 per cent) chance 3 Would take a few weeks to sort out, but not a serious injury (e.g. could result
in a broken arm)
4 3 in 4 (75 per cent) chance 4 Could cause serious injury or damage, but would eventually be resolved (e.g.
could result in a broken leg)
5 Very likely to happen 5 The result could be permanent disability, destruction of a building or death
114
Calculating risks for different individuals people have unclear speech, and some use sign
language, such as Makaton as well, or instead of
One factor that will impact on the likelihood and
spoken language. This could present a hazard if they
severity of harm occurring is the type of individuals you
need to tell you something urgently.
are dealing with.
Sensory impairment
Older people
People with sensory impairment, such as hearing loss
If you are taking older people out, you need to be
or poor vision, present other potential problems. A
aware of their physical and cognitive abilities. Outside
person who is blind will usually have a care worker
paths may be uneven or slippery, or the path may be
with them all the time, whereas this isn’t necessarily
too narrow for an accompanying carer to be able to
the case with people who are Deaf. The main danger
walk alongside.
for anyone who is Deaf is that they will not hear verbal
Older people are more likely to be affected by instructions, announcements or warnings. Special
extremes of temperature, so make sure they are arrangements need to be made to ensure they will be
wrapped up well in cold weather, with a hat to reduce alerted in an emergency situation, such as in the case
heat loss. In warm weather hats should be worn to of a fire.
protect from sunburn. You should take drinks with you.
Do consider the availability of toilet facilities, including Physical impairment
disabled toilets, when choosing venues. Wheelchair users may need to follow different
instructions in the case of a fire. Large public buildings
Cognitive impairment
often have safe areas where wheelchair users can
Some older people develop Alzheimer’s disease or assemble during a fire emergency. These areas will
other forms of dementia. This affects their ability be protected by fire doors that can withstand fire for
to remember recent events. It can also affect their about two hours. The fire service can be alerted on
communication skills, reasoning and understanding of arrival. Other buildings, such as theatres or pubs, may
the world around them. be less well designed to cope with wheelchair users
They can become disorientated, even in familiar in an evacuation. You may need to consider whether
surroundings. There must be adequate numbers of these are suitable venues, or if you would want to
staff on hand when taking out people with dementia – position wheelchair users just next to the fire exit, to
they will need close supervision. enable them to be quickly evacuated alongside other
people.
Learning disability
People with learning disabilities differ from one Children
another in their abilities, so you need to get to know Children pose a different set of challenges. Young
individuals and their particular needs. In general it children have poor awareness of danger and need
takes people with a learning disability more time to close supervision on outings. You may need to enlist
think things through, and a little longer to learn new the help of other adults, such as parents, to increase
skills, because of difficulty in processing certain types the child/adult ratio. You may also need to consider
of information. having adult volunteers checked with the Criminal
To help people with learning disabilities to understand Records Bureau (CRB). In this case you would need
health and safety information, break the information to plan well ahead, as CRB checks can take several
down into small manageable chunks, and give time weeks. You would also need to consider whether any
for them to process the information. They need lots of the children need special care during a trip, for
of time to practise skills. They may not be able to example, if they have a physical or learning disability,
respond quickly in an emergency, unless they have chronic illness or behavioural disorder.
learnt coping strategies for different situations in The types of environments to which you might take
advance. individuals are many and varied. Each will have
People who have learning difficulties can often different potential hazards. Look at section 1, where
understand far more than they can express. Some hazards in different environments are discussed.
115
How can play parks be designed

with safety in mind, but still provide
some challenge for children?
3.3 Controlling the risk

This involves thinking about what can be done to Imagine you were going to take a group of children
reduce the risk. There are several ways you can do this, out to the play area. Before letting them out you could
including removing the hazard, separating the hazard inspect the area for hazards.
from people, or using safety equipment or strategies
to make a resulting incident less severe.
Table 3.3: Sample hazard control measures
Hazard identified Control measures Examples

Play equipment Removing the hazard Broken or faulty play equipment should be
removed from use.
Traffic on road Separating the hazard from people You should make sure the gate is closed and
bolted so children cannot escape onto the road.
Climbing frame Using safety equipment Place soft mats underneath the climbing frame.
Sun Using safety strategies Put sunscreen on children in hot weather.

Small climbing frame Using safety strategies Restrict number of children using the climbing
frame to three at any one time.
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3.4 Monitoring how the risk is 3.5 Reappraising the risk

being controlled Even if a risk assessment has been agreed it is
important to keep thinking about ways to make an
Once a risk assessment has been completed and it has
activity even safer. If an incident has occurred, it may
been decided that an activity will go ahead, someone
have alerted staff to a risk that wasn’t previously
needs to check that the safety measures suggested are
identified, so this will need to be added. Perhaps
appropriate. This will usually fall to the manager or the
something has changed since the original risk
senior member of staff who has responsibility for health
assessment was done – for example, a new person with
and safety. It is good practice for risk assessments to
a condition such as epilepsy may have started using
be approved in this way before allowing the activity to
the care setting. Or a new piece of equipment may
proceed.
have been purchased that makes the activity less risky.
In Table 3.3, for example, the health and safety
Each time the activity is planned, get the risk
representative might amend the climbing frame
assessment out, read it through again as you plan the
example suggestion as follows:
activity, and consider whether you need to amend it.
‘The mats must be placed under the feet of the Discuss the proposed activity with other staff and look
climbing frame to ensure they cannot be moved and at the risk assessment together. Risk assessments only
a barrier must be placed around the climbing frame work if people read them and follow them. You need
area to prevent children tripping over the mats.’ to appreciate their value, rather than regarding them
as unnecessary paperwork.
Risk assessment form

Identified hazard Risk Control Monitoring
Food poisoning from Likelihood = 2 Food hygiene training. Staff to be in kitchen throughout
uncooked turkey Severity = 5 Supervision to ensure hands are but only to step in if unsafe
Risk =2x5 washed at all critical times, and practice occurs.
= 10 all surfaces are disinfected after
exposure to raw turkey.
Reappraisal of risk following activity
Fig 3.10: Use this form to have a go at a risk assessment
117
For P3, M2 and D1, you need to carry out a risk for you to predict what might go wrong. When you
assessment in a health or social care setting. Have come to do the assignment task for real, you will need
a go at this scenario as a practice run. There is a to use the box at the bottom of the Risk Assessment
template on page 117 for you to use. Form to record any unforeseen problems, and say
You are on placement at Bradwell House, a day what you would do differently next time.
centre for adults with Down’s Syndrome. There are • You will have to write in more detail on a separate
12 adults who attend regularly for three days a week. sheet to discuss the hazards identified.
The manager encourages the group members to take • Make recommendations to minimise the risks
the lead in planning what they want to do. At the last associated with the hazard (D1) by completing the
forum the members decided that they wanted to put ‘Reappraisal of risk’ box at the bottom of the Risk
on a Christmas lunch for their parents. Assessment Form.
• Look at the information on page 115, which
describes some of the difficulties experienced by Grading tips
individuals with learning disabilities. P3 Data from the Health and Safety Executive
• Break down the task of producing a Christmas and the Royal Society for the Prevention of
lunch into separate tasks and identify the Accidents could help you identify the factors
hazards that exist for individuals with learning you should consider in your risk assessment. For
disabilities. Use the list under the heading ‘Hazard this criterion you should submit the records you
identification’ (on page 113) to help you. have made in carrying out the risk assessment.
• Transfer the hazards onto a copy of the form M2 You will need to attach further information to
provided. your risk assessment form to show that you have
• Calculate the degree of risk by multiplying the considered all the possible hazards associated
score for likelihood by the score for severity, using with the nature of the activity and individuals
Table 3.2 (on page 114) to help you, and record the involved and have identified and explained
result for each hazard in the second column. The their relative importance when making
minimum score is 1 and the maximum is 25. decisions for calculating the risks. This further
information could be presented as numbered
• For each hazard, suggest how you could control footnotes to the form and be supported by
the risk, and record this in the third column. Think references to appropriate literature.
again about the score you gave in the second
column. You should aim to get the score to 10 or D1 Your recommendations should relate to either
below. If it is higher, think of ways of making it safer eliminating or reducing each of the risks and
by changing the way of controlling the risk. will be summarised in the third column of the
form. You should give brief reasons for the
• In the fourth column you need to say how you recommendations and could add these to your
would monitor the risk during the activity. footnotes.
• Without actually carrying out this activity, it is difficult
PLTS
Independent enquirer: This could be gained by
thinking carefully and identifying the hazards.
Effective participator: If you make suggestions to
reduce the risks, you could have evidence for your
effective participator skills.
Self-manager: Take the initiative to find out more
about the difficulties experienced by individuals with
learning disabilities and relate this to the task.
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4 Understand priorities and responses in dealing with

incidents and emergencies
No matter how careful you are, and how much planning • Believe what they tell you
you do, you will come across emergency situations if • Do not pressurise them to say more than they want
you work in health and social care. You cannot control to
everything, and sometimes other people may act
• Say that you are glad that the child told you
carelessly or recklessly. Some people deliberately cause
• Say that it is not their fault and the abuser shouldn’t
harm, and mistakes can be made due to human error.
have done these things
For these reasons, if such a situation arises you need to
know what to do to minimise the harm caused. • Say that you will do your best to protect and
support them
• Report what has been said to the person at your
4.1 Incidents and emergencies placement who has been nominated to deal with
child protection, who will take over and report the
Suspected or actual abuse incident to social services.
If you study the Unit 10 Caring for children and Abuse in vulnerable adults
young people and Unit 11 Safeguarding adults and
Your response to abuse in people over 16 years
promoting independence, you will cover this in much
depends on their ability to make a decision. This
greater depth. Even if you do not, it would be worth
can be quite hard to assess. If you feel the person is
reading those units to gain a better understanding of
capable, and does not want you to report the abuse,
the forms of abuse and signs to look out for. Anyone
then you should not do so. If, however, you feel that
can become a victim of abuse, including staff.
they do not have the capacity to make that decision,
Abuse is any behaviour towards a person that causes you should discuss it with the manager of the setting,
him or her harm or violates their rights or dignity. who can decide what to do.
Suspected abuse in children
In a case of suspected abuse in children your priority
Accidents
is to make sure that someone listens to your concerns
Despite all the measures taken to keep everyone safe,
and takes them seriously. It is better for suspicions
accidents still happen, and the response of those
to be investigated and found to be unfounded than
on the scene can have an enormous impact on the
ignored and then found to be correct.
outcome. Your priority is to ensure that the situation
If you suspect abuse in a child under 16 you must not
does not get any worse, and that you put into practice
keep your suspicions to yourself. You need to discuss it
first-aid principles.
with the child protection appointee, who will deal with
The first thing to do when an accident occurs is to
the situation.
stop and think. It will not help the situation if you put
Actual abuse in children yourself at risk and create another casualty.
If a child tells you about abuse, your priority is the • Check for danger from fire, fumes, moving vehicles,
child, however nervous you are feeling. It will have falling masonry, or chemicals. If any of these are
taken a lot of courage for the child to speak to you, present, do not enter the area.
and you should remember that you must have gained
• If it is safe to continue, the second priority is to
a lot of trust for the child to feel able to talk to you.
establish how seriously injured the casualty is, or,
• Remain calm and reassure the child if there is more than one casualty, to identify the
• Look for a quiet place to talk one needing the most urgent help. Approach the
• Tell the child that you will need to tell someone, but casualty to assess their condition.
reassure them that they have done the right thing, • You must ensure that the casualty’s condition is not
and it will be hard, but will get better made worse by incorrect first-aid action. The role
119
of first aid is to preserve life, to prevent a condition Strict hygiene is essential when working in a care
worsening and to promote recovery. setting as some individuals are at great risk from
• Protect yourself with vinyl gloves if you are likely infections that might be minor for other people. These
to come into contact with blood or other body include:
fluids. • pregnant women and babies
• Do not move the casualty unless they would be in • older people
more danger by staying in the same position. • those with reduced immunity, for example people
If any accident occurs, it must always be reported in receiving chemotherapy for cancer
the accident book so if there is any investigation it is
• those with asthma and diabetes.
clear what happened, who was involved, where the
incident occurred, whether there were any witnesses, To minimise the spread of infection, always wash your
and what action was taken. hands thoroughly between dealing with different
individuals, and use anti-bacterial gel if available. Use
tissues and cover your nose and mouth when coughing
Exposure to infection
and sneezing, and encourage those you are caring for
There are many opportunities in a health and social to do the same. Dispose of tissues quickly in a covered
care setting to be exposed to infection. MRSA and bin, and wash your hands.
hazardous waste, for example, have been mentioned
earlier in this unit. Your priority in such a situation is to Practise strict food hygiene to prevent contamination
protect both yourself and those around you. of ready-to-eat food with high-risk foods, such as raw
meat. Dispose of all out-of-date food.
Infection can enter the body in several different ways,
including: Spillage kits are available to deal with body fluids
• inhalation – breathing in such as vomit and blood. Granules are sprinkled on
the spillage to absorb the fluid, which can then be
• ingestion – swallowing
scooped up. The area should then be disinfected.
• inoculation – through a break in the skin. Gloves and aprons should be worn for this task.
1. Wet hands, apply soap 2. Rub the palm of one hand 3. Rub palms together 4. Interlock fingers and use the
1. and rub hands palm to 1. on the back of the other, 1. with fingers interlaced 1. palms to rub the backs
1. palm 1. fingers interlaced 1. of fingers
5. Clasp each thumb and 6. Rub fingertops in palm 7. Rinse hands with water 8. Dry hands thoroughly
1. rub using a rotating action 1. of hand 1. and turn off tap using 1. using paper towel
1. elbow
Fig 3.11: Correct hand-washing can significantly reduce the risk of cross infection
120
Cuts should be covered with a waterproof plaster

during working hours, to prevent germs entering
Activity 4: Medication
through the skin. If you deal with food, the plaster must round
be blue, in case it falls off.
PLEASE NOTE: YOU SHOULD NOT BE GIVING
DRUGS OUT ON WORK PLACEMENT!
Exposure to chemicals
Felicity Downs is a care worker at the Hawthorns
A number of substances used in care settings are
Residential Home. She has a resident called Albin
hazardous if misused. Your priority when dealing with Nowak, who has an irregular heartbeat. He suffered
chemicals is to prevent accidental exposure to the a stroke a few weeks ago and cannot swallow
chemical. Cleaning fluids can cause chemical burns to properly. His GP has prescribed Digoxin oral liquid
the throat and oesophagus if swallowed in error. They to slow and regulate his heartbeat.
can also cause irritation to the skin, so gloves should The GP has prescribed 200mcg Digoxin per day
be worn when dealing with chemicals. to start with. The Digoxin is dispensed by the
pharmacist and is in liquid form. The strength of the
Medication can also involve hazards. Even when medicine is 50mcg per ml.
medication is given correctly, there can be risks. It is
1 Calculate the volume in ml that would be needed
essential that all staff dealing with medication have to give Albin exactly the right dose.
completed a training course on safe handling of
2 Think about how dangerous it could be if the
medication. This will give them knowledge of potential dose was worked out incorrectly, or the medicine
side effects and enable them to follow guidelines was given to the wrong person!
on how to minimise these. Doctors and pharmacists 3 Write a set of rules that would reduce the
should have a comprehensive understanding of drugs chances of this happening.
in order to avoid problems. 4 Sometimes Digoxin can build up in the
A drug interaction means that if two drugs are given bloodstream, which would mean the heart was
at the same time a side effect occurs, which would not beating too slowly. Staff must check a resident’s
pulse before giving Digoxin. If it is below
occur if just one of the drugs were given. Of course, 60 beats per minute, they must not give the
it is not possible to remember every interaction, and medicine and they must inform the GP.
new medications are being developed all the time.
5 Practise taking the pulse on other students in
If there is any uncertainty, the doctor or pharmacist your group until you can find the pulse quickly.
should double-check. There are booklets and websites
that they can use to check for interactions before
prescribing or dispensing drugs.
Some drugs can interact badly with certain foods. Functional skills
Again, this information is available for professionals to
Maths: This activity will help you to demonstrate
check against if they are uncertain.
mathematical skill, by showing that you understand
Some medications are very toxic, particularly those routine and non-routine problems in a wide range of
used in cancer treatment, known as cytotoxic drugs, familiar and unfamiliar contexts and situations.
which interfere with cell division. They are not able to
target cancer cells specifically, and can interfere with
‘normal’ cells. As a result, they can produce side effects Spillages
in patients being treated, such as loss of hair. Without
Any spillage can lead to slips, especially on hard
precautions they would also cause side effects in carers
floor surfaces. Your priority is to alert everyone to
and health care professionals who are exposed to
the wet area on the floor. You could guard the area
them.
until someone else comes along and then ask that
Staff who are preparing these drugs need to be person to fetch a warning sign, mop and bucket. Some
extremely careful not to expose themselves to the organisations have spillage stations at regular intervals
drug, and must wear protective gloves, a plastic apron around the building. These store absorbent mats and
and an eye mask. warning signs that can immediately make the area
121
safer, by soaking up the spillage and warning passers-

by of the danger while you fetch equipment to clean
Reflect
up properly. Don’t forget that, under the Health and You have probably been in a situation where
Safety at Work Act, everyone is responsible for safety, someone was deliberately trying to annoy someone
else, perhaps at school, when another pupil was
so do not ignore spillages in the hope that someone
trying to annoy a teacher. Think about how you
else will deal with them. knew when the teacher was getting cross – their
Take care where the warning sign is placed, as the sign expression, their tone of voice, or their manner. You
itself could become a trip hazard, especially if there are can use this knowledge to help you recognise when
people around with poor vision. an individual is becoming agitated, so you can try
to defuse the situation and prevent an incident.
Intruders
Your main priority is to keep intruders out. Always Any of the following may be a sign that a person’s
remember to lock the external doors, and check the behaviour is about to become aggressive. The person
identity of any visitors before letting them in. may:
If an intruder does gain entry, your priority is to keep • be tense and agitated
yourself safe, and keep the people you are caring for
• raise his/her voice to a high pitch and speak loudly
safe. Property can be replaced – unlike people. You
should not attempt to approach the intruder. Alert the • reply to questions abruptly
manager or a senior member of staff if you are able. • show signs of muscular tension in the face and
If not, call the police yourself, even if the intruder has limbs and his/her pupils may become dilated
escaped. • close his/her hands in a fist
Another priority is to preserve evidence for the police, • bang his/her fist into his/her palm on the desk
so do not touch anything until they arrive. • resist eye contact
• invade your personal space by leaning forward.
Aggressive and dangerous encounters If you find yourself in this situation, call for help straight
Unfortunately some people you work with in a health away and leave the area immediately if you can. If you
and social care setting can be violent towards staff. are unable to leave, try to stand as far away from the
This may be part of their condition, as can be the person as you can. Talk in a calm voice and slow the
case in people with mental health issues or learning pace of the conversation down.
disabilities. It may be due to drug or alcohol abuse or
a reaction to the situation. Aggressive behaviour can
include verbal or physical threats.
If you are working in this type of environment you will
Did you know?
need to learn what triggers aggressive behaviour in There were 11,482 physical assaults against hospital
each individual, to help you prevent it occurring. staff in 2004/5, but this was less than a third of the
number in 2002/3. The NHS has introduced Conflict
If you are at a placement where challenging behaviour
Resolution Training for all frontline staff, and people
is likely, you should be informed of the procedure who threaten or assault NHS staff are prosecuted.
from the first day and make yourself familiar with panic
Source: NHS Security Management Service 2005
buttons or other systems designed to alert other staff
to a problem.
Your priority is your own safety, and the safety of the
other residents. In settings where aggressive behaviour Some staff have been threatened at gunpoint, and with
is expected, staff are trained in restraint techniques, knives, while others have been physically assaulted,
which allow them to control the person without hurting resulting in injuries such as broken noses and fractured
them. You may witness this, but would not be expected cheekbones. Nurses have been sexually assaulted on
to participate. duty and threatened with things like broken bottles.
122
There is growing concern about attacks on community dealing with those who are injured. Make sure people
care staff, such as district nurses and midwives, who are not standing too near the building, as it may
work on their own, visiting people’s homes, not always collapse.
knowing who is in the house and what kind of situation
they are walking into. There may be people in the Floods
house who are under the influence of alcohol or drugs, Floods can be caused by burst water pipes in a
who may be violent, and staff are very vulnerable. building or by extremely high rainfall. The former
Aggressors can even be relatives or patients would not constitute a major disaster, but is distressing
themselves. and causes a lot of disruption.
Fire Floods caused by heavy rain are usually known about
Your priority in a fire is to keep yourself safe, and if in advance. The Environment Agency issues warnings
possible the people you are caring for too. to enable us to make decisions about what to do, and
help managers decide if evacuation is necessary. If
You should familiarise yourself with the fire procedure
a building is in a known flood risk area, a flood plan
on your first day at work, or on a placement, so if a fire
should be in place (in the same way that organisations
does occur, you will know where the alarms and exits
have fire procedures). This is so that the staff know
are.
exactly what they will do if a flood occurs.
If a fire does break out and you are able to help
someone to escape without putting yourself in danger, Severe flood warning
then do so. This code means that you can expect severe
The most dangerous situation is being trapped inside flooding and there is extreme danger to life and
a building. This would only happen if all escape routes property. You should:
were blocked. In this situation you need to separate • collect the things you need for evacuation and turn
yourself, and other people if possible, from the fire. off the gas, electricity and water supplies if it’s safe
Move to a room with an outside window, close the door to do so
and put something along the gap at the bottom of the • stay in a high place with a means of escape, avoid
door to prevent smoke seeping in. A door will keep a electricity sources and avoid walking or driving
fire back for at least half an hour, and a fire door for two through flood water.
hours. The fire service will arrive well within this time.
Evacuation of a residential care setting
You should open the window and shout, to alert
Residents will be taken to an evacuation centre
passers-by that you are trapped inside the building,
run by the local council. Food and bedding will be
and the fire service will make you a priority when they
provided but staff should take spare clothing, essential
arrive.
medication and care items (such as feeder beakers and
If you are walking through a building that is on fire and baby bottles) if possible.
you come to a closed door, feel the door with the back
Your priority in a flood situation is to keep yourself
of your hand. Do not touch a metal handle, as it will
safe, but if you can safely help to evacuate others from
be extremely hot. If the door is hot the fire is burning
affected areas then you should do so. The flood water
behind it, so do not open it, as you will add oxygen to
may well be contaminated with sewage, so care must
the fire, causing it to flare up in your face. You will need
be taken to avoid swallowing water and careful hand-
to find another escape route.
washing will be needed before eating.
You are not expected to fight a fire. However, if you are
If possible, move people to a higher level while waiting
able to close doors as you evacuate, this will slow down
for rescuers. If you go upstairs, watch out of the
the fire by reducing the amount of oxygen available,
window for rescuers, to alert them that you are inside.
and may even cause the fire to extinguish itself.
Once outside, check that someone has called the fire Day care setting
service. You should help to care for others, especially A day care setting (such as a day centre or nursery)
those who are confused and distressed, such as would probably decide not to open if a severe flood
children or people with dementia. Staff may be busy warning was in place.
123
Following a flood, buildings take several weeks to dry

out and often need new carpets and redecoration, so
Activity 5: Critical incidents
the setting would not be operational again for some
time. Most equipment that got wet would have to be
As a whole group think of some other critical
replaced. incidents you might come across when working in
the health and social care sector.
Loss of water supply
In a health or social care setting water is essential. Subdivide into smaller groups, and allocate one of
the incidents to each sub-group.
You will need water for hygiene reasons as well as to
provide people with drinks. Toilets need flushing, and Within your sub-group, discuss the hazards that
would exist in the given situation and the best ways
would soon become very unpleasant. Sometimes you
to protect individuals from harm.
know in advance that the water supply is going to be
disrupted for a short time. Then you can plan ahead, Allocate roles such as the manager, health and
safety representative, care worker, and individuals
by doing tasks such as the laundry and bathing at a
receiving care.
different time. The manager can request a tanker of
water for hand-washing, toilet flushing, cooking and Prepare a role-play to illustrate how to deal with the
situation.
drinking, to use while the water is off.
If you are managing in this way it is important that you Afterwards, discuss the role-plays as a whole group.
use water wisely, making sure the tanker tap is turned
off properly.
Sometimes the water supply is disrupted without
notice, often as a result of a burst water main.
Someone should telephone the water supplier, as
4.2 Responses
they may not be aware of the problem. A tanker Maintaining respect and dignity
of water should be requested urgently for the care While saving a person’s life has to be the top priority
setting. in emergency situations, you should always try, if
Toilets can be flushed by pouring a bucket of water possible, to respect the dignity of the people you are
into the cistern. helping. Discourage crowds of onlookers, and use
Sometimes after the supply has been disrupted the blankets or coats to cover people who have been
water has to be boiled for a day or two before drinking. receiving treatment. Rescuers should speak to people
It is essential that this advice is followed, especially for in a professional way, and this will reassure them and
people with lowered immunity. give them confidence.
Civic emergency Emergency first aid

A civic emergency would be a situation that disrupted If the casualty is unconscious, follow the steps below.
public services, such as industrial action leading to • Gently tap the casualty, introduce yourself and ask if
strikes, or civil unrest, making it difficult for people they are all right.
to move around the area. This can cause all sorts of • If they respond, leave them in the position you
problems, such as rubbish building up, or supplies not found them in and try to find out what is wrong.
being delivered.
• If there is no response, shout for help from a
Your priorities here depend on the situation, but may bystander. If there is no bystander, carry on to the
include prevention of infection, and protection of next stage.
individuals and property.
• Check that the casualty is breathing. If not, ask the
Other critical incidents bystander to call the emergency services. If there is
You can probably think of other situations that would no bystander, go and call the emergency services
test your abilities to think calmly and work out how to yourself, as you need to have help on the way.
cope in a crisis. Part of being an effective health and • Even if you suspect back injuries, roll the casualty
social care worker is to be able to think on your feet. onto their back. Your first priority is breathing.
124
• Open the airway by tilting the head back. This will • Repeat this pattern of 30 compressions to two
draw the tongue away from the back of the throat breaths until they start breathing on their own or
and breathing may restart with no further action. until you can hand over to the ambulance service.
There are techniques to reduce the risk of worsening If you have established that the casualty is breathing
neck injuries but they are beyond the scope of this normally, the next most life-threatening situation is
unit. Try to attend a first-aid course if possible. severe bleeding. If available, protective gloves should
• Place your ear and cheek over the mouth of the be worn.
casualty. Listen and feel for breaths, while looking
External bleeding
for the rise and fall of the chest.
• External bleeding from a limb should be controlled
by applying firm pressure to the wound and raising
the limb above the level of the heart.
• Ask a bystander to call an ambulance.
• If available, dress the wound with a large pad and
bandage, keeping the pressure on as much as
possible and maintaining the elevation.
• If blood starts to seep through, apply another
dressing on top – do not remove the first one.
Fig 3.12: The open airway position Internal bleeding
• If the casualty is breathing normally, put them in the Internal bleeding, caused by the rupture of an internal
recovery position and examine for other signs of organ, such as the spleen or kidney, can result from
injury. a blow to the abdomen. You may not see any blood
loss at all, although there may be signs of bruising. You
might suspect internal bleeding from the history of the
incident and the casualty may go into shock (see below).
Shock
Signs of shock include pale, cold, clammy skin, a fast
pulse and fast breathing rate. The casualty may start to
feel light-headed and nauseous.
• Lay the casualty down and raise their legs. Cover
with a blanket or coat to retain heat.
• Be prepared to start resuscitation.
Fig 3.13: The recovery position

Reporting of accidents
• Keep a close eye on their breathing.
Any first-aid incidents dealt with in a work setting need
• If the casualty is not breathing, assume they have to be recorded in the accident book, in case there is
suffered a cardiac arrest. Kneel to one side of the any query at a later date. The accident book should
chest and, with straight arms, place the heel of record the name of the casualty, the nature of the
one hand on the breastbone and put the other injury, the date, time and location of the incident and a
hand on top, linking your fingers. Perform 30 chest record of first aid treatment given. Some organisations
compressions. also ask for the name of a witness to be recorded.
• You will now have to breathe for the casualty, Without a record of an accident, it is not possible
preferably using a resuscitation aid. to claim compensation. It is not always obvious at
• Make a good seal around the casualty’s mouth and, the time whether or not an injury is going to lead to
at the same time, pinch their nose and blow twice long-term problems, so even minor injuries should be
into their lungs to inflate them. recorded.
125
Follow-up review of critical incidents and and after incidents. These include the Red Cross, the
Salvation Army, the Women’s Royal Voluntary Service,
emergencies
and ministers of religion. Sometimes counselling is
It is always good practice to carry out a review required, and it is always advisable to talk over the
following emergency situations, to understand why the experience, even if this is not done in a formal session.
incident occurred and to evaluate how effective the
response was. You will have heard in the news about
enquiries that have taken place following incidents.
4.3 Priorities
Sometimes they take many months to complete. Reviewing policies and procedures
In June 2006 the results of an enquiry into the Once a crisis has passed, it is a good time to consider
emergency response following the terrorist attack how well policies and procedures worked. Managers
on the London Underground on 7 July 2005 were should review how smoothly the incident was dealt
published. One problem identified was related to with, and whether it could have been dealt with better.
ineffective radio communications between members The review might highlight a weakness. For example,
of the emergency services. The report set in motion a staff might have been unfamiliar with a policy, which
review of equipment to ensure that this would not be meant that they did not instantly know what to do. As a
the case if a similar incident happened again. result, the manager may revise training for their staff.
Accessing support for own emotional Implementing improvements for the future
reactions after an emergency In order to avoid the same difficulties happening again
Staff involved in rescuing or caring for casualties can if a similar incident occurs, any policy changes need
find they are emotionally traumatised after the event. to be implemented quickly. This may involve changes
Rescuers may experience flashbacks and nightmares. to the training schedule, or to the way information is
There are several organisations that offer support to presented. It might also involve organisations outside
both victims and emergency services personnel during the care setting.
Choose two incidents or emergencies for this task priorities should aim to reduce risk to the victim
from the sub-headings in section 4.1. To achieve the and/or rescuer, or reduce the risk of further
pass, criterion you need to explain how to deal with harm.
each incident. You should explain both the possible M3 Concerns arising from a specific incident or
choices for action and the order in which you would emergency in a health or social care setting
carry these out. You must provide reasons for the might include infection, risk of injury to
priorities and responses. rescuers, or risk of theft during the emergency.
You should discuss how the concerns might
influence responses and priorities. You could
Grading tips compare the concerns relating to each of the
P4 You should identify possible responses before two chosen emergencies/incidents.
you explain each of these. Each response D2 You should justify responses to a particular
may need to be broken down into smaller incident or emergency in a health or social
actions. Priorities are likely to be influenced care setting. You will need to select the best
by the importance and urgency of smaller response for the circumstances of the two
actions in relation to achieving the desired incidents and/or emergencies selected. You
overall responses to deal with each incident must then explain why you have chosen the
or emergency. Remember all responses and responses.
126
Resources and further Useful websites

reading Department of Health www.dh.gov.uk
Department for Transport www.dft.gov.uk
Ayling, P. (2007) Knowledge Set for Infection
Prevention and Control Oxford: Heinemann Down’s Syndrome Association
www.downs-syndrome.org.uk
Collins, S. (2009) Health & Safety, A Workbook for
Social Care Workers London: Jessica Kingsley Food Standards Agency
www.food.gov.uk/safereating
Health and Safety Executive (2008) A Guide to the
Health and Safety at Work magazine
Reporting of Injuries, Diseases and Dangerous
www.healthandsafetyprofessional.co.uk
Occurrences Regulations 1995 London: HSE Books
Health and Safety Executive www.hse.gov.uk
Health and Safety Executive (2006) Essentials of
Health and Safety at Work, fourth ed. London: HSE Health Protection Agency www.hpa.org.uk
Books National Statistics www.statistics.gov.uk
Hughes, P. & L. (2008) Easy Guide to Health & Safety NHS www.nhs.uk
Oxford: Butterworth-Heinemann NHS Business Services Authority
Langton, H. and Maclean, S. (2009) Protecting www.nhsbsa.nhs.uk
Children and Young People from Harm and Abuse Nursing Times www.nursingtimes.net
Rugeley: Kirwen Maclean Royal Society for the Prevention of Accidents
Maclean, I. and Maclean, S. (2008) Social Work and www.rospa.com
the Law Rugeley: Kirwen Maclean Sunsmart Campaign: Cancer Research UK
Mandelstam, M. (2002) Manual Handling in Health www.sunsmart.org.uk
and Social Care London: Jessica Kingsley Terrence Higgins Trust www.tht.org.uk
127
Just checking
1 What is the difference between ‘hazard’ and ‘risk’?
2 Who is responsible for health and safety in a care setting?
3 What might the consequences for a care provider be if health and safety law is breached?
4 Which organisations can provide advice on health and safety topics?
5 How can care workers reduce the risk of harm to themselves and the people they care for?
6 How can employers make sure that employees work to high standards of health and safety?
7 What is the Independent Safeguarding Authority’s Vetting and Barring Scheme?
8 Why has the introduction of legislation, policies and procedures improved health and safety
standards over the years?
9 What is meant by personal protective equipment and how does this reduce harm?
10 Give an example of unintentional abuse.
Assigment tips
1 Ask your tutor for a copy of the unit content sheet, so you can see what you need to include.
2 Take note of the verbs in each task. ‘Describe’ involves saying how, and ‘explain’ involves saying why
something happens. If you keep using the word ‘because’ this will help you achieve the higher grades.
3 Make use of the staff at your placement to gain an understanding of how health and safety applies to
the way care is delivered so you can really see the relevance of the theory.
4 Show your placement supervisor the assignment brief so s/he is aware of the tasks you need to
complete, particularly the risk assessment.
5 Remember to bring learning gained at the beginning of the unit into the answers to the later tasks.
For example, you need to ensure that recommendations in the risk assessment reflect legal and
organisational requirements, especially if you are aiming for the distinction grade.
6 Your justification for your responses to incidents/emergencies for LO4 must explain how your response
would result in a successful outcome.
128
Credit value: 10
4 Development
through the
life stages
This unit is about understanding the way we change over time. It
explores the course of human development and the range of genetic,
biological and social factors that influence how your life turns out. You
will investigate the major events which affect people throughout their
lifetimes and look at the effects of ageing, and theories about it.
You will need to think creatively about some very deep questions. Will you have a
fixed life course where you can predict much of what will happen to you? How can
people with genetic conditions be helped? And how far is your life fixed for you, by
your genetic inheritance, or by the social and economic environment you grow up in?
You will also need to consider the ageing process. How and why do we age? What
does it take to ensure a long and happy old age? And how can health and social care
provision provide opportunities for older people to remain as active as they wish?
Learning outcomes
After completing this unit, you should:
1 know the stages of growth and development throughout the human lifespan
2 understand the potential effects of life factors and events on the development
of the individual
3 understand physical and psychological changes of ageing.
129

To achieve a pass grade the To achieve a merit grade the To achieve a distinction grade
P1 Describe physical, intellectual, M1 Discuss the nature-nurture debate D1 Evaluate how nature and nurture
emotional and social development in relation to the development of may affect the physical, intellectual,
for each of the life stages of an an individual emotional and social development
individual See Assessment activity 4.1, page for two stages of the development
See Assessment activity 4.1, page 145 of an individual
145 See Assessment activity 4.1, page
145
P2 Explain the potential effects of

five different life factors, on the
development of an individual
See Assessment activity 4.2, page
162
P3 Explain the influences of two

predictable and two unpredictable
major life events on the
development of the individual
See Assessment activity 4.2, page
162
P4 Explain two theories of ageing M2 Discuss two major theories D2 Evaluate the influence of two major
See Assessment activity 4.3, page of ageing in relation to the theories of ageing on health and
171 development of the individual social care provision
See Assessment activity 4.3, page See Assessment activity 4.3, page
171 171
P5 Explain the physical and M3 Discuss the effects on self esteem

psychological changes which may and self confidence, of the physical
be associated with ageing changes associated with ageing
See Assessment activity 4.3, page See Assessment activity 4.3, page
171 171
130
Unit 4 Development through the life stages

In this unit you will be assessed through written work. You will be given an assignment
which will require you to develop a fact file. Your fact file will contain a wide range of
material about the human lifespan, life factors and the effects of ageing. Your file may
focus on imagining the development of an individual person. Guidance is included
throughout this unit to help you prepare your work.
Kiara, 17 years old

At first I thought – ‘oh there’s so much to learn for this unit’, but
my tutor helped me to see how stages of development work.
To begin with I set up a fact file to contain information on life
stages. Then I chose to study the biography of a famous tennis
player. This gave me lots of information about a real person’s life
experiences. I focused on adolescence and adulthood and explored
the nature–nurture debate in order to write my own conclusions about
intellectual, emotional and social development.
For the second assignment I had to work out how five life factors may have influenced
the famous person’s adolescence and adulthood. I also had to explain the influence of
two predictable and unpredictable life events. At first this seemed complicated but it all
clicked into place for me when we discussed the idea of holistic development. I realised
that you have to step back and see the big picture and not get tripped up with all the
detail.
For the third assignment I explained disengagement and activity theory and went on to
discuss how my celebrity would keep an interest in tennis after he was unable to carry
on playing. I looked at ways in which care workers could help to support someone like
my celebrity. I also had to imagine the effects of physical and psychological changes
on the person as they became older. I was careful not to think that later life is always
unpleasant and has to involve withdrawing from life. The person I studied had faced
great challenges in order to become successful and I realised that they might find ways
of coping with the problems of later life. I said it was possible that my person would
maintain a high level of self-esteem and confidence because of their previous life.
Over to you!
1 What do you think it takes to become famous? Can anyone become anything
that they want to be – what are the limitations?
2 Do things always get worse for people as they grow old?
3 Which sections of this unit do you think will help you to answer these questions?
131
1 Know the stages of growth and development

throughout the human lifespan
Life stories
Get
What do you think? Can someone become successful and famous just because
started they want to? Do you believe that people become important and successful
because they are born to do well? How far does success and fame depend on your
upbringing and your opportunities? What does later life hold for people? This unit
will help you to explore and make sense of individual people’s life stories.
Case study: An interview with John

Talking to John now:
John: It makes me laugh John had a clear idea of his life course when
looking back at my old he was 10, but his life experiences did not fit
school work. When you’re a straightforward pattern.
only 10 you don’t have
much idea of life. I got
some of it right. I did
start delivering milk and My life in the futu
I did get married in my Fig. 4.1: re 18th Jan 1960
twenties, but I ended up John’s school
having loads of different book from I will finish with sc
1960 hool when I am 15
jobs and have been .
When I get out of
divorced twice. school I will work
on the milk rounds
like my dad. When
Interviewer: So you would say you can’t predict
I am 17 I will meet
your life course? a girl and later we
will get married. Th
John: Well, life throws you lots of challenges – en I will be a dad.
I will play football
things don’t always work out like you want them to. at the weekends.
I worked for lots of companies but they went out of When I am 50 I ca
n stop work and
business and I had to retrain to do different jobs. watch TV all day.
By then people will
Nowadays I work in IT – in 1960 there wasn’t any
go on holiday to th
information technology. As the world changes you e moon but I will
too be to old to go on ho
have to change too. liday or go out
Interviewer: Would you say that there is no such any more.
thing as a life course?
John: No, you do change as you get older, and
some things you can predict. I mean, I’m just
not fit enough to play football any more – too
many aches and pains – your body does let you 1 Do you think John is unusual in not having
down as you get older. But I think if you’ve got a straightforward life story?
a dream, something you really want to do – well
you just might achieve your dream eventually. For 2 Why is it difficult to predict what will happen
instance I’m really happy now – good job, happy in your life?
family – everything is going great, but I had a lot of 3 How far can you choose how your life works
setbacks along the way. out?
132
1.1 Life stages Can you map your ‘life course’?

The human lifespan has been described in terms of A life course describes the path of the human life cycle.
life stages for centuries. The life stages are listed in Stages such as infancy, childhood and adulthood,
Table 4.1. The age ranges of some life stages are can be described alongside the social roles and
defined by social criteria. However, the age ranges for expectations associated with different stages of the
certain stages can vary depending on the expert who life course.
is describing it. In the past many experts assumed that the human
Table 4.1: Life stages life course would be controlled by biology. Growth
and development progress until adults are able to
Life stage Age Key features reproduce. As people get older a process of physical
Conception 9 months Egg and sperm fuse after decline sets in and continues until the person dies.
before sexual intercourse and This view of the life course can be described as the
birth create a new living being ‘springboard theory’.
Pregnancy 9 months Physical development of In the past people often assumed that everyone would
(gestation) to birth embryo and foetus have similar experiences of the life course. John’s story
at the beginning of this unit provides an example of
Birth and 0–3 years Attachment to carers
people’s expectations.
infancy
Childhood 4–9 years First experience of
education
Adolescence 10–18 Identification with peer

years group – puberty takes place Key terms
during this period Life expectancy – an estimate of the number of years that a
Adulthood 18–65 The right to vote, and person can expect to live (on average).
years manage one’s own financial Life course – a life course is a map of what is expected to
affairs, happens at 18 happen at the various stages of the human life cycle.
Older 65 years 65 is the current age when

adulthood onwards men (and women born after
6 April 1955) receive a state
pension Reflect
Final stages Variable Physical ‘decline’ Do you think that there is a ‘best age to be’ or can
of life every period of life be the best time in some way?
Life expectancy
Social Trends (2009) states that boys born in 2006 can
expect to live to 77 while girls born in 2006 can expect I am at the height
of my ability.
to live to 82 years of age. So life expectancy at birth
I am growing It‛s all downhill now!
is 77 for males and 82 for females. Life expectancy at stronger and taller.
Early adulthood
birth is an average, not some kind of limit. As you grow
older there is more chance that you might live longer
than the average expected life at birth. A man who has Childhood Later life
Springboard
already reached the age of 65 is expected, on average,
to live until the age of 82 while a woman who has lived
to be 65 is expected to live until the age of 85. So the Water
life expectancy of a man who is already 65 is a further

17 years and the life expectancy of a woman of 65 is a
further 20 years. Fig. 4.2: The ‘springboard’ model of the life course
133
Bromley (1966) designed a three-page outline of Many people have multiple careers. People may retire
the human life cycle, detailing physical and social from one career and start another. The state pension
development across the life course. Havighurst (1972) age is changing – after 2048 you may not retire until
produced a theory of ‘life tasks’ that people had to you are 68.
cope with at the different stages of their life course. Health in later life is immensely variable – some
Levinson et al (1978) described a series of transitions people experience heart disease in their forties, while
that most people could expect to go through during others remain healthy and active into their nineties.
their life course. Many people may continue to work part-time after
Nowadays it is much more difficult to describe the retirement age. Huge variety is now possible in the
general life course. Biology does not control the human life course. Your adult life course may turn out
adult life course like it used to! With the advent of to be quite different – even from that of your friends.
reliable contraception, one in five young adults may It is difficult to describe a general life course that will
deliberately choose not to have children. Many adults be true for most people. However, it is possible to
choose to delay starting a family until they have describe some patterns of growth and development
established their career. Some women even choose to relevant to everyone.
freeze their eggs in order to postpone pregnancy until
their forties. In recent times children have been born to Growth
mothers in their fifties and even sixties using artificial Growth is a term used to describe an increase in
techniques. quantity. For example, children grow taller as they get
older. As height and weight increase, we can refer to
the increase as a process of growth.
Did you know?
In December 2006 a woman called Maria del
Development
Carmen Bousada de Lara, aged 66, gave birth The word development is used to describe changes
to her first children (twin boys) after receiving that might be complex and involve a change in the
fertility treatment. She died in July 2009, just quality of some ability, as well as a change in measured
over two and a half years later! quantity such as height or weight. Most social,
intellectual and emotional change across the lifespan is
described in terms of development.
Activity 1: Discuss the idea of Maturation

People grow and they develop. Maturation is different
the ‘life course’ again from either growth or development. The term
Get together with other course members and ‘maturation’ is used when development is assumed
discuss how far you can choose your own life course to be due to a genetically programmed sequence of
and how far you should choose to step outside the change. For example, your experience of puberty can
traditional life stages? be explained as caused by an in-built genetic process
that unfolds as you grow older. Puberty can be seen as
an example of maturation.
PLTS
Creative thinker: Discussing the idea of the life
Key terms
course will help you develop creative thinking skills, Growth – an increase in some measured quantity, such as
by generating ideas, exploring possibilities and asking height or weight.
questions. The activity may also help to develop team
Development – complex changes including an increase in
working and participation skills.
skills, abilities and capabilities.
Maturation – when development is assumed to be due to a
genetically programmed sequence of change.
134
Very happy
Degree of happiness
OK
Miserable
0 5 10 15 20 25 30 35 40 45 50 55
Number of years
Fig. 4.3: Does happiness follow

BTEC a Health
National ‘springboard’ pattern for most people? Your life will involve more than your biology.
and Social Care
V499150_aw_004.5
Tek-Art (MJH)
Developmental norms Developmental milestones
A norm is something that is expected. Certain Early human development can be seen as travelling
sequences and developments are expected with on a journey. On a journey milestones can tell you
respect to physical and intellectual development. how far you have travelled. Developmental milestones
Although there are norms it is important to remember describe the skills children may be expected to
that every child will develop in their own way. Norms develop during the first months and years of life.
describe an average set of expectations; if a child
develops faster than the norm it does not mean that 1.2 Development
the child is necessarily ‘gifted’ and if a child develops
more slowly, it does not necessarily mean that there is Holistic development
something wrong. The term ‘milestones’ is sometimes Very few people experience their life in compartments
used instead of the term ‘developmental norms’. labelled ‘physical’, ‘intellectual’, ‘emotional’ or
‘social’. Most people experience a life course where
all these issues come together as one whole. Holistic
Activity 2: Research development comes from the idea of ‘holism’ – that
developmental milestones things need to be understood as a whole. It is possible
to analyse human development under separate
Undertake an Internet search to obtain a chart aspects such as physical, intellectual, social and
or list of developmental milestones. Compare emotional development, but all these aspects interact
your chart or lists with charts that other students with each other in the life stories of real people.
have researched. Discuss the advantages and
disadvantages of different styles of charts.
Key terms
Developmental norms – Description of an average
PLTS set of expectations with respect to an infant or child’s
Independent enquirer: This activity will help you development.
to evidence your ability to act as an independent
Holistic development – A person’s physical, intellectual,
enquirer. It will show that you can plan and carry out
emotional and social development as a whole. Development
research, together with analysing and evaluating
can be analysed under each of the individual categories to
information. The activity may also help to develop
help identify issues but, in life, the categories interact.
team working and participation skills.
135
Physical development Weeks 1 and 2 Passage to the uterus

The egg is fertilised in one of
Conception the Fallopian tubes and is
carried into the uterus
Human life begins with conception. A fertile woman
usually produces one egg cell each month, roughly Fertilisation of egg in
two weeks after the last menstrual period. The egg cell Ovary
Fallopian tube
travels from the ovary, along the fallopian tube towards Fertilised egg implants
the uterus. If sexual intercourse takes place while the in wall of uterus
egg is in the fallopian tube, there is a possibility of
conception. Millions of sperm are ejaculated by a man Forebrain
Head
during orgasm. Just one sperm may fertilise the egg. Heart bulge
Notochord (forerunner
Fertilisation means that the genetic material in the of spinal cord) Umbilical cord
sperm joins with the genetic material in the egg to Lower spine Tail
start a new life. Only about half of all fertilised eggs
develop to become babies. Many eggs are lost without Three weeks Four weeks
a woman knowing that fertilisation ever happened. The embryo becomes pear-shaped, The embryo becomes C-shaped
with a rounded head, pointed lower and a tail is visible. The umbilical
Pregnancy spine, and notochord running cord forms and the forebrain
along its back. enlarges.
Pregnancy begins when a sperm penetrates an egg.
One to one and a half days later, the single fertilised
egg cell begins to divide. After two or three days there Internal organs at five weeks
All the internal organs have begun to form by the fifth week.
are enough new cells to make the fertilised egg the
During this critical stage of development, the embryo is
size of a pin head. This collection of cells travels to the vulnerable to harmful substances consumed by the mother
lining of the uterus where it becomes anchored. The (such as alcohol and drugs), which may cause defects.
developing collection of cells is now called an embryo
– it is attached to the wall of the uterus by a placenta.
Once the embryo is attached to the uterus wall, a Gut
Mouth
Lung bud
chemical signal stops the woman from having another Heart bulge
Stomach
menstrual period. After eight weeks, the embryo may Liver Pancreas
have grown to between 3 and 4 cm, has a recognisable Intestinal loop
heartbeat and the beginnings of eyes, ears, a mouth, Urinary bladder
Gut
legs and arms. At this stage the growing organism is
called a foetus.
During the remaining seven months before birth, all Ear
the organs continue to develop. By 20 weeks, the Eye
Nose and mouth
foetus will have reached about half the length of the
Limb buds
baby at birth. By 32 weeks, the foetus will be about half
Umbilical cord
its birth weight.
Birth and infancy
Six weeks Eight weeks
At about nine months after conception the baby will Eyes are visible and the mouth, The face is more 'human', the
be born. The newborn baby (or neonate) has to take nose and ears are forming. The head is more upright, and the
easily digestible food such as mother’s milk in the first limbs grow rapidly from tiny buds. tail has gone. Limbs become
weeks in order to grow. A newborn baby does not have jointed. Fingers and toes appear.
a fully developed brain but can usually hear sounds, Fig. 4.4: Embryo development
tell differences in the way things taste, and identify
the smell of their own mother or carer. Infants are born
with various temporary and primitive reflexes. Key term
Reflexes – a rapid automatic response to a stimulus.
136
The primitive reflexes that infants are born with include Table 4.2: Average ages for some types of body control
the following.
Type of body control Age
• A newborn baby will turn their head towards any
touch on the cheek. This reflex is called the rooting Ability to lift head slightly 0–1 month
reflex and helps the baby to get the nipple into Ability to pass an object from 6 months
their mouth to feed. one hand to another
• If you place your finger in the palm of a baby’s Ability to roll over 6 months
hand, they will grasp your finger tightly. This reflex
Ability to crawl 9–10 months
is called the grasp reflex.
• If a baby is startled – perhaps by a loud noise – they Ability to stand alone 12 months
will throw their hands and arms outwards, arching
the back and straightening the legs. This is called
lot of growing to do. Reproductive organs remain small
the startle reflex.
until the onset of puberty.
• If a newborn baby is held upright with their feet
Children’s practical abilities continue to develop; at
touching the ground, they will make movements as
the age of 2, children may be able to run and to climb
if trying to walk. This is called the walking reflex.
stairs one step at a time. By age 4, children may be
Infants have the physical ability to recognise and able to kick and throw a large ball. By age 6 or 7, a
interact with people. Babies prefer the sound of human child may be able to skip and ride a bicycle.
voices to other sounds and soon learn to recognise
their mother’s voice. Adolescence
Babies are helpless when it comes to muscle co- Puberty in girls often starts between the ages of 11
ordination and control. Babies cannot hold up their and 13, although it may begin earlier in some girls.
head, roll over, sit up or use their hands to move Girls generally start puberty before 13 but boys
objects deliberately. Table 4.2 shows the average age generally start puberty later, often between 13 and
for some types of body control. 15 years of age. Puberty is a development stage
which prepares the body for sexual reproduction. It
Childhood is triggered by the action of hormones that control
Children grow steadily at this time but less rapidly than sexual development. Both boys and girls may
during infancy. By the age of 6, a child’s head will be 90 experience a ‘growth spurt’, where they grow taller at a
per cent of adult size, even though the body still has a faster rate than before.
(Eighths of Newborn 2 years 5 years 8 years Adolescence

body height)
Fig. 4.5: Growth profiles from birth to the end of adolescence
137
Girls’ sexual development during puberty includes Adulthood

the enlargement of breasts, the development of Young adults are often at the peak of their physical
pubic hair, increased fat layers under the skin and performance between the ages of 18 and 28. Most
the start of menstrual periods. Boys will experience champions of highly active sport are aged between
the enlargement of their testes and penis, the 16 and 30. Older adults generally tend to lose some
development of pubic and facial hair and increased strength and speed with age, although these changes
muscle strength. Boys’ voices also ‘break’ and become are often unnoticed outside competitive sport.
deeper in tone. These major changes mean that
Exercise can help develop physical fitness and athletic
adolescents look and behave very differently from
skills. An older adult could easily achieve a personal
children.
peak of fitness at 40 or 50 if they take up exercise late
in life.
There are a number of age-related changes that
Did you know? slowly become apparent as we grow older. During
their forties, many people find that they need to wear
Physical development is not purely controlled by
genetics. Berryman et al (1991) argue that records
reading glasses. Some people cannot hear high-
show that in the 1860s, girls did not start puberty pitched sounds so well during late adulthood. Many
until 16 years of age. It seems that children now adults show a thinning of hair, with hair loss being
start puberty earlier than in the past. This may be common in men.
because of improved diet and increased body
weight and shows that our environment interacts
with genetics in order to influence physical Key terms
development.
Adolescence – a general stage of lifespan development that
includes puberty.
Puberty – the developmental process where hormones
prepare the body for sexual reproduction.
Growth of The larynx

Oily skin, may result in facial hair (voice box)
acne grows so
Growth of voice 'breaks'
hair in
Hair grows in armpits Increased
armpits
muscle leads
Breasts develop to increased
Curvy outline due to strength
fat deposition Growth of The prostate
Wider hips pubic hair gland produces
secretions
Primary sexual organs
grow (uterus and vagina) The penis
The testes
Ovulation and menstruation enlarges
begin to produce
commence
sperm
Pubic hair
Fig. 4.6: Body changes at puberty in males and females
138
The menopause • A Doctor Hayflick proposed that most body cells

Women are most fertile (able to conceive children) can only renew themselves fifty times or so. When
in their late teens and early twenties. The risk of cells can no longer renew themselves, body
miscarriages and pregnancy complications rises with processes break down, body tissue becomes
age. Between 45 and 55, fertility reduces and then wasted and eventually we die. This limit to cell life is
comes to an end in a process called the menopause. called the Hayflick limit.
It takes several years to complete. • A theory that links with the Hayflick limit is one
The menopause involves: which suggests that cell DNA contains a region at
each end called a telomere. Each time a cell renews
• the gradual ending of menstruation (or having
itself, the DNA inside it is copied and part of the
periods) and a large reduction in the number of
telomere is lost. By old age, all the telomere can be
viable eggs in the ovary.
used up and DNA can no longer be replicated. This
• an increase in the production of hormones
results in cell death.
called gonadotrophins to try and stimulate egg
• Hormone production decreases with age and this
production which can cause irritability, hot flushes
reduction results in an inevitable breakdown of
and night sweats.
biological systems.
• a reduction in sex hormones (oestrogen and
• It is also possible that cell DNA simply becomes
progesterone) produced by a woman’s ovaries,
damaged with age. The longer we live the more risk
resulting in some shrinkage of sexual organs and
of cell mutation we may experience. Accumulations
sometimes a reduction in sexual interest.
of damaging chemical reactions involving protein
• associated problems, such as osteoporosis, which
structure may result in a range of degenerative
can be caused by a reduction in the production of
conditions such as hardened arteries and loss of
sex hormones (see page 38 for more information).
nerve function.
Older adults in Britain often put on weight. ‘Middle-
• Another theory is that our cells become changed by
aged spread’ may happen because adults still eat
the build up of molecules known as ‘free radicals’.
the same amount of food as they did when they were
Free radicals are toxic substances that we breathe
younger although they have become much less active.
or eat and are capable of damaging DNA and
Older adults are more at risk of disease and disability.
disrupting the way body cells work.
See pages 163–166 for more details of the ageing
So far scientific research has not yet provided a
process.
single simple definitive explanation of why there is a
maximum lifespan. It may be that there is some truth in
Reflect all of the different theories.
Can you think of any ideas that might help you to
stay healthy and fit for longer?
Reflect
At present we do not know how to extend the
The final stages of life human lifespan, but you might like to think about the
The longest any human being has been verified to conclusions below that may help you to survive to be
as old as possible.
have lived is just over 122 years. In round figures 120
years is often accepted as the maximum lifespan for a
human being. But why is there a limit to life? To increase your potential lifespan you should avoid
exposure to toxic substances such as tobacco smoke.
A range of processes may limit our lifespan. It seems
Nicotine from tobacco smoke may directly damage cell
that our body cells have a limited ability to renew
DNA. Eat a healthy diet with a good balance of fruit and
themselves. If cells cannot renew themselves, then we
vegetables and fibre. A balanced diet may help to limit
cannot repair ourselves and stay healthy. The following
the impact of free radicals that may damage body cells.
are theories about why we have a limit to our lifespan.
You should also take regular exercise. Research suggests
that people who exercise regularly have a lower risk of
degenerative diseases such as heart disease.
139
Intellectual development
We do not simply learn more as we grow older – we Key terms
also develop more useful ways of thinking. Piaget Concrete logical thinking – the ability to solve problems
(1896–1980) was a famous theorist who studied how providing you can see or physically handle the issues involved.
our ability to think and reason develops. Piaget Abstract logical thinking – the ability to solve problems
believed that there were four stages of intellectual using imagination, without having to be involved practically;
development which mature or ‘unfold’. In his theory, an advanced form of thinking that does not always need a
infants and children learn from experience, but the practical context in order to take place.
ability to think logically depends on an underlying
process. A 4-year-old cannot use abstract logic logic may not be part of a process of maturation – it
because they are not mature enough to think this way might depend on your education.
(no matter how well they are taught). Piaget’s theory stops in adolescence but many
Nowadays, research suggests that infants are more theorists believe that adults continue to improve their
able to understand their world than Piaget thought. thinking ability. Some psychologists suggest that
It also appears that most people take a lot longer there is a ‘post-formal operations’ stage of thinking
than 11 years to become skilled at abstract logical where adults become more skilled in their ability to
thinking. Your ability to use formal logical thought make flexible judgements. It may be that many adults
may depend on how much encouragement you have develop an ability that could be called ‘wisdom’ as
received to think logically. The ability to use formal they grow older.
Table 4.3: Piaget’s stages of development
The sensorimotor stage: birth to 1½ or 2 years Learning to use senses and muscles – thinking without language
• Babies are born with the ability to sense objects.
• Babies are also born with a range of reflexes such as the sucking reflex to enable them to feed. These reflexes
lead to ‘motor actions’ controlling body muscles.
• The sensorimotor stage is a stage when thinking is limited to sensing objects and performing motor actions.
• Piaget believed that a baby would not have a working system for remembering and thinking about the world until
they were about 18 months old.
The pre-operational stage: 2–7 years Pre-logical thinking – thinking in language but without understanding logic
• Pre-operational means pre-logical; during this stage Piaget believed that children could not think in a logical way.
Children can use words to communicate but they do not understand the logical implications involved in language.
• Piaget explained that pre-operational children cannot properly understand how ideas like number, mass and
volume really work. A child might be able to count to 10 but might not understand what the number 10 really
means. For example, in the case of 10 buttons stretched out in a line and the same number of buttons in a pile, a
young child might agree that there are 10 buttons in the line and 10 buttons in the pile, but then they might say
that there are more buttons in the line because it is longer!
The concrete operational stage: 7–11 years A stage where logical thinking is limited to practical situations
• Children in the concrete operations stage can think logically provided the issues are ‘down to earth’ or concrete.
In the concrete operational stage children may be able to understand simple logical puzzles.
• For example, if you ask a question such as ‘Samira is taller than Corrine, but Samira is smaller than Leslie so who
is the tallest?’ you might find that the 7- or 8-year-old has difficulty in mentally imagining the information in a way
that will enable them to answer the question. But if the child can see a picture of Samira, Corrine and Leslie they
might quickly point out who is the tallest.
The formal operational stage: from 11+ years Thinking using logic and abstract thought processes – adult thinking
• With formal logical reasoning, an adult can solve complex problems in their head.
• Formal logical operations enable adolescents and adults to use abstract concepts and theories in order to be
able to gain an understanding of the world beyond their own experiences.
• Adults with formal operations can think scientifically. For example, an adult can use formal logic to reason why a
car won’t start. They can work out that perhaps the car won’t start because the fuel is not getting to the engine or
because there is insufficient air or an electrical fault; each theory can be tested in turn until the problem is solved.
• Abstract thinking enables us to think through complicated ideas in our head without having to see the concrete pictures.
140
Language development Table 4.4: The development of language
Both Noam Chomsky (1959) and Steven Pinker (1994) Age The development of language
believe that the ability to develop a signed or spoken
Around 3 Infants begin to make babbling noises
language is genetically programmed into us. Chomsky months as they learn to control the muscles
states that we are born with a ‘language acquisition associated with speech.
device’ that enables us to recognise and develop
Around 12 Infants begin to imitate sounds made by
languages that we experience. Children do develop
months carers such as ‘da-da’; this develops into
language extremely rapidly and it is likely that the
the use of single words.
ability to use language is genetically programmed
in the same way as our ability to stand and walk. Around 2 Infants begin to make two-word
The ability to use language develops because of years statements such as ‘cat goed’ (meaning
maturation – it is an unfolding of our biological the cat has gone away). The infant
begins to build their vocabulary
potential. We need to experience other people using
(knowledge of words).
language but we do not need to be trained in order to
speak. Around 3 Children begin to make simple
years sentences such as ‘I want drink’.
Some children will develop speech much more rapidly
This develops into the ability to ask
than others. Just because language development
questions, ‘When we go?’ Knowledge of
involves a maturation process, it does not mean that
words (vocabulary) grows very rapidly.
every child will develop at the same rate. Language
development is outlined in Table 4.4. Around 4 Children begin to use clear sentences
years that can be understood by strangers.
Children can be expected to make some
Activity 3: ‘Learning mistakes with grammar ‘We met lots of
languages’ discussion peoples at the shops today’.
5 years Children can speak using full adult
Get together with other course members and onwards grammar. Although vocabulary will
discuss how quickly you learned to speak when you
continue to grow, and formal grammar
were young. Compare this with your experience of
will continue to improve, most children
trying to learn a second language in school. Reflect
on how far personal experiences can be explained can be expected to use language
in terms of a genetic basis for first language. effectively by age 5.
PLTS
Is language development just part of an
Independent enquirer: This activity may help
unfolding process of maturation?
you to evidence independent enquirer skills by
exploring issues from different perspectives. It may
also contribute towards team worker and effective
participator skills.
141
Activity 4: Observing speech

Visit a playgroup, nursery or household where you can course members. Can you identify a general
observe some young children. Listen to the way that pattern in the way children develop language? Can
they speak and make notes of some examples of one you identify ways in which individual children develop
or two word utterances or phrases that you hear. Later, differently?
get together and discuss your examples with other
Social development
There are great differences and cultural variations in PLTS
the way individuals will experience social relationships Independent enquirer: This activity will enable you
during the course of their life. Some generalisations to demonstrate independent enquiry skills by carrying
are listed in Table 4.5. out research and analysing information.
Table 4.5: Key aspects of social development
Life stage Social development

Infancy Interacting with carers
0–3 years Infants appear to have an in-built tendency to interact with carers. By 2 months they may start to
smile at human faces. At 3 months they will respond when adults talk. At 5 months infants can
distinguish between familiar and unfamiliar people. Infants make their first relationships as they
form an emotional attachment to carers. In the later stages of infancy, infants will play alongside
other children (parallel play).
Childhood First social learning
4–9 years Young children are emotionally attached and dependent on the adults that care for them.
Children begin to learn social roles and behaviour within their family context. This is called first
or primary socialisation. A family environment might provide a ‘safe base’ from which to explore
social relationships with other children through play. Children will learn to co-operate with other
children (co-operative play). As children grow older they will become increasingly independent
and begin to form friendships based on a sense of mutual trust. Friendships become increasingly
important as children grow towards adolescence. Children may begin to form social networks or
‘circles’ of friends who like and agree with each other.
Adolescence Secondary social learning
10–18 years During adolescence a person’s sense of self-worth may be more influenced by other adolescents
than by the family. Adolescents will copy the styles of dress, beliefs, cultural values and
behaviours of their own network of friends. Historically, adolescence was seen as a time of ‘storm
and stress’. Adolescents have to cope with the development of their own sexuality (the impact of
sex hormones at puberty) and the social transition to full independence from the family. Recent
research suggests that many adolescents experience a smooth transition to adult roles without
serious conflict with parents.
Adulthood During early adulthood, friendship networks continue to be very important. For most people,
19–65 years early adulthood is dominated by the formation of adult sexual partnerships and by the need to
find employment/establish a career. For many people marriage and parenthood represent major
social developments in their life. Many adults in their forties and fifties experience time pressures
that may limit their social activity. Mature adults may have to split their time between work, care
of parents, other family commitments and wider social activities. Some mature adults report a
reduction in the amount of social activity due to these pressures.
Older Following retirement, older adults have more free time. However, many older adults may choose
adulthood 65+ to increase their involvement with close friends and family rather than extend their network of
years social contacts. See page 170 for further details.
142
Activity 5: Discussing Functional skills

adolescence English: In discussing the changes in social
development, you will develop your speaking and
Fifty years ago adolescence was often seen as a listening skills and skills of presenting arguments and
time of ‘storm and stress’ where young people listening to others. Recording your conclusions will
would automatically find themselves in conflict with develop your writing skills.
(or rebel against) their parents and older people.
Organise a discussion with other course members
to decide how far this idea is still true today and
what may have changed since the 1960s. Record
your conclusions for incorporation into information
Emotional development
sheets on lifespan development. The way we understand and feel about ourselves and
other people develops as we grow older. Some key
features of emotional development associated with life
stages are set out in Table 4.6.
Table 4.6: Key features of emotional development
Life stage Emotional development

Infancy 0–3 Attachment
years Bowlby (1953) argued that infants have an in-built need to form an attachment with a carer.
The quality of this attachment may affect emotional development for the rest of the child’s life.
Ainsworth et al (1978) and Marris (1996) argue that the quality of our early attachment influences
the assumptions we make about our self and others. Infants who are securely attached will
grow up with the emotional resources needed to cope with uncertainty in life. Infants who are
insecurely attached may have a reduced ability to cope with stress and major life events.
Childhood Understanding self and others
4–9 years Children use their imagination to begin to understand the social roles that other people play.
Children begin to imagine a ‘me’ – an idea of self. Relationships with other family members may
influence how a child feels valued – a sense of self-worth. The way a child gets on with teachers
and friends may influence their self-confidence. The child might develop a permanent sense of
confidence or a sense of failure and inferiority.
Adolescence Identity
10–18 years During adolescence this sense of self continues to develop. An adolescent needs to develop a
secure sense of identity. Identity theory was first proposed by Erikson (1963). A person needs
a clear understanding of identity in order to feel secure when working with other people or
in order to make a loving sexual attachment. This may be a stressful time as self-esteem may
depend on the development of identity.
Adulthood Intimacy
19–65 years Erikson argued that the key task of early adulthood was learning to cope with emotional
attachment to a sexual partner. This may involve not being too self-centred or defensive and not
becoming emotionally isolated.
Staying involved
Later on adults may face a risk of emotional ‘stagnation’ when they lose interest in social issues.
According to Erikson, the developmental task is to stay emotionally involved with social life.
Older Making sense of your life
adulthood Erikson argued that older people need to develop a secure sense of self that enables them to
65+ years cope with the physical changes associated with ageing and death. People who fail to make
sense of their life might experience emotional despair.
143
Delayed development – potential causes and effects

Delayed development happens when a baby or
young child has not shown developments within the Key term
expected time range. The term is usually restricted to Delayed development – when a child’s development
development within the first five years of life. Delayed lags behind the developmental norms or developmental
development may be caused by issues such as: milestones for his or her age.
• brain damage (this can happen before and during

birth or during infancy)
Developmental progress will be checked by health
• poor social interaction with carers professionals such as health visitors, although parents
• disease and GPs may be the first to notice problems. Children
• visual disability who appear to have delayed development will be
• hearing disability referred to appropriate specialists for advice or
• poor nutrition. therapy.
Case study: Nia

Nia is a student visiting a centre for people who have Alex: Well, we learn things quickly, but Jay
learning difficulties. Nia has been watching Alex (a finds it very difficult – he has a disability. He
care worker) helping Jaylen to download some music couldn’t use his music player when I first knew him
from the Internet. Jaylen has Down’s syndrome. and I spent a lot of time showing him how to make
Down’s syndrome is a condition where a person it work, again and again. Now he can listen to his
inherits extra genetic information – usually a whole own music whenever he wants to. Having Down’s
chromosome. This extra genetic information causes syndrome should not limit the quality of life that a
extra proteins to be made and these extra proteins person has but it’s down to us to provide the right
disturb normal development. Down’s syndrome kind of support to help him take control of his life.
is complex and people are affected differently.
Nia: So have I got this right? Down’s syndrome
Many people with Down’s syndrome have learning
is genetic, and that causes the problems with
difficulties and health problems.
development, but the quality of life that Jay
Nia is now talking to Alex in private. experiences depends on the quality of care that
you provide. So what Jay can and can’t do is partly
Nia: Jaylen really enjoys his music but he can’t really
to do with Down’s syndrome and partly to do with
use the computer. Will he always need help to find
the quality of care here?
the music that he wants?
Alex: Yes, we are here to make a difference to
Alex: Yes, ‘Jay’ has a lot of difficulty with anything
people’s quality of life – to make life better for
complicated and I have to guide him and tell him
them.
when to click the mouse. He is genuinely choosing
his own music. 1 Describe some of the differences Jaylen may have
experienced during childhood and adolescent
Nia: Jay doesn’t speak properly; he often uses development compared with Nia and Alex?
just one or two words. He kept saying ‘broken’ if
something went wrong or didn’t work quickly. 2 Down’s syndrome could be said to have delayed
and limited Jaylen’s development. Can you
Alex: Yes, Jay says ‘broken’ to mean anything that isn’t identify three of the effects of Down’s syndrome?
going right. He is communicating his feelings but he
can’t explain things like we can. 3 Explain what might have happened to Jaylen if
care workers had assumed that nature (genetics)
Nia: His speech is more like a three-year-old's, was the only important issue and that nurture
and he can do practical tasks like my six-year-old (quality of care) was not important?
brother; but he is in his 20s isn’t he? Has the Down’s
syndrome delayed or arrested his development?
144
Arrested development
The term ‘arrested development’ means development ‘arrested’. But people with serious learning difficulty
that has stopped. The word ‘arrest’ means to stop can develop and the term ‘arrested’ can be argued to
something or someone. In the past people with be misleading if used to refer to people with learning
severe mental disability were sometimes regarded as difficulty or disability.
Activity 6: Undertake a Functional skills

web search for arrested ICT: The web search will demonstrate your ability to
development select information from a variety of Internet sites. The
task will also enable you to demonstrate the skills of
Undertake a web search to explore the concept speaking and listening.
of arrested development. Write some short notes
to summarise your research. Discuss your research
with other course members.
Imagine you are an investigative reporter for a M1 To achieve this criterion you will need to
magazine and you have been asked to discover as research a range of arguments from both
much as possible about a famous person in order to sides of the nature and nurture debate. In
describe the stages of their life so far and what might your assignment you should compare and
happen in their future. contrast the different viewpoints in the
debate. You should consider the different
When choosing your celebrity, try to pick someone
arguments in some detail and acknowledge
who has outlined details of their past life in interviews, the sources you use. You could use examples
or has written a biography or Internet ‘blog’ about from the individual selected for P1 to illustrate
their life. You should use your ICT skills to undertake the arguments for and against each side of
a web search to look for this information before the debate.
finalising your choice of celebrity. It will be important
D1 For this criterion you will need to apply the
to have some real information when you come to arguments of the nature-nurture debate in the
interpreting their life stages. context of your chosen person’s intellectual,
emotional and social development at two
Grading tips specific life stages. You should use examples
P1 To achieve a pass, develop a fact file and collect from the person’s life story to discuss how
information on life stages including pictures, nature and nurture has affected the different
graphs and charts to help you interpret the aspects of their development and form
information you collect about your celebrity. a conclusion as to which has been most
You could also produce a ‘life map’ showing influential.
the different stages in the life of this person.
145
2 Understand the potential effects of life factors and

events on the development of the individual
Case study: Hanna

Hannah is a 12-year-old girl in foster care. She 1 Hannah says she cannot stop herself being
attacked two girls at school with a kitchen fork. aggressive – are some people fixed from birth
Her statements below were made during an to be aggressive?
interview with a social worker. 2 What social and environmental factors might
‘They made me angry – I had to get them back.’ influence Hannah to be aggressive?
‘Don’t know why they make me angry – they just 3 Hannah’s aggression could be seen as caused
annoy me.’ by ‘nature’ (i.e. she was ‘born that way’) or
perhaps social and environmental issues
‘It’s just the way I am – I can’t stop it when I’m (nurture) have caused her to be so aggressive.
angry.’ How far might Hannah have chosen to be
aggressive?
2.1 The nature–nurture debate Choice and interaction

Historically, some philosophers and theorists have The alternative to determinism is the belief that
argued that we are born to be the way we are. Other people can take control of their own lives through the
theorists have argued that it is the way we are brought choices they make. In the past this has sometimes
up and influenced by our surroundings that makes us been labelled as the ‘free will’ viewpoint. Some people
the way we are. This historical argument is known as think that everything is fixed by nature or by nurture,
the nature–nurture debate. or that everything is a matter of choice. However, most
people understand that the human life course involves
an interaction of nature, nurture and the decisions and
Key terms choices that people make.
Nature – genetic and biological influences.
Nurture – social, economic and environmental influences.
Biological programming
Genes provide the instructions (which can be thought
of as like a computer program) for structuring amino
acids which in turn influence the proteins within our
Determinism body cells. In this way, genes program the chemical
Leijla is 65 and unable to walk very far. One of the basis of our biology.
nurses who works with her says, ‘These people bring
Our body shape and size, as well as our behaviour,
it on themselves you know. I bet she never did any
depend on the interaction of our biology with broader
exercise.’
environmental factors. A human being is the result of
Another nurse says, ‘Oh, I don’t think that’s true at all. the interaction of genes (biological programming)
Her genes will have caused her to be like this.’ Both and the environmental influences they are exposed to.
the nurses’ statements are ‘determinist’.
Determinism is the belief that your future is fixed Key term
or determined either by what you have genetically Biological programming – it is argued that our genes can
inherited or by your social environment and ‘programme’ the amino acids which influence our body cells.
experience. In Leijla’s case, one nurse believes that the Human development and behaviour are not ‘programmed’
environment controls what happens while the other by genes, although development may be influenced by
genes.
nurse believes that genes control what happens.
146
Maturation theory
Some aspects of development, such as the ability
to speak a first language, are thought to be due
to an inbuilt genetic process. Children ‘naturally’
become interested in the sounds and signs that they Nature Nurture
see around them and the ability to speak ‘unfolds’. (genetic inheritance and biology) (environmental and
socioeconomic issues)
Although development may be guided by genes,
genes cannot operate without an environment.
A child who is born Deaf will not start to speak a Nature Nurture
language. Instead the child might learn to sign using (genetic inheritanceIndividual reactions (environmental and
and biology)
a sign language, such as British sign language, if and choices socioeconomic issues)
people in the child’s environment use this system. The
environment always interacts with a person’s genetic
inheritance – including during maturational processes. Individual reactions
and choices
Activity 7: Research people’s

assumptions
How far are you and your friends determinists
when it comes to the nature and nurture debate?
Research the assumptions that your friends make
by asking a few simple questions such as: ‘Why
are some people good at number work and other
people are not’? ‘Why are some people better
than others at sport’?
People may give explanations such as ‘they are
born that way’ or ‘it’s in their blood’. Others may
say things like ‘some people get better education’;
‘some people have better opportunities’. Answers
like these may suggest determinist assumptions.
You may find that some people will mention the Your environment includes cigarettes.
idea of choice, and mention things like deliberately Your genetic inheritance make you vulnerable to cigarette smoke.
studying hard. These answers might suggest What happens to you depends on your reactions and choices.
non-determinist assumptions about the role of
nature and nurture. Use your research to contribute
towards a debate on nature/nurture with other Your environment includes cigarettes.
course members. Your genetic inheritance make you vulnerable to cigarette smoke.
What happens to you depends on your reactions and choices.
PLTS Fig. 4.7: Human development involves the interaction of

nature, nurture and individual behaviour
Independent enquirer: These activities will enable
you to evidence independent enquiry skills by carrying
out research and exploring issues from different
perspectives as well as creative thinking skills of
questioning assumptions.
147
2.2 Life factors and medication to prevent the build up of harmful

substances. Changing the infant’s environment will
Genetic factors prevent the genetic condition from causing damage.
Each living cell in the human body has a nucleus So although we can’t yet alter nature (a person’s genes)
with 23 pairs of chromosomes inside it. In each pair we can alter the environment so that the underlying
of chromosomes, one chromosome comes from the genetic condition does not cause illness and people
father and one from the mother. Each chromosome can go on to experience normal healthy development.
carries units of inheritance, known as genes, and these Nurture always interacts with nature and sometimes
genes interact to create a new set of instructions for it is possible to compensate for, or even prevent, any
making a new person. harmful effects of ‘biological programming’.
Genes are made of a substance called
deoxyribonucleic acid (DNA). The DNA contains the Cystic fibrosis
instructions for producing proteins – it is these proteins Cystic fibrosis is caused by a defective gene. This gene
that regulate the development of a human being. is thought to be carried by as many as 4 per cent of the
Although half of your chromosomes come from your UK population. The gene is recessive which means that
mother and half from your father, your genetic pattern children born to people who carry the gene will not
can be quite different from the patterns of either of develop cystic fibrosis unless both parents are carriers.
your parents. When both parents have the defective gene, there is
a one-in-four chance that their child will be born with
cystic fibrosis.
Did you know?
Cystic fibrosis results in the production of a defective
Although you inherit half of your chromosomes protein that can cause the lungs to become clogged
from your mum and half from your dad, you are with thick sticky mucus. People with cystic fibrosis
not simply half your mum and half your dad – may have problems absorbing nourishment from food
genetic inheritance is much more complicated!
In 2006, scientists discovered that individuals
and they may also suffer from respiratory and chest
often have multiple copies of the same gene infections. In the past, children with cystic fibrosis often
and that the different numbers of copies may be had a very short life expectancy but modern medical
the reason for people being different from one treatments have succeeded in extending it.
another.
We can change the environment in order to help
people with cystic fibrosis. Physiotherapy can help
A good example of the interaction of genes and the people to clear mucus from their lungs and various
environment would be the genetic disorder called drugs can help breathing and control infection in the
phenylketonuria or PKU for short. PKU is a rare genetic throat and lungs. People may be offered a special diet
condition which prevents a person from being able and drugs to help with food absorption. In the future it
to process a substance called phenylalanine, which may become possible to use a form of genetic therapy
is found in many foods. This condition causes the to replace the faulty gene and so cure the condition.
build-up of harmful substances in the body that in
turn damages the development of the brain and Coeliac disease
can eventually kill the person. The condition cannot A substance called gluten is found in foods made from
be cured and a baby born with undetected PKU wheat, barley and rye. People who do not have coeliac
would fail to meet developmental milestones and disease usually experience no ill effects from eating
would experience developmental delay as their brain gluten. In people with coeliac disease, gluten causes
became damaged. PKU could result in severe learning the body’s immune system to attack the lining of the
disability, the sort of damage that might be regarded small intestine. The small intestine becomes damaged
as arrested development. and people with coeliac disease have difficulty
Nowadays babies born in the UK are likely to be tested absorbing vitamins and minerals. These problems can
for this genetic condition soon after birth. If PKU is lead to further diseases including diarrhoea, anaemia
discovered then the child can be given a special diet and osteoporosis.
148
You are more likely to develop coeliac disease if Often the problem is passed on from a person’s
you have a close relative with the condition, and parents, although brittle bone disease can develop
the condition is often assumed to result from from a genetic mutation; this means that a child might
genetic causes although the exact cause is not yet have the condition even though it does not run in the
known. It is possible that some people may inherit a family. There are different types of the disease and
susceptibility to the condition which is then triggered some types are more serious than others. Brittle bone
by an environmental event such as an infection in the disease is different from osteoporosis. Osteoporosis is
intestine. The medical treatment for coeliac disease is a different type of disease that can make bones more
the gluten-free diet. likely to break later in life.
Although brittle bone disease has a genetic cause,
Did you know? people can often be helped through physiotherapy,
assistive equipment and drug treatments to help
Some food products carry a symbol and strengthen their bones.
statement to show they are suitable for
coeliacs. Rheumatic disease
The term rheumatic disease is used to cover a wide
Asthma range of disorders usually involving inflammation of
Approximately one in 13 adults is treated for asthma – the joints but also disorders involving ligaments, bones
a disease that causes airways to the lungs to become and muscles. Rheumatoid arthritis is an example of
swollen. The causes of asthma are not fully understood a rheumatic disease that affects about eight in every
but genetic inheritance, diet and pollution may all thousand people in the UK. It is a painful and disabling
contribute to causing the disease. condition that causes swelling and damage to the
cartilage and bones around joints, most commonly the
Brittle bone disease smaller bones in the hands, feet and wrists.
Children born with brittle bone disease are likely to You have an increased risk of developing rheumatoid
fracture or break their bones easily because their arthritis if you have relatives with the disease. However
bones develop without the right amount or type of a some people develop rheumatoid arthritis without
protein called collagen. Brittle bone disease is genetic. anyone in the family having a history of the disease.
The causes of rheumatoid arthritis are not fully
understood yet, but it is likely that both genetic and
environmental influences play a part. Rheumatoid
arthritis is not simply transmitted from one generation
The Crossed Grain Symbol, as it is known, to another and even when one identical twin has the
is a registered trademark. It is known the disease the other twin, with exactly the same genes,
world over as a reassuring sign that foods may not develop the illness. It is almost certain that
are gluten-free.
the role different genes play in the development of the
illness will turn out to be complex.
Reflect
Can you think of any ideas for helping people who
have rheumatoid arthritis to cope more easily with
daily living?
149
2.3 Biological influences before birth

The environment inside a mother’s womb can have women should eat plenty of fruit and vegetables;
a dramatic influence on the development of a child. plenty of starchy foods such as bread and pasta and
If a woman smokes or drinks during pregnancy then rice; foods rich in protein such as lean meat, chicken
nicotine or alcohol can affect the development of the and fish; plenty of fibre; and foods which contain
foetus. Nicotine can limit the amount of blood and calcium such as milk and cheese. They also advise that
nutrition that reaches the foetus. Children born to women should avoid or limit alcohol and avoid too
mothers who smoke tend to weigh less at birth and much caffeine as this may result in a low birth weight.
are more prone to infections. If you smoke during
pregnancy then it is possible that your child may have 2.4 Environmental influences
difficulties regarding attention and learning in school.
Drugs can also damage a child in the womb. Pollution
Air and water pollution can influence development
Foetal alcohol syndrome and be a major source of ill health. Historically, a lack
Alcohol can have a negative influence on a child’s of sanitation and sewerage in cities resulted in life-
development before birth. Mothers who drink large threatening diseases such as cholera. Until lead was
amounts of alcohol when pregnant may give birth to removed from petrol and paint, there were major
children with foetal alcohol syndrome. Children with concerns that lead pollution in the air might affect the
this condition tend to be smaller and to have smaller brain development of young children. There are still
heads than normal. These children may also have heart concerns about air and water pollution.
defects and learning difficulties.
Motor vehicles produce a range of pollutants,
Infections during pregnancy including carbon monoxide, nitrogen oxides, volatile
Infections such as rubella (a type of measles) and organic compounds and particulate matter. People
cytomegalovirus (a herpes-type virus) can attack who live near busy roads may be particularly exposed
the foetus if a mother becomes infected. Rubella to this pollution.
is particularly dangerous during the first month of
pregnancy. If a mother becomes infected in this Reflect
period her baby may be born with impaired hearing
Levels of pollution may be falling but are they
or eyesight, or a damaged heart. Most women acceptable?
are vaccinated against rubella to prevent this risk.
Cytomegalovirus can cause deafness and learning
difficulties.
The extent to which these biological influences before
birth affect the quality of a person’s life will depend on
the way in which Deaf or disabled people are treated
by others.
Effects of diet
Our biological life starts at conception nine months
before we are born. You will be affected by what your
mother ate during pregnancy and breast-feeding.
Some recent research on animals suggests that if a
mother has a diet that is high in sugar and fat it can
result in an increase of cholesterol and a risk of heart
disease for her children later in their lives. Malnutrition
or a lack of healthy food during pregnancy may result
in a lifetime of poor health for the child. The Food
Standards Agency (FSA) recommends that pregnant
150
Improved vehicle technology (such as the catalytic

converter) is reducing air pollution. For example,
Activity 8: Research air
carbon monoxide emissions fell by 81 per cent pollution
between 1970 and 2006. Emissions of nitrogen oxides
Just how serious is air pollution at present? Do an
fell by 46 per cent and particulate emissions by 50 per
Internet search for news items on air pollution in
cent between 1990 and 2006. Power stations now burn Britain. You could share and discuss your findings
less coal and this has contributed to a fall in sulphur with other course members in order to help you
dioxide pollution of 81 per cent between 1990 and decide how serious this issue is.
2006 (Social Trends, 2009)
While official statistics report improvements in
the levels of air pollution, there are concerns that
air pollution is still a serious problem. Professor Functional skills
Walters (2009) argues that 24,000 British people die
ICT: This activity will provide evidence of your ability
prematurely every year because of air pollution. He
to find and select information using your ICT skills.
states that more than 20 UK towns and cities, including
London, have air that is polluted to twice the level
permitted by World Health Organization standards.
People who live in cities with air pollution may be more
at risk of developing lung disease and asthma.
In addition to traffic what else affects

air quality?
151
Housing and is likely to make it difficult to study. People

on low incomes are more likely to live in damp or
Poor quality housing is associated with poor health.
overcrowded housing than people with a higher
Dampness and mould might increase the risk of
income.
allergic and inflammatory diseases including asthma.
Poor housing is also more likely to mean problems Some older people on low incomes will worry about
such as poor lighting, non-safety glass in windows, the cost of heating in their homes. Older properties
loose rugs and poor maintenance of stairs, which may are often less well insulated than modern flats and
result in accidents. Overcrowded housing may cause houses so that people on low incomes might receive
stress due to lack of privacy, noise and difficulties in higher heating bills than people who are better
relaxing and sleeping. Overcrowded housing may off. Poor quality housing may result in the stresses
limit people’s ability to access washing facilities, TV summarised in Fig. 4.8.
programmes and Internet and computing facilities
How do occupation and income

interact with other factors to influence
where people live?
Increased risk
Pollution from Architectural features
of crime in
nearby traffic that create safety
neighbourhood
hazards
Stress from
overcrowding including
noise, lack of privacy, Poor quality housing Dampness and the risk
having to wait to use can lead to . . . of associated allergies
facilities such as the and infections
bathroom
Poor heating and Poor facilities such as

Noise from other
ventilation in winter shops and parking in
high-density housing
the neighbourhood
Fig. 4.8: Stresses that may arise from living in poor quality housing
152
Access to recreational facilities income had access to a home computer and only 25
per cent had an Internet connection. People with a low
Low income may restrict access to travel and
income may have more difficulty obtaining information
other recreational activities. Social Trends (2009)
about leisure activities and much more difficulty
reported that, in 2007, 54 per cent of households in
travelling to them if they live in neighbourhoods
the lowest income group did not have access to a
without regular public transport. The issues in Fig.
car. 92 per cent of households with high incomes had
4.9 may create barriers to accessing leisure and
access to a home computer and had a home Internet
recreational facilities.
connection. Only 35 per cent of households with a low
Money – membership of sports Time – people with demanding jobs

clubs/recreational activities may be or family commitments may have
dependent on income reduced opportunities for leisure
Culture – certain types of leisure activity

Travel – many people may
Barriers to accessing may be perceived as only relevant to
find it difficult to travel
leisure facilities . . . specific groups (for example, golf may
without access to a car
be seen as male and middle class)
Location – some leisure activities may involve

Information – people with low
travelling; walking is the most common
incomes may have limited access
physical activity but access to countryside
to newspapers and the internet
walks may depend on access to a car
Fig. 4.9: Barriers to accessing leisure facilities
Access to health and social care services Bullying

Areas with a high proportion of low income Discrimination may result in bullying. Like
households may have poorer facilities than more discrimination, bullying may undermine your self-
wealthy areas. A range of studies has shown that life confidence and can create stress, depression and
expectancy is shorter in deprived areas in comparison anxiety.
to that in more affluent areas of housing. Many children experience bullying at school but adults
Although the National Health Service provides free also engage in bullying. Because bullying can threaten
health care for everyone, there are concerns that some a person’s self-confidence, victims sometimes keep
groups of people may not receive the same quality quiet about their experience. The Department for
of access to GP services and to preventative health Children, Schools and Families (DCSF) stresses the
services as others. Deprived areas may have greater importance of telling others, talking about the problem
difficulty in recruiting GPs and nurses. and getting support, in order to cope with and prevent
A low income may make it difficult to get to health or bullying within an educational context.
care facilities. For example, National Statistics (2006)
reports that 11 per cent of households without access
to a car said they had difficulty in seeing their local GP
Key term
compared with only 4 per cent of people with cars.
Bullying – when an individual or group of people intimidate
People without home access to the Internet will have
or harass others.
limited access to services such as NHS Direct.
153
Receiving abusive
False stories being
Theft of property messages such as
shared about you
text messages
Physical violence or Bullying can Receiving constant

assault involve . . . criticisms or ‘put
downs’
Interfering with
Verbal insults Exclusion (being
personal possessions
avoided or left out)
such as school work
Fig. 4.10: What bullying can involve
Family dysfunction A dysfunctional family is a family that is not working

well and not providing some or all of the benefits
A family is a social group of people who are related
listed above. There are many reasons why a family may
genetically (historically called ‘blood ties’) or by
become dysfunctional. Family members may become
marriage. There are four common types of family.
stressed because of health problems, including mental
1 Extended – parents, children, grandparents and
health problems, poor housing and low income.
sometimes other relatives live together or near each
Some adults have poor parenting skills. Some may
other.
try to control other family members in aggressive
2 Nuclear – mother, father and children live together. or manipulative ways. Others may be insufficiently
3 Reconstituted – as in a nuclear family, adults and involved with their children and so neglect them. Some
children live together but the children are not all parents may be inconsistent in the way that they teach
biologically related to both adults. children to behave socially. And some may have grown
4 Lone parent – a lone parent lives with a child or with up within a dysfunctional family themselves and have
children. little practical experience of providing appropriate
relationships and support for other family members.
A well-functioning family can help us to develop in the
Stressful family environments may disadvantage
following ways.
children. It may be hard to develop self-confidence if
• Families are where our first emotional relationships there are constant emotional tensions at home.
and attachments take place.
• They provide our first experiences of social Culture, religion and beliefs
interaction. A culture can be identified by distinct aspects of
• Families influence our view of what is socially language, self-presentation, religion, music, art,
expected of us. architecture and literature. Children learn the customs
associated with their family’s culture during childhood
• Our experience of family life will influence what
(see Unit 2 for further details).
we assume to be normal or socially acceptable
behaviour.
• The family home provides a setting that meets our
physical needs for protection, food, shelter and Key terms
warmth. Dysfunctional family – a family that is not working well, and
• Families can support each other emotionally and not providing all of the support and benefits associated with
protect people from stress. being in a family.
Culture – the collection of values, beliefs, customs and
• Family members may help each other financially or
behaviours that might make one group of people distinct
practically. For example, families may support older from others.
relatives.
154
In the past, most children would have learned the accommodation and to buy food and clothes. Income
culture and religion associated with their local mainly comes from:
community. Everyone on a particular estate, street or • wages from employment
village might have shared similar beliefs about religion,
• profits from your business if you are self-employed
work and social roles. Today, we live in a multicultural
• benefits paid by the government
society where people in the same geographical
location may belong to various different cultures. Many • money from invested wealth, such as interest on
people identify with others over the Internet. To some bank accounts or bonds
extent people can choose the culture and religion that • money raised through the sale of property you own.
they identify with. Income is not distributed equally in the UK. The top
Discrimination 20 per cent of households get around 18 times more
money each year than the poorest 20 per cent of
People are often discriminated against because of
households before tax (Social Trends, 2004).
their race, beliefs, gender, religion, sexuality, physical
or mental ability, or age. Households with an income that is less than 60 per
cent of ‘median’ income in the UK are considered to
Discrimination could influence your development
be living in poverty. These people are poor relative to
because it has a very negative impact. See Unit 2 for
the expectations of most people. Just over a sixth of
more details of the issues surrounding discrimination.
Britain’s population (18 per cent), were estimated to be
living on a low income in the period 2005–2007 (Social
Trends, 2009).
Key term Key groups of people who have to live on very little
Discrimination – treating some people less well than others
money include:
because of differences.
• lone-parent families
• the unemployed
2.5 Socio-economic factors • older people
Income and expenditure • the sick or disabled
The economic resources that you or your family have • single earners
can make a major difference to your quality of life. A • unskilled couples (where only one person works in
person’s weekly income enables them to pay for their an unskilled job).
A loss of confidence in your Feelings of

own abilities or a failure to Anger and
vulnerability and
develop confidence frustration
being unsafe
Low self-esteem Discrimination

(a belief that you are Stress and poor
may cause . . . mental health
inferior to others)
Exclusion (feeling that

you do not belong Depression and Withdrawal from
with others) anxiety other people
Fig. 4.11: The effects of discrimination
155
Employment status Activity 9: Researching

Being out of work is likely to mean that you live on a
low income. You will also be affected if your parents
information on poverty
live on a low income. Social Trends (2009) estimates Use the Internet in order to look up recent statistics
that around 22 per cent of children (2.9 million on the impact of low income on children and
adults. The Office of National Statistics website
children) lived in low income households in 2006/2007.
(www.statistics.gov.uk) and the Poverty Site
Children living in workless families or households are (www.poverty.org.uk) collect and report statistics on
more likely to have a low income than those in families poverty. Use the results of your research in order
where adults have full-time work. to discuss whether poverty rates are improving or
getting worse with other course members.
The impact of low income
Paxton and Dixon (2004) found that: children who grew
up in poverty in the 1970s achieved less at school, were
less likely to go to university or college, and one-and- Functional skills
a-half times more likely to be unemployed than those
ICT: This activity could evidence your ICT skills in
who did not experience poverty as children. They also
finding and selecting information.
earned 10 per cent less over their lifetime. Paxton
and Dixon point out the following disadvantages
of poverty:
• Poverty is associated with being a victim of crime
• Poorer communities are more likely to live in
polluted areas.
• Poorer people have an increased risk of dying
young.
Parents who feel Less chance of having

stressed by money the latest phones,
worries clothes, games or toys
Overcrowded housing
Less chance of travel – less room to play or
do homework
A child living in a
low income home Poor housing – more
Low self-confidence risk of illness
might have . . .
Expectations of More exposure to

growing up to be pollution
unemployed Less access to
Poor diet computers or books to
help with school work
Fig. 4.12: Some problems a child may face if they belong to a low income family
156
Education beliefs might be copied from the people we mix with,

People with few or no qualifications are more likely to or at least from people who we see as being similar
be unemployed or employed in low paid work. to ourselves. Peer groups provide a second source
of social learning after our family, which provides our
A government report called Unleashing Aspiration was
primary socialisation.
published in July 2009. This report points out that the
majority of professional people such as doctors and Values and attitudes
lawyers grow up in families with substantially higher Your beliefs, values and attitudes are influenced by
incomes than average. The report also highlights your socialisation with family, carers and peer groups.
growing inequality in the degree to which professions Your values and attitudes will also be influenced
are staffed by people from wealthy backgrounds. by your life experiences (issues like bullying and
People from low income families may have less chance discrimination) and the culture that you are exposed
of achieving high qualifications and good careers. to in your neighbourhood and that you access through
social networking and the Internet.
Did you know?

The Poverty Site (www.poverty.org.uk ) reported
in August 2009, that around half of all employees Key terms
with no GCSEs at grade C or above were paid Attitudes – assumptions that we use to make sense of our
less than seven pounds an hour in 2008. Only social experience.
one in 10 young people with degrees were paid Values – principles that we use to guide our thoughts and
less than seven pounds an hour; 20% of people decisions. They explain what we ‘value’.
between 25 and 29 years of age with poor
qualifications were unemployed compared with
only 5% of graduates.
Reflect
Peer groups What social pressures do people experience to
As a child you will have learned a lot about social achieve good educational qualifications? Where do
these pressures come from? How far have you chosen
relationships when you played with other children.
your own values and attitudes and how far have you
During adolescence we are very influenced by people
copied them from other people?
of our own age group – our peer group. Attitudes and
Limited access to
Poor or overcrowded information and More pressure to
housing can make it communication technology earn money and leave
difficult to study education early
Schools in Negative impacts

disadvantaged Children may come to
neighbourhoods may
of low income on school hungry
have restricted space education . . .
Parents may be less Less money for

able to support equipment, books,
Less value placed on
children with study educational outings, etc.
educational success
Fig. 4.13: Possible educational disadvantages faced by low income families
157
2.6 Lifestyle Did you know?

What leisure activities do you engage in? Do you
exercise? Are you careful about your diet? How do Government guidelines recommend that
a healthy diet should include at least five
you dress and present yourself when you are among
portions of fruit and vegetables a day.
your friends? These are some of the questions that will
explain your lifestyle. Your lifestyle represents the way
you choose to spend your time and money.
Activity 10: Research
supermarket food
Key term Do some research by reading the labels on
Lifestyle – how a person spends their time and money in processed supermarket food. Look at the amounts
order to create a ‘style’ of living. of sugar and salt in budget or low-priced ready
meals and compare these amounts with the sugar
and salt content in more expensive food products.
To some extent your lifestyle is something that you Can you find any evidence to suggest that a low
choose. Your choices will be limited by the money income might influence people to choose products
that you have and influenced by your culture and containing more sugar and salt?
the people in your life. People on low incomes
have limited choices. Most people develop habits
connected to diet, exercise and use of alcohol. Many
people never actively choose a lifestyle – it just PLTS
happens – but people can choose to change their Independent enquirer: This activity may enable
lifestyle. Some lifestyle issues are presented below. you to evidence the independent enquirer skills by
carrying out research.
Nutrition and dietary choices
Some people may choose to eat a diet that includes
unhealthy fatty, salty or sugary food. But some people
may eat an unhealthy diet because of convenience and Drugs
cost. Some authors argue that convenience food that National Statistics (2006) reported that 14 per cent of
has a high fat, salt or sugar content is often cheaper men and 8 per cent of women said that they had taken
than healthier or more labour intensive alternatives illicit (illegal) drugs in the previous year. Fewer than
People with a low income will find it harder to travel one in three young men and one in five young women
to supermarkets and stock up on cheaper food. A reported that they had used cannabis.
low income may push people to choose an unhealthy Smoking
diet, because it can be harder and more expensive to Among other serious risks to health, smoking is
choose a healthy one. associated with heart and lung disease. Smoking is
Use and misuse of substances associated with socio-economic class. More people in
manual occupations smoke than in the higher social
Alcohol classes. In 2007 roughly one in five people in the UK
The Department of Health recommends that, in a day, were smokers (Social Trends 2009).
men should not drink more than four units of alcohol
and women should not drink more than three units.
Social Trends (2009) states that 65 per cent of men and Did you know?
49 per cent of women reported drinking more than the
recommended limits in 2007. Statistics also show that The number of people who smoke has
32 per cent of young men and 24 per cent of young halved since 1974 when 51% of men and 41%
of women were smokers (Social Trends 2009).
women have a lifestyle that involves heavy drinking.
158
Activity 11: Discuss high‑ 2.7 Major life events

risk lifestyles Predictable and unpredictable events
Get together with other course members and During our life we are influenced by a range of life
discuss the role of nature and nurture in influencing factors and we are also influenced by the events
lifestyle choices. You may know of people who put which happen to us. Some major changes in life can
their health at risk by excessive drinking, smoking be predicted and even chosen, while others may be
or taking drugs. To what extent do you think these unpredicted. If your life suddenly changes there is
habits might be influenced by genetics? Are some
always the risk that you will feel out of control and
people more at risk from alcohol, tobacco or other
drugs? How far are lifestyles copied from friends, stressed. If you have chosen to leave home, marry or
with people just going along with what others are retire you may feel in control of these major events.
doing? To what extent do people choose to use The idea of predictable and unpredictable life events
alcohol, tobacco or other drugs in order to reduce involves generalisation. For some people issues like
stress in their lives? divorce or redundancy may be predictable, but other
people may not have expected to be divorced or lose
their job.
Functional skills Changes in life often involve positive learning as well
English: This activity will help you to evidence as a risk of stress. Some major life events are set out in
English speaking and listening skills. Table 4.7.
Table 4.7: Predictable life changes
Events that are Possible influence on development

often predicted
Positive learning Risk of stress
Starting school/ Learning to make new Feeling unsafe – withdrawing from others. Loss of support from
nursery friends and cope with parents
change
Beginning Choosing a work role and Feeling pressured by new demands on time and mental energy.
and changing having an income from Finding difficulty in adapting. Loss of past lifestyle
employment employment
Leaving home/ Achieving independence Feeling unable to cope in a new situation. Feeling pressured by
leaving care – controlling personal all the new tasks. Loss of family/care support
environment
Leaving prison Coping with freedom and Loss of routine, loss of a structured environment, possible lack
choice of support with finding an income and housing. Coping with
possible discrimination.
Marriage Making emotional Feeling threatened by intimacy and sharing possessions.
attachments and Possible loss of independence
experiencing intimacy
Parenthood Attachment to infant. Disruption of previous lifestyle, loss of free time. New demands
Learning parenting skills on time and energy. Feeling tired and loss of sleep.
Retirement Controlling own life – Loss of previous work roles. Loss of contact with work
disengaging from work colleagues. Difficulty establishing a new lifestyle.
159
Table 4.8: Unpredictable life changes
Events that are Possible influence on development

often unpredicted
Positive learning Risk of stress
Birth of a sibling Learning to make new Jealousy and rivalry – emotional tension because your role within
emotional attachments the family has changed. You may lose attention from parents
Redundancy Learning to adapt to changes Refusal to accept change. Anger or depression. Failure to cope
in income and lifestyle with a loss of income and lifestyle
Illness and serious Learning to adapt to physical Grief at the loss of good health. Anger or depression and failure
injury change to adapt to disability
Divorce Learning to cope with a new Resentment or depression. Grief at the loss of the relationship.
lifestyle Failure to adapt to a new lifestyle. Possible financial hardship
Bereavement Learning to cope with loss Grief at the loss of the relationship. Failure to adapt to an
and new lifestyle unwanted lifestyle
The interrelationship between factors in your home, or in your community and friendship
networks. Major life events will change your social,
Major changes in life may interact with all the life
emotional and economic circumstances.
factors discussed in this section. For example,
retirement, redundancy, divorce, bereavement or Many life events involve some kind of loss, but this
serious injury might all result in a loss of income change is rarely simple. For example, bereavement can
or having to live on a low income. Leaving home, involve a whole range of other losses and changes.
marriage or parenthood might all involve changes
Loss of friends –
because you are no
longer a couple
Loss of a person who Loss of income that

provided emotional the person brought
support into the household
Loss of home – Bereavement Loss of physical and

if you cannot cope
can involve . . . sexual comfort
on your own
Loss of self-confidence Loss of practical

– if there is no one to help with daily living
reassure you activities
Loss of person that Loss of leisure and social

you were emotionally activities if you do not like
attached to doing things on your own
Fig. 4.14: The effects of bereavement
160
Most major changes in life involve a whole range and overcrowded housing by smoking, drinking and
of issues. Being seriously injured or being divorced taking drugs. Smoking, drinking and taking drugs
will involve a range of losses. Even predictable and may damage physical health. Poor health may in
welcome changes can involve a great deal of new turn increase problems of low income and negative
learning and coping with a range of losses. life events. The whole thing is an interactive process
or a ‘vicious circle’. Just saying that pollution, or
Reciprocal influence low income, can influence development, does not
Leonie Sugarman (1986) discusses the theory of explain very much. If you are going to make sense of
reciprocal influence. Reciprocal means ‘goes both someone’s life you need to be able to understand how
ways’ or ‘give and take’. Biology and environment factors interact with each other and that the choices
impact on us, but we can influence our biology that a person makes also interact with life factors. You
and the environment around us. We respond to can influence your environment – and even your own
the environment we find ourselves in. For example, biology.
some people may respond to the stress of poverty
Case study: John continued
Interviewer: Thinking about your life, time I got respect from other people,
can you think of any major life factors I was the person that could solve their
and events that really influenced you? problems – it made me feel good. I
think I started to look after myself –
John: Well, I think the big things are you know – care about my health and
that when I was younger I couldn’t appearance more. Because I felt good
find work that I enjoyed so I kept about myself I think that helped me to
changing jobs. The same really with find the right partner – find a happy
relationships. I’ve been divorced twice. marriage. Once I had self-confidence at
I suppose I didn’t really have a happy work, well – I became different – better
childhood. My parents were always to be with. I suppose you could say I
fighting, I was an only child – I didn’t had a lucky break in finding something
know what to expect from family life. I was good at.
Also, I went to a rubbish school. I just
drifted around in different jobs, no real idea of 1 Using John’s story at the beginning of this
what I wanted to do. I felt like I was useless – other unit and the story above can you explain
people put me down. how environmental factors such as family and
educational opportunity have influenced his
Interviewer: So what factors changed your life to development?
the happy life you’ve got now? 2 Can you explain how major life events, like finding
John: I suppose you could say ‘they invented a job he was good at, interacted with other issues
computers’. No really! I had a computer in the such as a successful relationship in John’s life?
1980s and I just got fascinated with it all – went on 3 Can you use the theory of reciprocal influence to
courses to develop my skills. I found I was really explain how life events influenced John’s early life
good at solving problems and for the first time in but how he started to influence events such as his
life I was good at work. You know it was the first health and appearance once he felt respected?
161
Imagine you have been writing about the life of your Even the person you are writing about is
chosen celebrity for a magazine. The editor of the unlikely to know much about their own
magazine has now asked you to describe the effects biological background. However you can
that five life factors have had on two life stages your collect information on general issues associated
chosen person has experienced. with genetics and biological influences. For
You will already have found out about some of the example you could discuss the fact that genetic
experiences your celebrity has had during two stages influences interact with the environment to
of their life. Your two stages are most likely to be create people with different body shapes, sizes
chosen from childhood, adolescence or adulthood. and personalities. Your research may have given
You now have to imagine how the following factors you some information on the person’s past
may have influenced the individual: environment, their socioeconomic background,
lifestyle and perhaps some of the major life
• the person’s genetic background and early events that happened to them. You can use
biological experiences this information to help assemble a fact file
• the person’s general environment during these that will explain how these different life factors
stages could have influenced the development of this
• the social and economic circumstances of the individual.
individual’s family or carers P3 It is quite likely that your celebrity will have
• the person’s lifestyle or the lifestyle of their family written about major life events such as the life
• the impact of major life events. events listed in Tables 4.7 and 4.8 on pages
159 and 160. You may be able to explain how
Your editor has also asked you to explain the influence predictable and unpredictable events have
of two predictable and unpredictable life events on influenced this person using the person’s own
the person that you are writing about. story. If not, then you should try to imagine
how events such as starting school or work, and
Grading tips setbacks such as illness or career difficulties,
P2 You are unlikely to have any genetic or may have influenced the celebrity you are
biological information about your celebrity. writing about.
162
3 Understand physical and psychological changes of

ageing
Each person’s experience of ageing is different. Some • Hearing can deteriorate with a failure to hear high-
people develop serious problems associated with the pitched sounds.
ageing process in their fifties; other people have few • A lack of skin sensitivity can lead to an increased risk
problems even in their nineties. There is no simple of hypothermia.
process that affects everyone in the same way.
Organs
3.1 Physical changes • Muscles in the digestive tract can become weaker
creating a risk of constipation.
Some physical changes associated with ageing are
• The heart is less efficient at pumping blood.
summarised below.
• Blood pressure can rise.
Skin, bones, joints and muscles
• Nutrients from food are not absorbed as well as in
• The skin becomes thinner, less elastic and more earlier life.
wrinkled.
• Breathing can become less efficient because
• Bones can become less dense and more likely to respiratory muscles are weaker.
fracture.
• Gas exchange in the lungs becomes impaired as
• Joints can become stiffer and may become painful the elastic walls of the small air pockets called
as the cartilage on the bone ends becomes thinner. alveoli become damaged.
• The ligaments which reinforce joints can become • Body metabolism is reduced due to lowered
looser. performance of the endocrine glands.
• A person can lose height because the cartilage These physical changes do not come about just
that separates vertebrae in the backbone becomes because we ‘wear out’. If you take regular exercise,
compressed. The spine may also become more you may expect to live longer and stay healthier than
rounded. people who do not. The physical changes associated
• Muscles become weaker. with ageing may come about because there is a limit
Senses to how many times body cells can repair and renew
themselves, and because of damage that builds up
• The sense of balance can become impaired.
over a lifetime. For more information, see the section
• The ability to taste and smell can deteriorate. on the final stage of life on page 139.
• Vision can deteriorate because of a range of
problems and cataracts can develop.
Case study: Ivy ‘I do get cold in here sometimes – all the

young ones – I mean the staff – they always
Ivy attends a day centre for older people. She is 84 complain it’s too hot. But I feel the cold nowadays.
years old. She is talking about her experiences in the It’s never warm enough in here for me.’
day centre.
Using your understanding of physical changes of
‘The dinner here isn’t very good – it’s all just tasteless ageing answer the following questions:
mush. You can’t get real food nowadays, not like we
used to have.’ 1 Can you explain why Ivy might experience food
as being tasteless nowadays?
‘I get tired out on the days that I come here – there’s
so much activity – well it takes me a day to get over 2 Why might Ivy become tired and breathless
it. I do enjoy the keep fit activity but I get breathless following physical activity?
doing it. I suppose it’s all just my age.’ 3 Why does Ivy feel cold all the time?
163
Hormones and the menopause Emphysema can be induced by smoking, which causes
the lungs to produce chemicals that damage the walls
Women usually experience a major decrease in the
of the air sacs. In time, this results in a drop in the
hormone oestrogen following the menopause. This
amount of oxygen in the blood.
decrease in oestrogen is associated with osteoporosis.
Women are more at risk of osteoporosis than men Chronic obstructive pulmonary disease (COPD)
because bone strength is influenced by the reduction When there is an airflow obstruction, perhaps due to
of oestrogen. Some people may be more at risk of emphysema or bronchitis, the resulting condition is
osteoporosis than others because osteoporosis may be described as chronic obstructive pulmonary disease
influenced by genetic inheritance. The environment can (COPD). This condition can create a progressively
make a difference as exercise is known to strengthen worse disruption of airflow into the lungs. Some
muscle and bone and may help to prevent osteoporosis. people with COPD increase their rate of breathing
in order to cope, whereas others may have a bluish
Cardiovascular system appearance or might look bloated because of a lack of
The heart pumps blood around the body. Older oxygen and a build-up of fluid in the body.
people may develop a narrowing of the arteries and
other blood vessels due to fats such as cholesterol
being laid down in the walls of the blood vessels. Activity 12: Research
This process of ‘clogging up’ is called atherosclerosis. physical changes
‘Athero’ indicates fatty deposits and ‘sclerosis’
indicates the hardening of the arteries. Get together with other course members and
choose one topic each to look up using the NHS
Atherosclerosis can result in higher blood pressure and direct health encyclopaedia (www.nhs.uk). Present
high blood pressure puts the person at risk of stroke your topic in detail to the group. Make notes on
(where the blood supply to the brain is blocked) and other course members’ presentations so that you
heart attack. have detailed information on the physical changes
associated with ageing.
The elasticity in the walls of the blood vessels can also
decrease (sclerosis), causing the heart to work harder,
increase in size and cause a rise in blood pressure. Fatty
deposits can break away and cause a blockage in an
Functional skills
artery. These blockages can result in coronary heart ICT and English: You can use your ICT skills to find
disease. If the coronary artery is partly blocked a person and select information regarding your chosen topic.
may experience the breathlessness and chest pains Presenting this information to the group allows you
to practice your speaking skills. You can use writing
associated with angina. Where blood flow is seriously
skills to make notes on the other presentations.
blocked a person may experience a heart attack.
Respiratory system Nervous system

When blood is not being pumped round the body Ageing may involve the loss of nerve cells that activate
efficiently, breathlessness may result. The strength muscles. Neurotransmitters (the chemicals released
of the chest muscles may reduce with ageing and by the nerves in order to communicate and control
the efficiency of the lungs may deteriorate. Chronic muscles) may also function less effectively with age.
diseases such as bronchitis may develop. Bronchitis
Motor neurone disease
involves inflammation of the airways that connect
the windpipe to the lungs. Common disorders of the Motor neurone disease is a rare disorder that is more
respiratory system include emphysema and chronic common among people aged 50 to 70 than in other
obstructive pulmonary disease. age groups. The disease causes nerves to degenerate,
resulting in weakness and loss of muscle tissue. The
Emphysema causes of motor neurone disease are not understood
Emphysema is a disease in which the air sacs in the but it is possible that genetic inheritance may play a
lungs (alveoli) become damaged. This causes shortness role, or that exposure to toxic chemicals may increase
of breath and can result in respiratory or heart failure. a person’s risk of developing the disease.
164
Degeneration of the sense organs develop. The majority of people over 75 years have
some degree of cataract formation. Diabetes can also
Sight
cause the development of cataracts.
After 45 years of age, the ability of the eye to focus
Another problem that can affect eyesight in later life
begins to weaken and by 65 years there may be little
is glaucoma. Glaucoma involves an increase of fluid
focusing power left, making small print more difficult to
pressure within the eye.
read. Up to half of people over the age of 90 may have
serious problems with vision. Hearing
Cataracts result from changes in the lens of the eye. Many older people experience difficulty in hearing high
As people grow older the lenses can become hard frequency (or high-pitched) sounds. This can happen
and cloudy. This process stops the lens of the eye because the sensitivity of nerve cells in the inner ear may
from being able to change shape or transmit light decrease. There may also be a loss of nerve cells, which
appropriately. This process results in symptoms such results in hearing loss. Some older people experience
as blurred vision. Cataracts may start to form between an increase in wax in the outer ear and this can block
the ages of 50 and 60 years and often take time to the transmission of sound to the sensory nerves.
Case study: Joe

Since retiring, Joe works as a volunteer in a day 1 Would you generally expect problems with
centre. At first he found it very difficult to hear what vision and hearing associated with ageing to
people were saying. When talking to a colleague he develop slowly over time or would they be
said, sudden crises?
‘It’s strange that people here don’t talk clearly – 2 Joe had a problem with hearing high-pitched
even the staff group mumble all the time. It can’t sounds – he thought other people ‘mumbled’.
be a problem with my hearing because I can Would it have helped if other people had raised
understand my family all right.’ their voices and shouted at him or would it have
caused more problems?
Joe has since had a hearing check and now uses a
hearing aid. He says, 3 Why was Joe able to understand his family but
not new people at the day centre? Why did he
‘It’s funny how you don’t notice change – I really originally refuse to believe that he had a hearing
didn’t believe I had a hearing problem but loss?
everything is much clearer now that I use a hearing
aid.’
Cognitive changes
Ageing can involve a loss of nerve cells in the brain Key term
and a reduction in the ability of nerves to transmit Cognitive changes – changes to a person’s thinking, memory
electrical signals. But this does not mean that people or mental abilities that influence their behaviour.
lose their ability to think logically or reason. Many older

people do report problems with memory recall, for Musculoskeletal
example, ‘where did I put my glasses?’ Older people Older people may experience the following:
often report that it takes longer to do things; there may
• muscle thinning
be a feeling of slowing down. They may take longer
to respond to questions. Response times might also • decline in mobility
be slower, meaning that, for example, older people • arthritis.
need to drive more carefully in order to compensate Ageing can result in a general reduction and shrinkage
for slower response times. Slower response times and of skeletal muscles (the muscles we use to walk, lift
difficulty recalling recent memories are not symptoms things and move about). This loss of muscle tends to
of dementia. Senile dementia is not part of a general start after the age of 40 even in people who enjoy a
ageing process, although the disease is more common healthy diet. Lack of exercise may contribute to muscle
among people who are over 85. thinning in some people.
165
Absorption of nutrients that if no one smoked, lung cancer would be a rare

Absorption of food, including minerals and vitamins, disease. Smoking also causes cardiovascular disease
becomes less efficient in older people, meaning that associated with the hardening and narrowing of the
some people can experience malnourishment even arteries causing high blood pressure, heart attacks,
though they continue to eat the same diet that was strokes and lowered blood supply to extremities such
adequate in early adulthood. Some older people are as the feet. Smoking also causes chronic obstructive
prescribed additional supplements of calcium and pulmonary disease (COPD) and emphysema. Smoking
vitamin D in order to prevent osteoporosis as the is an example of exposure to toxic substances that
body may not absorb sufficient calcium and vitamin may cause damage to DNA. Damage to cell DNA may
D from the person’s diet. Other major deficiencies in result in skin developing a more aged appearance
the diets of older people often include insufficient iron including what is sometimes described as a leathery or
and fibre. wrinkled appearance.
Arthritis Dementia – a disorder more common in

Arthritis involves damage to joints within the body. ageing
A substance called cartilage covers the ends of our Dementia is more likely to occur in older people.
bones and helps to ‘cushion’ our bones as we move. Approximately 5 per cent of people over the age
Cartilage can become thinner and less elastic with age. of 65 years have dementia. The Alzheimer’s Society
In osteoarthritis the bone ends can thicken and even estimates that as many as 20 per cent of people over
form bony spurs which restrict movement of the joint. the age of 80 are affected by dementia. The majority of
Many people with arthritis experience stiffness and people who live to extreme old age will never develop
pain when they move their hips or knees, especially dementia.
after a period of immobility.
Dementia is a disorder that causes damage to the
Osteoporosis is a major problem associated with structure and chemistry of the brain. A person with
ageing, affecting about 3 million people in the UK. dementia is likely to experience problems with
Osteoporosis involves a thinning and weakening of understanding what is happening around them,
bone, making it easier for bones to become fractured. communicating, reasoning, finding their way and
remembering recent events. There are different kinds
Skin
of dementia; two major types are Alzheimer’s disease,
As people grow older the elasticity of the skin reduces.
and dementia caused by vascular disease, which
The amount of fat stored under the skin decreases, its
involves problems with blood supply to the brain.
appearance becomes looser and it develops wrinkles.
Skin can also be damaged by excessive exposure to
sunlight. Strong sunlight contains ultraviolet rays which Remember that many older people remain
can damage unprotected skin. Ultraviolet rays may physically active well into later life
cause an increase in freckles, age spots, wrinkles and
even rough and leathery skin. Using a sun cream with
a high ultraviolet protection factor can help to reduce
this damage.
The effects of smoking

Did you know?
Smoking exposes the body to around 400
different toxic substances including nicotine, tar
and carbon monoxide.
Smoking is a major cause of a range of cancers

including lung cancer. Some medical experts argue
166
experiences of 160 of her friends and colleagues. Her

Activity 13: Stereotypes of study showed that even within a group of people with
ageing similar cultural and life experiences, there were wide
variations in how people experienced later life. Some
Ask some of your friends or family to name some
people reported an increase in social confidence;
major health problems they expect older people
to have. Historically, many older people have been some people appeared to become more tolerant,
negatively stereotyped as suffering from disease while others became more irritable; some people
and dementia. Can you find evidence that these appreciated the respect that they received from
stereotypes still exist? other people, while others complained of a lack of
respect. The study suggested that ageing is full of
contradictions with no clear rules.
PLTS Heim suggested that confidence in undertaking
Creative thinkers: This activity may help you to practical tasks decreases in old age but that social
evidence the ability to question your own and confidence increases – and that this is one of the
others’ assumptions as part of your creative thinking contradictions involved in the ageing process.
skills.
3.2 Psychological changes Reflect

The effects of ageing on personal confidence Imagine a fit, healthy 16-year-old and a frail 84-year-
old person with poor eyesight who both have to cross
and self-esteem a busy road. Which of these two people is likely to
As with physical ageing, each person’s experience feel more confident in coping with the situation? Now
of psychological change is likely to be different. imagine the same two people faced with the task
of standing up at a wedding reception and making
Cumming (1975) argued that some people disengage
a speech. Imagine that the older person has had a
from social activity as they get older (see page 170 for
lifetime’s experience of public speaking. Which of the
more information about Cumming’s argument), but two people is now likely to feel more confident?
many people remain in close contact with friends and
family. Another famous theorist, Erik Erikson, argued in
1963 that older people would need to develop a sense
of ‘ego integrity’ if they were to avoid despair in later
life. Ego integrity involves making sense of your life –
holding on to a clear and meaningful sense of who you Think about why some individuals may
are. In part, ego integrity involves choose to take part in reminiscence
sessions as an important social activity.
holding on to your self-esteem. One
theory is that older people need
to engage in telling their life story,
reminiscing or reviewing their life in
order to help create self-esteem and
confidence. Coleman (1994) argued
that some types of reminiscence
work can be useful for most people,
but that there are wide differences in
individual needs. Joining a group to
discuss past events may not be good
for everybody.
Alice Heim (1990) was a psychologist
who wrote a book about her own
experiences of ageing and the
167
Case study: Grace

Grace is 82 years old. She suffers from osteoporosis ‘My old mum used to say that a problem
and recently fell and broke her hip. She made shared is a problem halved. It’s a real help down
the following statements in conversation with her the club – it lifts my feelings up when I’m down.’
physiotherapist who is helping her to learn to walk 1 Can you explain how osteoporosis has resulted in
again using sticks to support herself while walking in a problem that threatens Grace’s confidence and
her bungalow. self-esteem?
‘Sometimes I have a little cry because I can’t get 2 Can you explain what Grace does in order to
to the shops.’ keep her social confidence and self-esteem
‘I don’t know when I’ll have the strength and intact?
confidence to go shopping on my own again.’ 3 How far can services such as social clubs help to
‘I can still get on my mobility scooter and go prevent older people from experiencing a loss
down the club – that’s easier because there are of confidence and self-esteem despite physical
other people to help you there.‘ changes?
I don’t know what I’d do if I couldn’t get down the

club because there’s other people with problems
and you can talk to them.’
Physical illness may cause some people to lose confidence in doing certain activities but it would be wrong to
assume that physical decline automatically removes everyone’s general self-esteem and confidence.
Table 4.9: General issues that may influence individual psychology
Issue Explanation
Ageism Older people are sometimes stereotyped as being useless, diseased, demented and unable to
cope. Older people may experience prejudice from younger people who see them as ‘having
had their lives’. Many older people fear that they will not be treated with dignity in hospital or
care settings.
Role changes The majority of older people enjoy effective social networks with only one person in five
experiencing a degree of isolation. For many people retirement provides more opportunity for
contact with grandchildren and other relatives. Older people are more likely to vote than any
other age group suggesting more involvement in politics, whereas younger people may be
more disengaged from politics. Loss of work role, loss of partner and loss of income may all
result in major life changes that are difficult to cope with.
Loss of a Bereavement may result in a range of changes and losses including role changes. Bereavement
partner may cause temporary anxiety and depression.
The effects of For many people retirement provides freedom. Retired people may be seen as ‘time rich’ and
retirement free from work stress. But for some people retirement could result in a loss of income, contact
with work colleagues and the loss of interest in life.
Increased Free time may enable many older people to engage in physical leisure activities such as walking
leisure time and activity holidays. Gardening is very popular among people aged 50 to 70. Free time may
enable many older people to engage in enjoyable social and mental activities such as taking
new college courses, developing ICT skills etc. National Statistics Online (2006) reported that
51 per cent of people between 60 and 69 participated in some form of learning.
Financial The majority of people aged 65 and over own their own home and people over 65 have higher
concerns levels of savings in general than any other age group. Many older people enjoy a high standard
of living. Only about one in five older people live in poverty. Most of these people will not have
a private pension fund. These people may have concerns about paying for heating, shopping
and coping financially.
168
Other issues that may influence individual psychology

The majority of people over state retirement age Culture, religion and beliefs
experience reasonable health, a satisfactory social life The way in which you react to physical changes in later
and a reasonable standard of living. Only a minority life will depend on your attitudes and beliefs. Attitudes
of older people experience poor health, poverty and and beliefs are influenced by social issues such as
isolation. It is important to guard against the stereotype culture and religion. Some people can maintain a
that old age is always a story of decline and isolation. happy and positive outlook on life despite having
Old age is like any other life stage – whether or not serious physical health problems. Other people may
you lead a happy and fulfilled life depends on a large appear to be depressed or withdrawn despite being
range of individual issues. relatively fortunate in terms of physical health.
Case study: Jake and Joshua

Jake and Joshua are residents in a care home. Both I believe in a spiritual ‘me’. If my body lets
have heart disease and serious mobility problems. In me down – well my spirit hasn’t altered – why
conversations with the care home staff, Jake has said: should I be sad?
I’m finished with my life. I’m just a burden to my Jake believes that if you haven’t got your health life is
family. My body has packed up, there is nothing to not worth living. Joshua thinks quite differently.
live for, I can’t walk, I can’t get out, I’m no use to 1 Can you identify possible cultural and religious
anyone – I wish I was dead. reasons for these different beliefs?
Joshua has said: 2 Does physical health completely control and
determine how much a person can enjoy life?
I can’t get around anymore but I still enjoy my life.
It’s a joy just to wake up in the morning, to see the 3 Can you use Erikson’s theory of ‘ego integrity’ in
sun, to see a smiling face. You should never give order to explain Joshua’s positive attitude?
up on life – I learned that attitude from my family.
Case study: Interview with John continued

Interviewer: Do you think that body but I wouldn’t like to give up the life
the best time in life is when you that I have now.
are young and that you are less
Interviewer: Would you say you are more confident
confident now that you are older?
and your self-esteem has increased with age?
John: No. The best time for my body
John: Yes. I’m more confident in myself. I don’t care
was my early 20s, it is true. But I
what other people think – I know who I am and what
think now is the best time in my life. When I think
I’m good at, so I have self-esteem. I know I don’t look
back I had a lot of problems in my 20s and 30s. I
so good these days – but so what! You are what you
wasn’t really settled, I kept changing jobs. I got
are, and at my age I don’t have to be attractive!
divorced twice. Looking back I pretended to be
confident but I didn’t really know who I was. I love 1 Can you describe some of the physical changes
the work that I’m doing now – I don’t want to retire. that John has experienced and how they have
I finally found a relationship that works so I’ve never limited his life?
been happier. 2 Can you explain why John still enjoys self-
Interviewer: But what about the aches and pains confidence and high self-esteem even though he
you mentioned? Don’t they get you down? has experienced physical changes with ageing?
John: Yes. I’ve got arthritis and every time I try 3 John might be said to have successfully adapted to
to do things, like decorate the house, my wrists physical ageing. Can you explain why some people
and knees hurt. But I’ve got an answer – I don’t might adapt successfully while other people might
decorate the house any more – I pay someone experience of loss of self-esteem?
else to do it! I’d love to be back in a 25-year-old
169
Theories of ageing
Social disengagement Key term
Disengagement – a theory that older people will need to
Engagement means being involved with people or
withdraw from social contact with others. Older people will
activities. Disengagement means to withdraw from disengage because of reduced physical health and loss of
involvement. In 1961 two authors called Cumming social opportunities.
and Henry put forward a disengagement theory that
older people would naturally tend to withdraw from
social involvement with others as they got older; older
simply because old people have neither the physical
people would have restricted opportunities to interact
nor the mental resources they had when they were
with others. The issues that surround this are outlined
young.’
in Table 4.10.
The theory of disengagement fits with the
Cumming (1975) argued that older people would
‘springboard’ view of life (see page 133) and
experience a reduction in social contact as they grew
suggests that losing contact with other people is an
older and become increasingly ‘individual’ and less
inevitable consequence of biological decline and
concerned with the expectations of others. He argued
that withdrawing from other people is a natural and
that it was appropriate and healthy for older people to
appropriate response to ageing. However, there is little
withdraw from others – disengagement was a natural
statistical evidence to suggest that this is a general rule
part of ageing.
for everyone.
The theory of disengagement was widely accepted
Zimbardo (1992) argued that ‘The disengagement
in the past. For example, Bromley (1974) argued that
view of social ageing has been largely discredited for
‘although some individuals fight the process all the
a number of reasons’. The majority of older people do
way, disengagement of some sort is bound to come,
remain socially involved with family and friends and
Table 4.10: Issues that limit social interaction.
many older people become more involved with close
family as they become older. It may be that many older
Problem Explanation people choose to spend their time with people they
Ill-health Poor mobility or problems with feel close to, rather than seeking to make new friends.
hearing or vision may make If people only interact with close friends, does this
interaction with other people more mean that they are disengaged?
difficult. While many researchers today do not agree with
Geographical Many people retire to areas away disengagement theory, it is important to remember
mobility from friends and relatives. Family that when Cummings and Henry first proposed the
members may move away from theory in 1961 there was no Internet or text messaging;
older people in order to seek better many older people did not have access to a car and
housing or employment. quite a few would not even have had a phone in their
Retirement Retiring from work may mean less home!
contact with colleagues in a social
setting. Reflect
Ill-health of If friends or relatives have poor Imagine you have broken your legs. You have no
friends and mobility or other disabilities they may access to a phone, text messages or the Internet and
relatives have reduced social contact with you. you cannot go out. Would you begin to disengage?
Travel and Some older people do not have Now imagine the same situation but this time you
have a mobile phone and an Internet connected
technology access to a car, the Internet or
laptop. Would technology help? Do health problems
a mobile phone – this may limit
automatically cause social withdrawal or might it be
opportunities for social contact.
more complicated?
170
Activity theory with people or hobbies in order to feel that life is

Writing in 1966 Bromley argued that older people worthwhile.
needed to disengage, but that they also needed to
remain ‘active’ in order to prevent disengagement Key terms
from going too far. Bromley said: ‘It is not sufficient Activity theory – a theory which argues that older people
merely to provide facilities for elderly people. They need to stay mentally and socially active in order to limit the
need to be educated to make use of them and risks associated with disengagement.
encouraged to abandon apathetic attitudes and Continuity theory – a theory that older people will generally
fixed habits.’ Bromley argued that it was important maintain a continuous sense of who they are and continue to
to remain mentally active and maintain an interest adapt the self concept they developed earlier in life.
in life and enjoy the company of others. Too much
disengagement would lead to ‘stagnation’ and a loss
of mental and physical skills.
Ageing and health and social care provision
The majority of older people remain in their own home
Continuity theory in the community, where they may be supported by
Continuity theory (Atchley, 1989) stresses the friends, family and health and social services. Some
importance of continuing as the person you have older people choose to move to sheltered housing.
always been. For many people this may involve Sometimes people choose sheltered housing because
continuing with interests, lifestyles and social contacts maintaining the family home has become too difficult.
from the past. The important thing is that people can Day care centres provide a social setting where people
continue to develop an internal sense of self-esteem can meet and some health authorities provide day care
and self-concept. Memories of the past may be to assist with physiotherapy and other health needs.
important because they can help a person to tell their A small proportion of older people choose residential
life story. care where 24-hour support is available.
Continuity theory suggests that people will have All services for older people will aim to provide respect
different needs when it comes to activity. Some and choice for service users as part of their policy on
people may wish to withdraw from social and physical quality assurance. Many day and residential services
activity because they see themselves as a person who will provide a range of social and leisure activities
is entitled to retire and adopt a disengaged lifestyle. for service users. Older people should always have
Other people may have lived with active involvement a choice as to how active they wish to be. Quality
with family, friends or with hobbies and may not be services will never attempt to force older people
able to cope without staying active. Some people to be active and engaged, but they will provide
can disengage without losing their sense of who opportunities for individuals to maintain the continuity
they are. Some people need to stay actively involved of their lives and remain as active as they wish.
Assessment activity 4.3 P4 P5 M2 M3 D2
In your role as a reporter for a magazine, you now P5 To achieve P5 it will be important to use
need to write about the life of your chosen celebrity creative thinking and consider different
as they grow older. You must imagine some of the possibilities. Some older people may no longer
physical and psychological changes that could affect want to appear in public or be photographed.
the person in the future. You will also need to explain Other people will continue to develop their
two theories of ageing such as disengagement and celebrity status. Some people are celebrities
activity theory. because they have overcome serious difficulties
in their lives. These people might cope
Grading tips effectively with the challenges of later life. You
can discuss the different possibilities that the
P4 To achieve P4 you could choose to explain future may hold within your fact file.
disengagement and activity theory or you
could research alternative theories such M2 To achieve M2 you need to discuss the degree
as continuity theory. to which your celebrity might disengage or stay
171
actively involved with social activities as they D2 To achieve D2 you should evaluate how theories
become older. You might like to consider the of ageing influence health and social care
role of continuity (how important it will be for provision. If your celebrity was being supported
your celebrity to keep their interests) when you at home or in care would they be supported
discuss disengagement and activity theory. to maintain continuity with their past? Would
M3 To achieve M3 you will need to discuss how they be expected to withdraw, or would they be
these changes could affect your celebrity’s self- encouraged to remain active in order to prevent
esteem and self-confidence. excessive disengagement?
Resources and further Levinson, D.J., Darrow, D.N., Klein, E.B., Levinson,
M.H., McKee, B. (1978) The Seasons of a Man’s Life
reading New York: A. A. Knopf
Marris, P. (1996) The Politics of Uncertainty London:
Atchley, R.C (1989) ‘A continuity theory of normal Routledge.
aging’, The Gerontologist, 29,183–190 Paxton, W., Dixon, M. (2004) The State of the Nation
Ainsworth, M.D.S., Blehar, M. C., Walter, E., Wall, – an Audit of Injustice in the UK London: Institute for
S. (1978) Patterns of Attachment: A Psychological Policy Research
Study of the Strange Situation New Jersey: Pinker, S. (1994) The Language Instinct London:
Lawrence Erlbaum Associates Inc. Penguin
Berryman, J.C., Hargreaves, D., Herbert, M., Taylor, Sugarman, L. (1986) Life-Span Development London
A. (1991) Developmental Psychology and You & New York: Methuen
London: Routledge
Sugarman, L. (2001) Life-Span Development 2nd
Bowlby, J. (1953) Childcare and the Growth of Love Edition Hove & New York: Psychology Press
Harmondsworth: Pelican
Social Trends, Vol. 34 (2004) London: HMSO
Bromley, D.B. (1966) The Psychology of Human
Ageing Harmondsworth: Penguin
Unleashing Aspiration (July 2009) Report of the Panel
Bromley, D.B. (1974) The Psychology of Human
on fair Access to the Professions Cabinet Office:
Ageing, second ed. Harmondsworth: Penguin
London
Chomsky, N. (1959) Review of Skinner’s Verbal www.cabinetoffice.gov.uk/accessprofessions
Behaviour, Language, 35, 26–58.
Walters, R. (2009) Crime is in the air: air pollution and
Coleman, P. (1994) ‘Reminiscence within the study of regulation in the UK Centre for Crime and Justice
ageing: the social significance of story’, in Bornat, J. Studies Kings College London.
(1994) Reminiscence Reviewed Buckingham: OUP www.crimeandjustice.org.uk.
Cumming, E. (1975) ‘Engagement with an old Zimbardo, P.G. (1992) Psychology and Life London:
theory’ International Journal of Ageing and Human HarperCollins
Development, 6, 187–191
Cumming, E., Henry, W.E. (1961) Growing Old New
York: Basic Books
Erikson, E.H. (1963) Childhood and Society, second
Useful websites
ed. New York: Norton. Institute for Public Policy Research www.ippr.org
Havighurst, R.J. (1972) Developmental Tasks and National Statistics www.statistics.gov.uk
Education, third ed. New York: David McKay The Food Standards Agency www.eatwell.gov.uk
Heim, A. (1990) Where Did I Put my Spectacles? The Poverty site www.poverty.org.uk
Cambridge: Allborough Press
172
Day centre worker
Kayla works at a day centre for

older people. About 20 people attend the day
centre each day, although most members only come twice
a week. The centre offers a range of activities including artwork on
Thursdays, keep fit exercises, music and discussion groups. Many
members enjoy taking part in reminiscence sessions where a volunteer
will bring in old photographs from 40 or 50 years ago and ask members
to talk about their memories of that time.
Kayla is talking with the centre manager at the end of the day after
the members have gone home. She is concerned about Mary
who refused to join in discussion with other day centre
members.
Kayla: I enjoyed that reminiscence session. Some

of the members had so much to say, you could tell they were really
enjoying it too, but I can’t understand why Mary wouldn’t join the discussion.
I invited her to but she refused. She said: ‘Wait till you’re my age my girl, then you’ll
know how it feels to be old. I don’t want to do the things younger people do, I just want
peace and quiet’. The other members enjoyed talking, so why is Mary so difficult?
Manager: Mary isn’t being difficult. It’s her choice to join in or not. It would be against our code
of practice to try and make her.
Kayla: I understand that we must respect people’s choices but wouldn’t Mary be happier in the
long run if we could find a way to help her to be more active?
Manager: Perhaps not. You have to try and imagine Mary’s point of view. She’s not used
to taking part in group discussions. She does like doing art on Thursdays though, so
perhaps individual art work is more right for her?
Think about it!
1 Can you identify the theory of ageing that describes the way Kayla thinks?
2 Why might Mary think that discussion groups are not appropriate for her?
3 How would disengagement theory explain Mary’s behaviour?
4 Can you describe how continuity theory explains Mary’s behaviour
differently?
5 How could Kayla have talked with Mary in order to find out what Mary
would enjoy doing at the day centre?
173
Just checking
1 It can be argued that children develop language through a process of maturation. What does this
statement mean?
2 Are people biologically programmed to grow to be a certain height, no matter what?
3 If you have a genetically inherited disease, does that mean that nothing can be done to help you?
4 If you knew everything about a new born baby’s genetic inheritance and her current environment,
would it be possible to accurately predict her life course?
5 Some older people have difficulty with walking and moving around the home. Can you describe
two possible reasons for these difficulties?
6 Do the physical changes associated with ageing force all older people to lose confidence and
self‑esteem?
7 Should older people be made to be more active in order to prevent excessive disengagement?
Assignment tips
1 When you choose a famous person to study remember to ‘keep it real’. You will need to find somebody
who has made details of their life story public. You can use your imagination about general issues: for
example you could speculate about the way in which nature and nurture might affect people, but you
should not choose your favourite star and then make up a story about them. You must be careful not to
write things that could be seen as unfair, judgemental or offensive about real people. Celebrities have
human rights too!
2 You could construct a grid or chart listing the main issues associated with the five life factors. You can
then think about the information you have collected about your celebrity while looking at your grid. It
may help you think creatively about ways in which life factors interact within a real person’s story.
3 Within your fact file you could emphasise that different people experience different problems as they
grow older. It could be interesting to plan an article which starts with the question ‘Does physical ageing
always make life unpleasant for older people?’ You could identify the problems that your celebrity may
face as an older person, and also ways in which older people can adapt successfully to the changes age
brings. No one knows what will happen to your celebrity in the future, so you could leave your fact file
with an open ending.
174
Credit value: 10
5
Anatomy and
physiology for
health and social
care
If you are studying for a career in health and social care, you need to have
a basic knowledge of where organs are in the body and how they do their
jobs. You must have this knowledge to ensure the safety of those you are
caring for, and also to maintain your own health and well-being – because
you cannot give good care to others if you cannot look after yourself!
This unit explains the basic anatomy and physiology of the human body before moving
on to look at selected body systems. The body is made of billions of cells and, after
looking at the structure and functioning of cells, you will discover how these work
together, managing the energy we use. You will also learn how other body systems are
controlled – for example, how your body temperature remains the same, whether you are
sunning yourself in summer or shivering in a winter snowstorm.
This unit provides a basic understanding of human physiology that underpins the
specialist physiology units. It also provides an overview of body functioning that is
valuable for anyone working in health and social care.
Learning outcomes
1 know the organisation of the human body
2 understand the functioning of the body systems associated with energy metabolism
3 understand how homeostatic mechanisms operate in the maintenance of an internal
environment
4 be able to interpret data obtained from monitoring routine activities with reference
to the functioning of healthy body systems.
175

P1 Outline the functions of the main

cell components
page 183
P2 Outline the structure of the main

tissues of the body
page 191
P3 Outline the gross structure of all

the main body systems
page 197
P4 Explain the physiology of two M1 Discuss the role of energy in the D1 Analyse how two body systems
named body systems in relation to body. interrelate with each other to
energy metabolism in the body See Assessment activity 5.4, perform a named function/
See Assessment activity 5.4, page 216 functions.
page 216
P5 Explain the concept of M2 Discuss the probable homeostatic D2 Evaluate the importance of
homeostasis with reference to the responses to changes in the homeostasis in maintaining the
control of heart rate, breathing internal environment during healthy functioning of the body.
rate, body temperature and blood exercise. See Assessment activity 5.5,
glucose levels See Assessment activity 5.5, page 235
See Assessment activity 5.5, page 235
page 235
P6 Follow guidelines to interpret M3 Present data collected before and

collected data for heart rate, after a standard period of exercise
breathing rate and temperature with reference to validity.
before and after a standard period See Assessment activity 5.5,
of exercise. page 235
page 235
176
Unit 5 Anatomy and physiology for health and social care

This unit is internally assessed by your tutor. Various activities, exercises and scenarios
have been included to assist you with studying different aspects of anatomy and
physiology and in preparation for assessment.
Mia, 17 years old

At school, I wasn’t really into science although I did know it was
important to pass my GCSE because of all the nagging from my
parents. There seemed to be so many bits to it, and it was really
difficult to see how it fitted together. Uncle Pete hadn’t been
well that year. He was losing a lot of weight and his skin turned a
yellowy-brown and the whites of his eyes went yellow. I was really
worried about him and went to see him a lot. My Mum told me that he
had jaundice and was very ill. He died later, only 44 years old – I really miss him, he
always made me smile.
After the funeral, I wanted to know what exactly had been the matter with Pete. My
mum showed me the death certificate, which said that Pete had died from cancer of
the pancreas – I had only a vague memory of the pancreas and had no idea what it
did. The family expected me to know more just because I am now studying Health and
Social Care. I realise that it is important to have an understanding of the human body,
even for everyday life. After doing this unit, I know more about the pancreas but am still
not sure about the skin. It is more interesting to focus on one branch of science now. I
think I will write about Uncle Pete in Physiological Disorders next year and I will find out
about yellow skin.
Over to you!
1 How good is your understanding of the human body?
2 Which parts of this unit do you think you will enjoy the most?
3 How does the unit relate to your life and what you would like to do in the future?
177
1 Know the organisation of the human body
Build on what you know!

Get
In small groups, make a list of the human body systems that you already know
started about (on a large sheet of paper), and the organs associated with each system.
Using your list, write down all the functions of each system that you can think of. If
you bounce ideas off other members of your group, you will be surprised at how
much knowledge you can collect.
Each group can then share their list with the rest of the class.
1.1 Organisation of the body PLTS

Every individual is composed of billions of microscopic Reflective learner: This activity will enable you to
units called cells. The cells carry out vast numbers of demonstrate reflective learning by drawing on previous
chemical reactions and processes that make up the knowledge.
essence of life itself.
Cells rarely exist in isolation; they are usually grouped 1.2 Cells
together with other similar cells carrying out particular The largest cell in the human body is the female ovum,
tasks. Groups of cells are known as tissues. which can just be seen with the naked eye. Most
Different types of tissues are commonly grouped cells are much smaller than this, and microscopes are
together to form an organ, which carries out a required to view them. Ordinary light microscopes,
particular function. such as those found in school or college laboratories,
Finally, groups of organs that are responsible for major are quite good for viewing tissues and organs, but not
tasks or functions in the body are called organ systems very useful for looking inside individual human cells.
or sometimes body systems. Electron microscopes are necessary to see the
detail of cell contents. However, as these are highly
expensive instruments requiring trained operators to
Activity 1: Sorting out prepare and interpret the specimens, we use diagrams
and photomicrographs instead.
Get into groups. Each group should write
Details of the interior of a cell are often referred to as
on four large pieces of paper: ‘cells’,
‘tissues’, ‘organs’ and ‘body systems’. Each group the ultrastructure of the cell (‘ultra’ means ‘beyond
member should then write out the name of a type what is considered normal’). This is because they can
of cell, tissue, organ and body system on four only be seen with immense magnification. Before the
smaller slips of paper. Mix them up and give four to electron microscope was developed, the inside of a
every individual. Each member should place their cell was considered to be a granular sort of ‘soup’ but
slips under the correct label. The group can then
discuss the accuracy of their decisions.
If you are working on your own, you can sort the Key terms
following examples into cells, tissues, organs and Cell – The basic unit of living material.
body systems: heart, bone, blood, skeleton, red Electron microscope – A very powerful type of microscope
blood cell (or erythrocyte), cartilage, nervous system, needed to see inside cells.
kidney, brain, digestive system, skin, stomach, muscle
Photomicrograph – A photograph taken of an object
cell, bladder, muscle, renal system.
magnified under a microscope.
178
we now know that the ultrastructure is highly organised Cell ultrastructure is so complex and highly organised
and composed of many different bodies carrying out that a separate branch of science has arisen – cytology,
their own functions. the study of cells. In this unit you will learn about the
Do you remember the definition of an organ? structure and functions of the cell membrane, the
The very tiny bodies inside a cell are known as organelles in the cytoplasm, and the nucleus.
organelles because they have different physical
(and chemical) compositions and carry out their Cell (or plasma) membrane
own functions. The electron microscope shows the cell membrane
Although you will learn about a typical human cell, to be a phospho-lipid-protein bi-layer. The lipids are
there are actually lots of different types of cells each small, fatty molecules in two layers (bi-layer), with
with their own characteristics. The ‘typical cell’ exists larger protein molecules inserted at intervals partly or
only for study purposes and has no specialisation. completely through the bi-layer. The lipid molecules are
When studying actual cells in the body, you must phospholipids; the phosphate head is water soluble and
therefore adapt your knowledge to the specific type two lipid chains are insoluble in water. This is why the
of cell being considered. For example, a mature red two layers align themselves, with the lipid chains facing
blood cell does not have a nucleus, so any description one another. The fluid surrounding cells (called tissue
of the ultrastructure of a red blood cell would not fluid) and the cytoplasm are both watery environments
include the nucleus. next to the phosphate heads (see Figure 5.2, next page).
Living material making up a whole cell is called Protein molecules often form channels through the
protoplasm and this is subdivided into the cytoplasm membrane for substances to pass to and from the cell.
and nucleus. The protein molecules also act as identity markers or
reception sites for other molecules such as hormones,
Under the light microscope, cytoplasm appears
which are important to those cells. This structure
granular with no distinct features. This is the site of
is often termed the ‘fluid mosaic model’ of the cell
most complex chemical reactions, mainly directed by
membrane.
the nucleus, which is also responsible for inherited
characteristics. The nucleus is a dark body, usually Cytoplasm
centrally placed; a smaller, darker spot, the nucleolus, Cytoplasm is a semi-fluid material likened to a gel and
is often visible. Both the whole cell and the nucleus are capable of flowing slowly. Many chemical reactions
surrounded by a membrane, which appears as a single are carried out here. The collective term for these
line (see Figure 5.1). reactions is metabolism and you will find that this term
is frequently used in physiological and biological texts.
Plasma (cell) Cytoplasm Complex storage sugars such as glycogen and melanin
membrane
Nuclear
membrane Key terms
Organelle – A tiny body inside a cell, which carries out its
own functions.
Nucleus – The central part of the cell, which is usually darker
than the rest because it absorbs stain quickly.
Protoplasm – The word means ‘first material’; the protoplasm
Nucleolus refers to anything inside the cell boundary. Cell or plasma
membrane surrounds the protoplasm.
Cytoplasm – The word means ‘cell material’; the cytoplasm
Nucleus refers to anything inside the cell boundary and outside the
nucleus.
Metabolism – The metabolism is the sum of all the chemical
reactions occurring in human physiology and these involve
Fig 5.1: Diagram of a cell viewed under a light microscope using or releasing energy from chemical substances.
(× 300)
179
Peripheral Glycoprotein
protein
Layers of
phospholipids
Integral
protein
Fig 5.2: Model of the structure of the cell membrane magnified several thousand times
(the dark pigment responsible for skin and hair colour) Cell organelles
are found in cytoplasm.
Organelles are various components of a cell with a
Nucleus distinct structure and their own functions and can
This is usually the largest structure inside the cell and, be likened to miniature organs (hence the term
as it takes up dyes or stains very easily, it stands out ‘organelles’).
as a dark shape. Most cells have a single, central, Organelles include:
spherical nucleus but there are many variations. Some • mitochondria
muscle cells have many nuclei and are therefore • the endoplasmic reticulum
called ‘multinucleate’; some red blood cells have lost
• the Golgi apparatus
their nucleus during development and are said to be
‘anucleate’; and some white blood cells have distinct, • lysosomes.
lobed nuclei. Apart from red blood cells (which cannot Before looking at the organelles in detail, you will see
reproduce and have a limited lifespan), most cells that in Fig 5.3 a diagram of a typical cell that might be seen
are separated from their nuclei will die. under the electron microscope; refer to the diagram
The nuclear membrane has a structure similar to that of as you learn about the organelles. Note that the
the cell membrane but contains gaps or pores, through magnification is still not sufficient to make out the full
which proteins and nucleic acids pass. When a cell is structure of the cell and nuclear membranes.
not dividing (known as ‘resting’) the nuclear material
appears like a thick, tangled mass and is called the
chromatin network. A smaller, darker sphere is
often visible, the nucleolus, and this is a source of
ribonucleic acid (RNA), one of the nucleic acids. There Key terms
may be more than one nucleolus present in some cells. Chromatin network – The dark tangled mass seen in the
When a cell is in the process of dividing, the chromatin nucleus of a resting cell.
network separates into distinct black threads known Ribonucleic acid (RNA) – A nucleic acid found in both the
as chromosomes. There are 23 pairs of chromosomes cell and the nucleus. RNA is responsible for the manufacture
in a human cell, containing specific sequences of of cell proteins such as pigments, enzymes and hormones.
deoxyribonucleic acid (DNA), another nucleic acid, Chromosomes – Long threads of DNA and protein seen in
which is responsible for all our inherited characteristics a dividing cell. They contain the genetic material or genes
responsible for transmitting inherited characteristics.
such as hair and eye colour. The sequences of DNA are
Deoxyribonucleic acid (DNA) – A nucleic acid found only
our genes.
in the chromatin network and chromosomes of the nucleus.
The nucleus controls nearly all the activities of the cell DNA is responsible for the control and passing on of
and has been likened to the architectural drawing or inherited characteristics and instructions to the cell.
blueprint from which the cell operates.
180
Mitochondrion Nuclear Smooth endoplasmic active cells (like muscle and

membrane reticulum liver cells) will have many more.
Mitochondria are concerned
Cell with energy release. Each
membrane
mitochondrion (singular) has
a double-layered membrane
like the cell membrane but the
inner layer is folded at intervals,
Ribosomes producing a series of ‘shelves’
or ridges known as cristae. The
enzymes responsible for the end
Cytoplasm stages of glucose oxidation (or
cell respiration) are located on the
cristae. The energy released from
Lysosomes Golgi Rough endoplasmic Nucleus glucose is trapped and stored
apparatus reticulum until required by a ‘chemical
Fig 5.3: A typical human cell appearance from an electron micrograph battery’ called adenosine
triphosphate (ATP). When energy
is required for building complex molecules or doing
Activity 2: Organelle recall work like contracting muscles, ATP breaks down to
adenosine diphosphate (ADP), releasing energy to
You may be feeling somewhat bewildered
build chemical bonds. The ADP is then recycled, to be
by these difficult terms that are also
hard to spell. Don’t be disheartened! It really is built up once more into ATP, using the energy released
surprising how quickly you can learn them if you from glucose. This occurs in the mitochondria.
keep repeating them over and over and pointing
them out in electron micrographs. When you feel
confident about recognising their shapes, try Key terms
adding their functions too. Your tutor will be able
Mitochondria – Spherical or rod-shaped bodies scattered in
to find different copies of electron micrographs
the cytoplasm and concerned with energy release.
and you can research your own for practice. One
image is included on page 182. Try identifying each Cristae – Folds of the inner layer of mitochondrial membrane
organelle on the image and list each one with its on which the enzymes responsible for the oxidation of
main function. glucose are situated.
Adenosine triphosphate (ATP) – A chemical in mitochondria
that is capable of trapping lots of energy in the last chemical
bond: for example, A-P-P~P, where P is a phosphate group
PLTS (an ordinary chemical bond) and ~ is a high energy bond.
Effective participator: You will demonstrate Adenosine diphosphate (ADP) – A chemical left after ATP
effective participation when planning and carrying has released its stored energy to do work.
out research on cell organelles.
ATP
Functional skills
Energy
Energy
ICT: You will use ICT skills to access, search for and released to
supplied
use information on cell organelles in different types of do work or
from
produce
cells. glucose
new
breakdown
materials
Mitochondria
ADP
Every cell in the body has at least 1000 of these
rod-shaped or spherical bodies, and very energy- Fig 5.4: Flow chart of energy production in cells
181
Cristae formed by folds components of living cells, they are sometimes called
in inner membrane Matrix ‘suicide bags’. Lysosomes can travel freely throughout
the cell and, by releasing their contents, they can
destroy old or damaged organelles and even entire
cells. Another of their functions is to destroy bacteria
and other foreign materials, such as carbon particles,
that enter the cell. They do this by taking the foreign
matter into their vesicles. After destroying the foreign
matter with their enzymes, the lysosomes release the
digested or broken-down material.
Outer
membrane
What can you see in this electron
Fig 5.5: Structure of a single mitochondrion micrograph of cells?
Endoplasmic reticulum
This can be shortened to ER. There are two variations,
called rough and smooth ER. ‘Endo-’ means ‘within’
and ‘reticulum’ is a technical term for ‘a network’. ER
is a branching network that fills the cell interior. The
membrane of the channels is similar in structure to
the cell membrane and continuous with the nuclear
membrane. The channels form passageways for
transporting materials to and from different parts of
the cell.
• Rough ER is so-called because it is studded with
tiny black bodies, known as ribosomes, and has
the function of making cell proteins and acting as Some types of white blood cells – phagocytes (literally
a temporary storage area. Sometimes sugars are ‘eating cells’) and monocytes – and tissue cells known
added to the proteins to make glycoproteins, in as macrophages (meaning ‘large eaters’) are loaded
secretions such as mucus. with lysosomes because their function is to destroy
• Smooth ER has no attached ribosomes and is bacteria, viruses and foreign material entering the
involved in the metabolism of lipids or fats. body cells and tissues.
Golgi apparatus Many disease-causing agents are thought to be

capable of damaging lysosome membranes, bringing
This appears as a series of flattened, fluid-filled sacs
about internal cell destruction.
stacked like pancakes. Many tiny fluid-filled globules
or bags lie close to the main stack and these are often Now try Activity 3 and, when you feel that your learning
known as vesicles. Golgi was a famous Italian scientist is complete, try the assessment activity which follows.
who specialised in cells and tissues in the nineteenth You can improve your work if you are not satisfied with
and twentieth centuries and this organelle takes its it.
name from him. It is believed that the Golgi apparatus
packages proteins for delivery to other organelles
Did you know?
or outwards from the cell in secretions. The Golgi The electron microscope enables you to see
apparatus is also responsible for producing lysosomes. extremely small objects to identify their structure
but it does not tell you what the structures do.
Lysosomes Researchers with a range of expertise (such as
Lysosomes can be found in all parts of the cell chemists, physicists and biochemists) have to separate
cytoplasm and are also small vesicles produced by part out the different structures and carry out many tests to
identify the functions of the tiny objects they observe.
of the Golgi apparatus. Because they contain powerful
enzymes capable of digesting all major chemical
182
Activity 3: Interpreting photographs of cells

Using a copy of the electron micrograph on the appears! Although you can carry out this
previous page and/or similar material from your tutor activity on your own, you can learn more with
and the labelled diagram in Figure 5.3 (on page 181), a ‘study buddy’ because you can check each other’s
match the different parts of a cell and the organelles. learning and interpretation of the cell parts. After
You can download some electron micrographs each ‘journey’ through the cell parts, check your recall
from the Internet as well. As you carry out this against this text and any class notes you may have. You
exercise, describe the appearance and the function and a small group of peers can carry out a ‘thought
of each part. You will soon realise that interpreting shower’ on the roles of cell organelles and carry out
photographs of real cells is more difficult than it research on any you are not sure of.
Using a large piece of paper, produce an annotated function without including any more detail
poster of a cell as it is seen under an electron than is covered in the text. Although you are
microscope. You must include the following not obliged to include a separate image of
organelles: nucleus, cytoplasm, mitochondria, smooth each organelle, your work will clearly be more
and rough endoplasmic reticula, Golgi apparatus and comprehensive if you do. If you download
lysosomes. material from the Internet you must show clearly
The notes accompanying the labels should include how you have adapted it to show your learning,
the main activities carried out by the organelles. as well as providing a detailed reference and
acknowledgement. It would be acceptable to
Grading tip obtain an image and label it carefully yourself to
show the relevant parts. Make sure that you use
P1 To achieve P1, you need to outline the functions colour and make the poster clear, attractive and
of the main cell components. This means interesting.
giving an overview of the cell structure and
1.3 Tissues is attached to a basement membrane for support

and connection. Part of the basement membrane
Tissues are groups of similar cells carrying out specific
is secreted by the epithelial cells. There are nerve
functions. In this unit you will learn about the following
supplies to epithelia but they are supplied with oxygen
tissues:
and nutrients from deeper tissues by diffusion. As
• epithelial they are surface tissues and exposed to friction, their
• connective capacity for growth and repair is greater than other
• muscle tissues and usually occurs during sleep.
• nervous. Simple epithelia
Epithelial tissues Simple epithelial cells may be squamous, cuboidal,
columnar or ciliated. Squamous epithelial cells are
Epithelia are the linings of internal and external
surfaces and body cavities, including ducts (tubes
or channels) carrying secretions from glands. They Key term
may be composed of several layers of cells, called
Diffusion – This is the passage of molecules from a high
compound epithelia, or just a single layer known as concentration to a low concentration.
simple epithelia. The lowest or bottom layer of cells
183
very flat, with each nucleus forming a lump in the

centre. The word ‘squamous’ means ‘scaly’, referring Key term
to the flatness of the cells. They fit together closely, Osmosis – The passage of water molecules from a region
rather like crazy paving. Clearly, such delicate thin cells of high concentration (of water molecules) to one of low
concentration through a partially permeable membrane such
cannot offer much protection and their chief function
as the cell membranes of simple epithelial cells.
is to allow materials to pass through via diffusion and
osmosis. Simple squamous epithelium is found in the
walls of: Columnar epithelial cells are much taller, with
slightly oval nuclei. They can often be associated
• lung alveoli
with microscopic filaments known as cilia and are
• blood capillaries then called ciliated epithelia. Cilia move in wave-
• Bowman’s capsule of nephrons. like motions, beating towards the orifices, and are
As their name suggests, cuboidal epithelial cells are commonly found associated with goblet cells, which
cube-shaped, with spherical nuclei. They often line secrete mucus in the respiratory and alimentary tracts.
ducts and tubes and can allow materials to pass The mucus traps unwanted particles like carbon, and
through in a similar way to squamous epithelia. They the cilia transport the flow of ‘dirty’ mucus towards the
often occur in glandular tissues making secretions. exterior.
They can be found in: Columnar cells are found lining:
• kidney tubules • the trachea and bronchi
• sweat ducts • villi in the small intestine.
• glands like the thyroid gland and breast tissue.
Nucleus
Plasma membrane
Surface view
Cytoplasm
Side view
Basement membrane Fig 5.6: Simple squamous epithelium
Cube-shaped cells Tall cells
Fig 5.7: Simple cuboidal and

columnar epithelia Basement membrane
184
Compound epithelia Various types of cells lie in a background material

The principal function of compound epithelia is to known as a matrix. The matrix may be liquid as in
protect deeper structures, and multiple layers of blood, jelly-like as in areolar tissue, firm as in cartilage,
cells hamper the passage of materials. The vagina, or hard as in bone. The matrix of a tissue is usually
mouth, tongue and oesophagus are lined by stratified secreted by the connective tissue cells.
epithelia consisting of layers of squamous, cuboidal The functions of these tissues are to transport materials
or columnar cells, which gradually become flattened (as in blood), give support (as in areolar tissue and
by pressure from below as they reach the surface. cartilage), and strengthen and protect (as in bone).
The lowest layer of cells on the basement membrane Many tissues contain different fibres secreted by the
actively divides and the older cells are pushed cells to provide special characteristics.
upwards. This type of epithelia is usually a pink colour In this unit you will learn about the connective tissues
and is often termed mucous membrane. of:
The skin has an outer layer of epithelium similar in • blood
structure to the stratified epithelium but with the
• cartilage
important addition of a layer of flattened dead cells on
• bone
the outside. This is known as the epidermis. As the cells
advance from the basement membrane, they gradually • areolar tissue
become filled with a protein called keratin and are • adipose tissue (fatty tissue).
said to be keratinised or cornified. This layer is vital to
Blood
prevent micro-organisms invading deeper structures,
Blood consists of straw-coloured plasma (the matrix), in
and it has a waterproofing effect on the skin. The skin
which several types of blood cells are carried. Plasma
can be variously coloured, with pigment produced by
is mainly water, in which various substances are carried,
pigment cells in the lowest layer. The pigment melanin
such as dissolved gases like oxygen and carbon
darkens under the influence of the sun. The numbers
dioxide, nutrients like glucose and amino acids, salts,
of pigment cells in the skin is genetically inherited,
enzymes and hormones. There is also a combination
although they can divide during exposure to sunshine.
of important proteins, collectively known as the plasma
The structure of the skin epidermis can be seen in
proteins, which have roles in blood clotting, transport,
Figure 5.8 below.
Connective tissues
These tissues are the most widely distributed in the Key term
body and lie beneath the epithelial tissues, connecting
Matrix – Background material in which various types of cells
different parts of the internal structure. lie.
Squamous
cells
Columnar
basal cells
Basement Fig 5.8: Section through stratified

membrane epithelium
185
defence against invading organisms (part of the

immune system) and osmotic regulation.
Key terms
The most common cells by far in the plasma are red Arterial blood – Blood flowing through arteries that are
blood cells, also known as erythrocytes. These are coming from the heart, usually carrying oxygenated blood to
very small cells with an elastic membrane, which is the tissues.
important because the membrane often has to distort Venous blood – Blood flowing through veins that are
to travel through the smallest capillaries. Erythrocytes returning blood to the heart from the tissues; the blood has
have no nucleus in their mature state (the loss left considerable amounts of oxygen behind to supply the
cells and is known as deoxygenated blood.
produces a depression in the top and bottom of the
cell, hence their bi-concave shape), which provides
a larger surface area to be exposed to oxygen. They
are packed with haemoglobin, which gives them a
red colour. (This is why blood is red.) In oxygenated polymorphs, neutrophils and phagocytes). They are
blood (arterial blood), the oxyhaemoglobin is bright called granulocytes because they contain granules
red but, in deoxygenated blood (venous blood), after in their cytoplasm as well as lobed nuclei. They are
the dissolved oxygen is delivered to body cells, the capable of changing their shape and engulfing foreign
reduced haemoglobin is dark red in colour. material such as bacteria and carbon particles. This
Due to the absence of nuclei, erythrocytes cannot process is known as phagocytosis. A granulocyte
divide and have a limited lifespan of around 120 days. acts rather like an amoeba and is sometimes said to
White blood cells (or leucocytes) are larger, nucleated be amoeboid. Granulocytes, because of their ability
and less numerous. There are several types but the to engulf microbes and foreign material, are very
most numerous are the granulocytes (also known as important in defending the body against infection.
Can you identify the cells shown in

this photograph of human blood?
186
can leave the circulatory blood vessels to travel to

Did you know? the site of an infection and begin phagocytosing
The number of granulocytes rises significantly in
pathogens very rapidly.
infections, so a blood count can often be a valuable Thrombocytes are not true cells but are usually classed
indicator of infection when diagnosing illness. with the white blood cells. They are more commonly
called platelets. They are products of much larger cells
that have broken up and they have an important role in
Lymphocytes are smaller white blood cells with
blood clotting.
round nuclei and clear cytoplasm – they assist in
the production of antibodies. Antigens are found
on the surface coats of disease-causing microbes or Did you know?
pathogens and act as identity markers for different
Granulocytes, monocytes, platelets and red blood
types of pathogens (rather like name tags on a
cells are made in bone marrow but lymphocytes are
school uniform). Antibodies neutralise antigens and produced in lymphoid tissues.
prevent the microbes from multiplying. They can then
be phagocytosed by granulocytes and monocytes. Cartilage
Antibodies are chemically globulins (types of protein This is the smooth, translucent, firm substance that
carried in the plasma). protects bone ends from friction during movement,
In a completely different way from granulocytes, and forms the major part of the nose and the external
lymphocytes also contribute to the defence of the ear flaps, called pinnae. The matrix is secreted by
body because of their role in the production of cartilage cells called chondrocytes and is a firm but
antibodies. They form an important part of the immune flexible glass-like material of chondrin (a protein).
system. (‘Chondro-’ is a prefix associated with cartilage.) The
Monocytes are another type of white blood cell, cells become trapped in the matrix and sometimes
larger than lymphocytes. They also have large, round divide into two or four cells, giving a very characteristic
nuclei and clear cytoplasm. They are very efficient at appearance. It does not contain blood vessels and is
phagocytosis of foreign material and, like granulocytes, nourished by diffusion from underlying bone.
Fat-filled cells
Bone cells
Collagen
fibre Adipose
Channel
(for nerves and
Bone
blood vessels)
Cell
Areolar Cell
(loose)
Fibrous and hard
connective tissue
Fig 5.9: Other types of connective tissue Cartilage
187
Bone
Bone is a much harder substance than cartilage but it Key term
can be worn away by friction. The rigid matrix has two Collagen – Structural protein, generally in the form of fibres
for added strength.
major components:
• calcium salts, which form around collagen fibres
and give bone its hardness cells have multiplied to obscure other cells and fibres.
• collagen fibres, which offer some ability to bend When mature, an adipose cell becomes so loaded
under strain and prevent bone from being too with fat that the nucleus is pushed to one side and, as
brittle and therefore likely to fracture. fat is translucent, the cell takes on a distinctive ‘signet
ring’ appearance. Adipose tissue is common under
Osteocytes (or bone cells) are trapped in the hard
the skin and around organs such as the heart, kidneys
matrix on concentric rings called lamellae. A system of
and parts of the digestive tract. It helps to insulate the
these rings is known as a Haversian system or osteone.
body against changes of external temperature, acts as
(‘Osteo- ‘ is a prefix associated with bone.) Blood
a ‘hydraulic shock absorber’ to protect against injury,
vessels and nerves pass through the hollow centre of
and is also a ‘high-energy storage depot’.
each osteone.
Bone is designed to bear weight and the limb bones Muscle tissue
are hollow, like girders (the strongest mechanical Muscle is an excitable tissue because it is capable of
structures). Bone is also used to protect vital weaker responding to stimuli. There are three different types
tissues such as the brain, lungs and heart. Bones of muscle in the human body:
contain marrow in their central hollow and in some • striated
bones, marrow makes vital blood cells.
• non-striated
Areolar tissue • cardiac.
This is the most common tissue in the body and you Each is composed of muscle fibres that are capable
have probably never heard of it before! If you eat of shortening (or contracting) and returning to their
meat, you will have seen it many, many times. It is original state (known as relaxation). Contraction
the sticky, white material that binds muscle groups, causes movement of the skeleton, soft tissue, blood
blood vessels and nerves together. The matrix is semi- or specific material such as urine, food and faeces.
fluid and it contains collagen fibres and elastic fibres Muscle has both blood and nerve supplies.
secreted by the cells found in this loose connective
tissue. Elastic fibres give flexibility to the tissue, which
is located around more mobile structures. The deeper Did you know?
skin layer known as the dermis is a denser type of
Muscle activity generates heat and contributes to
areolar tissue, with extra fibres and cells. Areolar tissue maintaining the body temperature.
offers a degree of support to the tissues it surrounds.
Adipose tissue Striated muscle
Adipose is a technical term for fatty tissue and it is a Most striated muscle (also called voluntary, skeletal
variation of areolar tissue, in which the adipose (or fat) or striped muscle) is attached to the bones of the
Connecting tissue covering
Stripes or striations
Nuclei
Cylindrical muscle fibre
Fig 5.10: Microscopic appearance of striated muscle
188
skeleton, although some facial muscles are attached propel the food contents down the tract. This type of
to skin. Striated muscle makes up the familiar animal movement is known as peristalsis (see page 213).
meat seen in the butcher’s. This type of muscle will In the iris of the eye, one set of muscle runs radially
contract when it receives nerve impulses controlled by outward from the centre, like the spokes of a wheel,
conscious thought from the central nervous system while the other set runs in a circular fashion around the
– hence its alternative name of voluntary muscle. central pupil. This arrangement allows for the control
The name striated means ‘striped’; each individual of light entering the eye and the pupil is said to be
fibre shows alternate dark and light banding from the dilated (open) or constricted (narrowed).
muscle protein filaments from which it is made.
Cardiac muscle
Each fibre is cylindrical and multinucleate, lying
This type of muscle is found only in the four chambers
parallel to its neighbours. There may be hundreds
(atria and ventricles) of the heart. It is said to be
or thousands of fibres in a muscle, depending on its
myogenic because it can rhythmically contract without
size. Some fibres are 30 centimetres long and one-
receiving any nervous stimuli, and in this it differs from
hundredth of a millimetre wide. Muscle fibres contain
other muscle. The muscle cells branch repeatedly to
many thousands of mitochondria to supply ATP for the
form a network, through which contraction spreads
energy used in muscular contraction.
rapidly. Each cell has a central nucleus and is both
Non-striated muscle horizontally and vertically striped. The divisions
Although this type of muscle tissue (also called between cells are known as intercalated discs and are
involuntary, smooth or plain muscle) still contains specially adapted for transmission of impulses.
protein filaments, they do not lie in an ordered pattern Under normal healthy circumstances, cardiac muscle
and therefore do not produce the banding that is is not allowed to contract myogenically because
characteristic of striated muscle. The muscle fibres are the atrial or upper chamber muscle has a different
spindle- or cigar-shaped, with single central nuclei, contraction rate to that of the lower ventricular muscle
and dovetail with each other. This type of muscle tends and this would lead to inefficient and uncoordinated
to form sheets and, although still requiring nervous heart action. The autonomic nervous system controls
stimulation to effect contraction, this is not under the rate of contraction via the nerves in order to adapt
conscious thought, but supplied by the autonomic the flow of blood to specific circumstances such as rest
nervous system (which is why it is called involuntary and exercise.
muscle). This type of muscle is found around hollow
internal organs such as the stomach, intestines, iris
of the eye, bladder and uterus; it is not attached to
bones. Key terms
Non-striated muscle frequently occurs in two sheets Central nervous system – The brain and spinal cord.
running in different directions, known as antagonistic Autonomic nervous system – Part of the nervous system
muscles. In the digestive tract, one sheet runs in a responsible for controlling the internal organs.
circular fashion around the intestines, while another Antagonistic muscles – One muscle or sheet of muscle
outer sheet runs down the length. The two sheets are contracts while an opposite muscle or sheet relaxes.
said to work antagonistically (against each other) to
Nucleus
Connecting
tissue
Smooth
muscle cells
Fig 5.11: Non-striated muscle tissue
189
Intercalated discs Nervous tissue

Nervous tissue is only found
in the nervous system and
consists of the brain, spinal
Branching
cord and nerves. Receiving
network stimuli from both external and
internal sources, it serves to
create consistency (particularly
regarding homeostasis), co-
ordination, and communication
Striations Central nuclei between different parts of the
Fig 5.12: Cardiac muscle tissue body. The nervous system
interprets stimuli from the sense organs so that vision,
hearing, smell and the other senses become apparent.
Activity 4: Placing tissues
within organs
Working in pairs, use the Internet, bioviewers or Key term
reference books to research the different tissues Homeostasis – The process of maintaining a constant
found in four organs of the body (take two each). internal environment despite changing circumstances. For
Write a description of each tissue and outline the example, the pH, temperature, concentrations of certain
role it plays within the named organ. chemicals and the water content in the fluid surrounding
body cells (the internal environment) must be kept within a
narrow range even when you are consuming acids (vinegar,
lemon juice), are in a freezing climate, or are doing vigorous
exercise.
PLTS
Independent enquirer: This activity will enable you
to demonstrate independent enquiry skills when you Nervous tissue is composed of:
plan and carry out research on the tissues of the body, • neurones – highly specialised nerve cells that
and analyse and evaluate information on tissue types.
transmit nervous impulses. They are present only in
the brain and spinal cord, but their long processes
(nerve fibres) form the nerves
Functional skills
• neuroglia – connective tissue cells, intermingled
ICT: You will use ICT skills to access, search for and with neurones in the brain and spinal cord, that
use information on different types of tissues in organs.
offer support and protection.
Cell body of
neurone
Dendrites
Axon
Nucleus Myelin sheath Nucleus in

myelin sheath
Fig 5.13: General features of a neurone
190
Produce a written assignment that shows an overlying adipose tissue and skeletal muscle.
understanding of the main tissue types and the roles Describe keratinised stratified epithelium, adipose
they play in two named organs. tissue and striated muscle and their roles in the
Two organs you could choose might be the stomach functioning of the skin.
and skin. Here are some examples of tissue types that
occur in these two organs: Grading tip
1 The stomach has three layers of non-striated P2 To achieve P2, you need to outline the structure
muscle in its wall and an inner lining of columnar of the main tissues of the body. You could
epithelium with goblet cells. The tissue connecting supplement your written description with large
the lining with the muscular coat is areolar tissue. annotated diagrams of the named organs
Describe these three tissues and their roles in the to provide illustrated accounts. Ensure that
functioning of the stomach. the functions you describe are specific to the
named organs and not general.
2 Skin has an outer layer of keratinised stratified
epithelium and a deeper layer of areolar tissue
PLTS
Independent enquirer: Planning and carrying out
research on the tissues of the body will help you
demonstrate your enquiry skills; this activity will also
help you show that you can analyse and evaluate
information on tissue types.
Table 5.1: The major organs and where they can be found
Body organ Associated Location description

body system
Heart Cardiovascular Middle of the chest, between the lungs, with apex lying to the left.
Lungs (2) Respiratory Each lung lies to one side of the heart, filling the chest or thorax.
Brain Nervous Within the skull of the head.
Stomach Digestive Abdominal organ lying just beneath the diaphragm on the left side.
Liver Beneath the diaphragm, mainly on the right side but also overlapping part of
the stomach.
Pancreas Lies just below the stomach, in a curve of the duodenum.
Duodenum C-shaped part of the small intestine immediately beyond the stomach.
Ileum Long coiled tube, which follows the duodenum in the abdomen.
Colon Begins after the ileum in the right pelvic area, runs up the right side to the
liver, then sweeps across under the stomach and down the left side of the
abdomen to end at the rectum in the lower central pelvic area.
Kidneys (2) Renal One on each side of the posterior wall of the abdomen. The upper poles of
the kidneys lie just inside the ribs. The left kidney is slightly higher than the
right due to the bulk of the liver.
Bladder Lies centrally in the lower pelvis at the front.
Ovaries (2) Reproductive One on each side of the posterior wall of the pelvis, below the kidneys.
Testes (2) Below the pelvis, between the upper legs, one each side of the penis in a
skin bag called the scrotum.
191
Did you know?

The human trunk is divided into three body cavities. Inferior vena Aorta
The upper chest or thorax is separated from the larger cava
abdomen (often called inaccurately the stomach Renal
or ‘tummy’) by a fibro-muscular sheet known as the vein
Kidney
diaphragm. Only the oesophagus or gullet, and the
chief artery and vein (aorta and vena cava), penetrate
the diaphragm. The lower, narrower part below the
abdomen is the pelvis. There is no physical separation
Renal
(like the diaphragm) between the abdomen and the
artery
pelvis.
1.4 Body organs Ureters

You need to know the locations of major body organs;
most of these will be illustrated in detail later in the
unit. A quick reference list can be found in Table 5.1
(page 191).
The structure and functions of the skin will be
described on pages 221–222. Bladder
Sphincter muscle
1.5 Body systems
Urethra
Fig 5.14: Gross structure of the renal system

You are required to learn the gross structure of ten
body systems. Some systems will be considered in
much greater detail later in the chapter. You will find the
gross structure of the cardiovascular system included on
pages 199–206. The gross structure of the respiratory
system is included on pages 206–209 and that of the
digestive system on pages 210–212. Remember, gross Key terms
structure is only what the eye can see. Organ – A collection of different tissues, such as the heart or
the brain, working together to carry out specific functions.
The renal system
Body systems – A collection of organs with specific functions
The renal system consists of two kidneys with emerging in the body.
tubes (called the ureters) running down the posterior Artery – A blood vessel coming from the heart, usually
abdominal wall to a single pelvic collecting organ, the carrying oxygenated blood to the tissues.
bladder. The passage from the bladder to the exterior Vein – A blood vessel returning blood to the heart from the
is via the urethra, and the flow of urine is controlled by tissues; the blood has left considerable amounts of oxygen
a sphincter muscle located just below the bladder. The behind to supply the cells and is known as deoxygenated
kidneys are supplied by short renal arteries coming off blood.
the main artery of the body, the aorta. Renal veins take
the blood from the kidneys straight into the vena cava,
the main vein of the body.
192
The nervous system Brain
The nervous system comprises the central nervous Hypothalamus

Pituitary gland
system (the brain and spinal cord) and the peripheral
nervous system, the nerves running to and from the
brain (cranial nerves) and spinal cord (spinal nerves). Thyroid gland
A chain of ganglia runs close to the spinal cord and is Parathyroid
associated with the autonomic nervous system, which glands
controls internal organs. Autonomic nerve fibres are
also contained within the peripheral nerves. Thymus gland
Adrenal
glands
Cerebrum (brain)
Islets of
Cerebellum and Langerhans in
brain stem the pancreas
Ovaries in
the female
Testes in the
Spinal cord male
Peripheral Fig 5.16: Gross structure of the endocrine system

nerves
The reproductive system
Males and females have different reproductive organs,
as these serve different purposes.
Female reproductive system
This system comprises two ovaries, each with an
emerging oviduct (or fallopian tube) connecting to the
thick-walled uterus (or womb). The neck of the uterus
protrudes into the muscular vagina and this opens to
the exterior at the vulva. Two fleshy folds, known as the
labia, conceal the vaginal orifice.
Fallopian
tube
Ovary
Fig 5.15: Gross structure of the nervous system
Uterus
Cervix
The endocrine system

This is a collection of ductless glands scattered
throughout the body. Endocrine glands pass their Vagina
secretions (known as hormones) directly into the
bloodstream so they are always adjacent to blood
vessels. Fig 5.17: Gross structure of the female reproductive system
193
Male reproductive system

Two testes hang in a skin sac called the scrotum, Cervical lymph nodes
just outside the abdomen, and are connected by
long tubes (each known as the vas deferens) to Axillary lymph nodes Lymphatics of
Thoracic duct mammary gland
the urethra. The urethra is much longer than that
Cisterna chyli Lumbar lymph nodes
of the female and enclosed in an organ called the Lymphatics of Pelvic lymph nodes
penis. Two columns of erectile tissue lie alongside upper limb
Inguinal lymph nodes
the urethra in the penis. Two pairs of glands, the
seminal vesicles and Cowper’s glands, pour their
secretions into the vasa deferentia (plural), close
Lymphatics of lower limb
to the bladder. A single ring-shaped gland, called
the prostate gland, also adds secretions and is
located around the upper part of the urethra,
just below the bladder. The urethra and vasa
deferentia unite within the prostate gland.
Fig 5.19: The lymphatic system
Bladder
Ureter
Spermatic cord Vas deferens lymph vessel passes through at least one lymph node
Seminal vesicle (sometimes mistakenly called ‘glands’) and usually
more than one. There are hundreds of lymph nodes all
Prostate gland
over the body, often associated in groups. Lymphoid
tissue also occurs in specialised areas more associated
with potential sources of infection, such as the tonsils,
Erectile tissue
adenoids, small intestine, spleen and thymus gland.
Penis
Epididymis
Tiny lymphatic vessels, called lacteals, are present in
the villi of the small intestine (see Figure 5.34, on page
Testis 211) and are associated with the absorption of lipids
Scrotum
from the digestive tract.
Seminiferous tubules The musculo-skeletal system

Urethra The bones of the skeleton and their attached striated
Foreskin (Prepuce) muscles form this system. You are not required to
learn the names of the muscles or the individual
Fig 5.18: Gross structure of the male reproductive system bones, although you will probably know some of these
already.
The skeleton forms the framework of the body and is
composed of the:
The lymphatic system
• axial skeleton, in the midline of the body – the skull
Minute blind-ending lymphatic capillaries lie in tissue
and vertebral column or spine
spaces between body cells and join to larger lymphatic
vessels and eventually to two lymphatic ducts, the • appendicular skeleton, comprising the limb bones
thoracic duct and right lymphatic duct. These ducts and their girdles, which attach them to the trunk.
transfer the fluid collected in the lymphatic vessels The meeting place of two or more bones is known as a
back into the blood circulation close to the heart. Each joint and joints may be:
194
• fixed by fibrous tissue and therefore immoveable; White blood cells

this type occurs between several bones of the skull Spleen • lymphocytes
• slightly moveable because the bones are joined by • granulocytes
• monocytes
a pad of cartilage; this type is found in between the
vertebrae and joining the two halves of the pelvic
Lymphatic
girdle together vessels and Immune Thymus
• freely moveable with a more complex structure lymph nodes system gland
known as synovial joints; examples of synovial joints
are found at the shoulder, elbow, knee, hip, fingers
and toes. Other lymphoid
Adenoids tissue, e.g. in Tonsils
Striated muscle fibres are bound together to form intestine
muscles that pull bones into different positions by
contracting. Muscles never push so an ‘opposite’ Fig 5.20: The major components of the immune system
muscle is required to return the bones to their original
positions. As well as individual names (such as biceps
and triceps), muscles are often given names like
flexors and extensors, which describe their action. Activity 6: Researching
systems
In small groups, share out the body systems and
research their structure and how they work. Share
Key terms your findings with each other and provide useful
Flexors – These carry out flexion, which decreases the angle references.
between two bones; for example, the biceps (a flexor) raises
the forearm.
Extensors – These carry out extension, which increases
the angle between two bones; for example, the triceps (an
PLTS
extensor) straightens the forearm after flexion. Self-manager: Sharing out the work and organising
your own research in this activity may help you to
demonstrate your self-manager skills.
Activity 5: Finding your own

muscles
Try bending and straightening your forearm and
1.6 Main functions of body
feel the muscles that increase in firmness as you systems
carry out this action. Identify the biceps and Interactions of different structures within
triceps muscles. Repeat the action but this time
raising and straightening your leg. Identify where
each system
the flexors and extensors are located. You will find this information in each section detailing
the different systems.
The immune system Activity 7: How systems

The immune system is more scattered than most interact
other systems and is often not included as a major
system in textbooks. It is a collection of cells, tissues Working in small groups of three or four, research
how two or more systems work together, making
and proteins that protects the body from invasion by
posters for records and then feed back to the rest
harmful micro-organisms. Figure 5.20 (above) illustrates of the class in a plenary session.
the main components of the immune system.
195
Table 5.2: The main functions of the 10 body systems
Name of Main functions

system
Cardiovascular • Major transport of materials to and from cells
system • Distributes heat around the body and assists in temperature regulation
• Defence of the body
• Water regulation
Respiratory • Maintains oxygen supply to cells
system • Removes carbon dioxide and water from the body
Digestive • Reduces complex food molecules to simple substances capable of being absorbed and
system delivered to cells
• Removes undigested waste at intervals
• The liver is the main producer of important chemicals
Renal system • Removes excess water and salts
• Eliminates nitrogen-containing waste in the form of urea
• Assists in the production of new red blood cells
• Involved in the maintenance of blood pressure
Nervous • Receives and interprets information from the environment
system • Controls and co-ordinates the internal organs
• Associated with the endocrine system
• Reflex actions protect the body from injury
Endocrine • Controls and co-ordinates organs
system • Maintains blood glucose, water and salt levels
• Assists in reproduction and growth
Reproductive • Produces gametes that can create new life when united with a gamete from the opposite sex
system • Assists in growth
• Responsible for secondary sexual characteristics
Lymphatic • Removes excess tissue fluid and proteins from spaces between cells
system • Defence of the body
• Transports fatty acids from the digestive system
Musculo- • Effects movement (with the nervous system)
skeletal • Stores calcium
system • Protects vital organs
• Supports organs
• Manufactures many blood cells
Immune • Defends against invasion by micro-organisms
system • Has an anti-cancer role
• Rejects material perceived as ‘foreign’
196
Imagine that you wish to explain to individuals using a • musculo-skeletal

local health centre how the body works, and produce • immune.
a series of annotated diagrams to provide an overview
2 Download images of the more complicated
of each body system.
systems from the Internet. Delete any prepared
1 On large sheets of paper, draw your own version text and make the images your own by inserting
of the gross structure of each body system listed labels and functions as in question 1 above.
below, labelling each part with its name and
adding a short description of the function of the Grading tip
part.
P3 To achieve P3, you have to outline the gross
Body systems to be included are: structure of all the main body systems. You
• cardiovascular need not include any details of microscopic
• respiratory structures (such as alveoli or nephrons), as these
• digestive are not part of the gross structure.
• renal Make sure each image you download is of good
quality and clear enough to label.
• nervous
• endocrine The renal, female reproductive and endocrine
systems are particularly suitable for your own
• reproductive – male and female diagrams, as they are less complex than others.
• lymphatic

Creative thinker: You can demonstrate creative ICT: Presenting posters that are fit for purpose and
thinking by generating ideas and exploring possibilities audience demonstrates ICT skills.
when providing information about body systems.
Self-manager: By using initiative and perseverance
when preparing posters of body systems and
submitting the posters to a deadline around other
commitments, you will show self-management skills.
Reflective learner: You will show you are a reflective
learner when preparing the diagrams of the body
systems to display in a health centre.
197
2 Understand the functioning of body systems

associated with energy metabolism
The role of energy within the cell, respiratory, released, the energy in the bond is released as well.
cardiovascular and digestive systems has already been Heat, light, sound, electrical and nuclear are other
briefly discussed. This section will investigate the forms of energy.
concept of energy in more detail.
Did you know?

2.1 Energy laws
Energy can be defined easily as the capacity to do Placing a lump of coal or wood on a fire illustrates the
energy laws. As the coal burns, the chemical energy
work – but energy doesn’t just appear, it must come
contained within it is released and transformed into
from somewhere! heat, light and sometimes sound (crackling). The
The first law of thermodynamics, sometimes known as chemical energy in the wood or coal has come from
the conservation of energy, states that: the sun, and the tree has converted this into stored
glucose by means of photosynthesis.
Energy can be transformed (changed from one form
to another), but cannot be created or destroyed.
The first part of this law refers to the transformation of
energy from one form into another. The second form
2.3 Energy metabolism
may not be of use or be capable of being measured. The role of energy in the body
At this stage, you may be wondering why there is so
2.2 Forms of energy much emphasis on energy and be thinking that it is
Energy can exist in several forms and chemical energy only concerned with muscular activity and movement.
is the most common. The energy is in the chemical However, energy is also needed to circulate blood,
bond that unites atoms or molecules with each other. lymph and tissue fluid throughout the body; it is
When a new bond is made between two atoms, energy necessary for breathing and taking in oxygen; it is
is required for its formation and this is usually in the necessary for making new cells for carrying out growth
form of heat, although light and electrical energy and repair; it is used to transmit nerve impulses so that
can be used. When a bond is broken and atoms are we can respond to changes in the environment; and it
is needed to build different complex molecules such
as enzymes and hormones from the simple molecules
produced after digestion of food.
PLTS
Creative thinker: You can show creative thinking Anabolism and catabolism
ability when considering different types of energy. You have already learned about metabolism and
how some chemical reactions involve breaking down
Case study: An illustration of energy forms

Ian slid down a climbing rope in the gym wearing only 1 Which two items were in contact to cause
a vest and shorts. Later that day the skin on his hands the friction burn?
and inner legs became red, swollen and painful. Ian 2 Name the two forms of energy in the slide and the
had friction burns from the slide. The kinetic (motion) relationship between them.
energy had been partly converted into heat energy,
which had caused the burn. Friction is the resistance 3 What is the name given to the law associated with
to motion when two bodies are in contact. This was this example?
neither useful nor measurable! 4 What type of energy had Ian used to climb the
rope?
198
molecules and releasing energy – these are catabolic

reactions. The oxidation of glucose inside cells is Did you know?
a catabolic reaction and there are many more. The Very large numbers of mitochondria are found in
opposite process is building complex molecules tissues that use a lot of energy such as muscle tissues.
from simple substances and using energy – these are
anabolic reactions.
Reflect
2.4 The cardiovascular system
The heart is a muscular pump that forces blood around
Athletes are regularly tested for banned
the body through a system of blood vessels – namely
substances that might make them perform better
than other competitors. Many of these tests arteries, veins and capillaries. Blood carries dissolved
look for anabolic steroids which build up muscle oxygen to the body cells and at the same time
tissue. removes the waste products of respiration (carbon
Metabolism = catabolism and anabolism dioxide and water). However, blood is also important
in distributing heat around the body, along with
hormones, nutrients, salts, enzymes and urea.
Activities involved in supplying energy to the The structure of the heart

The adult heart is the size of a closed fist, located in
cells the thoracic cavity between the lungs and protected by
The activities involved in energy supply include the the rib cage. It is surrounded by a tough membrane,
roles of the cardiovascular, respiratory and digestive the pericardium, which contains a thin film of fluid to
systems. prevent friction (remember Ian and the rope!)
You will learn about these systems in more detail in the The heart is a double pump, each side consisting
sections that follow but we will start with a brief overall of a muscular upper chamber (the atrium) and a
view of how they interact: lower chamber (the ventricle). The right side of the
• The digestive system is responsible for taking in heart pumps deoxygenated blood from the veins
food and water and, using enzymes, breaking up to the lungs for oxygenation. The left side pumps
complex molecules into simple soluble materials oxygenated blood from the lungs to the body, and the
that are capable of passing into the adjacent two sides are completely separated by a septum. The
capillaries of the cardiovascular system. blood passes twice through the heart in any one cycle
• The cardiovascular system transports these and this is often termed a ‘double circulation’.
simple materials to the liver and body cells via the
bloodstream, driven by the pumping action of the
Lungs
heart.
Pulmonary Pulmonary circulation Pulmonary
• At the same time, the respiratory system constantly artery vein
refreshes lung oxygen and disposes of waste
products (such as carbon dioxide and water)
through the process of breathing. Dissolved
oxygen passes through the thin alveolar walls into Right Left
heart heart
the bloodstream and is transported to cells. Body pump pump
cells thus have a constant delivery of raw materials,
such as glucose and other nutrients and dissolved
oxygen, so that the breakdown (catabolic) process
of glucose oxidation can take place and release Vena cava Aorta
Systemic circulation
energy to do work. This takes place initially in the
cytoplasm and is completed in the mitochondria. Body
(non-lung tissues)
The released energy is trapped as chemical energy in
ATP (see ‘Mitochondria’ on page 181). Fig 5.21: The double circulation of the heart
199
A schematic diagram showing the double circulation, the rest of the body. In many diagrams of the heart,
with the heart artificially separated, is shown in Figure these are treated as one vessel.
5.21 (page 199). Each of the four heart chambers has a It is important that the blood flows in only one
major blood vessel entering or leaving it. Veins enter direction through the heart so it has special valves to
the atria, and arteries leave the ventricles. ensure that this happens. There are two sets of valves
between the atria and the ventricles, one on each
First rib side. Sometimes these are called the right and left
atrio-ventricular valves but the older names are also
Sternum
used – the bicuspid, or mitral (left side), and tricuspid
(right side) valves. These names refer to the number
of ‘flaps’, known as cusps, that make up the valve; the
bicuspid has two cusps and the tricuspid has three
cusps. Each cusp is fairly thin so, to prevent them
turning inside out with the force of the blood flowing
by, they have tendinous cords attached to their free
ends and these are tethered to the heart muscles of
the ventricles by small papillary muscles. The papillary
muscles tense just before the full force of the muscle in
the ventricles contracts, so the tendinous cords act like
guy ropes holding the valves in place.
The two large arteries, the pulmonary and the aorta,
Fig 5.22: The location of the heart
also have exits guarded by valves called semi-lunar
valves (so-called because the three cusps forming each
valve are half-moon shaped). These valves are needed
Did you know?
because when the blood has been forced into the
Atria have veins entering and ventricles have arteries arteries by the ventricular muscle contractions, it must
leaving. A and V for each chamber – NEVER two As or not be allowed to fall back into the ventricles when
two Vs. they relax. These valves are also called the pulmonary
and aortic valves.
The circulation to and from the lungs is known as the
pulmonary circulation and that around the body is the
systemic circulation. Arteries are blood vessels that Did you know?
leave the heart, while veins take blood towards the
It is easy to recall which side each valve is on if you
heart. think that the TRIcuspid is on the RIghT side, a
In the pulmonary circulation, the pulmonary artery rearrangement of the letters TRI, so the bicuspid must
carrying deoxygenated blood leaves the right ventricle be on the left!
to go to the lungs. You will realise that it must divide
fairly soon after leaving the heart because there are
two lungs to be supplied – hence the right and left How to work out the left and right sides of the
pulmonary arteries. The pulmonary veins (there are heart
four of them), now carrying oxygenated blood, must Sometimes learners are confused about the correct
enter the left atrium. labels for the heart chambers. When you look at an
The main artery to the body leaving the left ventricle image in front of you, it is like a mirror image so the
is the aorta and the main vein bringing blood back to left side of the image is opposite your right hand and
the heart from the body enters the right atrium and is vice versa. A paper-based image can be placed facing
the vena cava. The vena cava has two branches: the outwards on the front of your chest to make the sides
superior vena cava returning blood from the head and the same as your left and right hands. You do need to
neck, and the inferior vena cava returning blood from know which is your right and left hand though!
200
supply to organise and co-ordinate the contractions to

Activity 8: Hearing ensure that the heart is an efficient pump. The heart
heartbeats muscle has its own blood supply, provided by the
coronary arteries and veins.
Using a stethoscope over the heart area, either
on your own or with a partner, listen for the The muscular walls of the atria are much thinner than
heartbeat. Try to count the number of beats you the ventricular walls, as the flow of blood is aided by
hear in one minute. What does each beat sound gravity and the distance travelled is merely from the
like? atria to the ventricles. The ventricles are much thicker
than the atria but they also differ from each other. The
right ventricle is about one-third the thickness of the
A heartbeat makes a ‘lubb-dup’ sound, with a very
left ventricle because this has to drive oxygenated
short interval between each beat. Valves, like hands
blood around the whole of the body including the
clapping, make sounds when closing not opening.
head and neck, which is against the force of gravity.
‘Lubb’ represents the atrio-ventricular valves closing
The right ventricle only has to deliver blood a short
while ‘dup’ is the sound made by the semi-lunar valves
distance – to the lungs on either side of the heart.
closing. In some people, swishing sounds can be heard
between heart sounds and these are called heart
murmurs. All murmurs should be investigated but most Activity 9: Comparison of
are not related to disease. Murmurs are the result of
disturbed blood flow.
distances travelled
Heart muscle, as you learned on page 189, is cardiac With a partner, measure the distance from your
muscle, composed of partially striped interlocking, heart to one of your big toes, and compare this
branched cells. It is myogenic, which means that it with the distance from your heart to one lung.
is capable of rhythmic contractions without a nerve Now you understand the reason for the much
supply. However, the atrial muscle beats at a different thicker muscle of the left ventricle.
pace from the ventricular muscle so it needs a nerve
Aorta
Superior vena cava
Branch of
pulmonary artery
Branch of
pulmonary vein
Left atrium
Bicuspid valve
Pulmonary valve (mitral valve)
Aortic valve
Right atrium
Left ventricle
Tricuspid valve
Septum
Right ventricle
Muscle
Inferior vena cava
Aorta
Fig 5.23: A section through the heart
201
The cardiac cycle 5 As the blood leaves the ventricles, the muscle
starts to relax. For a fraction of a second blood falls
The cardiac cycle comprises the events taking place
backwards, catching the pockets of the semi-lunar
in the heart during one heartbeat. Taking the average
valves and making them close (the second heart
number of beats in a minute (or 60 seconds) at rest to
sound – dup).
be 70, then the time for one beat or one cardiac cycle
is 60 divided by 70 seconds, which works out at 0.8 6 With the ventricles in diastole, the atrio-ventricular
seconds. You must remember that this is based on an valves are pushed open with the blood that has
average resting heart rate. When the heart rate rises been filling the atria. When the ventricles are about
to say 120 beats during moderate activity, the cardiac 70 per cent full, the atria contract to push the
cycle will reduce to 0.5 seconds. As you can see, the remaining blood in rapidly and the next cycle has
higher the heart rate, the shorter the cardiac cycle, begun.
until a limit is reached when the heart would not have You can see that when the chambers are in diastole
time to fill between successive cycles. and relaxed, they are still filling. The heart is never
empty of blood. The cycle is continuous. With a high
1 cycle
heart rate, it is the filling time that has shortened.
Atria
Ventricles Activity 10: Changes during

1 square equals 0.1 second exercise
Run on the spot for a few steps and listen to the
Atrial systole 0.1 second Systole heartbeat again. What do you notice? Count the
Atrial diastole 0.7 seconds heart rate again in one minute.
Ventricular systole 0.3 seconds
Diastole Copy the set of boxes similar to those in Figure 5.24
Ventricular diastole 0.5 seconds
and discover how much time the atria and ventricles
have to fill when the heart rate is at the new level.
Fig 5.24: The timing of events in the cardiac cycle Work out the new value for the length of the
cardiac cycle and shade in the boxes for atrial and
The cardiac cycle appears in Figure 5.24 as a series of ventricular systole. On your chart, mark clearly the
boxes, each one representing 0.1 seconds, to show places where the heart sounds will be heard.
the events occurring in the heart; red boxes signify
when contraction is occurring and green boxes signify
relaxation time. The technical term for contraction
is systole and the term for relaxation is diastole. The Heart rate and stroke volume
activity of the atria is shown on the top line and the The cardiac output is the quantity of blood expelled
ventricles at the bottom. from the heart in one minute. To calculate this, you
The events in the cardiac cycle can be described in need to know the quantity of blood expelled from the
stages as follows: left ventricle in one beat (known as the stroke volume)
1 Both atria contract, forcing blood under pressure and the number of beats in one minute (or the heart
into the ventricles. rate). The average individual has a stroke volume of
70 cm3 and a heart rate between 60 and 80 beats per
2 Ventricles are bulging with blood and the increased
pressure forces the atrio-ventricular valves shut
(giving rise to the first heart sound – lubb).
Key terms
3 Muscle in the ventricular walls begins to contract,
Cardiac output – The volume of blood forced out of the
pressure on blood inside rises and forces open the heart in one minute.
semi-lunar valves in the aorta and pulmonary artery.
Stroke volume – The volume of blood forced out of the
4 Ventricular systole forces blood into the aorta heart in one beat.
(left side) and pulmonary artery (right side). These Heart rate – The number of beats counted in one minute.
arteries have elastic walls and begin to expand.
202
minute. An individual who trains regularly might have a abbreviated to ‘sphygmo’ (pronounced sfigmo).
lower heart rate but a higher stroke volume. Systolic blood pressure corresponds to the pressure
Control of the cardiac cycle of the blood when the ventricles are contracting.
Diastolic BP represents blood pressure when the
The heart is controlled by the autonomic nervous
ventricles are relaxed and filling. BP is usually written
system, which has two branches – the sympathetic
as systolic/diastolic (for example, 120/80) and the
nervous system and the parasympathetic nervous
units are still mm Hg or millimetres of mercury. Newer
system. These two systems act rather like an
SI (International System of Units) units are kPa or
accelerator and a brake on the heart. The sympathetic
kiloPascals but few establishments have converted.
nervous system (NS) is active during muscular
work, fear and stress, causing each heartbeat to be The standard BP for a young healthy adult is taken as
stronger and the heart rate to be increased. The 120/80 mm Hg (or 15.79/10.53 kPa).
parasympathetic NS calms the heart output and is BP is highest in blood vessels nearer the heart, like
active during peace and contentment. the aorta and the large arteries. BP drops rapidly as
blood is forced through the medium-sized arteries
Case study: Individual and the arterioles, as these muscular vessels present
differences in matters of the considerable resistance. BP in the capillaries is very
low and blood in the veins has to be assisted back to
heart the heart by a so-called ‘muscle pump’. Veins in the
Cheryl trains every day by doing cross-country limbs are located between muscle groups and, as they
running, while Louis enjoys playing computer games. have thinner walls than arteries and possess valves at
1 Complete the table below. intervals, muscle action ‘squeezes’ the blood upwards
2 Explain the figures in the table in the light of in columns, and the valves prevent backflow. The
their different lifestyles. slightly negative pressure in the chest during breathing
3 Explain how exercise benefits the cardiovascular also tends to ‘suck’ blood back towards the heart.
system.
Heart features Cheryl Louis

Case study: Why did
Stroke volume (cm ) 3
95 72 Paul faint?
Resting heart rate 62 72
Paul fainted in an overcrowded stadium on a hot
(beats/minute)
day. He had to stand for a very long time. As the
Cardiac output (cm3/min) event had lasted a few hours, he had suffered from
a lack of circulating blood to his brain, which had
caused him to faint. His muscles were inactive for
a lengthy period, the blood had pooled in his leg
veins, and he had also lost a lot of body water
PLTS through sweating.
Reflective learner: This activity will show that you 1 Can you suggest a way of avoiding fainting in
can communicate learning in relevant ways when these circumstances?
considering the effect of exercise on the cardiovascular 2 Describe the effect on Paul’s legs.
system.
3 Why is fainting an effective way of managing a
lack of circulating blood to the brain?
The sympathetic NS is boosted by the hormone
adrenaline during periods of fright, flight and fight!
Blood pressure PLTS

The force blood exerts on the walls of the blood Creative thinker: Generating ideas and exploring
possibilities when producing information on venous
vessels it is passing through is known as the blood
return to the heart will allow you to demonstrate your
pressure (BP). It can be measured using a special piece creative thinking skills.
of equipment called a sphygmomanometer, often
203
Blood vessels metabolic activities of the body cells (such as dissolved

carbon dioxide and water).
Arteries and arterioles
Venules and veins
Arteries leave the heart and supply smaller vessels
(known as arterioles), which in turn supply the smallest Venules are small veins, which are supplied by
blood vessels, the capillaries. Arteries usually carry capillaries and feed into veins. The largest vein is the
oxygenated blood. The exceptions are the pulmonary vena cava, which enters the right atrium of the heart.
and umbilical arteries, which carry, respectively, Limb veins contain valves to assist the flow of blood
blood to the lungs and placenta in pregnancy for back to the heart because of the low BP in the veins.
oxygenation. The arterioles provide an extensive Veins have a much thinner muscular coat than arteries,
network to supply the capillaries and, in overcoming more fibrous tissue and an oval lumen. BP is low in
the resistance of these muscular vessels, BP drops veins and venules. Generally, veins carry deoxygenated
significantly at this stage. Arteries and arterioles blood, with the exceptions of the pulmonary and
are lined by endothelium (see simple squamous umbilical arteries, which bring blood back from the
epithelium on pages 183–184) and have a thick lungs and placenta respectively.
muscular coat. The lumen (or central hole) is round.
Capillaries
Did you know?
These single-cell walled vessels are supplied with
blood by the arterioles (see simple squamous A first-aider learns that arterial bleeding is bright red
epithelium on pages 183–184). Body cells are never and spurts out in time with the heartbeat; capillary
very far from capillaries, on which they rely for nutrients bleeding oozes from a wound and is most common,
while venous bleeding is dark red (less oxygen) and
and oxygen. A protein-free plasma filtrate is driven
flows at a low pressure.
out of the arterial ends of capillaries to supply the
cells with oxygen and nutrients. This is called tissue (or
interstitial) fluid. Tissue fluid re-enters the venous ends Each type of blood vessel has structural and functional
of the capillaries, bringing the waste products of the differences outlined in the table on the next page.
140
120
100
Pressure (mm Hg)
80
60
40
20
0
Aorta Large and small arteries Arterioles Capillaries Venules Small and large veins Venae cavae
Fig 5.25: Graph showing the fall in blood pressure as blood moves through the circulation
204
An artery A vein A capillary
Inner layer Inner layer

Endothelium Endothelium
Elastic tissue Valve Endothelium
Middle layer Middle layer

Smooth muscle Smooth muscle
and elastic tissue and elastic tissue
Outer layer Outer layer

(elastic and (elastic and
collagenous tissue) collagenous tissue)
Lumen
Lumen Lumen
Fig 5.26: Arteries, veins and capillaries
Table 5.3: The roles of different blood vessels
Arteries Veins Capillaries

Carry blood away from heart to Carry blood to heart from the organs Connect arteries to veins
organs
Carry blood under high pressure Carry blood under low pressure Arterioles and capillaries cause
greatest drop in pressure due to
overcoming the friction of blood
passing through small vessels
Have thick, muscular walls, round Have thin, muscular walls, oval
lumen lumen
Usually contain blood high in Usually contain blood low in oxygen, Deliver protein-free plasma filtrate
oxygen, and low in carbon dioxide and high in carbon dioxide and high in oxygen to cells and collect
and water water respiratory waste products (carbon
dioxide and water)
Large elastic arteries close to the Veins in limbs contain valves at Walls are formed from a single layer
heart help the intermittent flow from regular intervals and are sandwiched of epithelium cells
the ventricles become a continuous between muscle groups to help
flow through the circulation blood travel against gravity
Pulmonary and systemic circulations The systemic circulation comprises all the blood
vessels not involved in the pulmonary circulation.
The pulmonary circulation comprises the pulmonary
arteries (which supply the lungs with deoxygenated
blood from the right ventricle) and the pulmonary veins Structure and functions of blood
(which carry oxygenated blood back to the left atrium You have already learned about blood in the section
of the heart). on tissues on pages 185–187. You might like to read
Each organ has an arterial and venous supply that this section again before reading about haemoglobin
brings blood to the organ tissues and drains blood below.
away respectively. The link vessels supplying the cells Erythrocytes contain haemoglobin, an important
of the organ tissues are the capillaries. respiratory pigment that is essential for human life.
205
Lungs Doughnut-shaped
red blood cells
Pulmonary Pulmonary vein
artery
Monocyte
Right atrium Aorta
Left Platelets
Vena cava
atrium
Valve Left
ventricle
Circulation in
arms, head,
ribs, etc
Circulation Lymphocyte
in liver
Granulocyte or
Hepatic
phagocyte with
portal vein Stomach and lobed nucleus
intestines
Fig 5.28: Different types of blood cell
Kidneys
Breathing
Legs, The thorax, better known as the chest, is an airtight
abdomen, etc box containing the lungs and their associated tubes,
Deoxygenated Oxygenated the bronchi and the heart. Air can enter the thorax
blood blood
via the nose or the mouth; the nose is specially
Fig 5.27: A simplified diagram showing human circulation
adapted for the entry of air in breathing and is the
Haemoglobin is a very special iron-containing protein recommended route.
because: Role of the air passages in the nose
• in an environment containing a high concentration The nose contains fine bones on its side walls, which
of oxygen, the haem part of the molecule forms are curled like scrolls and covered with moist ciliated
a strong chemical bond with oxygen, becoming mucous membrane, rich in blood capillaries. This
oxyhaemoglobin. Oxyhaemoglobin is formed in the arrangement produces a large surface area over which
blood of the lung capillaries and carries oxygen to incoming air flows. During the passage through the
tissue cells nose, the air is warmed and moistened by the close
• in an environment containing a low concentration contact with the mucous membrane and filtered by the
of oxygen, the oxygen is released to pass down a ciliated cells. By the time the air reaches the throat,
concentration gradient to body cells. Haemoglobin it is warmed to almost body temperature, moistened
is now said to be reduced haemoglobin. to almost saturation point and most foreign materials
(such as dust, carbon particles and many pathogens)
2.5 The respiratory system have been filtered out.
Respiration can be artificially subdivided into four The structure and function of the trachea and
sections to facilitate study, three of which are grouped
under ‘External respiration’. These are:
bronchi
The trachea starts at the back of the throat, or pharynx,
A External respiration, comprising:
and divides into two main bronchi, each serving one
• Breathing
lung on each side of the heart. The first part of the
• Gaseous exchange trachea is specially adapted to produce sound and
• Blood transport. is called the larynx, or voice box. It is protected by a
B Internal or tissue respiration carried out inside body moveable cartilage flap, the epiglottis, which prevents
cells. food entering during swallowing.
206
When any material, such as a crumb, manages to pass called bronchioles, and even these are held open by
the epiglottis it provokes an intense bout of coughing minute areas of cartilage. This branching arrangement
by reflex action, to expel the foreign body. is often called the bronchial tree.
The trachea (or windpipe) and the bronchi have rings The inner lining of the trachea and bronchi is
of cartilage to prevent them collapsing; those in the composed of mucus-secreting and ciliated, columnar
trachea are C-shaped, with the gap at the back against epithelial cells. Mucus is the sticky white gel which
the main food tube, the oesophagus. This is because, traps dust particles that may cause infection.
when food is chewed in the mouth, it is made into
a ball shape (called a bolus) before swallowing. The
The structure and function of the lungs
bolus stretches the oesophagus as it passes down Each lung is a pale pink, smooth structure that closely
to the stomach, and whole rings of cartilage in the mimics the interior of half the chest in shape. Each is
trachea would hamper its progress. The gap is filled divided into a few lobes and has a hilum, or root, that
with soft muscle that stretches easily, allowing the marks the entry of the bronchus, blood vessels and
bolus to pass down the oesophagus. nerves on the inner side.
The lungs themselves have a spongy feel to them, and
Reflect are lined on the outside by a thin, moist membrane
known as the pleura. The pleura continues around the
It is not possible to breathe and swallow at the
inner thoracic cavity so that the two pleural layers slide
same time so, when helping someone to eat, you
must allow time for breathing between mouthfuls
over one another with ease and without friction. The
of food. surface tension of the thin film of moisture does not
allow the two layers to pull apart but does allow them
Each bronchus divides and sub-divides repeatedly, to slide. This means that when the chest wall moves
spreading to each part of the lung. The tiniest sub- when breathing, the lungs move with it.
divisions, supplying oxygen to air sacs in the lung, are
Key term
Surface tension – The pull of water molecules so that the
Larynx surface of the liquid occupies the smallest possible area.
Trachea
Cartilage rings
Section of ribs
Intercostal muscles
Outer edge of Bronchus

lung surface
Bronchiole
Lung
Pleural cavity Heart
Pleural membrane
Fibrous region of diaphragm

Diaphragm muscle
Fig 5.29: A section through the thorax showing the respiratory organs
207
Each bronchus, after repeatedly dividing, ends in a

group of single-layered globe-shaped structures called
alveoli, which look rather like a bunch of grapes on
Capillary from
a stem. The walls of the alveoli consist of very thin, pulmonary artery
flat, simple squamous epithelium, and each alveolus To pulmonary Red cells
vein
is surrounded by the smallest blood vessels known
as capillaries. The walls of the capillaries are also Film of Oxygen
moisture enters
composed of simple squamous epithelium, in a single red cells
layer. This means that the air entering the alveoli Epithelium
of alveolus
during breathing is separated from the blood by only
two single-layered, very thin walls. There are elastic Carbon
dioxide
fibres round the alveoli, enabling them to expand and escapes into
recoil with inspiration and expiration respectively. A alveolus
film of moisture lines the inside of each alveolus to Diffusion of oxygen
enable the air gases to pass into solution. As the two Diffusion of carbon dioxide
layers of epithelium are very thin and semi-permeable,
Fig 5.30: Gaseous exchange in the alveolus
the dissolved gases can easily and rapidly pass
through, in a process called gaseous exchange.
contraction of the diaphragm causes it to flatten. All
Ventilation, or breathing, and the respiratory these movements increase the volume of the thorax
muscles and the lungs and thus reduce the pressure inside the
Ventilation is the movement of air in and out of the lungs, causing air to rush in from the environment. This
thorax to replenish the oxygen supply and remove is known as inspired, or inhaled, air.
surplus waste products (carbon dioxide and water). Expiration
Ventilation has two phases, namely inspiration The main force in expiration during quiet breathing
(or inhalation) and expiration (or exhalation). The is the elastic recoil of the fibres around the alveoli,
movements in these phases are effected by respiratory and the relaxation of the diaphragm. However, during
muscles attached to the skeleton. Two sets of exertion, more forcible expiration can occur with
intercostal muscles run obliquely at right angles to the assistance of the other set of intercostal muscles
each other between the ribs, and the diaphragm is a contracting to move the ribs downwards and inwards.
dome-shaped muscle attached to the lower ribs and The volume of the thorax decreases, the pressure
separating the thorax from the abdomen. increases above that of the environmental air, and air
Inspiration rushes out.
When the intercostal muscles contract, the ribs move Normal ventilation rate is 16 to 20 breaths per minute
upwards and outwards and at the same time the but this rises significantly during exertion.
Inhalation Exhalation
Air expelled
Air drawn in
Trachea Trachea
Ribs Ribs
raised return
Lungs return to
Lungs original volume
expand
Rib Rib
Diaphragm
relaxes
Diaphragm
pulled down
Fig 5.31: Changes in the thorax during inspiration and expiration

208
Nervous impulses from the brain cause the

diaphragm and intercostal muscles to contract
Diaphragm flattens and the intercostal muscles Volume of the chest increases, so the
cause the ribs to move upwards and outwards pressure inside the chest must decrease
Surface tension between the pleural layers drags Air containing oxygen rushes down the trachea
the lungs with the chest wall. As they expand, and bronchi to equalise the pressure with the
they fill with air external environment – inhalation
After a few seconds, the nervous impulses stop Volume of the chest decreases, so pressure
arriving and the elastic tissue in the lung causes increases, causing air to rush out of the
recoil: the diaphragm rises and the ribs lower trachea – exhalation
The cycle repeats after a few seconds because the respiratory control
centre becomes active again, sending more nervous impulses
Fig 5.32: The process of breathing
Gaseous exchange Although the largest component of air is nitrogen

The composition of inspired air (which is the air around and this too passes into solution, it takes no part
us) and that of expired air is shown in the table below: in the process of respiration. Breathing in fresh air
replenishes the high concentration of dissolved
Table 5.4: The composition of inspired and expired air
oxygen molecules in the lung alveoli, and the removal
Component Inspired air Expired air of diffused oxygen by the bloodstream maintains the
Oxygen 20 per cent 16 per cent low concentration. With carbon dioxide, the situation
is reversed – the high concentration is in the blood
Nitrogen 80 per cent 80 per cent and the low concentration is in the refreshed air, so
Carbon dioxide Virtually 0 (0.04 per 4 per cent diffusion (see below) moves dissolved carbon dioxide
cent) from the blood into the expired air from the lungs.
Water vapour Depends on climate Saturated Carbon dioxide and water are waste products from
internal respiration in cells.
Diffusion
Diffusion occurs in liquids or gases because the
Activity 11: Air changes molecules are in constant random motion, and
diffusion is an overall ‘equalling up’ of a situation
Write down the differences between
inspired and expired air that you can see in where you have a lot of molecules meeting a few
Table 5.4. Why have these changes happened? molecules. Diffusion will stop in time, as the numbers
of molecules become more evenly distributed. This is
PLTS Key term

Diffusion – The movement of molecules of a gas or a liquid
Creative thinker: When generating ideas and
from a region of high concentration to a region of low
exploring possibilities about air changes, you can
concentration.
demonstrate your creative thinking abilities.
209
said to be equilibrium. (Note that this does not mean

the molecules stop moving, only that there are now
equal numbers of molecules passing in all directions.) Salivary gland
In the human body, where diffusion is a common

method of transport, the state of equilibrium is Mouth
Pharynx (throat)
not desirable, as it means overall transport ceases.
To prevent equilibrium being attained, the high Oesophagus
concentration must be continually kept high, and the

low concentration must also be maintained.
Diffusion can only occur where there is no barrier at
all to the molecules or where the barrier (in gaseous
exchange, this is cell membranes) is thin. The rate of
diffusion is enhanced by having an increased surface
Stomach
area (usually created by folds or similar structures Liver
to alveoli) and a raised temperature, since warmth Gall-bladder
Pancreas
increases the random motion of molecules. Duodenum

Ileum
2.6 The digestive system Colon
The alimentary canal

Rectum
The alimentary canal is a tube that extends from the
mouth to the anus. It is dilated, folded and puckered in Anus
various places along its length. You will need to know Fig 5.33: The alimentary canal
the names of the various regions, their main purpose
The stomach
and the outcomes of their activities. Many glands
are associated with the alimentary canal, and have The stomach is the widest part of the alimentary
important roles to play in digestion. canal, tucked mainly behind the rib cage under the
diaphragm on the left side and receiving food from
When food is taken into the mouth it is mixed with
the mouth by way of the oesophagus. Food can stay in
saliva, chewed or masticated by the action of the
the stomach for up to three hours, with a protein meal
tongue and teeth, rolled into a small ball known
remaining the longest and food not containing protein
as a bolus, and swallowed. This process is called
passing through relatively quickly. During this time, the
mechanical digestion and it is an important part of
strong stomach walls roll and churn the food around
physically breaking the food down at an early stage.
and pour on secretions from the gastric glands. The
The salivary glands resulting paste-like material is called chyme.
Three pairs of salivary glands pour their secretions Gastric glands produce gastric juice that contains gastric
known as saliva into the mouth. Saliva, a digestive protease and hydrochloric acid. The gastric juice works
juice, contains an enzyme known as salivary amylase, on proteins. In babies, another enzyme, rennin, solidifies
which begins the digestion of carbohydrates as well as and digests milk protein. The pH of the stomach is
lubricating the mouth and helping bolus formation. 1–2; this is strongly acidic. The epithelial lining of the
The oesophagus stomach contains goblet cells, which produce thick
The oesophagus (or gullet) transports the food bolus mucus to protect the lining from acid erosion.
from the back of the mouth (the pharynx) to the
stomach in the abdomen. The swallowed bolus is in the Key term
oesophagus for a few seconds only and no enzymes are
Enzymes – These are biological catalysts that alter the rates
secreted here, although salivary amylase will continue to of chemical reaction (usually speeding them up) but which are
act during this brief journey. The oesophagus is mainly themselves unchanged at the end of the reactions. You can
a transit for food boluses which it moves by muscular read more about enzymes on pages 213–214.
contractions known as peristalsis (see page 213).
210
The stomach empties the chyme in spurts into the • epithelial cells of villi covered in microvilli,
duodenum through the pyloric sphincter, a thick ring of projections so small that they can only be detected
muscle that alternately contracts and relaxes. using an electron microscope.
The duodenum These adaptations enormously increase the surface
area for absorption of nutrients from digested food.
The next part of the alimentary canal is the small
intestine, so-called because of its small diameter – Each villus is lined by columnar cells and goblet cells
certainly not its length, for it is around 6 metres long! only one-cell thick, with an extensive internal capillary
The first C-shaped part, and the shortest, is called network and a blind-ended branch of the lymphatic
the duodenum; it is mainly concerned with digestion system called a lacteal.
and is helped by two large glands, the liver and the The chief products of protein and carbohydrate
pancreas, that pour their secretions or juices into this digestion pass into the capillary network, which drains
area. The duodenal wall also contains glands which to the liver via the hepatic portal vein. Products of
secrete enzyme-rich juices (called succus entericus) fat digestion pass into the lacteal and eventually
that continue the digestive process on proteins, they pass, via the lymphatic system, into the general
carbohydrates and lipids, or fats. These work either on circulation.
the surface or inside the epithelial lining cells.
The colon
The ileum
In the right-hand lower corner of the abdomen, the
The remainder of the small intestine, known as the
small intestine meets the large intestine; there are
ileum, is mainly concerned with the absorption of the
two biological remnants at this point, the caecum and
now fully digested food. It is specially adapted for this
the appendix. In grass-eating animals the caecum is a
by its:
large structure with the worm-like appendix at the end.
• long length
They are known as biological or evolutionary remnants
• folded interior because, in the human species, neither the caecum
• lining covered in many thousands of tiny projections nor the appendix has any function. The appendix can
called villi become inflamed or pustulous and threaten life – a
Small intestine showing the internal folds and the villi A villus and its blood supply
Outside single layer of cells
Longitudinal and circular
muscle to carry out peristalsis Microvilli
Blood capillary
Lacteal
Hepatic
portal
vein
Circular folds Inner layer of villi Lymphatic

vessels
Fig 5.34: Small intestine and villi of the ileum
211
condition known as appendicitis. As well as the caecum contains no enzymes at all, but it provides important
and appendix, the large intestine consists of the colon bile salts that cause the emulsification of fats (lipids)
and rectum, ending in the sphincter (the anus) for the in the duodenum. You will recall that protein and
elimination of faeces. carbohydrate have already experienced enzymic
The colon runs up the right side of the abdomen and action. Lipids, like all fats, do not readily mix with
turns to travel across to the left side before ending water, so the enzymes have only a small water/lipid
at the anus. There are no enzymic juices in the large surface on which to work.
intestine. The emulsification results in the fats forming millions
The colon has a puckered appearance because the of tiny globules, each with a water/lipid surface so
outer longitudinal muscle coat splits into three bands that enzymes can work efficiently over a massively
and the circular muscle bulges out between the bands. enlarged surface area. Bile also contains bile pigments
During the journey down the alimentary canal, many – bilirubin and biliverdin. These are the waste products
glands have poured watery juices onto the chyme. of degraded haemoglobin from old, broken, red
The body cannot afford to lose so much water and blood cells. They give the brown colour to faeces. Bile
the purpose of the large intestine is to slow down the is secreted continuously by the liver and temporarily
passage of food waste. (Food waste is all that is left stored in a sac called the gall bladder. When a lipid-
at this stage because all the absorption of nutrients rich meal arrives, the gall bladder releases bile into the
occurred in the small intestine.) This means that small intestine.
water can be reabsorbed and the motion, or faeces, The liver also removes glucose and other sugars
becomes semi-solid. It can then be eliminated by from the blood coming from the small intestine and
muscular action of the rectum and relaxation of the converts them into glycogen for storage. Surplus
anus at a convenient time. amino acids not required for manufacturing cell
Faeces contain: proteins are broken down in the liver to form glycogen
and urea – a nitrogenous waste product transported by
• cellulose (fibre or roughage) from plant cell walls
the bloodstream to the kidneys for elimination in urine.
from fruit and vegetables
• dead bacteria, including the usually harmless The pancreas
bacteria living in the large intestine that have died The pancreas is a slim, leaf-shaped gland, located
a natural death, and other bacteria, which are often between the intestines and the stomach, close to the
killed by the hydrochloric acid in the stomach duodenum. It secretes enzyme-rich pancreatic juice as
• scraped-off cells from the gut lining. well as alkaline salts needed to neutralise the acidic
The brown colour of faeces is due to bile pigments. secretions from the stomach. Pancreatic enzymes
go to work on all three macronutrients (protein, fat
and carbohydrate) and are important agents for the
Reflect
complete breakdown of complex food molecules into
When faeces become pale yellow and skin amino acids, glucose and similar simple sugars, fatty
becomes dark yellow/brown, what may have
acids and glycerol.
happened? See Student Voice on page 177.
Breakdown and absorption of food
Mucus, secreted by enormous numbers of goblet cells
in the gut lining, reduces friction as chyme and waste
materials
are moved along by peristalsis. It is vital to understand that, without the organs and
glands of the digestive system, we would be unable
The liver
The liver is a large, dark-red organ occupying the top
right half of the abdomen and partly overlapping the
Key term
stomach. It has many vital functions in the body, one
Emulsification – This occurs when an emulsifier causes oil or
of which is to produce bile. Bile flows down the bile lipids to be suspended as a large number of tiny globules in
duct into the duodenum, after temporary storage in water.
the gall bladder on the undersurface of the liver. Bile
212
to use the substances collectively called food by

means of digestion. Taking food in through the mouth
(what we would call ‘eating’) is known technically
as ingestion. Food is generally composed of large Intestine
complex molecules of protein, carbohydrate and walls dilate
lipids (or fats) that would be unable to pass through Bolus of food
the lining of the alimentary canal. Converting these
complex molecules into simple soluble molecules
Walls constrict
enables their absorption into the bloodstream and to push the
onward transit for metabolic processes. Waste material food onwards
that has not been capable of absorption is passed out
through the anus periodically: the technical term for
this is egestion.
Fig 5.35: Muscular coats involved in peristalsis
Key terms
Digestion –The conversion of food into simple, soluble
chemicals capable of being absorbed through the intestinal
lining into the blood and being utilised by body cells. 2.7 The role of enzymes in
Ingestion – The taking in of food, drink and drugs by the
mouth.
digestion
To break down large complex molecules in the
Absorption – The taking up of substances to be used by the
body cells and tissues. laboratory we would use heat (as in cooking) or add
chemicals such as acids or alkalis. These processes are
Egestion – The process involved in eliminating waste
material from the body as faeces. not possible in the human body, since cell and tissue
structures would be destroyed or severely damaged.
Body cells are able to produce ‘magical’ substances
called enzymes that can alter the rate of chemical
Peristalsis reactions to build up or break down other molecules
Food and chyme move down the alimentary canal by without using heat or harmful chemicals.
a process known as peristalsis. Note that in Figure 5.35
Enzymes are biological catalysts. This means that they
there are two sheets of muscle surrounding the tube
are substances that can act within living organisms
– one sheet runs in a circular fashion around the tube
to enable the breakdown or building-up of other
while the other runs down the tube. Behind the bolus
chemicals, but they remain unchanged themselves at
or chyme, the inner circular muscle contracts (and the
the end of the reactions or tasks.
longitudinal muscle relaxes), pushing material in front
of it. This is rather like your fingers pushing toothpaste Enzymes are specific to the material on which they act
up the tube. In front of the material, the circular muscle (called a substrate). For example, a protease only acts
relaxes and the longitudinal muscle contracts, to hold on protein and a lipase only acts on lipids or fats. You
the tube open to receive the food. Two sets of muscles may have noted that adding ‘–ase’ at the end of the
acting in this way are said to be antagonistic. substrate name signifies that it is an enzyme. Not all
enzymes are named in this way, but most are.
The main bulk of the human diet consists of protein, fat
Did you know? and carbohydrate so these are called macronutrients.
They provide calories or joules of heat energy.
Even if you stand on your head, peristalsis will still
Vitamins and mineral salts are only required in tiny
push your food down your alimentary canal!
amounts and are called micronutrients. They do not
Strong peristaltic waves will cause abdominal pain provide energy but are often important in energy
(usually called colic) and the food will be hurried down
release processes, oxygen carriage, metabolic rate, red
the intestines.
blood cell formation and so on.
213
Enzyme reactions have some special features: areas of need in body cells. They are important in
• Enzymes are sensitive to temperature. At low making enzymes, some hormones, plasma proteins,
temperatures they work very slowly, or stop new cells (growth) and in repair processes. Surplus
working; at high temperatures, they become amino acids are broken down in the liver, as they
distorted (denatured) and permanently stop cannot be stored. Some parts of the molecules are
working. Enzymes work best, or optimally, at body used for energy but the nitrogen-containing part is
temperature. converted into urea in the liver, by a process called
deamination, and excreted by the kidneys in urine.
• Enzymes are sensitive to the acidity or alkalinity of
their surroundings, known as pH. Some digestive • Sugars, chiefly glucose, are transported to cells to
enzymes like pepsin (also known as gastric be broken down in internal respiration to release
protease) work best in an acidic environment. energy; excess carbohydrate is stored in liver and
The stomach lining secretes gastric protease muscles as glycogen or converted into fat to be
and hydrochloric acid for maximum efficiency in stored around organs or under the skin. Glycogen is
breaking down proteins. Lipase prefers alkaline converted back to glucose when energy is required
conditions and the pancreas secretes alkaline salts, to top up the blood glucose supply to cells or for
such as sodium hydrogen carbonate, to provide muscle contraction. The end products of internal
optimal conditions. Salivary amylase prefers neutral respiration, carbon dioxide and water, are removed
or pH7 conditions. (Amylum is the Latin name for by the respiratory and renal systems.
starch, so amylase works on starch.) • Glycerol and fatty acids: glycerol is used for energy
• Relatively few molecules of enzymes are required to or reconverting fatty acids into a form of fat that
break down lots of large food molecules because can be stored. Fatty acids travel from the lacteals,
they are catalysts. through the lymphatic system into the main veins
of the neck; this circuitous route enables smaller
• Amylases work on cooked starch substrates (bread,
quantities of potentially harmful lipids to enter the
rice, potatoes, etc.), converting the molecules to
circulation gradually.
simple sugars like glucose.
• Fatty acids are also used in internal respiration to
• Proteases act on proteins, breaking them down into
release energy to drive metabolic processes. The
amino acids and peptides (two amino acids joined
end products of internal respiration, carbon dioxide
together chemically).
and water, are removed by the respiratory and renal
• Lipases convert lipids to fatty acids and glycerol.
systems.
Table 5.5, on page 215, summarises the sites of enzyme
• Fat is stored under the skin and around organs,
secretion and their role in digestion.
where it forms a long-term energy store to be used
after glycogen stores are depleted.
2.8 Major products of digestion
Roles in the body, storage and
deamination 2.9 Absorption of food
• Peptides and amino acids are nitrogenous This topic is to be found under the heading ‘The ileum’
compounds; they travel via the bloodstream to on page 211.
214
Table 5.5: The main digestive processes, locations and outcomes
Location Gland and Contents Substrate End product Other comments

juice
Mouth Salivary Salivary amylase Carbohydrate: Disaccharides: Salivary amylase is
glands/ starch ‘double’ sugar mixed with food during
saliva molecules mechanical digestion.
Requires a neutral pH to
function efficiently.
Oesophagus None None None None Salivary amylase still
acting on short journey.
Stomach Gastric • Gastric Protein Amino acids and The pH of gastric juice
glands/ protease* peptides (like must be acid for pepsin
gastric • Hydrochloric double amino to work. Food is churned
juice acid acids) into chyme. Bacteria in
• Rennin in raw food are killed by
babies acid.
Small Intestinal • Peptidase • Peptides • Amino acids Alkaline medium (pH8).
intestine glands/ • Various • Disaccharides: • Glucose and
a) Duodenum intestinal carbohydrates ‘double’ sugar other simple
juice molecules soluble sugars
(succus
entericus)
b) Liver, an Liver/bile • No enzymes None None Bile salts are important
associated • Bile salts in emulsifying lipids
gland (not • Bile pigments or fats. Convert small
part of the intestine contents from
alimentary acid to alkaline.
canal)
c) Pancreas, Pancreas/ • Lipase • Lipids or fats • Glycerol and An important digestive
an associated pancreatic • Pancreatic • Carbohydrates fatty acids gland. Salts convert acid
gland (not juice amylase • Proteins and • Glucose stomach secretions to
part of the • Pancreatic peptides • Amino acids alkaline so that enzymes
alimentary protease* work optimally.
canal) (formerly
called trypsin)
• Alkaline salts
d) Ileum None None None None Main area for absorption
of the end products
of digestion through
millions of villi.
Large None None None None Main area for
intestine reabsorption of water.
a) Colon
b) Rectum None None None None Muscular walls expel
semi-solid faeces
through anus at periodic
intervals.
*Gastric protease and pancreatic protease are secreted as inactive precursors; they become activated by other substances once they are mixed with
chyme in the lumen (hole) of the tube.
215
You are an adviser in your local sports centre and digestion, where this is associated with energy
you have been asked to design and produce an metabolism.
information booklet to explain to clients how the body The focus for the respiratory system should
requires and utilises energy. This should include: be on breathing, gaseous exchange and cell
• an outline of the respiratory, cardiovascular and respiration.
digestive systems The cardiovascular system should include the
• an overview of how energy is utilised in the body role of the blood and transport of materials
• and how two main body systems are linked to this within plasma and haemoglobin.
utilisation. M1 To gain M1, you have to discuss the role of
energy in the body. You will need to explain
Grading tips that energy in the body comes from the diet
P4 To achieve P4, you need to explain the and describe how it is transformed into energy
physiology of two named body systems in used by the body as well as saying where the
relation to energy metabolism in the body. First energy is used.
you have to decide which two systems you will D1 For D1, you have to analyse how two body
choose. The cardiovascular system should really systems interrelate with each other to perform
be one of them, to help understanding and give a named function or functions. Use examples to
coherence. Imagine the booklet is for an athlete explain how these body systems interrelate with
or an individual on a restricted diet. each other. As you explain your work, you will
If digestion is one of your selected systems naturally make links – for instance the regulation
you need only consider the three major of plasma glucose by the endocrine system, or
macronutrients present: protein, carbohydrate the way in which the nervous system is involved
and lipids. Start with mechanical digestion in in the regulation of the cardiac cycle. This will
the mouth and explain what happens in each lead you towards a distinction. Try to make at
part of the alimentary canal. You need not go least five substantial links of this nature. It might
beyond the ileum but you do need to include be advisable to draw attention to such links by
absorption and the fate of the end products of the use of headings.

Self-manager: This activity will allow you to illustrate
ICT: By storing work on a password-protected storage
self-management skills when working towards the goal
device you are using ICT systems. Use ICT to present
of producing an information booklet by a specified
information in a booklet that is fit for purpose.
date and dealing with competing pressures to meet
deadlines.
216
3 Understand how homeostatic mechanisms operate in

the maintenance of an internal environment
You have learned how tissue fluid bathes body cells a warm, energy-giving meal to counteract these
and is a protein-free plasma filtrate driven out of leaky feelings. This can be termed ‘feedforward’ (rather
capillaries by blood pressure, and how (digestive) than feedback), as you are taking steps to avoid a low
enzymes are sensitive to pH and body temperature. energy state before it has happened.
You will not be surprised therefore to extend this by Negative feedback systems require:
realising that blood and tissue fluid and consequently
• receptors to detect change
cell contents require stability in their chemical and
• a control centre to receive the information and
physical make-up. All metabolic processes are
process the response
governed by enzyme actions, which are subject to the
same characteristics as digestive enzymes. • effectors to reverse the change and re-establish the
original state.
3.1 Homeostasis Most control centres are located in the brain.
Homeostasis is the technical term for the process
of maintaining a constant internal environment Range of
normal activity
despite external changes. The ‘internal environment’
comprises blood, tissue fluid, body cell contents and
all the metabolic processes taking place. Response by Change in activity –
It is important to realise that the use of the term effectors restores increase or decrease
normal activity from normal
‘constant’ in this context is not absolute and fixed; it is
more flexible and dynamic and refers to the physical and
chemical composition being kept within a limited range
of variables for maximum efficiency, well-being of the Effectors become Detection by
whole body and, indeed, the maintenance of life itself. active to do something receptors which inform
about the change control centre
This limited range of variables is said to be regulated.
Negative feedback as a form of regulation

Control centre informed.
Negative feedback occurs when an important variable, Control centre activates
sometimes known as a key variable, such as the pH of the effectors
blood and tissue fluid, deviates from the accepted range
Fig 5.36: Feedback control systems
or limits, and triggers responses that return the variable
to within the normal range. In other words, deviation
produces a negative response to counteract or nullify the Activity 12: Prevention is
deviation. It is a ‘feeding back’ of the disturbance to the better than cure
status quo. During your study of the liver as part of the
digestive system, you learned that when blood glucose Can you think of other examples of times when your
levels fall, the liver glycogen is converted into glucose in brain might be suggesting feedforward strategies?
Try a thought shower with your peers and see how
order to top up those crucial energy levels in cells. This is
many examples you can suggest.
an example of a negative feedback system and we shall
study this further in due course.
The brain and nervous system play a vital role in
controlling homeostatic mechanisms and they also PLTS
help us to anticipate when key variables might rise Creative thinker: This activity will help you to
or fall beyond the accepted range. For example, if demonstrate that you can question your own and
it is several hours since your last meal and you are others’ assumptions when thinking of examples of
feedforward strategies.
beginning to feel tired and cold, you will try to eat
217
3.2 Homeostatic mechanisms for Ths sino-atrial node

Sympathetic nerves
accelerate the heart
regulation of heart rate (S-A node) begins the
heart beat and is
Which is slowed by the
parasympathetic nerve
First we will learn how the heartbeat is regulated. Let’s described as the
begin by looking at the control of the cardiac cycle heart’s pacemaker
and the role of the autonomic, parasympathetic and From the S-A node,
sympathetic nervous systems. stimuli branch
outwards and
The heart is controlled by the autonomic nervous downwards causing
system which has two branches, namely the atrial contraction
sympathetic nervous system and the parasympathetic Atrio-ventricular
nervous system. These two systems act rather like an (A-V) node
accelerator and a brake on the heart. The sympathetic Bundle of His made of
nervous system is active when the body is undergoing specialised Purkinje fibres
muscular work, fear or stress. It causes each heartbeat
to increase in strength as well as causing an increase
Fig 5.38: Control of the cardiac cycle by the conduction system
in heart rate. The parasympathetic nervous system
calms the heart output and is active during resting,
peace and contentment. The main parasympathetic
parasympathetic nerves acting on the S-A node
nerve is the vagus nerve and if this is severed the heart
regulate the activity of the heart to suit circumstances
beats faster.
from minute to minute, hour to hour and day to day.
The sympathetic nervous system is boosted by the
Every few seconds, the S-A node sends out a cluster of
hormone adrenaline during periods of fright, flight and
nerve impulses across the branching network of atrial
fight! Its nerves are the cardiac nerves.
muscle fibres to cause contraction. The impulses are
The sympathetic and parasympathetic nervous systems
caught by another group of cells forming the atrio-
supply a special cluster of excitable cells in the upper
ventricular node (A-V node) and relayed to a band of
part of the right atrium. This is called the sino-atrial
conducting tissue made of large, modified muscle cells
node (S-A node) or in general terms ‘the pacemaker’.
called Purkinje fibres.
An interplay of impulses from the sympathetic and
The transmission of impulses is delayed slightly in
the A-V node to enable the atria to complete their
contractions and the atrio-ventricular valves to start to
Sympathetic close.
nervous system
Heart valves are located on a fibrous figure-of-eight
between the atrial and ventricular muscle masses, and
Adrenal
gland
the first part of the conducting
tissue (the bundle of His)
enables the excitatory impulses
to cross to the ventricles.
Adrenaline Noradrenaline
80% The bundle of His then splits
into the right and left bundle
branches, which run down either
S-A node, or Vasoconstriction side of the ventricular septum,
pacemaker of arteries before spreading out into the
ventricular muscle masses.
Impulses now pass very rapidly
Increased Stronger Rise Effects on heart so that the two ventricles
+ + =
heart rate heart rate in BP and circulation
contract together, forcing blood
around the body organs.
Fig 5.37: Sympathetic and parasympathetic control of the heart
218
Cardiac centres are we voluntarily controlling our breathing. When

metabolism produces extra carbon dioxide, for
The medulla of the brain is the lowest part, located just
example, breathing rates will increase slightly until this
above the spinal cord and often known as the ‘brain
surplus is ‘blown off’ in expiration. Similarly a period
stem’. Two important centres for control of the heart
of forced ventilation, such as gasping, will lower the
rate are located here. The cardio-inhibitory centre is
carbon dioxide levels in the body and homeostatic
responsible for the origins of the parasympathetic
mechanisms will slow or stop breathing temporarily
fibres of the vagus nerve reaching the S-A node, while
until levels return to normal.
the sympathetic fibres descend through the spinal cord
from the vasomotor centre.
Role of internal receptors Activity 13: Voluntary or

Baroreceptors detect changes in blood pressure and involuntary?
are found in the walls of the aorta and part of the
carotid arteries delivering blood to the head and Count your own or a partner’s quiet breathing rate
neck and called the aortic and carotid bodies. A small over several minutes and then breathe (voluntarily)
rapidly for 2 minutes. Immediately afterwards count
upward change in blood pressure (BP) in these arteries
the breathing rate for the next 3 minutes. Compare
often indicates that extra blood has been pumped out the rates before and after the forced ventilation to
by the ventricles as a result of extra blood entering the demonstrate homeostatic regulation.
heart on the venous or right side. Baroreceptors detect
the change and relay the information in nerve impulses
to the cardiac centres. Activity in the vagus nerve slows
the heart rate down and decreases BP back to normal.
Roles of internal receptors
Receptors sensitive to temperature are known as
Internal receptors can be stretch receptors in muscles
thermoreceptors and these are present in the skin
and tissues that relay nervous impulses to the brain
and deep inside the body. They relay information
about the status of ventilation from the degree of
via nerve impulses to a part of the brain called the
stretch of muscles and other tissues. The intercostal
hypothalamus, which activates appropriate feedback
muscles are the site of many stretch receptors.
systems.
Chemoreceptors detect changes in chemical
Effects of adrenaline on heart rate stimuli (such as H+ ions and oxygen levels) and
Circulating adrenaline, a hormone from the adrenal supply the brain with this information. There are
gland released during fear, stress and exertion, central and peripheral chemoreceptors. The central
stimulates the S-A node to work faster, thus boosting chemoreceptors monitoring H+ ion concentration are
the effect of the sympathetic nervous system. located in the medulla of the brain; an increase in H+
ion concentration results in increased ventilation rate.
Effect of increased body temperature on Peripheral receptors, monitoring changes in oxygen
heart rate concentration, increase ventilation when oxygen levels
Thermoreceptors indicating a rise in body temperature decrease. Peripheral chemoreceptors are scattered
to the brain cause the hypothalamus to activate the around the aorta and carotid arteries in groups
sympathetic nervous system. This in turn causes the labelled the aortic and carotid sinuses (see Figure 5.39
heart rate to increase. on page 220).
Autonomic nervous system –

3.3 Homeostatic mechanisms for parasympathetic and sympathetic
regulation of breathing rate branches
We are mainly on ‘automatic pilot’ for our rate of Most internal organs have a dual autonomic supply and
ventilation and do not notice minor variations that the respiratory system is no exception. What can be
are the result of homeostatic regulations. Only when different, however, is the way they act. It would be easy
taking deep breaths, speaking or holding a breath to say that the sympathetic always causes contraction
219
Respiratory centre, diaphragm and

Brain
intercostal muscles
The brain area responsible for voluntary control of
breathing is in the upper part of the brain known as the
cerebral cortex. The involuntary centre, known as the
respiratory centre, is in the medulla and the area just
Information from Information from
stretch receptors Diaphragm chemoreceptors above, known as the pons. These are both at the base
and intercostal
in lungs and
muscles
● aortic sinus of the brain. Each centre gets information from internal
airways ● carotid sinus
receptors regarding the state of ventilation.
The respiratory centre is similar to a respiratory
‘pacemaker’. There are two groups of nerve cells,
known as the inspiratory and expiratory centres, and
Breathing
when one is active the other is inhibited. Clearly, the
rate inspiratory centre is actively sending nerve impulses
Fig 5.39: The role of internal receptors Pneumotaxic centre

Apneustic centre
and the parasympathetic causes relaxation of muscle
coats – but unfortunately this is not so. In the case
of bronchial muscle, the sympathetic causes it to Cerebrum
relax and the parasympathetic causes contraction,
resulting in narrowing of the bronchi. Most of these
fibres run in the vagus nerve (which you have already
met) in serving the heart. The vagus nerve is so-
called because it wanders all over, supplying internal Hypothalamus
Pituitary gland
organs; vagus means ‘a wanderer’ – like a vagrant! Pons Cerebellum
Sympathetic nerves emerge from a chain of ganglia Medulla
(places where nerves interconnect), to run to the Respiratory Expiratory centre Brain stem
centre Inspiratory centre
bronchi. Spinal cord
Fig 5.40: The brain showing respiratory centres
Activity 14: Emergency

to the nerve to the diaphragm – the phrenic nerve –
action and the thoracic nerves are sending impulses to the
The parasympathetic is active during rest, peace intercostal muscles to cause contraction, resulting
and contentment and the sympathetic during in inspiration. Inspiration ceases when the stretch
emergencies. A useful way to work out the actions receptors send bursts of impulses to the inspiratory
is to imagine yourself in a life-threatening situation centre, saying that the chest and lungs are fully
– such as being in the middle of a road when a car expanded, and the flow of impulses subsides, releasing
is suddenly closing fast. What would be likely to
the expiratory centre from inhibition. This centre then
happen physiologically to your body? Try a thought
shower with your peer group. sends nerve impulses to the respiratory muscles,
causing relaxation and expiration. This cycle of
activity is monitored and modified by the information
coming from the other internal receptors, such as the
chemoreceptors, effecting homeostatic regulation.
PLTS
Before exercise starts, the body predicts the changes
Creative thinker: You can show your creative because the sympathetic nervous system is stimulated
thinking skills by generating ideas and exploring
and adrenaline is released to increase cardiac output
possible actions associated with adrenaline release.
and stroke volume; BP rises because arterioles narrow,
220
temperatures such as +50°C, enzymes and body

proteins would be permanently altered or denatured.
Life would not be possible under these conditions
Brain so homeostatic regulation of body temperature or
thermo-regulation is vital. The skin plays an important
role in this so we will start with an explanation of its
structure and functions.
Carotid bodies
Carotid sinuses Structure and functions of skin
The skin covers the outer surface of the body and
surprisingly forms the largest organ. New cells are
Aortic bodies continually forming to replace those shed from the
surface layers. The skin is a significant part of our
in-built or innate immunity and forms not only a
Aortic arch waterproof layer but also a microbe-proof covering. It
plays an important part in the homeostatic regulation
of body temperature and is considered to be part of
our nervous system because of its sensitivity.
The skin varies in thickness throughout the body,
being thinnest over the eyelids and lips and thickest
on the soles of the feet. For study purposes, it is
divided into an outer thinner layer, the epidermis,
and a deeper layer called the dermis. The dermis
Fig 5.41: Location of internal chemoreceptors covers adipose, areolar, striated muscle, and some
cartilage and bone. You have already learned about
the structure of the epidermis as a tissue on page 185
except for those in muscle, which relax. The extra and the keratinisation of its cells. Hair follicles are also
demands for oxygen and glucose are met by increased extensions of the epidermis, which run down into the
blood flow and ventilation rate (the latter caused by dermis and produce hairs made of keratin. Attached
enhanced chemoreceptor activity on the medullary to these are the sebaceous (or oil) glands that coat
brain centres). the surface in hairy parts, assisting the water-proofing.
Sweat ducts penetrate the epidermis as they emerge
3.4 Homeostatic mechanism for from the actual sweat gland in the dermis. In the basal
layer, there are collections of pigment cells known as
regulation of body temperature melanocytes that produce skin colour. The pigment
Human beings are the only animals that can survive melanin protects against damage to deeper structures
in both tropical and polar regions of the earth. This is from ultra-violet light radiation.
largely due to efficient thermo-regulatory homeostatic The dermis is connective tissue, mainly areolar, in
processes and the use of intelligence (for shelter and which blood vessels, nerves, sweat glands, elastic and
clothing), which mean that body temperature varies collagen fibres intermingle.
only minimally. Nerve endings form specialised receptors for
The fundamental precept is to keep the inner core temperature changes, pain, touch and pressure.
of the body (containing the vital organs) at normal Hair erector muscles have their origins low down on
temperatures while allowing the periphery (skin, limbs, the hair follicles and their attachments to the basal
etc.) to adapt to changing conditions of external layer of the epidermis. When hair erector muscles
temperature. contract (usually from fear or the sensation of coldness)
At very low temperatures such as –30°C, the water the hair becomes more erect, making the skin surface
component of the body would freeze and at high lumpy (known as ‘goose bumps’).
221
Production of heat by the body

Did you know? Heat is generated by the metabolic processes
taking place in the body. Although energy released
When you have ‘goose bumps’, the hair erector
muscles have contracted and the effect is a small during chemical reactions is used to drive processes
bump at the base of the hair. In hairy animals, this such as muscle contraction (heart pump, breathing,
traps a layer of warm air around the body for extra movement, nerve impulses, etc.) some of it is always
warmth and makes the animal look larger in a released as heat. Hundreds of chemical reactions take
threatening situation. In humans, however, neither
place in the liver, for example, every day and the liver
effect is very useful! We rely on clothing, muscular
is a massive generator of body heat. It doesn’t feel hot
activity, fat layers and shelter to keep us warm.
because the blood distributes this heat around the
body, particularly the extremities. Some heat is also
gained from hot food and drinks and, under some
circumstances, from the sun’s rays.
The major functions of skin are:
• to protect the underlying tissues against friction
damage Loss of heat from the body
• to waterproof the body Skin capillaries form networks just below the outer
layer or epidermis. When you are hot, you need to lose
• to protect deeper structures from invasion by micro-
heat from the skin surface to cool yourself down. There
organisms
are four ways of losing heat from the skin:
• to protect against ultra-violet radiation
• Conduction – warming up anything that you are
• for thermo-regulation (control of body temperature) in contact with (like clothes and seats); even a
• to relay nerve impulses generated from the pen becomes warm from your hand when you are
specialised skin sensory receptors for heat, cold, writing!
touch, pain and pressure, thus informing the brain • Convection – this is when you warm up the layer of
of changes in the environment air next to your skin and it moves upwards (because
• to synthesise vitamin D from sunlight acting on the hot air is less dense and rises), to be replaced by
adipose layers. colder air from the ground.
Erector
pili muscle Horny
Blood capillary Nerve Sweat Hair Hair Hair (muscle to layer
Clear layer
Epidermis (outer skin)

vessel ending pore root follicle shaft erect hair)
Granular
layer
Prickle
cell layer
Dermis (true skin)
Basal layer
Reticular layer
Papillary
layer
Subcutaneous
layer
Adipose tissue Lymph Nerve Sweat Dermal Hair Sebaceous Blood

(fat cells) vessels fibre gland papilla bulb gland vessels
Fig 5.42: The structure of skin
222
• Radiation – you can think of this as being rather like

diffusion but of heat temperature. In other words,
Reflect
heat will pass from your skin to warm up any colder The monsoon season in tropical countries affects
objects around you; and, conversely, you will warm work and productivity because people feel very
uncomfortable. Sweat cannot evaporate and
up by radiation from any object hotter than yourself,
cool the skin because the saturated air is already
like a fire or the sun. holding as much water as it possibly can.
• Evaporation of sweat – when liquid water is
converted into water vapour (the technical term is
organs. These are specially adapted cells with nerve
evaporation), it requires heat energy to do so. When
fibres that run up the spinal cord to the temperature
you are hot, sweating will only cool the skin if it can
control centre in the hypothalamus of the brain (see
take heat energy from the skin surface to convert to
Figure 5.44 below). The hypothalamus sends nerve
water vapour and evaporate.
impulses to muscles, sweat glands and skin blood
Heat loss considerable Little heat loss
Warm skin Cold skin Stimulus Body temperature rises
Sun, fire, etc.

Hot food or drink
Infection
Capillaries full Capillaries shut down Thermal receptors in skin

– vasodilation – vasoconstriction Receptors and around internal
organs stimulated
Nerve impulses
Core Core Temperature control centre

Control in brain switches on heat-
centre losing mechanisms
Nerve impulses
Effectors
In warm conditions heat In cold conditions central
lost to keep core cool core heat preserved
Fig 5.43: Changes in skin radiation Arterioles in skin Behaviour altered:
Sweat gland
activated: dilated: • clothes removed
• sweat poured • increased blood • stretched out
Did you know? onto skin surface flow to skin posture
• evaporation of • skin warm and • cool drinks
Parents fuss about drying children properly with towels water removes pink
after getting wet because if water evaporates from heat energy from • radiation of heat
the skin naturally it chills the body. This is because the skin – cooling from surface –
process of evaporation uses heat energy from the body. occurs cooling
Although conduction and convection take place, NB Other methods of heat loss from the skin (i.e. conduction and
they cannot be changed significantly to alter body convection) still occur, but cannot be increased to any
temperature. The main methods of regulating significant level
temperature are by changing radiation and sweat-
evaporation processes.
Response Body temperature decreased
Role of the hypothalamus
The receptors for temperature, both heat and cold, are Fig 5.44: Homeostatic regulation of an increasing body
located in the peripheral skin and around the internal temperature
223
vessels to cause changes that counteract the external Role of arterioles and sweat glands
changes. You can see the precise effects of a rising As thermoreceptors tell the hypothalamus in the
and falling external temperature in the flow charts in brain that the temperature is rising, sweat glands are
Figures 5.44 and 5.45. activated by the sympathetic nerves, and arterioles are
dilated to let more heat reach the surface of the skin,
Roles of the parasympathetic and
thus increasing heat loss by radiation and evaporation
sympathetic nerves of sweat. Conversely, if the core temperature
The parasympathetic nervous system has no significant is cooling, the sympathetic is active in causing
role in thermo-regulation (although it helps the constriction of the arterioles but sweating is ‘turned
unstriated muscle coats of the skin arterioles to relax), off’. This reduces heat loss, makes the skin colder to
but the sympathetic nervous system controls both touch, and thus preserves the core temperature.
sweat glands and the calibre of the arterioles.
Activity 15: Seems all

wrong!
Stimulus Body temperature falls It is a very hot day and you feel that a long iced drink
is needed but your mother wants to make a warm
Exposure to cold, rain drink because it is more cooling. Explain why she is
Cold food or drink correct.
Wind chill, immobility
Thermal receptors in skin

Receptors and around internal PLTS
organs stimulated
Creative thinker: Demonstrate that you can
Nerve impulses question your own and others’ assumptions about
ways of cooling by completing this activity.
Temperature control centre

Control in brain switches on heat-
centre conserving mechanisms
The reason is that core temperature overrides the
Nerve impulses peripheral skin thermoreceptors when conflicting
Effectors
information is received. Think about what happens
when a hot volume of fluid reaches the core and
Sweat gland Arterioles in skin Behaviour altered: compare this with a mass of freezing food.
closed: contracted: • clothes increased
• no sweat poured • decreased blood • curled up posture Effects of shivering
onto skin surface flow to skin • hot food and Rhythmic involuntary contractions of the skeletal
• muscles beneath • skin cold and drink taken
the skin contract, pale muscles are known as shivering. Muscular activity
causing shivering • close down of generates heat so in a cold environment we may
and ‘goose pimple’ radiation surface stamp our feet, swing our arms, rub our face, hands
effect
and feet and also shiver. This is a very effective way to
generate heat, as it is all available to warm the body
NB Other methods of heat loss from the skin (i.e. conduction and up.
convection) still occur, but cannot be decreased to any
significant level Implications of surface area to volume ratio
in the care of babies
Response Body temperature increased Babies have a larger surface area to volume ratio
than adults and cannot effect changes to gain or lose
Fig 5.45: Homeostatic regulation of a falling body heat for themselves; this means that they are at risk of
temperature developing hyperthermia or hypothermia.
224
known as rigors. It is not until the new set point has

Case study: Seasonal been reached (often called ‘the crisis’) that sweating and
behaviour other heat loss mechanisms begin. When the infection
has subsided the set point is reset at a lower level.
In winter I curl up in a ball in bed and add layers of
clothing to keep warm. In summer, I wear one thin
layer of clothing and stretch out in bed. Did you know?
1 Explain why these different behaviours occur.
To reduce temperature during a fever, the usual
2 Explain the main way that heat is lost by
practice is to bathe with tepid water, blow cold air
increasing the surface area to volume ratio in
from a fan over exposed skin and/or use appropriate
hot weather.
medication.
3 Adolescents commonly go out in very cold
weather wearing skimpy clothing and no coats
without feeling cold. Explain why this might be
dangerous for older people. 3.5 Homeostatic mechanisms
4 Explain why babies need to wear hats in colder
weather.
for regulation of blood glucose
levels
Role of the pancreas, liver, insulin and
glucagon
PLTS You have learned how carbohydrates are broken down
Creative thinker: Demonstrate that you can by digestive enzymes to produce simple soluble sugars,
question your own and others’ assumptions about
mainly glucose. After a meal rich in carbohydrates (such
methods of thermal control by completing this activity.
as rice, bread, pasta and certain vegetables), blood
glucose will start to rise. This increased level of glucose
Babies do not sweat much and newborn babies do not stimulates the production of the hormone insulin from
shiver. Therefore, it is important in cold weather to wrap the beta cells in the islets of Langerhans in the pancreas.
babies warmly, including the extremities and the head, Insulin has two main functions:
and to guard against over-heating in hot weather. • to regulate the concentration of glucose in the blood
• to increase the passage of glucose into actively
Fever
respiring body cells by active absorption.
Fever is one type of hyperthermia and is most usually
In the absence of insulin, very little glucose is able to
caused by infection; other types are heat stroke and
pass through cell membranes (with the exception of
heat exhaustion – all can be life-threatening. Factors
liver cells) and so the plasma level of glucose rises.
released as a result of disease act on thermoreceptors
Individuals with untreated diabetes mellitus (caused by
in the hypothalamus, raising the upper set point.
a lack of insulin secretion) have high plasma glucose
Consequently the sufferer feels cold, curls up, pulls on
levels and this leads to other biochemical disturbances.
covers, looks pale due to vasoconstriction (narrowing of
In healthy people, the plasma glucose hardly varies
the arterioles) and even experiences intense shivering
at all because liver cells, under the control of insulin,
convert glucose into liver (and muscle) glycogen for
storage. When blood glucose starts to fall as a result
Key terms
of fasting or being used up by respiring cells, another
Hyperthermia – Increased body temperature above the
normal range of values
hormone, glucagon, from the alpha cells in the islets of
Langerhans, is secreted and this converts liver glycogen
Hypothermia – Decreased body temperature below the
normal range of values. back into glucose for release into the bloodstream.
Set point – The temperature of the ‘hypothalamic thermostat’,
These two hormones regulate the amount of glucose in
when autonomic thermo-regulatory mechanisms start to act to the blood plasma by negative feedback mechanisms.
reverse the rise or fall and restore normal temperature. Both have receptors attached to their islet cells to
identify rising and falling plasma glucose levels.
225
Insulin also promotes the conversion of glucose into

fat (once again removing surplus glucose from the Did you know?
circulation) and delays the conversion of amino acids Normally, there is no glucose in urine because it
into energy (see ‘Roles in the body, storage and has been completely reabsorbed in the first part of
deanimation’ on page 214). the renal tubule and is transported back into the
bloodstream. However, when the blood glucose is
Insulin from abnormally high, as in Diabetes mellitus, this part of
pancreas the tubule is simply not long enough for complete
reabsorption and a large amount of glucose is left
Rises behind to flow onwards into the urine. This can be
tested for chemically. Blood glucose is high because it
is not able to enter cells due to lack of active insulin.
Blood
glucose
Glycogen from
pancreas glucose. This outpouring of glucose provides energy
Falls Stored
(+ emergency adrenaline)
for muscles to become active under emergency
conditions. In addition, adrenaline converts fats to fatty
Liver glycogen acids for muscle contraction. When the emergency is
Muscle glycogen over, insulin will once more become active and store
Fat any surplus as before.
Fig 5.46: Negative feedback mechanism to maintain plasma
glucose concentration in blood
Case study: Mia’s mother

Case study: Jonathan
Jonathan goes jogging before breakfast and Mia noticed that her mother seemed to get tired
eats nothing but a slimming type of cereal very quickly and she disliked going upstairs as she
bar (low sugar, low fat) until lunch. Describe the became breathless quite rapidly. Her father was
homeostatic mechanism for restoring his plasma becoming quite concerned about his wife’s health
glucose levels to normal. and asked Mia to help out a lot more around the
house. Mia’s mother was having heavy monthly
Remember that:
bleeds as a result of starting the menopause. She
• muscular activity requires energy
also looked very pale and complained of having no
• energy stores are in the liver and in fat deposits energy.
• hormonal action is necessary to release stored Eventually they persuaded her to visit her GP, who
energy. sent her to the local hospital to get blood checks.
On receiving the results from the hospital, the GP
diagnosed iron-deficiency anaemia and prescribed
PLTS some ‘iron’ tablets.
Creative thinker: Generating ideas and exploring 1 Discuss the reasons for Mia’s mother’s signs and
possibilities about homeostatic control of glucose may symptoms.
enable you to demonstrate creative thinking skills. 2 Why do you think the anaemia occurred?
3 What role does iron play in the blood?
It is also necessary to identify the role of another 4 Examine the relationship between ‘having no
hormone, adrenaline, in the homeostasis of glucose. energy’ and anaemia.
Adrenaline, released by the adrenal glands when 5 How do you think the anaemia might impact on
the sympathetic nervous system is active under heart rate and breathing rate?
stressful conditions, acts antagonistically to insulin 6 Justify your answer to question 5.
and overrides it, to convert glycogen in the liver to
226
4 Be able to interpret data obtained from monitoring

routine variations with reference to the functioning
of healthy body systems
In this section you will collect data by measuring the feeling the ‘shock’ wave of the contraction as it travels
temperature, pulse and breathing rates of a healthy rapidly down the arteries.
individual at rest and at intervals during recovery from
Factors affecting reliability of pulse rate
a standard exercise test. You will need to know:
measurements
• how to take the measurements using safe practice
As well as the pulse rate, professional health care
• the range of normal values workers will also monitor the rhythm of the pulse,
• the factors that affect the reliability of the data you noting any irregularities and the quality of the pulse.
obtain. Terms used are: full, bounding, normal, weak or
You will have to interpret and analyse your data and thready. They will also take note of the character of
demonstrate how homeostatic mechanisms respond to the blood vessel: in a young person it feels straight,
exercise. flexible and elastic; but in an elderly person it might
feel much firmer, even hard, and take a winding course
4.1 Measurements due to arteriosclerosis. This condition might mean that
the pulse is harder to count.
You will now learn best practice in taking routine
measurements.
Key term
Pulse rate measurements – normal values Mean pulse – The mean of a set of numbers is calculated by
and range adding the numbers and dividing by the number of numbers.
If an individual’s pulse rates were 70, 68 and 64 beats per
A pulse can be detected when an artery is close to the
minute, then the mean would be 70 + 68 + 64 ÷ 3 = 67 (to
surface of the body and runs over a firm structure such the nearest whole number). As this calculation has considered
as bone. The pulse is the elastic expansion and recoil three readings, it is more accurate than taking the first
of an artery caused by the left ventricle of the heart reading only.
contracting to drive blood around the body. You are
Activity 16: Practising practical work 1

You will need a watch with a second hand or a stop 5 Place the first and second fingers lightly on
clock that can measure in seconds. the artery – get used to the feel of the pulse
1 Wash your hands to prevent cross-infection. before you start counting for 60 seconds. Record
the measurement, with the date and the time.
2 Explain what you are going to do to the person on Wash your hands.
whom you are carrying out the measurement and
obtain their consent. You may wish to repeat the measurement twice more,
as this is a practical exercise and a mean pulse is more
3 Make sure that the person is comfortable and useful for recording, as either you or the individual
relaxed, as this will help you to achieve an accurate might be a little apprehensive at first.
measurement. Observe the individual while taking
the measurement (this takes practice) so that you An average resting pulse in a healthy individual ranges
can stop if there are any signs of distress or anxiety. from 60 to 80 beats per minute. Increases in pulse
rates during vigorous exercise vary, depending on
4 Find the radial artery, preferably on the arm that is the fitness of the individual and the intensity of the
free from any restrictions such as a watch strap. You exercise, but can rise to 190–200 beats per minute.
will find the artery on the wrist, just below the base
of the thumb.
227
A pulse taken in babies or young children is much ‘Faulty, Do Not Use’ and taken out of use. No one
faster than in adults. Exercise, or even just moving should be asked to use faulty equipment in their job.
about before or during the pulse-taking, will cause an Only suitably qualified personnel should investigate,
increase in rate, as will an increased body temperature. modify, repair or scrap equipment belonging to the
Hypothermia will produce a slow pulse rate. establishment.
Many carers measure the pulse rate for 10- or
15-second periods and multiply by 6 or 4 respectively
to gain the pulse rate per minute. Any error in counting Case study: Calculating
will thus be magnified six- or four-fold. However, a accuracy
single error is still unlikely to be significant in terms
You used a pulse meter to measure the pulse rates
of results for monitoring purposes. Counting for the
of a peer and found the mean to be 80 beats per
whole 60 seconds is not a long time and reduces these minute. The manufacturer’s instructions quote
errors. accuracy at + or – 2.5%. This means that the rate
Irregular pulses, found in patients with heart disease or might range from 78 to 82 beats per minute.
ectopic (extra) beats, and fast pulses (tachycardia or in Explanation: (80 × 5) ÷ 200 (N.B. 2.5% = 5/200ths).
babies and young children) can prove difficult to count. This works out at 2 so the range is 80 – 2 to 80 + 2
(or 78–82).
Arteriosclerotic arteries also make it more difficult to
count heartbeats. Multiple counting errors are more Calculate the range of accuracy if the mean of
likely to occur and, when multiplied, these could be the pulse rate is 65 beats per minute and the
manufacturer’s quote is + or – 1% accuracy.
significant.
Key term
Significant – A simple explanation of the term ‘significant’ Once you have familiarised yourself with taking pulse
in this context would be whether the error was meaningful rate measurements at rest, practise taking them at
and likely to distort any conclusions drawn. ‘Not significant’ different levels of activity on, for example, one of your
means that the error can be ignored. peers.
Many establishments use electronic digital recorders Reflect

for measuring pulse rates, blood pressure, body
What different activities might you ask a peer to
temperature and other physiological features. You
do? Try a thought shower, bearing in mind that
should be familiar with the manufacturer’s instructions it must be an appropriate safe activity for your
for safe practice, potential risks and levels of accuracy. subject. Once you have made your decision, take
In addition, you must be trained by an appropriately your practice measurements.
qualified person to use this type of equipment. Take the pulse rate after light, medium or intense
Different pieces of equipment may operate in different exercise of your own design or use the Harvard
ways. step test described on page 232.
All items of electrical equipment are potentially
hazardous, both to the client and the carer operating
Safe practice in taking pulse measurements
the devices. The major hazards are burns and electric
shock. You should be constantly on the look-out for: You must not compress the artery over the bone when
taking measurements or you may stop the blood flow
• malfunction of the equipment
to part of the hand, causing pain and cramp. This is
• frayed electric flexes and trapped wires more likely to occur in babies and older people, in
• loose connections, plugs and sockets. whom the pulse is more difficult to detect and count.
Any fault must be reported immediately – verbally Ensure that the person being assessed is suitably
and in writing: most establishments have standard healthy to undertake physical exercise. For example,
forms for reporting faults or damaged equipment. The you would not ask your grandmother to run up and
device must be clearly labelled with a notice saying down the stairs several times or do a ‘step test’, as
228
this might trigger angina or a heart attack. The person to wash hands before and after the procedure to
must be used to participating in, and happy to carry prevent cross-infection.
out, the type of exercise you devise. There must be no
risk to health in carrying out the activities.
Body temperature measurements – normal
Ensure that you wash your hands before and after the
values and range
procedure to prevent cross-infection. Body temperature must be kept within a narrow range
so that the physiological processes of the body can
function at their maximum efficiency.
However, body temperature varies between individuals
Did you know?
even when they are in the same environment. They
A baby’s pulse rate is much faster than an adult’s and can vary in the same person, at different times of the
the radial pulse is difficult to find. Health professionals day, during different activity levels and depending on
usually take a baby’s pulse over the larger brachial whether or not food and drink has been consumed. In
artery in the arm.
women, body temperature is affected by the stages
of the menstrual cycle, being highest at ovulation
Breathing rate measurements – normal and lowest during actual menstruation. Most people
experience their lowest temperature around 3 a.m. and
values and range
their highest around 6 p.m.
You will need to observe the rise and fall of the
person’s chest in order to count the respiratory rate.
It is best to do this after pulse-taking. The problem
you may find is that, as soon as the person is aware of Did you know?
the count, voluntary control takes over and the rate
The range of temperature compatible with life is not
may alter. Many carers continue to keep their fingers
known accurately. Experts believe that the upper limit
on the pulse for an extra 60 seconds to distract the is around 44°C and the lower 27°C. An individual will
individual while counting the respirations. One rise and be seriously ill long before these limits are reached,
one fall counts as one respiration. You can then record and will be likely to die.
both rates. Normal respiratory rate is said to be 12–20
breaths per minute – during exercise, breathing rate
can rise to 30–40 breaths per minute. In addition to all these influences, body temperature
varies according to the location of the measurement,
Factors affecting reliability of breathing rate
for example, mouth, axilla (armpit), ear canal and
measurements
rectum. The latter is only used when the other sites are
You should be alert for any changes in chest movement unavailable and in patients who are unconscious and/
as the individual may have become aware of the or very seriously ill, as the procedure causes raised
measuring and alter their pattern of breathing. When anxiety and stress levels. Rectal temperatures are
you are taking a resting breathing rate measurement, nearer to actual body core temperatures but are slower
ensure that the person is not disturbed or anxious to change. Mouth or oral temperatures are about 0.5°C
and has been resting for at least 10 minutes or you higher than axillary temperatures.
might get a false reading. The individual should not
Normal body temperatures range from 36.5 to
have smoked recently, as this too will produce a false
37.2°C. Most people will quote 37°C as normal body
reading.
temperature but, given the range of influencing
Sometimes the rise and fall of the chest is slight factors, this is rather too precise.
and it is easy to miss and to miscount when you are
Temperatures are often taken once or twice daily as a
registering two movements as one count.
routine but the frequency can be varied according to
Safe practice in taking breathing rates need. A patient suffering from (or at risk of developing)
As you are observing a phenomenon rather than an infection, or who is recovering from hypothermia
actually doing anything, the risks are low. However, or who is post-operative, may have their temperature
clothing may need to be adjusted, and it is important taken hourly or every four hours.
229
(°C) (°F) Since mercury-filled thermometers were banned in

Celsius Fahrenheit
scale equivalent
care establishments, several types of non-mercury
44
? Upper limit of survival thermometers have become available. These are:
110 • disposable thermometers
43
• calibrated electronic probes
42
• tympanic (ear canal) thermometers.
41 106
Pyrexia However, you must remember that in many private
40
homes mercury-filled, clinical thermometers are still in
39 102 use.
38 Temperatures were once measured in degrees
37 Fahrenheit but now degrees Celsius are used. If you
98 Range of normal
are using an old thermometer, you will need to look at
36
it very closely to see the measuring scale.
35
94
The procedure outlined in Activity 16 below can be
34 adapted to any type of axillary thermometer.
33 Disposable oral and oral probe thermometers should
32 90 be placed under the tongue. There are right and left
Hypothermia pouches on either side of the fold of membrane (the
31
frenulum) on the underside of the tongue and either
30 86 one is a suitable place for the thermometer. The
29 individual should not bite or chew on the probe but
28
should close their lips around it for the prescribed
82
length of time. The rest of the procedure is the same
27
as for axillary temperature-taking.
? Lower limit of survival
26 Rectal thermometry should not be carried out by
78
25 unqualified individuals and so it will not be described
here.
Fig 5.47: Body temperature range

You are most likely to take temperatures in the axilla 8 Ask the individual to hold their arm across
(armpit). their chest to hold the probe in position.
1 Wash your hands first to prevent cross-infection. 9 Leave for the correct time (as per the
2 Explain what you are going to do to the individual manufacturer’s instructions).
and obtain their consent and co-operation. 10 Stay with the individual to ensure the position is
3 Make sure that the individual is sitting or lying maintained.
comfortably and can hold that position for a few 11 After the appropriate time has elapsed, remove the
minutes. thermometer, and read and record the temperature
4 Respect privacy, and help to remove clothing from along with the date and time.
one axilla. 12 Safely dispose of, or clean and store, the
5 Dry the axilla with a disposable tissue. thermometer as appropriate for the establishment.
Wash your hands again.
6 Place the temperature probe in the axilla so that it
is surrounded by skin. 13 Check that the individual is still comfortable and, if
relevant, compare this reading with previous
7 Observe the individual throughout the process to readings.
check for signs of distress.
230
Tympanic thermometers measure the temperature of Safe practice in taking body temperatures
the ear drum (tympanic membrane) and this is very See the information on dealing with electrical
near to the body core temperature. A probe with a equipment on page 228.
disposable cover is inserted into the ear canal while
Oral thermometers should only be used with attentive,
gently pulling the ear lobe downwards. When the ear
co-operative adults to ensure that the probe is not
drum can no longer be seen (because it is obscured
bitten or chewed, with the accompanying risks to
by the probe), hold the thermometer still and take
safety. All equipment should have disposable covers or
the recording. Remove the probe and dispose of the
sheaths or be thoroughly cleaned after use to prevent
cover before storing the equipment safely. Otherwise,
cross-infection.
use the same procedure as for axillary recordings. This
Even with the use of disposable covers, tympanic
is the preferred method for taking temperatures in
thermometers have been found to transmit ear
children, as it is fast and well-tolerated.
infections (often with drug-resistant bacteria) between
individuals. Extra care should be taken with personal
and equipment hygiene.
Mercury and glass thermometers are now considered
obsolete and even domestic settings should be
encouraged to replace them with LCD thermometers.
The danger is from mercury poisoning and glass
inhalation or ingestion.
Factors affecting reliability of body temperature
measurements
Several factors are discussed under normal values and
range (page 229).
Ensure that you fully understand how to use the
temperature measuring device and know both the
correct location of the sensitive probe, strip or bulb
and the length of time needed for measuring. Failure
Fig 5.48: Taking a tympanic temperature to comply with the manufacturer’s instructions may
lead to inaccurate readings and errors.
LCD (liquid crystal display) thermometers are cheap,

disposable, safe and easy to use. They are also Did you know?
available in high street pharmacies, and parents of
You should always allow an individual to rest before
young children are encouraged to keep a supply at taking temperature measurements and ask whether
home. They are single-use only and the manufacturer’s they have had hot food or drink or taken exercise
instructions must be followed to obtain correct results. recently. Such activities may lead to inaccurate
readings.
Prepare the equipment correctly and make sure that it

is calibrated where this is appropriate.
Activity 18: Comparing The accuracy of a temperature reading depends on
measuring devices fully functioning equipment and your skill in carrying
Using an LCD strip thermometer, take your out the measurements. When taking oral temperatures
temperature and then compare it with an oral do not ask the individual questions or allow them to
temperature reading. Comment on the difference talk, as the colder air flowing over the thermometer will
between skin and oral temperatures and refer back cause inaccuracies.
to the manufacturer’s stated accuracy for a final
conclusion. There have been several studies relating to the
accuracy of temperatures taken with tympanic
231
thermometers but, over time, carers are becoming individual at rest and at intervals during recovery from
more experienced at using these devices. a standard exercise test. You will need to know:
LCD strips, while valuable in domestic and community • how to take the measurements using safe practice
settings, are not absolutely accurate but they do provide • the range of normal values
useful guidance when the temperature is raised.
• the factors that affect the reliability of the data you
Consult the manufacturer’s instructions on accuracy obtain.
levels.
You will need to interpret and analyse your data and
demonstrate how homeostatic mechanisms respond to
4.2 Normal variations measured exercise.
at rest and following exercise You can use a standard exercise test of your own
In this section you have to obtain data by measuring choosing, subject to your tutor’s approval, but a useful
the temperature, pulse and breathing rates of a healthy resource is the Harvard step test described here.

You can practise assessments on yourself once you are exhaustion and the test is stopped at that
competent with making routine measurements. The point and the precise time noted.
procedure that might be used is outlined below. 2 The individual sits down after the test and the
measurements are taken as below. You will need
Harvard step test to start the stop-watch again immediately after the
You will need a safe step about 50 cm high and a stop- subject has stopped the test.
clock or stop-watch. Taking results:
3 Count the rate of pulse or breathing or take the
Procedure: temperature at 1–1.5, 2–2.5 and 3–3.5 minutes
1 The subject being tested steps up and down after the test.
(one foot, then both feet) at a rate of 30 steps per Note: it is a good idea to draw up relevant chart/s
minute for 5 minutes. for the recording of results before you start. An
Note: if the stepping cannot be maintained for example is provided in Table 5.6 below.
15 seconds at any time, this is deemed to be
Table 5.6: Recording the results of a Harvard step test
Subject name or code for confidentiality: ___________________________________________________________
Date of test: _____________________________ Tester’s name: ______________________________________
Measurement Rest 1–1.5 mins 2–2.5 mins 3–3.5 mins

Pulse/heart rate
beats/minute
Breathing rate
breaths/minute
Temperature °C
Duration of test if Test 1: Test 2: Test 3:

not 5 minutes
232
It is worth noting that taller individuals have a

mechanical advantage in this type of test.
Functional skills
Note: you may need to repeat the test more than Mathematics: Calculating the results of the Harvard
step test will enable you to demonstrate your
once, as it might be difficult for you to take more
mathematical skills.
than one measurement accurately per test.
The Harvard step test is commonly used to assess
cardiovascular fitness and a scoring system has been
devised for this. You might wish to use this or leave
the results in beats per minute.
4.3 Data presentation and
interpretation
Activity 20: Working out Graphs and charts
the Harvard step test Ensure that the data you have obtained is clear and
accurate by drawing up charts to record your results
results before you start the exercise tests. It is depressing and
To use the scoring system for cardiovascular frustrating to find that you are unable to remember the
fitness with the Harvard step test, use the following details of the work afterwards because you just noted
method:
figures haphazardly during the tests. You are likely to
1 Calculate, in seconds, the duration of the be analysing and presenting your data on a different
test as it was carried out by the subject. If the
day to the one when you carried out the tests.
subject did not become exhausted and finished
the test before the due time, this will be 5 × 60 Charts should have each column headed with a title
= 300 seconds. This figure will be represented and the unit of measurement. There should be clear
by T. indications of the time the measurements are taken,
2 Add together the number of pulse beats their frequency and the date.
recorded in the three time periods. This figure Graphs can be an effective way to display data and
will be represented by B.
trends as they are generally easier to interpret than
3 Substitute your data for T and B in the columns of figures.
following equation: 100 × T ÷ 2 × B
Each graph should have:
4 The product for this equation can be
interpreted from the following table indicating • a title such as: ‘Graph to show how pulse
cardiovascular fitness. measurements vary with exercise’
Excellent >90 • labels on both axes denoting what is being
measured and the units of the measurement
Good 80–89
• the vertical axis should be the unknown variable –
High average 65–79
in this case, it will be pulse rate, breathing rate or
Low average 55–64 body temperature
Poor <55 • the horizontal axis should be the known variable – in
this case it will be time
Example: Chris completed only 4 minutes 35
seconds of the test before he was exhausted.
• clear marks and values on the axes denoting the
His heart rates for the three time periods were: scales being used
108, 92 and 75. His assessment on this scoring • a key, if more than one trend is shown
was 100 × 275 ÷ 2 × 275 = 50. Chris therefore
• points plotted as accurately and finely as possible
has a poor cardiovascular rating.
• fine lines linking the plotted points.
233
Your graph will also need the period of exercise to The reader should understand exactly how you have
be defined and labelled after the resting period. You conducted the assessment.
might wish to lightly shade or hatch this area. After displaying the results, chart and graphs, you will
need to identify the trends shown by the figures and
180 graphs and, from your knowledge of homeostatic
mechanisms, attempt an explanation for each rise or
160
fall.
Pulse bts/min
140
For example:
120
The readings immediately after the exercise
100 ceased showed a marked rise above resting
80
levels in both pulse and breathing rates. This is
because muscular activity demands a massive
60 increase in oxygen and glucose. As the muscles
50 use up oxygen and produce extra carbon
Breathing rate bre/min
40 dioxide, chemoreceptors are stimulated and

these act on the cardiac and respiratory centres
30 in the brain.
20
You can also comment on the reliability and validity of
10 your data.
0
40
39
Key terms
Reliability – Relates to the extent to which a set of results can
Temperature °C
38 be replicated by repeating the test.

Validity – Relates to the quality of test results provided to
37
tackle the study in question. ‘Valid’ means true, sound or
36 well‑grounded.
35
34
Period of exercise
Time (mins) PLTS
Fig 5.49: How pulse, breathing rates and body temperature Creative thinker: Questioning assumptions when
vary with exercise carrying out and recording data from physical activity
will require creative thinking.
Supporting explanations of collated data Team worker: Reaching agreement and managing
Presenting a chart of results and a graph is not decisions to achieve results during practical work on
sufficient for your practical assessment; you will need physical activity, including collecting and recording
data, will allow you to show team working ability.
to describe details of the equipment you used and say
how you used it – in other words, explain your method. Self-manager: Working towards goals of collecting and
Your account of the way you organised the resting and recording data to meet completion dates and dealing
with competing pressures to meet deadlines will show
exercise periods in conjunction with the measurement
self-management skills.
of the data needs to be clear, accurate and complete.
234
Assessment activity 5.5 P5 P6 M2

P4 M3 D2
Produce a written report on the body’s response to • When you start to run, your muscles need
exercise. The report will be based on primary and a lot more oxygen and glucose. How is
secondary research. The report will include this accomplished? What prevents the
1 An explanation of the concept of homeostasis and cardiovascular, respiratory and endocrine
its role in exercise and healthy functioning of the systems from over-compensating during
body. exercise?
2 Measurements collected from practical work • Muscular activity generates heat. How does
involving physical activity and your interpretation the body resist over-heating?
of them together with comments on the validity of You will need to consider a falling glucose
the data collected. level as energy is being utilised for muscular
activity, an increased demand for oxygen and
Grading tips the need to eliminate more carbon dioxide
P5 Using your knowledge of body systems, explain (cardiovascular and respiratory mechanisms),
the concept of homeostasis. Using examples and an increased body temperature from
of the homeostatic mechanisms involved working muscles. You could use the data you
in regulating the heart rate, breathing rate have collected to support your discussion as
and body temperature would be particularly well as other sources of information.
relevant for this report.
D2 To gain D2, you have to evaluate the
P6 You should follow guidelines from your teacher importance of homeostasis in maintaining the
to measure heart rate, breathing rate and body healthy functioning of the body.
temperature before and after a standard period
• What might happen if body temperature
of exercise.
and blood glucose fall below or rise above
• Design a pattern of exercise for your their normal ranges?
individual, taking into account their state of
• What might be the consequences of having
health and general fitness.
a very slow or very rapid heart and breathing
• You are recommended to take rate?
measurements before the exercise,
You will need to show the importance of keeping
immediately after it stops and then two or
to a narrow range of variables and what can
three more readings in the first five minutes
happen if this is not done. Remember how
of recovery and at longer intervals until the
cell enzymes are responsible for speeding up
individual’s measurements have returned to
chemical reactions in processes like respiration
their pre-exercise levels.
and how sensitive enzymes are to some changes.
• Design your results chart.
M3 You should present all the data you have
• Carry out the practical work, recording collected before and after the exercise period
the data collected on the results chart you with reference to validity. You should present
have designed. You should obtain a witness the data recorded on your results chart as
testimony from your tutor to confirm you tables and charts and must make comments
have collected measurements yourself and about the validity of your data. Validity refers to
done so safely. the soundness of your results or how true they
You must also interpret the data by stating what are. Often, this will include how many readings
it tells you about the changes that are taking you have taken or whether you have assumed
place inside the body during and in a period certain trends which may not have been so had
straight after the exercise period. you taken more results. You could explain any
perceived errors or times when the activity did
M2 This criterion requires you to discuss probable not quite go to plan.
homeostatic responses to changes in the
environment inside the body brought upon Body temperature may vary very little over the
during exercise. period of time of the exercise and a graph may
not be useful.
235
Nurse practitioner
Willow Grove is a health centre in the UK; there are five

doctors, two practice nurses, a health visitor and a nurse
practitioner working in the centre. Ayesha Smith is the nurse
practitioner (NP) at Willow Grove and has been there for five years.
Mia and her mother often see Ayesha instead of a GP.
Ayesha runs daily surgeries in a rota with the other GPs and this
involves sensitive questioning and examining, as well as planning
and providing appropriate treatment and support for
individuals registered with Willow Grove.
Patient confidentiality and being

non-judgemental are important features of her work.
Ayesha must collaborate with the GPs and sometimes she makes
referrals to other health professionals. She provides counselling and
health education and can prescribe certain medications.
NPs can diagnose, treat and monitor both acute and chronic diseases
as well as carrying out immunisations and routine medical
examinations.
Think about it!

1 Why does Ayesha need to have a detailed knowledge of anatomy and physiology?
2 When might an NP need to refer an individual to a specialist?
3 Name two other services that a modern health centre like Willow Grove might offer
patients.
4 Explain why Ayesha still has to study anatomy and physiology to keep up to date with
medical developments, even though she has an advanced nursing degree.
5 Outline two different medical situations relevant to this unit that Ayesha might meet in the
surgery.
6 Discuss the importance of close and prompt liaison between Ayesha and the GPs at Willow
Grove.
7 Ayesha often has to undertake routine medical examinations of individuals for a variety of
reasons. Thinking about the body systems you have learned about in this unit, suggest how
each might be tested when carrying out a time-constrained examination.
236
Resources and further Vander, A.J. (2005) Human Physiology: The

Mechanisms of Body Function London: McGraw Hill
reading Ward, J. et al (2005) Physiology at a Glance Oxford:
Blackwell Publishing
Baker, M. et al (2001) Further Studies in Human
Wright, D. (2000) Human Physiology and Health for
Biology (AQA) London: Hodder Murray
GCSE Oxford: Heinemann
Boyle, M. et al (2002) Human Biology London:
Collins Educational Journals
Clancy, J. & McVicar, A. (2002) Physiology and Biological Science Review
anatomy: A Homeostatic Approach London: New Scientist
HodderArnold Nursing Times
Givens, P. & Reiss, M. (2002) Human Biology and Nursing Standard
Health Studies Cheltenham: Nelson Thornes
Indge, B. et al (2000) A New Introduction to Human
Biology (AQA) London: Hodder Murray Useful websites
Jenkins, M. (1996) Human Physiology and Health
BBC Science and Nature
London: Hodder &Stoughton
www.bbc.co.uk/science
Jones, M. & Jones, G. (2004) Human Biology for AS
Get Body Smart www.getbodysmart.com
Level Cambridge: Cambridge University Press
Instant Anatomy www.instantanatomy.net
Moonie, N. et al (2000) Advanced Health and Social
Care Oxford: Heinemann Biology Guide www.biologyguide.net
Pickering, W.R. (2001) Advanced Human Biology BBC Schools GCSE Bitesize Biology
through Diagrams Oxford: Oxford University Press www.bbc.co.uk/schools/gcsebitesize/biology
Saffrey, J. et al (1997) Maintaining the Whole Milton British Heart Foundation www.bhf.org.uk
Keynes: The Open University Net Doctor www.netdoctor.co.uk
Shaw, L. (2005) Anatomy and Physiology NHS Direct www.nhsdirect.nhs.uk
Cheltenham: Nelson Thornes Index of body systems illustrations
Stretch, B. et al (2007) Core themes in Health and www.webschoolsolutions.com/patts/systems
Social Care Oxford: Heinemann
237
Just checking
1 Complete the table below to outline the functions of the named organelles:
Name of organelle Main function
Lysosome
Energy release
Contains DNA
Rough endoplasmic reticulum
Cell membrane
2 Explain one location of the type of tissues given below:
• simple squamous epithelium
• ciliated columnar epithelium
• keratinised epithelium.
3 Describe the characteristics of each matrix in blood, cartilage and bone.
4 State the law of conservation of energy.
5 How is tissue fluid formed? Why is tissue fluid important in the sphere of energy metabolism?
6 Define diffusion and explain how this process is important in energy metabolism.
7 Describe the characteristics of enzymes.
8 Explain the role of baroreceptors in the homeostatic mechanisms controlling heart rate.
9 Why is it difficult to stay cool in a tropical humid atmosphere?
10 Explain how plasma glucose is regulated by hormones.
Assignment tips
1 This unit is internally assessed by your tutor on the evidence you present in your portfolio. The evidence
must be entirely your own work. Due to the nature of this unit, you will probably use many images, which
can be your own diagrams (or photographs), or professional images from reference texts, leaflets and
websites.
2 Work that is not your original creation must be appropriately referenced to the source and adapted
to demonstrate the scope of your knowledge and understanding. It is not acceptable to download or
copy images that you have not referenced, explained, adapted or annotated in any way. As you collect
samples, write on the back how you think you will use them and what adaptations you will make. It is
very easy to collect pieces of paper and then forget how you intended to use them.
3 To obtain merit and distinction grades, you will need to be able discuss energy metabolism and
homeostasis so reading around the topics is essential. Keep a notebook or file with all your text and
Internet references and the research notes you have made. Read these through before you begin your
reports and discussions.
4 Plan your practical work carefully and ensure that you have made out a results chart and practised taking
measurements beforehand. You must take account of health and safety issues and include them in your
written report.
238
Credit value: 20
6 Personal and
professional
development in
health and social
care
This unit is mainly about you: how you develop as an individual and as a
learner while preparing for future work in health and social care. All those
who work in health and social care need to have a good understanding of
themselves and their skills and abilities in order to contribute positively to the
care, health and well-being of others. In addition, once qualified, health and
social care professionals are expected to continue keeping up to date with
new developments in relevant knowledge, care practices and social policies.
Early on, you will identify your strengths and those areas where you require further
development. Your initial self-assessment will help you draw up a plan for your development
over the course and for progression to professional training either in the workplace or in
higher education. The different units in the course and the understanding gained from the
placements that are an essential part of this unit, will provide you with evidence of your
personal and professional development, which you will regularly review against your initial
development plan. You will also investigate a health or social care setting and assess how it
contributes to the provision of services nationally.
Learning outcomes
1 understand the learning process
2 be able to plan for, and monitor own professional development
3 be able to reflect on own development over time
4 know service provision in the health or social care sectors.
239

P1 Explain key influences on the M1 Assess the impact of key influences D1 Evaluate how personal learning
personal learning processes of on the personal learning processes and development may benefit
individuals. of own learning. others.
See Assessment activity 6.1, See Assessment activity 6.1, See Assessment activity 6.1,
page 254 page 254 page 254
P2 Assess own knowledge, skills,

practice, values, beliefs and career
aspirations at start of programme.
page 267
P3 Produce an action plan for self-

development and achievement of
own personal goals.
page 271
P4 Produce evidence of own progress M2 Assess how the action plan has D2 Evaluate own development over
against action plan over the helped support own development the duration of the programme.
duration of the programme. over the duration of the See Assessment activity 6.7,
See Assessment activity 6.4, programme. page 282
page 272
P5 Reflect on own personal and M3 Use three examples to examine

professional development. links between theory and practice.
page 282 page 282
P6 Describe one local health or social

care service provider and identify
its place in national provision.
page 292
P7 Describe the roles, responsibilities

and career pathways of three
health or social care workers.
page 299
240
Unit 6 Personal and professional development in health and social care

This unit will be assessed through assignment tasks that you will complete in stages over
the duration of the unit.
Your assessments will include:
• written assignments
• a detailed action plan for your own research project
• a report on the findings from your project.
Jude, 17 years old

I was a bit daunted by Unit 6 at first, especially when I realised the
unit wouldn’t be finished until the end of the second year. Still, our
tutor explained what we would be doing in the unit and we did
lots of the activities each week. These were really helpful in making
me think about myself and how much I had learned about caring
from helping my mum look after my younger brother who has cerebral
palsy.
At first, I wasn’t sure about how to reflect in my journal but I got the hang of it once I’d
been on placement. There was much more to think about, with something happening
most days that I could relate to one or other of the units on the course. Unless they
were really busy, most days the supervisors were good at telling me what I was doing
well or suggesting how I could improve.
The school’s placement officer visited me on each placement and gave me useful tips
and after each block week, we spent time in class talking about our experiences. The
question and answer sessions helped me make sense of what I had learned and made
it much easier to keep my journal.
At the end of the course, it helped to go back and compare what I had written in my
first placement with what I was doing in my last one. Also, some of the things that
seemed really important at the time they happened, worried me much less when I
came to look back on them much later. Maybe that is what is meant by learning from
experience.
Over to you!
1 What are you looking forward to most about Unit 6?
2 What do you think you will find most difficult?
3 Why do you think Unit 6 is important?
241
1 Understand the learning process
Get How much do you know about health and social care?
started How much have you learned about health and social care up to now? What health
and social care services have you used? Which health or care professionals looked
after you? What qualities do you think you need to work in health and social care?
Which of these qualities do you think you already have? And how do you need to
develop your abilities so that you can progress successfully in a career in health and
social care?
An overview of learning Before you qualify as a professional, learning from

experience is called personal and professional
Learning is a process by which we acquire knowledge, development (PPD) but learning after qualifying is
skills and an understanding of abstract concepts. called continuing professional development (CPD).
Learning starts with early experiences as an infant and You will come across both terms in this unit.
continues through formal schooling and academic
study or training. You will need to complete specialist
training to acquire the knowledge and skills for work Reflect
as a care assistant, nurse or social worker, for example. Workers in health and social care are required
The process is summarised in Figure 6.1 (on the next to undertake CPD. Why do you think this is
page). Learning also continues informally throughout necessary?
life, and most health and social care workers expect to
support the learning of other staff as a routine aspect As an older adolescent or adult, you will learn
of their work. Workers may also need to support from formal study but you will also learn from your
individuals to learn new information or skills. experience of daily life (jobs you have had, your home
Health and social care workers are expected to take life, etc.). You will have innate abilities that you are
active steps to develop their learning appropriately born with, such as having a good singing voice, or
for the specific care they do. This unit will help you to: practical skills you have acquired, such as learning
• understand how you learn to play a musical instrument through practice. Often
• understand what you have learned from your formal learning blends skills with theory – driving a car
study and life experiences to date involves practical skills and knowledge of the Highway
Code. Figure 6.1 shows how these three different
• set goals for your personal development during the
areas overlap. As you go through the course, you will
course
• plan for your personal development and implement
the plan
Key terms
• monitor your progress against the plan, amending it
Personal and professional development (PPD) –
as learning proceeds Learning acquired from experience before qualifying as a
• reflect on the progress of your learning and professional.
development on the national programme, Continuing professional development (CPD) – Learning
especially with regard to your career aspirations. acquired after qualifying as a professional.
242
develop your abilities in all three areas as preparation

for qualifying to work in health or social care.
1.1 Theories of learning
This section explores a limited selection of theories
that help understanding of how older adolescents and
Reflect adults learn. The aim is to enable you to recognise how
you learn and then plan your own development while
How do the theories presented here compare
on the course.
with the theories of learning you explored in
Unit 4 (Development Through the Life Stages)? The simplest way of looking at learning from experience
Theories relating to how adults learn are is using the experience-reflection-action cycle, or the
different. ‘plan, do, reflect’ cycle shown in Figure 6.2.
You may already know what sort of learner you are, i.e.
whether you are:
• a visual (seeing)
• auditory (hearing)
Experience
• kinaesthetic (movement) or
Theory
• tactile (touching/feeling) type of learner.
and Skills and
knowledge abilities Two of the best-known theories related to learning
Learning from experience are Kolb’s experiential learning cycle
and
development (1984) and Honey and Mumford’s learning styles theory
Start of programme (1982).
Level 3
BTEC
Completion of programme
Plan Take action
Learning and
development
Reflect
Fig 6.1: A model to show personal and professional Fig 6.2: The plan, do, reflect cycle — a basic model of
development learning from practice
Activity 1: How do people learn? How do I learn?

What (and who) has influenced your learning 1 What categories/groups have you identified?
throughout your life so far? Write each point on a 2 Why have you decided on these categories of
separate sticky note. Write as many points as you can influences?
in five minutes.
3 Share your findings with other groups in the class.
Work with two or three others. Stick everyone’s notes
on a wall or table and sort them into groups by moving 4 Make notes on the influences on learning identified
individual notes round until you have agreed the by the whole class.
groups.
243
Kolb’s experiential learning cycle 4 Active experimentation: This is the planning or

trying out stage. The next time you do the activity,
Kolb helps us to understand how adults learn. The
you tackle an aspect of it differently from the first
ways in which people learn are called their cognitive
time, thus demonstrating that you have learned
abilities. He suggested that during adolescence
from the first concrete experience.
and early adulthood we begin to develop instinctive
preferences as to the way in which we process
information and use it to make sense of our
experiences. Kolb identified two pairs of opposing Case study: Zofia
factors that, combined together, show learning as a
cyclic process with four stages (see Figure 6.3). Zofia speaks English as a second language.
She is talking to residents at her placement.
One of the residents, Gladys, who is very elderly
and frail, corrects her English. Zofia apologises but
Concrete experience
Gladys explains very clearly where she had been
(action/actual practice)
going wrong in her phrasing and vocabulary. Later,
Zofia thinks about what she had been taught in
her ESOL evening class and realises that Gladys
has enabled her to understand several rules of
Active
Reflective English that she had had difficulty understanding
experimentation
observation in class. After lunch in the care team meeting,
(exploring/revising
(analysing) Zofia feels more confident in how she expresses
approaches)
herself and her supervisor congratulates her on the
improvement in her English.
How does Kolb’s experiential learning cycle
Abstract conceptualisation explain Zofia’s learning?
(sense-making)
Fig 6.3: Kolb’s experiential learning cycle
The above example shows how Kolb’s learning

cycle theory can be applied to everyday practice.
Key term The following activity gives you a chance to try it for
Cognitive abilities – Ways in which you think, using your yourself.
knowledge and experience.
He claimed that, although it is possible to enter the Activity 2: Applying Kolb’s

cycle at any stage, for learning to be effective, each learning cycle
stage must be followed in the correct sequence.
Use Kolb’s experiential learning cycle to review three
Kolb described each stage as follows: recent tasks you have carried out for the first time in
1 Concrete experience: the doing stage where you the last two or three days. For each task, note down:
actually carry out or participate in an action or • the aspects you judged to be successful and why
actions. • the aspects you judged to be less successful and
2 Reflective observation: the reviewing or reflecting why
stage where you think about what you did and what • what you would do differently for the ‘active
happened during the concrete experience. experimentation’ stage before doing each of the
3 Abstract conceptualisation: the concluding stage activities again.
in relation to the concrete experience, sometimes Kolb developed his theory further and described
called the theorising stage. In this stage you use four learning styles. Research Kolb’s learning styles
theory and the definitions of each style. How well do
all the information you have gained about the
the descriptions of each style match your preferred
experience and organise your thoughts into some way of learning?
sort of order and so make sense of the experience.
244
Although Kolb’s learning cycle is useful in helping us Honey and Mumford’s learning styles
recognise that thinking involves a series of stages,
theory
there are some criticisms of his theory:
Honey and Mumford (1982) also developed a learning
1 The learning cycle does not take account of the role styles theory. They reviewed the way in which different
of feedback from others; it only considers what the employees learned, and identified four learning style
individual is thinking. preferences: reflector, theorist, activist and pragmatist.
2 Some argue that it is not necessary to follow the The characteristics of each learning style help to
same order of the different parts of the cycle for identify preferred situations for learning, and situations
learning to be effective. that are less favourable (see Table 6.1).
Table 6.1: A summary of the characteristics of Honey and Mumford’s learning styles and their impact on learning
Learning style Characteristics Preferred learning situations Less favourable learning

situations
Activists • Like to be involved • New experiences • Listening (e.g. lectures) or
• Like new ideas • Working with others when passive
• Lose interest quickly • Taking the lead • Doing things on their own
• ’Jump first/think later’ • Taking on difficult tasks • ‘Working to the rules’
mentality
• Like to dominate
Reflectors • Like to observe from the • Observing from the edge of • Taking a lead or performing
edge of a group a group in front of others
• Consider things from • Having time to think before • Having no time to prepare
a range of different contributing in advance
perspectives • Analysing • Facing the unexpected
• Collect information before • Working without tight • Feeling rushed or
drawing conclusions deadlines pressurised by deadlines
• Let others contribute before
they do
Theorists • Like to bring together • Having the opportunity to • Cannot identify with
different ideas to produce apply their knowledge and different approaches taken
new ways of looking at skills in complex situations by others
things • Working with abstract ideas • Having a lack of structure or
• Think logically • Having opportunities to purpose
• Like things to fit into an question and probe for • Working with emotions and
ordered scheme information and ideas feelings of others
• Often detached and remote • Having a clear structure and
rather than emotional purpose
Pragmatists • Like to experiment/try • Having a clear link between • Being unable to identify the
things out thinking and what has to be relevance of what has to be
• Seek feedback from others done done
• Practical, like to get on with • Having an opportunity to try • Not having guidance on
things rather than talk about things out how to do things
them • Like having new ideas that • Benefits being unclear
• Relate things to their own have clear benefits • Focus being only on theory
role • Happy to copy from role and not including practical
models aspects
245
Case study: Katya Activity 3: Using my preferred

Four health and social care students have
learning style
been asked to make a wall display for a 1 Identify your preferred learning style, if possible,
health promotion assignment. Katya is already using an appropriate questionnaire.
planning out her ideas on paper, referring back to 2 Identify a situation where your learning was
the assignment task to check she has understood particularly effective from your:
what is required. Sally is full of enthusiasm, talks
eagerly, has lots of ideas and is trying to persuade • course
the others to follow them. Lee is attentive but quiet • placement
and not contributing to the discussion. Surinder is
• home life.
picking up some of Katya’s and Sally’s ideas and
is trying to form them into a sensible order. After 3 Repeat the exercise, choosing one example
a while, Katya starts chatting to her friend in the from each situation where your learning was less
neighbouring group, Lee gets up to go to the effective.
library, and Surinder expresses exasperation at not 4 Compare the effective and less effective learning
having made any progress with the task. experiences and analyse the extent to which
1 What is the preferred learning style of each your preferred learning style helps to explain the
member of the group? differences in your learning.
2 Why do you think the group has ceased to 5 What steps could you have taken to enhance
function? your learning, from the situations you have
identified?
3 What could you suggest to the group to help
them achieve their task? 6 Do further research on recent findings about the
importance of learning styles.
Honey and Mumford devised a questionnaire for

individuals to identify their preferred learning style. 1.2 Influences on learning
Most individuals tend to use a range of learning styles, Learning style is only one influence on how people
depending on the situation, but we use our preferred learn. Understanding how you learn is helpful for your
learning style most easily, especially if we are tired progress on the course so that you can focus on the
or stressed. Being aware of your preferred learning positive influences. However, you should remember
style may help you work in a way that enhances your that other people’s learning may be influenced by
learning and avoid situations that are unhelpful. factors outside your own experience.
Reflect Activity 4: How do others

Compare Honey and Mumford’s learning styles learn?
with those of Kolb. To what extent are they the
same or different? Observe one of your peers learning a new skill or
routine. Note the factors that seem to help the
individual’s learning and those that hinder it.
Being aware of your preferred learning style means
1 How could the learning experience be altered to
that you can select an approach when planning your improve the individual’s learning?
study activities and personal development that fits
2 What would have affected your learning in a
your style. However, in working life, being able to similar situation to your peer?
adopt a range of different learning styles according to
the circumstances can make you more flexible and less
dependent on a single learning style. PLTS
Some people now consider that learning styles have Independent enquirer: Processing observed
less effect on an individual’s ability to learn than was information on complex subjects concisely and clearly
previously thought. will allow you to demonstrate your independent
enquiry skills.
246
Reflect Reflect
How could you reduce the negative influences on What factors affect your own learning? In what
your learning? Could you do things in a different way does each factor affect your learning? What
way or avoid unfavourable situations, e.g. work actions could you take to reduce the negative
in a library rather than among distractions from influences on your learning? How might the other
other members of the family at home? factors identified in Figure 6.4 affect how others
learn?
Those working in health and social care need to
be aware of the factors influencing other people’s
learning. If an individual needs to learn new
information and skills, such as taking new medication
1.3 Skills for learning
or using physical aids, they can be supported by taking Study skills
advantages of factors that help their learning and During this Level 3 BTEC course, you may find that
reducing those that hinder their learning. Some of the what is expected of you, and what your tutor does in
factors that may influence how different individuals the classroom, differs from your previous experiences
learn are shown in Figure 6.4. of learning – perhaps when you were doing your
Kolb recognised that socialisation (the way in GCSEs, for example. Studying on a BTEC programme
which a person learns to fit into a group – see Unit requires a different balance of skills from those often
7) experiences affect that person’s learning style. used in examination-based courses. Some of the
Personal habits and routines, beliefs, customs, values, differences arise because the course is aimed at more
motivation and career aspirations are all influences adult learners, who may have more experience of using
because they can affect attitudes to study and whether functional and interpersonal skills.
or not it takes priority over other demands on an
individual, such as home life or work.
Learning Subject Access to

Culture Health Motivation IT skills
style ‘blindspots’ study centre
Specific
Informal
learning
learning
needs
Previous Attitude
educational and self-
experiences discipline
Influences on
learning
Time Lifestyle
Access to
Care
books, the
responsibilities
Internet
Funding for
Family Relationships Friends Aspirations Employment Study space
study
Fig 6.4: Examples of factors that may influence learning
247
Reflect Did you know?

In what ways has your experience so far on
All health and social care professionals are expected
the Level 3 BTEC differed from your previous
to reflect on their experiences in order to learn
experience of study? What new skills have you
from them so that they can continually improve and
started to develop? Which skills from your past
develop their practice. If you progress to professional
have you found useful?
training at university, reflection will be integrated into
What aspects of your experience from past study your study.
have made it more difficult for you to adapt to
study on this course?
with friends, working alongside other people, etc.
In your course induction, you may have completed
Study skills that you will use extensively in this diagnostic skills assessments. These are designed to
programme include functional skills and research skills, find out whether your learning is being hindered by
as well as interpersonal skills in class activities and at difficulties with English and whether you could benefit
your placements. A new skill you will develop as you from specialist support. Work in health and social care
go through this unit is the ability to reflect on your requires you to use and interpret complex information
practice. This will be explored in detail later. in both written and numerical formats and, in all
workplaces, ICT skills are essential. For this course, you
Functional skills will need additional skills to develop the capabilities
Functional skills (similar to key skills) are skills that you needed for work in health and social care and to manage
use in everyday life when shopping, communicating your personal affairs as a citizen (see Figure 6.5).
English ICT Observation

• Use writing to record information • Use ICT for documents, ideas, data • Use informal observation for
accurately about service user care, storage, administration, obtaining learning from work placements.
draw up instructions and policies. information from the Internet, • Use formal observation when
• Read carefully to understand factual intranet and email. gathering information about skills,
information accurately. routines and procedures.
Feedback Questioning Mathematics

• Feedback comes from tutors, • Use questions to gather Important when:
placement staff, service users, information for your own • administering medication
peers, employers. learning from placements, • understanding clinical data in lab
• Use feedback to recognise peers and tutors. reports
strengths and areas for • communicating complex data
improvement. using charts.
Reflection
• Reflect in order to make sense of
information from reading,
observation, the Internet, other
people, using skills and routines.
Planning
Use planning for:
• Setting targets, identifying actions,
Review prioritising, implementation,
• Review progress against plans, monitoring progress
targets, priorities. • Further learning
• Amend plans, targets, priorities. • Care plans.
Fig 6.5: Skills that support PPD for work in health and social care
248
research. This helps to share out the initial work so

Reflect that everyone gets a broad idea of what the topic is
How do you think your preferred learning style about before they go off individually to prepare their
might influence your skills for learning? assignment evidence.
What could you do to help develop your skills for Research is planned investigation of a topic and
learning? you will need to carry out research for assignments
in all units of the National course. For this unit, you
need a basic understanding of research principles to
You will use functional skills throughout the course and obtain information needed to complete assignments
specialist support may involve one-to-one teaching successfully. Some of the techniques you will find
from a specialist tutor as well as class sessions for useful for your assignments in all the units are:
English, mathematical and ICT skills. Additional study observation, questioning and use of the Internet.
skills (those skills you need to complete a course of
study successfully) to prepare you for higher education Observation
are explored in Unit 46 Academic literacy in the health Much of what you will learn on placements will be
and social care sectors. through informal observation, by carefully watching
what is going on around you, as there are only a
few practical activities that you can actually carry
Activity 5: Checking your own out yourself before you are qualified. You may
learning online observe others demonstrating general skills such as
communicating and following procedures for specific
Are your individual learning plan and the records activities and routines. More formal observations are
of what you have achieved so far available to you an important feature in early years provision and you
online at your school or college? If so, it probably may be permitted to carry out a child observation in
means that your school or college has its own such a setting. Formal observations of adults may be
intranet or virtual learning environment. ICT is an
related to gathering information to judge their state of
increasingly important tool for study. Becoming
familiar with the way it can help you would be health.
valuable preparation for study in higher education.
Ask yourself the following questions about your own
online learning information: Reflect
1 How often do you use it? Why are observations of children in early years
2 Do you find it useful? settings so important?
3 Could you make more or better use of it to What routine observations of adult users of
support your studies? services are made, particularly in nursing care?
What do the different observations indicate
about individuals’ health and well-being?
Research skills Questioning

If Unit 22 Research methodology for health and social Questioning is a useful technique for focusing
care is included in your Level 3 BTEC programme, attention on specific aspects of a situation, issue or
then you will use research skills formally to carry out problem. The 5Ws and H tool is useful for formulating
a small research project. However, all learners on the questions.
programme will need to use research skills to some
extent. Some of the research skills are identified in
Figure 6.5 (left). You will use these in most units in Did you know?
some way. You can share the effort of researching a
The 5Ws and H stand for What? Where? Who? Which?
wide-ranging topic in a group and then feed back to
Why? And How?
the whole class so that everyone benefits from your
249
• Both qualitative information and quantitative

Activity 6: Using the 5Ws information is routinely used.
and H Most of your study will involve secondary research.
Think of a recent situation or issue that you have Useful secondary sources include:
come across either in class or at a placement in • books
relation to a topic you are studying. Compile at
• the Internet
least six questions using each of the 5Ws and H at
least once to explore the situation, issue or topic. • specialist journals
1 What have you learned about the situation/ • newspapers
issue/topic as a result of answering the • leaflets and brochures.
questions?
You should continually check the validity of your
2 How could you use your newly acquired
secondary sources for your purpose, i.e. that the
knowledge and understanding?
information or claim made is accurate in the sense that
it:
The Internet • measures what it claims to measure
The Internet provides vast quantities of information • is based on an accurate interpretation of the
and is a valuable resource for study and work. However, evidence presented
although it is relatively easy to get information from • is supported by sufficient evidence.
the Internet, it is often difficult to know who has written You should also check the reliability of your secondary
the material and how reliable it is. sources – that you can trust the evidence retrieved
(and therefore the claim made). The methods used to
obtain the information should:
Reflect
• reflect a realistic situation (rather than one that is
How many different types of information can be
found on the Internet?
unlikely to occur in normal circumstances)
• produce the same results if someone else repeated
Why do your tutors challenge you if you cite
generic websites such as search engines or the research exactly.
Wikipedia? Primary research is research in which you generate the
data. The informal observations you make during your
work placement will give you valuable primary data to
It can also be very difficult to find the same specific
use as examples in your assignment work.
source again at a later stage, even on a reputable
website, simply because there is so much material to
navigate through. Good discipline, when accessing
sources on the Internet, is to:
Key terms
• record the full URL (universal resource locator) for Qualitative information – Information that is described
each source by copying and pasting it from the using words and images.
window at the top of your screen; URLs usually Quantitative information – Information that is described
begin with http://www using numerical data (e.g. tables, charts and graphs).
• note the full date (day, month, year) that you first Secondary sources – Sources of information that have been
located the source published by others (e.g. a quotation from an individual that
appears in a book or journal).
• save URLs to your ‘favourites’ list on your Internet
Validity – A measure of the quality of information and how it
service provider so that you can find the source
is used.
again very quickly but remember to name it in the
Reliability – A measure of the quality of the methods used to
favourites list so you will recognise what source it is generate the information.
• avoid printing sources from the Internet unless and Primary data – New information generated by observation,
until you are absolutely sure that it is necessary to interviews, a survey or an experiment.
have a paper copy.
250
When you read a text (e.g. in a book or on a website), generate evidence for higher grades and is particularly
there will be ‘clues’ that give you some information expected for study in higher education – see also Unit
about the probable validity and reliability of sources of 48 Exploring personal and professional development
information; some of these are indicated in Figure 6.6. in health and social care.
More information can be obtained by analysing the Information that can be confirmed from more than one
content of the text itself. Making a judgement about source is likely to be more reliable than that obtained
the validity and relevance of the information it contains from a single source where you doubt its validity or
to your studies is an important skill that could help you reliability.
f. Is the claim valid?

a. Do I know who wrote it? • Does it relate to evidence
presented?
• Names?
• Is it accurate?
• Is it a well-known organisation?
• Is there enough evidence to
support claims?
g. Does the author refer to the

work of anyone else to back up
b. What do I know about the their claims?
person who wrote it? • Do they present alternative
• Organisation? arguments?
• Qualification/status, e.g. • Do they justify the one they
doctor/academic? have chosen?
• Do they give references or a
bibliography?
Check for validity

c. How neutral is the person/ h. Is the information relevant?
and reliability
organisation? • Does it come from the UK (or
• Has a business sponsored EU)?
research into a particular • To what extent does it relate to
product? what I need?
d. When was it written? useful to me?

• Date? • Statistics, graphs?
• Does it still apply? • Opinions, conclusions?
e. Does it present any evidence

to support claims/opinions/
• Record the full reference details,
conclusions?
including page numbers or a
• Were robust methods used? web address.
• Is it based on a situation that • For a website, also note the
would never happen in real life? date you looked at it.
1. Record the source details fully

2. Make notes from the source
3. Write up your work from your
notes.
Fig 6.6: Basic checks for validity and reliability of secondary sources
251
Activity 7: Using different Reflect

sources Plagiarism (or copying someone else’s work and
claiming it as your own) is a form of cheating,
Choose a topic that is relevant to health and social or dishonest behaviour. Honesty is essential to
care and of interest to you (e.g. for an assignment in establish trust, which is very important in health
another unit). Obtain one source from three different and social care.
types of source as listed on page 250. How would you feel if you discovered that
1 Retrieve relevant qualitative and quantitative a health and social care professional was
data. dishonest?
2 Identify three main points relating to the topic
from each source.
Failure to acknowledge the secondary sources you
3 To what extent does each source provide the use is plagiarism, a form of cheating, or malpractice,
same or different information about the topic?
and is not acceptable. Any attempt to pass off work
4 What do you know about the validity and reliability done by others (whether by a friend, relative or from
of each source and how does this affect your
a published source) will be challenged and the work
judgement about its value?
will have to be redone. In colleges and universities
5 Are the sources useful in providing information
plagiarism is a disciplinary offence, which can result in
and understanding relevant to the topic? Justify
your judgement. a student being barred from study at the institution.
Developing good referencing habits is essential
6 Suggest how you might obtain primary data
about the topic. preparation for higher education.
1.4 Support for learning

All learners benefit from support in order to check
Functional skills how their learning is progressing and Table 6.2 shows
different ways in which support may be given. Learning
ICT: You can demonstrate your ICT skills by selecting may be measured by passing exams, but on this course
a variety of sources of information and evaluating their
your knowledge and understanding of health and social
fitness for purpose.
care will be demonstrated through the coursework you
complete. You will receive written feedback on your
‘Data’ is a plural word (the singular form is ‘datum’, assessed work to tell you what you have achieved and
though ‘data’ is nowadays often used in the singular) provide guidance on what still needs to be done and
that describes several pieces of information (these how you could improve future work.
will often be numerical). Being able to collect,
As a student, your responsibilities for supporting your
organise (into tables, charts, etc.) and use numerical
learning are:
and statistical data to support the arguments you
are making is an essential skill, sometimes called • to recognise that support from others can help your
data handling. It is essential for study and in work learning
environments. • to accept the support that is available to you.
Whenever you use secondary sources, you are
expected to acknowledge each source in your
assessment work. While a bibliography may be Key terms
acceptable for the BTEC Level 3 programme, best Bibliography – A list of all the sources that have been used
practice (particularly if you are presenting new ideas to provide information and background knowledge about the
topic.
e.g. in a report for the Unit 22 research project)
Reference – An acknowledgement of a source used
would require you to use a formal reference system,
by someone else to support a specific idea, opinion,
and this would be essential for higher-level study. A quotation, statistic, diagram, flow chart, etc. The reference
bibliography or reference list is usually presented at acknowledges the original author.
the end of your work.
252
Table 6.2: Different sources of support for learning
Source of support Form that the support takes

Teaching Sharing of new knowledge; facilitating development of new understanding through
specific learning activities
Tutorials Support from specific subject tutors or for your whole programme from a personal tutor –
a two-way exchange
Feedback Formative – comments on your progress before a task/assignment is completed and
suggestions as to how it could be improved
Summative – a judgement on your work against the grading criteria and comments on its
strengths and areas for future development
Coaching Training for specific practical skills to improve performance
Mentoring Discussion with an experienced individual, often based in a workplace, who helps you to
learn from your own experience working in the same or a similar workplace
Supervision When a more experienced person oversees what an individual is doing, generally in order
to safeguard the individual and others
Discussion groups/ Learning through talking with others to share information, understanding and ideas about
meetings issues of common interest/concern to generate solutions to problems or new ideas and
to help make decisions
Help with specific This might be one-to-one tuition for a specific learning disability (e.g. dyslexia) and/or
learning needs provision of specialist equipment (e.g. for sensory impairment)
Seminars Formal forum for which participants prepare specifically and share research and thinking
about a specific topic
Giving oral Talking about a topic to an audience and answering questions they pose about the topic
presentations
Working with peers Working collaboratively, often in groups, to support each others’ learning
Peer assessment Giving and receiving feedback on the work/performance of fellow students, usually on
the same course
Self-awareness from Recognising through reflection on experience when you need support from others
reflection
Accessing information Knowing how and where to obtain the support you need
and support
You will probably make use of several sources of

support during your course. Mentors and supervisors
Reflect
will be important sources of support for your learning In what ways do you receive support?
about health and care practice on your placements. How does the support help you identify:
• what you have done well
• what you could improve
• how you could make improvements?
Did you know? What could you do to make better use of the support
available to you?
In counselling, supervision is a requirement of
Get into the habit of making your own notes during
professional registration as a counsellor. A counsellor
tutorials and discussions with your placement supervisor
is expected to undertake a supervision session after a
to record points made in the discussion. You could also
specified number of hours spent counselling clients.
use your journal for this.
253
1.5 Learning opportunities you might only apply it later. Your formal learning in
college may enable you to reflect differently on an
Opportunities to apply the Kolb experiential learning
experience from your past so you might now have
cycle to learn something new, or to increase your
a better understanding of why you received the
understanding, can happen at any time. This might be
treatment you did when you were ill as a child. In this
during formal learning in the classroom, supported by
instance, the reflection forms part of the reflective
a tutor, or on a placement, supported by a supervisor
observation and active conceptualisation part of
mentor. Everyday experience can also prompt
the cycle. Opportunities for learning can also come
reflection – for example, being a patient yourself or
from experiences in paid employment or voluntary
observing an incident in the street as a passer-by.
work, where you might gain experience of using and
You might apply the Kolb theory soon after an active developing your communication skills while working
experience, perhaps after a classroom discussion or with customers in a shop or a restaurant.
Produce a piece of writing that explains influences on M1 Sketch a timeline to help collect your thoughts
the personal learning process of different individuals. about the factors that have influenced your
Include an assessment of how different influences in learning from your childhood, school, work
your life have affected your own learning. Consider and other life experiences. You could put
influences on the development of your knowledge the significant events and experiences (e.g.
and understanding, skills and abilities. Present your starting school, moving home) on top of the
assessment as a personal statement and include a line and their effects below the line. Use the
curriculum vitae. timeline as a tool to help you construct your
Evaluate how the personal learning and development personal statement. Research how to present a
of health and social care workers can benefit others. curriculum vitae.
D1 Before you prepare your evaluation for D1, you
Grading tips could carry out some research about PPD and
its benefits in health and social care. You should
P1 For P1, you should consider a wide range of
influences that may affect people’s learning talk to staff at your placement about how their
and not just the factors that have influenced learning and career backgrounds have helped
your own learning. Remember to explain the them in their work. You could also consider how
possible effects of the influences, applying the you have used your own learning throughout
theories discussed in this section. your life so far to help others.

English: Producing extended writing and Independent enquirer: Your exploration of the
communicating your ideas effectively and concisely factors that influence your own learning and that of
will allow you to demonstrate your English skills. others will demonstrate your ability to explore issues
and analyse and evaluate relevant information as an
ICT: Using word processing skills. independent enquirer.
254
2 Be able to plan for and monitor your own

development
the expectations of those who work in health and
Activity 8: What are my social care. This initial review will establish a personal
abilities? baseline against which you can measure your
progress.
Make a list of your abilities in a table, under three
headings:
• knowledge
• skills and abilities
• experience. Key term
Discuss your table with two or three of your peers, Baseline – A starting point against which to make
and add any abilities you may have overlooked. comparisons.
While Section 1 introduced you to the concept of

learning and development in general, this section Case study: Surinder
focuses on your actual learning and development, Surinder has always wanted to be a nurse.
both in the past up to the point at which you started She got a Merit grade for a Level 2 Diploma
the Level 3 BTEC course, and throughout the period in Society, Health and Development at school but
on the course and for which you will be planning your only just achieved the mathematics part of the
development. This section has three themes: functional skills. She got a D in GCSE Maths but
managed to get C grades in English and Science.
• an assessment of your abilities at the start of the She has started the Level 3 BTEC in Health and
course Social Care at college because she wants to do
• an exploration of the skills and knowledge expected as much work experience as she can. She really
of those who work in health and social care enjoyed her Year 10 work experience in a primary
school. The class teacher said she was a ‘natural’
• a plan to help you develop new skills and at teaching and should think about it as a career.
knowledge and to enhance the skills and In Year 11 she was the class representative on the
knowledge you already have. school council and helped at the breakfast club for
the Year 7s and 8s. Surinder helps at home, looking
These themes all need to be considered before the
after her grandmother who has diabetes and uses
next assessment activity. In addition, while some of a wheelchair, and she did her Diploma project on
the assessment related to your development has diabetes. Now, Surinder is not sure what she wants
to be completed at the start of the programme, to do when she leaves college.
other assessment activities require you to apply the 1 What are Surinder’s strengths?
material in this section throughout the programme. 2 What is a priority for her development if she is
For this reason, these assessment activities cannot be to be able to progress to either teacher training
completed until the end of the course. or nurse training?
3 Who could help Surinder make her mind up
2.1 Review at start of about what career to choose?
programme 4 What does Surinder need to do to ensure that

she can put in a strong application for either of
In order to measure your development while you are her career options?
on the course, you first need to know your starting
point. You will therefore assess, or measure, your
development in the first few weeks of the Level 3
BTEC programme by exploring this in relation to
255
Understanding yourself is important because care

Activity 9: Learning about work means interacting with other people, and your
myself personal qualities and abilities will influence your
interactions. Being aware of how your own attitudes
Draw a spidergram to summarise your learning up to
the first day of the Level 3 BTEC course. Categorise and behaviour are influenced by your experiences
each item identified as knowledge (K) or skills (S). – having self-awareness – is an important aspect of
Using a different colour pen, add the knowledge
working professionally in care.
and skills you have acquired as a result of your The best way of making judgements about your
course induction programme. abilities is to identify:
What new things have you discovered about yourself • strengths
and about health and social care in the first few
weeks of the course? • areas for development.
Areas for development (sometimes referred to as
weaknesses) are those aspects of your knowledge,
skills and experience that you feel less confident about
doing, or which you have not yet had experience of
Probably, you are aware that you are good at some but which would be advantageous to acquire – to
things but less good at others; you may have a clear help you while on the BTEC programme, to help an
career path or be uncertain. You may have made application for professional training, or when you are
some new discoveries about yourself since starting on that training programme. The self-assessment
the course that have widened your career options. should be carried out as soon as possible after starting
Through actively thinking about what skills and abilities your course, before you have been influenced by new
you need to develop, you can make better use of learning and before you start a work placement. You
opportunities available on the course to develop your can then plan how to develop the areas identified. The
existing abilities, knowledge and skills, and choose – three-stage process outlined in Table 6.3 is sometimes
and work towards – a fulfilling career. called the SAP approach.
Your review at the start of the programme should The judgements you make in your initial self-
establish your personal baseline in relation to your: assessment should be based on as much independent
• knowledge and skills information about yourself as possible. Exam results,
• experience of caring for others (your practice) references from your school or employer, or the results
• personal values and beliefs of a functional skills diagnostic assessment would
present an objective assessment of your knowledge
• career aspirations
and abilities. Feedback from tutors and peers at the
• self-awareness. end of the course induction could also be used.
Each of these will be considered in some detail, The SAP approach could be used for reviewing
particularly in relation to what is expected of individual activities (such as an interview experience) to
individuals working in health and social care. This is the enable you to develop, perhaps for the next interview.
standard, or benchmark, that you will work towards in
this unit.
By comparing your baseline review to the health and
social care benchmark standard, you can identify how
Key terms
large (or small) the gap is between your development
Benchmark – A measure used as a standard against which
now, at the start of the course, and the sector comparisons can be made.
benchmark. You will be carrying out a self-assessment
Self-awareness – Being consciously aware of your own
and this will help raise your awareness of your strengths and limitations, how others may perceive you and
abilities and the extent to which these need further how you may respond to different situations.
development. The section could also help you clarify Objective assessment – An assessment that is free from bias
your career aspirations and personal goals, particularly and is based on evidence from independent sources.
in relation to working in health and social care.
256
Table 6.3: The SAP approach
• what you do well or easily, e.g. communicating orally, using IT and the Internet
S Strengths • the qualities you have that are helpful for health and social care and/or studying
• being able to recognise when you need support from others
• gaps in your knowledge and understanding
• skills and abilities that are less well developed but which are valuable for health and social
Areas for
A care and/or study
development
• gaps in your skills and experience, e.g. not having worked with learning disability or older
people
• setting specific goals and timescales for achieving the goals
Plan for
P • identifying the actions required to achieve the goals/targets
development
• setting deadlines for each action required to achieve your goals/targets
Did you know? 2.2 Knowledge

Knowledge is the factual information you have
A SWOT analysis is a useful tool as part of a self- acquired and understanding is your ability to use, or
assessment. SWOT is an acronym for Strengths,
apply, your knowledge appropriately (for example, to
Weaknesses, Opportunities, Threats.
retrieve relevant information from your memory or use
practical skills that are suited to the circumstances).
As you go through this section, you will complete
Knowledge can be acquired formally through study on
activities that will help you identify the strengths and
a specific course or training programme and informally,
weaknesses in your knowledge, skills and experience.
from life experiences. Your knowledge at the start of
This will help you draw up the plan for your
the course may be based on:
development at the end of the section.
• subjects you have studied at school
Did you know? • a hobby or leisure interest

• living in a household with others
These days, most employees undergo an annual
performance review with their line manager. When
• being part of a local community
preparing for their performance review interview, the • being an employee or doing voluntary work
employee is usually expected to assess what they see
• caring for others, e.g. children or older relatives
as their strengths and weaknesses and the progress
made against targets set at the last performance • keeping up with national and local news and current
review. affairs
Activity 10: How well do I do things?

You could use a SWOT analysis to start this activity. • What actions could you take so that you are
Simply divide a page into quarters and put the well prepared for your first placement?
headings ‘Strengths’ and ‘Weaknesses’ in the top Return to this activity when you have worked through
left and top right quadrants, and ‘Opportunities’ and the whole of this section and amend your plan for
‘Threats’ in the bottom right and left quadrants. Then your first placement to take account of your increased
list your strengths, weaknesses, opportunities and understanding of health and social care work.
threats under the appropriate heading.
The SAP approach could be used for any specific
To use the SAP approach in relation to starting your activity such as preparing for placements or planning
first placement, ask yourself the following questions: an assignment.
• What strengths do you have?
• What areas are you less sure of or need information
about?
257
• experience of using health or social care services and identifying where and/or when it might be useful
• specific experience of a health condition from can help you learn more quickly and effectively from
personal experience or that of an individual close to experiences as they happen.
you. Understanding of potential careers
Your career aspirations at the start of your programme
Reflect may be quite general – for example, to be a nurse
Patients can find out very detailed information or a social worker. Nurse training is divided into four
about their specific medical condition from the different branches and you need to choose one branch
Internet. How would you feel, as a newly qualified before applying for training. Social work training
nurse, caring for a patient who delights in telling tends to be generic at undergraduate level, with
you how things should be done or otherwise opportunities to specialise as a postgraduate. The
indicating that he knows much more than you do
university where you study is likely to deliver a degree
about his condition? What would your response
be to this situation? programme that, while meeting the requirements
of the relevant professional body, differs from the
programme delivered at another university for the
Understanding of theories, principles and same qualification. You will need to research these
concepts details before applying for professional training,
possibly in the second year of your course, so you can
These have similar meanings and tend to be used
apply to the programmes that are right for you.
interchangeably in the context of study and learning.
They involve more abstract thinking although they may Different learning opportunities
be developed as a result of experience. The wider the range of your learning experiences,
the more informed you become. Different placement
Activity 11: What’s in a experiences enable you to make comparisons and
highlight contrasts between different health and social
theory? care options. Breadth of experience could include, for
In a group, make a list of as many well-known example:
theories as you can. Try to summarise each one for
your peers. • different types of settings, e.g. day centres,
Think of a concept or principle introduced at residential care, schools, nurseries, etc.
school, which you found hard to understand, e.g. • different age groups, e.g. young children, older
fractions, politics or homeostasis. Work with a adults, older children or adults with learning
small group to improve your understanding of this disability
concept.
• different health and social care sectors, e.g. public
sector, private sector or voluntary sector.
Reflect
How could you use your learning from your 2.3 Skills
previous study and experience to support your A skill is the ability to perform a practical activity
current study on the Level 3 BTEC Health and appropriately, or with competence. If you are on the
Social Care course?
Level 3 BTEC course, you have reading and writing
How do you think the subjects that you are skills that are sufficient to achieve four GCSEs at grade
currently studying as part of your overall C or above. You may have learned how to ride a
school or college programme will help you at
bicycle during your childhood, or be able to draw, use
placements?
a computer, or have football skills. On this course you
will have to think about your skills in communicating,
Being aware of those aspects of your learning that working with others, using equipment (technical skills),
you find more difficult helps you identify areas for researching information and personal skills such as
development. Recognising your prior knowledge organising yourself.
258
Communicating professionals, specialist care workers, supervisors,

managers, support staff or people who work in
Being able to communicate effectively is an essential
different agencies or organisations. The skills and
skill for all care workers and is addressed in detail in
abilities required to contribute effectively to team work
Unit 1 Developing effective communication in health
include:
and social care.
• understanding your own skills, knowledge and
experience so that you can contribute appropriately
Activity 12: Using feedback to the team task
Use formal and informal feedback from • recognising how the skills, knowledge and
others in order to judge how well you experience of each of the other members of the
communicate: team contribute to the team task
• with text, e.g. when reading, in handwriting, • supporting members of the team with their
sending emails or texts, understanding the contributions to the team task
written content of sources
• respecting contributions from all members of the
• orally, e.g. your use of language and what you
team
say, how you say it and how you convey your
intended meaning • evaluating the effectiveness of the team in carrying
• non-verbally, e.g. how you listen, use gestures, out its task
facial expressions and posture • evaluating your own contribution to the team
• using the communication cycle (see Unit 1). effort.
You may get feedback as part of any unit in the
course or informally from peers, friends and family.
Reflecting on these points will help you assess your
communication skills at the start of the course.
Functional skills
English: You can show your English skills by listening
to complex information given in feedback and
processing ideas.
Did you know? Are you an effective team worker?
Communicating all relevant information clearly,

sufficiently and accurately and to the right individuals
You will work with individuals with different care
is essential in health and care so that the information
is received and understood accurately by the needs on your placements, under the supervision of
recipient. Failure to do this could result in mistakes placement staff. You will probably talk to them on a
when providing care. one-to-one basis and will work with small groups of
individuals, helping them to meet their developmental,
creative or recreational needs.
Working with others
Working in health or social care requires continual
interaction with others, which is why communication
skills are so important. Workers interact with individuals
using services and often their relatives, and with
259
Case study: Jake

Jake is a trainee social worker in the second year and, with the couple distracted, she is able to
of his programme, working in placement with an talk to the child alone. She only has five minutes
experienced social worker, Abena. Following a but the child, while quiet, is playing with a few toys
domestic violence incident a couple of days ago that scattered on the bedroom floor of the flat and appears
involved the police, Jake and Abena are going to visit unharmed. They leave but indicate, as agreed in
a family living in an upper-floor flat where there is a advance, that they will call again next week.
six-year-old child at risk. The mother and her partner 1 Who were the members of the team?
are alcoholics. They plan the visit in advance, in
consultation with Abena’s supervisor. 2 How did Jake contribute to the team task?
On arrival, they sense some hostility but Jake notes a 3 What skills did Jake use to make an effective
football scarf for a well-known football team. He asks contribution?
the partner about the match the team played at the The supervisor, Abena and Jake planned their team
weekend, which was televised. The partner is very task of checking on the safety of the child so that
knowledgeable and serious in his discussion about Abena was able to see the child alone in her own
the club. Abena asks the mother to make a cup of tea home.
Activity 13: How is my team work?

Complete this activity when you are carrying out a 5 As a group, discuss how well the team
group task in class. did and the reasons for the strengths and
1 Define the group task and draw up a plan to weaknesses of the team activity.
achieve it, identifying timescales and targets. • How successful was a) the team task and b) your
2 Agree the contribution to be made by each own contributions to it?
individual to the group task. • How did the contributions of all members of the
3 Plan your own contribution to the team task. team affect the group task?
4 Implement the individual and group plans to • What could you have done differently to
complete the task. improve the outcomes for the team task?
Technical skills associated with your studies or work in care settings.

When on work placement, you might use equipment
The most important technical skills you will encounter
or you may only be able to observe others using it.
in health or care work are those associated with
information and communication technology (ICT).
You may already be confident using a computer (IT Activity 14: Learning
skills) to access information on the Internet or produce technical skills
documents. However, you will also be expected to use
software: Observe the technical skills used by your tutors and
the workers in placements. What does this tell you
• for your research about:
• when preparing assignment work • the training needed to use equipment?
• when giving presentations • the purpose of the equipment in the context in
• when presenting numerical information, e.g. in which you observe it being used?
tables, graphs and charts • how it benefits individuals?
• when storing data. • health and safety considerations when using the
equipment?
You may have other skills too. Creative or musical
skills could be an asset in some work placements, or What should you take into account when using
equipment?
you may develop skills in using specialist equipment
260
You should not use equipment that you have not Personal skills
been trained to use and it is unlikely that you will
Your personal skills and abilities relate to you as
have authority to do so when on placements. You
a person and they affect you as a student on the
can observe how equipment is used and learn about
BTEC programme, in your role in placements, in
its purpose, how it helps individuals and gain an
any part-time job you may have and in your private
understanding of the health and safety considerations
life. Personal skills are related to personality and
for yourself and the individual when using it.
temperament.
Research skills Organisational skills
Research skills have been discussed in Section 1. For Being able to organise yourself has a major impact
your baseline self-assessment, you could review the on your ability to take responsibility for yourself and
experience you have of: for the well-being of others. Individuals who are
• observing health and social care practice as an disorganised also tend to have poor time-keeping
onlooker (non-participant observation) or as a skills, lose or forget things more frequently and so can
participant, e.g. as a patient be unreliable.
• interviewing an individual to obtain information
• research using secondary sources such as the
Internet, textbooks, journals
• producing tables, graphs and charts using a Reflect
spreadsheet. What do you think might be the disadvantages
for colleagues and individuals using services of
You may have gained prior experience from
having a disorganised worker in the team?
completing a project as part of a Level 2 Diploma,
using ICT to manage a budget or finances, or carrying
out a survey for GCSE coursework. You could also
consider how well you are able to read quantitative
information in newspapers, leaflets, etc. Personal presentation skills
Personal presentation relates to how you appear to
others and may include consideration of:
• dress (e.g. cleanliness of clothes, appropriateness
Activity 15: Observing for the context)
Even if the unit is not included in your Level • body cleanliness (e.g. grooming of hair, skin, nails,
3 BTEC Health and Social Care programme, body odour)
read the section on research methodology in Unit • non-verbal communication (e.g. facial expression,
22.
posture, gestures).
Work in threes, one as the observer, one as a carer
and one as an individual who is talking about their
Figure 6.7 shows the aspects of personal presentation
difficulty doing their shopping. Take it in turns to that are important when working in health and
play each role. Remember that an observation only social care. How you present yourself indicates your
records what you see/observe, so the record should professional role to individuals and other workers;
not include any interpretation. some placements require you to wear specific clothing
for this reason. Personal cleanliness is paramount for
health and safety reasons so that you:
• do not pass on infection to others
• reduce the risk of acquiring infection from others.
Functional skills
Care work sometimes requires you to work very closely
English: Make notes and feed back orally to the carer
with an individual (within their personal space), and
– this will give you an opportunity to demonstrate your
lack of good personal hygiene would be particularly
English skills.
unpleasant for others.
261
throughout this unit and highlighted by the headings

Make-up – Hair – in this unit. The requirements include:
light, not off the face
excessive
• demonstrating the value base of care (care value
and shoulders
and tied back base)
Jewellery – if long • recognising your own personal values and beliefs
discreet and not
dangling Neckline – and developing these to support good practice
(e.g. earrings) discreet • interacting professionally with others
• contributing to team work
• demonstrating awareness of the impact of
Sleeves –
legislation, codes of practice and policies on your
elbow length Waistline –
covered own practice
• accepting your responsibilities and recognising the
Nails – Hands –
limitations of your role as a student on placement.
short, trimmed clean with wounds
and no nail covered up and a Influence of personal values and beliefs
varnish wedding ring only Your own values and beliefs influence how you interact
with others. For the baseline self-assessment, you
Dress code – should consider what your values and beliefs are –
Shoes – clean and because they may differ from the care value base,
covered toes, presentable, in perhaps more in some aspects and less in others.
low heel, accordance
non-slip and
comfortable
with placement
policy
Influence of legislation, codes of practice and
policies
Fig 6.7: Good practice in personal presentation for health and
social care placements Legislation
Before starting your placements, you will require
an enhanced disclosure from the Criminal Records
Did you know? Bureau: this is a requirement under the Care Standards
Act 2000 (CSA) for all those who work with children,
Hospital-acquired infections are a major concern.
According to the Health Protection Agency (HPA),
young people and vulnerable adults. There are
thorough hand-washing is the single most effective restrictions on some practical activities if you are under
way of controlling infection (HPA, 2009). There are lots 18. For example, the CSA means you cannot assist
of guides on the Internet to show you what is meant with personal care (bathing, toileting and feeding).
by thorough hand washing. You should not be asked to assist with moving and
handling individuals or equipment. You will also have
personal responsibilities under the Health and Safety
at Work Act 1974 (see Unit 3) and the Data Protection
2.4 Practice Act 1998 (see Unit 1).
Working professionally Codes of practice
Everything that you do in your placements is your Codes of practice are statements about the behaviour
‘practice’, although the detail of your work will vary expected of a group of individuals in carrying out
according to the type of setting and the people using their work. Each health and social care profession
its services. You will be expected to demonstrate the has its own code of practice that defines what is
skills and attributes that are expected of all those expected of all those who are on the professional
who work in health and social care. Even though, as register. Registration (usually following successful
a student, you are not yet working as a professional, completion of the recognised training) is a requirement
you will still be expected to work professionally. What to gain employment as a professional. Members
is expected of you as a professional is integrated of the profession may be suspended or struck off
262
RY COUNCIL CODE OF
THE NURSING AND MIDWIFE NDUCT
PROFESSIONAL CO
and ethics for nurses and midwives
Standards of conduct, performance
with their health and wellbeing.
The people in your care must be able to trust you
To justify that trust, you must:
and respecting their
the care of peo ple you r firs t con cern, treating them as individuals
• make
dignity
those in your care, their
k wit h oth ers to pro tect and pro mote the health and wellbeing of
• wor
community
families and carers, and the wider
e and care at all times
• provide a high standard of practic
your profession.
grity and uphold the reputation of
• be open and honest, act with inte
your practice and
ion al, you are per son ally acc oun table for actions and omissions in
As a profess
r decisions.
must always be able to justify you
practice or personal
alw ays act law full y, wh eth er tho se laws relate to your professional
You must
life.
Fig 6.8: The NMC Professional Codes of Practice
the professional register if their behaviour does not services. All settings must have a health and safety
conform to the code of practice of the professional policy but the wording will not be identical in all your
body concerned. placements.
Codes of conduct are internal codes used by individual
organisations to set a standard of behaviour for those Reflect
in the organisation. Health and social care settings may Why do you think you always need an induction
have a code of conduct, often for all staff, whatever when you start work at a new placement setting?
their job role or professional status, and sometimes
for the users of the service. For example, schools and
colleges may have codes of conduct for their pupils
and students. These are usually presented in a school Recognising personal responsibilities and
or college handbook that all pupils or students receive. limitations
In recent years, some organisations have introduced
Recognising your personal responsibilities and
codes of conduct to protect their staff from abuse by
limitations is an important aspect of professionalism.
people using services.
The amount of responsibility you have taken for
Policies your life and affairs up to the start of the programme
Policies are the formal documents drawn up by each may be fairly limited if you have just completed your
setting to state how their organisation will meet the compulsory schooling at 16. If you are a bit older then
requirements of legislation and relevant codes of you may be taking responsibility for many aspects of
practice. They are unique to each setting and written your day-to-day life such as your accommodation,
specifically to be appropriate for the services they are meals, getting around in a car or on public transport,
providing, the buildings and accommodation they are etc. You may have had responsibilities such as
using, the staff who work there and the users of the organising yourself with regard to GCSE coursework,
263
or this may have been controlled by your teachers

at school. Taking responsibility for your own actions
Activity 17: Caring for
is an important part of growing up. However, we all others
have limitations to our abilities, especially when we
1 Review your past experience of helping others,
have had less experience. Recognising when we have
e.g. escorting a frail relative to the shops,
reached our limits is important for ourselves as well as looking after children.
for individuals using services. Limitations may include,
2 What skills have you used when helping others?
for example:
3 What are your feelings and emotions when you
• insufficient skill to perform a task are helping others?
• inadequate knowledge to make an appropriate 4 What skills do you think you need to develop to
decision be better at helping others?
• insufficient time to complete the task as required
• inadequate or unsafe equipment
• being too tired to carry out the task safely, reliably 2.5 Values and beliefs
or accurately.
Personal values and beliefs
The value of something is often measured in monetary
worth but values are important moral and ethical
Activity 16: What’s my principles that influence how you think and behave;
they are an essential part of your personality. A belief
limit? is an understanding that is held with strong conviction;
Being professional in health and social care requires personal beliefs may be associated with a religious faith.
you to be able to recognise when you are moving
beyond your personal limitations in such a way that
it might be unsafe for yourself or others. Identify
Reflect
your personal limitations at the start of the course Think about situations when you have felt that
and ask yourself: the values and beliefs of others have meant you
1 How do they affect others? have been misunderstood or not listened to.
How did you feel?
2 How often do circumstances mean that you reach
Can you think of situations where your own
your limits?
values and beliefs affected the way you behaved
3 What could you do to reduce your limitations? or meant you overlooked or misunderstood the
situation? What could you do differently to avoid
this happening again?
We all have personal values and beliefs and they

influence how we lead our lives – for example, how
Personal practice of care we see the world, other people, what our priorities
Many learners starting a Level 3 BTEC programme may are and the decisions we make. Another person may
not have had any experience of caring in a care setting have similar values and beliefs to you, or different
at the start of the course but may have some informal ones. Your values and beliefs will have formed as a
care experience such as looking after a relative, result of the influences of the people around you and
neighbour or friend. Whenever you help someone your experiences from your early childhood onwards,
else to carry out their daily activities, you are providing and they may continue to develop as you go through
informal care and reviewing this experience will form your life. Unit 2 explores some of the factors that
the basis of your self-assessment. Your knowledge and influence personal values – for example, experiences
understanding of care practices will develop as you of family, friendships, diversity, education, religious
complete each work experience placement, working faith or ethical beliefs. You may have explored how
with different individual groups, in different care these have influenced your development through your
settings and with different work teams. life so far. As a young child, family and home tend
264
to be significant influences. When the child goes to The care value base
school, moves through adolescence and becomes
In the UK, legislation and the regulatory framework for
more independent, the circle of influence tends to
health and care provision are based on values that are
widen through school, friendships and interactions with
shared across all health and care professions. Many
others at work and elsewhere.
of the values are those that are addressed within the
European Convention on Human Rights (see Unit 2).
Activity 18: What are These values are written into professional codes of
my values? conduct for all health and care practitioners registered
in the UK and into the codes of practice and charters
This activity will help you understand your own values that apply to care provision. You will be expected to
and beliefs. demonstrate respect for these values on your work
1 How do you feel when someone ignores or makes placements.
fun of your values and beliefs?
Part of your development as a worker in health and
2 How do you react when you meet someone who
social care is to show, through your behaviour, that
has different values and beliefs from yourself?
you respect the rights of others. This is part of your
3 How do your personal values and beliefs compare
with those that underpin health and social care
professional responsibility. Table 6.4 on page 266
work in the UK? gives just a few examples of the ways in which care
4 What modifications to your attitudes and professionals demonstrate their responsibilities in
behaviour might you need to make when on work respecting the care value base.
placement to show respect for the care value
base?
Activity 19: Rights and
responsibilities
Your values and beliefs may be different from those
of others, including your peers in class, those on your Individuals using health and social care services have
rights and responsibilities, as do care workers.
placement and individuals using health and social care
services. It is important for care workers not to let this 1 Give some examples of the responsibilities
expected of individuals using services.
affect how they behave or interpret what they observe.
So, for example, if you did not agree with homosexuality, 2 What are your rights as a care worker?
your behaviour and the care you gave to an individual 3 What are your responsibilities in a setting, as a
who was homosexual should be no different from the student on placement?
way you would behave with a heterosexual individual
with the same needs. Workers should be objective and
free from bias in order to avoid discrimination. This will
mean that care practice is based on evidence of need
and not on stereotyping or prejudice.
2.6 Career aspirations

Did you know? You should complete your self-assessment within
the first few weeks of your course, to identify your
If your work in health and social care were to involve strengths and the areas you wish to develop in the
you participating in a care activity that was against
context of your career aspirations at the end of the
your beliefs, then provided you have declared
beforehand what practice is against your beliefs and
course. If you aim to pursue a career in health or social
provided there is another carer who can deliver the care, then you will need to study for professional
care instead, you may opt out of that aspect of care. qualifications at the end of the course and there may
For example, a nurse, whose Catholic faith meant she be specific entry requirements or experience that
did not agree with contraception, could refuse to take would strengthen your application for a course. Before
part in a family planning clinic if another staff member
you can make decisions about your career pathway,
was able to take her place.
you need to be aware of the options available to you.
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Table 6.4: Respecting an individual’s rights
The rights of Examples of how you could respect this right

individuals
Diversity and respect for • Attending to the needs of each person as an individual
differences • Encouraging individuals to express their views, for example on a service they receive
Equality in care practice • Showing respect and care for all individuals, including those who may be of a
different culture or have different values from yourself
Anti-discriminatory • Learning how to challenge appropriately the behaviour of a worker or individual who
practice subjects another person to discrimination or abuse
• Reporting discriminatory incidents to your supervisor or a manager
Confidentiality • Never talking about any individuals to people outside the care team
• When discussing placement learning in class, never identifying an individual or
member of staff
Control (autonomy) • Allowing individuals to make choices about their day-to-day care and activities
over own life, choice, • Never presuming to carry out a task for an individual
independence • Always asking whether a individual would like you to help
Dignity and privacy • Not drawing attention to an individual in distress but helping them, without fuss, to a
quiet area or to relieve their distress
• Making sure an individual is dressed and covered, even if this is inconvenient for you
Effective communication • Reporting events and observations accurately to staff
• Explaining your actions to individuals when providing care
Safety and security • Being observant of potential hazards for individuals and workers and reporting any
hazards you see
• Taking responsibility for your own safety
• Being vigilant about your own safe practice
• Reporting any abuse you witness
• Following procedures to maintain the security of individuals
Activity 20: What are my career options?

Research the career options available to you at the end • within eighteen months/by the end of the
of the Level 3 BTEC. Make a shortlist of at least three course?
options and investigate in detail the qualifications and Using your self-assessment, analyse the extent to
experience you will need to gain for each. For each which your experience and learning could enable you
career option, what actions do you need to take: to follow the three career options chosen.
• in the next few weeks? What further actions would you need to take to pursue
• within six months/by the end of the first half of the any of these three options?
programme?
Functional skills Reflect

ICT: Retrieving relevant information about career To what extent have you made use of the support
options will enable you to demonstrate your ICT skills. systems available to you in your school/college
or locality to help you make an informed career
choice?
266
Decisions about your career path do not need to be Colleges Application System (UCAS) awards points
taken immediately but you do need to be aware of according to the grades you get. On a Level 3 BTEC
realistic options from which you can make choices later programme, the grade for every unit contributes to the
on in the course. However, you should find out about overall grade for the qualification. If the UCAS point
the entry requirements to training early on so that, if score required is high, this could mean that most year
you need specific qualifications or experience to be 1 units may need to be achieved with a good grade
eligible, you can plan to acquire these before applying. as well as those studied in year 2. You should consider
Entry to university also involves achieving qualifications this when developing your PPD plan for this unit.
at a sufficiently high level, and the Universities and
Write a report that assesses your own knowledge, present that have contributed to your current
skills, practice, values, beliefs and career aspirations at knowledge and understanding. You should
the start of the programme. then consider the strengths and weaknesses of
your experience thus far in your life in relation
Grading tip to your career goals. The recommendations
P2 Use each of the areas explored in this section you make in your report could then help you
to help you. You should consider in some detail develop a suitable action plan for the next
how aspects of your experiences up to the assessment activity.

Creative thinker: The discussion in your essay
English: You can show your English skills by writing
should enable you to demonstrate creative thinking
using an essay format and conventions.
through challenging your own assumptions, and those
of others.
2.7 Plan for own development

Personal goals – short-term and long-term Activity 21: A personal
Your initial self-assessment should now be complete. stock-take
You have established your personal baseline and
Review your responses and what you have learned
identified your strengths and areas for development about yourself from all the activities completed so
against a benchmark standard appropriate for health far in this unit.
and social care so you have some realistic career List those aspects of your development where you
options. You can now start to plan your PPD as the think you could make improvements to your learning
third stage in the SAP approach. To do this, you will and personal skills.
need to understand the principles of planning, which Compare the assessment of your skills and abilities
include: at the start of the programme with those you are
likely to need to fulfil your career aspirations. Then
• setting goals or targets identify any specific skills, quality and experience
• drawing up an action plan to work towards you could develop during the programme to
achieving your personal goals support your application for the next stage of your
career.
• implementing the actions in the plan.
267
Goals and targets of which is likely to be delivered over two academic

years. Ends or beginnings of months, terms, semesters
Goals are statements of what you intend to achieve
or years make convenient deadlines for personal
before you start – they do not tell you how you
goals but some dates may be quite specific e.g.
will achieve them. They are sometimes called
dates of university open days or the deadline date
objectives. Targets tend to be specific, e.g. grades for
for submitting a UCAS application. In practice, your
qualifications; you will be familiar with target-setting
goals are likely to require shorter-term deadlines of up
from your school or college’s individual learning plan.
to six months ahead, particularly if they relate to the
Completing the personal stock-take activity (above)
course itself or you need time beyond the first goal to
will highlight the gaps in your development so that you
meet further goals before the end of the programme.
can now set your personal goals with the aim of filling
Longer-term goals, of 18 months or more, may relate
those gaps. Some of your goals may be quite specific
to completing the course with the right grades for
(for example, ‘get a grade C in GCSE maths’) or more
successful career progression. Of course you may also
general (such as ‘participate more in group work’). Both
have goals with deadlines between 6 and 18 months.
will require specific actions to be achieved. The goals
you set for yourself should relate to knowledge, skills, Table 6.5: Examples of short- and long-term goals
practice, values and beliefs and your career aspirations.
Short-term goals Long-term goals
Priorities
• Targets for each term of • End of course,
Some of your goals may be easy to achieve, but be the course: for example, overall qualification
relatively minor and unimportant, whereas others (for grades for specific units, grades: for example,
example, resitting a GCSE) will be challenging, require researching university higher education or
additional work on top of the BTEC programme and courses employment
have externally set deadlines. However, if you are • Targets for next • Making an UCAS
aiming to teach or be an early years professional, placement: for example, application
grade C is a requirement in English, maths and science interactions for Unit 1, • Passing driving test
researching policies and • Improving listening
in order to start professional training. Meeting these
procedures skills
requirements is far more important than, say, spending
• Re-sitting GCSE English • Gap-year plans
extra time on placement to help with the school play,
• Achieving Maths
even though doing so would be relevant experience to Functional Skill at
put on your application form. Level 2
Reflect
Developing an action plan
When faced with several things to do in a limited
• An action plan identifies how you intend to achieve
time, which task do you do first – the most
important one or the task that is easiest or most your goals or targets. The plan for your PPD should
enjoyable? Do you prioritise the tasks, doing the relate to your development as revealed by the areas
most urgent one first? Do you leave the hardest for development identified in your self-assessment,
task to the end? Do you run out of time? Your including development needed for your career
answers to these questions are an indication of options. Each goal is likely to need breaking down
your approach to managing your time.
into smaller individual actions, for the following
reasons:
Timescales • to make it more attainable
Not all your goals will need to be completed in the • so that you can take different actions at different
same timescale so you may set different deadline times
dates for each to be achieved. Some goals may need
• to ensure that you do not omit important steps
to be achieved in a particular order or sequence so
the deadline dates will need to take account of this. If • so that you can plan sufficient time for each activity
you are studying Unit 6, then you are working towards involved
a Level 3 BTEC Diploma or Extended Diploma, each • to allow some flexibility in the plan.
268
The plan is likely to become a list of detailed actions

that need to be taken but, in order to have a good Activity 22: How SMART are
chance of being achievable, each goal should be you?
SMART.
Think of an activity you have been involved with
Table 6.6: SMART goals recently and which required you to plan ahead.
1 To what extent did the planning involve SMART
Each action should be a short,
principles?
S Specific clear statement of what is to be
done. 2 Use the SMART principles as a tool to evaluate
the effectiveness of the plan in enabling the
The outcome or result of each activity to be completed successfully, or helping
M Measurable action can be specifically to explain why the activity was less successful.
measured.
Each action should be
something that can be put into If your plan is based on SMART principles, it becomes
practice; the action may need much easier to identify the extent to which you are
A Achievable
breaking down into smaller, implementing the plan and also to show progress
more realistic steps so it against it sooner. Most individuals are encouraged
becomes actionable. when they see they are making progress towards
Each action should help you achieving their goals. If you cannot measure your
work towards one or more of the progress, it is much more likely that you might
R Relevant
goals or targets you have set for abandon the plan and then not achieve your personal
yourself. goals.
A deadline date is set for each
T Timely
action and the timing of each 2.8 Consider personal goals –
deadline is appropriate for other
actions needed within the plan. in terms of knowledge, skills,
practice, values, beliefs and
For the purposes of this unit, you will be preparing a
personal development plan and so the responsibility
career aspirations
In the case study on the next page, Jim only has the
for all the actions will rest with you. If you tend to put
equivalent of four GCSEs with good grades but does
off some types of task, you could set earlier deadlines
have unusual personal experiences. He will need to
for those so as to encourage you to start and finish
investigate whether his qualifications and experience
them earlier.
will enable him to pursue either of his career options
and he will need to work hard to meet his ILP target.
This might include making direct contact with
Reflect admissions tutors to find out whether he should take
What are the advantages of having a detailed an additional GCSE to gain the minimum of five Grade
action plan rather than just overall goals to work C passes usually needed for entry to nursing training.
towards?
Below the case study is an example of a PPD drawn
up by a student of Level 3 BTEC Extended Diploma in
Health and Social Care. Note that the plan includes the
dates when the plan will be formally monitored (see
also Assessment activity 6.5).
269
Case study: Jim

Jim didn’t like secondary school, truanted regularly Diploma and is unsure whether to become a
and only took two GCSEs. He got a Grade D in English social worker or a mental health nurse. His tutor has
and got himself a job in a warehouse. He got on OK set a DDM grade as his ILP target.
with a colleague, Umed, who was 19. One day, Umed 1 Write three aims for Jim’s career plan.
invited Jim to come along to a meeting with him. Jim
2 Break down each aim into specific actions. (You
discovered it was a social support group for individuals
may need to do some research on Jim’s career
with Asperger’s syndrome. He found he got on really
options.)
well with the others in the group. They had interesting
discussions about things and he discovered that Umed 3 Identify suitable targets for Jim to achieve within
read lots of books, which he started to lend to Jim. three months, one year and two years, and draw
up a detailed and SMART action plan for him.
Then Jim started to help the volunteers who ran the
support group. Jim decided he wanted to do this sort 4 Compare your plan for Jim with those of your
of work. He did a BTEC Introductory course at the peers. This should raise your awareness of a range
local college, got GCSE Maths and English with Grade of actions, priorities and timescales that could be
Bs and a BTEC First Certificate with Distinction. He is suitable for Jim’s situation.
now 20, in the first year of a Level 3 BTEC Extended
Table 6.7: An example of a personal and professional development action plan for a BTEC National Diploma in Health and
Social Care
PERSONAL ACTION PLAN 2010–2012
Main goals
1 Decide my career choice for progression at the end of the course
2 Get at least DMM grades for my Level 3 BTEC
3 Arrange some relevant volunteer work over summer 2011
4 Get a part-time job
Action Target Review 1 Review 2 Date Notes
date completed
Research careers 30/09/11 15/6/11 Still not sure, 15/09/11 More news 15/10/11 Searched
in teaching and info on nursing looks on difficulty getting newspapers to
nursing; find out better than teaching places for HE through get an idea of unis
qualifications but going to be clearing where places still
needed and target competitive available in clearing
UCAS scores
Prepare UCAS 30/11/11 12/11 On 3rd draft of 1/12 Still haven’t 10/12/11 Went to get advice
application for personal statement decided where to from Learning
nursing apply Services on 18/12
Work hard on all 30/06/11 30/06/11 Two Merit 15/2 Merits on all U22 Didn’t work as hard
units grades so far on units so far this year. due 15/3 as I could have in
4 units; others are Research project going first year but easier
passes. Must work on well so should get good now I’ve had more
U6 to get 24 grading number of points from work experience
points that if can get a Merit (11/11)
Contact special 11/4/11 31/3 Will be difficult 10/6 CRB has come 12/6/11
families to help to get a place, lots of through and I have an sent email
with summer applicants and need offer for one week only confirming
holiday fortnight CRB
Find a part-time 10/12/10 15/12/10 Nothing 8/2/11 Been offered 15/2/10 Started work
job going; sent off 6 part-time work in
applications placement.
Start 12/2
270
Develop an action plan for your personal your progress against the plan over the duration
development, presenting it in a format that clearly of the course.
identifies short- and long-term personal goals with Set targets/goals based on SMART principles.
regard to developing your knowledge, skills, practice,
beliefs and as appropriate for your career aspirations. Identify your overall personal goals/targets and
then break these down into more detailed and
specific actions.
Grading tip Include dates for the overall goals/targets and
P3 Design a form for your personal development completion of each action, as well as dates for
plan, using ICT, and include space to record monitoring your plan.

Self-manager: Your plan will show that you are a ICT: You can show your ICT skills by developing a
self-manager in terms of being able to organise your template for the action plan that is fit for purpose.
time and prioritise activities appropriately.
notes are made is the working document and is likely

to look well worn as a result.
2.9 Monitor and evaluate plan in It is a rare action plan that goes exactly to plan without
terms of own development any changes. Reasons for amendment might include:
An action plan is of relatively little use without • delays in completion of previous actions or changes
implementation. in circumstances, e.g. a change of career goal
An action plan should be a working document that • adding extra actions to make the plan more
you refer to regularly to remind yourself of what detailed, e.g. changing the responsibilities of the
actions need to be carried out and when. You should individual(s) involved in implementing actions
also examine the plan to check whether you have • having to find information yourself because the
completed the actions that should have been done intended source has not provided it
already. Monitoring involves:
• removing actions that are no longer applicable
• reviewing actual progress made against the actions because circumstances have changed or new
that should have been completed up to the time of information means they are no longer appropriate.
the review date
Each time you monitor your action plan, you will almost
• recording the actual progress made, e.g. certainly need to make some changes. A plan that
completion dates, any changes made to shows no changes is very unusual. You should monitor
past actions as a result of experience when your progress against each action point of your plan
implementing them, and progress on ongoing regularly but also monitor your progress towards the
actions relative to planned timescale overall goals you set for yourself.
• identifying the next sequence of actions required
by the plan and their deadlines so that their
implementation can either continue (if already Key terms
started) or start Implementation – The process of actually carrying out the
actions identified in a plan.
• recording changes to future action points or
Working document – A document that is modified and
deadlines. adapted at the same time as it is being actively used to guide
The copy of the action plan on which the monitoring practice.
271
Formally review your progress against your plan on circumstances that have affected your progress
each of the review dates you specified in your plan. against your personal goals and targets,
Keep a copy of your personal development action including reasons for any changes you make
plan as it is at each of the review dates, and get your to the goals themselves as you go through the
tutor to sign saying that they have seen your plan on programme.
each monitoring review date. Get your tutor to sign and date your working
document in tutorials as evidence that you are
Grading tip monitoring your plan.
P4 Keep your plan in your day-to-day file so you Present the starting version of your
can add changes easily, as and when necessary. development plan and an updated final version
When you make a change to the plan, enter the that summarises the main outcomes of each
date on which you make the change. monitoring review of your plan.
At each monitoring date, write a short personal
statement summarising the challenges and

Independent enquirer: Monitoring your plan and
English: You can demonstrate your English skills by
recording amendments will demonstrate that you are
communicating progress on your plan concisely.
reviewing your progress as an independent enquirer.
At the end of the whole programme, when Unit 6 is

completed, you will be able to assess to what extent
your plan has helped you complete your Level 3 BTEC
programme as well as Unit 6.
Assessment activity 6.5 M2
Write an informal report that assesses how well your Consider all aspects of the plan, e.g. your
action plan has supported your development over the overall goals, the actions themselves, their
duration of the programme. sequencing and timescales, when assessing
the usefulness of the plan in supporting your
Grading tip development from the start to the end of the
M2 Review the original personal development plan programme.
you drew up at the start of the programme
and all the records you have kept as part of the
monitoring process.
272
3 Be able to reflect on own development over time

3.1 What is reflection? Reflection is important for all those who are faced
with complex, uncertain or new situations as part
You will be familiar with looking in the mirror and
of their day-to-day work activities. Health and social
seeing a reflection of yourself to assess whether or
care professionals encounter complex, uncertain
not you look as you want to look. If, for example, you
and variable situations continually because no two
judge your hair to be out of place, you tidy it up and
individuals are identical and their health condition or
check again in the mirror until it is as you want it. In this
care needs are rarely exactly the same. The individuals
scenario, you have
may be users of health and social care services or
• reviewed your appearance – or ‘performance’ people who work in the services.
• made a judgement about whether it is as required
or not – the judgement is made against a personal
standard you are aiming for
• taken an action to make an improvement – you
Activity 23: Reflecting
may also have experimented with different ways of Think of an incident that has happened in
arranging your hair before you get to this point. the last week but which you have found
yourself thinking about again since. Jot down a
Reflection is a widely used term that describes the way
few notes to remind you of the details of what
in which we think about our experiences in order to happened.
understand them and, as explored in Section 1, this is
• How did you feel at the time of the incident?
an important aspect of the way adults learn.
• Why did you return to thinking about it again
We may still learn a few specific pieces of information later?
by rote, e.g. ‘ABC’ as a mnemonic (memory aid) for
• How did you feel at that stage?
remembering the order of priorities for resuscitating
• In what way was your later thinking about the
a casualty in first aid training (see Unit 3 Health, safety
incident different from the time it actually
and security). happened?
We use reflection to, for example: • How do you feel about the incident now?
• make positive, negative or qualified overall • What have you learned from the incident?
judgements about an experience • Why do you think differently now than you did at
• make sense of a complex experience or situation the time?
by teasing out different aspects of it into individual
components and dealing with each component
separately
In this unit, the emphasis is on demonstrating that
• assess our own performance either against an you can reflect and that you have learned from the
externally set standard (e.g. the correct technique reflection, rather than how far you have actually
for resuscitating a casualty) or against a personal developed over the duration of the Level 3 BTEC
standard (e.g. personal values, targets, etc.) programme. At this stage of your professional
• consider alternative approaches to doing things
• seek explanations for feelings and emotions and
the responses made as a result – these might be Key terms
your personal feelings and responses or those Reflection – A conscious process of thinking about a
problem in order to understand it.
observed in others
Complex – Influenced by many inter-related factors.
• find answers to questions and problems that
Uncertain – Where there are many unknowns, where there
confront us are considerable gaps in the relevant information, or the
• apply existing knowledge and understanding to a strength of different influences could be variable.
new situation to explain and understand it.
273
development, learning through reflection should help Figure 6.2, page 243, and 6.3, page 244) and graphic
you to: organisers (most of the other diagrams in this unit).
• achieve as well as you can on each unit of the
course
• understand work in health and care better so you
know what to expect and what is expected of you in Case study: Sara
your placements On her first day on a placement in a care
• understand yourself better so you can prepare home, Sara was present when one of the
yourself for future training or employment in health residents collapsed in clear distress and died before
an ambulance arrived. Sara had not been able to
or care
help, had never seen a person dying before, and has
• make an informed career choice for progression thought repeatedly about the incident ever since.
from the course Compile a list of questions that Sara could ask
• be successful in progressing to the next stage of herself to better understand why it worried her and
your career after you have completed the Level 3 to learn from the incident.
BTEC programme.
Techniques to aid reflection

There are various techniques to help reflective Did you know?
thinking.
A simple model for reflecting on experiences is to ask
Questioning three questions: What? So what? Now what?
Asking yourself lots of questions about an issue, topic,
event or situation helps you explore different aspects
of the issue so that you can consider each aspect in 3.2 Changes
turn. Change happens continually and particularly in health
Talking to others and social care. It is also a feature of our personal lives
and we have to adapt in order to cope with it. In this
The process of having to express yourself orally
unit, you may experience change relating to:
to others helps you organise your thoughts. It can
be particularly helpful when dealing with practice • placements
problems and is the basis of a supervisor or mentor • career aspirations
role. • changes of tutor
Writing about it • changes in personal circumstances (e.g. moving
Again, committing your thinking to the page helps home or getting a job)
you organise your thoughts and make sense of • illness.
experiences. Keeping notes about incidents, your Reflecting on how well you have coped with change
feelings and your responses to them will be the basis could help you identify for the future which coping
of your practice journal or diary. For academic study, strategies you have found helpful and which strategies
you may use abstracts or extracts from your journal in to avoid. You also need to look at changes in relation
assignments and should make reference to academic to your ongoing development needs and goals.
theories.
Tools for thinking 3.3 Variety of contexts
These often use visual formats or mnemonics to You should have gained experience from at least three
structure your thinking. The SWOT analysis and 5Ws placements working with different users of services,
and H have been suggested already but you may different multidisciplinary teams, organisational
have used other useful tools during your programme structures and possibly in different health and social
induction and tutorial activities. Examples are the care sectors. Comparisons between these could form
Johari window, Venn diagrams, flow charts (see part of your reflection. You should demonstrate that
274
you can apply theory learned in all the units of the • updating your self-assessment (i.e. strengths and
programme to further your understanding of different areas still requiring development) and comparing it
experiences and observations made on placements, in with your baseline assessment of your knowledge,
employment or when volunteering and, if appropriate, skills, practice and values
in other aspects of your life. • assessing the extent to which you have met the
personal goals in your development plan
3.4 Professional development • consideration of unplanned or unexpected ways in

which you have developed over the duration of the
portfolio programme
Evidence of PPD and CPD is usually placed in a • assessing the extent to which you feel prepared and
portfolio, which includes a professional practice diary ready for the next stage of your career
and indexed, authenticated records to demonstrate • discussion of how well you have made use of
your personal progression. Your portfolio may be paper- support and resources to aid your development.
based or it could be an e-portfolio in which all the
relevant evidence is stored in an e-document. If you use 3.5 Relevant evidence
a hard copy, the portfolio could be a ring binder or lever
Evidence is material that records your knowledge
arch file but it should not be any bulkier than that.
and abilities. Figure 6.9 (page 276) identifies several
Your Unit 6 portfolio should contain all the evidence that different forms of evidence that could be relevant for
you submit for the Unit 6 assessments, systematically this unit.
presented. (It should not contain all evidence relating to
preparatory work and activities that help you generate Formal evidence
that evidence but which are not themselves assessed. All assignments and reflective reports written for this
Examples of these items might be the notes you make unit are essential items of formal evidence as part of
when using ‘tools’ to help your reflection.) As part of your professional development portfolio. Supporting
this unit, you will store evidence of your development formal evidence is that which enables others to judge
throughout the course in a PPD portfolio. your abilities objectively either by direct observation
of you carrying out an activity or scrutinising materials
Structure of portfolio you have produced (e.g. written evidence). Written
The evidence in your assessment portfolio should be assignments, forms (e.g. your individual learning
structured clearly so that you and your assessor both plan or UCAS application) and certificates are formal
know what evidence it contains and where it is. evidence. A witness testimony form, signed and
Index dated by a suitably qualified professional (e.g. your
A list of contents should be inserted at the front of tutor or placement mentor/supervisor) is also formal
your portfolio. You should identify (e.g. in a mapping evidence and necessary to capture practice skills in
table or in a short statement) how the evidence relates ‘live’ situations such as doing presentations and role
to the assessment criteria. plays or demonstrating awareness while on placement
(e.g. working safely). DVDs can be used for classroom
Authentication activities but are not acceptable for placement activities.
You should obtain signatures from your tutors or
placement supervisors as appropriate (e.g. for your
plans or to verify your descriptive accounts).
Did you know?
Personal progression At this level, it is your responsibility to make
arrangements for a witness to provide testimony as
This will be demonstrated partly by your records to your participation in an activity. You should make
showing the monitoring of your developmental plan the request in advance for any planned activity and
and partly by a reflective account of your overall as soon as possible after the event for unplanned
development that you will need to complete at the experiences (e.g. critical incidents). Always supply the
form to be used promptly. A witness should not be a
end of the unit. Suggestions to help you reflect on your
relative.
progress include:
275
Informal evidence information. Always ensure that your diary is stored in

a personal password-protected file. If you make entries
Informal evidence is that which you generate for your
while at a placement, store them on a data stick or email
own use. It can include feedback you receive from
them to your home email address. Never store your diary
peers or other unqualified individuals and notes you
on a drive that can be accessed by others.
make. Your personal diary (or journal) is the main
informal evidence you will use for this unit. Other Any activities you participate in during the BTEC
examples are identified in Figure 6.9 (below). National course will contribute to your learning and
PPD. Keeping a diary is an important way for you
Your personal diary to keep track of these experiences – to record, for
You will be working on this unit throughout your course example, notes on:
and learning from your college studies, work placements • your responses to activities in this book from any unit
and wider life. This means you will need to be organised
• practical details of work activities in which you
and keep careful records of your experiences so that you
participated
can refer back to them later in your study. A practical way
• descriptions of events and unforeseen incidents
of doing this is to buy a bound notebook, either A5 or
(sometimes called critical incidents)
A4 size. Ideally it should have a firm cover for protection
so that you can write in it on your lap if necessary. This
will be your personal diary.
Key term
If you choose to maintain an e-journal, you should be
Critical incident – An experience that enables significant
fully aware of the implications of doing so. Any electronic learning. It may be a one-off emergency but may often arise
information about individuals is subject to stricter data from more routine activities that trigger specific learning or
protection legislation requirements than hand-written flashes of understanding (insight).
Activity
Contents Copies of Journal/
Practice log CV plans and PPD goals
list certificates diary
records
Placement
reports PPD action
plans
Peer
feedback Witness
testimonals
Video/audio
PPD portfolio
evidence
Placement
Periodic profiles
reflective
reviews
Observation
Descriptive
records
accounts
Individual Programme Notes Assessment Copies

Tutorial Narrative of oral of UCAS
learning tracking feedback
record accounts feedback application
plans record sheets
from tutors/ forms
supervisors
Fig 6.9: Potential sources of evidence for personal development for health and care practice
276
• observations of routines and practices

• ideas and thoughts you have about your learning Key terms
and development Extract – A section of text taken exactly as written from an
• your feelings and emotions existing piece of writing.
• oral feedback received from peers, tutors, Abstract – A new piece of writing that brings together (or
summarises) various points made in an existing piece of
supervisors and others
writing.
• notes from discussions
• regular reflection on your overall development.
It is best to make your diary entries as soon as possible
after the event, however briefly or quickly, so that Although your diary is confidential to you, your tutor
you capture the details of the experience while it is will expect to see it periodically to monitor how you
still fresh in your mind. You can come back to the are learning from your experiences during the course.
entry later and add to it. What you write later will be
different because you will have learned and changed 3.6 Support for your
already in the interval since the event. Usually, the
longer the interval between the event and making
development
notes about it, the more likely you are to forget the The different types of support for learning have
experience altogether, or to lose the opportunity for as already been summarised in Table 6.2 (see page 253).
much learning because you have forgotten the details. A supervisor will be your main source of support on
Always date each entry in your diary, as this will enable placement.
you to see how you are developing over time. You Increased self-awareness
might also find it helpful to number the pages of your
This was discussed earlier but towards the end of
diary so you can easily refer back to a comment on a
the programme you will probably have a greater
specific page in a later entry.
awareness of your abilities and limitations with regard
The notes you make in your diary entries are a personal to working in health and social care than you had at
resource for you to refer to later in the course. You the start of the programme. Your developing self-
may want to quote extracts from your diary or write awareness should be evidenced through the entries in
an abstract of the entries to demonstrate an aspect of your reflective diary.
your learning and personal development.
Reflect
How do you think your self-awareness has
developed over the duration of the programme?
Reflect
Think about the information in your diary. It will
contain confidential information about yourself
and possibly about others with whom you interact and
you will want to keep it secure so that it is neither lost
nor seen by anyone else apart from your tutor. Also
think about how you will be adding to your journal Accessing relevant information and
throughout the course. Using a loose-leaf book/file support
could enable you to keep the majority of the entries safe
Supervisors and other workers at placements will be
at home and only carry around the most recent sheets.
This would reduce the risk of losing the whole record. a major source of information, particularly if you show
Similarly, if you are compiling an e-journal, it is sensible interest by asking appropriate questions and respond
to back up your entries regularly to a specific file on to advice and instruction given. You may also be able
your main computer, even if the most recent entries are to access specialist resources (such as journals and
temporarily stored on a data stick for convenience. other literature) that are available on placements but
not in your school or college.
277
3.7 Reflect on own development Did you know?

Activity 24: My first It is illegal to pass on information about adult
individuals to others, including their relatives.
reflection Relatives do not have an automatic right to
information about an individual using a health or
Make notes in your diary about your feelings and social care service.
concerns:
• on the first day of starting your course
• at the end of the induction period for the course As you become more experienced through the course,
• before you start your first work placement you should be able to bring increasing amounts
• after you have attended your placement for a of knowledge and understanding to the setting,
few days according to the core and specialist units you have
• at the end of the placement. studied. As a result, placements might expect you to
Suggest reasons for your feelings and concerns be able to show more initiative, ask questions to aid
and note how they change on each occasion. You your learning, apply more knowledge and participate
could make notes about each placement and your in more complex tasks, perhaps planning specific
experiences as you go through the course. activities to carry out with individuals and groups.
Reflecting on how well you are able to apply theory
to your placement experiences would be helpful for
There is a two-way link between your study on the
assessing how well you are developing personally and
course and your placement experiences and your
professionally through the programme.
reflections should consider these links.
Linking theory and practice

Every unit in your programme has potential links
to placements and your unit tutors will encourage Reflect
you to link them. Placements will enable you to gain Most breaches of confidentiality arise from
understanding through experience of a range of: careless chatter between workers, with friends,
relatives and in public. How can you ensure that
• individuals using services
information about individuals you encounter while on
• different health and social care workers placements remains confidential when you participate
• different multidisciplinary teams in class discussions?
• different settings.
Placements will expect you to have acquired sufficient
relevant knowledge and understanding from your Linking practice to theory
school/college studies so you can: Placements are an invaluable aspect of the whole
• work under supervision and follow instructions Level 3 BTEC programme as well as an essential
• listen and communicate effectively with staff and component of this unit. They provide excellent
users of services opportunities to understand work in health and
social care and to relate your study on the course to
• understand the importance of good time-keeping,
practice. Wherever the placement, you will work under
self-organisation, personal presentation and high
the supervision of care workers, helping them with
standards of personal and general hygiene
tasks and activities and observing how they interact
• understand relevant legislative requirements with with individuals and each other. This will provide an
regard to health and safety, care standards, policies understanding of team work and multidisciplinary
and procedures, confidentiality (about individuals teams. A detailed study of one of your placements
and workers), equality, diversity and rights could be used in one of the assignments in this
• demonstrate respect for the care value base in all unit. Your learning on placement could accumulate
that you do. through, for example:
278
• informal observations of routines, procedures and could reflect on the role of routines and compare
practices of a range of care workers them across settings. You could also plan simple
• interacting with individuals and groups using services activities (see Figure 6.10), which might be recreational,
therapeutic or educational according to the setting,
• interacting with care workers and professionals
and reflect on how your skills in planning and
during work tasks, in team activities, through
implementing these change over the programme.
listening and questioning, as a non-participant
observer of professional discussions
• practising your own skills in practical tasks and
team work, fitting into routines, planning and Activity 25: Planning an
implementing specific activities with users of activity
services, etc.
Also, listening to the experiences of your peers Plan and carry out a specific recreational activity
with an individual or small group of individuals on a
on their placements may give you additional
placement.
understanding of your own practice or of work in other
1 What were the individuals’ responses to the
settings with different individuals and care teams.
activity?
Routines and specific activities will structure your
2 To what extent did the activity achieve its
time on placements. Your contributions should be objectives and proceed according to your plan?
beneficial either in assisting care workers to perform
3 What would you do differently if you carried out
their duties or by meeting the needs of individuals the activity again?
using the services. As your experience develops, you
Consultation
• Consent from manager/supervisor
• Links to placement routines/activities
Aims and objectives Resources

• How it will benefit individuals • Equipment
• Are there equal opportunity • Consumable resources
considerations? • Accommodation
• Is it age/ability appropriate? • Staffing
• Budget/costs
Health and safety Practicalities

• Equipment and materials • Time for planning, preparation,
• Abilities of individuals versus the activity itself, and for clearing
needs/benefits up
• Numbers taking part
• Managing risks
Activity plan
• Aims and objectives
• Age in years and months if children
• Number of service users
• Duration
• Workers present
• Setting
• Date and time
• Schedule
− order of actions/event/tasks
− layout of space
− preparation of site
Fig 6.10: Planning for specific activities on placement
279
A routine is a sequence of activities for a specific can discuss in your assignment work. Given the large
purpose that follows the same pattern on each number of units in the programme, it is impossible to
occasion. Routines operate at organisational and team address all the ways in which practice can be linked
levels and most individuals have set routines as part of to theory. Indeed, it is difficult to separate whether
their daily activities. the link is from practice to theory or the other way
around, but the following list suggests potential links
relevant to your knowledge, skills and practice when
Reflect communicating in health and social care:
What routines do you follow when you get up
• observing skills demonstrated by others that
in the morning, when you return from school or
illustrate theory explored in Unit 1
college? How do you think routines are beneficial
to a) individuals using services and b) to care • applying Unit 1 theory to your own practice
workers? In what way might routines pose a • using oral communication to convey key information
danger to individuals or potentially conflict with
and messages clearly and succinctly
respect, choice and diversity?
• developing your questioning skills to better
understand the practices you observe and relating
Formal consent is necessary to carry out any activity on them to your study
placement, including interviewing staff, specifically for • observing how communication is assisted and
the purpose of assignment work. practising techniques yourself
• being aware of factors that influence
Achievement of personal goals communication, e.g. confusion states, stress and
Your professional development plan (PDP), drawn up cultural difference.
in the early part of the programme, will have identified
specific targets or goals for you to achieve by the end Values and beliefs
of the programme, relating to your knowledge, skills, On every placement you will be expected to
practice, personal values and beliefs and to your career demonstrate respect for care values in all that you
aspirations. This section suggests some ways in which do and indeed your ability to do this is likely to be
you could reflect on your progress towards achieving a major influence on how placement professionals
the goals as you go through the programme. It may be judge your practice in your end-of-placement report.
that your experiences in school/college, placements Understanding the care value base will have been
and in other aspects of your life over this period result part of your preparation for placements, and equality,
in you amending or completely changing your goals. rights and diversity are addressed specifically in Unit
This would be part of the monitoring process for your 2. You will observe how the care value base applies
PDP. in different settings and for individuals with different
Knowledge, skills and practice needs and should continually reflect upon the extent
If you are continually observant when on placements to which you demonstrate appropriate values in your
you should be able to identify opportunities for own practice.
learning in settings that are relevant to your study in As you become more confident on placements, you
school/college. Placements should enable you to learn should be able to compare how your experiences
about a range of: are influencing your personal values and beliefs and
• individuals using services also how these affect your practice. Again, regular
reflection on this, particularly when tensions arise
• different health and social care workers
between the two, can enhance your learning. If you
• different multidisciplinary teams encounter difficulties, you should seek support through
• different settings. discussion with tutors or a placement supervisor.
Understanding of all of these could be relevant to Practical experience on a placement is essential to
any unit in the Level 3 BTEC programme and every gain a full understanding of the values expected of
placement should provide you with examples that you care workers.
280
Career aspirations with your peers that contribute to your learning. It is

Opportunities to work in different health and social especially valuable at this level for you to think about
care settings and with different individuals are different opinions and viewpoints and not just the ones
invaluable for helping you make informed decisions you have had previously. Also, life experiences outside
about the next stage of your career at the end of the programme may provide learning opportunities
the Level 3 BTEC programme. Reflecting on your that can be reflected upon in your personal diary.
overall professional development, and comparing
it with the requirements for the career you chose at
Unit 6 and Unit 44
the start of the programme, could help confirm your This unit explores your overall development as a
choice or help you recognise that an alternative is learner, with some time spent on placements to gain
more appropriate for you. If you choose to progress an understanding of health and care work. Unit 44
to professional training in health or social care or Vocational experience for health and social care is
to other study in higher education after finishing closely related to Unit 6 and focuses much more on
the programme, this reflection could be valuable in your professional development through extra time
providing a basis on which to compile the personal spent on placements. If Unit 44 is included in your
statement you make on your application form. course, your diary and portfolio should contribute to
the assessment of both units.
Influence of personal values and beliefs
The ways in which your own values and beliefs may
affect how you study, your contributions on placement, Activity 26: Applying what
and how you learn, have been explored already in this you have learned
unit. Reflection on how you reconcile your own values
and beliefs with those expected in health and social Review the evidence you have collected from your
care is an essential aspect of your development if you practice experiences.
aim to follow a career in this sector. 1 What skills have you acquired from your practice
experience?
Impact of other influences on evolving 2 What knowledge and understanding have you
development of self developed from placements?
The units of the BTEC programme will introduce you 3 How has this helped you in your assignment work
to several different subjects and you will research for the course?
and discuss topics in each. You will also acquire some 4 What personal skills and qualities have you
specialist knowledge and understanding of settings developed as a result of your placement
and individuals through your placements. News experiences that will be particularly
advantageous for your chosen career?
stories and issues of public concern relating to health
may spark spontaneous discussions in the canteen
281
Produce a personal development portfolio that you Ensure that your portfolio contains supporting
have assembled over the duration of the programme. evidence.
Write a reflective report on this portfolio. Use formative feedback from your tutor to
Using three specific examples, explain links between help you write a final reflective report on
theory from your study on the course and your your portfolio of experience over the whole
practice experiences. programme.
M3 For M3, select examples that have clear links
Grading tips with theories. You can use examples that you
have used in assignments for other units but
P5 At the end of each placement, write a reflective you need to ensure that you assess the links for
account of your learning from the experience. this particular task. You may have generated
Write a reflective report at the end of year 1 on evidence through periodic reflective accounts
your overall learning on the programme so far. completed at any stage of the programme.

Self-manager: Your portfolio will provide evidence English: Communicating appropriately, using a
of your ability to organise yourself for this unit as a self- variety of formats, will allow you to demonstrate your
manager. English skills.
You can only complete Assessment activity 6.7 below at

the end of the unit and the whole programme.
Assessment activity 6.7 D2
Produce an evaluation of your personal and developed. Support your evaluation by using
professional development over the whole programme. examples from your experiences during the
course and your diary entries. The reflective
Grading tip reports from placements and Year 1 should also
D2 An evaluation requires you to make judgements be helpful.
about how well or otherwise you have
Functional skills
ICT: Locating and using computer records to compile
your evaluation will demonstrate your ICT skills.
282
4 Know service provision in the health or social care

sectors
care services were separate but increasingly the two
Activity 27: What services are aspects of care overlap. In the UK, health and social
available? care services are provided predominantly by the public
sector of the economy but some services are also
In pairs, list ten different health and social care
provided by the private and voluntary sectors.
services that you are aware of. Share your list with
another pair and add those services you did not Public sector services
have on your list.
Public sector organisations are funded by the state
Now think about how you would access the services
through taxes. Health services are paid for almost
you have identified.
entirely through central taxation, with a small
1 Can you refer yourself or do you have to go to
proportion funded by National Insurance contributions.
your general practitioner (GP) first?
All public health services in the UK are funded through
2 How near are these services to where you live?
the Department of Health (DH) and provided directly
or indirectly by the National Health Service (NHS).
Social care services are funded through local
This section explains how health and social care
authorities (metropolitan boroughs, county councils
services are organised and provided. Every health and
and unitary authorities) from both central and local
social care setting will involve interaction with other
taxes (the council tax in England). Local authorities
services and you can add to your knowledge by being
(LAs) receive central funding via the Department of
alert to how services interact when you are at your
Communities and Local Government (DCLG). State
placements. Knowing about different services and
schools are also funded through central taxes (via the
provision is valuable for all those who work in health
Department for Children, Schools and Families, DCSF)
and social care and will add to your awareness of the
and, for most, also by local taxes.
many different career paths within the health and social
care sector. In England, dental, optician and social care services
are only completely free to those in receipt of certain
4.1 Provision of services welfare benefits and those under 18, who are in full-
time education. Everyone else pays a contribution to,
Provision of health and social care services is of or the full cost of, the health or social care service by
immediate concern to almost everyone in the UK, paying charges or fees (such as prescription charges
whether they are visiting their GP, receiving maternity for medicines and spectacles or residential home fees).
care, or seeking support for frail older relatives to stay
in their own home. Health and social care is therefore Private sector services
an important aspect of social policy and is very much Services in the private sector are funded by fees paid
influenced by the changing demographics of the UK to the service provider. Services provided by the
population, particularly the increasing proportion of private sector include:
older people as life expectancy increases. This section • day care nurseries
describes services as they are in 2009–10. Changes will
• residential and nursing homes for older people
probably be introduced by the government during the
• private schools
lifetime of the Level 3 BTEC Health and Social Care
qualification and you should be alert to these changes • specialist treatment centres
so that you are up-to-date with current policies. • hospitals.
Health and social care professionals aim to provide Professionals such as doctors and some dentists work
the most appropriate care to meet individuals’ needs mainly in the public sector but may also provide private
and they need to be aware of the range of services services to fee-paying patients. In the UK, individuals
available in their locality. Historically, health and social who choose private health care usually subscribe to
283
health insurance schemes so the insurance company in England, Wales, Northern Ireland and Scotland.
pays the fees for care and treatment, subject to the Responsibility for the delivery of health and social care
conditions of the insurance policy. services differs in each of the four home countries of
the UK with the Welsh Assembly, the Northern Ireland
Voluntary and community sector services Assembly and the Scottish Parliament deciding how
Voluntary organisations are charities funded by the funds are to be spent in each country.
donations. The voluntary sector makes an important
In England, health and community care services are
contribution to health and social care services in the
provided through the DH and social care services
UK and many charities focus on particular diseases and
through local authorities (LAs). Government policies
disorders.
now require more co-operation between the NHS and
local social services departments. In Northern Ireland,
Reflect health and social care services have been organised
How many health related charities can you think together by Health and Social Services Boards since
of? 1972. Since devolution, health and social care services
have been integrated in both Wales (through the
Many voluntary organisations are commissioned by Minister for Health and Social Services) and Scotland.
public bodies, often local authorities, to provide
services on their behalf. Patient support groups are Change and health and social care
examples of voluntary organisations supporting Change is continually taking place in health and social
health care, and examples of organisations providing care services because of expectations for continuous
social care services are Age Concern, Barnardo’s, improvement in services and advances in technology.
Help the Aged, Mencap, Action For Children, Red
Cross and many others. Community-based voluntary Reflect
organisations (such as hospices) also provide health Identify recent technological advances that have
and social care services. affected health care. In what ways are these
advances affecting how services are delivered
Activity 28: How does the and organised?
voluntary sector contribute Change is also taking place because of changes in the
to health and social care? population. People now live longer and where people
As a class, find out about the health and social live also affects the services needed.
care services provided by different voluntary
organisations. You may find it useful to visit your
local Council for Voluntary Organisations office Activity 29: What is your
or their website (www.ncvo-vol.org.uk). Create a local population like?
wall display in your classroom that shows how the
Research www.statistics.gov.uk and local sources
voluntary sector contributes to health and social
to investigate the population profile in your local
care service provision both in your locality and
authority area (e.g. age distribution, health profile,
nationally.
etc.) and find out what plans there are for new
1 Reflect on how well your group worked as a team developments in your area that will change the
in producing the display. population profile (e.g. new workers and their
2 Evaluate your display for its visual attractiveness families entering or leaving).
and identify points to consider when creating What effect will these changes have on the need for
displays in the future (e.g. in a school). health and social care services?
Functional skills
Service provision in the UK home countries
Maths: You will need to draw conclusions from
The Department of Health (DH) negotiates an
mathematical information and this will enable you to
allocation of funds for the NHS from the Treasury demonstrate your mathematical skill.
and distributes these between the NHS services
284
The structures of services are described here as they Special health authorities
are at the time of writing but may change during your
The special health authorities operate nationally.
course. And you will certainly encounter changes that
Examples of special authorities are:
will affect your future working life in health and social
care. • NHS Direct: provides a 24-hour health care
information and advice service remotely by
telephone, online and via digital television.
Reflect
• National Institute of Health and Clinical Excellence
When researching health and social care services,
(NICE): develops public health guidance, produces
why do you think it is important to check the date
of the information and to check whether it is still guidelines for clinical practice and evaluates
relevant today? new medications and technological techniques.
Clinical guidelines also influence the curriculum of
professional training for health care workers and
help inform patients. NICE incorporates the former
Levels of services Health Development Agency (HDA).
Care is provided at different levels: primary, secondary • Health Protection Agency (HPA): monitors
and tertiary. communicable diseases and environmental,
chemical and radiological hazards and contributes
Table 6.8: The three levels of care
to national emergency planning. Most HPA workers
Level of Referral Examples are scientists.
services • NHS Blood and Transplant Authority: established
Primary Self GPs, dentists, in October 2005 and manages the National Blood
pharmacists, private Service, supplying blood products, organs and
social care tissues for transplantation.
Secondary GP, District General
Individual involvement in health and social care
emergency Hospitals, Outpatients,
services Accident and Emergency services
In 2008, under the requirements of the Local
Tertiary Inter- Spinal injuries units,
Government and Public Involvement in Health Act
specialist Burns units
2007, the DH set up Local Involvement Networks
(LINks). These enable local people to comment on
The differences between the three levels of services their experiences of health and social care services and
are sometimes unclear. For example, some GPs carry to hold the services to account.
out minor surgical procedures in community-based
facilities.
Regulation of health and social care
The National Health Service (NHS) services
The NHS was formed in 1948, to provide a health care Regulation means ensuring that desired practices are
service that was free at the point of delivery. During actually being delivered and making recommendations
the decades since it began, the NHS has seen many for improving services. Professional bodies regulate
changes. Current policy is for the NHS to ensure their own profession by striking off members who
ongoing improvements in the quality of care for break their codes of practice, and various organisations
individuals, especially those with the greatest needs, regulate many different activities. Usually this is done
and to develop its workforce so it has the skills and by a process of inspection and reporting.
flexibility required to provide this service. The DH has
developed National Service Frameworks (NSFs) which The Care Quality Commission
set long-term goals for a range of health care priorities, All health and social care service providers in the UK
for example, for cancer, diabetes and coronary heart are regulated by the government through legislation
disease. and regulatory bodies. Until April 2009, regulation
285
of health and social care was the responsibility of: For individual users of services, the Common
the Commission for Social Care Inspection (CSCI) for Assessment Framework is being developed with a view
adult social care; and the Healthcare Commission for to providing an integrated approach to assessing their
health service provision; and the Mental Health Act long-term health and social care needs.
Commission for mental health services. Ofsted
Since April 2009, regulation of all health and social Ofsted is the regulator responsible for the inspection
care provision has been the responsibility of the of state schools, colleges, residential schools in the
independent Care Quality Commission (CQC). Its public sector, children’s services, youth work and
reports of inspections of individual service providers, teacher training. It is directly answerable to Parliament,
and those of its predecessor regulatory bodies, are like the CQC. It took on the responsibilities for
available to the public online. The CQC produces an inspection of LA children’s services in 2007 when its
annual rating of NHS Trusts in England and reports full title became the Office for Standards in Education,
annually to the DH. The CQC also investigates Children Services and Skills but it is still known as
complaints and failures in services. Examples of the Ofsted.
organisations that the CQC currently regulates include:
• private care homes
Activity 30: What’s in an
• care delivered in people’s homes
inspection report?
• nursing agencies
• private hospitals Read the most recent inspection report on one of
your placement settings. What are the implications
• hospices. of the inspector’s findings, as presented in the
report, from the perspective of:
Did you know? • an individual using the service
From April 2010, all adult social care providers in

• workers in the setting?
both the public and private sectors will have to be Note the actions and/or recommendations made
registered with the Care Quality Commission, all by the inspector and find out from your placement
dentists by April 2011 and all GPs’ surgeries by April mentor what actions were taken in response to the
2012. report.
Functional skills
The NHS National Service Frameworks (NSF) and ICT: Using the Internet to seek specific information
the Care Minimum Standards set out the standards will allow you to demonstrate your ICT skills.
expected for the provision of health and care services
and the regulator takes these into account when
judging the quality of health and social care services Social Care Institute for Excellence (SCIE)
and providers. The Care Minimum Standards were last SCIE was established in 2001 as an independent
revised in 2007 by the CSCI. charity operating in England, Wales and Northern
Ireland. It supports social care services for adults,
children and families, promoting good practice and
Key term sharing information with individuals to enhance the
Minimum standards – These define the minimum standard quality of the care they receive. SCIE works with the
of practice required. CQC, social work educators and policy makers, and
commissions research.
286
4.2 Local health or social care casualty before transport to hospital. Air ambulances
used in some rural areas are usually funded by
service providers voluntary contributions. Ambulance trusts also
provide patient transport services to collect patients
Primary care trusts (PCTs)
needing to attend a hospital for appointments or
PCTs are responsible for the majority of the NHS
non-emergency treatment, who otherwise would not
budget and they commission all primary health care
be able to get there. These ambulances do not have
services. For example, they commission:
paramedics on board.
• family doctors (GPs)
• NHS dentists
Strategic health authorities (SHAs)
SHAs were established in 2002 and in 2006 their
• health centres (usually jointly with at least one GP
number was reduced to 10. SHAs operate regionally to
practice)
develop plans for health services in the area they serve,
• family planning clinics monitor the quality of the services, ensure that local
• community hospitals plans incorporate national priorities for health, and
• community-based services (e.g. health visitors, report to the DH.
community dieticians, speech and language
therapists)
• out-of-hours cover for GPs. Case study: Provision
PCTs pay acute trusts, which run hospitals, to provide of services
secondary care for patients. Currently, this may be
within the patient’s home area but the PCT may pay A large new facility, close to a new shopping
centre, provides a base for two GP practices, a
another acute trust to treat the patient. This would
pharmacy, a drop-in centre for those with mental
be agreed with the patient when the GP is arranging health problems and family planning services.
the referral for hospital treatment. Representatives of A community health team is based in the same
PCTs and local health services have an active role in LA building, which also houses the local social services
children’s services. offices. A children’s centre is adjacent. There is
limited parking.
Hospital trusts 1 How does this service fit into the national
Hospital trusts include a district general hospital framework?
serving a wider area, providing a full accident and 2 What are the advantages and disadvantages
emergency service and one or two smaller hospitals of this facility for users of the services and for
providing more limited services (e.g. minor injuries health and social care workers?
units and outpatient services) within the same area.
Teaching hospital trusts are associated with university
medical schools.
Reflect
Foundation trusts
PCTs are able to commission any acute trust to
Some hospitals have opted to be self-governing
provide elective (planned) surgery for patients
rather than governed by the DH, although they are still living in its area. This means that secondary care
funded by the DH. could be carried out by a hospital outside the
PCT’s geographical area. What advantages do
Mental health trusts you think this might have for an individual waiting
Mental health trusts provide hospital- and community- for an operation, e.g. a hip replacement or heart
based care for those with mental illness. bypass?
Ambulance trusts
Paramedic ambulances respond to emergencies Private hospitals
and carry life-support equipment to provide on-the- In addition to NHS-funded provision, most cities will
spot life-saving procedures if necessary to stabilise a have a private hospital that provides, for example:
287
• screening services for breast cancer, osteoporosis for children have undergone major reorganisation
and other conditions since the failings that resulted in the death from
• operating theatres for planned surgical procedures neglect and abuse of 8-year-old Victoria Climbié in
such as hip replacements and other routine 2000. Every Child Matters 2003 and the Children Act
operations 2004 were major policy developments arising from the
recommendations of the 2003 Laming Report. There
• outpatient services as appropriate.
have been many other policy changes relating to
Private hospitals do not usually provide emergency
children and young people (up to the age of 19) since
services. Some privately funded specialist treatment
then, although not all of them relate to the Climbié
centres have been established in recent years. These
case. Some of the more recent ones include:
specialise in specific procedures, such as kidney
• From 2008, education and children’s social care
dialysis or cataract operations, and it can be more
inspections integrated
cost-effective for PCTs to pay these centres to provide
the treatments for NHS patients than to provide the • From October 2009, the Vetting and Barring
service within a district general hospital. Scheme introduced with the Independent
Safeguarding Authority for all those working with
Local social care services children, young people and vulnerable adults
Schools and social care services account for most • From 2008, all local authorities have had to have a
of the expenditure of English LAs, who are also Director of Children’s Services in post
responsible for other services related to health but • Introduction of the Early Years Foundation Stage
not part of health and social care services, such as (EYFS) from September 2008
environmental health (rubbish collection, food hygiene,
• Early Years Professional status requires achievement
pest control) and housing.
of an approved early years degree at HE level 3
In recent years, local authorities have increasingly
• The government aims to have an Early Years
organised their services according to individual groups
Professional in every full daycare setting by 2015
of users rather than according to the type of service
and in every children’s centre by 2010
(e.g. social care or education). The Children Act 2004
made it a requirement for all services for children • A report of the Social Work Task force, published
and young people to be integrated so local authority jointly by the DH and DCSF in December 2009,
children’s services departments include early years recommends establishing a professional body for
child care and schools, as well as services for older social workers
children and adolescents up to the age of 19. Adult • The five outcomes of Every Child Matters 2003
services usually include health and social care services continue to underpin policy in relation to children
for older people, those with disabilities and those with and young people.
mental health issues.
Adult social services
Children’s services Adult social services provide services for adults with
You will probably have a placement with an early years disabilities and for older people who are unable to
age group (for children up to eight years old) in a support themselves without assistance as they become
daycare or education setting. Local authority services frail and infirm with increasing age.
Activity 31: What does your local authority provide?

Explore the website of your local authority and find 2 What is your opinion of the priorities it
out what services it offers for different age groups and identifies? Do you think the priorities
individuals with specific health and social care needs. should be different? If so, how and why?
1 Find out what your local authority’s priorities are for 3 Search the website to find out how you can express
the next three years for your district by searching your opinion to the local authority.
for the relevant local area agreement.
288
• coordination of home-based services (e.g.

Reflect assistance with personal care, adaptations to homes
In the last few years there has been a move away such as ramps, grab rails, etc.)
from recommending that older people move
into residential care. Instead, adult social services are
• residential care for adults with learning disabilities
increasingly providing support to older people in their • residential care for older people (relatively few
own homes. What advantages and disadvantages might local authorities still run their own residential care
there be to this change in policy for older people? homes).
Partnership working
Activity 32: Social care Government policies require public sector agencies
services for adults (for example, PCTs and LAs) to work co-operatively with
each other and other organisations in the private and
Find out what services are available (and where) in
voluntary sectors. These relationships are formalised
your local authority area for each of the following
groups: in local partnership agreements (LPAs) to improve
the services available for different individual groups.
• adults with learning disabilities
LPAs set partnership goals and identify how the
• adults with physical disabilities
partners will achieve these. Local Area Agreements
• adults with sensory impairment (LAAs) are agreements drawn up between local and
• older people. central government to ensure that LAs meet their local
needs in the context of central government policies
Services for adults may include:
and priorities. Social services departments also work
• day centres in partnership with other agencies to ensure that
• training centres for adults with learning disabilities individuals’ needs are addressed. Examples include the
Pharmaceuticals
Laboratory sciences Complementary therapies

Health
care
Diagnostic technologies Advice and guidance
Occupational Residential
health care
Young offender teams Family learning
Mental Adult
Probation service health services Adult education
Health and
social care
provision
Police Health Disability Higher education
promotion services
Leisure and sport Housing

Health Children’s
surveillance services
Environmental health Voluntary sector
Substance
misuse
Catering Community development
Community relations
Fig 6.11: Partners in health and social care and the wider context
289
voluntary sector, private companies delivering personal Local health or social care providers
care, the probation service and housing associations.
A person who carries out activities specifically to
support the well-being of another person is providing
Case study: George care. Caring for a family member, friend or neighbour
is informal care. Formal care is different because
George lives alone in a detached bungalow and it is subject to external regulation even if the care
is fiercely independent, keeping very much to is being provided by a voluntary organisation and
himself. He has a son but his son rarely visits. One
in the individual’s own home. This unit is preparing
day his neighbour is in her garden when she sees
George fall as he puts his rubbish out. She calls an you to work professionally, delivering formal care in
ambulance on her mobile and goes to help George. a provider organisation such as the settings for your
He is in some distress and has a sharp pain in his work placements.
ankle, and she notices he looks unwell, unkempt
and very thin. The paramedic thinks George
has broken his ankle but George needs strong
persuasion to be taken to hospital for treatment.
Key terms
Informal care – Care provided by family, friends or
1 What services will fulfil George’s immediate neighbours without payment or necessarily involving health
needs? or social care providers.
2 What services will George require to meet his Formal care – Care provided by workers who are part of a
needs in the longer term? health or social care service organisation.
Social care may also be available entirely from private

providers. Most residential care is now provided by This section of the unit requires you to investigate
private companies. If an individual chooses, they one health or social care provider. You could choose a
may access private services entirely independently placement setting but this is not a requirement.
of social services departments, in which case, it is
likely that the individual would be paying the full cost
Type of social care provision
themselves. Nursing home fees are higher because Health care and social care provider organisations
it is a requirement that nursing care is managed by differ widely, depending on a range of factors such as:
a qualified nurse and the care needs of individuals • the individuals who are using the service
require a higher ratio of staff to patients. • their social or health care needs
• whether the service provides residential or day care
Activity 33: How much • whether the care is required for a short period or
does care cost? long-term
• the number of individuals being provided for.
In a group, research the fees charged by different
residential care homes in your area. Funding
From observations made on your placements, Health and social care providers are the organisations
what would you consider to be the most important that deliver services directly to individuals. As stated
features of good-quality residential care? Is there
previously, individuals visiting a GP or a hospital do not
a relationship between the fees charged in local
homes and the quality of care they provide? pay directly for the service unless they choose to do so
privately. In England, social care services are means-
tested so individuals pay the full cost, or contribute
to the cost, according to their financial circumstances.
Functional skills
Those in receipt of certain welfare benefits may
Maths: You will need to understand routine not have to pay any contribution for some social
mathematical problems and select and apply care services. In contrast, at the time of writing, all
mathematical techniques, drawing appropriate
individuals in Scotland are entitled to free social care
conclusions.
services as well as health services. Although the service
290
Day care
Health NHS Private Residental
Hospices centres for
centres hospitals hospitals care
older people
GP Nursing
surgeries homes
Specialist
Childminders
units
Health and social
care providers and
organisations
Voluntary
Schools
organisations
Dental After school

surgeries clubs
Mental Family Fostering

Maternity
health planning and adoption Nurseries
services
centres clinic agencies
Fig 6.12: Examples of health and social care service providers
provider organisation may be in the voluntary sector, • physical access relating to transport or getting into
the funding for the services comes from the public the provider premises (e.g. up stairs and through
sector, mostly through the PCTs or LAs. doors)
• how the individual becomes known to the service
so that a service provider may meet the individual’s
Did you know? needs.
Age Concern and Help the Aged both provide The Disability Discrimination Act 2005 (page 461)
services for older people. They are merging in 2010 to requires premises to be accessible to those with
form Age UK. disabilities. Other barriers to individuals actually using
a service could be financial (e.g. the cost of dental
treatment), emotional (e.g. embarrassment about
Provider organisations vary in size, location and the
talking about health) or the way the provider offers
type of premises used, regulation, their internal
the service (e.g. being made to feel unwelcome or if
structure, the number of employees and their
the service is only available at an inconvenient time or
qualifications. You will explore these in more detail if
location).
Unit 44 Vocational experience in health and social care
is included in your Level 3 BTEC programme.
Policies and procedures
Access to services Legislation and national policies and frameworks
A health or care service must be accessible to users of directly influence practices in care settings. Each
the service. Access to services may involve: setting is required to develop its own policies to
291
Activity 34: Policies and procedures

You should be introduced to the policies and settings receive a high standard of care at
procedures of your work placement as part of your all times.
induction to the setting. 4 After your final placement compare three types of
1 List all the policies of the setting and state briefly policy from each of your placement settings and
why each is required. explain the reasons for differences between them.
2 Make notes from the policies of your first Note: If you are on a placement and not an employee,
placement to record your individual responsibilities you should not expect to retain a copy of each
under the policies and those of your placement setting’s policies. Instead, arrange with your supervisor
supervisor. a quiet session when you can be left undisturbed to
3 Find out how policies are reviewed and developed study the policy documents.
so that individuals using services and those in
ensure its practices are in accordance with the law All employees should be aware of the policies and
and national policies and appropriate for the way procedures in their setting. Some procedures may be
in which their particular service is organised and its embedded in routine (for example, washing hands for
accommodation. infection control); other parts of a policy may only become
A policy is a statement of responsibilities and a active when there is a critical incident (for example, when
statement that identifies what the policy relates to and several patients on a ward get the same infection).
aims to achieve. Policies underpin different aspects of
practice, such as health and safety or anti-discriminatory Key terms
practice. A policy states when it should be applied and Policy – A statement of intent and responsibilities in relation
the responsibilities of key people in implementing the to a specific aspect of practice.
policy. A procedure is a detailed description of the Procedure – A step-by-step description of the processes
steps that have to be taken to apply the policy. involved in implementing the policy.
Describe one local health or social care provider that working in the setting and will find it easier to
provides services in your area. Identify its place in ask questions of staff if you need clarification.
national health and social care provision, and describe Consider how users of the service gain access
the services it provides, its policies and procedures. to it and possible barriers they may encounter.
Also consider how the service is funded and its
Grading tip policies and procedures.
P6 Select one of your placement organisations You could present your evidence as an
to investigate for this activity, as you should informative booklet for potential users of the
be able to gain a clearer understanding from provider’s services.
Functional skills
English: You can use listening and speaking skills PLTS
when researching this activity and writing skills to
present your findings. Independent enquirer: This activity will
demonstrate your ability to conduct research as an
ICT: Use appropriate ICT tools to develop a visually independent enquirer on a specific topic.
interesting booklet.
292
4.3 Health and social care Care teams

workers Whatever the provider setting, health and care workers
work together as a team to deliver care that meets
Work in health and social care settings each individual’s needs. You will work as part of a
A sizeable proportion of the total workforce in the UK professional team on placements with each member
is involved directly or indirectly in health or care service of the team contributing different professional
provision. The government has made development expertise. Some team members may work for a partner
of the health and care workforce a priority, to enable organisation.
services to adapt effectively to demographic and Job roles and responsibilities
technological changes. In this way, it is hoped that
There are many different job roles available in health
workers will have the skills to deliver care using new
and care work. Staff members with professional
methods and raise standards.
qualifications and experience have more senior job
roles and more responsibility for making decisions
Did you know? about others (both individuals using services and staff).
Job role titles give some indication of the level of
The NHS is one of the largest employers in the EU, training and responsibilities expected but conventions
employing over a million people. can vary in different professions.
Each worker in health or social care will have a job role.
Health and social care work differs according to the The job role is usually indicated in their job task (e.g.
provider organisation. Acute trusts employ large ‘coordinator’, ‘team leader’, ‘lead practitioner’ etc.)
numbers of workers including health professionals, and may include more information, perhaps the groups
support staff such as scientists and others (such as of individuals with whom the carer will be working
administrators) who may not have direct contact ‘for older people’, ‘14–19 age group’ or ‘early years’
with patients. Care workers and professionals in or identified by the department (e.g. ‘haematology’,
hospitals and residential settings often work shifts. ‘children’s services’, etc.). The responsibilities of a
Workers in community care may work daytime hours job are more specific, defining the different tasks
only and some workers may work independently in that make up all the aspects of the role (e.g. keeping
an individual’s home or in an outreach centre, only records, monitoring care plans, being a member of a
meeting colleagues occasionally. In the smallest social particular team, etc.). In the public sector a typical job
care settings, there may be only two or three staff on description usually includes:
duty at any one time, with all of them working directly • the job title (e.g. special educational needs
with individuals. coordinator)
Case study: Working as a SALT

Jill is a speech and language therapist (SALT). Her spends one day in the health centre where she
office is in the local health centre but for most of the has appointments with parents, meets her line
week she is out in local schools and nurseries working manager in the community health team and catches
with children, most of whom have speech or language up with her record keeping.
delay or a speech impediment. She spends a day 1 Who are the colleagues that Jill spends most time
in each of three different primary schools, working with?
individually with specific pupils. On the fourth day
she travels to different nurseries where she sees very 2 What do you think might be the challenges for Jill
young children. She works directly with the children working this way?
but in the schools she also works with a teaching 3 What are the advantages for the children?
assistant who supports the children with speech and
language needs during the rest of the week. She
293
Table 6.9: Job titles and responsibilities
Examples of job titles and qualification level Outline of possible responsibilities

Assistant Work directly with individuals in relation to activities of
Level 2 daily living
Senior assistant Make routine decisions about care, care planning,
Level 3 supervise a team of assistants
Technical/Professional Cert HE equivalent Make more complex decisions about care,
responsibilities for managing and training others
Senior technical/practitioner Dip HE equivalent Staff nurse, manager of small care unit, laboratory
technician
Professional Honours degree Nursing sister, health care professional, early years
teacher
Senior professional Postgraduate/Masters Junior doctor, nurse manager
Expert/specialist Doctorate/advanced professional Senior doctor, leader of other professionals
qualifications
• the main responsibilities (e.g. membership of a qualification, usually as a full-time student at university
named team, liaison between departments) for three years. Training involves academic study
• the specific duties (e.g. keeping records, monitoring leading to a BSc degree and will include assessment
care plans) of your practice skills in care settings. Specific
qualifications are required for each health or social
• the line manager for the post.
care profession and the curriculum for training is
In the NHS, the specific responsibilities and duties
influenced by the National Service Framework (NSF),
expected of a worker are profiled under the KSF
regulators and the organisations representing each
(Knowledge and Skills Framework) which classifies
profession.
specific care activities as being Level 2, 3 or 4 tasks.
Sub-professional level qualifications for support
This detail may then determine the salary paid.
workers in health and social care are influenced by
National Occupational Standards (NOS) set by the
Did you know? relevant Sector Skills Councils (SSCs), particularly:
Job descriptions tend to change over time, and they • Skills for Health
may be reviewed as part of the annual performance • Skills for Care
management review process.
• The Children’s Workforce Development Council.
At the end of 2010, National Vocational Qualifications
Activity 35: Jobs in health (NVQs) in health and social care will no longer be
and social care available in England, Wales and Northern Ireland,
although the Scottish equivalent (SVQs) will continue
Search relevant websites and local newspapers to in Scotland. Instead of NVQs, learners will study for a
find out about the range of jobs available in your area
Level 2 or Level 3 Health and Social Care diploma that
in the NHS, GPs’ surgeries, social care and childcare
settings. includes the core knowledge needed to work in health
and social care plus more specific job-related units.
Individual workers will then be expected to acquire
Education and training for work in health and further qualifications to help them develop more
social care specialist competencies in accordance with the NHS
If you aim to work as a professional in health or Knowledge and Skills Framework (KSF) and the actual
social care, you will need to study for a professional work role they have.
294
Health professionals Support workers

• Doctors • IT services
• Nurses • Hospital porters
• Dietitians • Caterers
• Orthoptists • Childminders
• Radiographers • Care assistants
• Podiatrists • Phlebotomists
• Occupational therapists • Playworkers
• Midwives • Administrators
• Physiotherapists
Workers in health
and social care
Care professionals
• Eductional psychologists
• Registrars
• Teachers
• Finance managers
• Social workers
• Medical secretaries
Fig 6.13: Some of the people who work in health and social care
Professional bodies All health, social care and education professionals who
work in the UK must be registered with the relevant
Successful completion of initial training in the
UK professional body and with the Independent
health and social care professions leads to a legal
Safeguarding Authority. Professional qualifications
qualification with a licence to practise as a nurse,
gained in the European Union and a few other named
teacher or social worker. Each profession is regulated
countries are accepted automatically but those gained
by a professional body that maintains a register of
in other parts of the world are subject to scrutiny by
its licensed professionals. It is now a requirement for
the professional body before registration is granted.
all professionals in health, social care and teaching
All non-European workers whose first language is
to provide evidence of continuing professional
not English are required to pass an English language
development (CPD) to maintain their registration with
proficiency test before gaining registration.
their professional body.
Table 6.10: Professions and their associated bodies
Profession Professional body

Nurse, midwife, specialist community public health nurses Nursing and Midwifery Council (NMC)
Social worker, General Social Care Council (GSCC)
social care employers
Professions allied to medicine (PAMs) Health Professions Council (HPC)
Currently regulates 15 professions
Teachers General Teaching Council for England
Doctors General Medical Council (GMC)
Dentists General Dental Council (part of Royal College of
Surgeons of England)
295
Nurse
Lesley is an experienced nurse

who qualified ten years ago. Until recently, all
her experience had been working in a teaching hospital in
theatre as a staff nurse and then as a sister on a surgical ward.
The work was varied and interesting because one of the surgeons
was a professor and gastrointestinal expert so difficult cases were
referred to him. She enjoyed the work because she was responsible
for managing the nursing care for patients before and after their
operations. Some of the patients were seriously ill and needed
specialist support and care.
Sometimes patients had to
have central intravenous catheters inserted for their
nutrition support and medication, and scrupulous standards of
hygiene were required to prevent the catheters from getting infected, as this
could be life-threatening.
After their surgery, many patients needed careful monitoring to ensure that they recovered from
the effects of surgery, and because of the specialism, patients needed particular support to adjust to
coping with stoma bags. Patients often found this very embarrassing but Lesley became expert at putting
them and their families at their ease. Very careful attention to personal hygiene was needed and Lesley trained
all junior nurses for the routines she expected on the ward.
Lesley had two small children and, after her maternity leave, chose to work shifts in the accident and
emergency department of a district general hospital, as this was more convenient for childcare and her
home. Throughout, she has taken various training courses to meet the relevant KSF specialist dimension
requirements of these jobs.
However, now Lesley has moved to a rural area with her family and her choice of jobs in nursing
is more limited than in the city. She has been appointed assistant manager of a local
residential and nursing home and now finds she has to acquire skills for work in
health and social care and as a manager. She has recently decided to
enrol on a distance-learning Masters course to develop her
management and leadership skills.
Think about it!
1 What has helped Lesley adapt her nursing skills to fit each
of the jobs she has done?
2 What aspects of her past nursing experience might be
useful for her new job?
3 How would you cope with changes in your career?
296
Professional codes of practice managers must be registered with the General

Social Care Council (GSCC) and have an approved
Professional bodies regulate their profession by
management qualification.
establishing codes of conduct for all registrants that
define the minimum standards of behaviour that are
expected. The codes of practice reflect the ethics and Reflect
values of the profession, which are similar in all the Do you know where your GCSE certificates are,
health and care professions. and those any from other similar qualifications?
As already mentioned, all professional bodies Have you stored them carefully so they will not get lost
or damaged? Why do you think it is important to take
have the power to remove an individual from the
care of all your certificates for qualifications gained from
professional register after a formal process of enquiry, GCSEs onwards?
if the professional code of practice is breached. An
individual who has been struck off their professional
register is unable to work in any role requiring
professional status. Employers usually suspend the
Multidisciplinary teams
individual concerned as soon as a claim of professional Individuals using services are the most important
misconduct is made. people in any care setting and all work activity in
a health or care organisation is either directly or
Other workers in health and social care indirectly associated with meeting the needs of its
services individuals. It is probable that for any one individual,
Training for health and care work is statutory under the the expertise of several different types of health and
Care Standards Act 2000 and any untrained worker in care worker will be required to meet their needs. Each
health or social care must complete induction training. worker will have a different job role but, by working
together, they can meet the needs of the individual.
This group of workers, each with different and specific
Activity 36: The Induction roles, is known as a multidisciplinary team (MDT).
Standards
Find out about the GSCC Induction Standards
2006 for those commencing work in health and
Case study: Khalid
social care for the first time. Khalid is 7 years old. He has cerebral palsy,
limited hearing and needs a laptop, as he has
insufficient control over his arms and fingers to hold
a pen. He is intelligent and he and his parents want
Care assistants do not have to be registered with a
him to remain in mainstream school.
professional body (in addition to the GSCC) but this
What professionals would be involved in the MDT
situation may change in the future. Care employers
in supporting Khalid at school?
must ensure that at least 50 per cent of their workers
have a relevant qualification at least to Level 2 and
Activity 37: Work in practice

Investigate the qualifications and experience of three adapt to new roles throughout their career?
different types of worker in one of your placement 3 What are the arrangements in the setting for staff
settings. to take part in PPD/CPD?
1 What training have they completed and how did 4 What opportunities are there in the setting for the
they obtain it, e.g. by full-time or part-time study? staff to advance in their career by taking on new or
2 How does the experience from training and additional responsibilities?
previous employment help each of the workers
in their current role? What has helped the staff to
297
Career paths Networking
In health and social care work, the pathways to reach Partnership working Professional updating
a particular job role become more diverse as you Developing a
proceed beyond your initial practitioner or professional specialism
ge
Different settings
qualification (see Fig 6.14). With an increasing amount
led
Sk
Research
ow
ills
of partnership working, health and care professionals
Kn
find themselves working routinely in non-traditional Different service CPD Training/
user groups educating
settings within multidisciplinary teams. others
Interaction with different professionals in different Experience
settings, and working with different individuals and
Leading others Management
groups using services and working at different levels Formal study
of responsibility, provide diverse experiences that may
Fig 6.15: Continuing professional development
be relevant for a wide range of job roles, sometimes
only later in a career. Experience of health or care
work is valued in a wide range of workplaces, not just in the future, ongoing reflection on your experience of
those in health and social care – your career path may working with individuals, other workers and different
eventually take you into industry, work abroad, or the providers and agencies will continue to add to your
voluntary sector. knowledge and understanding. Gaining objective
Broad pathway options after gaining practice evidence of this CPD through formal qualifications and
qualifications may be in management, education and skill-set competencies will enhance your opportunity to
training, research or as an advanced practitioner in a progress your career in the direction you choose (see
specialist area. A higher-level qualification develops Fig 6.15).
your abilities to use knowledge and understanding
and to work with, and lead, others. With a licence
to practise, you can work as a professional in an
appropriate setting. Whatever career choices you make
Fig 6.14: Where next? Career pathways in health and social care
298
Activity 38: Portfolio review PLTS

Review the evidence in your Unit 6 portfolio Independent enquirer: Research carried out for
and diary. this activity could demonstrate your skills as an
independent enquirer.
1 What evidence do you have to demonstrate how
you have worked with policies and procedures on
your placements?
2 In what ways have funding and access issues
affected the care that individuals have received in
placement settings you have attended?
Choose three health or social care workers and development of staff in the work of each of the
describe the roles, responsibilities and possible career three workers.
paths of each. Your description should include consideration
of how each of the workers would work
Grading tip with other health or social care workers in a
P7 The workers could work in the provider multidisciplinary team.
organisation described for P6. Your evidence could be presented as a
Include description of the role of professional reference card for display in your school or
bodies, codes of practice and the training and college.
References and further Department of Children, Schools and Families

www.dcsf.gov.uk
reading Department of Communities and Local Government
www.communities.gov.uk
Honey, P., Mumford, A. (1982) The Manual of General Social Care Council www.gscc.org.uk
Learning Styles Maidenhead: Peter Honey Health Professions Council www.hpc-uk.org
HPA (2009) www.hpa.org.uk National Council for Voluntary Organisations
Kolb, D.A. (1984) Experiential Learning Englewood www.ncvo-vol.org.uk
Cliffs: Prentice Hall National Institute for Health and Clinical Excellence
Schön, D.A. (1983) The Reflective Practitioner: How www.nice.org.uk
Professionals Think in Action Basic Books National Statistics Online www.statistics.gov.uk
NHS Careers www.nhscareers.nhs.uk
Useful websites NHS www.nhs.uk
Northern Ireland Social Care Council www.niscc.info
Care Council for Wales www.ccwales.org.uk
Nursing and Midwifery Council www.nmc-uk.org
Care Quality Commission www.cqc.org.uk
Sector Skills Council: Skills for Care and
Chartered Institute of Personnel and Development
Development www.skillsforcare.org.uk
www.cipd.org.uk
Sector Skills Council for Health: Skills for Health
Children’s Workforce Development Council
www.skillsforhealth.org.uk
www.cwdcouncil.org.uk
Social Care Institute for Excellence www.scie.org.uk
Department of Health www.dh.gov.uk
299
Just checking
1 What are the three main components of learning and development?
2 What are the differences between learning styles, the learning cycle, support for learning and
learning opportunities?
3 What are the three most influential factors that have affected your learning so far in your life?
4 What is the difference between primary and secondary sources?
5 Distinguish between qualitative and quantitative data.
6 What are SMART actions?
7 List four different sources of feedback obtained during the course that you could use when
reflecting on your development on the course.
8 What is the difference between primary, secondary and tertiary care?
9 Identify three different types of support worker in health and social care.
10 What sort of work would each of the following workers do in health and social care:
•• occupational therapist
•• medical physicist
•• biochemistry laboratory technician
•• health service manager
•• community mental health nurse
•• health care assistant
•• manager of a day centre?
What qualifications would be required for each of these occupations and what sort of experience
would be expected?
Assignment tips
1 Remember to be objective about your own performance on the course and on placements so that you
neither understate nor exaggerate how well you have done something.
2 Always try to support your own views and judgments with an opinion from another source (e.g. feedback
received from tutors, placement or work supervisors, peers in group activities and from books and
diaries and so on).
3 Always date each entry in your diary, as this will enable you to see how you are developing over time.
You might find it helpful to number the pages so you can easily refer back to a comment on a specific
page in a later entry.
300
Credit value: 5
7
Sociological
perspectives for
health and social
care
Why are UK teenage pregnancy rates the highest in western Europe? Why are
recorded rates of anxiety and depression higher for women than for men? Why
has there recently been a fall in the divorce rate in the UK? These are the kinds of
questions that concern sociologists. This unit provides an introduction to sociology
and explains how sociologists can help us to understand society and particularly
disadvantaged groups within our society. In this unit you will study the different
approaches that sociologists have used to explain health and social care issues.
The unit opens with an introduction to key sociological terms, and to the key sociological
approaches. You will then relate these ideas to the study of health and social care issues. You will
consider different definitions of health and illness and examine the impact of the family, occupation,
social class and other aspects of our environment and culture on our health and well-being. There
will be particular consideration of health differences among different social groups, particularly
groups identified by social class, gender, ethnicity and age.
This unit also provides a very helpful foundation for those who, later in the course, go on to study
Unit 19 Applied sociological perspectives.
Learning outcomes
1 understand sociological approaches
2 understand sociological approaches to health and social care.
301

P1 Explain the principal sociological M1 Assess the biomedical and socio-

perspectives. medical models of health.
page 319 page 323
P2 Explain different sociological

approaches to health and ill-health.
page 323
P3 Explain patterns and trends in M2 Use different sociological D1 Evaluate different sociological
health and illness among different perspectives to discuss patterns explanations for patterns and
social groupings. and trends of health and illness in trends of health and illness in two
See Assessment activity 7.3, two different social groups. different social groups.
page 331 See Assessment activity 7.3, See Assessment activity 7.3,
page 331 page 331
302

This unit will be assessed by internal assignments that will be marked by the staff at your
centre. It may be subject to sampling by your centre’s external verifier as part of Edexcel’s
on-going quality assurance procedures. The assignments will be designed to allow you to
show your understanding of the unit learning outcomes. These directly relate to what you
should know and be able to do after completing this unit.
Your assignments could be in the form of:
• presentations
• written assignments
• case studies
• essays.
Guidance is included throughout this unit to help you prepare and present your work.
Sam, 18 years old

I’ve been on placement at a hostel for homeless young people for
six weeks so far. Many of the residents at the hostel have very sad
life stories. Few of them have any family support. Some have been
in care. They have come from poor areas, where unemployment
and crime are high and drugs are easily available. They all seem
to have had very deprived childhoods. Has this all led to the hostel
being their home?
I think of Joe. He was brought up by his grandparents, who were retired and on a
very low income. He never knew his dad, and his mum had a drug habit. When he left
school he also left home. After that he lived with friends, sometimes in hostels and
often on the streets. He has been in hospital at various times with chronic bronchitis,
pneumonia and hypothermia. His diet has been very poor – sometimes eating from
rubbish bins. He hasn’t ever worked. He often seems very depressed. He doesn’t seem
to talk to anyone very much. His personal hygiene is poor and his self-esteem is low.
This unit helped me to see that guys like Joe are homeless partly because they haven’t
yet had much of a chance in life. Poverty, little family support, poor housing and poor
health seem to have led them to this.
Over to you!
1 Which parts of this unit do you think you will find most interesting?
2 Which other units do you think are linked with the issues covered in this unit?
3 Which parts of this unit will help you better understand the homeless young
people at the hostel?
303
1 Understand sociological approaches to study
Asking the big questions

Get
Should the state support people who do not care for themselves? How far does
started family background influence health and well-being? Would reducing poverty
lead to a healthier population? Are we all responsible for our own health? These
are some of the questions that you will explore in this unit, using a sociological
approach to consider the issues they raise. Discuss these questions now and then
revisit them when you have completed this unit. It will be interesting to compare
your views ‘before’ and ‘after’.
1.1 Sociological terminology Religious The Health and

Sociology is a word drawn from the Latin socius family social care
organisations
services
(meaning ‘companion’) and the Greek ology (meaning
‘study of’). Sociologists are concerned with the study
of human societies, but most specifically the groups
within these societies and how these groups relate to Society
each other and influence individual behaviour.
Social structures
Society can be viewed as the sum of its social The political The The education
institutions (its major building blocks). These may system economy system
include the family, the education system, work and the
economic system, the political system, religious groups Fig 7.1: Key institutions in our society
and the health and social care services. Sociologists
look at the way these institutions are structured, and
how they relate to each other and influence the way we Activity 1: Social
behave.
institutions
For example, sociologists describe the different
forms of the family in our society, the changes that Draw a personal spidergram identifying the social
are taking place within the family, how the family institutions to which you belong. Try to identify
structure influences our behaviour, and how the family how two of these institutions have influenced your
relates to other social institutions. They examine how behaviour. In small groups discuss why you think
these particular institutions have influenced you.
our family background may influence our values,
attitudes, religious beliefs, educational achievements,
employment prospects and our health and well-being.
Key term PLTS

Social institution – A major building block of society, which Independent enquirer: If you consider the impact
functions according to widely accepted customs, rules or of previous experiences on your attitudes and your
regulations. The family, the education system and the legal behaviour, the above activity will help you demonstrate
system are all social institutions. your ability to analyse and evaluate information.
304
Social diversity Social class

Social class is the form of stratification that describes
Social stratification
the social hierarchies in most modern industrialised
Social stratification is a term used by sociologists
societies. Social class is largely based on economic
and borrowed from geology. In geology, ‘strata’ refers
factors (such as income, property ownership and other
to different layers of rock laid on top of each other.
forms of wealth). Sociologists are particularly interested
In sociology, the term is used to describe hierarchies
in the link between our social class position and other
in society, highlighting the fact that some groups of
aspects of our lives such as educational achievement,
people are seen as having higher status than other
lifestyle choices and health and well-being.
groups. People identified as being of higher status
The official classification of social class used by British
are often wealthier and have easier access to the
governments to measure and analyse changes in the
possessions and way of life most valued in that society.
population began in 1851. The broad classification
Almost all societies have some form of stratification.
of occupations into social ‘grades’ (later called social
In African countries following colonisation, and in
classes) was used for the analysis of death rates.
America before the Civil War (1861–1865), groupings
were based on race. Black communities had far less The five social classes identified by the Registrar
social status than white communities. Some people General of 1921, based largely on perceived
would argue that, despite legislation, such hierarchies occupational skill, remained in place until 2001.
and inequalities still exist. Government statisticians and others used these
categories to analyse population trends until very
In India, the Hindu caste system has five clearly defined
recently.
social strata, into which people are born:
The Registrar General’s Scale of Social Class included:
• Brahmins – the highest caste, priests
• Class 1: Professional class
• Kshatriya – the military, rulers and administrators
• Class 2: Managerial and technical occupations
• Vaisya – merchants and farmers
• Sudras – manual workers • Class 3: Skilled occupations:
– Non-manual (3N)
• The Dalits, or social outcasts – the people who have
– Manual (3M)
almost no status (they have no caste at all).
• Class 4: Semi-skilled occupations
There is no intermarriage and very little social contact
between the castes. There is no social mobility (i.e. • Class 5: Unskilled occupations.
improving or changing your position in society). It is a Since 2001, the National Statistics Socio-economic
closed system of stratification. Indian governments have Classification (NS-SEC) has been used for official
passed laws attempting to remove the inequalities of government statistics and surveys. It is still based
the caste system but with limited success. on occupation but has been altered in line with
In feudal England the different strata were called employment changes and has categories to include
‘estates’ and were based on ownership of land. The the vast majority of the adult population:
monarchy and the knights, barons and earls formed • Class 1: Higher managerial and professional
the highest estate, the church and clergy were in the occupations
second estate, and the merchants, peasants and serfs • Class 2: Lower managerial and professional
were in the lowest estate. occupations
• Class 3: Intermediate occupations
Key terms • Class 4: Small employers and own-account workers
Social stratification – A term (borrowed from geology) • Class 5: Lower supervisory and technical
describing the hierarchies in society, whereby some groups occupations
have more status and prestige than other groups.
• Class 6: Semi-routine occupations
Social mobility – The process of moving from one social
stratum (level) to another. Social mobility can be upward or • Class 7: Routine occupations
downward. • Class 8: Never worked and long-term unemployed.
305
Social class differs from the more closed systems of

the caste or feudal systems, or those based on race or Activity 2: Social class
gender, in that:
• the class differences are more difficult to define
Some people think that class differences in
• the class differences are not backed by law or our society have disappeared. Write four short
regulation paragraphs, giving two arguments in favour of this
view and two arguments against this point of view.
• social class barriers are arguably far less rigid
• there is the possibility of social mobility
• people can rise, or indeed fall, in the class system. Functional skills
We will be studying the links between social class and
ICT: Using the information presented in this chapter,
levels of health and sickness in our society.
class discussion and your own view of the world, you
will need to prepare and present clear points of view
as they apply to social class. This may enable you to
demonstrate your ability to find, select, present and
Socialisation communicate information.
Sociology is based on the idea that most of our

behaviour is learned through the process of
socialisation (and very little of our behaviour is
Key terms
Egalitarian community – A community without hierarchies,
instinctive). Socialisation is the process by which
where all members are regarded as equal.
individuals learn the culture of their society – that is,
Socialisation – The process of learning the usual ways of
the language, values and beliefs, customs and ways
behaving in a society.
of behaving that are seen as acceptable. It may be
Culture – The values, beliefs, language, rituals, customs and
argued that the most critical period of socialisation is rules associated with a particular society or social group.
in the early years of life.
Activity 3: Communes and egalitarian communities
Many communes (small and relatively self-contained communities still exist that support people with
egalitarian communities) were established during the identified health and care needs.
1960s in the USA, Britain and other parts of western
In groups, carry out the following tasks.
Europe by groups of people who wanted to establish
alternative and less materialistic lifestyles. 1 Explain the difference between an egalitarian
society and a hierarchical society.
Communes often try to develop an alternative type
of household. Rather than separate family units, there 2 Describe three differences between the experience
is an emphasis on collective living. All adult members of children living in a commune and the experience
of these communities are seen as equal. Children are of children living in separate households with their
seen as the responsibility of the community, rather parents or carers.
than of individual parents. 3 Discuss two advantages and two disadvantages of
Many communes were short-lived but more this type of community living.
longstanding religious communities and therapeutic
Functional skills Reflect

English: In discussion, you will develop your Would you like to live in an egalitarian society,
speaking and listening skills and your skill at where all members are regarded as equal?
presenting arguments and listening to other people’s
arguments.
306
This period of primary socialisation takes place, who do not conform to expectations, i.e. those who
for most of us, within a family – whether it is our disregard the norms of the society or group, are said to
birth family, a family of adoption or a foster family. be deviant.
Secondary socialisation is the process that carries on
as our social life develops through playgroup, nursery,
school, friendship or peer groups, religious groups, the Key terms
mass media and employment. Primary socialisation – The first socialisation of children that
Our socialisation affects our attitudes towards the care normally takes place within the family.
and support of vulnerable people, children and older Secondary socialisation – The socialisation that takes place
people. For example, should we care for the very old as we move into social settings beyond the family, such as
at home, as part of the family? Or should we access nursery, school and friendship groups.
residential care for them? In Islamic and Hindu cultures, Norms – The guidelines or rules that govern how we behave
in society, or in groups within society.
care would normally be provided at home by grown-up
Deviant – Someone who does not conform to the norms of a
children and grandchildren; whereas in white British
particular society or group.
families residential care and other support services
would be far more usual. Sociologists would argue
that this is largely because of a difference in the values
and beliefs learned during primary and secondary Reflect
socialisation. The socialisation process varies from one culture
to another. Health and social care workers need
The socialisation process affects our attitudes to
to be mindful of the contrasting socialisation of
education and our choice of career. Our home different people living in a multicultural society.
circumstances and the lifestyle of our friends and
family can influence our attitudes and our behaviour at
school and college. Consider Delton and Nadia in the What happens when there is no socialisation? This
case study below. question can be partly answered by reports on children
The norms, or expected way of behaving, of the who have been found living with animals in the wild –
society or group to which we belong are learned, it is sometimes called ‘feral children’. These children have
argued, by absorbing and copying the behaviour of no sense of personal hygiene and they are unable to
others in our social group. We adopt the main values interact with other human beings. They often ‘walk on
and beliefs of the society to which we belong. Those all fours’, like the animals they have lived with.
Case study: Delton and Nadia

Imagine two 16-year-olds from very different social 1 Write down three factors that you think might
backgrounds. influence Delton’s achievements at school and
plans for the future. Then write down three
Delton lives with his mother, who has no paid work.
factors that might influence Nadia’s achievements
His father left them when he was a baby. None of his
at school and future career plans.
relatives or friends have been to college or university.
Delton does not enjoy school and he and his friends 2 In small groups share the factors that you thought
often play truant. There is very little work about, and were important and compare them with those
Delton has no idea what he will do when he leaves identified by others in your group.
school. 3 Discuss how these factors may influence other
Nadia’s dad is a solicitor and her mother is a teacher. aspects of their lives, where they live, their range
Nadia is at a very academic school, where most girls of leisure activities, their opportunities for travel,
get good A levels and go on to university. She is very and so on.
good at sport, plays the violin and is in the school
orchestra. She hopes to go to university and study
medicine.
307
Case study: Activity 4: Social roles

Celebrating diversity and expectations
First try to identify the social expectations linked
Karl is a senior member of staff in a residential care
with your role as a student at school or college.
home for adults with disabilities. The residents
Then compare your list with the expectations listed
have grown up in an ethnically mixed community
by others in your group.
and they are from diverse cultural and religious
backgrounds. Now describe your role at your placement or work.
What expectations are associated with your role in
Karl and the other care staff are committed to
the work setting? Present a summary of your ideas
ensuring that all residents and their families feel
to your group.
welcome and that they celebrate and enjoy the
customs and traditions of others who live at the
setting.
1 Explain what is meant by ‘celebrating diversity’.
2 In groups, identify two challenges that may
PLTS
face the care staff in promoting equality and Creative thinker: This activity will help you develop
diversity at the setting. your skills as a creative thinker. You will consider the
3 Discuss ways in which they could ensure that social expectations linked with social roles in important
individual cultural needs are met and diversity areas of your life, as a student and as a future care
is celebrated. worker.
Functional skills
They have missed out on socialisation, the process by English: The activity may also enable you to
which the helpless infant gradually learns the norms demonstrate your speaking, listening and presenting
(beliefs, customs and social expectations) of the skills.
society in which they have been born.
Of course the groups to which we belong will change
Our approach to health and social care issues may be
throughout our lives and our position in those groups
influenced by our socialisation. For example, young
will change. For example, within our family, as the
people who smoke are more likely to live with carers
years pass, we may be the teenager, the married son or
who also smoke, and children are more likely to eat a
daughter, the parent and finally the grandparent.
wide range of foods at nursery (including a variety of
fruit and vegetables) if they are introduced to these Most of us occupy multiple roles, sometimes referred
foods at home. In these kinds of ways, socialisation can to as our ‘role set’, at any one time. You may be a son
influence our levels of health and well-being. or daughter, a student, an employee, a carer and a
member of a youth group. Sometimes the associated
Social roles and expectations role expectations will have competing and conflicting
You may have identified several social institutions or demands. Role conflict is the term used to describe a
groups to which you belong. Membership of a group situation where the demands of our various social roles
brings a range of expectations and obligations. In clash or cause strain.
sociology, these expectations are called social roles.
For example, there are expectations linked with the
social position of being a parent, a son or daughter, or Key term
a student. The generally accepted social role (or social Social role – The social expectations associated with holding
expectations) of parents in our society are that they will a particular position or social status in a society or group.
protect their children, ensure that they are kept safe Role conflict – This exists when the demands of the social
and warm, provide a home, teach them acceptable roles that we are expected to perform are not consistent with
each other, making it difficult and sometimes impossible to
ways of behaving, and ensure that they attend school
meet all demands.
ready to learn.
308
Social control
Reflect
Social control refers to the methods a society uses to
Can you identify role conflict within your own
ensure that its members conform to the expectations
role set, i.e. the range of social roles that you are
expected to perform?
associated with their social roles. It is impossible to
imagine a society without norms and rules to guide
behaviour or ways of dealing with those who are
deviant. Formal methods of social control in our
Case study: society include the police and judicial system, as well
Multiple roles as disciplinary systems in schools, colleges and in
employment. There are also informal social control
strategies, such as excluding people from group
John is a paramedic. His wife, Pat, is a community
midwife and works full time. They have three activities, embarrassing them, ridiculing them and
children aged 10, 11 and 15. John’s elderly gossiping about them. Methods of social control can
mum has arthritis, lives on her own and needs be positive or negative. Positive methods include
considerable support with household jobs. She giving praise and other rewards for conformity;
relies on John and Pat and they want to support negative methods include punishment and other
her. The family are active members of their local
reactions to deviance.
church. John runs the youth club and Pat is the
church secretary. The children all go to the youth
club.
1 Identify the groups to which Pat and John Activity 5: Social control
belong and their positions within those groups. methods
2 Describe the social expectations or social roles
associated with those positions. In groups, identify and briefly explain two formal
and two informal methods of social control used at
3 Discuss how and when the various role
your work placement. Present your ideas to the rest
expectations may cause role conflict.
of your class. Be prepared to take questions at the
end of your presentation.
Nature versus nurture

The nature versus nurture debate centres on
the relative importance of environment and the Functional skills
socialisation process (nurture) in human development,
English: In this activity, you can demonstrate your
compared to the impact of genetic inheritance
English skills by expressing your ideas clearly, listening
(nature). This debate has been particularly important carefully to each other and agreeing the key points to
in: share with the rest of the group.
• education – whether educational achievements
are more influenced by inherited intelligence or by
upbringing?
• crime – whether criminal tendencies are inherited Key terms
or a product of environment? Nature – Those human characteristics that are genetically
• gender – whether observed differences between determined.
the behaviour and achievements of men and Nurture – Those human characteristics that are learned
women are genetically determined or the result of through the process of socialisation.
different opportunities? Social control – The strategies used to ensure that people
conform to the norms of their society or group.
Sociologists tend to give more weight to environment
and socialisation (nurture) when explaining individual
differences. The nature/nurture debate is also
considered in Unit 4.
309
1.2 Principal sociological Talcott Parsons (1902–1979) played a vital role in

the development of functionalism as a sociological
perspectives approach. He saw society as a system made up of
We are now going to look at the key sociological interrelated institutions, which contributed to its
perspectives, or approaches, that have been used to smooth running and continuity. He thought the main
describe and understand societies and the behaviour role of an institution was to socialise individuals and
of individuals within societies. We will then consider ensure that they understood the underlying values of
how these approaches can help explain the impact their society and behaved in acceptable ways. This
of social life on health and well-being. The key terms ensured that there was order in society.
introduced earlier will provide the main vocabulary for
this discussion.
The first two perspectives that we will consider are
Functionalism Marxism Feminism
structuralist approaches. Structuralists are interested
in describing and understanding the main institutions
of societies. In modern industrialised societies, these
include the family, the education system, the health Sociological
services, the economy, the political institutions, Collectivism Interactionism
perspectives
religious groups and the media. Structuralists are
concerned with how these institutions relate to each
other and how they influence and mould individual
behaviour. The two structuralist approaches that New Right Postmodernism
we will discuss are known as functionalism (or the
consensus model) and Marxism (the conflict model). Fig 7.2: Key sociological perspectives
Feminism, considered separately on pages 315–316, is
normally regarded as an example of a conflict model
We can go on to consider the functions of the family
that focuses on the continuing oppression of women in
and how it contributes to the order and stability of
our society.
society, or the social system (a term that functionalists
Functionalism would often use). George Murdock (1897–1985), in
The functionalist approach to sociology can be best his classic 1949 study of the family, examined over
understood by likening society to the human body. 250 societies, ranging from small hunter-gatherer
Just as the body functions through the efficient communities to large industrialised societies, and
interrelationship of major organs (such as the lungs, found some form of the family in all of them.
heart, liver and kidneys) and has mechanisms to deal Murdock claimed that in all societies the family had
with disease, so the different institutions in society four functions:
each have particular contributions to make. They work • The sexual function allowed for the expression of
together, and use methods of social control to deal sexuality in an approved context.
with deviant members or groups, to ensure that society • The reproductive function provided stability for the
functions smoothly. rearing of children.
• Socialisation included the responsibility of teaching
children the acceptable ways of behaving in society.
Key terms
Functionalism – A sociological approach that sees the
• The economic function meant that food, shelter
institutions of society as working in harmony with each and financial security had to be provided for family
other, making specific and clear contributions to the smooth members.
running of society. Talcott Parsons (1951), writing about American society,
Conflict model – A sociological approach first associated argued that the family had two ‘basic and irreducible
with Karl Marx, which sees the institutions of society as being
functions’:
organised to meet the interests of the ruling classes.
• the primary socialisation of children
310
Reproduction
Socialisation and care of
children
Functions of the family
Provision of
Economic
emotional
function
security
Fig 7.3: The functions of the family
• the stabilisation of adult personalities – in a Criticisms of functionalism

complex, stressful and demanding world the family Probably the most fundamental criticism of the
provides warmth and emotional security, especially, functionalist approach is that it does not address
as Parsons saw it, for the male breadwinner. areas of conflict, which certainly characterise
modern societies and in principle could be found
in all societies. Functionalists emphasise consensus
Activity 6: The functionalist and agreement and paint a rather rosy picture of
approach institutions having clear, positive functions and co-
operating effectively for the good of all. However, this
In small groups, consider the social functions of
does not seem to reflect many people’s experience of
one of the following social institutions:
the modern world, where there are often clear winners
• the family
and losers and many non-conformists.
• school or college
Functionalism is based on the idea that in all societies
• work members share some basic values and beliefs – and
• parliament. that this value consensus underpins the socialisation
1 Compare and discuss the range of answers. process and the working of the main institutions.
2 Are you able to agree on the principal functions Researchers have not been able to find that common
of these institutions? values are clearly shared in modern societies.
Key term
Functional skills Value consensus – A general agreement as to the values and
English: This activity will enable you to demonstrate beliefs of a society.
your listening skills and your ability to communicate
clearly in group situations.
311
Functionalists are also very clear that the way we

Activity 7: Is there a common behave is a direct result of the socialisation process
value system? and that very little of our behaviour is the result of
In groups, make a list of the values you think are our personal choices. They believe that we are largely
most important for our society. Then compare ‘programmed’ to behave in particular ways. The
your list with others in your group, and discuss the interactionist model (see pages 316–317) provides an
similarities and differences. alternative to this view.
1 Can you agree a common value system to which
most people would subscribe?
Reflect
2 Do you think we have a common value system
in our society? Do you think we are ‘programmed’ by our
socialisation or do we have some freedom of
choice?
Finally, functionalists tend to present a picture of a

PLTS socialisation process that never fails. They give no clear
Independent enquirer: This activity may enable explanation of deviant behaviour and especially the
you to demonstrate independent enquiry skills by
extreme forms of deviance found in crime, delinquency
using previous learning and experience to evaluate
and abuse, which are destabilising for society as a
information and judge its relevance and value.
whole.
Activity 8: Key sociological approaches
Complete this table as you cover the key sociological approaches in your lessons. The first one has been
completed for you, as an example.
Sociological Key words Key ideas Identify two Identify two
approach strengths weaknesses
Functionalism Structuralism All societies are made Provides Does not address
Function up of key institutions explanations areas of conflict in
Common value (e.g. the family) with for the smooth society.
system functions to perform. running of Does not allow for
These institutions society. free will. We are
ensure the smooth Analyses the role socialised into our
running of society. of key institutions. social roles.
Marxism
Feminism
Interactionism
Collectivism
New Right
Post-
modernism
312
PLTS
Self-manager: This activity will involve ensuring
Key terms
that you complete the table as you learn about the Bourgeoisie – In Marxist theory, the bourgeoisie are the
sociological perspectives. You will need to summarise powerful social class, who own the factories, land and other
your knowledge and express your ideas clearly and capital and are able to organise the economy and other
succinctly. You will also need to be organised about important social institutions to their own advantage.
keeping the table up to date! Capitalist – Another word for a member of the bourgeoisie.
Proletariat – In Marxist theory the proletariat are the
‘working class’, who have only their labour to sell. They work
Marxism for and are exploited by the bourgeoisie.
False consciousness – In Marxist theory, false consciousness
Marxism, as well as being a conflict model, is also a
is the taking on, by the proletariat, of the views and beliefs
structuralist model. This approach was first developed of their class enemy, the bourgeoisie. They do not realise
by Karl Marx (1818–1883). He also thought that that, by working hard, they are serving the interests of the
individual behaviour was shaped by society but he capitalists much more than their own.
believed that the economic system defined society
and people’s place within it. Marx held the view that in
the industrial society of his time there were two social Like functionalists, Marxists have a structuralist
classes: perspective. They see the family as contributing to a
• the bourgeoisie, or capitalists – the small powerful stable social system and would regard the family as
group who owned the factories and other places of the servant of the capitalist system. They believe that
employment it provides the context for the socialisation of children,
• the proletariat – a much larger, poorer group preparing them for the disciplines and routines of
of ‘workers’ (the people or ‘hands’ that the work. Just as children have limited power in the family,
bourgeoisie employed). so people are prepared to be obedient to their bosses
at work as adults. In addition, Marxists see the family
His view was that these two social class groups would
as providing a secure emotional base, a home, from
always be in conflict: the owners of the factories, land
which people will return to work rested and refreshed,
and offices would want high profits; and the employees
ready to make large profits for their employer. As
would want higher wages, which would eat into the
a servant of the capitalists, the ordered family is
profits. This is why Marxism is often called the conflict
necessary for passing on inheritance. Children born
model. He thought that this conflict would lead to
within the nuclear family are the rightful inheritors of
revolution. There was an unequal relationship between
the family’s wealth.
the bourgeoisie and the proletariat and conflict was
inherent in the economic system.
Marxists argue that the ruling class (the bourgeoisie) Reflect
also hold power in the other social institutions and Are there equal opportunities for all? Or do some
they shape the society because they control the mass people have advantages over others?
media and the legal system and it is their ideas that If you think there are inequalities in society, what
influence the curriculum in schools. Through the could be done to reduce them?
socialisation process, it is the values and attitudes
of the ruling class that are passed on, rather than
Criticisms of Marxism
the common value system of the functionalists. This
is so successfully achieved that the majority of the Like functionalists, Marxists believe that individual
proletariat do not realise that they are being exploited behaviour is the direct result of the socialisation
or that they are serving the interests of the bourgeoisie process, with very little individual choice. In the case
rather than their own class. This lack of awareness by of Marxist theorists, however, it is a socialisation that
the proletariat is called false consciousness – and it meets the values and interests of the ruling classes.
is used to explain why the conflicting interests seldom Closely linked with this point is the view that
erupt into actual conflict or revolution. Marxists put too much emphasis on different class
313
interests and potential conflicts of interest. Although

clear inequalities remain, the standard of living in
industrialised societies has improved immensely
over the last 100 years and arguably employers and
employees share some common interests. All will
potentially benefit from a successful company.
Some writers believe that the Marxist model, which
sees the economy as the institution that drives all
others, does not give sufficient emphasis to the power
of other institutions – religion, race and family life – in
moulding our behaviour.
Why do you think so many poor

people lived in dreadful conditions
in British cities in the nineteenth
century?
Case study: Child labour in

the nineteenth century
‘Children of the poorer class worked from a very Activity 9: Structuralist
early age… Conditions in the factories were
bad and the working day was at least 14 hours. approaches
Accidents were common and discipline very
strict. Some factories operated the machines Functionalist sociologists believe that societies
day and night, so that one shift of children used are united by common values that are shared
the beds vacated by the next shift… the work across society and which lead to the smooth
people were often responsible for recruiting and running of that society. This contrasts with the
disciplining juvenile workers.’ Marxist perspective, which holds that societies are
organised and controlled by powerful minority
Source: Clifford Lines (1990) Companion to the groups to meet their own needs.
Industrial Revolution Facts on File Ltd (Oxford)
In groups, consider whether the following groups
1 Which of the two social classes identified or institutions work for the good of all in society or
in the Marxist model are described in this mainly for the successful and powerful groups:
passage?
• schools and colleges
2 Explain why Marx expected that working
• the economy
conditions such as these would lead to
conflict and revolution. • health and social care services.
3 Why might these conditions impact on the Feed back your ideas to the whole class.
health and well-being of these children?
Functional skills
English: This activity will enable you to demonstrate
your listening skills and your ability to communicate
clearly in group discussions and when preparing a
group presentation.
314
Feminism in sociology Activity 10: Feminism in

Feminism is normally seen as an example of a the home
conflict model. There are three main types of feminist
approach: Are these views dated? Who in your family would
• Marxist feminism normally cook the meals, do the washing-up,
• radical feminism vacuum, clean and tidy the house and/or mend
electrical equipment? Are the traditional gender
• liberal feminism.
roles still in place?
Feminists have argued that sociology, as an
Carry out a research activity in your group to test
academic discipline, was developed and dominated
the hypothesis:
by men. Hence the term ‘malestream’ sociology
was introduced. Pamela Abbott and Claire Wallace ‘Women take responsibility for most domestic
(1997) clearly summarised feminist concerns and tasks in the home.’
criticisms of mainstream (or malestream) sociology. Each student in your group should identify two
They argued that this male dominance has produced households with which they are familiar and
biased descriptions and analysis and that not enough identify who normally:
attention has been paid to the issues of women and 1 does the washing
their unequal place in society. 2 does the ironing
3 mends electrical goods
Marxist feminism 4 does the household shopping
Marxist feminists see women, especially working-class 5 cooks the evening meal
women, as oppressed both by capitalism and by men 6 tidies the living room
or the patriarchal society. Women produce the next 7 cleans the cooker
generation of workers. They meet the physical, social 8 does the gardening
and emotional needs of their children so that they are 9 does the vacuuming.
ready to work in the offices and factories of the future.
Analyse your findings and write a brief report
They support their husbands and partners, cook meals,
explaining whether your hypothesis is proven or
care for their children and clean their houses – for not.
no pay! Thus they are dominated by their husbands
and they are also subsidising industry. The family
would not be ready for work if somebody did not take
responsibility for domestic life and this, it is argued, PLTS
remains the primary responsibility of women. Independent enquirer: This activity will enable you
to demonstrate your ability to carry out individual
research, to share your findings, collate your results and
Radical feminism
to present one group report.
For radical feminists, it is not capitalism that dominates
women, but men. The family is seen as a patriarchal
institution. They see the socialisation of women as
housewives and mothers as a form of oppression and
Functional skills
this oppression as a characteristic of nuclear family life. English: Preparing the questionnaire, interviewing your
respondents and discussing the results will develop
your speaking and listening skills, and recording your
conclusions will develop your writing skills.
Mathematics: Mathematical skills will be developed in
analysing your results and justifying your conclusions
with statistics.
ICT: You will have the opportunity to develop your
ICT skills in presenting statistical information and your
conclusions.
315
Liberal feminism
Liberal feminists would argue that changes have taken
place. They believe that, through changing attitudes
and legislation, such as the Equal Pay Act (1970)
and the Sex Discrimination Act (1975), there is more
equality. Liberal feminists believe that improvements
will continue by means of legislation and policy.
Activity 11: Equal rights

for men and women
1 Write a short report in which you identify and
briefly describe the key legislation relating
to sexual equality. Remember to include the
introduction of civil partnerships through the
Civil Partnership Act 2004.
2 Discuss in groups how far changes in the law
can influence attitudes to the position of men
and women in society, both at home and in the
wider community.
3 Summarise your key points and report back to
the rest of the class.
Functional skills How does this photo show that

ICT: To complete this task, you will need to find and many women remain in traditional
domestic roles?
select relevant and up-to-date equality legislation.
English: In discussing how far changes in the law can
influence individual attitudes, you will develop your groups as diverse as teenage gangs, staff, patients and
speaking, listening and presentation skills. visitors on hospital wards or social interaction in school
classrooms. They will study the dynamics within these
groups. For example, they may ask:
Did you know? • How do different members of the group see
themselves?
Despite the Equal Pay Act of 1970, the 2009 Social
• Do some have more power than others?
Trends reported that the average wage for men in
full-time employment was 12 per cent higher than the
average wage for women in full-time work.
Key term
Interactionism Interactionism – A sociological approach that focuses on
Interactionism, or the social action approach, the influence of small groups on our behaviour, rather than
contrasts with the structuralist perspectives in that the power of large institutions. Interactionists believe that
our behaviour is driven by the way we interpret situations
the focus is not on the large institutions and how they
in smaller groups, how we see ourselves in relation to other
function and link with each other. Instead, the focus people in the group, how we see other members and how
is on small groups and how they influence individual they see us.
behaviour and shape society. Interactionists may study
316
• Who are the formal leaders? might have defined or caused the situation. Social
• Are there some informal leaders who actually have action theorists tend to focus on the interactions within
power in the group? the group, rather than these wider issues.
Social action or interactionist theorists do not believe Postmodernism
that we are ‘programmed’ by the socialisation
Postmodernism is an approach to sociology, or
process. They see individuals as being influenced
understanding society, that focuses on the rapid
by the socialisation process but having the power to
change and uncertainty (some would even say chaos)
choose how they will actually behave and create their
in our society. Postmodernists would suggest that we
own roles. These theorists have very little interest in
can no longer talk about established institutions like
social structure as a whole. They see our behaviour as
the family, religion or the economy because nothing
driven by the way we interpret situations, how we see
stays the same. Domestic arrangements are so varied
ourselves and other people and how they see us.
these days that it is no longer possible to talk about
In the family, a mother may understand what is the ‘typical’ family. Postmodernists hold the view
expected of a ‘good’ mother but social action theorists that, because of the constant change, structuralist
think that social roles are not clearly defined. They perspectives like functionalism and Marxism no longer
believe that the mother will interpret what that means help us to understand society. The social institutions
for her in the context of her family, her relationship with have become fragmented. Individuals and groups
her children, and her links with the wider society. There of people now make their own lifestyle decisions,
is no blueprint. For the social action theorist, the main choosing from the many leisure activities and
aim is to understand how people interpret situations consumer goods that are available.
and behave in small-group face-to-face situations.
Reflect Activity 12: Is there a

Try to analyse the social dynamics at work or ‘typical’ family?
on work placement. Are some people more
powerful than others? Do some people have In groups:
power and influence even though they are not 1 Identify and list the different types of family in
managers or supervisors? Do some clients or our society.
customers have more power than others. If so,
can you analyse why? 2 Is there a typical family type in our society?
3 Are the postmodernists right – these days
‘anything goes’?
Criticisms of interactionism 4 Discuss the possible consequences for the
Social action theorists, although they emphasise individual and for society of one change in
family life. You may consider:
individual choice, accept that social roles exist – even
if they are not clearly defined. They do not, however, • Fall in the number of marriages
study where the social roles come from. They are • Introduction of civil partnerships
criticised for paying insufficient attention to issues of • High levels of divorce
power in society. Although they would say that social • Smaller families
roles are only vaguely defined, they do not explain • Higher proportion of lone parent families
where these roles come from and they do not explain
• Increased number of much older relatives
why people largely behave in very predictable ways.
5 Report back to the whole class and compare
In addition, they are sometimes criticised for issues.
describing social behaviour ‘in a vacuum’. They
describe behaviour in delinquent gangs or the
relationship between staff and patients in a hospital
ward but they do not describe the wider social factors
that have influenced this, or the historical factors that
317
Did you know? Squalor Want Disease

(poor housing) (poverty) (ill-health)
In 2006 there were only 237,000 marriages in England
and Wales, the lowest number recorded since 1895.
Beveridge’s
five giant
Collectivism evils
Collectivism is an approach to providing health
and social care services that is underpinned by
a government commitment to provide care and
Ignorance
support for the vulnerable, funded through taxation Idleness
(inadequate
and National Insurance. This contrasts with the New (unemployment)
education)
Right (see page 319), who consider welfare to be the
responsibility of the individual and their family and Fig 7.4: Beveridge’s five giant evils
believe that the state should play a minimal role.
• combating ignorance through the expansion of
Collectivism and the New Right are examples of
secondary education for all
political responses to the role of government in
our society and, for our purposes, their response • eradicating squalor through the building of council
to meeting identified areas of welfare need. In houses
all societies there are groups of people who are • removing idleness by supporting policies of full
potentially vulnerable. These may include children, employment and the development of labour
older people, people with physical impairments and exchanges.
those with mental health needs. In some societies the This placed the provision of key services in the hands
care of these people will be seen as the responsibility of the state, working co-operatively with families and
of the individual or their family; in other societies it will voluntary organisations, and was to be financed by
be seen as the responsibility of religious groups, the taxes and National Insurance.
commune or the local community.
The state has played a role in the care of the
vulnerable in Britain since the passing of the Poor
Law in 1601. However, it was not until the nineteenth
Activity 13: Yesterday’s evils
century that governments took a significant role in today
the support of the vulnerable (many would say this In five groups, design posters to identify services
did not happen until after the Second World War that are in place today which address each of
with the ‘birth of the Welfare State’). The Beveridge Beveridge’s ‘giant evils’:
Report, in 1942, provided the political foundation • Want – Poverty
for a comprehensive range of welfare services. Lord
• Squalor – Poor housing
Beveridge, in his Report on Social Insurance and Allied
• Disease – Ill-health
Services, identified five giant evils that urgently needed
to be challenged. • Idleness – Unemployment
There was cross-party agreement that the state should • Ignorance – Inadequate education.
take collective responsibility for:
• addressing poverty through a wide range of
welfare benefits including Family Allowance,
Unemployment and Sickness Benefit and retirement PLTS
pensions Independent enquirer: This activity may help you
demonstrate your ability to plan and carry out research
• fighting disease through the National Health
and analyse and evaluate information.
Service
318
The New Right the responsibility of the individual and their family.
The post-war collectivist approach to welfare remained The New Right regarded state support as intrusive and
largely in place for over a generation and was not supporting a dependency culture. Mrs Thatcher and
seriously challenged or questioned until the election of her government thought the welfare state produced a
Margaret Thatcher’s Conservative government in 1979. society in which people relied on state benefits rather
The view of this government was that the state should than planning for the future and taking responsibility
play as small a role as possible in welfare provision. for their own needs and those of their families.
They believed that welfare should be largely seen as
Produce an information booklet explaining the status, social roles, diversity, and social class.
principal sociological perspectives: functionalism, You may also find it helpful to refer to your table
Marxism, feminism, interactionism, collectivism, of perspectives (see page 312).
postmodernism and the New Right. Around 150–200 words for each perspective
would be a good guide to length. Provide
Grading tips examples from your personal or placement
P1 To achieve a pass grade, you will need to experience to show your understanding of, for
use the sociological terms introduced at the example, the functions of the family, the place
beginning of the chapter, such as culture, of women in the home or the range of services
values, beliefs, norms, socialisation, social provided by the state in a collectivist society.
2 Understand sociological approaches to health and

social care
2.1 Application of sociological example, to go to school, college or work, and from
meeting normal family obligations
perspectives to health and social • to be cared for.
care Parsons would see it as one of the key functions of
the family to care for the sick and other dependent
The functionalist approach
members of the family group.
The functionalist approach to considering health and
The responsibilities of the sick role included the
illness derives from the work of Talcott Parsons. Using
individual:
the traditional functionalist approach, he described
how, for society to function efficiently, its members • taking all reasonable steps to get better and
need to be healthy. He described illness as a form seeking to resume their normal place in society as
of deviance and ill members as performing a form of soon as possible
social role – the sick role. This became a very powerful • co-operating with medical professionals, particularly
concept in the sociology of illness. In his view, if doctors and their staff.
people declared themselves ill, specific rights and The functionalist view (and the view of most
responsibilities came with their new role. governments) is that illness has social consequences.
The rights associated with the sick role were: The ill are not normally at work and they may need
• to be exempt from normal social obligations, for to be cared for, and this must, whenever possible, be
swiftly dealt with, in order for society to run smoothly.
319
The Marxist approach the patient be signed off work or not? How far
should someone’s bad back limit their daily activities?
Marxist approaches believe that the definitions of
health and illness, and the health and social care • the impact on people’s self-image and on their
services provided, serve the interests of the more relationships if they are labelled as ‘ill’.
powerful dominant social classes. Doctors are seen Interactionists, in studying the sociology of health and
as agents who ensure that people go back to work illness, do not look at structures and institutions but
as soon as possible, working in the interests of the study the complex relationships between people, their
employers rather than those of the patient. Their family and friends and their links with the professional
job is to provide the company owner with a healthy services. They think that these relationships have as
workforce. In addition, the government allows much influence as any medical diagnosis on whether or
companies to make profits from products that cause not people declare themselves to be ill.
ill-health, such as tobacco and junk food. Firms and Critics of the interactionist approach say that,
factories continue to produce toxic waste and large in concentrating on these relationships and the
cars pollute the atmosphere. negotiations that take place, it ignores the ‘real’ causes
Unlike the functionalists, who regard ill-health as of ill-health. These include medical explanations and
something that occurs almost randomly, conflict environmental factors such as pollution, stress and
theorists see levels of illness as being related to poverty.
differences in social class. For example, there is a
higher level of illness and lower life expectancy in areas The feminist approach
of poverty, high unemployment and environmental Feminist writers have focused on male domination
pollution. The government does not do enough to in the medical professions and its impact on women.
tackle the issues that lead to illness, as this costs They have been particularly concerned with the
money, which would have to be found by the most way in which pregnancy and childbirth have been
advantaged in society. regarded as medical issues (even sometimes as
illnesses), rather than as natural processes. Feminist
writers also comment on the way in which the
Reflect medical profession and the related pharmaceutical
Why do you think there is more illness in areas of industries have given relatively low priority to the
poverty and high unemployment? development and promotion of the male contraceptive
pill (which arguably has fewer harmful side-effects
than the contraceptive methods used by women).
The interactionist or social action In considering issues of mental health, anxiety and
approach depression, and the fact that relatively higher numbers
Interactionism is probably the theoretical approach of women suffer from these conditions, feminists would
that has devoted the most attention to issues of health see this partly as a result of their exploited position
and illness. It is concerned with: in society and especially in the family. These issues
• the processes that lead a person to define are, however, defined as a medical problem, for which
themselves as ill – people with the same ‘complaint’ medicines are a solution. This shifts attention away
vary as to whether they will call themselves ill from the fact that a woman’s day-to-day circumstances
and certainly vary as to whether they will seek may be the cause of stress.
professional help. Some people with very serious Marxist and other socialist feminists have been more
illnesses do not regard themselves as ill. concerned with the impact of social inequalities on
• the interaction between the professional and the women’s health. In What Makes Women Sick? Lesley
patient in agreeing how ill they are. Although they Doyal (1995) particularly highlights the increasingly
understand that there are sometimes quite clear dual role of women, or the ‘double day’ as she calls it:
diagnoses, interactionists are interested in the women often have full-time jobs outside the home and
negotiation that takes place with the professional in then also take most of the responsibility for domestic
trying to agree on the impact of the illness. Should life.
320
2.2 Understanding different they will also want to carry out a holistic assessment,
recognising the importance of the young woman’s
concepts of health and ill- wider needs when providing their specialist care.
health
Concepts of health Key term
It will come as no surprise that sociologists have great Holistic assessment – An approach to care that addresses
difficulty in agreeing on a definition of what it means to the individual’s physical, social, emotional and spiritual
be healthy. Health can be defined in negative terms, health, attempting to meet the needs of the ‘whole’ person.
as ‘the absence of disease’. This is contrasted with a
positive definition such as that provided by the World
Health Organization (WHO) in 1974: ‘not merely an
absence of disease, but a state of complete physical, Intellectual Spiritual Social
mental, spiritual and social well-being’. health health health
A negative concept of health (as the absence of
disease) is therefore opposed to a positive concept
of health as being concerned with people’s physical,
intellectual, social and emotional well-being.
In the health and social care sectors, care professionals
usually adopt a holistic approach to care and support.
They see their role as addressing the needs of the
‘whole’ person, rather than single issues or identified
problems.
Activity 14: Who is Holistic approach

healthy? to care
1 In groups try to agree a definition of ‘good
health’. Then compare your definition with those
of other groups in your class
Emotional Mental Physical
2 Think of someone you regard as being very health health health
healthy. What makes you think that they are
healthy? Do they fit your definition of ‘good Fig 7.5: A holistic approach to care
health’?
Mildred Blaxter (1990) interviewed almost 10,000

people in her large-scale study, Health and Lifestyles.
PLTS She identified three strands to people’s understanding
Self-manager: This activity will require you to agree of health and well-being:
the key points to share with the rest of the group.
• a positive definition, regarding health as feeling fit
and well
• a negative definition, regarding health as being free
A person with complex needs, such as a young
from pain or discomfort
mother with multiple sclerosis, may be supported by
a range of professionals. These would include a GP, a • a functional definition, regarding health in terms
community nurse, an occupational therapist, a social of being able to perform certain, often day-to-day,
worker and a health visitor, often referred to as a multi- tasks.
disciplinary team. They will each have their particular Defining health, then, is not easy and there is certainly
roles and responsibilities for her care and support but no clear agreement on it among scholars.
321
In fact, most sociological research concerned with in our society. Research indicates that life expectancy
studying and comparing levels of health within and rose and death rates began to fall, especially infant
between societies actually focuses on issues of ill- mortality rates, with improvements in sanitation and
health. For example, sociologists use a great deal of the provision of clean water, the building of new
information about death rates, visits to GPs’ surgeries, council houses and generally improved standards
incidence of serious diseases, admissions to mental of living during the late-nineteenth/early-twentieth
health units and suicide statistics. This data is often centuries. This was long before 1948 and the
analysed by social class, occupation, ethnicity, gender, introduction of universal free personal health care
age and geographical location. through the NHS. This sort of evidence supports the
This type of information can be measured statistically view that environmental and social conditions are a
and is generally clearly defined. It is much more significant source of disease, and the causes of ill-
difficult to measure the positive indicators of health health are not solely located in the individual.
(people’s physical, intellectual, social and emotional The socio-medical model sits more easily with the
well-being), as in the WHO definition on page 321. conflict theorists than the functionalists. The conflict
theorist would explain the shorter life expectancy and
Models of health the relatively higher rates of ill-health among the poor
Biomedical model as consequences of the inequalities in society and the
The model of health that has dominated Western life circumstances of the disadvantaged. The poor,
industrialised societies, certainly since the industrial they would say, are more likely to have an inadequate
revolution of the mid-nineteenth century, has been diet and live in damp houses, often in inner-city areas
the biomedical model. This view of health underpins where unemployment and environmental pollution
the policies and practice of the National Health tend to have the most impact. The ruling groups in
Service (NHS). According to this model, health is society, the politicians and the owners of industries,
largely regarded as being the absence of disease, and are not willing, they would say, to make the changes
the intervention of health professionals is necessary needed to protect the poor from ill-health and disease.
in times of illness. The main purpose of the health The biomedical model of health has a clear focus on
services is to cure disease, and health professionals will individual diagnosed illness, and the socio-medical
use scientifically tested methods to address diagnosed model is concerned with the environmental causes
illnesses. Sociologists believe that the focus on the of illness. They can be seen as two complementary
individual patient for whom a cure should be found approaches to the study of health and illness.
is a limitation of this model. Little regard is paid to
environmental and social factors that may have led
to ill-health. The causes of illness may be many and Activity 15: Social factors
varied, but the biomedical approach tends to focus on
the individual while largely ignoring the environmental
linked with poor health
factors that might cause disease. Draw a spidergram or similar diagram that
summarises the range of social and environmental
The biomedical model fits well with the functionalist
factors that may lead to ill-health.
perspective discussed earlier (on page 317), in which
illness is regarded as in itself dysfunctional for society.
If people are ill they cannot make their normal
contribution to the smooth running of society. For
Key terms
the functionalist, if people adopt the sick role and are
Biomedical model – An approach to health and illness that
exempt from their usual social responsibilities, they identifies health as ‘the absence of disease’ and focuses on
also have a responsibility to co-operate with health diagnosing and curing individuals with specific illnesses.
professionals and take all reasonable steps to get better. Socio-medical model – An approach to health and illness
that focuses on the social and environmental factors that
Socio-medical model
influence our health and well-being, including the impact of
The socio-medical model of health focuses on the poverty, poor housing, diet and pollution.
social factors that contribute to health and well-being
322
Case study: Life expectancy

The Child Poverty Action Group reports that life per 1,000 live births. This is 20 per cent higher
expectancy at birth varies significantly according to than the average 4.9 per 1,000.
social class, with professional men expecting to live
Source: Child Poverty Action Group
to around 80 years and unskilled manual men to 72.7
Facts and Figures
years. For women, the figures are 85.1 and 78.1 years
www.cpag.org.uk/povertyfacts
respectively.
1 In three groups explain why levels of the following
Poorer children on average experience poorer health vary by social class:
during their childhoods and the effects of this last
throughout their lives. Three-year-olds in households • life expectancy
with incomes below about £10,000 are 2.5 times • health and well-being
more likely to suffer chronic illness than children in • infant mortality rates.
households with incomes above £52,000. Be prepared to feed back your views to the rest of
The risk of infant mortality is higher for poor children. your class.
In the lower social group (routine and manual 2 Discuss the view that this evidence supports the
occupations) infant mortality is 5.9 infant deaths socio-medical model of health.
Aziz and Tamsela have four young children. Tamsela’s Grading tips
elderly parents live with them. Their three-bedroomed
house is in a deprived and rather depressing area of P2 • If using examples from placements or others
London. Their house is in a poor state of repair; it is known to you, respect the confidentiality of
damp and very expensive to keep warm in the winter. individuals and their contexts.
Neither Aziz nor Tamsela is currently in paid work. • You should apply the perspectives
The family is in poor health. In the winter the children introduced in Assessment Activity 7.1
seem to have permanent colds. Tamsela suffers when explaining the different sociological
from asthma and her father has bronchitis. Tamsela’s approaches.
mother is depressed and has been prescribed drugs • Include an explanation of different concepts
for this condition. of health and different definitions of health
Write an essay of 800–1000 words that explains and illness in the essay.
different sociological approaches to health and M1 • To assess the two models of health, you will
ill‑health P2 and include in the essay an assessment need to weigh up the relative strengths and
of both the biomedical and socio-medical models of weaknesses of each when considering health
health M1 . Use the case study of Azis and Tamsela and illness.
and/or other examples from those known to you
• Apply a range of sociological perspectives
or from placements to illustrate points you make in
when comparing the two models of health
the essay.
as part of the assessment of each.
• Consider the extent to which each model
takes into account any environmental and
social issues that should be considered
when assessing the needs of individuals in
health and social care.
323
Concepts of ill-health Activity 17: The enabling

Disability and impairment environment
The related ideas of disability and impairment are
very closely linked to the medical and social models Write a short report describing:
of health. Like many of the other sociological terms • either how accessible your college is for people
introduced in this unit, the words ‘disability’ and who are wheelchair users
‘impairment’ can be used in different ways, and the • or how easy it is for wheelchair users to do their
term ‘disability’ is not easy to define. It is important shopping in your local high street.
that you are absolutely clear on how you are using In your opinion are these enabling environments?
these terms when considering the issues. Tom
Shakespeare (1998) formalised a helpful distinction
between disability and impairment.
Impairment focuses on the individual and refers to
the day-to-day restrictions that may arise because of Case study: Impairment
a long-term physical or mental condition, such as the and disability
loss of a limb, a sensory impairment or depression.
This has similarities to the biomedical model of health Mohammed is 45 years old and has multiple
sclerosis. He needs considerable help with daily
and illness. From this point of view, the patient would
living activities. He is a wheelchair user and he
need to co-operate with the health and social care is unable to leave his house without a carer.
professionals to limit the restrictions caused by the Mohammed lives alone, he speaks very little
impairment. They will have similar social obligations to English and he feels socially very isolated.
a person in the ‘sick role’ discussed earlier. Mohammed has recently been assessed by the
Disability, in contrast, is seen by Tom Shakespeare as local social services department for a range of
a problem that arises when a society does not take community care services. He is going to receive a
direct payment so that he can choose his own care
into account the needs of people with impairments.
provider and he will be able to pay them directly.
For example, there may be no ramps into buildings, He is quite confused by this arrangement and does
and doorways may be too narrow for people who not know where to go for help.
use wheelchairs. A person with a hearing impairment 1 Explain what is meant by the terms
may only be disabled if they do not have access ‘impairment’ and ‘disability’ in this context.
to a hearing aid or have not been taught to lip- 2 Briefly discuss the view that Mohammed lives in
read. Disability, from this point of view, is seen as a disabling environment.
a restriction on the opportunity to take part in the
3 Evaluate the usefulness of the distinction
normal life of the community because of physical, between impairment and disability.
social or attitudinal barriers. In this context writers will
sometimes refer to the disabling environment – an
environment where facilities are not in place to ensure
that people with impairments can take full part in a
social life; this is a social model of disability.
Key terms
Disability – Sociologists will often refer to disability as the restrictions that arise for a person with an impairment because of the
attitudes and the lack of appropriate services and facilities to meet their needs.
Impairment – The restrictions on day-to-day activity caused by a physical or mental dysfunction or abnormality, such as the loss
of a limb, a sensory impairment or a learning difficulty such as Down’s syndrome.
Disabling environment – A social context where adaptions and other facilities are not in place to ensure that people with
impairments can take a full part in social life.
324
Nurse practitioner
Yasmin is the nurse practitioner

at a busy GP’s surgery in a northern town. The
practice has a lot of elderly patients and Yasmin runs regular
‘well man’ and ‘well woman’ clinics for the over-sixties. Among
the couples who come to her clinics are the Tattons and the
Bensons, and she has got to know them quite well over the years.
Mr and Mrs Tatton both worked as solicitors and had a very good
income all their working lives. They were able to save and now
have a very good occupational pension. They have a beautiful
home by the sea, and they play tennis and golf all year.
They go on holiday abroad most winters and have
their grandchildren to stay every summer.
They just don’t seem to age, and hardly ever come to the surgery
for treatment. Their daughter Sally married John Benson, the Bensons’
eldest son, and John and Sally settled down in London.
The Bensons have lived very different lives. Mr Benson was a miner and was made
redundant in the 1970s. He managed to get other work but the jobs were all poorly paid. He
now has to rely on his state pension. Mrs Benson has worked part-time all her life in unskilled
jobs. She doesn’t have a works pension and she never paid into the state pension scheme.
They still live in the three-bedroomed council house they moved into when they got married.
It is damp and difficult to heat. In the winter they have to choose between eating well and
keeping warm. They do manage to get away for a week in the summer but they have
never been on holiday abroad. Some would say that they are rather proud and will
not accept financial help from their grown-up children. Mr Benson has angina
and Mrs Benson has suffered from asthma for about ten years. They
both attend the surgery frequently so Yasmin tends to see
them every few weeks.
Think about it!

1 List the factors that might contribute to and detract from the health and well-being of the
Tattons and the Bensons.
2 What services will be available to each couple in their later lives?
3 Are there additional services that might be available to the Tattons?
4 How have changes in the family made it more difficult for children to look after their ageing
parents? What are the implications for families, social services and government finances?
5 There is evidence that people in socio-economic class 1 have a greater life expectancy
than those in socio-economic class 8. Using the Internet or other sources, check the current
statistics for life expectancy by socio-economic class.
6 Which factors mentioned in the case study could indicate that the life expectancy of the
two couples might be different?
325
2.3 Understanding patterns analysed by sex, age, geographical location or social

class. Are mortality and morbidity rates higher in some
and trends in health and parts of the country than in others? Is there a difference
illness among different social in mortality and morbidity between social classes?
Specific morbidity rates may be measured in terms
groupings of the prevalence of a disease. Disease prevalence
Measuring health is the total number of cases of a specific disease in a
population during a specified period of time. Disease
Statistical trends in the levels of health and illness are
incidence is the number of new cases of a specific
generated from three main sources:
disease occurring in a population during a specified
1 Government statistics period of time.
The Office of National Statistics (ONS) provides Mortality rates, especially infant mortality rates, are
current data on a wide range of health and often used as an indicator of the health and well-being
care issues. Publications include Social Trends, of the population as a whole. If they are higher or
Population Trends and, for more detailed rising in a particular location, or among a particular
information on health issues, Health Statistical social group compared to others, this is seen as a sign
Quarterly. These publications (available in hard that levels of general health and well-being may be
copy and electronically) provide a wide range declining within those groups and that the causes of
of statistics on birth rates and death rates, this may lie in their social and economic environment
infant mortality rate and suicide rates, as well – perhaps inadequacies in a range of social and
as appointments at GPs’ surgeries and hospital economic services and higher levels of poverty and
admissions, and these are often analysed by social economic hardship.
class, gender, geographical location and age.
Mortality rates are collected from the official and
2 Charitable organisations and pressure groups required registration of deaths, and the causes of
Many charitable groups and special interest groups death from the legally required death certificates.
also collect and publish statistical and other Information on morbidity rates is drawn from a
information which informs the discussion on issues wide range of sources including GP and hospital
of health and illness. For example, Mind appointments, hospital admissions and the registration
(www.mind.org.uk) and YoungMinds (www. of notifiable diseases (certain infectious diseases).
youngminds.org.uk) are charities that support There have also been more general studies measuring
people and young people with mental health levels of ill-health. These studies are not related to
needs, and www.youreable.com (formerly www.
disabilitynet.co.uk) is a website that provides a
disability-related news service on the Internet.
All provide ongoing and up-to-date information
relating to their areas of concern. Key terms
Infant mortality rate – The number of deaths occurring in
3 Academic researchers and other authors
infants under one year old per 1000 live births.
Largely based in universities, researchers and
Mortality rate – The number of people who have died in the
authors also contribute to the evidence and debate population in a given year. The crude death rate is expressed
on a wide range of health and social care issues. as the number of deaths in a year per 1000 of the population.
Throughout this book you will find references to Morbidity rate – This refers to the number of people who
evidence drawn from all these sources. have a particular illness during a given period, normally a
year.
Government statistics not only include mortality rates Disease prevalence – The total number of cases of a specific
(death rates) in the population but also the morbidity disease in a population during a specified period of time.
rates, the number of people who have particular Disease incidence – The number of new cases of a specific
diseases during a specified period, usually a year. disease occurring in a population during a specified period
These trends will be compared over periods of time. of time.
Have rates increased or decreased? They may be
326
a specific condition; instead they use self-reported Similarly the reasons for death (as recorded on death
measures of health, which ask people to describe or certificates) may not always be accurate or reflect the
rank on a scale of 1 to 10 how healthy they feel. ‘real’ causes of death. The cause of death of a street
person dying in freezing conditions may be stated as
Difficulties in measuring health ‘hypothermia’ but it could be argued that the ‘real’
When referring to statistics and using them in your cause of death was years of malnutrition, substance
work, it is always important to quote the source of abuse and inadequate or no housing. A person with
the data. Were they collected by a particular group AIDS may die of liver failure but it is probably AIDS
in order to persuade and gather support? Should that gave rise to the liver condition. The cause of
you also consult data from an organisation with an death recorded on the death certificate will depend
opposing view? Was the information published in a on the doctor’s interpretation of the symptoms.
newspaper to satisfy the views and prejudices of their Sometimes the doctor may record a condition that
readers? Does the newspaper support a particular is one of a number of contributory reasons, but they
political party? Statistics must be treated with caution! choose the one that will cause least distress to the
relatives of the deceased. Statistics drawn from death
Furthermore, statistics gathered from official sources
certificates therefore need to be used with care and an
may not provide an accurate picture of patterns of
understanding of their limitations.
health and illness. For example, some people who
are ill may not go to the doctor; and conversely some Social class and patterns of health
people who visit the doctor may not really be ill. and illness
Two doctors presented with similar symptoms may Although official statistics must be treated with
suggest different diagnoses. For example, a patient caution, there is overwhelming evidence that health,
describing persistent fatigue with no interest in life ill-health and life expectancy vary according to
and no energy may be described by one doctor as social group and especially according to social class.
depressed, while another doctor may diagnose ME Members of the higher social classes are living longer
or post-viral fatigue syndrome. Another doctor might and enjoying better health than members of the lower
decide that they are a malingerer who simply does not social groups. The most influential modern studies
want to go to work. This would certainly distort the that consider the reasons for this difference are The
official figures of the number of people with a specific Black Report (Townsend et al, 1980) followed by The
illness. Acheson Report (1998). They provide detailed and
Ken Browne (2006) provided a useful framework to comprehensive explanations of the relationships
explain this problem: between social and environmental factors and health,
‘For people to be labelled “sick” – and also to be illness and life expectancy.
recorded as a health statistic – there are at least four In fact, the findings of The Black Report exposed
stages involved: such vast differences in the levels of health and illness
• Stage 1: Individuals must first realise that they have between different social classes that the government
a problem. of the time suppressed its publication. A small
number of duplicated copies were circulated and
• Stage 2: They must then define their problem as
made available just before an August Bank Holiday
serious enough to go to the doctor.
weekend, when they would expect to get very little
• Stage 3: They must then actually go to the doctor. press coverage. Nevertheless, this study has been
• Stage 4: The doctor must then be persuaded that extremely influential and the explanations offered in
they have a medical or mental condition capable of it are still used by sociologists today when examining
being labelled as an illness requiring treatment.’ and considering these issues.
Official statistics on levels of illness are sometimes The Black Report considered four types of explanation
described as ‘the clinical iceberg’ because it is thought that might account for the differences in levels of
that the ‘true’ levels of illness are largely concealed. illness and life expectancy experienced by different
This is because, for a wide range of reasons, people social classes. The researchers were persuaded that
who are ill do not necessarily visit their doctor. the differences in health and well-being were an effect
327
of the level of people’s income, the quality of their bronchitis and diabetes. However, the fact is that many
housing and the environment in which they lived and people in economically deprived circumstances use
worked. smoking and alcohol to help them cope with their
The four possible sociological explanations were: difficult circumstances. It is their difficult circumstances
that lead to their lifestyle choices – not the other way
1 the statistical artefact explanation
round.
2 natural or social selection
Material or structural explanations
3 cultural or behavioural explanations
Material explanations claim that those social groups
4 material or structural explanations.
for whom life expectancy is shorter, and for whom
The statistical artefact explanation infant mortality rates are higher, suffer poorer health
Here the researchers working on The Black Report than other groups because of inequalities in wealth
suggested that the differences could be explained and income. Poverty and persistently low incomes are
by the fact that the statistics themselves produced a associated with poorer diets, poor housing in poor
biased picture. They argued that the people in the
lowest social classes had a higher proportion of older
people and people working in traditional and more Why do you think people’s lifestyle
dangerous industries and so it would be expected that choices, such as the amount of
exercise they take, can have such a
they would have higher levels of illness than the more dramatic impact on their health?
prosperous, younger people working in offices, call
centres and other service industries. This explanation
suggests that it is not really social class but the age
structure and patterns of employment of people
in the lowest social classes that really explain the
differences. However, more recent studies have shown
that, even when the researchers account for this bias
in employment and age, they still find a link between
low social class and high levels of illness, and lower life
expectancy.
Natural or social selection

This explanation suggests that it is not low social class
and the associated low wages, poverty and poorer
housing that cause illness, higher infant mortality rates
and lower life expectancy for adults – it is, in fact,
the other way round. People are in the lower classes
because of their poor health, absenteeism and lack
of energy needed for success and promotion. This
explanation has been rejected by sociologists because
there is evidence to show that ill-health is caused by
the deprived circumstances rather than causing it.
Cultural or behavioural explanations

This explanation focuses on the behaviour and lifestyle
choices of people in the lower social classes. There
was evidence that people in the lower social classes
smoked more, drank more heavily, were more likely
to eat junk food and take insufficient exercise. Their
poor lifestyle choices were linked to a range of chronic
illnesses including heart disease, some forms of cancer,
328
environments, and more dangerous and insecure • the impact of the female role, especially in the
employment. It is these inequalities and the associated family.
deprivation that lead to the differences in health and
well-being – an explanation that can be traced back to
Prevalence1 of cardiovascular disease in adults 35

the work of Marx and Engels in the nineteenth century.
The writers of The Black Report (Townsend et al, 1980) Top
p
and over: by income group (England)

presented very persuasive evidence to support the
materialist explanation. Shaw et al (1999) completed Males
Ma
4th Females
Fem
a major review of all the research in this area and
concluded that the major factors that contributed
to these differences in health and illness were social
3rd
d
factors. Put simply, a consequence of poverty in a
community is poor health and lower life expectancy.
Gender and patterns of health and illness 2nd

d
Although women’s life expectancy is higher than that

of men (with women in our society typically living Bottom
some five years longer than men and with the infant
mortality rates for boys being persistently higher than
0 5 10 15 20
2 25
those for baby girls), studies consistently report higher Percentage (%)
levels of illness for women than for men. The social 1 Equivalised household income has been used to rank the
factors that contribute to these differences can be households into five groups of equal size. The bottom fifth,
or bottom quintile group, is then the 20 per cent of households
identified as: with the lowest incomes.
• risk factors Fig 7.7: Prevalence of cardiovascular disease by household
• economic inequalities income and sex, Social Trends (2006)
Projections2
100
Expectation of life1 at birth: by sex (UK, years)
80
60
40
20
Females
Males
0
1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011 2021
1
Expectation of life. The average number of years a new-born baby would survive if he or she experienced age specific mortality rates for
that time period throughout his or her life.
2
2006 based projections for 2007–2021.
Fig 7.6: Expectation of life at birth by sex, Social Trends (2006)
329
Risk factors women may be linked with the dull repetitive nature
The higher death rate for men can be linked with of this work. Popay and Bartley (1989), studying the
the higher levels of cigarette smoking and drinking hours spent on domestic labour in 1700 households
by men, and their participation in more risky and in London, found that women spent up to 87 hours
dangerous sports and other activities. The relatively per week on housework and that women with children
high death rate of young men between 17 and 24 spent 64 hours per week even if they had a full-time
is specifically linked with this risk-taking and the job. Often women will be managing on a limited
associated deaths from road accidents. budget, working long hours, and will have little time
to themselves. Nevertheless, it may be that the higher
Economic inequalities
rates of diagnosed stress-related illness for women are
Despite changes in the law, women still earn less due to their willingness to discuss mental health issues
than men. In a recent survey by the Higher Education with their doctor, rather than them actually having a
Statistics Agency, women who have degrees, for higher rate of stress-related illnesses.
example are paid, on average, less than men. Men
earn £1,000 more than their female college classmates Did you know?
within three years of leaving university. They are much
more likely to go straight into high paid jobs with In England and Wales suicide rates for men aged 25
40 per cent of men earning over £25,000 a year and over are three times higher than the suicide rates
for women. Source: Social Trends (2009)
compared with 26% of women three years after
graduating.
A higher proportion of women than men are in low-paid
Ethnicity and patterns of health and illness
part-time work. They are also far more likely to be the Evidence for a link between race (or ethnicity) and
main carer in a lone-parent family and are more likely to illness is difficult to study systematically because
be on means-tested state benefits. In older age they are there are difficulties in defining a person’s racial type,
more likely to be in poverty because they are less likely particularly in the context of the increasing numbers
to have an employer’s pension and may not, because of of people who are of mixed race. In addition, a high
family responsibilities, have a full state pension either. As proportion of people from minority ethnic groups
discussed earlier in the unit, there are clear and direct live in areas of deprivation in inner-city areas with
links between poverty and poor health. associated poor housing, pollution and relatively high
unemployment. It is therefore difficult to know whether
Impact of the female role the poorer health is due to poverty or ethnicity.
Women still take responsibility for housework in most Nevertheless, compared to the white majority ethnic
homes, and the higher incidence of depression in group, there is evidence that:
Fig 7.8: Unemployment rates of men

by ethnic group, Social Trends (2006)
Unemployment rates of men: by ethnic
Black Caribbean
Black African
group, 2004 (Great Britain)
Bangladeshi
Mixed
Pakistani
Chinese
e
Indian
White Irish
White British
0 4 8 12 16
Percentages
Source: Annual Population Survey, Office for National Statistics
330
• there is a higher incidence of rickets in children from there are higher levels of illness among the older
the Asian sub-continent because of a deficiency of population and particularly those people over the
vitamin D age of 75. During a three-month period in 2003, 24
• most minority ethnic groups have a shorter life per cent of people over the age of 75 had attended
expectancy the casualty or out-patient department of a hospital,
compared with 14 per cent of people of all ages
• most minority ethnic groups have higher infant
(General Household Survey 2003). The Alzheimer’s
mortality rates.
Society in 2007 estimated that one in 20 people over
In addition to the health implications of higher levels
65 and one in five people over the age of 80 suffered
of poverty, there are issues of access to the health
from dementia.
services. Language problems and other cultural
barriers may limit full use of the health services. Asian Locality and health and illness
women are often reluctant to see a male doctor, There are also regional variations in patterns of health
many of them speak little English and, despite and illness. Mortality and morbidity rates vary in
improvements, translators are in short supply and different parts of the country and also within towns and
much important information is not translated into cities in the UK. It is probably no surprise to learn that
minority languages. In addition, racism, or the fear it is in the poorer regions and the poorer parts of cities
of racism, is stressful. Unless health and social care that higher levels of illness are recorded.
workers understand the religious and cultural beliefs For example, research has shown that there are
and practices of minority ethnic groups, their care regional trends in the incidence of lung cancer across
needs are unlikely to be fully met, leaving them the UK. Within England, the rates for lung cancer are
vulnerable to higher levels of ill-health. higher than average in the north-west, northern and
Age and patterns of health and illness Yorkshire regions and below average in the south-
western, southern and eastern regions.
Many people over retirement age are fit, healthy and
making valuable contributions to our society through
paid work, voluntary activities, and caring for their
Reflect
families. In fact, the 2001 census revealed that 342,032 Can you think of reasons why these regional
people aged 65 and over provided 50 hours or more differences in health and well-being might exist?
unpaid care per week. However, it is also true that
You have been asked by your employer to investigate Grading tips

which social groupings are most in need of health and
To achieve P3 , you will need to explain the
social care services. In order to assist in the planning
of care provision, write a report or an extended essay different patterns and trends in health and illness
that will: in social groupings identified according to factors
such as gender, social class, geographical location,
1 explain patterns and trends in health and illness
ethnicity and age.
among different social groups
2 discuss patterns and trends of health and illness To illustrate your answers you may, for example,
using sociological perspectives consider differences in life expectancy, morbidity
and mortality rates, incidence of disease and
3 evaluate different sociological explanations for
suicide rates, and suggest reasons for these
patterns and trends in health and illness in two
different social groups. differences.
You will need to refer to statistical data from a
range of sources to explain the patterns of health
continued on page 332
331
and illness in the range of different social groups. both of your chosen social groups, the quality
When quoting statistics, make sure that you clearly of the evidence for the differences in health
identify and reference reliable and up-to-date and well-being. You will need to consider the
sources for your data. strengths and weaknesses of the evidence and
To achieve M2 , you may develop material used come to your own conclusion. For example, you
in your response to P3 . You need to use the could ask: ‘Is there sufficient reliable evidence to
language and tools of sociology to examine suggest that there is a difference in the health
trends in health and illness in two different and well-being of people in higher social classes
social groups. Make sure that you plan your as compared with the lower social classes or
work carefully. You are not required to apply all between men and women?’ and ‘Is there sufficient
sociological perspectives to each group. That evidence to claim that infant mortality rates vary
would be a textbook in itself! between countries and different social classes?’
When examining the patterns of health and illness Having weighed up the evidence, you may
you may consider, for example, the difficulties present your evaluation as a final section to the
involved in defining health and issues relating work presented for M2 . You will not yet have
to the reliability of statistical data. Introduce the all the evidence required to reach a definitive
sociological approaches as they are relevant to conclusion. Further research is always needed.
the groups you have chosen. However, you have to make a judgement and
come to a conclusion based on the evidence you
To achieve D1 , you will need to evaluate, for have found.
332
Resources and further Shakespeare, T. (1998) The Disability Reader: Social

Science Perspectives London: Casssell
reading Shaw, M., Dorling, G. & Davey, G. (1999) The
Widening Gap Bristol: Policy Press
Abbott, P. & Wallace, C. (1997) An Introduction
Singh, J.A. & Zingg, R.N. (1942) Wolf-children and
to Sociology: Feminist Perspectives, second ed.
the Feral Man New York: Harper
London: Routledge
Acheson, D. (1998) Independent Inquiry into
Townroe, C. & Yates, G. (1995) Sociology, 3rd ed.
Inequalities in Health London: HMSO
Harlow: Longman
Blaxter, M. (1990) Health and Lifestyles London:
Townsend, P., Davidson, N. & Whitehead, M.
Routledge
(1980) Inequalities in Health: The Black Report
Browne, K. (2006) Introducing Sociology for AS
Level Cambridge: Polity Press
World Health Organization (1974) Alma-Ata
Doyal, L. (1995) What Makes Women Sick? London:
Declaration
Macmillan
Engels, F. (1845) The Conditions of the Working
Class in England London: Panther Books
Illich, I. (1976) Limits to Medicine Marion Boyars:
Useful websites
London Age Concern www.age.org.uk
Lines, Clifford (1990) Companion to the Industrial Alzheimer’s Society
Revolution Facts on File Ltd: Oxford www.alzheimers.org.uk
Murdock, G.P. (1949) Social Structure New York: disabilitynet www.youreable.com
Macmillan Equality and Human Rights Commission
Oliver, M. (1990) The Politics of Disablement www.equalityhumanrights.com
London: Macmillan General Household Survey
Parsons, T. (1951) The Social System New York: The www.statistics.gov.uk/ssd/surveys/general_
Free Press household_survey.asp
Popay, J. & Bartley, M. (1989) ‘Conditions of labour King’s Fund www.kingsfund.org.uk
and women’s health’, in C. Martin and D. McQueen
Readings for a New Public Health Edinburgh:
Edinburgh University Press
333
Just checking
1 Define the following key terms: socialisation, culture, norms, ethnicity, social role and social class.
2 Provide a definition for the following sociological perspectives: functionalism, Marxism, feminism,
postmodernism, interactionism, collectivism and the New Right.
3 Explain the following concepts of health: negative concept, positive concept and the holistic
concepts of health.
4 Explain the biomedical model of health and the socio-medical model of health.
5 Identify and give examples of three main sources of statistical information about trends in health
and illness.
6 Why may statistical evidence be unreliable as a measure of the nation’s health?
7 Identify five social groups who, according to research, have a higher level of illness than the
population as a whole.
Assignment tips
1 The sociological terms introduced at the beginning of the unit (such as socialisation, culture, social
class, gender and ethnicity) should be used in class discussion of sociological issues and in your written
assignment tasks.
2 To achieve the pass grade in this unit, you are required to explain ideas and issues, such as different
sociological perspectives, different sociological approaches to health and ill-health, and trends in
health and illness among different social groups. Explanations require more detail than a definition
or a description. In this case, the grades can be achieved by using appropriate examples to illustrate
the concepts introduced. As a rule, you should devote one or two paragraphs to each sociological
perspective or approach that you are explaining.
3 To achieve merit grade, you are required in M1 to assess the biomedical and socio-medical models of
health described in P2 . When assessing ideas you are should consider the strengths and weaknesses
of the approaches or ideas, in this case the two models of health. M2 requires you to discuss trends of
health and illness in two different social groups e.g. gender, social class or ethnic group. This requires
you to develop further and in more detail two of the groups introduced in P3 , presenting clearly the
evidence for the patterns and trends explained. You may, further, refer to the difficulties in defining
health and to issues relating to the reliability of statistical data. Ensure that you use the sociological
terminology accurately and appropriately when considering these topics.
4 To achieve the distinction grade for this unit, you are required, in addition to meeting all other grading
criteria, to evaluate patterns and trends in health and illness among two social groupings. Draw on the
evidence presented earlier, in particular commenting on the strengths and weaknesses of the evidence,
and in the final paragraph present your conclusion.
334
Credit value: 5
8
Psychological
perspectives
for health and
social care
Psychology is a science devoted to the study of the mind and behaviour.
There are different ‘schools’ of psychology, which have grown up
around different ways of understanding the mind and behaviour, called
perspectives. A perspective is a point of view or a way of considering
how certain ideas can be linked together and their relative importance.
In this unit you will be introduced to several of these psychological perspectives and
encouraged not only to understand them but also to apply them to a work setting.
Each has its merits but no one perspective can explain all behaviour. For example, the
biological perspective explains behaviour in terms of brain and bodily functions, such
as the influence of brain chemicals and hormones. By contrast, the psychodynamic
perspective sees behaviour as originating in early childhood experiences and
being motivated by unconscious forces. You will therefore be encouraged to think
critically about the strengths and weaknesses of each one, and to use more than one
perspective to explain different types of behaviour in individuals.
Learning outcomes
After completing this unit you should be able to:
1 understand psychological approaches
2 understand psychological approaches to health and social care.
335

P1 Explain the principal psychological M1 Assess different psychological

perspectives. approaches to study.
page 353 page 353
P2 Explain different psychological M2 Compare two psychological D1 Evaluate two psychological

approaches to health practice. approaches to health and social approaches to health and social
See Assessment activity 8.2, care service provision. care service provision.
page 363 See Assessment activity 8.2, See Assessment activity 8.2,
page 363 page 363
P3 Explain different psychological
approaches to social care practice.
page 363
336
Unit 8 Psychological perspectives for health and social care

You will be assessed by means of two written assignments. The first assignment requires
you to show understanding of the different psychological perspectives; the second to
show that you can apply these perspectives to health and social care provision.
Tara, 18 years old

When I first started this unit I thought it would be really hard.
There was so much jargon and all the different perspectives
seemed so confusing. I found class discussions really useful and
made notes each time we had a discussion, and made notes on
arguments for and against them, which helped me to get the M and
D grades. I also found that the jargon wasn’t so bad when I started to
keep a glossary. This helped me to meet the P grades.
I found I knew much more psychology than I had realised – I just didn’t know the
terminology. For example, all the theories of learning made sense to me because I had
watched my mum and older brother ‘reinforcing’ my little sister, Patti, when she was
good, and seen Patti imitating people she saw on television, so I could understand
about role models. I found the idea of the hierarchy of needs really useful for my work
placement in a hospital, as it guided me in knowing how to help people better by
identifying where on the hierarchy they were. I also found the ideas of self-concept,
self-esteem and self-fulfilling prophecy really useful as they could be applied directly to
patients. I have gained a lot of insight into behaviour, which I can use in my own life and
in my future career as a nurse.
Over to you!
1 What do you think you will find most interesting about this unit?
2 Do you think keeping a glossary will help you remember the terminology?
3 How do you think you might use the knowledge you gain in this unit in your
future career?
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1 Understand psychological approaches to study
What kind of psychologist are you?

Get
Consider the following scenario and discuss reasons for Aisha’s behaviour.
started
Five-year-old Aisha’s parents divorced a year ago. Today her dad is taking her out
for the day. He arrives at the house to find his ex-wife flustered and upset because
her new baby has been up all night and Aisha has refused to wear the clothes she
laid out for her. The trip starts with a visit to McDonald’s, with a breakfast of chicken
nuggets, chips and Coke. Aisha throws a tantrum when they leave because she
wanted ice-cream and her dad refused so he promised she could have a packet of
Smarties in the car if she behaved well. Her mum has specifically asked him not to
give her Smarties because they are so sweet and sugary. Towards the end of the
day, Aisha’s dad needs to get some food from the supermarket and once again
Aisha throws a tantrum. He tells her if she behaves he will give her some sweets in
the car on the way home.
1 Could Aisha’s tantrums be in any way linked to her parents’ divorce? Make some
suggestions about how and why their divorce may influence her behaviour.
2 What would you say to Aisha’s dad about giving her Smarties when her mum has
asked him not to?
1.1 The behaviourist perspective Classical conditioning

In the introduction to this unit it was explained that The first theory of learning we shall investigate is called
perspectives in psychology explain behaviour based classical conditioning. This theory was developed by
on a particular set of beliefs and ideas. The key idea of a Russian physiologist called Ivan Pavlov (1849–1936).
the behaviourist perspective is that we can understand He was working with dogs to investigate their digestive
any type of behaviour by looking at what the person systems. The dogs were attached to a harness, as
has learned. This will include personality traits such as shown opposite, and Pavlov attached monitors to their
shyness, confidence, optimism or pessimism, as well as stomachs and mouths so he could measure the rate of
more fleeting behaviours such as offering to help with salivation (production of saliva).
the washing up. He noticed one day that a dog began to salivate when
Behaviourist psychologists explain all human behaviour the laboratory assistant entered the room with a bowl
as resulting from experience. Two key thinkers of food, but before it had actually tasted the food.
associated with this perspective are Pavlov (classical Since salivation is a reflex response (which until then
conditioning) and Skinner (operant conditioning). was thought to be produced only as a result of food
Although these two theorists believed that different touching the tongue), this seemed unusual. Pavlov
processes were involved, they both explained all speculated that the dog was salivating because it
types of behaviour as being the result of learning – had learned to associate the laboratory assistant with
everything from shyness to aggression, from happiness food. He then developed his theory in the following
to depression. This is quite different from, say, the way.
psychodynamic or biological approaches, which are Food automatically led to the response of salivation.
explored later in this unit. Since salivation is an automatic (not learned)
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Fig 8.1: The harness used by Pavlov

while conducting his conditioning
experiments with dogs
response, he called this an unconditioned response

(UR). ‘Unconditioned’ means ‘ not learned’. As food Case study: Sandra
automatically leads to this response, he called this an Sandra is 25 years old and is due to have an
unconditioned stimulus (US). Pavlov then presented anti tetanus booster. She is absolutely terrified
food at the same time as ringing a bell (a neutral of this and asks her GP to prescribe her a
stimulus), to see if the dog would learn to associate tranquilliser. The doctor is, naturally, reluctant to
the bell with food. Over several trials the dog learned do so and questions her a bit about why she is so
afraid. Sandra reveals that she remembers having
that the bell was associated with food and eventually
an injection when she was seven (she doesn’t
it began to salivate when only the bell was rung consciously remember her earlier immunisations),
and no food was presented. It had thus learned which resulted in her fainting. She has never been
the conditioned response (CR) of salivation to the able to bear injections since that time.
conditioned stimulus (CS) of the bell. 1 Identify the unconditioned stimulus,
unconditioned response, conditioned stimulus
Operant conditioning and conditioned response in Sandra’s case.
This type of learning is associated with the theories 2 Do you think this theory explains Sandra’s fear
of Burrhus Frederic Skinner (1904–1990). (For a well?
fuller description of the work of Skinner and other
Key terms behaviourists, consult the book Learning and

Unconditioned response – A response that regularly occurs
Behaviour by L. Barker – see page 365 for details.)
when an unconditioned stimulus is presented, e.g. the startle Skinner was an American psychologist who worked
response resulting from a thunderclap. mostly with rats and pigeons, to discover some of the
Unconditioned stimulus – A stimulus that regularly and key principles of learning new behaviours. He used a
consistently leads to an automatic (not learned) response very famous device, called a Skinner box, illustrated
from, e,g, a clap of thunder. below. The box contains a lever which, when pressed,
Conditioned response – A new, learned response to a releases a food pellet into the box, thus reinforcing
previously neutral stimulus that mimics the response to the lever-pressing behaviour.
unconditioned stimulus.
When the rat is first placed in the box it will run
Conditioned stimulus – A neutral stimulus that, when paired
with the unconditioned stimulus, produces a conditioned
around, sniff the various items and at some point it will
(learned) response, just as the unconditioned response used press the lever, releasing a food pellet. After a while,
to. when the rat has repeatedly performed this action,
it will learn that this behaviour (pressing the lever) is
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Speaker Signal Lever

lights Reflect
Have you ever worked really hard to finish an
To food
dispenser assignment and felt pleased and relieved when
it was completed and handed in on time? The
consequence here is reinforcing and increases
the probability of you repeating the behaviour
Food pellet again.
Electric grid
Case study: Sean
To shock Sean is known for his kind behaviour. His friends
generator think this is a bit over the top because he seems
to get involved with every needy person in the
college. If he is out on the street he almost seems
Fig 8.2: A rat in a typical Skinner box
to search out homeless people and gives away
more money than he can afford.
automatically followed by the release of a food pellet One day, in discussion with a group of friends
who are curious about his behaviour, he explains
(the consequence). Because the pellet is experienced
that when he was a small child he was out in a
as reinforcing (something the rat would like to have shopping precinct with his father, who gave money
more of), this consequence increases the probability of to a homeless person. His father asked him to
the behaviour being repeated. There are two types of give some money out of his pocket money but he
reinforcement: positive reinforcement and negative refused. The disapproving response from his father
reinforcement. was experienced by him as punishing (he felt bad).
Next time they were out together, he gave all his
Skinner investigated negative reinforcement by pocket money (50p) away and his father praised
running a very low electrical current on the floor of the him.
Skinner box. The current could be de-activated if the Ever since that experience, he learned that
rat pressed the lever. The behaviour of lever pressing not being kind made him feel guilty and
was thus negatively reinforcing. For humans, this can uncomfortable, whereas being kind led to feelings
be demonstrated by the example of using pain relief. of pleasure and pride and took away any initial
For example, if you have a headache and you take a feeling of guilt. He thus felt that the punishment
for not being kind was removed by giving money
painkiller, which results in the headache going away,
(negative reinforcement). The act of giving in itself
you are negatively reinforced for taking a painkiller. had therefore developed his sense of worth and
Punishment occurs when behaviour is followed by was thus positively reinforcing.
a consequence that is experienced as unpleasant. 1 If Sean hadn’t felt guilty about refusing to give
Skinner investigated this by giving the rat a small money, would the consequence have changed
electric shock when it pressed the lever. The his later behaviour?
consequence of lever pressing (the electric shock) was 2 Do you think Sean’s kindness and generosity
experienced as unpleasant, so the rat learned to stop can be fully explained in terms of operant
pressing the lever. conditioning?
Key terms 1.2 Social learning theory

Positive reinforcement – This happens when the The effects of other individuals on behaviour
consequence following a particular behaviour is experienced
as desirable. We do not live in a vacuum and there are many
Negative reinforcement – This happens when behaviour
influences on our behaviour – from peers, siblings,
results in a consequence that removes something unpleasant. parents, television, sports personalities and other
celebrities, as any parent of a teenager can tell you!
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According to social learning theory, role models are very The effects of groups on behaviour
important. While we may learn new behaviours from
Our behaviour is dramatically influenced by the
anyone, the likelihood of imitating such behaviours is
presence of others, however much we may believe
strongly influenced by the way we perceive the person
ourselves to be truly individual in our beliefs and
performing the behaviour (the model).
behaviour. Nowhere is this more clearly demonstrated
If we observe someone we admire behaving in a than in the experiments conducted in the 1950s by
particular way, we are more likely to imitate such social psychologist Solomon Asch. He was interested
behaviour. If, for example, a sports personality in a concept called majority influence. This is when
such as Cristiano Ronaldo is shown on television the presence of other people causes us to change
recommending wearing a cycle helmet, we are much our public behaviour or opinions because we do not
more likely to feel motivated to imitate such behaviour want to stand out from the crowd. We have a powerful
ourselves because this will bring us closer to being like desire to belong and will ‘go along’ with what others in
this admired model. On the other hand, if cycle helmet our group say, think or do in order to fit in. This is what
wearing is associated with a model we look down on he did to test this idea.
(e.g. someone we regard as a ‘geek’) then we are much
A group of six stooges or confederates of the
less likely to imitate it. The diagram below illustrates
experimenter (people who were play-acting according
factors associated with a model that influence whether
to instructions) were joined by a naïve participant
we will imitate him or her.
(a genuine participant who knew nothing about the
nature of the experiment) in a task that supposedly
tested visual perception. The experimenter explained
that the task involved stating whether a target line
Similarity to shown matched the length of one of a set of three
Gender Status
ourselves
Key term
Features of a model Majority influence – A type of influence exerted by groups
that may influence us that is associated with the individual’s desire to be accepted.
to imitate their Behaviour, beliefs and views are changed publicly in order to
behaviour be in line with the norms of a group, although privately they
are unchanged.
Prestige Competence Fame
Fig 8.3: Certain attributes of a model make it more likely that

their behaviour will be imitated
Activity 1: How much are

you influenced by observing
others?
Over the course of the next few weeks, make notes
on how you personally are influenced by observing
the behaviour of another individual. This may be
a lecturer, teacher, peer or someone you meet A B C
on a work placement. Do you imitate the type of
clothing, hairstyle and mannerisms of others in Target line Comparison lines
order to ‘fit in’? Fig 8.4: The target line and comparison lines used in Asch’s
experiment
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lines (a, b and c) similarly shown to all participants. An The effects of culture and society on
example of this task is given in Fig 8.4.
behaviour
As far as the genuine participant was concerned, all Culture refers to the shared values, norms, language,
those taking part in the experiment were similarly customs and practices of a group. Although we tend to
naïve (i.e. didn’t know what was happening and were think of culture as being specific to different countries,
genuine participants). The group was seated in a it also refers to different sub-groups within society. For
horseshoe arrangement, with the naïve participant example, people from different socioeconomic groups
always last but one to be asked to make a judgement. within the UK will share different aspects of culture,
The procedure began with the first participant stating such as the value placed on eating at a table rather
out loud whether the target line was equal in length than on your lap in front of the television; the way in
to one of the specified comparison lines. The next which money is spent; how to talk to your elders, and
person in the horseshoe then answered, and so so on. It is important to understand how culture affects
on, right through to the end. This ‘perceptual trial’ our behaviour in order to gain a full understanding
was repeated 18 times but on 12 of the 18 trials the of the people we encounter and those we work with.
confederates all gave the same wrong answer when Watson (1970) found that the average amount of eye
the correct answer was obvious. Astonishingly, out of contact made varied between countries, with high
123 naïve participants, 28 per cent gave an incorrect degrees of eye contact being seen as insolent by some
answer eight or more times. This shows clearly how an Africans and East Asians, whereas among Indians and
individual can be influenced by a group. Latin-Americans this was seen as desirable.
Fig 8.5: The participant is always the last but one person to give his or her judgement out loud
342
The extent to which we value individualism is also

heavily dependent on culture. Generally speaking, My behaviour:
I am sullen,
in European cultures and the USA, self-reliance, aggressive, unfriendly
assertiveness and individualism are highly valued and hostile
traits and parents see it as part of their duty to enable
children to grow up with these characteristics. In
many Eastern and Asian cultures, by contrast, the
emphasis is on collectivism: the child is socialised My thoughts Other people’s
to put the needs of the group before his or her own and beliefs: response to me:
I think I am worthless; They are cool, distant
needs. Thus, a 40-year-old American male living at the world is full of and perhaps even
home with his parents would perhaps be seen as a people out to get me unfriendly or hostile
‘mummy’s boy’ and disparaged as such, whereas in
parts of Africa, India and China this would be seen as Fig 8.6: The way we think and feel about ourselves influences
the way others respond to us
normal, admirable behaviour and as showing respect
for parents.
Activity 2: Investigating Case study: Ruby

social and cultural norms Ruby has just begun her work placement at a
residential care home for the elderly, and her
Do you always join a queue at the back and stand
supervisor, Janine, is giving her a brief description
in line until you get to the front? Is your language
of the people she will be working with. When
and speech more formal with teachers and
describing 85-year-old George, Janine says:
people in authority than with friends and family?
Think of how your upbringing has influenced ‘Well, George… What can I say? He’s just
your behaviour. Discuss with others whether their trouble, from start to finish. He moans and
experience is the same or different, and think of grumbles all the time, annoys the other
three more examples of norms that may differ residents, and is attention-seeking. Lots of
across social and cultural boundaries. people are much worse off than he is, but he
causes the most disruption.’
1 What sort of expectations do you think Ruby
will have of George?
2 Do you think Janine’s negative attitude to
George affects his well-being, and if so, how?
The self-fulfilling prophecy
3 Do you think it is possible to break the self-
This is an important concept in psychology that has fulfilling prophecy?
a big impact on the way we behave towards others
and expect them to behave towards us. If we believe
ourselves to be worthwhile, pleasant and likeable then
we will almost certainly be polite and cheerful towards
those we meet, thus creating a favourable impression.
In response, those who come into contact with us Role theory
perceive us favourably and behave in a positive way There is a similarity between role theory and the self-
towards us, with the result that our positive self-beliefs fulfilling prophecy, in that role theory suggests that,
are confirmed. If, on the other hand, we are angry, full because we live within a particular culture, society and
of resentment, believe the world is against us and so social group, we are influenced by other people. This
on, then we are likely to behave in a more aggressive, influence helps lead us to adopt certain roles and try
confrontational or argumentative way, in which case to live up to the expectations that go with this role.
that is how we will be responded to, which will confirm For example, a nurse is expected to be level-headed,
our views of ourselves and the world. An example of warm and competent. However, whereas we might
this is illustrated in Fig. 8.6. expect a surgeon to be similarly level-headed and
343
competent, we would not necessarily expect him or

her to be particularly warm. Since we all take on many
1.3 The psychodynamic
different roles, our behaviour will change according approach
to the role we are currently in. A woman visiting This approach is associated with the Austrian
the zoo with her children will take on the role of a psychologist Sigmund Freud (1856–1939), who
mother; whereas when she goes to work she may be a developed the theory of psychodynamic psychology
colleague, a supervisor or a subordinate and she will and the treatment known as psychoanalysis. A key
adopt the expectations of her job role. Later, if she follower of Freud was Erik Erikson (1902–1994), who
goes out to a party she may adopt the role of a friend. adapted aspects of Freud’s approach.
Albert Bandura The importance of the unconscious mind:

Social learning theory explains behaviour as the result Sigmund Freud
of learning from people we are exposed to in our Freud described the occasion when a Member of
environment. We can also learn new behaviours from Parliament was referring to the MP for Hull, with whom
people we observe, either in real life or in the media. he disagreed about some policy. Instead of saying ‘the
This is known as observational learning and this honourable member from Hull’ he started to say, ‘the
theory was developed by the American psychologist, honourable member from Hell’. What do you think
Albert Bandura. caused him to say Hell when he should have said Hull?
The person we learn from is known as a role model, Freud was one of the earliest thinkers to bring to
and the process of imitating is called modelling. public attention the idea that we are not always
However, we do not imitate all behaviour we observe aware of all aspects of ourselves. He suggested that
and remember. Whether or not it is in our interests what we are aware of is represented in our conscious
to imitate particular behaviour is influenced by mind but that many of our memories, feelings and
characteristics of the model (see Figure 8.3 on p. 341). past experiences are locked up in a part of our mind
If we see a model being punished for a certain he called the ‘unconscious’. We cannot access the
behaviour, we are less likely to imitate it than if we see contents of our unconscious, but they often ‘leak out’
him or her being positively reinforced. in dreams and slips of the tongue. Freud believed
that the conscious mind was like the tip of an iceberg
– only a small part being available to awareness. Part
Reflect of the unconscious that we can easily access he called
What features of a model would influence you to the pre-conscious. This contains information not yet
imitate that person? in consciousness but that can easily be retrieved (e.g.
Conscious level
Thoughts
Perceptions
Preconscious level
Memories
Key terms Easily accessed knowledge
Observational learning – This occurs when we observe

someone behaving in a particular way and we remember this Unacceptable Unconscious level
behaviour. We can learn positive and negative behaviours sexual desires
from observing others. For example, we may observe Violent urges
someone going to the aid of a person who collapses. Irrational fears
Role model – An individual who has characteristics that Selfish needs

Immoral urges
inspire us to copy their behaviour (for example, because they
are prestigious, attractive or have high status).
Modelling – The process of basing behaviour, attitude, style
of speech or dress on someone we admire or want to be like. Fig 8.7: According to Freud, the conscious mind represents
the ‘tip of the iceberg’. Most of our experiences and memories
are either pre-conscious or unconscious
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the name of Aunt Edie’s cat). The rest, well under the During the ages of four to five the child passes through
surface, consisted of the unconscious. This is illustrated the ‘phallic stage’. Fixation at this stage is associated
in Fig 8.7. with anxiety and guilty feelings about sex and fear of
castration for males. If this stage is not resolved, the
theory suggests that a boy may become homosexual
The importance of early experiences
and a girl may become a lesbian. Freud thought these
The importance of early experience in determining
were abnormal fixations; however most people today
later behaviours is clearly illustrated by Freud’s
would not view them in this way.
developmental theory of psychosexual stages.
Between the ages of five to seven and the onset of
He believed that we all go through several stages
puberty, the child enters the ‘latency stage’, which
of psychosexual development. At each stage, the
is not strictly speaking a developmental phase but
individual’s libido (energy) is focused on a part of the
a time when the focus is on social pursuits such as
body that is particularly relevant at that stage. If the
sport, academic excellence and the development of
needs of the developing child are met at each stage, it
friendships.
moves on to the next developmental stage. If, however,
there is struggle or conflict or some unsatisfactory The final psychosexual stage is the ‘genital stage’,
experience, the individual becomes ‘fixated’ (stuck) which begins at puberty. Freud believed that the less
at this stage. This results in certain ways of being, fixated the individual has become during the earlier
or personality traits, which are carried through into
adulthood and which can explain behaviour later in life.
The earliest stage is the ‘oral stage’. The focus here
is on the mouth and activities such as sucking, biting
and licking. (You will probably have noticed that young
babies seem to put everything in their mouths.) Freud
believed that there could be two reasons for fixation.
If the infant was weaned too early, it would feel forever
under-gratified and unsatisfied and would develop into
a pessimistic, sarcastic person. If, on the other hand,
it was over-gratified (weaned too late) the individual
would develop a gullible personality, naively trusting in
others and with a tendency to ‘swallow anything’. This
stage lasts from birth to approximately 18 months.
If the infant successfully passes through the oral stage
without becoming fixated, the next stage is the ‘anal
stage’, which lasts from approximately one to three
years. Here the libido is focused on aspects to do
with potty training. If there is a battle with parents
about potty training, with the child feeling forced to
use the potty before they are ready, or feeling over-
controlled in various areas, they may rebel by retaining
their faeces: the child refuses to ‘go’, thus holding
on to control and withholding satisfaction from the
parent. This type of fixation is called ‘anally retentive’
and is associated with later personality characteristics
such as obstinacy, miserliness and obsessive traits.
The alternative scenario is that the child is not given
enough boundaries over potty training so they take Think about how, if fixated at this
stage, this person may become a
excessive pleasure in excretion and become a messy, smoker in later life.
creative, disorganised sort of person.
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stages, the more easily this stage will be negotiated,

resulting in the ability to form strong heterosexual
Key terms
relationships with an ability to be warm and loving as
Ego – The part of the mind whose function it is to moderate
well as to receive love in a new, mature fashion. the demands of the id and prevent the superego being too
A second important feature of early experience is the harsh. It operates on the reality principle.
development of ego defence mechanisms. The use Id – Part of the psyche we are born with. It operates on the
of a defence mechanism allows us to block out events pleasure principle.
that threaten to overwhelm us. Examples of these are Psyche – The structure of the mind, consisting of three
given below. dynamic parts.
Superego – Roughly equivalent to a conscience, the
Table 8.1: Examples of defence mechanisms
superego consists of an internalisation of all the values of
Name of Explanation Example right and wrong we have been socialised to believe in. It also
defence contains an image of our ideal self.
mechanism
Repression The person Forgetting a A person who is very submissive, guilty and always
forgets the event traumatic event in wanting to please may have a very strong superego.
childhood (e.g. a A person who is impulsive, careless of other people’s
car crash) feelings, doesn’t think through the consequences of
Regression Reverting to an Wetting the bed their actions and is perhaps inclined to aggression,
earlier stage of when a sibling either verbal or physical, probably has a dominant id.
development is born, having A person who can be submissive and assertive when
been dry before
necessary, who is able to think about other people’s
Denial Pushing an event Denying that a feelings but also consider and value their own needs,
or emotion out of loved one has has probably got a strong enough ego to balance the
consciousness died demands of the id and the superego. They are likely to
Displacement Redirecting Kicking the cat have quite a rational and realistic outlook on life.
desires onto a at home because
safe object your boss gave
Erik Erikson
you a hard time Erik Erikson was a psychologist who agreed with
at work much of Freud’s theory in so far as he thought that we
developed through a series of stages. However, he
A final influence is that of the mind. Freud suggested thought that these continued throughout our lifetime
that the mind (which he called the psyche) is divided and were essentially social in nature. He also believed
into three dynamic parts. The id is a part of the mind that Freud put too much emphasis on our desire for
which is totally unconscious and which exists at birth. individual gratification and not enough on our need
It is focused on getting what it wants and consists to be accepted by society and lead a meaningful life.
of aggressive, sexual and loving instincts. It is the Erikson suggested that we move through a series of
part of us that says ‘I want it now!’ The superego is psychosocial crises with a different social focus at each
formed as a result of socialisation and consists of all stage. For example between birth and the age of one,
the instructions, morals and values that are repeatedly the life crisis concerns developing trust or mistrust in self
enforced as we are growing up. It takes on the form of and others. The social focus at this stage is the mother.
a conscience and also represents our view of our ideal
self. The main role of the superego is to try to subdue
the activity of the id. The ego tries to balance the
Reflect
demands of the id and the superego. It is the rational Identify which stage you are in, as outlined by
part of the mind, always seeking to do what is most Erikson. As you work through the following
section, make notes on whether you think he is
helpful for the individual. Different behaviours can be
correct in his explanation of this stage. Is there
understood by trying to infer which part of the psyche anything you disagree with?
is dominant at any time.
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PLTS Case study: Word

Creative thinker: By questioning Erikson’s theory association
and generating your own ideas, you are developing
your creative thinking skills. One method used by Freud to access the contents
of the unconscious is known as word association.
He would say a word and the patient would
respond with the first word that came to mind. The
speed of response and lack of conscious editing
Key terms produced some curious responses. One example
Trust – A sense of hope and faith in others. was a man who replied ‘shroud’ in response to
Autonomy – Faith in one’s ability to influence the the word ‘white’. Upon further probing, Freud
environment through one’s own actions. uncovered his client’s fear that he would soon die
Doubt – Lack of self-belief; a sense of shame associated with
from heart failure and be covered with a shroud.
failure.
It emerged that a relative of this man had died at
the age he now was, as a result of heart failure. The
Initiative – A sense of purpose and belief in one’s abilities to patient, being overweight himself, had developed
pursue appropriate goals. a deep fear of dying at this same age but had
Guilt – The result of trying to follow goals that conflict with buried the fear in his unconscious.
those of family members.
1 Do you agree that much of what motivates our
Industry – An application of skills and abilities to projects in behaviour is, indeed, unconscious? Can you
the world, including at school. think of examples?
Inferiority – A sense of being a failure. 2 Can making the contents of the unconscious
Identity – A consistent sense of sameness, associated with accessible to the conscious mind really help us
occupational choice and social roles. deal with our innermost fears? How and why?
Role confusion – The inability to find a social role; indecision
about occupational choice and the lack of a continuous sense
of self.
Table 8.2: Psychosocial stages
Stage Key focus of stage Positive outcome Negative outcome

Stage 1 How the infant is Dependable, responsive, Parenting that lacks warmth and affection
(0–1 year) parented caring parenting leads to a or is inconsistent leads to mistrust
sense of trust
Stage 2 Being enabled to do Being supported in growing Being criticised and over-controlled leads
(1–3 years) things by yourself independence leads to a to a feeling of doubt about your own
sense of autonomy competence
Stage 3 Interaction with the Being encouraged to try out Being hampered in the desire to find things
(3–6 years) world new skills and explore the out (e.g. criticised, told not to be silly) leads
world leads to a sense of to a sense of guilt and a lack of confidence
initiative
Stage 4 Understanding how The ability to succeed at Being pushed to take on tasks they are not
(6–12 years) things are made and realistic tasks leads to a ready for leads to a sense of inferiority
how they work sense of industry
Stage 5 Developing a Experimentation leads to a The inability to experiment and develop a
(12–18 consistent sense secure sense of identity sense of identity leads to role confusion
years) of identity by and a negative identity
experimentation
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How does belonging to a group

help us to experiment with a new
identity?
1.4 The humanistic perspective

Humanistic psychology looks at human experience
from the viewpoint of the individual. It focuses on the
idea of free will and the belief that we are all capable
of making choices. Two psychologists associated with
this approach are Abraham Maslow and Carl Rogers.
Self-actualisation
Abraham Maslow needs
(achieving full potential)
Maslow (1908–1970) was an American psychologist
who believed that we are all seeking to become the Self-esteem needs
best that we can possibly be – spiritually, physically, (respect, including self-respect)
emotionally and intellectually. He called this self-
actualisation. He constructed a theory known as the Love and emotional needs
hierarchy of needs, in which he explained that every (affection from others, being with others)
human being requires certain basic needs to be met

Safety and security needs
before they can approach the next level. This hierarchy (freedom from anxiety and chaos,
of needs is shown in Fig 8.8. stability, predictability)
Key term Basic physical needs

(oxygen, food, drink, warmth, sleep)
Self-actualisation – An innate tendency we all possess as
human beings to become the best that we can be in all
aspects of personality and intellectual, social and emotional Fig 8.8: Maslow’s hierarchy of needs – according to Maslow,
we need to progress through each level before we can reach
life.
self-actualisation
348
As the diagram shows, Maslow believed that, until blonde or brunette, tall or short, as well as personality
our basic physiological needs are met, we will focus traits such as being kind, humble, assertive, hard-working.
all our energies on getting them met and not be able The self-concept is formed from an early age and young
to progress further. When we are well-housed, well- children internalise other people’s judgements of them,
fed and comfortable physically, we begin to focus which then become part of their self-concept. If a child is
on our emotional needs, such as the need to belong told they are silly, naughty and will come to no good, part
and be loved and to feel self-esteem. When our lives of their self-concept will contain these aspects. If, on the
are such that these needs are also met, we strive other hand, a child is praised, encouraged to succeed
to self-actualise. As Maslow said, ‘A musician must and told they are valued, they will have a positive self-
make music, an artist must paint, a poet must write, concept and see themselves as someone who is
if he is to be ultimately at peace with himself. What a worthwhile and competent.
man can be, he must be. This need we may call self-
actualisation.’
Case study: Amina Key terms

Self-esteem – How valuable we feel; literally, the amount of
This case study shows how the hierarchy of esteem we give to ourselves. Someone with high self-esteem
needs can be applied to the case of an asylum will believe they are loved and lovable and that they are
seeker. important and valued. By contrast, an individual with low self-
Amina is a refugee from Somalia. She arrived in esteem may feel themselves to be worthless, of no value to
the UK at the age of 16, having been given a place anyone else, unloved and unlovable.
on a lorry after both her parents were killed. When Self-concept – The way we see ourselves. In early life this
she reached the UK she applied for asylum. She comes from what we are told about ourselves (e.g. ‘you’re
was housed in temporary accommodation for the so pretty’, ‘you’re a good footballer’, ‘what a kind girl you
first 18 months and was then granted leave to are’). As we grow older, our ability to think about ourselves
remain and given a bedsit. She is being supervised develops and we begin to incorporate our own judgements
by a multi-disciplinary team, including Helen, an (e.g. ‘I did well at that test – I’m good at maths’, ‘I wasn’t
outreach worker from Connexions. Helen is due invited to that party – I must be unpopular’).
to visit her to assess her needs, and suggest an Internalise – This is to do with the way we take in information
educational route that could enable Amina to gain from the outside world and build it into our sense of self.
qualifications, so she can eventually support herself. It then becomes part of our feelings, thoughts and beliefs
Helen’s supervisor advises her to familiarise herself about who we are and what we expect from the world around
with Maslow’s hierarchy of needs before she meets us.
Amina for the first time.
1 At what stage of Maslow’s hierarchy of needs
was Amina when she first arrived in England?
2 What needs may she satisfy by entering
education? Activity 3: Investigating your
3 Suggest some questions Helen might ask in own self-concept
order to find out whether or not Amina is yet Write down 20 statements about yourself.
ready to benefit from education. How many of these are positive and how many
negative?
Consider the influences there have been on your
self-esteem. How much praise/criticism did you
receive from others when you were growing up?
Carl Rogers Are you able to feel good about your
Rogers (1902–1987) was particularly interested in the achievements, and accept praise from others or
concept of self. There are many aspects of the self but do you tend to brush it off? People with high self-
two are especially important here. Self-concept refers to esteem and a positive self-concept are able to
the way we view ourselves. This includes physical and accept praise.
biological attributes such as being male or female,
349
Rogers believed that we also hold a concept of self, processes such as attention, memory, perception,
called the ideal self. This represents a view of ourselves information processing, problem solving, thought,
as we feel we should be and as we would like to be. language and other aspects of cognition. However, to
When there is incongruence (a mismatch) between our understand this perspective as it relates to health and
actual self and our ideal self we become troubled and social care, we shall concentrate on just two theorists:
unhappy. Jean Piaget and George Kelly.
Jean Piaget
1.5 The cognitive/information Jean Piaget (1896–1980) was a Swiss psychologist who
initially worked on measuring intelligence. During his
processing perspective research he noticed that children of the same age
This psychological perspective has gained enormous made the same mistakes in logic, however bright
ground since the 1960s, when the influence of they were. He came to the conclusion that cognition
behaviourism began to wane. With the development develops through a series of stages, each new stage
of computers came the idea that brain activity was building on the previous one. The stages and key
like the operation of a computer. A great deal of associated features are described below. (For more
research has been devoted to understanding cognitive information on these stages, see Unit 4.)
How does this photo show that a

baby is only able to experience the
world through sense perceptions
and motor activity – the sensori-
motor stage?
Table 8.3: Piaget’s stages of development
Stage Age Key features

Stage 1: Sensori-motor 0–2 years The world is experienced through motor activity and the senses
Stage 2: Pre-operational 2–7 years Language develops along with memory. The child is egocentric and
unable to conserve
Stage 3: Concrete 7–11 years The child can now understand conservation but cannot yet solve
operational problems mentally
Stage 4: Formal 11+ The child can now use abstract thoughts and represent problems
operational mentally
350
George Kelly Genetic influences on behaviour

George Kelly (1905–1966) developed a unique Genes can affect behaviour in many ways. Some
psychological theory known as the Psychology of disorders, such as Huntington’s disease, are caused by
Personal Constructs. He saw the individual as a a single dominant gene, which either parent can pass
scientist, making predictions about the future, testing on to their child. Others, such as cystic fibrosis and
them and, if necessary, revising them according to sickle cell anaemia, are caused when both parents pass
new evidence. A construct is a way of construing on the gene for the disorder.
(interpreting and making sense of) reality and the Disorders that occur regardless of environmental
environment. For example, if an individual develops influences, such as those listed above, are genetically
deafness in middle age they may construe this as determined disorders. This means that the individual
a disaster, withdraw from the world and become who inherits the gene or genes is certain to develop
socially isolated. Alternatively, if they construe this the disorder, regardless of environmental factors. An
as a challenge, they may seek out new, exciting example of this is Huntington’s disease. This disorder
opportunities, work around their deafness and usually begins to show when the individual is aged
continue to live a rich, fulfilling life. between 30 and 50. Symptoms of dementia appear
Kelly believed that we do not have to be constrained and the individual is likely to die about 15 years after
by our past history but can seek out new, alternative, the onset. Some of the changes in behaviour are listed
more positive meanings. below, though this list is not comprehensive:
• hallucinations and delusions
1.6 The biological perspective • severe confusion
Maturational theory • progressive memory loss
The theory of maturation holds that the effects of the • inappropriate speech; use of jargon or wrong words
environment are minimal. The child is born with a set • personality changes including anxiety and
of genetic instructions passed down from its parents, depression, withdrawal from social interaction,
and its cognitive, physical and other developmental decreased ability to care for oneself and inability to
processes merely unfold over time, rather than being maintain employment.
dependent upon the environment to mature. It is,
in effect, a theory which states that development is
due to nature not nurture. This is quite a contrast to Did you know?
learning theory or humanistic theory, where the effects
of nurture are paramount. Out of 23 pairs of identical twins affected by autism,
both twins had the disorder in 22 cases. For a sample
Gesell’s theory of maturation of 17 non-identical twins affected by autism both twins
had the disorder in only 4 cases. This demonstrates
Arnold Gesell (1880–1961) believed that development
that the environment is also responsible for this
occurred according to a sequence of maturational disorder.
processes. For example, development in the womb
Ritvo, Freeman et al (1985)
follows a fixed set of stages: the heart begins to form
first, along with a rudimentary nervous system. Bones
and muscles develop next and over time the organism
develops into a fully functioning human being, ready
to be born. As the child develops from birth onwards,
its genes allow it to flower gradually into the person
he or she is meant to be. The environment should
provide support for this unfolding of talents, skills,
personality and interests but the main thing driving this
development is the maturational process.
351
Disorders that are not genetically determined, but The influence of the nervous and endocrine
where an individual’s genes may leave them with a systems on behaviour
vulnerability to developing the disorder, are far more
For more information on the nervous system, see
common. A classic way of measuring the contribution
Unit 5.
of genes to any type of behaviour is through twin
studies. There are two types of twins. Monozygotic The autonomic nervous system produces its effects
(or identical) twins share 100 per cent of their genetic through activation of nerve fibres throughout the
material since they are formed from only one fertilised nervous system, brain and body or by stimulating the
egg, which has divided into two. Dizygotic (or fraternal) release of hormones from endocrine glands (such
twins share only 50 per cent of genetic material since as the adrenal and pineal glands). Hormones are
they occur when two eggs are fertilised by different biochemical substances that are released into the
sperm at the same time. If, the reasoning goes, one bloodstream and have a profound effect on target
of a pair of monozygotic twins has a disorder, it would organs and on behaviour. They are present in very
be expected that, if genes are the only influence, the small quantities and individual molecules have a very
second twin must also have the disorder. short life, so their effects quickly disappear if they are
not secreted continuously.
There are a large number of hormones including:
Activity 4: The contribution • melatonin, which is released by the pineal gland
of genes and acts on the brainstem sleep mechanisms to
help synchronise the phases of sleep and activity
Research the genetic component in susceptibility • testosterone, which is released in the testicles and
to one of the following diseases:
may influence aggressiveness
• breast cancer
• oxytocin, which is released by the pituitary gland
• bowel cancer
and stimulates milk production and female orgasms.
• diabetes
• stroke. Some hormones are released as a response to external
stimuli. For example, the pineal gland responds
to reduced daylight by increasing production of
melatonin. Other hormones follow a circadian rhythm,
PLTS with one peak and one trough every 24 hours.
(Circadian means ‘about a day’ and refers to a 24-
Team worker: If you work in a group on this activity,
hour rhythm.) For instance, levels of cortisol rise about
you will show your team working skills by collaborating
with others to work towards common goals. an hour before you wake up and contribute to your
feelings of wakefulness or arousal.
Central nervous system Autonomic nervous system

Consists of the brain and Regulates organs of the body and processes such as heart rate and blood
spinal cord pressure; only one branch is activated at any time
↓ ↓
Sympathetic branch Parasympathetic branch
Associated with arousal and the fight or Associated with rest and relaxation
flight response
Person may appear agitated, with a fast Person will appear calm and relaxed,
pulse and heavy, rapid breathing with a slow pulse
Fig 8.9: A representation of the nervous system
352
Produce an information booklet including: the behaviourist perspective; and outline what
1 an explanation of the principal psychological is meant by the ‘psyche’ and ‘ego defences’ for
perspectives the psychodynamic perspective.
2 an assessment of the different psychological M1 For M1, you need to assess different
approaches to study. psychological approaches to study. When
doing this, you could consider how well the
Grading tips different approaches explain behaviour. Do they
miss out alternative explanations? For example,
P1 To achieve P1, you need to explain the principal does everyone who has an injection develop a
psychological perspectives. When you do this,
needle phobia? Why do we not always perform
remember to use the appropriate terminology
a behaviour we have learned by observing
for each perspective. For example, explain
others?
‘unconditioned’ and ‘conditioned stimulus’ for

Self manager: By completing this assignment you English: By researching textbooks and websites
may be able to gain evidence that you can organise regarding psychological perspectives and approaches,
your time and resources, prioritising your actions. you can show evidence of being able to compare,
Independent enquirer: Analysing and evaluating select, read and understand texts and use them to
evidence, judging its relevance and value, may enable gather information, ideas, arguments and opinions.
you to obtain evidence for this skill. Producing an information booklet for this assignment
may also enable you to demonstrate that you can
write documents, including extended writing pieces,
communicating information, ideas and opinions
effectively and persuasively.
353
2 Understand psychological approaches to health and

social care
2.1 Application of the desensitisation’. This involves first creating a ‘hierarchy
of fear’. Supposing the feared object is hospitals. The
behaviourist perspective individual would create a list of aspects associated with
The behaviourist perspective is extremely useful in going to hospital. It might look something like this:
explaining learned behaviours, as we can look at a
particular behaviour and trace its origin, using the Systematic desensitisation: creating a hierarchy of
concepts of association (classical conditioning) or fear
reinforcement or punishment (operant conditioning).
Most feared The procedure itself
The case study below gives an example of this.
Smells associated with hospital
People in green gowns
Case study: Understanding Hospital equipment and machinery
challenging behaviour Hospital wards
Farai is 13 years old and was recently admitted to Taking a lift to a ward
a local authority children’s home after her foster
placement broke down. She has fierce rages, Walking into the building
during which she smashes windows and shouts Driving to the building
at people. It turns out that Farai used to behave
in exactly this way at her foster home and that Least feared Receiving an appointment card
everyone ran around trying to please her. Fig 8.10: A patient’s hierarchy of fear in relation to hospitals
1 Explain, using the terminology of learning
theory, how and why Farai may have learned
the undesirable behaviours. The principle of this procedure is to help the
person achieve a state of very deep relaxation –
2 Do you think an explanation that relies entirely
on learning is sufficient to explain Farai’s on the assumption that relaxation and anxiety are
behaviour? incompatible. The aim is to replace the anxiety and
fear with a state of calm and relaxation. An image of
the least feared object or situation is then shown to the
individual and they are encouraged to relax until they
Changing behaviour are able to view this without fear or anxiety. This may
For some people, there may be aspects of everyday take more than one session. When this level of fear has
life that are simply impossible to cope with. A small been satisfactorily overcome, the person moves to the
boy may be unable to go to school or to the park object or situation at the next level, again working on
because he has an overwhelming fear of dogs, which relaxing until they are able to contemplate the object
he is likely to encounter in the vicinity of school or the or situation without a trace of anxiety. Over a period
park. An elderly woman may never leave her home and of time the procedure is repeated until the final, most
be isolated and depressed because her agoraphobia feared, object or situation can be faced without worry.
(fear of going out) is so severe that it dominates her With some treatments, the patient is encouraged
life. Fortunately, as well as explaining the development to practise some of the lower level fear-inducing
of phobic behaviours, classical conditioning is also situations (for example, opening an envelope
useful in helping to change such behaviours. containing an appointment card or driving as close to
We can apply the principles of classical conditioning the hospital as is tolerable without arousing too much
to everyday life in a very practical way. A commonly anxiety).
used method of changing phobic behaviour uses a The principles of classical conditioning are also used
method of treating acquired fears known as ‘systematic in a common treatment for alcoholism. Individuals are
354
given a drug which, when mixed with alcohol, leads to

extremely unpleasant physiological effects including
Activity 5: Investigating the
nausea and vomiting. The person thus learns to use of role models to promote
associate alcohol with an aversive rather than desired behaviour change
response.
Take note of television adverts you see over the
next few weeks and ask yourself why a particular
individual was chosen to promote a product or
Did you know? service. What are the features they have that might
appeal to viewers? What influence might they have
Phobias are culturally specific. In Japan a syndrome
on your behaviour or that of others?
known as tai-jin-kyofu-sho is a fear of embarrassing
other people by, for example, glaring at their genitals
while blushing in their presence, or making odd faces.
(McNally, 1997, cited in Davison and Neale, 2001,
p.129)
PLTS
Independent enquirer: By carrying out this activity
Shaping behaviours you may be able to gain evidence for the skill of
considering the influence of circumstances, beliefs and
Just as we can learn inappropriate or unhelpful feelings on decisions and events.
behaviours, so we can use the principles of operant
conditioning to create new, more helpful, behaviours
and eliminate the unhelpful ones. Using the principles imitate the behaviour. An example of a model who
of reinforcement and punishment is a very powerful was prestigious, of high status, attractive and most
way to change someone’s behaviour: this is sometimes definitely a ‘celebrity’ was the late Princess Diana.
called behaviour modification. When she visited patients with HIV and AIDS at a
This technique has been used with autistic children to hospital in 1987 and shook hands with a patient with
help them interact socially. Target behaviours, such as AIDS, she not only broke a taboo on the subject, but
making eye contact, are identified. The child is initially also helped remove a great deal of prejudice and
reinforced (e.g. with a sweet) for looking in the general misunderstanding about this illness.
area of the adult. Once this behaviour is established,
more specific behaviours (e.g. looking at the face) are
reinforced, until finally the target behaviour of making
eye contact is achieved. This is known as shaping
behaviour.
Key term
Target behaviours – Those behaviours that have been
defined as being of benefit to the individual’s well-being.
2.2 Application of social learning

theory
Promotion of anti-discriminatory behaviours
and practices
Earlier in this chapter (on p. 344) we discussed Inaugurated in 2009 as the first African
the way people can learn new behaviours by American President of the United
observing others. We also noted that the model’s States of America, Barack Obama is an
inspirational role model to all.
characteristics influence whether we are likely to
355
Another example of how a model can be influential in

promoting anti-discriminatory behaviours and practices
2.3 Application of the
is provided by the President of the United States, psychodynamic perspective to
Barack Obama. When lifting the ban on entering health and social care practice
the USA, which had previously applied to individuals
with HIV/AIDS, he stated that it was important for the Understanding challenging behaviour
United States to be a good role model as a country – if The basic tenet of this perspective is that much of
the overall intention was to take the lead globally in our behaviour is driven by unconscious forces. It is
reducing the stigma associated with this disease. therefore important to recognise that we may not
be able to understand behaviours using question
The use of positive role models in health and answer techniques, as the individual may not be
education campaigns aware of what is troubling them. It is necessary to
As explained above, role models can play a powerful delve a little deeper and try to interpret behaviour, on
part in influencing the behaviour of those who observe the assumption that the behaviour is in some way a
them. For example, celebrity chef Jamie Oliver has had symptom of what is going on in the unconscious.
a huge impact in terms of getting local authorities to
re-introduce freshly cooked school meals (as opposed Understanding and managing anxiety
to pre-cooked meals, which were much less healthy). When we are anxious we often have fears about events
His celebrity status greatly influenced the likelihood of that have happened or might happen, about things
his message being taken on board and acted upon. we have done or might do, and about whether the
On a more practical, everyday level, modelling is an world is a safe or unsafe place. We often try to control
excellent way of helping patients overcome anxieties. anxiety using a variety of strategies. Sometimes we use
For example, Melamed et al (1983) found that children denial – the ostrich approach where we bury our heads
in hospital suffer reduced stress and recover better in the sand and pretend the object of our anxiety
from surgery if the procedures they are about to doesn’t exist. Sadly, for most of us, the anxiety still
undergo are modelled, for example using films or seeps through, and may present itself in the form of
video tapes (cited in Sarafino, 1990, p. 149). physical symptoms.
Case study: Juliet’s dilemma

Juliet is the eldest of three children. When she was that Juliet has repressed her grief about her
11, her mother died, and since that time her father mother’s death, that she is resentful that her father is
has depended on her more and more to look after not taking better care of her needs, and also that she
the younger children and help run the household. is effectively having to ‘mother’ her younger siblings.
Juliet is a naturally conscientious and dutiful daughter Juliet’s extreme conscientiousness also suggests
and she misses her mother terribly but hides this, that she has a dominant superego and a weak id.
as she can see all too well how much she is needed Although she at first denies these suggestions, Juliet
by other family members. She doesn’t feel able to gradually comes to realise that all these feelings
confide in her father about her own grief but instead were being buried, and the symptom of headaches
puts a smile on her face and busies herself with daily served the purpose of preventing her from looking
tasks. When she is 13, she begins to get paralysing after other family members and allowed her to receive
headaches, which are so incapacitating that she some much-needed care herself.
has to stay in bed for up to three days at a time. 1 Aisha has identified that Juliet is using certain
Despite optical and neurological tests, there is no defence mechanisms. What are these?
physiological explanation for the headaches, which do
not resemble migraines either. 2 Are there other explanations for Juliet’s behaviour
that Aisha may have missed by focusing solely on
Juliet’s GP refers her to Aisha, a clinical psychologist the psychodynamic perspective? Discuss these.
with a particular interest in psychodynamic
psychology. After several sessions, Aisha concludes
356
2.4 Application of the humanistic Next, think of something that brings you out in a cold
sweat of paralysing fear. This may be something ‘real’
perspective to health and social such as having been buried under an avalanche of
care practice snow and fearing for your life, or something imaginary.
Recollect this fear. Did it help for people to tell you,
Carl Rogers is famous for developing a particular
‘Well, you were all right, weren’t you? You didn’t die!
type of counselling based on unconditional positive
Here you are – as well as anything!’? Now put aside
regard from the counsellor, to help the individual
all judgement about the individual’s fear or terror.
develop a more positive sense of self. Unconditional
Recognise that what they are feeling makes sense
positive regard refers to the idea that the therapist
to them. It is painful, agonising, terrifying. Tune in to
supports and validates the person’s experiences,
those feelings and you will be much closer to feeling
feelings, beliefs and emotions unconditionally (i.e.
true empathy.
without making a judgement about whether they
are good or bad). In this way, over time, the person Understanding
comes to accept themselves as they really are and to
Rather like empathy, understanding is of crucial
see themselves as worthy. The incongruence between
importance when applying this perspective to health
the actual self and the ideal self dissolves as the two
and social care practice. In fact, Rogers often refers to
become closer, or the individual lets go of unrealistic
more than just understanding at an intellectual level:
expectations associated with the ideal self.
he talks about empathic understanding, which involves
Empathy using your own emotions and sensitivity to become a
One crucial feature of this approach to helping others more effective helper. All too often we allow our own
is to develop empathy. Unlike sympathy, where we feel personal experience or judgements to dominate the
sorry for someone, empathy requires us to really listen way we relate to others. We think ‘Well, that’s not a
to the other person, be in tune with their emotions problem – they should just pull themselves together!
and respect them for who they are. This is not always I’ve dealt with worse myself!’ This is a major barrier to
easy, as we do not always understand why someone understanding and will not help the client or patient.
feels so bad about an issue that we could easily Instead, we need to listen carefully to what is being
dismiss. However, if we try to respect the individual said and to ask probing questions that enable the
we are working with and understand that the issue is individual to break down the problem and recognise
of crucial importance to them, we can come closer to its component parts. Useful questions might include:
demonstrating empathy. True empathy requires us to • ‘How does that make you feel?’
put aside judgements about another person and do all • ‘Can you identify what it is you are afraid of?’
we can to ‘put ourselves in their shoes’.
• ‘Could you tell me a bit more about that?’
Tips for achieving empathy • ‘That seems to have upset you?’
Suppose you are working with a client or patient who is
terrified that eating more than three grains of rice will
make them obese and ruin their lives. You are probably
aware that this is factually incorrect. You may find it Key term
difficult to understand, let alone feel empathy for such Unconditional positive regard – This refers to a totally non-
an extreme view. judgemental way of being with and viewing a client. The
Now try really listening to them. Observe their body therapist does not like or approve of the client at some times
and disapprove of them at others: they value the client in a
language. They may be so frozen with fear that they
positive way with no conditions attached.
appear calm and indifferent. Or they may be so
anxious that they are pale and sweaty with huge fearful
eyes almost bulging out of their head.
357
Psychiatric nurse
Sanjay is a community psychiatric

nurse who is visiting Irene, a 35-year-old teacher,
for the first time. Irene lives in a beautiful five-bedroomed
house in a leafy suburb of a university town. Her three children
are all at private school and her husband is a respected university
professor of biochemistry. Irene has been referred to the outreach
team after a suicide attempt and is receiving medication for
depression.
Sanjay himself comes from a high-rise in an inner-city suburb and
has worked hard to get where he is. During the course of his
visit, he finds himself feeling irritated with Irene. What has
she got to be depressed about? Her life is
the envy of many.
She should just pull herself together and get on

with things – many people are far worse off than she is.
Sanjay is, fortunately, aware that his attitude to Irene is unhelpful
so he books an appointment with his supervisor, who encourages him to
identify where his judgemental feelings are coming from, and to challenge his
negative perceptions of Irene. When he next visits her, he is able to use active
listening and gentle probing questions to help her express her feelings, and finds
that he is feeling empathy and understanding and is in a much better position
to help her. He recognises that his own upbringing and experiences have left
him with a tendency to be judgemental about others more fortunate than
himself in material terms, and that active listening and the tips for
empathy described above help him to ‘see’ Irene more clearly
and to hear the pain in her story and thus be more
understanding.
Think about it!

1 Explain how Sanjay’s own upbringing was at risk of interfering
with his ability to adopt a non-judgemental approach
2 Do you think the fact that Sanjay was a man and Irene was a
woman might have made a difference to Sanjay’s ability to
show empathic understanding?
3 How might the humanistic perspective explain Irene’s
unhappiness?
358
Unit 8 Psychological perspective for health and social care
Active listening with the other person, for example because there are
differences in gender, social class, ethnicity, religious
For more information on active listening, see Unit 1.
beliefs, language, culture and so forth, then we may
Another key feature of the humanistic approach is that
find ourselves taking a judgemental stance. This is
of active listening. All too often in our interactions with
a major barrier to respect. The workspace opposite
others, what we think of as a conversation is merely
illustrates this problem.
two or more people ‘queuing up to talk’. We just wait
for the other person to finish what they are saying so
we can have our own say. This is the opposite of active
2.5 Application of the cognitive
listening, which involves a very focused approach. perspective to health and social
We need to avoid daydreaming and distractions and care practice
listen sensitively to the meaning and emotions behind
the other person’s words. Attention is also paid to the Supporting individuals with learning
person’s body language and facial expressions. The difficulties
active listener suspends all judgement about what is Individuals with learning difficulties can experience
being said and seeks to use empathic understanding. enormous frustration in their daily lives as they seek to
When the listener does intervene, it is not to pass make sense of what can be bewildering experiences.
judgement but to interpret what the other person is The cognitive approach can be used to help people
saying, or to check understanding. who misread situations. By identifying irrational
thoughts, an individual can be guided to change
Respecting other individuals and adopting a them, with consequent benefits for their emotions and
non-judgemental approach behaviour. Cognitive work of this type can improve self-
Giving people respect may seem an obvious feature of esteem and reduce outbursts, which may be triggered
a helping relationship but in fact it can sometimes be by lack of understanding of the requirements of a given
quite difficult to achieve. If we find it hard to identify situation (for example, having to wait in turn for a meal).
Consider how a cognitive approach

can be used to help people with
learning difficulties
359
Supporting individuals with emotional

problems
Negative or irrational
The cognitive perspective is widely used with beliefs about the self
individuals with a wide variety of emotional problems. ‘I am a hopeless person
This perspective begins by examining how distorted and nobody likes me.’
and irrational negative thoughts influence feelings,

which then lead to changes in behaviour.
Reflect
Negative beliefs Negative views of
Do you ever find yourself having negative or about the future the world
irrational thoughts? For example, you might think ‘I will always be hopeless ‘The world is unpredictable
‘I did badly on that assignment – I’m going to fail and the world will always and filled with hostile
be dangerous.’ people and events.’
the course!’
Write down some of your negative thoughts or
those of someone you know.
Fig 8.11: The cognitive triad described by Beck
Supporting individuals with depression Supporting individuals with post-traumatic

The psychologist Aaron Beck has formulated a helpful stress disorder
approach to understanding depression, known as This disorder consists of a set of symptoms as outlined
cognitive behaviour therapy (CBT). The pattern of below. It is commonly experienced by soldiers but is
behaviour common to those suffering from depression also experienced by others who have undergone a
is described by Beck as a cognitive triad. To begin with, traumatic experience (such as rape), which is too much
the individual thinks he is worthless and inadequate. for them to bear.
This self-appraisal then leads to the belief that this
Re-experiencing the traumatic event (intrusion)
lack of worth means that the future will be just as bad
as the present. This then generalises to a conviction • Nightmares
that the world contains problems and difficulties that • Flashbacks
the individual is powerless to overcome. The goal • Frequent recall of the event
of cognitive therapy is to challenge these negative • Intense emotional upset produced by stimuli that
thoughts and to encourage the patient to develop symbolise the event (e.g. fireworks may symbolise a
alternative, more positive, ways of seeing the world. battlefield).
Identifying negative/irrational/distorted thinking Avoidance of stimuli associated with the event (or
This can be done by keeping a diary and recording numbing of responsiveness)
every instance of negative thinking and the feelings • The person tries to avoid thinking about the trauma
that follow. Initially this can be difficult, as these or encountering stimuli that will bring it to mind
patterns are so automatic it can be difficult to notice • The person may be unable to remember the event
them. However, it will get easier over time. For each
• Decreased interest in others
example, try to challenge the thinking. Ask yourself:
• A sense of estrangement
• What is the evidence for such negative thinking?
• An inability to feel positive emotions.
• Are there alternative explanations? It can be helpful
to think how others would respond, or ask them. Increased arousal
• How does it affect me to think so negatively? (This • Difficulties falling or staying asleep
helps you develop self-awareness.) • Difficulties concentrating
• What type of thinking errors am I making (for • Hyper-vigilance
example, magnifying or catastrophising)? • An exaggerated startle response.
360
Case study: Post-traumatic stress disorder

Spitzer et al (1981) describe the case of a 27-year-old work and also withdrew socially, avoiding her
woman referred to a psychiatrist showing symptoms friends.
of PTSD after she had witnessed her boyfriend being
Source: Spitzer et al (1981), cited in
stabbed to death during the course of a mugging.
Davison & Neale (2001)
Although she appeared to go through the grieving
process and return to normal, the arrest of the 1 Which of the symptoms shown in this case study
murderer triggered severe symptoms. She suffered suggest that the patient is suffering from PTSD?
from impaired sleep and when she slept often had 2 Is there any evidence here of negative or irrational
nightmares involving blood and shadowy figures thinking?
chasing her. She became preoccupied and day-
3 According to the psychodynamic approach,
dreamed to the extent that she would forget what
does this patient appear to be using defence
she was meant to be doing. This poor concentration
mechanisms to deal with this traumatic event?
affected her work and she began to avoid going to
The above are some, or all, of the symptoms child’s behaviour and understanding matches that
experienced by individuals with a diagnosis of post- of their chronological age (how old the child is). This
traumatic stress disorder (PTSD). These are illustrated scale enables the child’s scores to be compared
in the case study above. against their scores at an earlier age to determine
The treatment of post-traumatic stress disorder whether development is proceeding satisfactorily. It
usually involves a healthcare practitioner (such as also enables a skilled and trained assessor to identify
a psychiatrist, psychiatric social worker or clinical developmental problems that may emerge for an
psychologist) working with an individual to help individual, thus allowing for early and appropriate
them re-frame their thoughts. The aim would be intervention. There are three overlapping stages at
to recognise that the feared events have actually which development can be measured:
happened and are not recurring so that eventually the • between two and a half years up to age six
constant mulling over of these traumas will disappear. • between four and six years old
There would also need to be some treatment involving
• between six and nine years old.
behavioural therapy, however, and this might be
accomplished by an outreach worker or home carer At each age there are various tests to assess different
helping the individual to face feared situations. By aspects of development. One test administered at
confronting their feared situations and learning that around the age of four consists of comprehension
they are not going to suffer as they did originally, the questions. It measures the child’s ability to use
physiological effects of fear, panic and anxiety will perceptual accuracy and skills involved in regulating
diminish until the individual is eventually able to lead a its own behaviour and emotions by asking him to plan
normal life. solutions to hypothetical social situations. This allows
for a judgment to be made on the child’s ability to deal
2.6 Application of the biological with actual social situations as it reaches the age of
about five years old.
perspective to health and social The Cubes test, which is used primarily with children
care practice aged two to six, assesses the ability to follow directions
and perform a structured task. Visual perception and
Understanding developmental norms fine motor co-ordination skills involved in colouring,
You may want to read this section in conjunction with cutting and handwriting are assessed against
Unit 4. developmental norms. The child’s attention span,
Arnold Gesell developed an assessment scale to together with the ability to perceive different shapes
enable judgements to be made about whether a accurately, is also measured and together these give
361
information about reading comprehension, spelling Suppose, for example, a child is born with a genetic
and mathematical tasks. vulnerability to a disease, such as breast cancer. If, as
an adult, she practises regular breast examination, has
Understanding genetic predisposition a healthy lifestyle and has regular screenings, these
to certain illnesses or health-related health-related behaviours may make all the difference
behaviours to the potential outcome. A healthy lifestyle and
The topic of genes is also covered in Unit 4. vigilant health protection measures may reduce the
chances of a genetically vulnerable person contracting
While it is difficult to determine the extent to which
the disease or allow for prompt action to be taken if
genetic inheritance influences behaviour, there is
she is unfortunate enough to develop breast cancer.
considerable evidence suggesting that genes do
So a genetic predisposition to illness needs to be
have a role in behaviour. One example is infantile
considered together with health-related behaviours in
autism, a rare (but seemingly increasing) disorder,
order to understand fully this aspect of the biological
which affects about one child in 2000. There are
perspective.
psychological explanations for autism (for example,
see Bruno Bettleheim, 1967) but these have not been
satisfactorily investigated, and current research shows Understanding the effects of shift work on
that genetic influences play a more important role in individuals
this disorder. When we work shifts, particularly night shifts, we
The disorder of schizophrenia similarly shows a genetic tend to find that there are certain times when we feel
link, though not as strong as in autism. In monozygotic an overwhelming urge to sleep while we should be
(identical) twins, who share all their genetic material, working. Alternatively, when we go home after our shift
50 per cent of schizophrenia cases occur in both twins. and try to sleep and get refreshed for a new day at
This percentage is known as ‘the concordance rate’. work we may find ourselves pacing the floor, unable to
However, in dizygotic (non-identical twins), who share sleep. These unpleasant physical effects occur because
half as much of their genetic material, schizophrenia of disruption to circadian (or biological) rhythms.
only affects both twins in 15 per cent of cases. Circadian rhythms govern a cycle of physiological
In 1995 Sarafino and Goldfedder investigated the bodily processes which last for between 24 and 25
concordance rate for asthma. They found 59 per hours. One example is our core body temperature,
cent of monozygotic twins (23 out of 39 pairs) were which follows approximately a 24-hour cycle and
concordant for the disease, compared with 24 per cent influences our level of alertness. For most people,
of dizygotic twins (13 out of 55 pairs). the lowest core temperature is 36.1oC (97oF) and the
If schizophrenia and asthma are genetically determined highest is 37.2 oC (99 oF). Core body temperature
(like cystic fibrosis), twins who share 100 per cent fluctuates (rises and falls) over the course of the day.
of their genes should both develop the particular When it is at its highest, we are at our most alert. As
disorder. There is clearly a genetic component in our temperature gets lower, we begin to feel sleepy.
both these disorders, since monozygotic twins show The graph on the next page shows typical fluctuations
a higher concordance rate than dizygotic twins, in in body temperature.
line with the proportion of genetic material shared. Shift workers on an evening shift have to be awake
However, environmental influences must explain the and functioning at a high level when their body
proportion not accounted for. In schizophrenia, for temperature is at its lowest and dropping, a time
example, an individual can inherit a vulnerability to when their body is telling them to go to sleep. They
this disorder but if life goes smoothly and is relatively therefore have to fight against an overwhelming urge
free of stress, this person may live a life free of illness. to sleep. On returning home, when their temperature
Similarly with asthma, environmental factors such as levels are rising, they then need to try to sleep at a
stress, pollutants and pollen, can be responsible for time when their body clock is telling them they should
the onset of the disorder. be awake and encouraging alertness.
In terms of health-related behaviours, it is difficult The brain is also involved in governing our desire to
to separate out the effects of nature and nurture. sleep. A part of the brain called the pineal gland is
362
responsible for production of the hormone melatonin.

When levels of this hormone are high, we feel sleepy.
Activity 6: Are you a lark or
As they begin to drop, we become increasingly alert. an owl?
The rhythm of this hormone production is linked to
To find out how your own circadian rhythms
operate, go to www.proprofs.com, click on ‘Quiz
School’ and search for ‘lark’. Then take the ‘Are
you a lark or an owl?’ quiz to find out when you will
be most alert.
the sleep–wake cycle. As it gets dark, the pineal gland

recognises this and triggers an increase in melatonin
Body temperature
production, while, when light levels increase,

production of melatonin is reduced. Melatonin levels
fluctuate throughout the day. Between about 8 p.m.
and 10 p.m. these levels increase, with the resulting
feeling of sleepiness occurring about two hours later.
Melatonin levels then begin to fall, from about 2 a.m.
to 7 a.m. The onset of daylight is recognised by the
pineal gland, which then reduces the secretion of
melatonin, leading to increased alertness. For those
who are trying to sleep during the day, their levels
of melatonin are working against them, as low levels
0 03 06 09 12 15 18 21 24
encourage alertness. Similarly, those trying to work
Time (hours)
at night, when the pineal gland is secreting large
Fig 8.12: Typical fluctuations in core temperature over a
24-hour period: as our core temperature rises, we become amounts of this hormone, will have to fight against the
increasingly alert sleep-inducing effects of melatonin.

P2 M2 D1
You are a psychology student who wishes one day to health and social care service provision
have a career as an educational psychologist. At your • an evaluation of two psychological approaches to
placement, you have been asked to investigate the health and social care service provision.
need for a new, larger therapy and counselling centre
for local people. Grading tips
You need to evaluate two psychological approaches
P2 and P3 For P2, you need to explain the
to health and social care provision and put forward
different psychological approaches to health
your findings. Suggest what new provision is needed
practice, and for P3 you need to explain
for your locality.
different psychological approaches to social
Write a report that includes the following: care practice. Use the concepts of the different
• an explanation of the different psychological perspectives to complete this assessment.
approaches to health practice You may wish to use examples of individuals
• an explanation of the different psychological or groups of individuals who will benefit from
approaches to social care practice the new centre, or to staff it with psychologists
• a comparison of two psychological approaches to working within different perspectives.
continued on page 364
363
M2 For M2, you need to compare two psychological work in such a venue and the type of individuals
approaches to health and social care service they would help.
provision. Choose just two psychological D1 To achieve D1, you need to do all of the above
perspectives and focus on these in detail, as but, in addition, you have to evaluate the two
they relate to the new centre you are proposing. approaches, making an informed judgement on
You may find it helpful to suggest how which aspects of each perspective are most or
practitioners from the two perspectives would least useful, justifying your conclusions.

Independent enquirer: By focusing on both health ICT: By writing this report you may be able to
provision and social care provision, you may be able demonstrate that you can select and use a variety of
to provide evidence for exploring issues, events or sources of information independently for a complex
problems from different perspectives. task, and bring together information to suit content
Creative thinker: In applying your knowledge and and purpose.
understanding of the potential uses of this new venue, As this is your second assignment, you may also be
you may be able to demonstrate creative thinking able to provide evidence that you can produce two
skills: asking questions to extend your thinking and different assignments in different formats for different
questioning your own and others’ assumptions. purposes.
Self manager: By planning and writing this report, you English: This assignment may also allow you to
may be able to show evidence of organising time and demonstrate your research and writing skills.
resources, and prioritising actions.
364
Resources and further Rogers, C.R. (1961) On Becoming a Person London:

Constable & Robinson Ltd
reading Sarafino, E.P. (1998) Health Psychology:
Biopsychosocial Interactions, third ed. New York:
Barker, L.M. (1997) Learning and Behaviour: John Wiley & Sons
Biological, Psychological and Sociocultural
Sarafino, E.P. and Goldfedder, J. (1995), cited in
Perspectives, second ed. New Jersey: Prentice Hall
Asthma and Genetics http://acc6.its.brooklyn.cuny.
Bettleheim, B. (1967) The Empty Fortress: Infantile edu/~scintech/asthma/Genetics2.htm
Autism and the Birth of the Self New York:
Shaffer, D.R. (1993) Developmental Psychology:
Macmillan Publishing
Childhood and Adolescence, third ed. Pacific Grove:
Birch, A. and Malim, T. (1988) Developmental Brooks/Cole Publishing Company
Psychology: From Infancy to Adulthood Bristol:
Watson (1970) cited in Smith, P.B. & Bond, M.H.
Intertext Limited
(1993) Social Psychology across Cultures: Analysis
Davison, G.C. and Neale, J.M. (2001) Abnormal and Perspectives New York: Harvester Wheatsheaf
Psychology, eighth ed. New York: John Wiley and (p. 103)
Sons
Ewen, R.B. (1993) An Introduction to Theories of
Personality, fourth ed. Hove: Lawrence Erlbaum
Associates
Useful websites
Eysenck, M.W. (1994) Perspectives on Psychology Circadian rhythms www.guardian.co.uk/
Hove: Psychology Press science/2003/dec/04/lastword.health
Kalat, J.W. (1995) Biological Psychology, fifth ed. Cognitive behavioural therapy (Royal College of
Pacific Grove: Brooks/Cole Publishing Company Psychiatrists) www.rcpsych.ac.uk
Kelly, G.A. (1970), cited in Ewen, R.B. (1993) An Gesell’s assessment scale: www.gesellinstitute.org
Introduction to Theories of Personality, fourth ed. Health Education & Behavior journal
Hove: Lawrence Erlbaum Associates Ltd www.sph.umich.edu/hbhe/heb
Melamed, B.G., Dearborn, M. and Hermecz, D.A. Infantile autism (NARSAD – The Brain and Behavior
(1983), cited in Sarafino (1990) Research Fund) www.narsad.org
Nolte, D.L. & Harris, R. (1998) Children learn what Mind www.mind.org.uk
they live: parenting to inspire values New York: Stages of prenatal development
Workman Publishing www.babycenter.com
Ritvo, E.R., Freeman, B.J. et al (1985), cited in Kalat,
J.W. (1995) Biological Psychology, fifth ed. Pacific
Grove, California: Brooks/Cole Publishing Company
365
Just checking
1 Which psychologist is associated with the theory of classical conditioning?
2 What perspective in psychology uses the terminology of positive reinforcement, negative
reinforcement and punishment?
3 Why are features of the model important in observational learning?
4 Can the self-fulfilling prophecy be positive as well as negative? Explain your answer.
5 List three ego defence mechanisms.
6 Which theorist developed a scale to assess normal development in infants and children?
7 List three aspects of circadian rhythms.
Assignment tips
1 You can carry out further research by accessing the following websites:
Behaviourist and social learning theory The humanistic perspective
http://psychology.about.com/od/ http://webspace.ship.edu/cgboer/rogers.html
behavioralpsychology/a/introopcond.htm (operant http://www.businessballs.com/maslow.htm
conditioning) The cognitive perspective
http://psychclassics.yorku.ca/Pavlov/ http://webspace.ship.edu/cgboer/piaget.html
http://psychclassics.yorku.ca/Bandura/bobo.htm http://webspace.ship.edu/cgboer/kelly.html
Freud and Erikson
http://www.freudfile.org/theory.html
http://psychology.about.com/library/bl_psychosocial_
summary.htm
2 Preparing for assessment: Copy out the following table and complete each section as you work your
way through this unit. You will find it helps you to work on the merit and distinction grade material.
Perspective Strengths Limitations My opinion
Behaviourist Classical Not everyone There must be other

conditioning develops a phobia factors, e.g. genes or
explains phobias family influences
Social learning
Psychodynamic
Humanist
Cognitive developmental
3 See Unit 4 for more information on aspects of developmental psychology covered in this unit. For more
details on how to carry out research, see Unit 22 (Research methodology). You may also want to look at
Unit 10 Caring for children and young people and Unit 29 Applied psychological perspectives for help
with this unit.
366
Credit value: 10
21 Nutrition for
health and
social care
This unit introduces you to nutrition issues in health and social care settings. It
looks at nutrients from a scientific perspective, and also explains the role that
food plays in social situations. You will investigate the importance of nutrition
for different population groups, and relate this to health risks, as well as to
factors that influence food intakes. Finally, you will carry out a study of the
food intake of one individual, analyse it and prepare a plan to improve that
person’s nutritional intake.
For at least 20 years, concerns have been raised about poor nutrition in individuals using
health and social care services. In August 2006 Age Concern published a report entitled
‘Hungry to be Heard: The Scandal of Malnourished People in Hospital’. The report looked
at the numbers of people, particularly older people, who become, or stay, malnourished in
hospital. As a future practitioner, you need to understand why some individuals do not receive
adequate nutrition, and what makes up a healthy diet.
Learning outcomes
1 understand concepts of nutritional health
2 know the characteristics of nutrients
3 understand influences on dietary intake and nutritional health
4 be able to use dietary and other relevant information from an individual to make
367
recommendations to improve nutritional health.

P1 Explain concepts associated with

nutritional health
page 380
P2 Describe the characteristics of M1 Discuss similarities and differences

nutrients and their benefits to the in the nutritional and energy
body requirements of two groups of
See Assessment activity 21.2, individuals
page 389
P3 Explain possible influences on M2 Assess how influences on dietary D1 Make realistic recommendations
dietary intake intake may affect the nutritional for minimising negative influences
See Assessment activity 21.3, health of individuals on the individuals in a specific
page 399 See Assessment activity 21.3, health and social care setting
page 399
P4 Carry out a quantitative analysis of M3 Assess how the plan will meet the
daily intake of nutrients and energy nutritional needs of the chosen
by one individual. individual
page 402 page 402
P5 Prepare a one-week plan for D2 Evaluate how the nutritional plan

improving the nutrition of the might improve the health of the
chosen individual. chosen individual
page 402 page 402
368
Unit 21 Nutrition for health and social care

This unit will be internally assessed by your tutor. Various exercises and activities are
included to help you understand all aspects of nutrition in health and social care
environments, and prepare for the assessment. You will also have the opportunity to work
on some case studies to further your understanding.
Charlene, 17 years old

I have to admit my diet was terrible before I did this unit. I never
sat down for a proper meal except on a Sunday, when my Dad
cooks me an enormous roast dinner! I used to get up late and
rush out of the house without any breakfast. Then I would grab a
chocolate bar from the vending machine. At lunch it was a quick
trip to the chippy, and then some evenings I was either going out or
going to work, so again I was grabbing a quick snack.
This unit has really made me think. Although I am not overweight, I do value my health.
My mum died of bowel cancer when I was 12, and my grandad died of a heart attack,
so there is certainly a bit of family history to consider. I hadn’t realised these things run
in families.
So when it came to Assessment activity 21.4 I looked at my own diet, which gave me
plenty of food for thought!
What I really enjoyed was learning about all the things that can affect what you choose
to eat. I notice the supermarkets’ little tricks now, trying to tempt me to buy the wrong
things. I sometimes do the shopping and even Dad has commented that I am choosing
better things – and our food bill has gone down.
So now I get up a bit earlier, make some sandwiches and have breakfast before college
– and guess what – I can concentrate better now as well!
Over to you!
1 Why do you think nutrition is important in health and social care?
2 Which part of this unit do you think you will find most difficult and why?
3 Which aspects of health and nutrition do you find most interesting?
369
1 Understand concepts of nutritional health
Get Food, glorious food

started How much do you know about healthy eating? Divide into small groups and see
which team knows the most about foods that promote good health. Perhaps your
tutor will have some healthy prizes for the team that knows the most!
1.1 Concepts Did you know?

Food Care settings have a unique opportunity to ensure
Food is any substance eaten to nourish the body. Food that individuals are well nourished, yet the Nutrition
can be solid or liquid, and can be taken by mouth, by Screening Survey (BAPEN 2007) found that between
19 and 30 per cent of all people admitted to hospitals,
tube or even directly into a vein, if a person is unable
care homes and mental health units were at risk of
to eat or drink normally.
malnutrition. According to Age Concern, six out of ten
Diet older people are at risk of becoming malnourished or
dehydrated or their situation getting worse. Patients
A diet refers to the types of food eaten regularly by an who are malnourished stay in hospital for longer,
individual. The word diet does not necessarily refer to require more medication, and are more likely to suffer
a weight loss diet. A person’s diet means all the meals from infections.
and snacks they eat.
Meals and snacks Undernutrition

The traditional pattern of eating three meals a day still Undernutrition is a deficiency of calories or nutrients
exists in some households, but a significant number and results from eating insufficient food or an
of people gain a lot of their food intake from snacks. inability to digest nutrients from the diet because
Some people have snacks between meals if they feel of a medical condition such as ulcerative colitis (in
hungry, and sometimes just because the food is there. which food passes through the digestive tract very
Snacks are not necessarily unhealthy. quickly, preventing nutrients being absorbed into
the bloodstream). A body mass index (see page 372)
Nutrients of less than 18.5 is considered underweight by the
Nutrients are the specific chemical constituents Department of Health.
of food that provide energy or support growth,
repair or normal functioning of the body. Protein,
Deficiency
carbohydrates, vitamins and minerals are all nutrients. A deficiency is the absence of a particular nutrient in
the body. This may be due to a lack of the nutrient in
the diet, or a medical condition that prevents certain
nutrients being absorbed from the diet.
1.2 Nutritional health
Malnutrition Key term
Malnutrition is any condition in which the body Overnutrition – A condition that results from eating too
does not receive enough nutrients to function much, eating too many of the wrong things, or taking too
properly. Malnutrition can include undernutrition or many vitamins or other dietary supplements.
overnutrition.
370
Overweight You can find out more about energy balance on the
British Nutrition Foundation website:
The Department of Health define overweight as
having a body mass index greater than or equal to 25. www.nutrition.org.uk/nutritionscience/energy
Being overweight increases the risk of arthritis, Type 2 Growth charts
diabetes and high blood pressure.
Babies and young children should be taken to the
Obesity health centre regularly to monitor their weight gain, so
According to the British Nutrition Foundation, obesity that action can be taken if they are not gaining weight
is a condition in which abnormal or excessive fat or they are putting weight on too quickly. Weight
accumulation in adipose tissue impairs health. A is recorded on a chart which has lines printed on it
person with a body mass index greater than or equal to show the range of weights for children according
to 30 is considered to be obese. to age, so babies can be compared to others of the
same age. The range of normality is quite large. The
The National Audit Office warns us that being obese
most important thing is the rate of increase, and just
can take up to nine years off our lives. In addition
because a baby is within the normal range for their
to the social and psychological problems linked to
age does not mean that all is well. For example, it is
being overweight, people who are obese are far more
worrying if a baby at the top end of the scale stops
likely to develop health problems such as cancer,
gaining weight.
cardiovascular disease, osteoarthritis, gallstones,
infertility and depression. Weight for height and gender
When monitoring people’s weight, it is important to
1.3 Nutritional measures consider their height (Fig 21.1). Someone weighing
12 stone 7 lb (80 kg) would be very overweight if they
Nutritional and energy balance
were 4 ft 9 in (1.45 m) tall, but normal weight if they
The body needs energy to function. Even when you were 6 ft 2 in (1.9 m). Men are slightly heavier than
are resting, your body uses energy for all the processes women of the same height as they have more muscle.
going on inside it. This is known as the basal metabolic
rate and depends on your gender, size, and the climate
you live in. The amount of extra
2.00
energy you need depends on your
lifestyle. It is important to balance 1.95
the amount of energy being used Under Ideal Over Obese Very
1.90
and the amount of calories eaten. weight weight weight obese
Too many calories will lead to 1.85
weight gain, and too few, to weight
Your height in metres
loss. 1.80
Of course, it is not just calories that 1.75

we need to think about, but the
types of foods we eat. You will learn 1.70
about a balanced diet later in the
chapter, but nutritional balance just 1.65
means having the right proportion 1.60

of different types of foods.
1.55
1.50
1.45
Fig 21.1: This chart is an easy way to 40 50 60 70 80 90 100 110 120 130 140 150 160
check if a person is a healthy weight
for their height Your weight in kilograms
371
Activity 1: See how they grow
Look at the two charts in Fig 21.2. Using the Internet or a child development book, find out what the
different lines mean. Compare the difference between the expected height at 5 and 18 years between boys
and girls. Contrast the growth patterns of boys and girls.
school entry screen and body mass index [BMI] school entry screen and body mass index [BMI]
The National Screening Committee recommends that the height and weight of The National Screening Committee recommends that the height and weight of
every boy in the United Kingdom be measured at, or around, school entry and the every girl in the United Kingdom be measured at, or around, school entry and the
data stored for the calculation of BMI for public health and the National Minimum data sorted for the calculation of BMI for public health and the National Minimum
Dataset purposes. A boys BMI centile chart [birth – 18yrs] is available. It also Dataset purposed. A girls BMI centile chart [birth – 18yrs] is available. It also
features waist circumference centiles as a second measurement to confirm fatness features waist circumference centiles as a second measurement to confirm fatness
more conclusively. The International Obesity Task Force definitions of paediatric more conclusively. The International Obesity Task Force definitions of paediatric
overweight/obesity [from 2 – 18yrs] are superimposed over the UK centiles to overweight/obesity [from 2 – 18yrs] are superimposed over the UK centiles to
facilitate international comparison. A BMI chart can of course be used to monitor facilitate international comparison. A BMI chart can of course be used to monitor
under-nutrition as well as over-nutrition. The charts may be purchased in packs of under-nutrition as well as over-nutrition. The charts may be purchased in packs of
20, 50 and 100 upwards. 20, 50 and 100 upwards.
growth assessment at school growth assessment at school

If two growth assessments have not been recorded If two growth assessments have not been recorded pre-school,
pre-school, two further assessments should be made two further assessments should be made after the school entry
after the school entry check and preferably within the check and preferably within the next 12 months to establish
next 12 months to establish normal/abnormal growth. normal/abnormal growth. Approximately 20% of growth-
Approximately 20% of growth-related disorders may related disorders may not be identifiable until the school years
not be identifiable until the school years because of because of their late onset or their association with puberty.
their late onset or their association with puberty.
Fig 21.2: There are different charts for boys and girls, and the normal patterns of gaining weight are different according to
gender. © Child Growth Foundation
372
Body mass index health. Again, this will vary according to age, size and
gender.
The body mass index is used to decide whether
people are the right weight for their height. The ideal
BMI is between 18.5 and 24.9.
Table 21.1: Examples of the information you would
expect to find for two different cereals
Activity 2: Overweight or
Cereal A
obese?
Per 30 g serving
Using the formula Typical values Per 100 g with 125 ml of semi-
weight in kilograms skimmed milk
BMI =
(height in metres)2
Energy 368 kcal 169 kcal
calculate the BMI of the following individuals:
Protein 8.0 g 6.5 g
• Stewart – weight 50 kg, height 1.7 m
• Shabnam – weight 78 kg, height 1.6 m Carbohydrate 69.1 g 26.7 g
• Claude – weight 85 kg, height 1.8 m of which sugars 26.5 g 13.9 g
Fat 6.6 g 4.0 g
of which saturates 3.6 g 2.4 g
Actual food intakes
Fibre 7.7 g 2.3 g
Sometimes there is a difference between what people
think they eat and what they actually eat. For example, Sodium 0.29 g 0.16 g
equivalent as salt 0.7 g 0.4 g
a diet may consist of only healthy foods, but if portion
sizes are large, an overweight person may be puzzled Iron 11.9 mg 3.6 mg
as to why they are not losing weight. Some people do Cereal B
not realise how often they are eating high-fat, high-
sugar foods. A food diary can be quite revealing if it is Per 30 g serving
Typical values Per 100 g with 125 ml of semi-
completed honestly, and is a good starting point for
skimmed milk
someone who is trying to improve their diet.
Energy 327 kcal 157 kcal
Recommended intakes Protein 10.8 g 7.4 g
The Food Standards Agency has produced simple, Carbohydrate 66.7 g 26.0 g
easy-to-follow guidance on healthy eating, in the form of which sugars 17.2 g 11.1 g
of eight tips:
Fat 1.9 g 2.6 g
1 Base your meals on starchy foods. of which saturates 0.4 g 1.3 g
2 Eat at least 5 portions of fruit and vegetables a day.
Fibre 13.6 g 4.1 g
3 Eat 2–4 portions of oily fish a week.
Sodium 0.57 g 0.24 g
4 Cut down on saturated fat and sugar.
equivalent as salt 1.4 g 0.6 g
5 Try to eat less salt, no more than 6 g a day.
Iron 16.1 mg 4.9 mg
6 Get active and try to be a healthy weight.
7 Drink plenty of water.
8 Don’t skip breakfast.
You can find out about recommended intakes of Reference Nutrient Intakes
specific types of food later in the chapter. Reference Nutrient Intakes (RNIs) are used for protein,
vitamins and minerals, and are an estimate of the
Dietary Reference Values amount that should meet the needs of most of the
Dietary Reference Values (DRVs) are estimates of the group to which they apply. They are not minimum
amount of energy and nutrients needed for good targets.
373
Nutrients per portion and per 100 g

of food Fruit and
Bread, other
cereals and
vegetables potatoes
When buying packaged foods, the nutritional value
has to be displayed on the label. The label explains
the amount of calories, protein, fat and carbohydrates
provided per serving and per 100 g, and will state how
much a ‘serving’ weighs for that product. Some also
list the vitamins and minerals found in that food, and
Milk and
the percentage of the recommended daily amount Meat, fish and
dairy foods
alternatives Foods containing fat
(RDA) provided. If you want to compare one product Foods and drinks
containing sugar
with another, compare the amount per 100 g on each
product. Fig 21.3: The Eatwell Plate – a pie chart like this can help
people to visualise the proportion of their daily intake that
should come from different types of foods
Activity 3: Choosing foods for
good health
Activity 4: A balanced diet
Look at the tables on the previous page. Which
product would be best for: Look at the Eatwell plate below and
• someone with anaemia needing to increase their estimate what proportion of your diet
iron intake? should be made up of the following types of foods:
• someone suffering from constipation who needs • Fruit and vegetables:
a high-fibre diet? • Bread, cereal, potato, rice and pasta
• someone trying to eat fewer calories to lose • Milk and dairy produce
weight? • Meat, fish and alternatives, such as soya
• someone with high blood pressure trying to • Foods containing fat and sugar.
reduce salt intake? You could give your answer as a fraction or a
percentage, whichever makes most sense to you.
How does this compare with your own intake?
1.4 Dietary intake guidelines

The dietary intake of an individual is simply the food
they consume. Functional skills
Maths: By estimating the proportion of the diet that
Food groups should come from different types of foods you can
The Balance of Good Health illustrates food in groups; provide evidence of mathematical skill, as you will
this is a simple way of categorising foods. The five food need to understand and use percentages, fractions
groups are: and angles at the centre of a circle.
1 Fruit and vegetables

2 Bread, other cereals and potatoes
Five-a-day
3 Milk and dairy products
The five-a-day programme promotes the message that
4 Foods containing fat and foods containing sugar people should eat at least five portions of a variety of
5 Meat, fish and alternatives. fruit and vegetables. Fresh, frozen, canned and dried
It is easier for people to plan a healthy diet if advice is vegetables, fruit and pulses all count. The programme
not made too complicated. Even children can usually includes health education initiatives to increase public
understand these food groups. awareness and inform people of the benefits of fruit
374
and vegetable consumption. There are also direct or sugar content. However, many manufacturers have
schemes to increase access to fruit and vegetables, responded to these criticisms and it is now possible
such as the Healthy Start programme and the school to buy fish and vegetables in spring water and fruit in
fruit scheme. natural juice.
Effect of food preparation/processing Freezing foods is an excellent way to preserve

goodness.
methods
Vacuum-packed foods, including bacon and fish,
The nutritional value of food can be affected by the
can be kept in the fridge for two or three weeks.
way food is prepared. Fresh vegetables served raw
The majority of bacteria found in food need air to
provide a high nutritional value. Cooking vegetables
reproduce, so vacuum packing will slow down the
destroys some of the vitamins, but some cooking
rate at which food goes off. The fridge should be kept
methods cause less damage than others. When
below 3oC for these foods, as this will prevent bacteria
vegetables are boiled the vitamins are lost in the water,
that can breed without air from multiplying. Vacuum-
and the longer they are boiled the more vitamins are
packed foods are sometimes also heated for a short
lost. A study carried out by Professor Paul Thornalley at
while, or preserved in salt solution, to increase their
Warwick University, published in 2007, found that the
shelf life.
anti-cancer substances found in green vegetables are
much reduced by boiling. UHT stands for Ultra-High Temperature. UHT milk is
If you use the vegetable water to make gravy, you briefly heated, for one or two seconds, to 135oC, which
can save some of the vitamins, or vegetables can be kills off any bacteria and spores in the milk. The milk is
steamed instead of boiled to retain much of their then cooled quickly and packaged in sterile cartons.
nutritional value. Stir-frying is also a good cooking The milk will not deteriorate for six to nine months, as
method for retaining vitamins, and only requires a it is the bacteria in milk that cause it to go off.
minimal amount of fat. Pasteurisation also involves heating milk, but only to
73oC for 15 seconds. It kills most bacteria, but not all,
Frying food retains nutrients, and dry-frying (frying
so after a week or so the milk will start to go off. Most
without adding fat to the pan) is a useful method if you
people prefer the taste of pasteurised milk to UHT.
wish to have a quick, healthy meal.
The nutritional value of food is also reduced by
keeping food hot, so whenever possible food should
1.5 Current nutritional issues
be served up as soon as it is cooked. Food labelling
Food manufacturers use various methods to prevent Falsely describing food is an offence. The Food
food from deteriorating. Canning, freezing, and Labelling Regulations 1996 require food to be marked
sealing in vacuum packs are all ways of commercially or labelled including the following information:
preserving foods. • the name of the food
Canning involves heating food to very high • a list of ingredients (including foods often linked to
temperatures to destroy bacteria, and, although allergies)
carbohydrate and protein are not affected by this, • an appropriate ‘best before’ or ‘use by’ date
some vitamins are – in particular, vitamins B1 and C.
• any special storage instructions and cooking
Canned food does not deteriorate for years, so it
instructions
is better to eat canned foods than vegetables that
are deteriorating, or meat that is past its use-by • the name and address of the manufacturer, packer
date. Canned food has been criticised as being less or retailer
nutritious than fresh food, and often having high salt • the country of origin.
375
Functional skills
Fat
LOW
2.4g per serving English: You could provide evidence of your English
skills by making a significant contribution to the group
discussion, and helping to formulate the key points.
Saturates
MED Fig 21.4: The Food
1.47g per serving
Standards Agency
recommends ‘at a
glance’ information
PLTS
Salt
HIGH on food packaging, Creative thinker: You can demonstrate your
1.5g per serving
giving consumers creative thinking ability by examining the issues from
information about different angles.
Sugars the nutritional
LOW content of foods Self-manager: Self-management skills are required to
4.8g per serving
through the use of organise your research and work with other members
traffic light colours of your group.
Organic food
Organic farming involves restrictions on the use of previously damaged the crop; to make them more
fertilisers and pesticides to control pests and diseases. nutritious; or to make foods deteriorate more slowly.
Organic food products must use ingredients that were You can find out more about genetic modification on
produced organically, and organic ingredients must www.bionetonline.org (or refer to Bionet 2009).
make up at least 95 per cent of the food. There are
only a limited number of additives used in organic
Environmental aspects of food production
food production. Modern methods of food production can affect
the environment in many ways. Pollution problems
Genetically modified foods are caused by the use of pesticides and fertiliser.
Genetically modified food involves altering the genetic There are also links between meat production and
make-up of a plant or animal, or inserting one from global warming because it has been estimated that
another organism – that is, a living thing. Genes meat production is responsible for nearly one-fifth
carry the instructions for all the characteristics that an of emissions of greenhouse gases (UN Food and
organism inherits. They are made up of DNA. Food is Agriculture Organization 2008). This is because cows
genetically modified for several reasons: to produce release methane, which causes substantially more
higher yields; to make them poisonous to pests that global warming than carbon dioxide.
Another related issue is deforestation. Meat
Activity 5: Finding out the production is a good source of income in less
truth about food production developed countries, and unfortunately this
encourages farmers to increase the amount of land
and the environment used for growing soy, which is used for cattle feed.
Look on the Internet and investigate the following This has led to the destruction of vast areas of forest
topics: in South America. In addition, the use of hazardous
• pesticides pesticides to spray the soy crop sometimes causes
• fertilisers health problems for local people.
• global warming Self-prescribed health supplements
• deforestation.
According to the Food Supplements (England)
1 In small groups, look at the sources you Regulations 2003, food supplements are defined
find and, in each case, consider the writer’s as ‘food sold in dose form whose purpose is
viewpoint. Is the article sensationalist or factual,
or a bit of both?
to supplement the normal diet, and which is a
concentrated source of a vitamin or mineral or other
2 Draw up a list of six key factual points for each
substance with a nutritional or physiological effect,
topic.
alone or in combination’.
376
There is a huge range of products marketed to Treatments for obesity

supplement our diet. These range from vitamin and
Reducing diets
mineral supplements to unusual substances like gingko
biloba, green-lipped mussel and devil’s claw, which are The first method most people try is a reducing diet,
sold with carefully worded claims about their health- which is lower in calories than those being used by
improving properties. the individual. By doing this, the person has to use
energy stored by the body as fat to provide energy not
Activity 6: What’s the obtained through eating, so they should lose weight.
Many ‘fad’ diets have been created over the years, but
evidence? the principle remains the same: eating less than the
Research on the Internet what gingko biloba, energy you use.
green-lipped mussel and devil’s claw are reputed Exercise
to do. Look at the way the claims are worded, and
investigate any scientific proof about the benefits Along with reducing the number of calories being
of taking these supplements. Then consider what eaten, increasing exercise will use more energy up, and
care workers should do if asked for advice about has the added benefit of improving heart health and
alternative therapies. mental well-being.
Surgery
Functional skills Surgery is only considered in the case of people who
ICT: Finding out information about supplements from are classed as morbidly obese, with a BMI of 35 or
secondary sources will show that you can select and more. At this size, people have significant health
use appropriate sources of ICT-based and other forms risks, such as heart disease and diabetes. If they have
of information that match requirements. been unable to reduce their weight through diet and
exercise, surgery may be considered. Patients will
Some people struggle to consume sufficient amounts
only be accepted for this treatment if they are fit for
of important vitamins and minerals due to their diet.
anaesthetic, and if they are prepared to commit to
This can include fussy eaters, those on a special diet,
follow-up care, to ensure that the cost can be justified.
and people with conditions leading to poor absorption
or frequent attacks of diarrhoea. Some people need Surgery is performed to reduce the amount of food
to consume high quantities of particular nutrients; for that can be eaten or digested.
example, a woman who suffers from heavy periods may There are three operations widely used in weight-loss
benefit from iron supplements. surgery:
Under the Food Supplements (England) Regulations • gastric band (also known as stomach stapling)
2003, the supplement container must state: • gastric bypass
• the name of the substance • intra-gastric balloon.
• the recommended daily amount Medication
• a warning not to exceed the stated recommended It is now recognised that obesity is a complicated
daily dose disorder, and that weight loss is very difficult for some
• a statement to say that food supplements should people to achieve.
not be used as a substitute for a varied diet.
There are a number of foods that have recently Key terms
been given the status of ‘superfoods’. These include Antioxidants – Substances that are especially good at
blueberries, strawberries, goji berries, walnuts destroying free radicals (harmful molecules that damage cells
and DNA and can contribute to ageing, heart disease and
and watercress. Generally these foods are high in
cancer). Antioxidants are therefore thought to lower the risk
antioxidants.
of developing cancer and heart disease.
In October 2009 the European Food Safety Authority Morbidly obese – When a person’s weight is causing
brought in regulations to ban the use of health claims disease, and likely to shorten their life.
that could not be scientifically proven.
377
Currently there are two drugs approved to help with Advertising food
weight loss, Orlistat (Alli) and Sibutramine (Reductil).
There has been a lot of media coverage on the topic
They still require the person to eat a healthy diet and
of obesity in children, and food advertisers have been
exercise, but make it a little easier to lose weight.
heavily criticised for influencing children to pester
To find out more, you can visit www.nationalobesity parents to buy unhealthy foods. Of course, this only
forum.org.uk (National Obesity Forum 2009). applies to children. Adults are expected to be able to
understand the basics of healthy eating and not be so
easily influenced by advertisements.
Case study: Georgia

Georgia is 18 years old. When she was 8 she already 1 Investigate and discuss with your peers the
weighed 10 stone (63 kg). She was being teased at options available to Georgia.
school. Her mum and the school nurse put her on 2 What are the pros and cons of each of the
diets, but Georgia comfort-ate when they weren’t treatments available for morbidly obese
looking, and her weight continued to rise. Now individuals?
she is 18 and her weight is nearly 28 stone (177 kg).
She has difficulty walking, high blood pressure, and 3 Discuss whether these treatments should be
sleep apnoea, which means that her breathing keeps available on the NHS, trying to see both sides
stopping during the night. of the argument.
Did you know?

In 2003, Ofcom, responsible for standards on TV and radio, children’s magazines, are even stricter, and only fresh fruit
was asked to consider restricting the advertising of junk and vegetables may be promoted in this way.
food. As a result, since December 2008 foods containing
It is also not permitted to use recognised cartoon
high levels of fat, salt and sugar may not be advertised at
characters to promote unhealthy foods.
times when children are likely to be watching TV.
To find out more, visit www.asa.org.uk (Advertising
Restrictions on advertising in non-broadcast media, such as
Standards Authority).
Using psychology, might it be possible to tempt

people to buy healthy foods in the same way as they
are attracted to high-fat, high-sugar foods?
378
Community project worker
Jackie works at a community project set up in a

former mining village in South Yorkshire. It is part of the Health
Action Zone set up to improve the health of the local community.
The obesity rates in the village are much higher than average and
Jackie has been researching the eating habits of the local community.
She wasn’t surprised to find a high consumption of high-fat, high-sugar
foods and a poor intake of fruit and vegetables.
Jackie decided to try to gain more understanding of the
psychology used by shops to persuade customers to buy
certain goods.
The project opened a community

shop in the centre, so they could try the same techniques to
persuade people to buy healthy foods.
Jackie found out that retailers have become very skilled at persuading consumers to
spend their money. In supermarkets the smell of freshly baked bread is often pumped out
to draw people to the in-store bakery, or just to make shoppers feel hungry.
Products the retailer is trying to persuade shoppers to buy on impulse are placed at the entrance
and at the ends of aisles.
The large supermarket chains produce own-brand products, which have a higher profit margin
than branded ones, so they often position them near well-known brands, hoping the
consumer will buy the cheaper alternative.
The products that give the highest profit are often stacked at eye-level,
as it is known that consumers are more likely to buy
products in their line of sight.
Think about it!

1 What are the major influences on your own family’s food
consumption? Think about the last week. Why did your
family buy the food it did?
2 Discuss with other people in your group reasons for making
particular food purchases.
3 Devise a plan for Jackie to use in the new shop. Think
about different types of consumers, including children,
teenagers, adults and older people, males and females.
379
Global food inequalities actually seen increases in their hunger levels since
1990’. At the other end of the scale, the World Health
According to the International Food Policy Research
Organization reports that there are more than a billion
Institute, ‘Twenty-nine countries around the world have
overweight adults in the world and 300 million of these
alarming levels of hunger, and thirteen countries have
are obese. Why do these differences exist?
Task A Task B
Produce a booklet suitable for patients in a health Carry out research to extend your knowledge about
centre to improve their understanding of nutrition. one of the nutritional issues discussed in Section 1.5.
• Start with a page explaining the terms: food, diet, Then prepare a wall display or presentation to explain
meals and nutrients. how that issue impacts on the nutritional content of
food.
• Explain what nutritional measures and dietary
guidelines could be used to identify a person who Grading tip
was malnourished, undernourished, deficient in
certain nutrients, overweight or obese. P1 To achieve P1, you need to explain concepts
associated with nutritional health. Take care to
• Use illustrations and examples to make the use clear, simple language. This will show your
information easier to understand. understanding and your ability to explain the
• Explain the dietary intake guidelines that are concepts of nutrition to other people.
published to help individuals to have a balanced
diet.
2 Know the characteristics of nutrients

2.1 Characteristics of nutrients Sugars
This section will help you to understand which foods Sugars occur naturally in foods, such as fruit and milk,
are important sources of particular nutrients, and or can be added. Some of the simplest forms of sugar
the functions of those nutrients in the body. This are glucose and fructose (found in fruit). These are
will enable you to offer suitable foods to ensure that monosaccharides, single molecules, and are easily
nutritional needs are met. You also need to understand digested by the body. Glucose can be absorbed into
the way in which processing (such as heat and storage) the bloodstream and transported around the body to
can affect the nutritional value of foods, so you can provide energy.
avoid the destruction of nutrients. Disaccharides are formed when two monosaccharides
combine. Common disaccharides include sucrose,
lactose and maltose. Sucrose is table sugar, and is a
2.2 Carbohydrates combination of glucose and fructose; lactose is the
Carbohydrates provide energy for the body. Even when natural sugar in milk and is a combination of glucose
you are asleep, your cells need oxygen and nutrients and galactose. Maltose comes from grains and is a
to function. Your heart needs to beat, your brain needs combination of two glucose molecules.
energy to maintain your vital functions and you need to Sugars are added to many types of foods. Biscuits
replace cells. This is known as basal metabolism. When and cakes contain added sugar, but you may not be
you are active you need energy for movement. About aware that there is sugar in tomato ketchup, beer,
50 per cent of the total dietary intake should come high-fibre snack bars and some tinned vegetables. It is
from carbohydrates. There are two different types of recommended by the British Nutrition Foundation that
carbohydrate, simple carbohydrates (or sugars) and no more than 11 per cent of an adult’s diet should be
complex carbohydrates (starches and fibre). sugar.
380
If a person’s diet is seriously deficient in carbohydrate

Did you know? the body starts to break down muscle and other
tissue to produce glucose. This causes a state known
The ingredient listed first on food labels is the main
ingredient. It is surprising how many foods list a sugar as ketosis, and is more often associated with people
first. Sometimes sugar is listed as: glucose or glucose with diabetes, who are unable to use glucose in the
syrup, sucrose, maltose, dextrose or invert sugar. bloodstream in the absence of insulin. Another group
where this may be seen is those with anorexia nervosa.
A diet low in carbohydrate is likely to be low in fibre,
vitamins A, B group, and E, calcium, magnesium, iron
and potassium and antioxidants. Such a diet could
increase the chances of a person developing cancer
and other diseases.
Non-starch polysaccharides
Non-starch polysaccharides (also known as fibre) are
an important component of a healthy balanced diet
obtained from vegetables and cereals. There are two
types of fibre: soluble and insoluble.
Soluble fibre can be partially digested and is important
in reducing cholesterol in the blood. It also helps
to control blood sugar levels, which in turn control
appetite. Pulses, such as peas, beans and lentils, are a
good source of soluble fibre, as are oats.
Insoluble fibre is contained in vegetable stalks,
wholemeal cereal and brown rice, for example. It is also
known as cellulose. Insoluble fibre is not absorbed by
Fig 21.5: Sugar is in many foods and drinks, not all of which the body and therefore contains no usable calories.
taste particularly sweet
It is important because it forms the bulk in our faeces,
preventing constipation, and is thought to help prevent
Starch bowel cancer and other bowel conditions. Fibre makes
The Food Standards Agency recommends that a people feel full, so they are less likely to overeat.
third of the food we eat should come from starchy
foods like pasta, rice, bread, potatoes, and chapattis. Sugar substitutes (e.g. artificial sweeteners,
Starchy foods, sometimes referred to as complex sorbitol)
carbohydrates, release energy more slowly than Artificial sweeteners allow food to be sweetened
sugars, so they will keep you satisfied longer. Starches without the use of sugars, which are high in calories
are polysaccharides, made of many monosaccharide and cause tooth decay. Saccharin was the first
molecules combined together. sweetener to be developed in 1879. Aspartame was
All carbohydrates have to be broken down into approved in 1982, and has the advantage of being
glucose before the cells can use the energy. If the suitable to use to replace sugar in recipes, which is not
body doesn’t need all the glucose in the bloodstream possible with saccharin. Sorbitol is used to produce
the hormone insulin is released from the pancreas, sugar-free products. Artificial sweeteners are 200 to
which converts the excess glucose into glycogen. This 300 times sweeter than sugar, so only a tiny amount is
is stored in the liver and muscles. Excess glucose may needed. Every time you use sweetener instead of sugar
also be stored as body fat. in drinks you save 15 calories per level teaspoonful. A
Eating insufficient carbohydrates may result in protein diet soft drink has very few calories, whereas a normal
being used for energy instead of for growth and repair. version has about 150.
381
different polypeptides, eight of which must come

Did you know? from the food we eat. The rest we can make ourselves.
Complete proteins provide all the eight essential
Aspartame contains phenylalanine, and is not suitable amino acids and include meat, fish, poultry, eggs, milk,
for individuals who have phenylketonuria, an inherited
soya and cheese.
condition where a build-up of phenylalanine in the
bloodstream causes brain damage. Protein is used in the body in a variety of ways. All
tissues in the body contain protein, including hair
and bone. Enzymes and hormones are also proteins.
Proteins are used in all activities taking place inside
2.3 Proteins the body, such as messages travelling along nerves,
Protein is a vital nutrient used by the body for growth digesting food, and muscles contracting.
and repair, so it is particularly important for infants and The recommended daily intake of protein, according
children, and people who are ill or injured. Proteins are to the Food and Agriculture Organization of United
made up of amino acids. Nations (2009), varies according to age, size, gender
Amino acids all have the same basic molecular and how active a person is. For example, a baby boy
structure: a carbon atom, with four groups of atoms weighing 4 kg needs approximately 10 g of protein per
attached. One of the four groups is always one day – about 2.5 g per kg body weight. An adult only
nitrogen and two hydrogen atoms, and this is the needs about 0.6 g of protein per kg body weight, so if
amino group. Another is always one carbon, one you weigh 60 kg you need about 36 g of protein a day.
hydrogen and two oxygen atoms, and this is the acid It is unusual for people in the UK to be short of protein
group. The third is a single atom of hydrogen, and in their diet, and it certainly should not be the case in
the fourth is a variable side chain and is the part that a residential care setting, although people receiving
distinguishes one amino acid from another. daycare may not receive an adequate diet at home.
If someone is following a vegan or vegetarian diet
you must make sure it is varied, so that all the eight
(Amino group) essential amino acids are eaten. Don’t worry too much,
NH2 as the body can store amino acids for a short time,
so as long as the diet is varied and well-balanced
CH3 C COOH (Acid group) there shouldn’t be a problem. Good vegan sources of
protein include nuts, seeds, lentils, beans and soya. In
H fact 2 oz (56 g) of kidney beans, chickpeas and lentils
Fig 21.6: The amino acid alanine contain as much protein as 3 oz (85 g) of steak. These
nutritious foods are low in fat and loaded with fibre so
they will keep you feeling full for a long time.
Polypeptides, essential and non-essential Foods we consider as protein foods are not pure
amino acids protein. For example, 100 g of lean beef contains
about 23 g of protein.
Proteins are formed when amino acids join together
in chains, known as polypeptides. They are linked by
peptide covalent bonds. The amino end of one amino
acid links with the acid group of another. There are
2.4 Lipids
20 different amino acids, which can combine to form The term ‘lipids’ means fats and oils. Lipids are
insoluble in water. About 95 per cent of lipids in our
diet are triglycerides, which are made up of three
fatty acids attached to glycerol. Bile is secreted from
the gall bladder into the digestive tract, and lipase is
Key term secreted from the pancreas into the jejunum. These
Covalent bond – A bond in which two atoms are connected
two substances split the fatty acids and glycerol apart.
to each other by sharing two or more electrons.
Fatty acids can be used as energy in most cells.
382
Glycerol can be converted into glucose by the liver and fat on meat, comes from animal sources. Saturated
can be used for cellular respiration. We need to have fat is generally solid at room temperature. Most
some fat in our diet, as it is an important source of unsaturated fat is from vegetable sources, and it is
vitamins A, D, E and K. We also need to eat fat to make usually liquid at room temperature.
hormones, to keep our skin healthy and to prevent loss Unsaturated fats contain essential fatty acids that
of body heat. If we eat too much fatty food it is stored cannot be manufactured by the body so we need to
as adipose tissue, leading to obesity. get them from food. Unsaturated fat in the diet can
Monounsaturates, polyunsaturates, and lower the levels of low-density lipoproteins (LDLs),
known as ‘bad’ cholesterol in the blood, and raise
saturates the levels of high-density lipoproteins (HDLs), known
Fatty acids are made up of carbon, hydrogen and as ‘good cholesterol’. HDLs protect against heart
oxygen. They are arranged as a carbon chain with disease. Saturated fat is blamed for the high rate of
hydrogen atoms attached and an identical COOH acid heart disease and strokes in the UK. There is also some
group to protein at one end. Each carbon atom has evidence that a diet high in saturated or unsaturated
the potential to bond with four other atoms. There are fat can increase the risk of cancer.
two main types of fat: saturated and unsaturated. In
saturated fats the carbon atoms are joined in a chain Cis and trans fats
by single bonds, and the remaining bonds are with Unsaturated fats can exist in two different forms, as
hydrogen atoms, apart from the last carbon atom, cis fats or trans fats. Most of the fats found in plants
which is attached to the acid group. Monounsaturated exist in the form of cis. Cis fats are monounsaturated
fatty acids have two fewer hydrogen atoms than the or polyunsaturated, but have a short shelf life.
carbon atoms could hold, and instead there is one Hydrogenation is the process of adding hydrogen to
double bond between two of the carbon atoms. cis fats to change them into trans fats, which makes
Polyunsaturated fats have four or more less hydrogen them saturated. It increases the shelf life, but the
atoms and consequently two or more double bonds resulting products have been found to increase the risk
between carbon atoms. of heart disease, and many food manufacturers have
The monounsaturated and polyunsaturated molecules stopped using them in their products.
are too big to fit on the page, so the illustrations below
show the principle rather than a specific molecule. Cholesterol
Most saturated fat, such as lard, cream, butter and the We naturally make a certain amount of cholesterol
ourselves, and some people make more than others.
H H H Cholesterol can build up in the artery walls, narrowing
O the lumen (the channel within the artery). If this
H C C C C happens in the coronary arteries it may eventually lead
OH
to angina or a heart attack. If arteries in the brain are
H H H
affected the risk of stroke is increased. People who
Fig 21.7: Butyric acid (saturated)
naturally make a high amount of cholesterol need to
H H H be particularly careful to eat a diet low in saturated fat.
O They can be prescribed tablets called statins, which
H C C C C reduce the cholesterol in the blood, thus reducing the
OH chances of a heart attack or stroke. Some people are
H lucky and have a naturally low cholesterol level.
Fig 21.8: An example of a monounsaturated fatty acid molecule It is recommended that adults and children over five
H H H H H H years, have a low-fat diet. Children under five years
O may struggle to get sufficient calories to meet their
H C C C C C C C energy needs if their diet is low in fat. You cannot
OH dictate to people what they eat, but it is important to
H H offer healthier alternatives and ensure that individuals
Fig 21.9: An example of a polyunsaturated fatty acid molecule are aware of healthy eating advice.
383
Table 21.2: The major vitamins, their functions, sources and characteristics
Vitamin Functions Food sources Effects of Water/fat soluble Notes

and shortage
RDA
A Night vision; Fish oil, liver, Night blindness, Fat soluble Stored in liver;
800 µg keeps skin and butter, cheese, itching, dry and excess can be
linings of nose, eggs, milk, fruit thickened skin harmful
mouth, lungs and vegetables
and gut healthy;
antioxidant
D Absorption Fish liver, oily Rickets, Fat soluble Produced in skin
5 µg of calcium in fish, eggs, milk, osteomalacia, by sun; stored in
intestine; regulates margarine, fractures liver
calcium and sunlight
magnesium in
bone tissue
E Maintains Eggs, cereal oils, Poor muscle, Fat soluble
12 mg healthy muscles; vegetable oils, circulatory and
antioxidant; nuts, seeds nerve performance
protects cell
membranes
K Blood clotting Leafy vegetables Rare, bleeding Fat soluble Widely given by
75 µg (especially spinach into brain in injection to babies
and celery), newborn babies at birth; can be
cheese and liver, made by intestinal
asparagus, coffee, bacteria
bacon and green
tea
B group Release of Liver, yeast, leafy B1 Beri-beri, Water soluble
(see energy from green vegetables, B3 Pellagra
table carbohydrates; nuts, milk and B9 Megaloblastic
below metabolism of whole grains. anaemia, neural
for fats and proteins; tube defects
RDA) health and (Spina bifida and
maintenance of Hydrocephalus,
nervous system which occur during
development of
unborn baby)
B12 Pernicious
anaemia
C Formation of Blackcurrants, Scurvy, poor Water soluble Not stored in
bones, teeth and citrus fruits, green healing, easy body so daily dose
blood; wound vegetables, bruising needed; lost in
healing; fighting peppers, tomatoes cooking
infection, healthy
skin and gums;
antioxidant
384
2.5 Vitamins haemoglobin a person will become anaemic. They will

be breathless, feel tired and cold, may be dizzy and
Vitamins are essential nutrients that your body needs
may have headaches. The pulse will be fast. It can also
in small amounts to work properly. There are two types
affect concentration.
of vitamins: fat-soluble and water-soluble. Fat-soluble
Good sources of iron in the diet are dark green
vitamins can be stored in the body and therefore do not
leafy vegetables, red meat, liver, apricots, dried fruit
have to be eaten daily, whereas excess water-soluble
and many breakfast cereals. Vitamin C increases
vitamins are excreted in the urine, so a daily intake is
absorption of iron. Taking iron supplements may cause
necessary. Soaking vegetables in water for long periods
constipation, nausea, vomiting and stomach ache. If
before cooking results in vitamins being lost in the
someone is taking iron supplements their faeces will
water. Chopping vegetables too small creates a larger
be black, and people should be warned of this so as
surface area, and more nutrients will be lost. If you do
to avoid alarm. The recommended intake of iron for
boil vegetables, use the water to make gravy. Vitamins
adults is 14 mg per day.
are also lost when food is kept hot after cooking.
Table 21.2 shows the main vitamins, their functions, Calcium
food sources and deficiency diseases, based on A good calcium intake is needed to develop strong
information from the Food Labelling (Nutrition bones and teeth. Vitamin D is required for the
Information) (England) Regulations 2009. The absorption of calcium from the small intestine. Calcium
recommended daily allowance (RDA), of vitamins is is laid down in the bones up to early adulthood, so it is
shown in Table 21.3. particularly important for young females to eat lots of
calcium-rich foods to reduce the risk of osteoporosis
Table 21.3: RDAs for B group vitamins in later life. Calcium is also essential for blood clotting,
and helps the heart, muscles and nerves to work
Vitamin RDA
properly. Calcium activates certain enzymes. Good
Thiamin (B1) 1.1 mg sources of calcium include milk, bread, flour, cheddar
Riboflavin (B2) 1.4 mg cheese, skimmed milk, green vegetables, sardines
(with bones) and tofu. Insufficient calcium in the diet
Niacin (B3) 16 mg
causes rickets, osteomalacia, osteoporosis and muscle
Pyrodoxine (B6) 1.4 mg cramps. The recommended intake of calcium in adults
Folic Acid (B9) 200 µg is 800 mg per day.
Cyanocobalamin B12 2.5 µg Other major minerals

Biotin (B7) 50 µg The tables on the next page (adapted from Food
Standards Agency, www.eatwell.gov.uk) give you
Pantothenic acid (B5) 6 mg
information about other important minerals.
Trace elements
2.6 Minerals Trace elements are minerals that are only required in
There are six major minerals and eight trace minerals very tiny amounts, so unless a person has a specific
found in food. Major minerals include iron, calcium, condition, such as a genetic abnormality, it is highly
magnesium, sodium and potassium. Even though unlikely that a deficiency will occur. Trace elements
some are only required in tiny amounts, they are include zinc and selenium.
needed for chemical processes in the body and our
health suffers if we do not get them.
Iron
2.7 Energy
Iron is essential for the production of haemoglobin Dietary sources and measurements
in red blood cells. It also helps the immune system The main dietary sources of energy are fats and
and growth in childhood. Haemoglobin is the carbohydrates. Energy is measured in both kilocalories
oxygen-carrying part of the cell, so without sufficient and kilojoules, with both being displayed on food labels.
385
Table 21.4: Magnesium, sodium and potassium: functions, sources and characteristics
Mineral and Function Food sources Effects of shortage Notes

RDA
Magnesium Needed for storing, Green leafy Symptoms include High levels of
375 mg burning and using vegetables, nuts and insomnia, muscle magnesium also
energy; keeps all the grains cramps, palpitations, cause symptoms such
minerals in balance; cold hands, soft as nausea, muscle
helps muscles to or brittle nails and weakness, low blood
work properly and depression pressure and an
keeps bones and irregular heartbeat
teeth strong; it has
an important role
in reducing blood
pressure
Sodium Helps maintain fluid Occurs naturally Dizziness, confusion, Salt lost by body
1600 mg balance (sodium in eggs, meat, tiredness, muscle in diarrhoea and
works with potassium); vegetables, milk; cramps sweating; restriction
regulates blood added to many needed in renal
pressure; aids muscle processed foods disease and high
contraction and nerve blood pressure
transmission
Potassium Helps maintain fluid Found in most Irregular heartbeat, Most is absorbed;
2000 mg balance (with sodium); foods; good sources muscle weakness excess is excreted by
needed for cells include potatoes, fruit kidneys; excess can
and nerve function; (especially bananas), cause heart failure
controls pH of blood vegetables and juices
Table 21.5: Selenium and zinc: functions, sources and characteristics
Mineral Function Food sources Effects of shortage Notes

and RDA
Selenium Selenium plays an important Good food sources Keshan disease, a Too much selenium
55 µg role in the immune include Brazil nuts, potentially fatal form causes selenosis, a
system’s function, in thyroid bread, fish, meat and of cardiomyopathy condition that in its
hormone metabolism and in eggs (disease of the heart mildest form can lead
reproduction; it is also part muscle) to loss of hair, skin
of the body’s antioxidant and nails
defence system, preventing
damage to cells and tissues
Zinc Helps make new cells and Meat, shellfish, milk Hair loss, loss of Taking high doses
10 mg enzymes; helps process and dairy foods such taste, poor wound of zinc reduces the
carbohydrate, fat and as cheese; bread, healing, diarrhoea, amount of copper
protein; helps with healing and cereal products and failure to thrive the body can absorb;
of wounds such as wheatgerm in children this can lead to
anaemia and to
weakening of the
bones
(Information in tables adapted from Food Standards Agency, www.eatwell.gov.uk)
386
We normally work in kilocalories in the UK, but is about 2 litres a day. Most of the fluid we consume
confusingly refer to them just as calories. comes from drinks, but we also get fluid from foods
1000 calories = 1 kilocalorie = 1 kcal = the energy it such as lettuce and cucumber, soups and jelly.
takes to raise the temperature of 1 kg of water by 1°C Children and older people are particularly vulnerable
1 kilocalorie = 4.2 kilojoules to dehydration as they sometimes don’t recognise
thirst, or don’t ask for a drink when they need one.
The Food Standards Agency currently recommends
Older people often restrict their fluid intake, wrongly
an average daily intake for adults as 2000 calories for
assuming that this will reduce the likelihood of
women and 2500 for men.
incontinence.
Energy values for protein, fat, carbohydrate
Dietary fibre
and alcohol
Dietary fibre is made of non-starch polysaccharides.
The energy density for proteins and carbohydrates is 4
You can read about this in the section on
calories per gram, compared to 9 calories per gram for
carbohydrates on page 381.
fat, so you should avoid fat to lose weight.
Alcohol provides 7 calories per gram of alcohol, so the Alcohol
calories in alcoholic drinks depend on the percentage Alcohol plays a significant part in British culture, and
of alcohol they contain. Drinks with high-percentage therefore cannot be ignored when exploring diet. As
alcohol, like spirits, have more calories for their volume well as its effect on overall calorie intake, alcohol can
than lower-percentage alcoholic drinks like beer and affect health in both negative and positive ways.
lager. For example, 50 ml gin has just over 100 calories, The current government guidance is that we should
whereas 50 ml lager has 20 calories. limit our weekly intake of alcohol to 21 units a week for
women and 28 units for men, spread over the week,
2.8 Other diet-related rather than in binges.
Excessive alcohol consumption can lead to an
consumption increased risk of liver damage, known as cirrhosis.
Water Some cancers are linked to alcohol, particularly liver,
mouth, oesophagus, breast, bowel and larynx. Alcohol
Water is not only found in drinks, but is also a
can also affect mental health, increasing depression,
component of many foods. For example, fresh celery is
anxiety and aggression, and it can cause dementia.
94 per cent water. Water makes up 70 per cent of the
body’s weight. It is very important that people have an In moderation alcohol is thought to reduce the risk of
adequate intake of fluids because most of the chemical heart disease, in particular red wine, which contains
reactions that take place in our cells need water. Water flavonoids that reduce atherosclerosis.
is also required to carry nutrients around the body.
Water has several very important functions including:
Key terms
• regulating body temperature
Flavonoids – The pigments in plants that function as
• improving bowel function antioxidants.
• enabling chemical reactions to take place inside cells Atherosclerosis – A thickening of the artery wall caused by
cholesterol deposits.
• helping the exchange of oxygen and carbon
dioxide in the lungs
• aiding the action of medicines.
There is medical evidence to show that water is helpful
2.9 Groups
in preventing or reducing the effects of a wide variety Young children and young people
of conditions, including constipation, blood clots, low Growth and development is fast during this phase,
blood pressure, kidney stones and incontinence. and children should be very active. Protein and
Opinions vary about the amount of fluid that adults carbohydrates are therefore very important. The diet
should drink daily, but the average recommendation should follow the Food Standards Agency guidelines
387
outlined on pages 373–374. If children are hungry You can access the report by visiting the Age Concern
between meals, healthy snacks should be offered, such website: www.ageconcern.org.uk
as fruit or toast. Crisps and sweets will increase the risk Similarly, the Royal College of Nursing, with the
of obesity and tooth decay. Nursing Standard, launched a campaign on 18 April
Adults 2007 entitled ‘Nutrition Now’, following a survey
of over 2000 nurses to find out the main barriers to
Once growth has stopped, adults need to maintain
helping patients to get good nutrition. The main
their weight, but should try to avoid putting on extra
reasons given were the lack of availability of food
weight. High-fat foods should be kept to a minimum,
outside mealtimes and the lack of staff available to
as they raise cholesterol. Being overweight can also
support patients during mealtimes. Many hospitals
increase the chances of developing arthritis, diabetes
have now introduced protected mealtimes.
and cancer. To reduce the risk of developing high
blood pressure. salt should be limited to 6 g per day, Pregnant and breast-feeding mothers
which is about 1 teaspoonful. High-sugar foods should Extra folic acid should be taken during the first three
be a treat rather than a regular part of the diet. Ideally, months of pregnancy, as this is recommended to
alcohol consumption should be limited to 1 unit a day prevent spina bifida.
for women and 2 units a day for men.
During the last three months of pregnancy a woman
needs about an extra 200 calories a day. While breast-
Did you know? feeding, she will need an extra 500 calories. Extra
calcium should be eaten as the developing baby will
1 unit of alcohol is:
take what it needs, leaving the mother deficient. This is
• half a pint of 3.5 per cent proof beer, cider or lager
why women often have to have more dental treatment
• or a 125 ml glass of 9 per cent proof wine
during pregnancy and for the first year after having a
• or a 25 ml measure of spirits
baby.
Pregnant women are advised to avoid certain foods
Older people that are known to be a potential risk to the unborn
The dietary needs of older people do not change and child. These include soft and blue vein cheeses,
they should follow the basic guidelines for a healthy pâté, unwashed raw fruit and vegetables, raw or
diet in order to avoid poor nutrition. undercooked meat, unpasteurised goats’ milk or
In August 2006 Age Concern published a report goats’ cheese, and liver. It is also recommended that
entitled ‘Hungry to be Heard: The Scandal of pregnant women eat no more than four medium-
Malnourished People in Hospital’. The report looked sized tins of tuna per week, as tuna has been found to
at the numbers of people, particularly older people, contain traces of mercury.
who become, or stay, malnourished in hospital. There
were several reasons suggested including:
• insufficient help being offered to those who are
unable to feed themselves independently
Key terms
• staff failing to notice when patients were Protected mealtimes – A policy whereby patients must not
persistently leaving meals be disturbed from their meals for treatments and tests.
• food being placed out of reach Spina bifida – A condition in which the backbone is not
• failure by staff to ensure that personal preference is properly formed. It can result in paralysis.
taken into account.
388
Task A Produce one booklet that discusses nutritional and

Produce a set of wall charts, one for each of the energy requirements, comparing and contrasting
following nutrients, which demonstrate your similarities and differences between the two groups
understanding of the characteristics of the nutrients for each nutrient, and for energy.
and their functions:
Grading tips
• carbohydrates
P2 To gain P2, you must describe fully the
• proteins characteristics of nutrients and their benefits to
• lipids the body. A list of bullet points or a table is not
sufficient. Avoid copying out the charts from the
• vitamins
book.
• minerals.
M1 To achieve M1, you have to examine similarities
Make the charts as attractive as possible, using and differences in the nutritional and energy
images to create visual stimulation. requirements of two groups of individuals.
Task B You need to show your understanding of the
fact that people need different amounts of
Choose two of the following groups of individuals:
certain nutrients at each life stage, depending
• young children on whether they are growing, very active, or if
• young people they need to actively prevent certain disorders.
You can also discuss differences within the
• adults
group – between male and female, or active or
• older people sedentary jobs, for example.
• pregnant women and breastfeeding mothers.

Independent enquirer: The activity requires ICT and English: You can use your ICT skills to find
you to carefully check the differences in nutrient and select information about the nutrients, and you
requirements at different life stages against reliable can use writing skills to produce the booklet.
sources of information about nutrient content of foods.
Creative thinker: You can demonstrate this skill
by researching carefully and not relying on your
assumptions.
Self-manager: This activity requires you to work carefully
and thoughtfully to produce an accurate set of fact
sheets and a professional-looking booklet within a
specified timescale.
389
3 Understand influences on dietary intake and

nutritional health
3.1 Health factors anaemia and osteoporosis. It can also increase the risk
of bowel cancer.
So far, this chapter has concentrated on the diet of
Symptoms include abdominal pain, diarrhoea,
healthy people, but there are many underlying health
constipation, bloating, failure to gain weight in
conditions that result in specific nutrient needs, and
childhood, weight loss in adulthood, and anaemia.
influence what people can and cannot eat. It is always
important for individuals to eat a healthy diet, and People with coeliac disease need to eliminate all
include all the essential nutrients, but it can be more foods containing wheat, rye and barley from their
complicated – when you have to avoid certain foods – diet. Gluten-free products are available, but are very
to ensure that you eat a balanced diet. expensive to buy. If a person has been medically
diagnosed with coeliac disease some gluten-free
Diabetes mellitus products can be obtained on prescription. Food lists
Diabetes mellitus is a condition in which the hormone are available from Coeliac UK, and some information is
insulin is either not being produced by the pancreas, available on the Internet at www.coeliac.org.uk.
is being produced in insufficient quantities or is not
being used properly by the body. There are two types
of diabetes mellitus. If left untreated, the most severe Case study: Sonia
type of diabetes would lead to certain death due to
lack of glucose in the cells and vital organs. Sonia works as a carer, visiting people who
require help at home. One of the people she
The most severe type is IDDM (insulin dependent visits is Mrs Hannaway, a lady in her eighties, who
diabetes mellitus). It is sometimes known as Type I has a number of health problems including gluten
diabetes. The less severe form is NIDDM (non-insulin intolerance. Sonia has to bear this in mind when
dependent diabetes mellitus). It is sometimes known she does the shopping and cooking for Mrs
as Type 2 diabetes. IDDM is treated with insulin Hannaway.
injections, whereas NIDDM is treated either by diet 1 Make a list of foods that contain gluten.
alone or with a combination of diet and tablets. 2 Design a menu for one day for a person who
Anyone with diabetes should see a registered dietician. has to avoid gluten; try to make it as tasty as
possible.
A healthy diet is important, as poorly controlled
diabetes can lead to some very serious complications, 3 Next time you are in a supermarket look at the
range of foods available to customers who are
including blindness, kidney failure, strokes, and
intolerant to particular food components. It is
gangrene, leading to amputation of lower limbs. useful to see what you can buy in case you ever
need to get some at short notice. Compare the
Coeliac disease prices of these products to other foods in the
This is intolerance to the protein gluten, which is supermarket.
found in wheat, barley and rye. Gluten causes the
immune system to produce antibodies, which attack
the lining of the bowel. This can affect the body’s
ability to absorb nutrients from food, and can lead to Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a condition where the
bowel function is easily disturbed, causing abdominal
Key term pain, flatulence, bloating and either constipation or
Intolerance – A condition in which a specific food causes diarrhoea, or even both. However, on examination
unpleasant symptoms such as diarrhoea, bloating and wind. there is no apparent abnormality in the bowel. The
An intolerance is not the same as an allergic reaction. cause is not clear, but there seems to be overactivity
in the nerves in the gut, and some people can identify
390
particular foods that cause their symptoms. Sometimes

IBS develops following a bout of diarrhoea caused Key term
by an infection, and continues after the infection Allergen – A substance that can cause an allergic reaction
has gone. Some people find that they have these in sensitive people when their immune system recognises
symptoms after a course of antibiotics, which kill the it as ‘foreign’. These substances cause no response in most
normal bacteria that should be present in the bowel. people.
There is a lot of varied advice given to people with IBS,
but the best thing is to experiment with the diet to try Some people develop a severe reaction called
to identify which foods make it worse, and avoid them. anaphylactic shock. This is a rare but potentially fatal
Probiotic yogurt drinks may also help. allergic reaction where the symptoms develop all
For more information, visit www.patient.co.uk/sitemap. over the body, causing swelling, a rash (hives), loss
asp/ and look up Irritable Bowel Syndrome under ‘I’. of consciousness, low blood pressure and breathing
problems. Every effort should be made to ensure
Lactose intolerance that the person is never given food containing the
Lactose, the natural sugar in milk, is a common substance to which they are allergic. Anyone who
intolerance. It can be mild or severe. Children who are is known to have a severe food allergy should be
lactose intolerant do not produce lactase, an enzyme prescribed an Epipen, which they should carry with
that is used to break down lactose into glucose and them at all times. Both the person and anyone who
galactose before being absorbed during digestion. cares for them should be trained to use the Epipen.
Children with this condition in its severest form have
difficulty putting on weight and suffer from diarrhoea. An Epipen can quickly deliver adrenaline to
The lactose ferments inside the bowel, causing lessen the symptoms of anaphylactic shock
bloating. Lactose is present in a wide variety of foods,
including chocolate, cheese, ice cream, mayonnaise
and cakes. Anyone eliminating all these products from
their diet is at risk of calcium deficiency, which can lead
to rickets and osteoporosis, so it is important to make
sure that sufficient calcium is still eaten.
Food allergy
Some people may have an allergy to particular foods.
A food allergy is sometimes confused with food
intolerance, but, in fact, is much more serious. An allergic
reaction can be severe and life-threatening. In adults,
the most common food allergies are to nuts, fish and
shellfish. In children cows’ milk, eggs, soya, and wheat
are common allergens, but any food can cause allergies.
Symptoms
Following contact with the allergy trigger food, the
person will develop one or more of the following signs
and symptoms within minutes or hours:
• itchy mouth
• swollen lips, mouth, tongue and/or throat
• rash
• wheezing
• vomiting and/or diarrhoea
• red itchy eyes.
391
Loss of ability to feed independently Some people may need to be fed via a tube. This is
Unfortunately some people are unable to feed usually due to problems with the digestive system.
themselves independently, either throughout their Swallowing difficulties, known as dysphagia, can cause
lives, or following an accident, leading to paralysis, a person to choke frequently, or be unable to eat
or development of a debilitating condition. A further sufficient food to maintain nutritional health. A stroke
reason may be that they are unable to take food in or cancer of the oesophagus can cause dysphagia.
through the mouth and have to be fed by tube. Liquid feeds can taste unpleasant. Sometimes a tube
is passed up the nose and down the throat, but if it is a
If some degree of independence can be maintained,
permanent problem a gastrostomy can be created – a
then it should be. There are a wide variety of gadgets
hole through the abdomen straight into the stomach
available to assist people who are having difficulty
(sometimes called a PEG or Mic-Key button).
in feeding themselves. Some of these include wide-
handled cutlery, plate guards and non-slip mats. Tube feeding is potentially very unsociable. Children
may be happy to be fed at the table and play with
Another way of maintaining independence is to cut up
utensils, but teenagers and adults may be self-
food before serving it, enabling a person to manage
conscious, and prefer to be fed in private. You should
without further help.
always respect privacy and dignity.
Sometimes there is no possibility of an individual
feeding themselves. This may be because of cognitive
impairment, such as advanced dementia, where a
person does not even recognise that their meal has
arrived, or know how to feed themselves. Whatever
the reason for needing full support with eating and
drinking, it is important that meals are given while they
are still hot. The person should not feel a nuisance,
so you should sit down and create a relaxed situation
where the meal can be enjoyed. Make sure you protect
the clothing with a napkin. Offer drinks frequently, do
not overfill the person’s mouth and let them swallow
one mouthful before offering more. Ensure that they
are offered enough to eat. It may be necessary to tell
the person what you are going to feed them, especially
if they have a visual impairment or are confused. It is an
opportunity for some social conversation as well.
A gastrostomy may be
The face and hands should be washed at the created for someone who has
beginning and end of the meal. problems swallowing food
What problems do you think

these items could help with?
392
3.2 Dietary habits to be taken into account, as you also need to ensure
that the diet provided is nutritionally balanced. So it is
Meal patterns not enough just to serve the same meal to everyone,
‘Meal patterns’ refers to the way a person takes their omitting the foods that are not wanted. They must be
food. Some people stick to the traditional three replaced with foods of equal nutritional value.
meals a day. However, there are many possible
Food availability
variations. Some households do eat together, but in
Another influence on the diet taken is the food that is
an increasingly busy world mealtimes have changed
available. You can probably think of many occasions
in many families, with individual family members
when you have eaten a chocolate bar just because
eating separately, people eating frequent snacks, and
it was in the house, and if it had not have been you
microwave meals all being normal patterns. According
might have had toast instead! It is important that
to the website www.disordered-eating.co.uk, ‘It is
healthy food is readily available for people using
thought that eating meals regularly together as
health and social care services, or they too will not eat
a family may help to prevent the onset of eating
a healthy diet. National Minimum Standards for Care
disorders in children and adolescents’.
Homes for Older People require that residents should
There has been an increase in the habit of ‘grazing’
have access to cooking facilities. Drinks should be
over recent decades, and this pattern of eating is one
readily available. Water should be available at all times,
of the factors blamed for rising obesity levels in the UK.
perhaps by leaving jugs of water for people to help
Snacking themselves.
Eating between meals, once discouraged, is now For those who live in their own homes, but who are
normal behaviour in the UK. If the snacks consist unable to cook or shop independently, planning is
of healthy foods, such as fruit, and do not push the needed to ensure that food and drink are available
daily calorie intake above energy use, then there is when needed and desired. Lunchtime can usually
no problem with this. However, snacks often consist be accommodated by the local meals service, which
of high-fat, salty and sugary foods so this can be is organised through social services. Hot meals are
a problem. Occasional unhealthy foods are of no delivered daily, even at weekends in cases where
consequence, but people who consume several there is no realistic alternative. Some local authorities
packets of crisps a day or several bars of chocolate are provide a choice of meal, which has to be ordered
significantly increasing their risk of obesity, high blood in advance; others will just deliver meals without
pressure and heart disease as they age. offering a choice. Special diets will be catered for. If
the meal arrives too early, it can be kept hot in the
Personal tastes oven, although this will reduce the nutritional value as
Most people have likes and dislikes in foods, and very vitamins levels soon start to drop as food is kept hot.
few people like absolutely every food offered to them. The food should be kept above 63oC to prevent food
Some people feel it is morally wrong to eat animals, poisoning (Food Standards Agency, 2005). It is less
and therefore wish to follow a vegetarian diet. Some risky to keep the food hot than reheat it, but if food is
people extend this to a vegan diet, where no animal being reheated after being allowed to cool it must be
products are eaten at all. Religion can also impose piping hot all the way through.
restrictions on dietary intake. When providing food For other meals, people may be able to manage
and drink for individuals these considerations need independently as long as the food is in the house.
Shopping can be done by a home care assistant,
a relative, a neighbour or by ordering on the
Internet. For those who cannot prepare any meals
Key term independently, a home care assistant, relative or
Vegetarian – A diet that omits all meat and fish, but includes neighbour might help. If a cooked lunch has been
dairy produce. provided, many people will be happy with a flask of
Vegan – A diet that omits all animal products. hot drink or soup and a light evening meal left in the
fridge, covered to keep it fresh.
393
3.3 Lifestyle
Eating at home
Eating at home means that
you can have total control
over what you eat. Cooking
from raw ingredients can be
a real eye opener when you
find out exactly what goes into
particular recipes, and is likely
to make you eat a healthier diet.
However, the sales of ready
meals have rocketed in recent
years. Research conducted by
Mintel estimated that Britons
spent £1.9 billion on ready
meals in 2006 and 30 per cent
of adults in the UK eat at least
one ready meal a
week.
The social services meals service
The 2008 Tesco survey on home ensures that older people and those
cooking, which was reported with disabilities get at least one
in The Daily Telegraph, found cooked meal a day
that people in the UK were
cooking more foods that originate from abroad (such
as spaghetti bolognaise) than traditional British dishes • 60–70 per cent of calories in the diet from
like Lancashire hotpot. Of course, many traditional carbohydrates
British meals are high in fat and sugar, so this trend is • 12 per cent from protein
not necessarily a bad thing.
• and the remainder (18–28 per cent) from fat.
Social eating and drinking This in effect means eating a diet far higher in
carbohydrate, and lower in fat and protein, than the
According to the Office of National Statistics, the
average.
amount of money spent on eating outside the home
more than doubled between 1992 and 2004. The risk Carbohydrate is important for athletes, as it provides
of eating out frequently is that it is tempting to choose fuel. Carbohydrate is stored as glycogen in the liver
high-fat, salty and sugary foods, which is fine for and muscles, and released when needed during
occasional treats, but not on a regular basis. The Food exercise. It can be quickly broken down to provide
Standards Agency website gives advice on making energy, but only limited amounts can be stored,
healthy choices when eating out. so during prolonged periods of exercise glycogen
will become depleted, leading to an increased
Exercise/activity levels risk of injury. The other source of energy is fat, but
People who participate in strenuous activity will this cannot be converted into energy as quickly as
have different dietary needs. Professional athletes glycogen.
usually have a dietician to advise them on the most The other crucial component of the diet for athletes
appropriate diet for their sport. is fluids. Water is usually adequate, but for intense
The International Conference on Foods, Nutrition activity isotonic and hypotonic drinks are useful to
and Sports in Lausanne (1991) agreed the following speed up the process of water transferring into the
optimum nutrient intakes for most sports: bloodstream.
394
Activity 7: Calorie Leisure pursuits

The way people spend their leisure time can also
calculator influence what they eat. Eating out and sporting
There are several websites that enable you to activities have already been discussed. Most people
calculate how many calories are burnt up by doing eat differently on holiday, and this can be a time when
different types of exercise. people eat unhealthily and justify it to themselves.
Experiment with all the different types of sports and Some destinations can pose risks due to poor food
fitness activities you participate in to see which ones hygiene, and some parasitic diseases can cause long-
burn the most calories. term health problems.
3.4 Economic factors

PLTS Cost of food
Independent enquirer: You can provide evidence It is generally accepted that a healthy diet costs more
of independent enquiry by demonstrating your than an unhealthy one. Supermarkets have been
appreciation of the potential effects of choosing criticised for focusing on high-fat, salty and sugary
different types of activities.
foods when running promotions. The Low Income Diet
and Nutrition Survey (LIDNS) was commissioned by
the Food Standards Agency and published in 2007. It
looked at the eating habits, nourishment and nutrition-
related health of people on low incomes. You can see
Occupation a summary of its results on:
Another influence on the diet needed is your www.food.gov.uk/science/dietarysurveys/
occupation. It will be no surprise to you that a
building labourer will use up far more calories than
an office worker. Just like athletes, manual workers Activity 8: Diet and low
should gain the extra calories they need from starchy
income
carbohydrates rather than from fatty foods.
As people get older, they may do less physical activity, Have a look at the results of the Low Income Diet
so if this is the case, their energy needs reduce. If they and Nutrition Survey to help you understand more
about the effects of low income on diet.
do not reduce their calorie intake they will start to gain
weight, which will put strain on ageing joints. Make a table to compare the nutritional intake of
people on a low income with the average for the
When trying to decide whether an older person is general population.
eating sufficient amounts of food, it is important to
keep an eye on their weight. Weighing someone
monthly should soon tell you if they are starting to lose
or gain a significant amount of weight, and action can
PLTS
be taken to rectify this. Creative thinker: You can demonstrate creative
thinking by trying to explain objectively why people on
If a person is losing weight they are obviously not low incomes usually eat a particular diet.
eating enough calories. This might be because they
have lost their appetite. The food being consumed
will need to be a good source of protein, vitamins Not all healthy foods are expensive so you may be able
and minerals. The highest-calorie foods are fats but, to advise people on healthy foods that they can afford.
of course, you cannot just feed people on high-fat For example, chicken and pork tend to be cheaper
food, as this could raise their cholesterol levels. Plant than beef and lamb, and are healthier foods, because
foods, such as nuts, seeds, olives and avocados, have they are lower in fat.
unsaturated fats that are less harmful than animal fats, Larger supermarkets often produce own-label products
so these could be one solution. with very similar nutritional value to branded ones.
395
Some supermarkets have two ranges of own-label

products, with the more expensive one usually being
3.5 Socio-cultural issues
One of the biggest influences on diet is the family. You
of a similar quality to the branded ones. Budget own-
will have developed your first eating habits from your
label foods are sometimes higher in fat, salt and sugar,
carers and it is they who have guided you about what
with poorer-quality ingredients. However, some of the
you should and should not eat. This may have been
budget own-label foods are still nutritious. As a rule,
directly through teaching you about healthy eating or
unprocessed foods, such as raw meat and vegetables,
religious rules, or indirectly through the foods that you
from the budget range are a good buy.
have been served and your carers’ own preferences
Access to shops and tastes.
The food you are able to eat may depend on how Fasting and feasting feature in many religions, along
easy it is for you to access shops. Supermarkets usually with beliefs about certain animals being sacred or
provide the best value for money, with a better choice unclean.
and more competitive prices. Most supermarkets can
be accessed by public transport. If you live in a rural
location and do not have a car, you may have to shop
at a small local shop, which can be expensive with a
Activity 10: Religious rules
limited range. Internet shopping has helped those with on eating and drinking
access to the Internet and the skills to use computers. Investigate the religious rules around diets.
Food supply 1 Choose a religion, find out which foods are

prohibited and why.
At one time, fruit and vegetables were sold only
2 Consider whether the religious restrictions could
when they were in season. Now we are in a global
affect health.
market and produce travels many thousands of miles
around the world. This means that most fruit and
vegetables are available most of the year, which has
had a big influence on menus. In developing countries As children are brought up, they are socialised into
and remote areas there will be much more seasonal the norms of their culture. Mealtimes are more
variation affecting what people eat. important in some cultures than others. Where they
The fact that we expect to be able to buy all types of are important, a mealtime is a good opportunity to
food all year round has had a dramatic effect on some introduce good manners and the ability to make
food supplies. One example of this is fish. social conversation. Being a guest at another family’s
mealtime can be awkward for young children, as they
are faced with unfamiliar foods. It is an opportunity
Activity 9: Pollock and chips, to introduce children to a variety of foods and to
please! encourage them to take risks by trying them.
Over-fishing of cod has depleted stocks of this fish in Some religious occasions involve food rituals. For
the sea, as we are catching fish faster than they are example, in Hinduism there is a ceremony called
able to reproduce. Annaprasana for a baby’s first meal of solid food.
1 Find out what other species of fish are now being
used to make products like fish fingers. 3.6 Education
2 Design a campaign to persuade customers that A substantial amount of money is spent on educating
they should try other fish.
the population about healthy eating, and food
hygiene, and this education has had a considerable
influence over the foods we choose to eat, and how we
PLTS prepare them.
You can show your creative thinking abilities by
devising an imaginative campaign.
396
Public health Table 21.6: The Food Standard Agency’s ‘traffic light’ guide to
what is regarded as high or low quantities of sugar, fat, fibre
The environmental health department of each borough and salt and sodium
council is responsible for monitoring anyone preparing
food for public consumption to ensure that the food High per 100 g Low per 100 g
they serve is fit to eat, and prepared in a hygienic way. Sugars 10 g 2g
Any food that is found to be unfit is confiscated and
Fat 20 g 3g
destroyed. If unsafe food hygiene practice is identified,
improvement notices are issued, and organisations Saturated fat 5g 1g
can be temporarily or permanently closed. Inspections Fibre 3g 0.5 g
are carried out both with and without warning, and
Salt 1.25 g 0.25 g
good practice is rewarded through a scheme awarding
between 0 and 5 stars. Sodium 0.5 g 0.1 g
Health education example, unless the food is much lower in calories than
In recent years there have been a number of prominent the standard version. There are no legal definitions for
campaigns to improve public awareness of healthy terms such as ‘low-fat’; however, producers would not
eating. The five-a-day campaign began in 2003, when be allowed to describe a high-fat food as ‘low fat’.
a £150,000 Big Lottery grant was awarded to improve If a food label has an image on it of an ingredient, that
the consumption of fruit and vegetables in Primary ingredient must be contained in the food.
Care Trusts. The success of the campaign has been
monitored, but by 2008 only 12 per cent of the UK Role of health professionals
population was managing to achieve this target. Dieticians
However, the report did say that children’s lunch boxes Dieticians work with patients who need a special
now contain 16 per cent more fruit and 25 per cent diet, and they try to enable the individual to eat
more vegetables than a year before. within the restrictions of their medical condition while
Other health education campaigns include ‘Eat Well, maintaining a healthy balanced diet.
Be Well’ and ‘Change 4 Life’. Public health nutritionists
Food hygiene Public health nutritionists do not work with individuals,
Food hygiene is crucial for the provision of food that but advise the government about healthy eating
will benefit health. It doesn’t matter how fresh or high messages that can inform policy makers. Their advice
quality the food is, if good hygiene is not practised forms the basis of public health campaigns.
it will make people ill and could even kill them. Doctors
Good food hygiene involves frequent hand-washing, General practitioners (GPs) are in an ideal position
correct storage of food, and thorough cooking. More to discuss diet during consultations. Many of the
information can be found about food hygiene in people they see do not regularly see any other health
Unit 3 Health, safety and security in health and social professional. They may have come to discuss a minor
care, and by visiting the Food Standards Agency ailment, but the GP can take the opportunity to check
website (www.food.gov.uk). their weight or blood pressure, or order blood tests for
Marketing and labelling diabetes or cholesterol levels. Advice about avoiding
saturated fat or high-salt foods can be given, and a
Food labels allow people to make choices about the
referral made to a dietician if necessary.
food they eat. If a person is trying to choose a healthy
diet they need to know whether food is high or low in Nurses
different components. Nurses also need a good understanding of both
Many foods are marketed as healthy options, and healthy diets and special diets. They are expected to
some food manufacturers make claims about their know what foods to suggest and what to avoid for
health benefits. There are rules governing this. a range of medical conditions. They are involved in
Manufacturers cannot call foods ‘reduced calorie’, for administering tube feeds and ensuring that those who
397
are unable to eat independently receive adequate Every Child Matters was a government Green Paper
food and drink. The ‘Better Hospital Food’ programme published in 2003, following the death of Victoria
was introduced during 2001, and included the Climbié, aiming to improve the well-being of all
requirement for hospital wards to introduce protected children, and was the forerunner of the Children Act
mealtimes (during which non-urgent treatments are not 2004. One of the intended outcomes of Every Child
allowed if they will disturb patients from eating their Matters is ‘being healthy’ and the quality of food
meals). The initiative also introduced 24-hour catering, that children eat is one aspect of this outcome. The
meaning that patients can ask for hot food, snacks and outcomes were revised in 2008.
drinks at any time of the day or night. In Scotland the Early Years and Early Intervention
Carers Policy has much the same aims for improving child
Care workers in both residential and community settings health. For more information on this, visit the Scottish
should understand healthy eating and special dietary government website (www.scotland.gov.uk).
requirements. However, this has not always been the The government publication Healthy Weight, Healthy
case. In response to a 1998 survey, which revealed Lives: One Year On looks at progress towards reducing
serious problems with nutrition in care homes and childhood obesity. It states that, ‘Our ambition is to
hospitals, Skills for Care, the sector skills council for the be the first major nation to reverse the rising tide
care industry, devised a set of knowledge sets, setting of obesity and being overweight in the population
out the minimum level of understanding that care by ensuring that everyone is able to achieve and
workers should have in a variety of topics, including maintain a healthy weight. Our initial focus will be on
nutrition and well-being. It is hoped that this will address children: by 2020, we aim to reduce the proportion of
the poor understanding of some care workers and overweight and obese children to 2000 levels.’
improve their ability to advise individuals on good diet. In 1996 the Scottish government launched ‘Eating for
Sports nutritionists Health: a Diet Action Plan for Scotland’.
A sports nutritionist will work with athletes to devise In 2004 ‘Eating for Health: Meeting the Challenge’ was
a diet that maximises their strength, stamina and published, reviewing the strategies.
fitness to enable them to perform at their best. The The Food Standards Agency launched the Healthy
nutritionist prepares a diet plan that considers different Food Code of Practice, encouraging clear labelling
needs according to whether the person is training for on packaging indicating the levels of saturated fat,
an event, recovering from an event, or resting. The diet salt and sugar in foods (Every Child Matters 2008). The
usually includes powder supplements as well as normal Scottish Executive Health Department and the Food
foods to match the requirements of the particular sport Standards Agency Scotland jointly established the
they participate in. Scottish Food and Health Alliance to support further
Health and fitness instructors the implementation of the Scottish Diet Action Plan.
These staff work at gyms and leisure centres and The School Food Trust (SFT) was set up by the
include personal trainers who work with people who government in 2005 to improve the nutritional quality
are trying to improve or maintain their fitness levels, of food served in schools and the cooking skills of
but are not athletes. These instructors have a good children and their parents.
understanding of diet and healthy eating, as this is part Research carried out by the SFT found that there had
of their training. been an improvement in school lunches, but not in
packed lunches brought from home.
3.7 Social policy Nutritional Standards for School Lunches were agreed
Legislation, regulations and policies by the School Meals Review Panel and implemented in
2006. The standards require that:
There have been several attempts to improve the
diet of the population through social policy. This is a • high-quality meat, poultry or oily fish are regularly
different approach to health education, and involves available
creating more opportunities for people to choose • at least two portions of fruit and vegetables should
healthy foods. be available with every meal
398
• bread, other cereals and potatoes are regularly appealing, wholesome and nutritious diet, which is
available suited to their assessed and recorded requirements,
• deep-fried food is limited to no more than two and that meals are taken in a pleasant setting and at
portions per week flexible times.
• fizzy drinks, crisps, chocolate and other Residents should be offered a choice of three meals
confectioneries are removed from school meals and a day, at least one of which should be cooked. Drinks
vending machines and snacks should always be available. Foods should
• children and young people must have easy access be nicely presented and appetising. Special diets
at all times to free, fresh drinking water in schools. should be catered for, including religious and cultural
diets. Menus should be available in different formats.
Under the National Minimum Standards for Care
Diet should be assessed on admission and recorded
Homes for Older People, the registered manager is
on the care plan.
required to ensure that individuals receive a varied,
Using a case study approach, explain how the Grading tips

following factors have influenced four individuals’
diets:
P3 To achieve P3, you need to explain how each
of the factors influences what people choose to
• medical disorders eat.
• personal preference M2 To achieve the merit, you need to make a link
• lifestyle between the factors that influence the food
choices people make and how this can increase
• socio-cultural factors or decrease risks to their health. Try to balance
• economic positive and negative influences.
• social policy. D1 To achieve the distinction, you need to think
For M2, assess how influences on dietary intake may creatively about what you could do to help
affect the nutritional health of individuals. people overcome the effects of negative
influences. This will usually involve giving
Choose a setting, such as a residential home, a day people skills and knowledge, and changing
centre or a Sure Start nursery, and make realistic their attitudes, away from feeling helpless
recommendations about how you could compensate and towards taking personal responsibility to
for negative influences on diet in that setting. improve a situation.
PLTS
Self-manager: You can demonstrate self-
management skills by working carefully and
thoughtfully to produce innovative case studies showing
how negative influences can be overcome and by
submitting your work within the timescale given.
Why do you think encouraging children to

enjoy cooking at school can have a positive
impact on healthy eating at home?
399
4 Be able to use dietary and other relevant

information from an individual to make
recommendations to improve nutritional health
4.1 Recording food intake 4.2 Sources of nutritional
In order to assess a person’s actual diet, it is often information
necessary to keep an accurate diary of everything
Information about the recommended intake of
eaten and drunk over a period of a few days. This can
nutrients is available. Some of these sources are more
be a real revelation, and many people are surprised
complicated than others. The Food Standards Agency’s
when they see exactly what they have been consuming.
‘Eat Well, Be Well’ campaign offers dietary guidance in
The record needs to cover all food eaten including
a way that is fairly easy to follow, although, apart from
meals, snacks, sweets, drinks and food supplements.
fruit and vegetables, it does not provide much help on
It should indicate the portion size as well, as it is not
portion sizes.
just what a person eats but how much that is important
when assessing intake. In section 2 of this unit you will find information about
the recommended daily amounts of components
A comprehensive nutritional analysis method involves
of diet to help you analyse a person’s food intake.
recording the frequency of eating specific foods,
You can also look at the British Nutrition Foundation
categorising them as in the example below. This type
website (www.nutrition.org.uk).
of table can be used to analyse food intake over a long
period of time without the need for a detailed record Many food manufacturers now give indications
of everything eaten. of portion sizes on the package, and also include
information about the amount of specific nutrients in
You could clearly see from this type of chart whether
the food, both as a portion and as 100 g.
a person was eating a healthy diet, and if not, which
nutrients they were eating too much or too little of, by
comparing their intake to the recommended healthy 4.3 Quantitative analysis
balanced diet for that person according to age, gender When analysing a person’s diet, you need to identify
and activity level. Of course you would also need to how much of each nutrient they are consuming daily,
take into account any dietary restrictions. including energy in calories, and the proportion
Table 21.7: Frequency of eating chart

Never/less than once a month
1–3 times a month
2–4 times a week
5–6 times a week
2–3 times a day
4–5 times a day
6+ times a day
Once a week
Once a day
Food and amounts

Fruit and vegetables ✓
100 g meat/fish ✓
400
gained from fat, protein, iron, vitamin C, and fibre

intake. These measures can then be compared to
recommended intakes to enable you to analyse the
diet in terms of health, and risk of ill-health.
4.4 Strengths and weaknesses

The strengths of a person’s diet would relate to foods
they eat that are known to maintain good health and
prevent ill-health. The weaknesses would include foods
contributing to risks of ill-health such as deficiency
diseases, heart disease or obesity. Look back at section
2 to remind yourself of recommended intakes and the
health risks related to eating too much or too little of
particular nutrients.
Reflect
Unfortunately, when asked to record food intake,
some people may present a plan that is not really
representative of their normal diet. What impact
would this have on the benefits of the exercise
for the person being assessed?
4.5 Nutritional plan

When devising an improved menu for a person, you
should include their total intake for the day, including
drinks and snacks, and give advice on the portion size.
For example, seven cherry tomatoes are considered
to be one of your five-a-day portions. Likewise,
recommendations about protein intake should give
People who exercise a lot will
details of the weight of meat or volume of milk. need more calories than those with
sedentary lifestyles
4.6 Activity
As you know from earlier in the chapter, nutritional 4.7 Lifestyle influences
needs vary according to how active you are, so your Finally, in order to create a realistic diet plan, you
plan needs to take into consideration whether or not need to know about a person’s lifestyle. It is no good
the person participates in any exercise, and if so how recommending foods that they do not like, or that are
much and what sort of activity they do. You can then forbidden by their religion. Suggestions should not
take that into account when suggesting a diet plan. be too expensive if a person is on a limited budget,
You will need to ask them to complete another diary nor should they include time-consuming recipes if the
about their exercise patterns to find out how long they person works long hours or has a busy lifestyle.
sleep, how much of their day is spent sitting, and how If your diet plan is going to include the weekend you
much time being active. You will need to know what may need to consider differences in their lifestyle
exercise they have taken, such as fast or slow walking, compared to weekdays. They may have more time at
or particular sports and fitness activities. the weekend, or wish to eat out.
401

P4 M2
M3 D2
Identify a person who would be willing to keep a Grading tips

detailed food and activity diary for three days. This
person should ideally be yourself, although it could
P4 To achieve this, you need to find a
comprehensive source of information about
be someone you know in a private capacity, e.g. a
the composition of foods, such as the Food
relative or a friend prepared to share the necessary
Standards Agency Manual of Nutrition, or
information with you. Design a chart to capture the
the FSA website (www.food.gov.uk). You are
information you need. It is important that the diary
expected to analyse in detail the nutrients
is accurate and includes every meal, drink and snack
consumed in the food diary and the energy
that has been eaten, including portion sizes (i.e.
expended on activity during the three days. You
weight) and cooking methods, and describes the type
will need to record labelling information from
and duration in minutes of all activity undertaken,
food packaging and weigh unpackaged food.
including sleeping, sitting, walking, dancing, sports,
The results could be recorded on a spreadsheet
etc.
to help you to calculate intake and energy
1 Carry out a quantitative analysis of daily intake of expenditure more easily.
nutrients and energy by the individual chosen.
P5 The seven-day nutritional plan should include
2 Once the chart has been completed, analyse the all meals, snacks and drinks, with portion sizes
strengths and weaknesses of the diet in relation to and cooking methods. You should also include
energy, protein, fat, iron, and vitamin C intakes. information about lifestyle changes, and take
3 Calculate the additional energy used for into account the beliefs and preferences of the
physical activities, on top of the basal metabolic chosen individual.
requirements, so you can compare energy intake
with energy expenditure.
M3 To achieve the merit, you have to be able to
explain how the menu and lifestyle changes
4 Prepare a one-week plan for improving the you have devised will maintain the health of the
nutrition of the chosen individual, based on their chosen individual. Refer to the person’s age,
lifestyle, beliefs and preferences. gender, lifestyle, beliefs and preferences when
5 Assess how the plan will meet the nutritional needs justifying your choices in the improved menu.
of the chosen individual. This will involve justifying
D2 To achieve the distinction, you will need to
your choice of foods recommended to provide all show your understanding of how particular
the nutrients they need. foods can prevent illness in the short, medium
6 Evaluate how the plan might improve the chosen or long term. Short term might be preventing
individual’s health. You need to consider the health constipation; medium term might be
benefits of the foods you have chosen for reducing preventing tooth decay; and long term might
risks of ill-health. be preventing cancer. You will need to explain
how the foods actually work inside the body to
create health benefits, or how foods you have
eliminated cause ill-health.
PLTS
Reflective learner: You can demonstrate reflective
learning by analysing the daily intake of nutrients and
the daily amount of energy expended.
402
Resources and further BAPEN (British Association for Parenteral and

Enteral Nutrition) www.bapen.org.uk/
reading BBC Health www.bbc.co.uk/health/
Bionet – New discoveries in science
Aldworth, C. (2008) Knowledge Set For Nutrition and www.bionetonline.org
Well-being Oxford: Heinemann
Bupa www.bupa.co.uk/
Arnold, A. and Bender, D. (1999) Food Tables and
Coeliac UK www.coeliac.org.uk
Labelling Oxford: Oxford University Press
Disordered Eating www.disordered-eating.co.uk
Barasi, M. (2003) Human Nutrition: A health
The Food Standards Agency www.eatwell.gov.uk,
perspective London: Arnold
www.food.gov.uk
Byrom, S. (2002) Pocket Guide to Nutrition and
The Environment Agency
Dietetics London: Churchill Livingstone
www.environment-agency.gov.uk
Donnellan, C. (ed) (2004) Food and Nutrition
The Food and Agriculture Organization of the
Cambridge: Independence
United Nations www.fao.org
Food Standards Agency (2008) Manual of Nutrition
International Food Policy Research Institute
London: Stationery Office
www.ifpri.org
Webb, G. (2008) Nutrition, A Health Promotion
National Obesity Forum
Approach, third ed. London: Hodder & Stoughton
www.nationalobesityforum.org.uk
Neumark-Sztainer et al (2004) ‘Are family meal
NHS Choices www.nhs.uk
patterns associated with disordered eating behaviors
among adolescents?’ Journal of Adolescent Health British Nutrition Foundation www.nutrition.org.uk
Minnesota: University of Minnesota Patient UK www.patient.co.uk
Peak Performance – Sporting excellence
www.pponline.co.uk
Useful websites Online Publications – Every Child Matters

http://publications.everychildmatters.gov.uk
The Official Documents Archive School Food Trust www.schoolfoodtrust.org.uk
www.archive2.official-documents.co.uk UK Government public services www.direct.gov.uk
Age Concern www.ageconcern.org.uk Weight Loss for Good
The Advertising Standards Authority www.weightlossforgood.co.uk
www.asa.org.uk
403
Just checking
1 What sources of information are available to assist people in selecting foods to provide a
balanced diet?
2 Why has general dietary advice become simpler over time, when more people are educated to a
higher standard?
3 What are the current guidelines for a healthy diet?
4 What are the main factors that have a negative impact on the nutritional value of the diet eaten by
individuals?
5 What initiatives have been launched in recent years to improve the diet of people in the UK?
6 Why are people in residential care settings at greater risk of malnutrition?
7 In what ways have eating patterns changed in the UK over the last 30 years?
8 What health risks are associated with obesity?
Assignment tips
1 To get the best out of this unit, you need to really get to grips with nutrition, so that you can advise
confidently on specific foods and preparation methods to provide the most nutritious diet for people
you are caring for.
2 You need to understand the huge range of influences on what people choose to eat, and take these
factors into account when planning menus for individuals, who may have to work around medical
conditions, religious restrictions and budget as well as personal taste or constraints on time. Only if you
can do this will your recommendations stand any chance of being adopted. This is the way dieticians
and nutritionists have to work.
3 There are some fantastic resources available on the Internet to support this unit, written at a level that is
both in-depth and readable. The Food Standards Agency is particularly good on nutrition, and the Food
and Agriculture Organization of the United Nations gives an excellent overview of international aspects
of nutrition (see the ‘Useful websites’ on page 403).
4 To achieve the highest grades, you need to think for yourself about how to apply the knowledge you
gain from this unit to improving the diet of people receiving support from the health and social care
sector. This is the way effective professionals work, so if you can do this you have the potential to
become an excellent practitioner in the future.
404
Credit value: 15
22
Research
methodology for
health and social
care
Health and social care professionals carry out a form of research whenever they
observe, take measurements and refer to other professionals to gather and record
information about the individuals in their care. They interpret the information and use
it to assess the individual’s progress against the individual’s care plan. If necessary, the
plan is changed and the effect of this is also monitored. This is regarded as informal
research because it is part of routine health and social care practice and relates to
the care of individuals. However, all new advances in health and social care are tested
using a formal research process, which involves specific planning, collecting relevant
information, interpreting it and publishing the results of the research.
This unit investigates different functions of health and social care research and the principles that
underpin it. You will explore ethical and legal issues relating to health and social care research and
different techniques that may be used to gather research data. You will plan a small-scale research
project on a topic relating to health and social care, subject to consent from your centre and the
assessment requirements of the unit. The plan will include a justification of your choice of methods to
gather new information in the context of existing knowledge of the subject gathered from a literature
review. You will carry out the research and produce a report in which you present your results, interpret
them and evaluate the research methodology you used in the project.
Learning outcomes
1 understand the function of research in health and social care
2 understand ethical issues relating to research in health and social care
3 understand research methodologies relevant to health and social care
4 be able to plan for a research project
5 be able to conduct research relevant to a health and social care context
6 be able to interpret research findings. 405

P1 Explain the function of research in M1 Discuss the function of research in

health and social care. chosen area of interest.
page 413 page 413
P2 Discuss ethical issues relating to D1 Assess research methodologies

research in the health and social with regard to ensuring validity of
care sectors. findings.
page 424 page 446
P3 Compare different research M2 Justify the research methods

methodologies for health and chosen for the project.
social care. See Assessment activity 22.4,
See Assessment activity 22.3, page 446
page 440
P4 Plan a research project.

page 446
P5 Carry out the planned research M3 Assess strengths and weaknesses

project. of the research project in meeting
See Assessment activity 22.5, the aims or hypothesis.
page 456
P6 Report findings and conclusions M4 Assess findings of the research D2 Evaluate how the research project
from research project. project in relation to the original could have been improved.
See Assessment activity 22.6, hypothesis. See Assessment activity 22.6,
page 456 See Assessment activity 22.6, page 456
page 456
406
Unit 22 Research methodology for health and social care

This unit will be assessed through assignment tasks that you will complete in stages over
the duration of the unit. Your assessment will include written assignments, a detailed
action plan for your own research project, and a report on the findings from your project.
Dave, 17 years old

I chose swine flu as the topic for my project because there were
lots of scary headlines in the news at the time and I wanted to find
out why everyone was worried.
Because I chose my topic quickly, I had plenty of time for my
project. I found the Internet most useful for research, especially as
the information on swine flu was changing all the time. Information
about other types of flu helped me decide on the questions and answer choices for
my questionnaire. It took quite a long time to get the questionnaire right but the
pilot study was worth it because I got good data from the survey. I interviewed a
practice nurse and got lots of information about vaccination because I had planned my
questions in advance. I also found the latest government statistics about swine flu on
the Internet so I was able to use these in the discussion of all my results.
Although I had to alter the timescales (I had to rearrange the interview because the
nurse was ill and I got a bit behind), my plan helped me stick to what I had to do and I
handed in the report early. I concluded from my results that the public is very confused
about swine flu, partly because of the news stories. By the time I had finished, the
government was saying that there was no swine flu epidemic after all, even though they
were predicting an epidemic when I started my project.
Over to you!
1 What will you choose to investigate for your research project?
2 How could you use the research skills you learn in this unit to help you with other
units on the programme?
3 Why do you think research is important in health and social care?
407
1 Understand the function of research in health and

social care
Get How has research affected your health and well-being?

started In pairs, discuss how your own experiences of health and/or social care, or of others
known to you, could have been influenced by research. You could think about
changes in procedures introduced in recent years, either nationally or locally. Why
were these changes introduced? What sort of research do you think might have
been carried out, both before the change was made and after it was implemented?
Share your examples in a small group and list as many different purposes for
research as you can.
1.1 What is research? 1.2 Functions of research

Research is a planned process in which information Research can have many different functions or
is collected systematically for a specific purpose, purposes: identifying needs, highlighting gaps in
analysed and reported. The processes of research will provision, planning provision, informing policy or
be explored in detail in this unit but key features are practice, extending knowledge and understanding,
presented in Table 22.1 to provide an introductory improving practice, aiding reflection, allowing
overview. progress to be monitored, and examining topics of
contemporary importance.
Table 22.1: A summary of key features of research
Purpose The overall aim of the research

Rationale The reasons for the research (e.g. its value to health and social care)
Audience The people interested in the research findings
Literature search Finding out what is already known about the subject of the research
Ethical issues Ensuring that the research does not cause any harm
Research proposal The plan for the research
Methodology The strategy and techniques used to conduct the research
Participants The individuals who provide research information about themselves or their experiences
Research data New information obtained from carrying out the research
Interpretation Analysing the research data to gain new understanding of the topic
Evaluation Making judgements on the quality of the data, etc.
Conclusions A summary of the key points that have been learned from the research
Recommendations Suggestions for further research or ways in which the research findings might be applied
Research report A detailed, full (usually written) account of the research, sometimes also accompanied by
an oral presentation by the researcher, who is questioned by experts about the research
408
Identifying needs up; and young adults moving on, leaving older
adults in the family home. The services needed for
All health or social care workers who are involved
a new housing estate, with lots of young children,
in care planning use research principles to identify
are usually different from those needed on a well-
the needs of individuals. A doctor takes a medical
established estate with a greater proportion of
‘history’ of a patient in an initial consultation and may
older adult residents. In addition, risks to health also
take measurements such as the pulse rate or blood
change. Government and local authorities continually
pressure and require blood samples to be analysed.
gather data at local and national levels to monitor
A care home manager observing an individual resident
whether health and social care services are adequate
may identify that they may need more assistance with
to meet the needs of the local population. In the UK,
personal care and discuss this with the individual.
the proportion of older people in the population is
The information gathered enables the professional to
increasing steadily as people live longer and much
make decisions about treatment or care to meet the
attention is being given to how best to provide
individual’s needs.
services to meet their needs effectively and efficiently.
The specific needs of one individual may be similar
Support for adolescent mental health needs, the
to those of others but, before a new treatment or
predicted swine flu epidemic and maternity care
care routine is introduced for everyone, it is necessary
are some other examples of services where gaps in
to carry out a specific study, or research project, to
provision have been highlighted in recent years.
investigate the benefits to others. There are many
organisations, often charities, which are dedicated to Planning provision of services
improving the care of individuals with specific diseases Provision of services for health and social care is
and disorders through research. Their research may expensive and a new service can take several years
focus on better diagnosis so that needs can be to develop. Strategic health authorities, primary
identified earlier or more specifically, e.g. through care trusts (PCTs) and local authorities, which are
screening or by researching the physiological aspects responsible for planning health and social care service
of the disease so that treatment can be more carefully provision, have to be sure that any decision to invest
targeted to interact with the body’s systems and public money in developing new services is justified.
tissues to slow the progress of the disease or to cure Their decisions need to be based on information that
it. For example, 2.5 million people in the UK have Type is accurate, recent and reliable. They may carry out the
2 diabetes and Diabetes UK spent over £6 million on research themselves or they may commission others,
research in 2009 (Diabetes UK, 2009a). Its website has such as universities or organisations, to do it for them.
considerable information about its diabetes research Research reports about various aspects of service
(Diabetes UK, 2009b). Health professionals, commercial provision are available online, for example on the NHS
companies and others who work in the NHS frequently Direct (2009) service.
contribute to this type of research.
Did you know?

Key terms
In 2008/09 UK medical charities invested over £935 Provision of services – This refers to health and social care
million in research relating to medical conditions such services which are provided, and how they are organised, in
as cancer, heart disease and arthritis. communities (e.g. hospitals, care homes, Sure Start centres,
Source: Association of Medical Research Charities etc.).
(AMRC), 2009 Commission – The process by which an organisation
requests and funds another organisation to carry out work
on their behalf. For example, the Department of Health may
Highlighting gaps in provision commission a university to conduct research on a specific
topic. In the UK public sector, the commissioning process
The health and social care needs of communities usually requires the organisations to tender competitively
change over time with the rise and fall of local against others.
employment; young families moving in and growing
409
residential homes and now deliver more home-based

Did you know? care. Similarly, some doctors’ surgeries are now based
A recent research report indicates that the incidence on out-of-town business or industrial parks because
of Type 1 diabetes will rise dramatically by 2020, with research has shown that workers take less time off if
an increase of 50 per cent for children under 5 years they can see a doctor near their workplace, rather than
and of 70 per cent in children under 15 years. This taking a day’s leave to get to a surgery near where
level of increase is likely to require an expansion of they live. To assist in developing health and social care
services to support children with diabetes.
policy, the government commissioned a major review
Source: Sennika, 2009 of the NHS, known as the Darzi Review (DH, 2008),
to identify priorities for health care over the next ten
years or so.
Reflect Practice
Research into health and social care practice may be
Where is the nearest accident and emergency
unit located for your home? In the last decade associated with, for example:
or so, many older Victorian hospitals located • the needs of individuals
in the centres of towns and cities have been
• improving the quality of care
replaced by new hospitals built on the outskirts,
near fast roads and away from city-centre traffic • ensuring that resources are used efficiently, without
congestion. Why do you think this is? waste
• addressing specific problems that have arisen
• reducing risks, e.g. of acquiring infections such as
Activity 1: Local MRSA.
information Improvements to practice might involve, for example:
Search on the Internet for information relating to • modifying care routines
planning health and social care provision in your • changing how care teams work together
local authority area. You should find documents
• reorganising the layout of a care space
relating to different types of provision, e.g. day care,
domiciliary care and services for adults with learning • developing better communication for visitors
disabilities. • increasing choice
What research do you think has been carried out • enabling more autonomy.
to provide the evidence on which decisions about
provision are based? If a health or social care professional identifies that the
care received by the individuals they are responsible
for could be improved, they may carry out action
research within their everyday duties that leads to
Functional skills improvements to practice being made.
ICT: In this activity you can demonstrate your ICT The professional would research published literature
skills by selecting a variety of sources of information on the subject, plan a simple project to introduce a
and navigating to evaluate their relevance to the task.
change in practice, collect information to measure
Informing policy and practice Key term

Policy Action research – Research in which the researcher
is a participant in a situation that occurs, regardless of
Research shows that older people stay healthier the research, but from which information is collected
for longer if they remain in their own homes so systematically. The purpose is to gain a better understanding
local authorities have reorganised their social of the situation so that knowledge, understanding or
services departments (see also Unit 6, Personal and practices in that context can be enhanced.
Professional Development), closed down many of their
410
Early years practioner
Sally has worked as an early

years practitioner for about ten years and has
noticed that an increasing number of children are coming to
the nursery with delayed speech development. She is completing
her degree to gain early years professional status. For her dissertation,
she has chosen to research how the nursery could better support these
children and their parents/carers to help the development of their
speech. Sally discusses her ideas with her tutor, gains consent from
the nursery’s governors and plans her project. From her literature
search, she realises there are a range of schemes and support
programmes available but she is not sure which one
is best.
She also wants to gain a better understanding of why the

children in her nursery are not developing age-appropriate speaking skills.
Sally decides to survey the parents of all the children in the setting to find out what
interactions the children usually have with adults when they are not at nursery. She realises from
her initial research that it would also be useful to know how long the children spend watching television
and playing with other children. She knows the questionnaire needs to be simple to complete because some
of the parents have limited English and others have limited reading skills. Another aspect of her project is to
observe parent–child interactions when the parents come into the setting. Sally also researches, critically analyses
and evaluates reviews of six specific language support strategies. As a result of her research, she makes several
recommendations for actions the nursery can take to promote speech development in all the children and particularly
those with language delay. These include:
• inviting a speech therapist to take a two-hour evening CPD training session for staff to raise their
awareness of speech and language difficulties
• nominating two staff members to work with the therapist as specialist support workers for the
children with speech delay
• presenting a request to the governors for an early years practitioner to
be sponsored to undertake specialist training in supporting
speech and language development.
Think about it!

1 What type of research is Sally carrying out?
2 How could Sally’s recommendations improve practice
in the nursery?
3 What can you find out about delayed speech and
language development in young children?
411
its effects, and then analyse and interpret it. If the you with data on which to reflect. Data obtained using
results show positive or negative effects on individuals, a research methodology is likely to be more objective
the professional could recommend that the change and reliable than information obtained by casual,
becomes standard practice in the care unit. Publishing unplanned observations, etc.
a report of the research in a health or social care
journal could encourage similar care units to adopt the
Monitoring progress
improved practice. When any major change has been introduced it is
important to find out what the effect of the change is.
Extending knowledge and understanding On an individual level, a care worker in a care home
Science and technology research leads to the makes regular observations and checks to see that
development of new knowledge and understanding a new resident settles in well. A PCT manager wants
of materials and the living world. Although some to know that a newly introduced practice or service is
scientific research may appear quite far removed working well. If the change is complex, such as using a
from health and care needs, health and social care is new building and staff team, monitoring systems and
a very important area in which scientific knowledge processes would help assess whether the service is
and discovery can be applied. New drugs, techniques effective in benefiting individuals. Monitoring involves
and equipment (such as MRI scanners) are all products research, for example:
of laboratory-based science research. For example, • using questionnaires to investigate perceptions of
when the ‘pacemaker’, to regulate the heartbeat, was individual users of a new service
introduced, it had a huge impact on many individuals,
• interviews or questionnaires with staff
enabling them to live a near-normal life. Other
• gathering quantitative data, e.g. the number of
computerised devices allow continuous monitoring of
individuals using the service, how quickly they are
the body so that critically ill patients have an improved
seen or that their needs are met
chance of surviving previously fatal conditions.
• reviewing the data to see whether there are any
weaknesses in the service
Did you know? • developing and then implementing an action
plan to address problem areas and enable further
Survival rates for leukaemia, a cancer of the blood, improvements.
have doubled since 1971. This is largely because of
research into finding new drugs to treat the cancer, Examining topics of contemporary interest
how the drugs are given, and the testing that can be
New, or contemporary, issues relevant to health and
done to see how the body is responding to treatment.
social care continually emerge both at national and
Source: Cancer Research UK, 2009 local levels and become the subject of debate among
the public and professionals. Before the debate can
give rise to changes in services or practice, research is
Sometimes research in apparently unrelated areas may needed to explore the extent of the issue and possible
have consequences for people’s health, well-being benefits to individuals and society. Examples of issues
and care. For example, research into climate change that have emerged in recent years include:
has highlighted the fact that there will be a shortage • the role of alternative therapies in health and well-
of food and that some communities may be displaced being
by rising sea levels. Action research following previous
natural disasters suggests that major disruption to
communities affects basic amenities such as safe
drinking water and adequate food, both important for Key term
individuals’ health. Data – A plural word for ‘information’. Strictly, a single piece
Aiding reflection of information, fact or statistic is ‘datum’ but because data
usually consists of more than one piece of information, this
The concept of reflection is explored in Unit 6 Personal term is rarely used.
and professional development. Research can provide
412
• the likelihood of a global epidemic of influenza (flu)

Activity 2: Contemporary
• the strategy to focus accident and emergency cover
in fewer larger hospitals and downgrade more local
issues
emergency departments to ‘minor injuries’ units. Can you think of other contemporary issues that are
• whether individuals with terminal illnesses should relevant to health and social care both nationally
be assisted in ending their life and locally?
• concerns about global warming and climate change Spend 20 minutes researching the issues above, or
your own choice of issues, on the Internet and share
and its impact on populations and their needs for
your findings with others in your group.
survival
• whether genetically modified crops are harmful to
man and the environment.
More examples of different purposes for research are
Activity 3: Current research
given in Table 22.2 on the next page.
Most of us will have experienced new health or social Use the Internet, journals and newspapers to
care developments introduced as a result of research. find specific research that illustrates each of the
examples in Table 22.2.
For example, advances in development of new
materials mean that dental fillings are now plastic and Go back to the starter activity at the beginning of
white, rather than the more visible metal (amalgam or the unit and match your ideas about how research
has influenced your experiences of health and
gold) used for most of the last century. At the same social care with the purposes identified in the table.
time, other research into the chemistry of the teeth
and dental decay means that the chemicals included
in toothpastes also make it less likely that people will
need fillings.
Write an essay: Grading tips

• explaining the function of research, using a range P1 Before you start your task, review research
of examples you have researched reports from a range of health and social care
• examining the function of research, using the sources. Make notes on the purpose of the
examples you have researched. research reported in each case.
M1 Use Internet research to investigate a range
of different points of view on the examples of
research you select, and discuss these in your
assignment task.

Independent enquirer: This assignment requires ICT: In this assignment you will be navigating
you to analyse and evaluate information and judge and discriminating between sources to meet the
its relevance and value for the task. requirements of the task.
413
Table 22.2: Examples of how different purposes might apply in health and social care research
Purpose Examples
To find an explanation for a • Why there is an increase in the incidence of hospital-acquired infection
phenomenon
To improve an outcome from a • So that older people discharged from hospital can be rehabilitated in their
process own homes more successfully
To improve practice • To enable an operation to be carried out without the need for a general
anaesthetic
• To identify support that will enable carers to communicate better with
relatives of people with dementia
To develop new equipment, tools • The development of MRI scanners
and devices for use in health and • The development of microscopic nanotechnology devices circulating in
social care the blood that continually monitor changes in levels of specific circulating
chemicals, together with computers that pick up the signals from the
microchip and process the data onto a monitor screen
To describe new knowledge • Finding out more about the ways in which people are using a newly opened
drop-in centre
• Describing the way a gene works to control a particular metabolic process in
a cell or tissue
To measure the effect of a • Finding out whether a day centre for those with mental health difficulties
change reduces the amount of medication these individuals need to take
To criticise a theory/practice/ • Gathering evidence to disprove the theory that there is an association
opinion between the MMR vaccine and autistic spectrum disorders
To explore the effects of different • How specific socio-economic factors influence the health and well-being of
variables on a phenomenon a community
• How different activity levels affect individuals’ ability to lose weight
To apply new knowledge and • Applying advances in medical genetics to identify young women at risk of
understanding to a previous developing breast cancer at a particularly young age
interpretation of a phenomenon
To predict an outcome • Moving individuals into sheltered housing will enable them to live
independently for longer
To assess perceptions of an • Assessing young people’s perceptions of their experience of school health
experience education lessons
• Assessing the public’s understanding of the nutritional information provided
on food packaging
To find out attitudes • Examining students’ attitudes to behaviours that may damage their health
• Examining workers’ views of people who experience stress in their workplace
To answer a question • Is there an association between being overweight and education?
• What causes myalgic encephalomyelitis (ME)?
To test a hypothesis • Proving (or disproving) that intensive support for families with children under
three will increase the children’s life chances as adults
414
2 Understand ethical issues relating to research in

2.1 Ethical principles of Activity 4: What is
research acceptable research?
Ethics are written statements that reflect the morals
There are two research projects relating to teenage
of society. Whereas morals are unwritten codes behaviour being proposed. The first involves 14-
setting out what is deemed to be acceptable or to 16-year-old participants using sun beds and
unacceptable behaviour, ethics are written codes and the second, with 16–18-year-olds taking part in a
reflect society’s views of what is right or humane. There physical exercise activity.
are internationally recognised guidelines in place 1 What are your views as to the acceptability of
that provide a framework for ethical research and this each project? What would your reservations be?
influences the codes of ethics that apply to research 2 What safeguards would you want to put in place?
carried out in the NHS and universities in the UK.
Codes of conduct or practice (see Unit 6, Personal and
Professional Development) for health and social care
professionals do not explicitly include research but the
underlying principles of professional practice would be
consistent with expectations for ethical research.
be considered when planning the project and
collecting the data from the individuals. Research
Did you know? should not cause harm, or maleficence, but this
should be considered in the context of the research
The conduct of modern medical research is based
on the principles stated in the Nuremberg Code of
being undertaken. Thus it might be unacceptable for
Human Rights in Experimentation published in 1947. a researcher to cause a patient with mental illness to
This code was introduced to prevent any repeat of become very distressed when being asked questions
the abuse suffered by concentration camp prisoners about mental health. However, if tests for an anti-
during the Nazi era, who were subjected to degrading cancer drug cause a patient’s hair to drop out, this
and inhuman experiments in the name of research.
might be seen as acceptable harm under the principle
of beneficence, if the drug destroys the cancerous
The ethical principles that underpin all research include growth and the patient survives the cancer.
clauses:
• protecting individuals
• ensuring that individuals only participate voluntarily
• ensuring that any personal information relating to Key terms
the research is treated confidentially Ethics – Written statements, relating to what is acceptable
• stipulating that the plan for any research project is and unacceptable, that reflect the morals of a society. Morals
may be modified over time, so ethical codes tend to evolve
subject to independent scrutiny by experts.
to reflect these changes.
Although codes of ethics are written, they are not
Morals – The unwritten codes of what a society considers to
rules, but serve to set the boundaries of what is, and is be acceptable or unacceptable. The morals of a society tend
not, an acceptable way to conduct research. to change over time.
Voluntarily – Doing something of your own free will, without
being forced, or coerced, into doing it.
Protecting individuals from harm
Maleficence – Causing harm.
This principle ensures that researchers consider the
Beneficence – Something that does good or has a beneficial
possible effects of their research on the participants. effect.
For example, participants’ rights and feelings should
415
Occasionally, it may be necessary to withhold

Did you know? some information from participants in order to
avoid knowledge about the research affecting how
In 2006, several young adults, who had accepted a fee
to participate in a research trial testing drugs, were participants respond. This can arise particularly
taken so seriously ill within minutes of being given in behavioural studies, when knowledge of what
the drug that they had to be rushed to hospital and behaviour is being studied might affect how
placed on life support. They experienced extreme participants respond in the research. Another example
swelling of their tissues and took several weeks to
would be the double-blind trials that are used to
recover. The most seriously affected victim lost all his
test the effectiveness of new drugs. The doctors who
toes and the tips of several fingers, and is still unable
to work. administer the test drug to patients do not know
whether they are giving the patient the drug or a
placebo (an apparently identical dose that does not
contain the drug). This ensures that the doctor remains
Informed consent totally objective in monitoring the patient’s progress in
response to the treatment.
Activity 5: Would I
Confidentiality
participate? Researchers must ensure that data from participants
You have been asked to take part in a research cannot be identified or be traceable back to specific
project investigating sexual behaviour in adolescents individuals. The researcher needs to establish
and young adults. In pairs, decide what questions appropriate systems to ensure confidentiality and
you would ask about the project before you agree to prevent data about individuals being accessed
participate.
by unauthorised people. This can be achieved by
designing systems for collection and processing of the
data that do not reveal the identity of the participants,
Getting informed consent means telling participants
yet enable all the data from any one participant to
how their contribution will advance the research. They
be linked. Usually, this involves representing each
should receive all the information they need before
participant by a unique code reference, rather than by
agreeing to participate, including:
name, so the anonymity of individuals is maintained.
• the overall purpose of the research
Maintaining anonymity is an important protection
• what is expected of the participants if they take part
for participants. It is also important for maintaining
in the research
the integrity of the study because it helps to reduce
• what, if any, risks are involved in participating, the risk of bias. As a consequence, any analysis and
e.g. possible side-effects, how severe these might interpretation of the data from the project would be
be, how data generated from participation will less objective or comparable.
contribute to the research
• an entitlement to be able to withdraw from the
research at any time.
Researchers should tell participants explicitly about
their rights. In the examples above, the distressed Key terms
patient could therefore withdraw from the research, Informed consent – Being provided with all relevant
information that may influence the decision to give consent
and the cancer patient should be warned beforehand
to participate.
of possible effects. Participants may withdraw from
Confidentiality – Keeping information, such as research
the research while the study is in progress or have
data, confidential or hidden, so that only the information
their own data withdrawn from any report of the study. needed for the purpose of the research is made available to
Participants should be free to use their personal the health or social care researchers.
judgement about whether to participate according Anonymity – Keeping the identity of an individual hidden
to their own perception of the risks associated with from others.
participation.
416
A research ethics committee consists of a panel of

Case study: Janice individuals who critically evaluate each proposal in
Janice is a nurse in a psychiatric research team
relation to the ethical implications of the planned
investigating dementia. The research protocol research. An ethics committee may accept, reject or
requires her to make observations of patients with ask for modification and resubmission of a research
dementia while they are undertaking specific tests proposal. NHS ethics committees are made up of
of memory and cognitive function. One of the health and care professionals and scientists, who
patients does not complete the research tests and, contribute technical and research expertise to
although Janice saw this patient doing something
almost identical earlier in the day, she did not make
the discussion, and lay members contributing as
the observation under the conditions set for the representatives of the general public. Universities, for
research test, so she realises she cannot include the whom research is often a major part of their activity,
observations in the research. will have a research ethics committee and publish
1 Why couldn’t Janice include her observation guidelines for researchers.
from earlier in the day?
2 In what way was Janice demonstrating her
awareness of ethical principles? Did you know?
Each NHS Strategic Health Authority operates an
ethics committee for its own region. Information
Ethical approval about all these committees and dates for submitting
proposals to be considered at monthly intervals are
All research carried out in the NHS, care settings,
available online from the National Research Ethics
the community or in university departments requires Service (NRES), via the National Patient Safety Agency
ethical approval. The research should not commence (NPSA) website.
before the approval has been received and, if it does,
any data collected prior to the approval date has to be Gaining ethical approval for a research project is time-
discarded. consuming, often taking many months. Any research
Organisations such as the NHS, charities and university involving vulnerable individuals (such as patients,
departments have formal procedures for the ethical children or individuals using care services) or a health
approval process. The researcher submits a specially or social care setting, would only be approved if the
designed form to present the relevant information study was being carried out by professionals. It is not
about the proposed research project to the ethical acceptable for students to carry out a research project
committee. in health or social care settings for these reasons.
Did you know?

The ethical guidelines from the Medical Research
Council, which is funded by the government, include
sections among others, on data sharing, use of
animals, use of human tissue and global bioethics.
Fig 22.1: Why are research proposals scrutinised by an ethics research committee?
417
2.2 Ethical issues and research Human rights

Ethical codes for research are only guidelines, not Individuals in European Union countries have, among
legislation. While it may be straightforward to make other rights, a right to life, to be free from torture,
a judgement about what is, or is not, acceptable for degrading treatment, and discrimination and to have
many projects, the judgement for some research their privacy respected. All research must respect
may be much less clear. Over time, the boundaries these rights. Stem cells are retrieved from embryos
of knowledge are continually extended by research, that are a few days old, and it is this that creates the
particularly in science. Society’s understanding of ethical dilemma in relation to research using this type
what is acceptable is based on existing knowledge. of tissue.
Research that is breaking through existing boundaries Role of the media
of knowledge, into the unfamiliar, creates ethical
The media, whether print, broadcast or Internet, are
dilemmas.
powerful influencers of public opinion. For example
Examples of dilemmas relating to research that have the media were very influential in publicising the
arisen in recent years include: contents of the 1998 research report on MMR and
• using stem cells in research to better understand autism. In 2002, the media publicised destruction by
certain diseases protestors against experiments in which genetically
• investigating genetically modified crops as a way of modified crops were being grown in fields to
increasing food production to support increases in investigate any potential effects on the environment.
the human population. This research trial was subsequently abandoned
because it was impossible to protect the research sites.
Activity 6: Research News media are mostly controlled by private

companies, which often think it more important to
dilemmas print spectacular headlines that will maximise profits
Research one of the research dilemmas mentioned
for their shareholders, rather than take care to present
above, or another that interests you. a fair and objective report of all the uncertainties
and weaknesses the researchers may have discussed
1 Identify the different arguments in relation to the
ethical issues raised by the research dilemma. in their full research report. However, there are
other examples where the media have campaigned
2 What would your decision be, if you were a
member of an ethical committee discussing vigorously to benefit groups who would otherwise
whether or not to give consent to similar not be in a position to influence opinion and social
research? policy. The Thalidomide case, for example, led to
3 Compare your judgement with that of other major changes in the ways new drugs are tested before
members of the class. being prescribed.
Activity 7: The Thalidomide

story
Dilemmas such as the examples above make news In the late 1960s and early 1970s, the Sunday Times
headlines because they affect society. Resolution of ran a vigorous campaign on behalf of children born
the dilemma may involve changes in the law and in with limb deformities after their mothers took the
drug Thalidomide for morning sickness. As a result
the interpretation of the ethical codes that govern
the Distillers Company, which marketed the drug, set
research. up a trust fund in 1973 to support the needs of the
Thalidomiders, as they now prefer to be called.
1 Use the Internet to research the role of the
Key term Sunday Times in influencing research on drugs.
Dilemma – Arises when it is difficult to choose between 2 Extend your research to investigate how the
different choices. Thalidomiders are coping with life, now that they
are in their middle years.
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Use and misuse of data an accuracy that is inappropriate for what is being
Researchers have a duty not only to protect measured, or by setting the scale of a chart or graph
participants from harm but also to ensure that the in such a way that it makes the difference between
project is carried out with integrity. Integrity in research two measures look proportionately greater (or smaller)
involves: than it is. For example, recording the body weight of
60–70 kg adults to the nearest 0.01 kg (i.e. the nearest
• carefully considering the methods used to carry out
10 grams), while very accurate, would be relatively
the research
meaningless because a 0.01 kg difference in weight
• ensuring the accuracy of the data would not be significant in relation to normal hour-by-
• ensuring the accuracy of generalisations derived hour fluctuations in body weight. However, it might be
from the results and the analysis appropriate to record the weight gain of a premature
• ensuring that the contributions of participants are baby weighing less than 2 kg to the nearest 0.01 kg.
not wasted because the research is of poor quality Generalisations
due to flawed methodology. (This is not the same
A common strategy for researchers, when interpreting
as research that does not prove its underlying
their results, is to use inductive reasoning to apply
hypothesis or does not provide an answer to the
their findings from the specific results obtained under
question posed by the research.)
the specific methodology of their particular research
Research methods project to make a more general claim. Similarly, in a
Methods of research are described in the next section wide-ranging project, deductive reasoning could be
but, in relation to ethics, it is important to design used to make claims about more specific situations.
the project with care and select methods that are If the researchers have sufficient valid evidence
appropriate for the purpose of the research. A flawed from their research, preferably combined with other
methodology reduces the validity of the research evidence published in the literature, inductive or
findings, lessens the usefulness of the research and deductive reasoning may be acceptable when making
devalues the participants’ contributions. claims about the value of their research findings.
Research accuracy However, if the logic of the arguments put forward in
support of the reasoning is flawed and not supported
Inaccuracies due to equipment faults and sloppy
by reliable and valid evidence, then making either
practice or carelessness in taking measurements would
inductive or deductive claims is not valid and the data
be considered unethical because they abuse the
is being misused. For this reason, researchers use very
commitment participants make to the research project.
tentative language when drawing conclusions about
Changing data or ignoring unexpected or ‘rogue’
their research. For example, they may emphasise that
results is unethical because it is falsifying evidence.
their conclusions only hold for their particular research
Sometimes a rogue result could indicate an important
methodology, for their particular participants, or use
difference. The researchers should investigate the
language such as ‘the results suggest that’ or ‘are
cause of the rogue result before dismissing it.
consistent with those found in other studies’. (This
Deliberately presenting data to exaggerate or means they do not disagree with the other studies but
downplay research findings is also unethical. This can cannot be more certain than that.)
be done, for example, by taking measurements with
Key terms
Did you know? Inductive reasoning – Arguing logically from the specific to
the general.
The discovery of the antibiotic Penicillin came from a
Deductive reasoning – Arguing logically from the general to
chance contamination of a culture of bacteria being
the specific.
grown in a laboratory by Alexander Fleming.
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These are some of the reasons why it is rare for Research carried out by an organisation is likely to
researchers to claim they have ‘proved’ a theory or reflect that organisation’s interests. The Alzheimer’s
claim. However, when introduced to the implications of Society will therefore commission research, or carry
research, e.g. in relation to the effectiveness of a new it out itself, relating to that disorder. However, if the
treatment, the public may find it easier to understand organisation paying for the research is a commercial
certainty, rather than a balance of probabilities. company, it may only be interested in the findings of
the research if they promote the company positively,
Vulnerability of individuals e.g. if they boost sales or enhance the public’s
Research involving vulnerable individuals is important if perception of the organisation. As the commissioner of
health and social care services and practice are to meet research, the organisation has the power to influence
their needs. However, their vulnerability, perhaps from the research by:
learning disability or acquired cognitive impairment (e.g.
• setting up the research methodology so that it
brain injury or dementia), means that as participants,
deliberately only investigates a selected aspect of
individuals may find it difficult to understand the
the subject
information about the research, to ask questions about
it or to answer questions (e.g. in a questionnaire) without • only comparing its own findings with those from
help. There is a risk that anyone helping the participant other research projects that also support the
to answer questions could influence the responses given arguments in favour of its own interests and
or change them, either deliberately or unintentionally. ignoring contradictory evidence
Also, researchers could exploit the vulnerability of the • suppressing, by not making public, any research
participants by omitting to check that the participant findings that are against the company’s interests in
has understood the information they have been given or promoting its activities.
possibly not being truthful about the research. Omitting Not all research carried out by private organisations
individuals from a sample because they are vulnerable is necessarily poor quality. Nevertheless reports
is also not ethical. Researchers should make provision to based on commercially sponsored research should be
avoid exploitation or abuse of vulnerable people when evaluated critically so that any possible bias is clearly
they participate in research. identified; and the results of the research should then
be used with appropriate care to take account of this.
2.3 Implications of research
Who commissions research?
Research costs money by taking up professionals’
time, or because they require particular equipment Activity 8: Who’s paying?
and other resources. It also requires specialist research
skills, which an organisation may not have – either Several companies relevant to health and
because they are too small or because they do not social care carry out extensive research,
have sufficient use for such skills. These considerations which they publish in relevant journals. Just because
a commercial company has commissioned research,
mean that research is often commissioned from
it does not necessarily mean that the research
another organisation. will not conform fully to ethical principles and be
conducted and reported openly and objectively.
Look at a selection of research reports and note
the name of the organisations involved in the
Did you know? research, either as researchers or through funding
(sponsoring) the research project.
Research commissioned by the government, the NHS
1 To what extent do you think the organisations
and other public sector organisations is usually won
may benefit from the research?
through a competitive tendering process whereby
each organisation interested in carrying out the 2 Is there anything in the research methodology
research submits a proposal and budget for the and findings that suggests the research may be
research. biased?
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Functional skills • The methods used to conduct the research should

be appropriate for the purpose of the research.
English: In this activity you will be reading a range of
This might include the underlying premise of the
texts and understanding the detail in order to detect
meaning and identify the purpose of the research
method, the accuracy of the equipment used
when considering bias. to make measurements, whether any tests for
reliability of the research instruments/equipment
used were carried out, the care with which the
Authenticity conditions of the experiment or investigation were
Research aims to add new knowledge and carried out, how the results were analysed and any
understanding either by: assumptions made in doing this.
• generating new data • The presentation of the findings, for example what
• or interpreting or applying existing knowledge in a arguments are used to explain the relationship
new way. between the results and the conclusions,
Research is based on the principle that the researcher assumptions or bias in the arguments presented,
is a neutral observer of a phenomenon and does not ignoring some results and/or over emphasising
distort or alter observations made of the natural world. others.
• The conclusions should be an automatic outcome
from a discussion of the results. Conclusions that
Key terms have been evaluated against evidence from other
Bias – A situation in which an investigation produces results
sources apart from that being reported (see also
that are influenced by unacknowledged factors, perhaps
because of the way the investigation was designed, errors triangulation, page 449) have greater validity
were ignored or how the results were interpreted. than those that are not evaluated against existing
Phenomenon – A term used to describe an event or knowledge and understanding of the subject.
observation, e.g. the rise in hospital-acquired infections. The Conclusions that have very little relationship with
plural is phenomena. the results reported would have very limited, if any,
validity.
However, due to pressures on a researcher, such as:
• the need to produce results by a deadline
• wanting to gain prestige for career advancement Reliability
• inappropriate influence of others (e.g. the sponsors Reliability is about the extent to which the research can
of the research) be reproduced. Reliable research when repeated by
there may be a temptation to alter results from those another researcher using exactly the same methods,
actually recorded. This is unethical and can have produces the same results. Researchers often test
serious consequences for the researcher involved. the reliability of equipment used in experiments
before they conduct a long, complex series of
Did you know? tests. In a laboratory, experiments may be repeated
several times. Once the scientists have perfected
A health or social care professional may be charged their techniques and equipment, an average value
with professional misconduct if they are involved in may be used, or if the variations between results
unethical research practice.
are unavoidably great, then many measurements
may be required and statistical tests applied to the
Validity results. It is much more difficult for social scientists
Validity depends on what claims are made about to repeat a survey. Even if they use exactly the same
a piece of research and how well the claims are participants, the circumstances could not be exactly
supported by the evidence or results from the the same because participants’ second contributions
research. Various factors, listed below, may affect the could be influenced by their previous experience of
validity of research. participating.
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Did you know? Impact of key reports

The government and other reputable organisations,
Good practice in social research is to conduct a pilot such as The King’s Fund and the Nuffield Trust,
study on a small sample of participants beforehand,
commission or produce research reports on health and
to test the reliability and validity of research
social care topics.
instruments such as the questions combined together
in a questionnaire. This enables possible sources of
error to be identified and steps can then be taken to
reduce them before starting the main study. Activity 9: Independent
research organisations
Apart from conducting a pilot study, social science Explore the websites of The King’s Fund and The
Nuffield Trust to find out about each organisation.
researchers take great care to keep as many aspects
of the research methodology as constant as possible. 1 How do they contribute to health and social
care?
In a large study, several different researchers may be
involved in carrying out interviews. In this situation all 2 Investigate one health and social care report
from each organisation.
the interviewers should take part in trial interviews,
compare the results, discuss the differences and agree
the actions they will take to reduce the differences
when carrying out the research interviews. This process Reports that are based on high standards of research
is sometimes called standardisation. tend to be influential, often giving rise to significant
changes in policies that benefit individuals. Influential
in health and social care reports include:
Did you know? • The Beveridge Report 1942
The National Child Development Study (NCDS) is a

• The Black Report 1980
longitudinal study of all the people born in England, • The Griffiths Reports 1984, 1988
Scotland and Wales in one specific week in March 1958.
• The Acheson Report 1998
The numbers of people in the original sample have
decreased slowly over the years since then, because • The Laming Reports 2002, 2009
people die or emigrate. Source: IoE, 2009 • The Darzi Review 2008.
In social science research, one way to maintain the Activity 10: Influential
validity of data over a long period is to start with
large numbers of participants. In the above study,
reports
over 17,600 babies were born in that week in 1958 Find out the full titles of these reports and what their
but, although nearly two thousand were no longer key recommendations were.
traceable, there were still well over 15,000 participants 1 What social policy initiatives have resulted from
remaining in 2004. Research that involves unstructured these reports?
interviews may only report fewer than ten case studies 2 What reports relating to health and social care
but if the interviewees were selected because they have been published in the last year? Write a
have a very rare disease, the findings – even from such summary of what each is about in no more than
a small sample – could still be valuable in improving two sentences.
the care sufferers from the disease receive. A survey
using a questionnaire enables many more people to
give information for the research and, provided that all Functional skills
reasonable care is taken with the methods, the results
should be reasonably reliable. Each method used in English: This activity will involve reading to
understand key points and ideas presented in the
social science research is limited by the reliability of
reports.
the data it generates.
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Publication of many reports on health and care matters Human Rights. The Act makes clear statements about
is highlighted in public news bulletins. Sometimes the rights of individuals, which include:
reports of research carried out by journalists • the right to life
themselves, and published in newspapers, draw public
• the right to freedom from torture or degrading
attention. Green papers are consultation documents in
treatment
which the government outlines their thinking on policy
• the right to privacy (and family life)
issues, and these documents can result in the drafting
of legislation in a white paper, which is then debated • the right to freedom of expression.
in Parliament. All research should respect these rights.
Did you know? The Data Protection Act

Any information held about an individual by others is
Not all reports are influential in a beneficial way. In
subject to the Data Protection Act (DPA) 1998. There
1998 a report was published in the highly respected
medical journal The Lancet, which made a link are greater restrictions on sensitive information,
between the MMR vaccine and autism. As a result of such as ethnicity, beliefs, health and sexual life.
the publicity this report received, large numbers of Organisations (e.g. employers that hold personal
parents refused to have their children vaccinated so information about individuals) have to register with
that by 2005 the incidence of measles showed a very the Information Commissioner’s Office, the public
sudden rise. The scientific evidence for the claim was
body that enforces the Act. The DPA means that if
found to be seriously flawed and, in 2007, the doctors
involved were charged with professional misconduct information is held, it can only be used for specific
by the General Medical Council. In January 2010, after declared purposes and the information can only be
lengthy investigation, the GMC announced that 30 held for a specified period of time. For a researcher,
charges of unethical research practice were proven this means that under the DPA:
against the doctors. The Lancet had already published
an apology regarding the publication of the flawed
• only data relevant to the project can be collected
research in February 1998, and retracted the paper in • the data can only be processed according to the
January 2010. Despite the major flaws in the research stated purpose so a researcher could not use the
that invalidate the findings, some parents still believe data collected for one project in another project,
there is an association between MMR and autism.
unless consent for the second project had also been
obtained from each participant
Access to information • it would be illegal to change the information so that
Participants in research should have access to all the it is no longer accurate
information held about them (see next section). Also, • the information must be processed in such a way
researchers may consider that some information would that it does not breach an individual’s legal rights,
be valuable for their research but they may not have or cause them harm or distress. This would include
the right to see, or access, it. Under the Freedom of revealing the person’s identity either directly or
Information Act 2000, any individual is entitled to apply indirectly. Thus it would contravene the DPA if, in
to see information held by public authorities but this a case study using a pseudonym, the information
Act does not apply to information held by private given still enabled the individual to be identified
companies. Without access to information that may be
• all information gathered from participants should
important to the research, the validity of the findings
be kept securely
could be reduced.
• after the data is analysed, each individual’s personal
2.4 Legislation, policy and records would need to be destroyed
research • the individual data cannot be taken outside the UK

unless it is protected (e.g. encrypted).
The Human Rights Act Any participant could request to see the data you
The Human Rights Act 1998 embodies in UK law have collected on them under the principle of ‘right of
the rights enshrined in the European Convention on subject access’ laid out in the DPA. All organisations
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collecting and using personal information are legally

required to comply with these principles and you, as a Activity 11: The NPSA
researcher, should also respect them throughout the
Research the guidance produced by the
period of your project. Once you have completed the NPSA, the British Psychological Society and
project, you should destroy the original records such the Medical Research Council regarding their codes
as the completed questionnaires (e.g. by shredding of practice for the conduct of ethical research.
them). If information relating to an individual’s ethnic
background, political opinions, religious beliefs, health
or sexual life is gathered, you need to be particularly
careful about the security and anonymity of the data.
Policies and procedures
Codes of practice All research involving staff or individuals using
All professional bodies associated with the health services, either in a health or social care setting or in
and social care professions have codes of practice. individuals’ own homes, must comply with the policies
Any researcher in health and social care would be and procedures of the care organisations involved. In
expected to comply with the code of practice of their some settings (e.g. early years), parents sign a general
professional body. All those whose work is in any way consent for staff, including students on placement, to
associated with the NHS must conform to the NHS observe children as part of their routine care. However,
National Patient Safety Agency’s (NPSA) guidelines for observations carried out for a research project would
Research Ethics Committee review. require additional specific consent.
Prepare a piece of writing that discusses how ethical examples of ethical issues associated with
issues influence health and social care research. health and social care research. Practical issues,
such as how a confused older person could give
consent to participate in a research project, or
Grading tip when it might be ethical to withhold information
P2 Before you complete the task, take part in a about the research from participants, could also
discussion or debate with your peers about be considered.
PLTS
Independent enquirer: This activity will enable you
to independently enquire into the ethical issues
associated with health and social care research and
consider your own values and beliefs, as well as those
of the researchers.
Effective participator: You can show effective
participation by discussing different viewpoints and
dilemmas about the ethics of research and seeking
resolution of these.
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3 Understand research methodologies relevant to

Laboratory-based research into diseases and disorders,
Activity 12: Participating using tissues and chemicals, is likely to be based on
in research scientific method until such time as the research needs
to involve people. Your project for this unit is most
Have any of your class group ever filled in a likely to follow a social science approach.
questionnaire or been interviewed? Use the
following questions to explore your experiences: Quantitative research
1 How did the interviewer or person who Quantitative research involves numbers and
distributed the questionnaire choose or find you? measuring quantities or amounts. Scientific method
2 Did you know what the purpose of the often involves quantitative data – for example,
questionnaire was or why you were being measuring changes in the body’s physiology in
interviewed?
laboratory analyses of blood or urine samples.
3 How did you know this? Measures of weight and height can be used to
4 Did you have an opportunity to agree to being calculate body mass index (see Unit 21) to find out
interviewed or to complete the questionnaire (or whether an individual is a healthy weight.
not to complete it)?
5 How easy was it to understand what was
expected of you, e.g. how much to say in
response to the interviewer’s questions or how to
Key term
fill in the questionnaire? Quantitative – Describes information that is directly
measurable; quantitative data usually involves number values
6 Did the interviewer or the questionnaire enable and units of measurement, e.g. number of breaths per minute
you to give the answer you wanted to give, or weight in kg.
e.g. did the interviewer give you enough time
to answer or did the questionnaire give you
answer options that enabled you to provide a fair
answer? Activity 13: Measuring
7 What were your feelings at the end of the
interview or after you had completed the
health status
questionnaire? Why did you feel this way? List other measurements that may be taken
to investigate whether the body systems are
functioning normally or not. Identify the units of
measurement used for each measure listed.
Functional skills
Quantitative research may also involve finding out, for
English: This activity requires you to make a range of example:
effective contributions and to listen to those of others,
presenting ideas clearly and appropriately for the • frequency or how many times something happens
context of this activity. in a given period, usually expressed as per minute,
per hour, per day, and so on (e.g. minutes of
exercise per day or number of falls per year or
3.1 Types of research population data such as the number of deaths in a
year from stroke)
Research in health and social care tends to adopt
the methods of social science research because • how many individuals there are in a particularly
the projects often involve investigating people’s category (e.g. smokers or non-smokers)
feelings, perceptions, attitudes etc., which do not lend • information involving more complex equipment and
themselves to investigation by scientific methodology. processes such as analysing a sample of blood to
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measure its haemoglobin content to assess whether received information second-hand (e.g. from a GP’s
a patient is anaemic or not (see also Unit 5 Anatomy letter or from the accident and emergency team) but
and physiology for health and social care). the doctor who is overseeing the patient’s care on a
Quantitative research requires the use of specific ward needs to hear the patient themselves describe
measurement instruments. Measurements gathered their experience of their illness, even if the doctor
routinely are sometimes recorded on charts, which supplements this information by obtaining quantitative
can reveal how small variations between individual data from blood samples and other investigations,
measurements may add up to a more noticeable often called ‘tests’. Only the patient can describe their
change over a longer period. Body temperature, symptoms; pain is only experienced by the sufferer and
for instance, may change over a day or body weight can therefore only be described by that individual. If
over a few weeks. Multiple-choice questions, with the patient is not conscious, then the health worker has
specific answer options, can generate data that can be to rely on descriptive information provided by relatives
analysed quantitatively; questionnaires are often used or whoever is available.
for this purpose.
Qualitative research
Qualitative research involves gathering data that
cannot be easily quantified and instead can only be
recorded using language. Qualitative data tends to
be collected using unstructured interviews, audio A doctor interviewing a patient
as part of the process of being
recording of conversations or narrative observations.
admitted to hospital. What sort of
An individual’s feelings or emotions may be evident questions is this doctor likely to ask?
through observing facial expression (see Unit 1
Developing effective communication) but can really
only be fully understood by letting the individual
describe how they feel.
Did you know?

Patients who experience a heart attack most often
describe the experience of the pain as if someone has
clenched their fist around their heart. This description
is so often used by patients that it can enable
paramedic teams to diagnose the heart attack before
they even get to the scene in the ambulance.
In routine practice, health professionals gather both

qualitative and quantitative data and use both types of
information to make judgements about the individual’s
care and treatment. Every conscious patient admitted
to a hospital ward is interviewed by a doctor, who
takes notes about the patient’s experience of their
illness – their medical ‘history’. The doctor may have
Key term
Qualitative – Data that cannot be ‘measured’ quantitatively
but can only be described using words.
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In a research study, researchers often attempt to

express qualitative data about individuals and their Did you know?
experiences in quantitative ways. Examples of this Sharing research ‘publicly’ does not necessarily mean
might be: that the findings get into the daily newspapers.
• using a rating scale to quantify the severity of pain Research work is often very specialised so reports
of the research are therefore published in specialist
• completing a questionnaire to find out an
magazines, or journals, which may only be read by
individual’s experience of using a health or social others with a similar specialist interest. University
care service libraries hold stocks of many specialist journals.
• recording how often a specific event or behaviour However, these days most researchers access journals
happens (its frequency). online.
Primary research
Primary research involves seeking new knowledge
that has not been previously published. The researcher Activity 14: What’s in the
gathers new data from participants or by examining library?
objects, materials or data in a different way from
Go to a library and look at the magazine rack. What
previous studies. For example, interviewing individuals
specialist publications relevant to health and social
in their twenties about their experiences of health care are available? What sort of articles do they
education in school as teenagers could help devise a contain? Who is writing the articles? You might
new policy for health education. A study repeating one find different types of publications available in
carried out thirty years previously would be primary your school or college library compared with those
research that was relevant to young people now, rather available at a public library.
than young people as the world was for an earlier 1 Repeat the exercise looking at the book stock.
generation. Using a new technique that enables traces 2 Can you access any e-books from your school
of a specific chemical to be identified in blood or urine or college library? If so, find out how to use
samples might produce new understanding of a disease. e-books.
Primary research in health and social care often
involves gathering data from individuals. Surveys using
questionnaires and interviews are commonly used
techniques and participants may be users of services, Did you know?
staff working in the services or members of the public.
A PhD (Doctor of Philosophy) is the post-graduate
Secondary research qualification expected of professional researchers.
Usually a full-time PhD student takes three years to
Given that research is about finding out new complete the research and submit the thesis (i.e.
information or understanding, a researcher needs to the report of the research) for examination by the
know what the existing information and understanding university.
about the topic is, as published in books, journals
and on the Internet. Secondary research is essential
for any research project. All researchers need to read
widely around their subject of interest so that they Key terms
are aware not just of long-established knowledge Primary research – Research that generates new data from
sources.
but also of new knowledge that is emerging while
Participant – An individual who contributes information
they are doing their own research. Research carried
about themselves to a research project; the information may
out by researchers in universities and other research
be qualitative or quantitative.
establishments may take several years to complete
Secondary research – Research in which data is obtained
and report in full. Small-scale research projects can be from sources that are already in the public domain, i.e.
completed more quickly but need to be clearly defined sources that have been published in journals, books,
in order to produce results that can be analysed and magazines, etc.
reported within a few months.
427
3.2 Primary sources Activity 15: Questionnaires

Research techniques that can be used to generate
primary data include questionnaires, structured Examine a selection of questionnaires
gathered from a range of sources, e.g.
and unstructured interviews, formal and informal
those your school or college distributes to learners.
observations, measurements and scientific experiments. What is the purpose of each questionnaire? What
sort of information was being sought? How was the
Questionnaires questionnaire completed? Do you always complete
Research in health and social care often relies questionnaires when asked to do so?
on obtaining information from individuals using
social research methodologies. Questionnaires are
convenient for obtaining information from many responses actually received by the researcher are,
individuals in a survey and those answering them are compared to the number of individuals originally asked
sometimes known as respondents. A questionnaire to complete the questionnaire.
asks questions of participants but, usually, also only The sample population should be defined when
enables answers to be given according to options the research is planned, as it will influence what
constructed in advance by the researcher using a information can be obtained from a survey. The
response frame. The response frame usually only method for selecting the participant sample from the
allows a limited choice of different responses. sample population should also be considered at the
In small surveys, questions may be put to the planning stage.
respondent orally by the researcher, who then ticks Some frequently used sampling techniques include:
a box corresponding to the answer given and also
• random sampling, in which individuals are selected
records the responses provided. Market research
randomly; researchers may use random numbers
carried out in the street usually follows this approach.
selected by a computer or from a table of random
In health and social care, this method may be the only
numbers
way to capture information from a frail older person
about the care they receive, for example. • systematic sampling, which involves selection of
the individual at a regular interval, e.g. distributing
a questionnaire to, say, every sixth student who
Reflect enters the college canteen, or every other patient
In research about care for older people, what who presents with diabetes
potential ethical issues could arise when asking
a frail 90-year-old, who is partially blind, unable
to hold a pen or understand the questions to
complete a questionnaire? How could the risk of
Key terms
unethical research practice be reduced? Survey – A systematic process of gathering information from
several people, often using a questionnaire.
Response frame – The menu of answer options to an
In a self-completion questionnaire, respondents fill individual question provided in a questionnaire.
in the answers themselves. The questionnaire may be Respondents – The individuals in the selected sample who
distributed to individuals directly by hand, by post or actually complete the questionnaire and return it to the
online, provided the organisation or researcher has a researchers.
means of making contact through an email address or Response rate – The percentage of respondents from the
information held on a database. selected sample. For example, a 30 per cent response rate is
good in a survey in which individuals are sent a questionnaire
You may well have been asked to complete a customer by post.
satisfaction questionnaire but being asked to complete
Sample population – The group of individuals in a
a questionnaire is not the same as actually doing so. population who are targeted for investigation, e.g. older
The respondent may ignore it, only answer some of people, college students, etc.
the questions or not return the questionnaire to the Sample – In social research, the individuals selected to
researcher. The response rate to a questionnaire participate in the research from the sample population.
is an important measure of how representative the
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• quota sampling, which requires the researcher to Open questions require the respondent to answer
select a pre-determined number of individuals from freely, either orally or by writing in a blank space
representative groups (e.g. according to age, area provided on the questionnaire. The respondent has
of the country, socio-economic profile, male and/or to write the answer (or the researcher, if it is not a self-
female etc.); opinion pollsters use this method completion questionnaire).
• opportunity sampling, which involves researchers Other response frames enable more specific and
handing out questionnaires to individuals who detailed information to be obtained. Examples include:
happen to be passing by at the time. Standing in • ranking scales, which require respondents to
a college canteen on a particular day and handing rank different statements in an order, often using
out questionnaires to anyone who will take a copy a number scale, where, for example ‘1’ is very
would be opportunity sampling. important and ‘5’ is not at all important (see Figure
The sampling technique and sample size chosen for a 22.2)
research study affect the validity of the research and
the conclusions that may be drawn from it. finish your current
Q. Which of the following is most important to you when you
course?
important each statement
In the right hand column, enter one number per line according to how
Reflect is to you with 1 representing the most important and 5 the least important.
Getting the highest grades I can for my Level 3 qualificatio

n(s)
Passing my level 3 qualifications(s)

The more complex or varied the information
Getting to university
being sought from the survey sample, the larger Getting a job
the number of respondents that are required to Moving away from home
ensure the validity of the data obtained. Why do

you think this is?
Fig. 22.2: In this ranking questionnaire the statements assume
that the respondent is on a Level 3 programme. Unless the
sample population is selected for this reason, how would the
response options prevent other respondents from answering
Who your respondents are could affect the the question?
interpretation of the results so it is usual to gather
factual information about them that your secondary • Likert scale response frames, which gather
research has suggested might be significant. respondents’ opinions of carefully worded
Questionnaires usually request information on age, statements using a five-point scale such as ‘strongly
or age group and gender. However, requesting agree, agree, neither agree nor disagree, disagree,
information that is not relevant to the research (e.g. strongly disagree’. Other descriptor words may be
about marital status) would be unethical because used (see Figure 22.3).
it invades individuals’ privacy. Ethical approval may Examples of other response frames are presented
involve removing some questions if this were the case. in Figures 22.4 and 22.5 on page 431. Constructing
The simplest questionnaires have response frames a questionnaire takes time if it is to yield good-
that offer only straightforward choices and require quality research information. Questionnaires are very
all responses to be indicated entirely by ticks. More useful when finding out about people’s opinions,
complex questionnaires may have: perceptions, experiences, or to find out how much
• more questions knowledge and understanding they have of a topic.
Surveys undertaken for a student project are likely to
• more options in each response frame
focus on this type of information because of the ethical
• require respondents to provide written comments. constraints on students regarding research in health or
Questionnaires with only closed and open questions social care settings or with users of services.
are probably the simplest response frame for the The drawback of using response frames is that the
researcher to construct but provide more limited data, answer options offered may not include the answer
which can be more difficult to interpret, especially the respondent thinks is right for them. One way round
when working with a small sample. this is to include an option such as ‘none of these’, ‘all
Closed questions only offer two alternative answers: of these’ or ‘other’, with a space for the respondent to
usually ‘Yes’ or ‘No’. provide an alternative answer.
429
What is your experience of using your GP surgery?

Please enter one tick per statement
Neither Strongly
Strongly Disagree agree or Agree
disagree agree
disagree
1 I can get an appointment

with the doctor I choose
within two days
✔
2 The surgery offers evening For Q4 the respondent may never have been ill
appointments enough to need this service in which case the
3 The surgery has male and Likert scale on its own does not give a sensible
female doctors answer option; inserting a ‘don’t know’ column on
4 The doctor will visit me in the right, could get round this problem.
my home if I am too ill to go
to the surgery
5 I can have prescriptions
made up at the surgery In Q6 and Q7, by separating these two apparently
similar questions, it enables respondents to
6 Staff at the surgery are
helpful acknowledge helpfulness even if the staff are not
7 Staff at the surgery are friendly and vice versa.
friendly
Fig. 22.3: What other questions could you include in this Likert scale patient questionnaire?
Partly completed questionnaires reduce the quality of

Did you know? the data from a survey and therefore limit the validity
In the UK, the government carries out a survey of of any interpretation and conclusions drawn from
all households, called the National Census. It is the research. Factors to consider when designing a
compulsory by law for Census forms to be completed. questionnaire include:
The Census has been carried out every ten years since • a clear understanding of the contribution the data
1851 (with the exception of 1941, when the country
respondents will make to the research
was at war). The next Census is due in 2011. The
data gathered in the National Census is analysed by • the abilities and experience of the respondents, e.g.
government statisticians and computers and provides their understanding (avoid jargon), literacy skills, etc.
valuable information about the population that is
• how you will address ethical issues (e.g. providing
used to formulate social policy. Census forms are
particularly long and complicated questionnaires. information about the research)
• what the document looks like; does its layout, font
size and style help the respondent complete the
questionnaire?
• what instructions the respondent will need to
Reflect complete the questionnaire
Why is it important to hold the respondents’ • the order of the questions, e.g. simple questions at
interest throughout the questionnaire, rather
the start and more complex ones later; questions
than getting them bored or annoyed by the
questions and the answer options? probing personally sensitive information are best
placed towards the end of the questionnaire
430
ers?
Are you affected by any of the following common chronic disord
Please tick only those that apply. The term chronic may need
to be explained to respondents
Asthma □ Irritab le bowel □
Eczema □ Crohn’s Disease □
Psoriasis □ Rheumatoid arthritis □
Diabetes (Type 1) □ None of these □
Diabetes (Type 2) □ Other chronic disorder □
(Please specify below)
Other (please state): The last two options enable respondents to

provide information other than that given in the
response frame and to indicate if they have
no chronic disorders at all
Fig. 22.4: This response frame requires respondents only to indicate those responses that apply to them
you?
How important are each of the following social contacts to
Circle one number per statement.
1 = very important, 5 = not important at all
1 2 3 4 5
Others living at my home
1 2 3 4 5
Relatives not living at my home
1 2 3 4 5
Work or college/school colleagues
1 2 3 4 5
Neighbours
Friends outside of home and work/study that 1 2 3 4 5

I first met face-to-face
Social networking on the Internet with people 1 2 3 4 5

I have never met
Fig. 22.5: In what ways could you use a response format that enables the respondent to quantify a statement using a numbering
system?
431
How often do you exercise?

Enter one tick per line for each statement (a)–(e)
Construct the statements 3–4 Once Less
Once a every Once a often
carefully; meanings should Every times
day per week 2–3 month than
be unambiguous weeks this
week
(a) Walk at a steady pace uninterrupted for

20 mins This option enables a respondent
(b) Walk briskly for 1 hr uninterrupted who does not exercise regularly
‘at least’ is easier
to enter an answer rather than
(c) Attend yoga or similar session for at to understand than
leave the line blank
least 1 hr ‘a minimum of’
(d) Participate in moderate specific activity,
resulting in mild sweating, for 1 hr
minimum Define the frequency of an event or
(e) Participate in energetic activity e.g.
activity rather than using relative
squash, rugby, resulting in substantial descriptors such as often or very often
sweating, for at least 40 mins because ‘often’ may mean different
things to different individuals
Fig. 22.6: How could you use a response frame like this to find out the frequency of other behaviours and lifestyle habits such
as diet?
• how you will hold the interest of the respondent so Distributing questionnaires by email or post means
they answer all the questions that you need the email or postal addresses of the
• the distribution method and how long the participants. This information is confidential and may
questionnaire will take to complete, e.g. will not be known by the researchers. All such information
respondents have a hard surface available for the would be subject to the DPA. The aim of any survey
writing involved? is to get as many of the completed questionnaires
returned as possible; the return rate is an indicator of
• how the completed questionnaires will be returned.
the reliability of the data generated from the survey.
To calculate the return rate, you need to record exactly
how many questionnaires are printed and distributed,
as well as how many are returned.
Interviews
Activity 16: Distributing Interviews involve an interviewer interacting with
questionnaires participants in the research. Sometimes there
In groups discuss the advantages and disadvantages
of different methods of distributing questionnaires
for research projects investigating: Key terms
a) the alcohol consumption of university students Return rate – The number of questionnaires returned,
relative to those distributed, expressed as a percentage.
b) how older people manage their finances
Interview – An interaction or conversation between a small
c) the exercise habits of busy professionals. number of people for the purpose of eliciting information.
432
may be more than one interviewer or two or three to be audio-recorded but there the interviewee would
interviewees. Interviews may take place: need to give explicit consent for the interview to be
• face-to-face recorded. Alternatively, a scribe could be present
solely to record what is said but this may affect the
• over the telephone
interviewee’s responses. After the interview is over, the
• using text messaging
interviewer listens to the tape again and prepares a
• online transcript.
• using video-conferencing facilities so those involved
are not in the same location but can see each other
Scientific experiments
The scientific method involves making an investigation
• via social networking websites
to establish factual information. Its origins are in
• in a focus group, where several interviewees making careful observations of different phenomena in
respond to questions. the natural world.
An interview is a useful research method for example,
when:
Key term
• detailed information is required
Transcript – An exact word-for-word written record (‘ums’
• knowledge and understanding are being sought and ‘ers’ included) of what is said, both by the interviewer
from a specialist and the interviewee, taken from an audio record of the
interaction.
• the population sample is very small
• participants may have difficulties completing a
questionnaire
• a wide range of experience is being investigated
• the information being sought is not sufficiently
predictable to be gathered using a structured
questionnaire.
Structured interviews
In a structured interview, the interviewer has pre-
prepared questions, which are put to the interviewee.
The interviewer writes down the answers given by the
interviewee, possibly using a structured template,
which may involve ticking boxes and recording a
summary of what the respondent is saying.
Unstructured interviews
An unstructured interview is not constrained by pre-
prepared questions. Instead the interviewer will have
identified some broad topics to ask the interviewee
about but will then use follow-up questions, according
to the answers provided by the interviewee. This
approach enables the interviewer to probe specific
aspects in detail, to check understanding, return to On his 1831–36 voyage on HMS Beagle, Charles
points already mentioned, etc. Unstructured interviews Darwin filled 37 notebooks with observations of
are therefore time-consuming and it is more difficult thousands of different species and their environment.
to standardise the technique if several interviewers These detailed records formed the core of the
are involved. Also, it is difficult for the researcher to evidence from which Darwin developed his theory of
evolution. He eventually published his theory in 1859.
concentrate on what responses the interviewee is
This drawing, which he made in an 1837 notebook, is
giving, if these have to be written down at the same the first sketch of the evolutionary tree.
time. It is therefore quite common for such interviews
433
The scientific method involves testing a hypothesis, these variables, as expected in a scientific experiment.
which is a statement about a phenomenon. The While experimental work is used in some psychology
statement is based on prior knowledge and is an research, much other social science research can only
‘educated guess’ about the relationship between be based on scientific principles as far as is permissible
factors influencing an observed phenomenon. within ethical frameworks. Sometimes the research
Factors that influence a phenomenon are called strategy mixes scientific method and social research.
variables. A scientific experiment is a test specifically For example, an investigation of the effect of an
designed to investigate the nature of the influence of a exercise routine on individuals’ health could measure
single variable on the phenomenon. some aspects (e.g. changes in pulse rate, respiration
rate, blood pressure, etc.) under scientific conditions
The phenomenon is the dependent variable and the
but would then have to adopt a social science
factor influencing it is the independent variable. A
methodology, such as a questionnaire, to investigate
single experiment is only valid if it tests the effect of
how the exercise made the individuals feel about their
just one dependent variable against one independent
health.
variable, so making it a ‘fair’ test. Both variables need
to be measurable, as far as possible using quantitative
measures. Activity 17: Experiments
An experiment may prove or disprove a hypothesis.
Either outcome is equally positive. If a hypothesis is In groups, discuss the following questions:
disproved, the scientist will analyse and evaluate the 1 What experiments have you carried out, and
results, construct a modified hypothesis and conduct where? The most likely place will have been in a
a further experiment to test it. Scientists may pose a science laboratory.
hypothesis that requires knowledge and understanding 2 What was the hypothesis?
of a whole range of factors or variables. The scientists 3 What were the variables in these experiments?
break up the main hypothesis into individual 4 Which was the dependent variable and which
hypotheses and investigate a single pair of variables was the independent variable?
for each of these in turn so that the main hypothesis 5 Were you measuring quantitative results or
is not fully tested until a series of experiments is making qualitative observations?
completed. 6 Did you have a control and, if so, why?
Human beings are complex organisms and their
behaviour and physiological responses are influenced
by very many variables. Ethical considerations mean
that researchers have very limited scope to control Observations
An observation involves gathering information
visually, and is not necessarily dependent on verbal
Key terms content. Observations are valuable for understanding
Hypothesis (plural: hypotheses) – A hypothesis is a behaviour, and for recognising the degree of mastery
statement that predicts an association between two variables.
of practical skills and how people interact with each
Variable – An entity or factor that can have a range of values other and their environment and events as they
that can be measured.
happen. Observations can be made in ‘live’ situations
Experiment – A test designed specifically to test the validity
or from recorded visual media. Consent is always
(truthfulness) of a hypothesis.
required from the participants who are being observed
Dependent variable – A variable whose value is dependent
and, for good practice, from the organisation on whose
on that of another variable. The dependent variable is
associated with the phenomenon being measured. property the observation is being made. Observations
Independent variable – A variable whose value is made in public spaces may not need consent, on the
not dependent on that of another variable. Time and grounds that anyone can observe others as a passer-
temperature are common independent variables in scientific by. Recording events and activities (e.g. on mobile
experiments. phones or video cameras) for research purposes would
also require explicit consent from participants.
434
If the observer is actively engaged in the event or of the environment. A health and safety audit is a form
activity being observed, then they are a participant of routine research that involves close examination of
observer. For example, a care worker might be equipment, décor and furniture to see that it is still in
stimulating an individual with profound and multiple a good state of repair and not a risk to people. The
learning needs to respond to various stimuli by health and safety officer might use a checklist to record
moving objects, talking and otherwise interacting what has been observed and note any signs of wear
with the individual and at the same time making a and tear that might be a danger.
record of the individual’s reactions. Alternatively, if
Informal observations
another care worker was observing the interaction
Informal observation is an important aspect of
between the carer and the disabled individual and
all care. Carers should always be watchful of the
noting the responses, this care worker would be a
individuals they care for. In this context, an informal
non-participant observer because they would not be
observation could simply mean noticing changes
involved in the interaction between the two people
from normal patterns. For instance, a person might
and would be observing it as an outsider.
be uncharacteristically aggressive, or quiet and not
Formal observations participating in a group activity, or look pale and
Formal observations can provide specific information unwell. Informal observations are often the only
for a research project. A formal observation is a means of gathering information about unplanned
planned event in which the observer watches a specific events or incidents (e.g. a violent outburst or a patient
activity for a period of time and makes a record of what collapsing). Informal observations may have a place in
goes on during that time. a research, and they have greater validity if the person
making the observation is a health or social care
professional.
Did you know?
The Early Years Foundation Stage curriculum Reflect
introduced in England in September 2008 requires
Gathering information through informal
early years workers to observe young children
observation, i.e. being observant, may provide
regularly to record their progress in meeting specific
valuable information. What ethical issues might
developmental objectives.
arise in relation to using informal observation
in a research project? How should you present
Techniques for making formal observations include findings acquired in this way in a report of the
narrative, time sampling, checklists, event sampling research to take account of these?
and sociograms. The observation may be documented
on a specific form but should always record the date,
time, duration and context of the observation. In Measurements
childcare, observations are a routine aspect of the Research may be based on changes to the values of
early years practitioner’s work and information from measurements. For example, a study exploring levels
observations helps the practitioner plan activities to of stress experienced by individuals may involve
promote the development needs of the children in measuring their blood pressure and possibly pulse
their care. rate. Measurements usually generate quantitative data.
Formal observations are not limited to observations of
individuals. They may involve observations of staff and 3.3 Secondary sources
In the twenty-first century, information that has already
Key terms been published can now be obtained through a variety
Participant observer – The individual doing the observation of different media. Books, journals and magazines are
is part of the process being observed. traditional sources but, increasingly, researchers use
Non-participant observer – The individual is an onlooker digital media to access secondary sources for their
and not part of the situation being observed. research. However, to do this successfully, researchers
need:
435
• the technological resources to access them (e.g. Examples of secondary sources that could be a source
access to the Internet, to a library that subscribes to of relevant data for a research project include:
online journals, etc.) • websites
• the skills and understanding to use the software • specialist journals that are relevant to health and
required to access and use the resources effectively social care and the research topic
• to be able to establish the validity of any secondary • media (e.g. newspapers, radio, television, Internet
source accessed via the Internet news pages)
• to understand the legal expectations regarding • books
copyright, confidentiality, etc. when using
• e-books
secondary sources.
• government reports
Information literacy • reports from other reputable bodies (e.g. charities
Information literacy means understanding the and research foundations).
limitations of different information sources so that
data from them can be used appropriately to maintain Websites
validity for the purpose for which the information is
being used. Factors to consider when using secondary Activity 18: Websites
sources are highlighted in Unit 6 Personal and
professional development page 251. a) Search the websites of:
Secondary sources accessed for a research project • a government department

are likely to reflect the specialist focus of the • a voluntary organisation
research. They may contain advanced text that is less • your local authority
fragmented by headings than a Level 3 textbook and • a local primary care trust.
they may discuss complex ideas and detailed factual b) Find one document from each website that is
data. Here are some strategies for making the best use relevant to health and social care, open it and
of secondary sources: summarise what the document is about in no
• ask yourself what the heading tells you more than 50 words. Share this with your peers.
• skim-read to identify the type of text (e.g. research c) Make a list, with brief notes of the sort of
information each website contains, to use later in
report, critical analysis, review article) and its your research project.
structure (e.g. headings, referencing, sources)
• scan-read to identify key words and judge the
relevance of the text for your purpose
Websites are a useful means of accessing government
• target more detailed reading on the abstract/
documents and important reports. The details for the
summary (if there is one, it may be in a feature box
government departments most relevant to health and
or sub-heading), conclusions (at the end), discussion
social care research are listed at the end of this unit.
(towards the end), introduction (start of main text),
Websites for charities that provide health and social
results and method, in that order
care services or carry out medical research can also be
• make notes in your research notebook useful sources of data.
• record all details needed for later referencing. The amount of information available on the Internet is
vast, and can be accessed via many different websites,
which can make it difficult to find an article again at
Reflect a later date. Good discipline is valuable, not only for
Why would it be particularly important to pay your research project, but for all study. Here are some
attention to the country to which a secondary useful tips for Internet research:
source related when carrying out research • always save all the details you need to compile a
relating to health, social care or education in your
reference list for the research report; these should
local area or region?
include a) the URL (full web address details as taken
436
from the textbox at the top of your Internet screen),

b) the day/month/year date you accessed the
Activity 19: Newspapers
webpage and c) if possible, the year the document Work in a group of 6–8 for this. Each group
was posted on the website or published member should obtain a copy of a different
• save web addresses on the personalised daily or evening newspaper on a day when there
‘Favourites’ directory of your Internet Service is a story relevant to health and social care in the
news. Bring the newspapers to class and investigate
Provider (ISP) so you can return to the same site
how each paper has reported the story.
with a single click
1 Each newspaper will have presented the health
• download documents you may want to return to and social care news differently. What key
later, saving them to a data stick or hard drive on message is each putting across in its headlines?
your computer What factual information do they present?
Where is the story located in the newspaper?
• avoid printing out whole documents unless they
Has the paper sought the views of different
are difficult to read on screen, or contain complex people? What is the newspaper’s opinion?
information you wish to annotate or return to (You may need to look at the ‘comments’ or
repeatedly; sometimes printing selected pages is ‘editorial’ page to find this out.) What is the style
sufficient, combined with saving an e-copy. of writing?
Journals 2 When you have compared the way each

newspaper has covered the story, you need to
Journals are specialist publications published think about how the information has influenced
at regular intervals for specialist groups such as your own perspective. What have you learned
professionals, scientists and other researchers. about the story? Which newspaper do you think
Academic journals publish reports of research. The has given the fairest (most balanced) coverage
to the news story? What are your reasons for
publication of research in a journal is an important
this? What is your opinion of the story now? How
aspect of the research process. Indeed, in the UK, important do you think the story is in relation to
government funding of research partly depends health and social care? What has influenced your
upon publication this way and in future will also be judgement on this?
dependent on how often other people read the 3 Now consider where you may find out more
research reports. Some weekly or monthly journals about the story – to check the accuracy of the
may be available for reading in your school or college information you have read in the newspapers. Is
library or in placement settings. These days, libraries there a report that you could read? What does
the government say about it? Where could
subscribe to online versions of journals so those
you get other opinions on the story? If you
registered with the library can access them online. investigate these sources, to what extent does
Media additional information confirm or alter your own
opinion and conclusions about the health and
Print and broadcast media can be a valuable source of social care story?
information, particularly in relation to news but also on
other topics of broad interest to the public.
Newspapers
Newspapers are a traditional source of information PLTS
about what is going on in the world and individual Effective participator: You can participate
customers tend to purchase the same paper every day. effectively in this activity by collaborating with other
group members when sharing out the tasks across
Newspapers can be influential in developing opinions
a range of newspapers and enabling each group
among the public (e.g. about controversial topics or at member to contribute.
election time). However, each UK newspaper is written
to appeal to its particular group of customers and they
can show their bias by:
• what they present as the main news (e.g. on the
front page)
437
• what they decide to write about it interest, including books about specific disorders and
• from what perspective they write (e.g. that of health and care issues.
business or the private individual, etc.). e-resources
Professionals and researchers should be aware of this Apart from the Internet itself and online academic
when using newspapers as a source of information for journals and newspapers, an increasing number
research. Some newspaper publishers are beginning of books are available as e-books, either by direct
to restrict free access to news stories online so that purchase or if you are a member of a library.
people have to pay a subscription in order to read
them.
Broadcast media Activity 20: e-books
Radio and television provide news, information and
discussion of different opinions on a wide range Find out what e-books you can access
through your school, college or public
of topics. The rigour of the broadcast content can
library that could be relevant to your BTEC
vary across channels but several television and radio course. Arrange to view an e-book and
programmes frequently discuss topics relevant to experiment with the software capabilities for
health and social care including, for example, long- using the book for study.
standing favourites such as Panorama, Horizon
and Regional News on television and The Today
Programme, You and Yours, and Woman’s Hour on
Radio 4.
Literature review
Books
The literature review is carried out at the start of a
Books are the traditional means of publishing research project to enable the researcher to find out
information. Social science theory tends to be what is already known about the topic so that the
published in books, whereas science-based research research does not simply repeat work already done
reports are usually published initially in journals. New by others. The review involves reading around the
knowledge and understanding from research gets immediate topic of the research to acquire knowledge
incorporated more widely into specialist textbooks and understanding relating to the context of the
later so recently published textbooks have greater research. A literature review also helps to narrow down
credibility than books published several years ago. the research topic and identify the specific aspects that
In health and social care, continual policy change will be the focus of the research project.
can mean a textbook is soon out of date. However, a
The review is likely to involve accessing a range of
book published a long time ago may be the original
secondary sources. It is important to be systematic
book written by a particular theorist. When quoting
in recording all the details needed to construct a
the theory in your own writing, you need to reference
reference list from every source used. The details
the source in such a way that it is clear whether you
you need to record are listed on page 444. You could
have read the original book or journal article or just
expand a literature review by following up items
read about the theory (or research) in a more recently
from bibliographies and reference lists in the sources
published textbook.
you have already viewed. Sources where sufficient
information is provided to make a judgement about
Reflect their reliability should be used in preference to poorly
Can you think of some famous theories you validated sources, such as online encyclopaedias, or
have studied (in other units) that were originally where there is no named author or other identifier to
published a long time ago? enable reliability or validity to be established. It is usual
to return to the literature review and sources used
School, college or university libraries tend to stock when writing up the report of research.
textbooks and other books for study. In contrast, Once you have established the usefulness of a source,
public libraries tend to stock books of more general you can go back and read it more carefully.
438
Table 22.3: Stages in a literature review
Extracting • skimming and scanning for preliminary judgement on relevance

information • identifying key words for exploration in text
• establishing type of information, e.g. research report, essay, comment, quantitative/
qualitative, etc.
• detailed reading in order: 1 Abstract or summary; 2 recommendations; 3 introduction; 4
discussion; 5 results and methodology
Interpretation • understanding what is being said in the source
• understanding the reasons for the interpretation presented
• how objective is the interpretation?
• identifying the relationship with research topic/your purpose
Analysis • what are the arguments presented in the source?
• to what extent are they supported by valid and reliable evidence?
• what assumptions are being made?
• what are the similarities to, and differences from, your own research?
• how does the source compare with other secondary sources?
• who are the participants?
• what methodology was used?
• how objective is the data?
• exploring other factors relating to the data, e.g. when and where it was collected
Synthesis • bringing together the knowledge and data from all the sources to develop a new or different
perspective on the topic
• possibly identifying gaps in the knowledge
• acknowledging similarities and disagreements between your own findings and information in
the literature
• possibly suggesting explanations, influences, etc.
• defining the limitations of the source in relation to your own project
Analysis Synthesis
Analysis means a detailed exploration of a text to Synthesis is the process of constructing or developing
better understand different aspects of the information a new/different argument or perspective, based on
it contains. Analysis involves dissecting the text of the issues revealed by the preceding analysis. Once
the source, or breaking it down, by exploring and each source in the literature search has been critically
discussing each detail. An important part of analysis analysed individually, the researcher will have a
is to identify any arguments being proposed by the different perspective on the research topic and be able
authors. Strengths and weaknesses in the evidence to identify more specifically how further research could
or arguments should be discussed as part of a critical contribute new knowledge and understanding. The
analysis. researcher can then decide on exactly what aspect of
the topic to research, formulate a suitable hypothesis
or research question and plan their project.
Key terms Data
Assumption – Conditions that apply to a situation but which Quantitative data, in the form of graphs, tables and
are not investigated in the research. It is good practice to be
statistics, often features in health and social care
explicit about the assumptions being made.
research.
Argument – A point of view that aims to persuade others
to the same view by presenting supporting evidence. An Tables enable data to be viewed systematically,
argument is more than a statement of fact. without the need for a lot of text. They are most
frequently used to present numerical data, but can also
439
be used to summarise qualitative information concisely

and for clarity.
Activity 21: Statistics
Graphs and charts present quantitative data visually, Go to the ONS website (www.statistics.gov.uk)
which usually assists interpretation of the data. They and note the type of data that can be retrieved
also enable large quantities of data to be presented in from each site and the different types of graphs
a manageable format. and charts used to present the data.
Note all the information provided with the data, e.g.
headings, keys, scales, units, etc.
Reflect
Select one table and two different types of chart,
How confident are you about reading and all unrelated to each other and describe orally to
interpreting quantitative data presented within each other, the results shown in each. You could do
text, in tables or in graphs and charts? Discuss this activity in pairs. Use questioning to each other
any concerns you have with your tutor who may to clarify any uncertainty or misunderstanding you
be able to arrange specialist support during your have in interpreting the data.
project.
Check your own interpretation of the statistical data
by reading the descriptions of it given in the text
Demographic statistics collected by government accompanying the visual representations of the
departments or agencies, local authorities and health data.
trusts are valuable for comparison with data gathered
in your project.
Functional skills
The Office for National Statistics (ONS) publishes a
range of demographic statistics that are categorised Mathematics: This activity enables you to
demonstrate your understanding of statistical
under health, social care, education, etc. They provide
information presented in different formats and
national data as well as a breakdown of the data for communicate this to others.
each of the UK regions. They also present comparisons
with similar data from earlier years.
The ONS website has several reports that present Key term
health and social care data through its link to the NHS Demographic statistics – These are statistics relating to
Information Centre. Statistical information may be populations. In the UK, statistical information is collected
presented in various formats such as tables, graphs continuously by various agencies but particularly by
and charts. government departments through information about UK
residents gathered from e.g. tax collection, driving licences,
passports, the ten-yearly Census, schools, GPs’ records, etc.
Present a comparison of different research Grading tip

methodologies as they might be used in health and
social care research. P3 You could present your comparison in a
summary form, e.g. as a detailed table, giving
examples of where each method could be used
in health and social care research, and submit it
with the evidence for your research project plan.
PLTS
Creative thinker: The questions you ask in order to
make the comparisons will demonstrate your creative
thinking skills.
440
4 Be able to plan for a research project

Please note: you may wish to cover the content in This is a pilot study, which is good practice in
Section 5, Topic selection (pages 443–447) first, research. A few, carefully worded questions and well-
before covering this section on Planning. thought through response frames may provide more
valuable and reliable data than several, poorly thought
4.1 Planning out questions consisting only of closed answer options.
You should indicate in your action plan if you intend to
Methodology carry out a pilot study and should get any amendments
The methodology is the overall approach you select made checked by your tutor before starting the full-
to conduct your research – for example, whether you scale study.
will use a scientific or social science methodology. It
includes the specific methods you will use and the Action plan
literature search to contextualise your project within Once you have decided on your methodology, you can
existing knowledge and understanding of the subject. construct a detailed plan for your project. The action
plan you will submit for your research project may
follow a similar format to the action plan for personal
Activity 22: Selecting your development you prepared for Unit 6. The plan
subject should be sufficiently detailed to give you all the time
needed for different tasks. If the plan is not detailed,
Once you have selected your research topic, carry
it is more likely that the time needed will be seriously
out some further reading. At the same time, you
should start to compile a reference list of the sources underestimated and you will get behind with your
you use. overall plan.
Draw a mind map to break down the subject into The details of your action plan should include time
different aspects and decide: needed for the literature search, gaining ethical
• whether your research will be based on a research approval, developing the research tools, gathering
question or a hypothesis and then what it will ask the data, interpreting it, and preparing your report
or propose on the findings. Ethical approval for your project will
• which information could be gathered qualitatively, be organised internally at your centre and you should
which quantitatively, and what questions you follow your tutor’s instructions. The approval process
could ask to generate relevant data. could be part of the assessment process for P4.
Consider whether you could gather relevant data
from formal and/or informal observations. Timescales
Most professional research projects are time limited.
In this unit, the timescale will be determined by the
submission date set by the unit tutor. You will need to
work backwards from this deadline to plan how you
These decisions should be influenced by the
knowledge and understanding you have gained from
your literature search, supported by advice from your
tutor and, at this stage, the aims and the hypothesis Key terms
proposed or research question posed. Designing Fit for purpose – A product or object that performs its
a questionnaire that is fit for purpose is very time- intended function well.
consuming and you should therefore allocate sufficient Pilot study – An initial, small-scale (perhaps only 10 per
time in the action plan to do so. cent of the full sample number planned) exercise, in which
you use your research tools to see if they are fit for purpose.
If you have time, you may be able to trial your It is acceptable to make small amendments to improve the
questionnaire to see whether the questions, and reliability and validity of the data gathered in the main, full-
instructions for answering them, enable respondents scale study.
to complete the questionnaire as fully as you intended.
441
26
Week number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Tasks/Actions
Explore topic
Read secondary sources
Submit outline proposal
Identify hypothesis
Decide methodology
Design research tool/s
Write proprosal
Submit plan for approval
Make arrangements for data collection
Amend plan after feedback
Gather data
Collate data
Draft report
Edit report
Check references
Presentation
Submit report
Fig 22.7: Would you use a project action plan like this to identify and monitor the overall goals, deadlines and outcomes of the
project and the practical tasks required to meet them?
will use the time available. This means you need to authority, something which is unlikely to be granted,
allocate time for each of the actions you identify in given your unqualified status.
your action plan. Developing a questionnaire that has It is ethically acceptable to involve your peers as
well-focused, clear questions and carefully constructed participants in a student project. Since most students
answer frames takes time, especially if you carry out a on a BTEC Level 3 course will be studying in a college
pilot test on it. If you aim to have a large participant or sixth form, their peers would be fellow students at
sample, then you may need to factor in time for the same institution. However, you should be aware
printing the questionnaire. Depending on the overall that only students over the age of 16 years should
timescale, you may be able to build in some slack be included in your sample because involvement of
time to allow for the slippage that often occurs when individuals younger than this would require written
planning over several weeks and months. consent from their parents/guardians. If based in
a college, you may need to consider this, as some
Target group learners at Key Stage 4 may also attend college.
The target group is the sample population from It might be possible to include friends, family and
which the participant sample is selected. As you are acquaintances as participants provided they know you
a student on a course that in itself does not lead to a through your private life rather than through work or a
professional qualification, in almost all cases it would college placement and you can interview them away
be unethical for your participants to be sampled from a setting. Sampling from the general public in a
through contacts in health or social care settings. To public space could expose you to personal risk, and
do so would require ethical approval from external your centre would be unlikely to give consent for this
organisations such as the local strategic health method of accessing participants.
442
Consent This would also apply for any pilot study to trial your
research tools. Remember too that you should obtain
In addition you need to plan how you are going to
written consent from an appropriately senior manager
gain informed consent from each individual participant
to hand out questionnaires or carry out observations
and be explicit about this in your project plan. You
on the premises of any other organisation apart from
also need to consider how your questionnaires will be
your school or college.
distributed so that participants have privacy while they
complete them. Peers may ridicule respondents, which Informal observations of general practices and
would be a form of harm. They may also influence their behaviours observed in placements or in public spaces
responses, which would greatly reduce the accuracy of might be included but, because the information has
the data and the validity of any findings. not been collected formally, it has only limited validity
in a research project. However, data collected this
You will need consent or approval from your school or
way may be better than having no data. Informal
college to carry out the overall project and this consent
observations (e.g. from placements) may support the
should be included with your project plan. You should
rationale for selecting the topic of the project in the
always remember to gain consent for the project
first place.
before you involve any participants in the research.
5 Be able to conduct research relevant to a health and

social care context
5.1 Topic selection
Activity 23: Narrowing down a topic
1 List five aspects of health and social care that 2 Have the discussions with your group
interest you. altered your selection? If so, why?
2 For each topic, draw a spidergram to highlight 3 What possible project topics have other groups
anything at all related to it. explored? What factors influenced their choices?
3 In groups of 2–3, quiz each other about each topic Has the class discussion altered which three topics
and discuss possible primary methods you could you have chosen? If so, why?
use to investigate each. 4 Spend no more than 60 minutes in total conducting
4 After 20 minutes’ discussion, narrow down your a preliminary search for information on each of the
choice of topics to three and justify your selection three topics.
to your group. 5 Which one topic do you think is the most
Now work in your group to consider the following: appropriate one to select for your research project?
Why? Record your reasons in a notebook.
1 What factors influenced your selection of three
topics from the original five? To what extent did
each member of your group identify similar or
different influences?
Subject • Ethical constraints on who participants can be

The subject, or focus, of your research project will be • Accessibility of secondary sources in the subject
the specific aspect of the topic you eventually decide and appropriate for Level 3 study
to investigate. Selecting a suitable subject can be • Access to a sample population to whom you can
likened to a filtering process. Some of the factors distribute questionnaires
that should be considered when selecting a topic are • How the topic relates to health and social care
summarised below.
443
• What hypothesis or research question could you to analyse the topic closely. Drawing a detailed mind
propose? map of the different aspects of the topic can help
• Can you test the hypothesis or is the question narrow your focus on a specific aspect that is sufficiently
answerable? small to be manageable in the time you have available.
• Time scale for duration of project and planning it Research question
• Is the scale (breadth and depth) of the topic A research question is used when the research aims
manageable with the time and other constraints? to investigate a topic without making any prediction
• Sensitivity of topic for participants as to what the research might discover. It enables the
• Making the data you can collect, given the research to be broader than when testing a hypothesis.
constraints, relevant to the topic An example of an ‘open-ended’ research question
• Travel accessibility e.g. to conduct interviews, might be ‘How do college students cope with stress?’
time and cost factors Hypothesis
• Access to specialist equipment and resources If you plan to test a hypothesis in your research,
• Personal safety when doing the primary research. you will need to identify measurable variables and
Some of the influences may be specific to the distinguish between the independent and dependent
circumstances of your school or college. For example, variable. You will then need to design a test to see
if you are in a rural area, the cost of transport when whether the hypothesis is true (i.e. proven) or not (i.e.
making visits to interview a specialist might be more of disproved). For example, you might want to find out
an obstacle than if you lived in an urban area. whether people’s drinking habits varied across the
days of the week. The days of the week would be the
Some of the factors to record when reviewing the topic independent variable and the alcoholic drinks they
for your research project and carrying out a literature consumed on each day would be the dependent
search are: variable. You then need to construct a statement that
• full surname (last name) plus first name initials of identifies an association between the two variables.
every author Your hypothesis might be, for example, ‘people drink
• if an edited book, also note full surname and first more alcohol at the weekend than they drink in the
name initials of all the editors week’. However, before setting up the test you would
need to consider the statement more carefully.
• year of publication or day/month/year for
newspapers and broadcasts • Who are the ‘people’? This might be determined by
what participants you can include in your sample.
• full title of the book (as on the cover), journal,
Would it be interesting to compare the drinking
Internet/newspaper article or broadcast programme
habits of different age groups, e.g. young people/
• if using/referencing an edited book, full title of young adults compared with older adults with
book, plus the title of the chapter read, plus its start family responsibilities and a mortgage to pay? How
and end page numbers could you distinguish between the different groups?
• town/city of publication (books) By age? By gender? By whether they are a parent or
• name of publisher or broadcasting company not? How will you find this information out?
• for all sources from the Internet • Are you going to ask the respondents to tell you
– the day/month/year accessed whether they drink more on particular days? Do
you think they would know this reliably? Could you
– full URL reference copied from the box at the top
ask a less direct question that would enable you to
of Internet screen.
calculate how much they drank? Would it still be
Note: you should include all the relevant information valuable to ask the question because there is often
from each source used in a literature review and a mismatch between people’s perceptions of what
project report. they consume and what they actually consume. And
Your literature search will have highlighted different would this mismatch be interesting to investigate in
aspects of the topic you are interested in but you need its own right?
444
Case study: Nazrul

Nazrul is interested in doing a project on lifestyle choices when they are no longer at school. He wants to
and health because he is aware that lifestyle factors have test the hypothesis ‘school meals are unhealthy’.
a negative impact on the health of his own family and His tutor asks him lots of questions such as ‘What does
community. He creates a spidergram that identifies diet, being “unhealthy” mean?’, ‘How will you measure it?’,
smoking, alcohol consumption, exercise and relaxation and ‘How are you going to get hold of school meals to
as relevant lifestyle factors. Starting with diet, he thinks of make a measurement?’
different aspects of the topic he could look at. He adds After some discussion with his tutor and a group of
five-a-day, school lunches, omega 3, vitamins, obesity, his classmates, Nazrul decides it would be better to
BMI, dieting and food allergies around the word ‘diet’. use a questionnaire to find out what his fellow college
He ends up with over 30 different topics about lifestyle. students eat at lunchtimes and then draw his own
Nazrul chooses school lunches, thinking he could conclusions as to whether or not they eat healthily. He
go into his younger sister’s school to do his primary also decides to interview the catering manager about
research. However, his tutor points out that it would not the college’s lunchtime menus and a practice nurse
be ethical for him to carry out a survey of schoolchildren who is a friend of his mum’s to find out about dietary
and instead he can only survey his fellow students at issues affecting young people’s health in the local area.
college. Nazrul then finds some government statistical 1 How have ethical constraints affected Nazrul’s
data on the Internet and an organisation called the original idea for his project?
School Food Trust, which has lots of information. He still
wants to investigate school meals but is not sure what 2 Can you think of a suitable hypothesis for Nazrul to
relevant information he can get from his college friends test in his project?
• Could you recall what you drink (alcoholic or non- • What is ‘the weekend’? Friday, Saturday and
alcoholic) each day? If you cannot, then are your Sunday nights or just Saturday and Sunday?
respondents likely to remember? Could you ask Would a different combination of days be more
them a more specific question or, rather, give them representative of the days when you suspect people
some answer options that enabled them to give drink most? Do you think all your respondents will
you more accurate information about their drinking think of the weekend as being the same days?
habits? How could you make sure in your questionnaire
• What do you mean by an alcoholic drink? Do that there was no confusion about how you were
all alcoholic drinks contain the same amount of defining a ‘weekend’?
alcohol? Does it matter? Do you need to know what This sort of questioning can be relevant to any
people drink more specifically? How could you get project but it is important to be clear about what you
this information from your survey questions? Do are actually measuring when testing a hypothesis,
you need to know the size of the drink as well as otherwise the validity of the test may be considerably
what type it is (e.g. wine can be served in a range of reduced. For example, you may end up with an
different-sized glasses)? amended hypothesis such as ’people consume most
• What about students who are under 18? It is illegal alcohol at the end of the week‘.
for them to consume alcohol other than in their
home. Does this mean you should ask respondents Rationale
where they drink their alcohol? Do you think under- The rationale is the reason why you have selected the
18s might not give you a truthful answer because topic and the particular aspect of it that you have chosen
they are drinking illegally? Do you think people to investigate – for example, the research question
might not give you a truthful answer because they posed or the hypothesis proposed. Explaining the
are aware they probably drink too much? How reason for your choice by referring to a wider context
could you ask the questions so that you reduced would be helpful. Maybe your research has been
respondents’ concern about giving you this triggered by current interest in the media, your wider
information? What are the ethical issues that might reading or a specialist interest or because you wanted
be relevant here specifically? to follow up in more detail something studied in another
445
unit. For a more complete justification, good practice the grading criteria within the time limits set for you,
would be to support your explanation by referring to it is important to establish clear boundaries for the
some secondary data from your literature search. project. This means defining what it is you are going
to investigate and also what you are not going to
Relevance to sector research. If you identify the boundaries at the planning
Your project should be relevant to health and social stage, then it is much easier to stay within them as
care and the research could be relevant because it you conduct your literature search and develop your
relates to health care needs, raises awareness of health research instruments. In this way your research project
risks from particular behaviours, or relates to changing should be achievable within the time and using the
policies and practices. resources available to you.
Identifying relevance at this stage can support A project that does not have a clear focus tends to
your rationale and aid interpretation, analysis and generate such a wide range of data that it becomes
evaluation of your results in your project report. difficult to analyse and evaluate your results and draw
Achievable and realistic valid conclusions. This could make it difficult to meet
the higher-grade criteria.
In order to make your project manageable, so that you
can obtain sufficient results to enable you to meet all
Produce an action plan for a research project Keep a research notebook in which you record
investigating an aspect of health and social care that all notes and details regarding your project
interests you.
M2 Support your reasoning with reference to
Justify why you have chosen the research methods literature on research methods and the specific
identified in your plan and rejected others. subject chosen for your research project. You
Assess the value of different research methodologies should consider a good range of reasons, to
in ensuring the validity of findings from health and justify your choice of methods for your project,
social care research. and present your arguments logically and
clearly.
Grading tips D1 In the first instance, you may find it easier
P4 Make sure your actions follow SMART principles to consider the value of the methodologies
(see Unit 6). you are planning to use in your own project
in ensuring validity, as you will already have
Remember that your research project needs to thought about this in some detail and the
enable you to meet not just P4 but also P5, P6, evidence could be integrated with that for M2.
M3, M4 and D2 so the plan you submit for P4
could consider how and when you are going If your project does not enable you to assess
to carry out the research, report the findings, all the methodologies, then you could consider
and analyse and evaluate your findings and health and social care research more generally
methods as part of the plan. However, you will if it enables you to make a more thorough
not present the evidence for the other criteria assessment regarding their influence on the
until later in the project. validity of research findings.
PLTS
Reflective learner: You will be demonstrating your skills
as a reflective learner when planning the project and
setting the aims of the research itself and success criteria
and when you review your progress.
446
5.2 Conduct research As already discussed, disproving a hypothesis has as

much validity as proving it. After you have gathered
Secondary sources the data, you may realise that you are in fact testing
a different hypothesis from the one you originally
The range of secondary sources and their use in the
intended. If this is the case, then this adjustment
literature search have already been discussed. While
should be justified through the analysis and evaluation
you will start the literature search as you decide
of the research when you write the report. If results
the topic of your research, and produce the written
from a pilot study indicate there is a problem, then
literature review at the same time as you research your
it may be acceptable to make adjustments at this
action plan, you should also continue reading about
preliminary stage, before you commence the full
your research topic while the project is ongoing. As
primary research study, provided this is discussed with
you get more involved in the research, you will gain a
your tutor first. It is not acceptable to change your
better understanding of the subject and, by re-reading
methodology after the pilot stage because any change
a source, you will understand more of the detail in the
will reduce the reliability of your results, severely limit
sources and therefore adapt your interpretation of
valid comparisons between data and make it difficult
it, possibly realising that it is more relevant than you
to draw any conclusions. The validity of all findings will
originally thought, or less relevant. You may need to
be reduced and it is better to persevere to the end and
find new sources to support an unexpected finding
then address the issues in the evaluation (see pages
from your primary data.
453–454). The risk of encountering such problems can,
of course, be reduced by carrying out a pilot study to
Data collection test the experimental method first.
It is now increasingly easy and economic to use
information technology (IT) as a tool to make routine
tasks easier. A mobile phone may be able to execute
Modification
several useful functions to help you process data Examples of possible changes to your project plan
from your project, whether this is simple arithmetic that may be necessary might include revising the
on a calculator function, taking a photograph of order/sequencing of tasks, adjusting the timescales,
your equipment as set up to take measurements, or altering how equipment is used so that measurements
possibly other functions such as recording an interview are more reliable, or even amending the scope of
or accessing the Internet. You may also use specialist the study by amending the range or depth of detail
equipment that incorporates technology, e.g. a that you investigate. If your primary research reveals
pedometer to record walking activity or an electronic more interesting results than anticipated, you may not
counter to record a particular behaviour observed in have time to analyse them all before the end of the
people in a public space, etc. scheduled period for reporting on the project. Your
tutor can advise you in these circumstances. However,
it would be better to keep the project more narrowly
Monitoring focused from the start.
An important aspect of any research project is to
continually monitor your progress against your original
research plan. There are two reasons for this: firstly to Reflect
keep focused on the purpose of the research as stated
What are the ethical implications associated with
in the research question or hypothesis; and secondly to
not using all the primary data gathered from your
monitor your progress against your action plan so that participants?
you complete the different stages of the project by
the deadlines set. Research rarely proceeds exactly as
planned. Regular monitoring of your progress against
your plans should enable you to identify variations
from the plan promptly so that you can make changes
to overcome any problems before you have lost too
much time.
447
Carry out your research according to the approved Record on the plan any amendments made
action plan. to the research methodology. You will
discuss these later and include the reasons
Grading tips for any amendments and the consequences
P5 Remember to monitor your progress against for reliability of the data and validity of the
the plan and record this on the plan. interpretation, as part of M3.
Use your research notebook to record all the Initial and date all monitoring and amendments
details relating to your project and summarise made on the plan, according to good practice.
the main changes and progress points on your
plan.
6 Be able to interpret research findings

6.1 Methods of analysis entered onto spreadsheet software. This will enable
easy conversion of the data into an appropriate format
In this section you will examine the data gathered from
for your report on the findings from your project.
your research. Firstly, you will place all the original
records from your primary sources in an order that
will enable you to return to them easily at any time. Collecting data
Next, the data can be transferred (if necessary) into The notes you make throughout the project from
systematic formats as the ‘results’ of your research. your literature research, records of measurements,
Then you can interpret the data to find out whether experimental results, observations and interviews, as
your project has met its aims in answering the research well as completed questionnaires, comprise the raw
question or testing the hypothesis. data from your research. The raw data needs to be
sorted, collated and ordered systematically so that you
Use of IT software
can interpret all your findings.
You may have used IT (e.g. a digital counter linked to
Raw data may be collected in different forms, for
a computer or an ergometer that produces a trace of
example:
an individual’s responses to exercise) in which case
you will need to download the relevant files to your • as handwritten figures from a laboratory experiment
own data stick or hard drive. However, remember entered on to a pre-designed tabulated template
that the DPA demands a higher order of security on • as graphical printouts from equipment, e.g.
electronically stored data, so do not store it on a ergometers
shared drive on a networked system. • as images, e.g. scans, X-rays, photomicrographs,
Once you have collated your raw data, you may have photographs (but not of individuals, for ethical
generated quantitative data that lends itself to being reasons)
448
• digitally organised according to a specifically are discrete data because they only come in definite
designed computer program, e.g. responses to and separate values e.g. 5, 5½ or 6 with no values in
online questionnaires between. It is important to recognise which is which
• on CD, an MP3 player, e.g. used as a pedometer. because this will determine what type of chart or graph
should be used (see page 451).
A tally chart is the best way of collating data from
the responses to each question on completed Triangulation
questionnaires. This could be done using a blank copy Interpreting results from any research should be based
of the questionnaire. You should go through each on rigorous analysis and evaluation of your results.
questionnaire in turn and enter a tally of each response This is done by comparing the primary data you obtain
option the respondent has made. The numerical with data from secondary sources accessed in your
totals from the tally chart can then be entered literature search. Good practice would be to make
onto a spreadsheet. If you have used an electronic comparisons with several different sources, a process
questionnaire, this is done automatically. Responses known as triangulation. In your project, you should aim
to open questions should be transposed into a single to include at least one published source. However, it is
location so they can be compared. You should also acceptable to triangulate using two different types of
record where respondents have not entered answers. primary data. For example, you might say that analysis
For interviews that have been recorded, it is usual to of the survey data suggests that respondents had
make a transcript so you can study it more easily and little accurate knowledge of the dangers of excessive
include it as evidence The full transcript would be alcohol consumption and this was confirmed by
appended to a research report and this is expected comments made by the nurse you interviewed, as well
for unstructured interviews. For structured or semi- as by statistical data you found in a government report.
structured interviews, a copy of the questions/prompts
used and contemporaneous records of responses Graphical presentation
would probably be sufficient for this research study. This is explored in the next section.
Collectively, your organised and collated data are your
results. 6.2 Data representation and
Spreadsheets
interpretation
Interpretation of data involves understanding the raw
Spreadsheets can be used in a variety of ways. They data collected in the primary research in the context of
are most appropriate for collating numerical data either the research question or the hypothesis. Visual
because the software makes it easy to perform
calculations involving the data, to rearrange data (e.g.
in ascending or descending order of size, etc.) and
to convert the data into charts and graphs. Which of
these capabilities you use will depend on the data you Key terms
have gathered and the way you interpret the data. Raw data – Consists of the records of data collected from
research in the form they were originally generated.
Presentation of data Results – Results from research are the data collected and
There are conventions regarding the presentation of collated into tables, graphs and charts.
data, which should be followed, particularly within a Data set – A series of quantitative measurements of the
research report. Data may be presented in a table, same variable, recorded under the same conditions.
chart, graph or other diagram such as a flow chart, as Continuous data – Data that can have any value. Weekly
already discussed. A set of data collected from a single changes in body weight or changes in body temperature over
a day would both generate sets of continuous data.
experiment or from a group of individuals under the
same conditions is called a data set. Discrete data – Factual information presented in numerical
form; the data can only have specific values, e.g. male or
Data may be either continuous or discrete. Time, female, smoker or non-smoker, those born in 1980, those
weight and temperature are examples of continuous born in 1981, etc.
data because they can have any value. UK shoe sizes
449
formats for presenting data help to reveal patterns in The mean, median and mode are different types of
the data that are difficult to identify just by looking at average.
the raw data. • The mean is the arithmetical average of all of the
actual measures making up the data set.
Tables, graphs and charts
• The median is the middle value of all the individual
Tables, graphs and charts (e.g. pie charts and
measures when they are ranked, i.e. listed in
histograms) are often used in data interpretation. The
increasing size order (lowest first and largest last).
features of each of these formats are summarised in
• The mode is the value which occurs most frequently
the table on the next page.
in the data set, (the most popular value).
It is important to remember that, when presenting data
Understanding the different ways in which data may be
in any format, including within the text of a report, it
presented and analysed gives you a range of possible
should be presented in accordance with mathematical
approaches for interpreting your primary data.
conventions. The conventions ensure that all the
Secondary sources may also include quantitative data
necessary information required to interpret the data
and accompanying analysis, and comparing your data
is provided within the table, graph or chart. This
with independent data is helpful when evaluating your
information is as follows.
research to draw conclusions from it.
• An overall heading, which identifies the format
either as a ‘table’ or as a ‘figure’. The item is
numbered and followed by words describing the
data presented in the item. For example, note how
all tables and diagrams are titled in this book.
• Each column in a table should have a heading to Activity 24: What can I
identify what the data in that column is measuring. learn from my data?
If it is a number, it will have no units. If it is a
measurement, then the units should be given once In groups of two or three, discuss your findings from
only, in the heading title. The data should then be the research each of you have carried out.
entered into the column without repeating the units. 1 How could you present the primary data to help
you understand what it means?
• In graphs and charts, both the horizontal (x) axis
and the vertical (y) axis should be labelled with a 2 Construct tables, graphs and charts as
descriptive title and, as for columns, with the correct appropriate and get a friend to check that you
have presented each of these correctly.
units if the variable is a measurement. If it is a
number, then the axis will state ‘number of …’ 3 Describe in words what each table, graph and
chart shows, using the language introduced in
• A key should be provided to differentiate between this unit and especially in this section. In class,
different colours, shading, codes or any other visual discuss each form of presentation with a partner.
device used to contrast the data presented. 4 To what extent does your data interpretation
You should remember to use all these conventions in enable you to answer your research question or
every graph, chart or visual image you include in your hypothesis?
project report, oral presentation or appendix. 5 How does your data compare with data from
your literature searches? What are the similarities
Mean, median and mode and differences?
As indicated in Table 22.4, many biological
measurements tend to follow a standard pattern
called a normal distribution similar to that shown
Functional skills
in Figure 22.8. The spread, or distribution of the
measurements in a data set, is an indicator of how Mathematics: You will be selecting and applying
much the measurements vary from each other. a range of mathematical solutions to your data,
checking accuracy and interpreting the data in this
The height of the histogram indicates how many
activity.
measurements fall into each category or data group.
450
Table 22.4: Features of different forms of data representation
Presentation Features
Tables • may be used for qualitative as well as quantitative data
• can organise data systematically
• may record several sets of measurements for one set of variables
• may enable trends to be identified
• can organise quantitative data in order of increasing or decreasing size
• data may be continuous or discrete
Graphs • for plotting continuous data only
(line graphs) • for plotting changes in a dependent variable against a dependent variable (often time)
• the dependent variable is usually plotted on the vertical axis and the independent variable
on the horizontal axis
• the values of individual measurements of each variable are plotted and joined together
using straight lines (not a best-fit line)
• can reveal trends, e.g. how the variable changes over time
Bar charts • bars have identical width and vary in height/length
• each bar is separated by a small space (the bars do not touch)
• bars are usually drawn vertically but can be drawn horizontally
• in complex bar charts, each bar may show more than one measurement
• used to plot discrete data, e.g. data for males and data for females
Pie charts • used to represent different categories within a larger group (segments of a pie)
• each segment of the ‘pie’ is proportionate to the percentage of the whole that the
category represents
• each category of the ‘pie’ is calculated as a proportion of the whole group represented, i.e.
as a percentage of a circle (360o)
Histograms • a special type of bar chart with vertical bars with no spaces between bars (see also below)
• used for large data sets of the same variable, usually of at least 50 measurements, e.g.
blood pressure of 100 students
• groups of possible values of the measurement are defined, each the same size
• the possible measurement of the variable are categorised into equal sized groups, e.g.
1–4, 5–9, 10–14 etc., and each measurement recorded is allocated to the group in which
the measurement falls and counts as 1 in that category
• the boundaries for each category should not overlap
• when all the measurements have been categorised into the right group, the numbers in
each group are totalled
• the totals in each category can be 0 or a whole number only
• when drawing the histogram, the y axis is the number of measurement and the x axis
shows each category of the measurement, all the same size
• if no measurements are within the range of a group/category, then no bar is drawn and the
space is left empty
• histograms are useful to show the average and spread (range) of the values measured in
the data set – the distribution of data
Key term
Distribution of data – An indication of the range or spread
between the lowest and highest value of actual measures in a
data set measuring the same variable.
451
What BTEC Level 3 learners at Sidson College Line graph showing changes in annual incidence of measles in
do after completing their programme England and Wales over a 10 year period
Teacher training 12% 1500
Other 29% 1200

England
Number of cases of measles

900
Nurse training 26%
600
Non-vocational
degree 13% 300
Health & social Social work Wales

care work 10% training 10%
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Bar graph to show the form of transport members Graph to compare prevalence of underweight,
of a BTEC class use to travel to college healthy weight, overweight and obese men
and women in a sample
6
100
5
80 Underweight
Percentage of individuals (%)

4
Healthy weight
60 Overweight
3
Obese
2 40
1
20
0
Foot
Bicycle
Bus
Train
Car
0
Men Women
Fig 22.8: How could you use the various forms of charts and graphs to present your quantitative data?
Histogram to show BMI of 50 adults
14
12
10
Number of adults
0
17 19 21 23 25 27 29 31 33 35 37
BMI for 50 adults
Fig 22.9: What information about distribution and frequency can be shown using a histogram?
452
6.3 Evaluation Activity 26: What are the

Evaluation requires you to make a judgement about
findings?
the worth, or value, of your research, based on the
evidence you have generated from your primary • What are the main findings from your primary
and secondary sources and already interpreted. An data?
evaluation involves examining critically all aspects of • How do these compare with your aims?
the work you have done on your project. This process • To what extent does the secondary data validate
should enable you to identify any weaknesses in your the primary data?
methodology that may have affected your results so • What reservations would you acknowledge about
you can estimate the reliability (see Section 2, pages your findings and conclusions?
421–422) of your data, both primary and secondary. • Identify three conclusions you can draw from
This evaluation is an essential part of the research your research.
because the critical review of the whole process • What recommendations would you make for
enables you to place the results of the research in a further research?
context, and so formulate the findings of the research
in your overall conclusions to the project.
Functional skills
Key term Mathematics: This activity could enable you to
Findings – The overall conclusions of an investigation. calculate the impact of the errors and bias on your
data and draw conclusions about its reliability.
Activity 25: Sources of the data. Bias might come from factors such as
error inadvertently including a lot of sports students in your
participant survey for a project investigating student
• What are the possible sources of error in your fitness.
data?
• What is the reason for each of these errors?
Ethical considerations
Because ethical considerations are so important in
• How do the errors affect your interpretation of
the results? all social science research, and particularly when
researching health and social care, your evaluation
should include a thorough analysis of the steps taken
to ensure that the research was conducted ethically.
Comparison with the research aims However, despite these measures, unforeseen issues
This aspect of the evaluation should analyse the extent may have arisen during the research, and discussion of
to which the original aims of the research, as presented how these were dealt with should also be included.
as part of the research plan, have been met. The focus
will be the research question or the hypothesis. You Relationship with current research
should present arguments based on the evidence from Your research report should include references to
your project to judge whether these have been fully secondary sources throughout, as appropriate. Your
addressed or only partly so. ability to identify and discuss the extent to which your
findings are supported by, or differ from, secondary
Bias and error evidence from your literature review should be
Errors and bias occur in all research but it is important particularly evident here, as well as in the introduction
to examine how the errors and bias have arisen and to the report, data interpretation and discussion.
assess the extent of their influence on the overall
findings from the research. Errors can arise from, for Limitations of research
example, weaknesses or flaws in questions or response All research projects have limitations imposed upon
frames that limit your ability to analyse and interpret them by external circumstances. Limitations may arise
453
from practical difficulties, although you should have Conclusions

considered these at the planning stage. Limitations can Conclusions identify concisely the main findings from
arise, for instance, because of more restricted access your project and should be linked very clearly to the
to sources or more participants than anticipated. A arguments and judgements made in the evaluation.
small sample size or low return rate in a survey is a They should only be statements, should not include
common limitation. Any factor that affects the validity any discussion and certainly not introduce new ideas.
of the research findings limits their value and this could The conclusions should primarily be about the research
be discussed here. subject but it may be appropriate to have one or two
conclusions that relate to the methodology.
Strengths and weaknesses
Assessing the overall strengths and weaknesses of your Recommendations
research will mean reviewing all aspects of the project, Recommendations relate to how the research findings
including the planning stage. Firstly, identify the could be used in the future. They may include
factors that contributed to the success of the project. suggestions of what further research is required, for
You should discuss practical aspects, considering example, to provide more robust evidence in order
factors such as time, the sequencing of actions, to fulfil the original aim of the project. There may also
communication limitations, as well as advantages and be general recommendations in relation to health and
limitations that you have highlighted in earlier parts of social care practice.
the evaluation. Your assessment could be supported
by evidence of similar experiences encountered by Reporting research findings
other researchers. Reporting the findings of research is an important
part of the research process because it enables your
Areas for improvement findings to be scrutinised by others. Research is
This aspect of the evaluation will be closely related reported using a formal report structure, which usually
to the previous section. Clearly any weaknesses, includes the following items.
limitations arising from ethical considerations, • A title page with the project title, author name and
methodological errors and bias should enable you the date of the report.
to identify aspects of the project that you would do • A contents page (number the pages of the report).
differently if you were to carry out a similar study again. • Abstract (usually only about 300 words) providing a
summary of the key findings being reported.
Implications for the sector
• Introduction, including the literature review,
It may be appropriate to link your comments back to
updated.
the research aims and the findings from the project
• Methodology presenting a detailed description,
when discussing the relevance of the project to
with reference to sources that have influenced
health and social care for practice, individuals, service
the methodology and preferably supported by a
provision and topics that you have explored in other
justification of why the methods were appropriate.
units. You could also discuss the extent to which the
(For assessment in this unit, the methodology and
findings enable generalisations to be made about
Introduction sections may be submitted in advance
the limitations of the study. For example, your study
of the rest of the report.)
is likely to involve your student peers and, depending
on the nature of your project, it might not be realistic • Results described in the text and supported by
to suggest that the findings could also apply to older tables, graphs and charts.
people, although they may apply to other young • Discussion – a substantial section presenting the
adults. By this stage of the evaluation you should have analysis and the evaluation.
discussed the overall validity of your research data, • Conclusions, which should be an obvious outcome
as this is a significant influence on the conclusions from the discussion; no interpretation or new ideas
that can be drawn from your findings. Your comments should be introduced in this section. Conclusions
should be analytical and evaluative and could make an should be succinct and to the point and may relate
appropriate ending to your evaluation. to the results and methodology,
454
• Recommendations – 3–5 recommendations that

could be related to health and social care practice. Did you know?
• References, presented in alphabetical order Professional researchers aim to publish their research
by surname of first author, preferably using a in professional or academic journals. Publication in
recognised academic style. peer-reviewed journals is highly regarded because
the report is scrutinised by experts in the same field
• Acknowledgements – optional, but a place to make before it is published. If the quality of the research
a brief statement to thank participants publicly is not of a good standard then the report will not be
(but anonymously) as well as others who may have published. Some researchers publish the results of
supported you. their research in books so they may only be reviewed
by experts who review the book after it is published.
• Appendices – number will vary but one should be
a blank version of any questionnaire distributed
(not the completed ones). Transcripts and
context statements might also be appended. All
appendices included should be there only because your results. From the information in your report, they
they are referred to in the text of the report. may be able to repeat your research using your exact
It is usual for the researcher to answer questions on methodology, or take into account any weaknesses
their research, often face to face, following a brief oral you have discussed so they can avoid the same
presentation of the findings. This scrutiny will involve problems in their research. This will have the effect of
critical analysis and evaluation from other perspectives producing new, more reliable data from which future
apart from your own and so provides another check claims could be made with greater certainty. Also,
on the validity of your results. However, research the recommendations you make could help improve
presented as a written report has greater validity. practice for individuals in health and social care. Thus
Another reason for reporting your research publicly your research report may become a secondary source
is that it enables other researchers to benefit from for another research project.
455

P4 M2
M4 D2
Write a report of the findings from your research. techniques and secondary sources used and
Examine the strengths and weaknesses of the how well they enabled you to meet the project
methodology of the project in addressing the research aim or test your hypothesis.
question or hypothesis. Consideration of errors and bias, ethical
Analyse your findings from the research in relation considerations and limitations on the research
to answering the research question or proving/ should also be included.
disproving the hypothesis. M4 The focus here is an analysis of whether the
Finally, evaluate how you could have improved the findings enabled you to prove or disprove your
project. hypothesis or answer your research question.
Remember to take into account the aim of the
Grading tips research and its relevance to health and social
P6 Present all the evidence for this assessment care when discussing your findings, drawing
activity using a formal report format, as advised conclusions and making recommendations.
by your tutor, and including a reference list and D2 Your evaluation should be a thorough
appendices. examination of all aspects of the project,
Remember that findings are based on an with particular attention to errors, bias and
evaluation and that there are several aspects to weaknesses throughout.
consider when evaluating a research project. Improvements should be clearly linked to the
M3 When examining the methodology, consider judgements made in your evaluation.
the type of research, the primary research

Effective participator: Collating, interpreting and English: You will be preparing a formal report in which
evaluating your research data and organising it you will present information relating to your findings
effectively to present it in the research report will allow concisely, using formal English to express complex
you to demonstrate your effective participation skills. ideas.
Mathematics: The report will require tables, graphs
and charts to present the results from your research.
ICT: You will develop a complex document using your
ICT skills to produce the report, containing text and
imported objects from a range of different files and
applications.
456
Resources and further Stretch, B. & Whitehouse, M. (2007) BTEC National

Health and Social Care Book 1 Oxford: Heinemann
reading Walsh, M. (2001) Research Made Real: A Guide for
Students Cheltenham: Nelson Thornes
Bell, J. (2005) Doing Your Research Project — A
guide for first time researchers in health, social care
and early years Maidenhead: Open University Press
Bowling, A. (2002) Research Methods in Health:
Useful websites
Investigating Health and Health Services Association of Medical Research Charities (AMRC)
Maidenhead: Open University Press www.amrc.org.uk
Denscombe, M. (2006) The Good Research BBC News http://news.bbc.co.uk/
Guide: For Small-scale Social Research Projects
Cancer Research UK
Maidenhead: Open University
http://info.cancerresearchuk.org
Lawrence, J. (2009) “Thalidomiders”: still fighting for
Channel 4 www.channel4.com
justice’, The Independent Online, Tuesday 26th May
Daily Telegraph www.telegraph.co.uk
2009
Department of Children, Schools and Families www.
Michie, V. Baker, L. Boys, D. & McLeavy, J. (2008)
dcsf.gov.uk
BTEC National Health and Social Care Book 2
Cheltenham: Nelson Thornes Department of Health www.dh.gov.uk
Pears, R. Shields, G. (2008) Cite them right: the The Guardian www.guardian.co.uk
essential referencing guide, seventh edition, Independent www.independent.co.uk
Durham: Pear Tree Books The King’s Fund www.kingsfund.org.uk
Sennika, D. (2009) ‘Incidence trends for childhood Medical Research Council www.mrc.ac.uk
type 1 diabetes in Europe during 1989–2003 and
National Research Ethics Service
predicted new cases 2005–20’. The Lancet, Early
www.nres.npsa.nhs.uk
Online Publications
NHS Direct www.nhsdirect.nhs.uk
Silverman, D. (2006) Interpreting Qualitative Data,
third edition, London: Sage Publications Statistics Agency www.statistics.gov.uk
Smith, K, Todd, M. & Waldman, J. (2009) Doing The Times www.timesonline.co.uk

your undergraduate social science dissertation UK government and public services
Abingdon: Routledge www.direct.gov.uk
457
Just checking
1 What is research?
2 Identify five different purposes of research and give a specific example for each.
3 Why is ethical committee approval required to carry out a health and social care research project?
4 Distinguish between:
a) validity and reliability
b) results and findings
c) continuous and discrete data
d) analysis and evaluation.
5 What is:
a) a hypothesis?
b) a variable?
c) triangulation?
d) bias?
6 How does legislation affect research?
7 Explain when it is appropriate to use:
a) a pie chart
b) a histogram
c) a line graph.
Assignment tips
1 Make use of knowledge and understanding developed in Unit 6 because there are several links between
these two units, e.g. planning, being organised and study skills.
2 At the start of this unit, create a Word document called ‘References’ on your data stick and every
time you use a new secondary source type/copy and paste all the details needed for a reference list,
including the access date if it is an online resource. Back it up regularly.
3 Get a spiral-bound A4 notebook (about 50 pages) to keep all your records for your research in one
place. Date every entry and make notes on class discussions, observations, interviews, and more
detailed ones from each of your secondary sources. Scan, copy or type up notes from it weekly as a
back-up.
4 Do not be tempted to make your project too large. Have a well-defined aim and keep to it.
5 Test your questionnaire when you think you have a reasonable draft by distributing it to 5–10 members
of your chosen sample population. Get them to complete it independently. Examine their responses
and see whether all the questions have been answered as you intended. If there are gaps, errors or
unexpected answers, review the questions, response frames and order of the questions, and make
improvements before distributing the final version to the full participant sample.
458
Relevant legislation and organisational policy and procedures
Relevant legislation and organisational policy

and procedures
This grid provides a list of some of the legislation and organisational policy and procedures relevant to health
and social care. The content which is particularly relevant has been listed.
Legislation policy Website Relevant content EU directive Link to BTEC Level

procedure implemented 3 National Health
by the Act and Social Care
Adult Placement www.wales- Regulates placements for vulnerable 2005/36/EC Unit 11 Safeguarding
Schemes (Wales) legislation.org. adults over the age of 18 in the home adults and promoting
Regulations 2004 uk of a person who is not a relative independence
Age Discrimination www.direct. Protects individuals from 2000/78/EC Unit 2 Equality,

Act 2006 gov.uk discrimination in employment on diversity and rights in
grounds of age in: health and social care
• redundancy
• unfair dismissal
• unfair treatment
Care Quality www.direct. The new health and social Unit 2 Equality,
Commission gov.uk care regulator for England; the diversity and rights in
Commission replaces: health and social care
• Commission for Social Care Unit 9 Values and
Inspection planning in social care
• Healthcare Commission Unit 11 Safeguarding
• Mental Health Commission adults and promoting
Regulates all health and adult social independence
care services in England, (statutory,
private and voluntary)
Protects the rights of people
detained under the Mental Health
Act
Care Standards www.opsi.gov. This Act set up an organisation 2005/36/EC Unit 2 Equality,
Act 2000 (England uk called the National Care Standards diversity and rights in
and Wales) Commission. This was replaced health and social care
by the Commission for Social Unit 3 Health, safety
Care Inspection which has now and security in health
been replaced by the Care Quality and social care
Commission Unit 9 Values and
The Act sets standards all social care planning in social care
workers must meet. Unit 11 Safeguarding
• standards can be found in the adults and promoting
booklet ‘General Social Care independence
Council Code of Practice’
• ensures all care provision meets
with the National Minimum
Standards
• sets standards of the level of care
given to individuals requiring social
care
• requires that all staff have a
thorough police check before
they begin working with children
and adults and a list is kept of
individuals who are unsuitable to
work with vulnerable adults
459

Children Act www.ecm.gov. Introduced Children’s Commissioner, 2003/9/EC Unit 2 Equality,
(2004) uk local Safeguarding Children boards diversity and rights in
and provided legal basis for Every health and social care
Child Matters Unit 10 Caring for
children and young
people
Unit 21 Nutrition for
Children (Leaving www.ecm.gov. Requires local authorities to plan 2003/9/EC Unit 10 Caring for
Care) Act (2000) uk for children leaving care. Local children and young
authorities must ensure children: people
• have support for housing and
preparation for independence
• have a personal adviser
• can remain looked after in full time
education until 21 years
Children (Leaving archive.nics. Provides a legal framework for those 2003/9/EC Unit 10 Caring for
Care Act) gov.uk leaving care including: children and young
(Northern Ireland) • an assessment of a young person’s people
2002 needs
• personal advice
• provision of a pathway plan
• personal support and suitable
accommodation for 16 and 17 year
olds leaving care
Children Act www.desf.gov. This brought about: 2002/58/EC Unit 2 Equality,
(1989) uk • major change in childcare practice diversity and rights in
• concept of ‘significant harm’ health and social care
www.scotland. • concept of ‘parental Unit 10 Caring for
gov.uk responsibilities’ rather than ‘rights’ children and young
It makes the wishes and interests of people
the child paramount
Control of www.hse.gov. The details of this include: 67/548/EEC Unit 3 Health, safety
Substances uk • storing cleansing materials correctly and security in health
Hazardous to • labelling of hazardous substances and social care
Health (2002) correctly
(COSHH) • appropriate handling of bodily
fluids such as blood and urine
• appropriate handling of flammable
liquids/gases
• appropriate handling of toxic/
corrosive substances/liquids
Community www.opsi.gov. Introduced free nursing and personal Unit 9 Values and
Care and Health uk care for older people in Scotland planning in social care
(Scotland) Act Older people who qualify receive
2002 payments of between £145 and £210
per week, depending on their needs
Convention on the eur-lex.europa. Ensures the interests of the child 2002/58/EC Unit 10 Caring for
Rights of the Child eu are the primary consideration when children and young
(1989) making decisions concerning them people
Ensures children have the right to:
• protection and care
• express their views freely
460
Common www.dcsf.gov. Provides a standardised approach to 2002/58/EC Unit 10 Caring for
Assessment uk conducting assessment of children’s children and young
Framework additional needs and deciding how people
these should be met
Care Homes www.opsi.gov. Applies to England only 2005/36/EC Unit 9 Values and
(Adult Placements) uk Regulates placements for vulnerable planning in social care
(Amendment) adults in the community Unit 11 Safeguarding
Regulations 2003 adults and promoting
independence
Data Protection www.dh.gov.uk Relates to the protection of the 95/46/EC Unit 2 Equality,
Act (1998) individuals’ personal data with regard diversity and rights in
Date Protections to processing and safe storage: health and social care
(Amendment Act • storing confidential information Unit 9 Values and
(2003) • protection of paper based planning in social care
Access to Medical information Unit 10 Caring for
Records 1988 • protection of information stored on children and young
computer people
• accurate and appropriate record Unit 22 Research
keeping methodology for
Disability www.direct. Came into force in 1995 and was 2005/75/EC Unit 2 Equality,
Discrimination Act gov.uk amended in 2005 diversity and rights in
2005 It requires: health and social care
• providers of public transport Unit 9 Values and
to reduce the amount of planning in social care
discrimination on its buses Unit 11 Safeguarding
and trains towards people with adults and promoting
disabilities independence
• public facilities and buildings to be
made accessible to those who have
disabilities
• employers to make reasonable
adjustments to allow an
individual with a disability to gain
employment
Education www.direct. States the standards required for all Unit 21 Nutrition for
(Nutritional gov.uk aspects of meals for school children health and social care
Standards and
Requirements
for School
Food) (England)
(Amendment)
Regulations 2008
Environmental www.dh.gov.uk Section 34 of the Environmental 2006/12/EC Unit 3 Health, safety
Protection Act Protection Act (1990) imposes a duty and security in health
(1990, Section of care on persons concerned with and social care
34) and the control of waste; it places a duty
Environmental on anyone who in any way has a
Protection (Duty of responsibility for control of waste to
Care) Regulations ensure that it is managed properly
(1991) and recovered or disposed of safely
461

European www.dh.gov.uk These regulations extend the Care 2005/36/EC Unit 2 Equality,
Qualifications Standards Act 2000 in England and diversity and rights in
(Health and Social Wales health and social care
Care Professionals) Provides for mutual recognition of
Regulations 2007 Diplomas, Certificates and other
evidence of formal qualifications in
order to assist the free movement
of professionals throughout the
European Union
European eur-lex.europa. Outlines basic human rights to which 2006/24/EC Unit 2 Equality,
Convention on eu all European Citizens are entitled, for diversity and rights in
Human Rights example: health and social care
• safety and liberty Unit 11 Safeguarding
• right to marry adults and promoting
independence
Food Safety www.opsi.gov. These regulations provide guidelines 93/43/EEC Unit 3 Health, safety
(General Food uk for safe handling and preparation of 93/43/EEC and security in health
Hygiene) food. They include: and social care
Regulations 1995 • basic hygiene principles for
handling and preparing food
• food safety risks
All staff who prepare food for users
of services in day centres, residential
settings and hospitals must follow the
guidelines and be aware of the food
safety risks
Freedom of www.dh.gov.uk Produced to promote a culture of 95/46/EC Unit 9 Values and
Information Act openness within public bodies planning in social care
(2000) Allows anyone the right of access to
a wide range of information held by a
public authority
Access to information is subject to
certain limited exemptions, such as
information about an individual
Under this Act individuals can access
their health records
An individual can request the
information to be provided in Braille;
audio format; large type; or another
language if necessary
Freedom of www.uk- In Scotland this Act established Unit 9 Values and
Information legislation. the office of Scottish Information planning in social care
(Scotland) Act hmso.gov.uk Commissioner, responsible for
(2002) ensuring public authorities maximise
access to information
General Social www.gscc.org. These codes set out six 2002/58/EC Unit 9 Values and
Council Codes of uk responsibilities for social care planning in social care
Practice employers and six responsibilities for Unit 22 Research
social care employees, stating the methodology for
standards of conduct, performance health and social care
and ethics expected of employers
and staff
462
Health and Safety www.hse.gov. Gives instructions for health and 89/391/EEC Unit 3 Health, safety
at Work etc. Act uk safety in the work place: and security in health
(1974) • ensuring the environment is safe and social care
and free from hazards
• assessing risks before carrying out
tasks
• checking equipment for faults
before use
• use of appropriate personal
protective clothing
• handling hazardous or
contaminated waste correctly
• disposal of sharp implements
appropriately
• shared responsibilities of employers
and employees
Health and Social www.opsi.gov. Places a duty on each Health and Unit 2 Equality,
Care (Reform) Act uk Social Care Trust to ‘exercise their diversity and rights in
(N.I.) 2009 functions’ in order to improve the health and social care
health and well-being of people who Unit 9 Values and
use the service and to reduce health planning in health and
inequalities social care
Health and Social www.dh.gov.uk Established the Care Quality Unit 9 Values and
Care Act 2008 Commission for England and: planning in social care
• enables co-ordinated regulation for
• helps to ensure better outcomes
for people who use services
Human Rights Act www.opsi.gov. Came into effect in October 2000 2002/58/EC Unit 2 Equality
1998 uk and allows people to take complaints diversity and rights in
about how they have been treated to health and social care
a UK court Unit 11 Safeguarding
• there are 16 basic human rights adults and promoting
covering everyday things, such as independence
what a person can say and do and Unit 22 Research
their beliefs, as well as the more methodology for
serious issues of life and death health and social care
• human rights are rights and
freedoms that all people living in
the UK have, regardless of their
nationality or citizenship
• although everyone has these rights,
they can be taken away from a
person if that person does not
respect other people’s rights
Lifting Operations www.hse.gov. Aims to reduce risks to people’s 95/63/EC Unit 3 Health, safety
and Lifting uk health and safety from lifting and security in health
Equipment equipment provided for use at work and social care
Regulations (1998) by ensuring it is:
• strong and stable enough for
the particular use and marked to
indicate safe working loads
continued
463

Lifting Operations • positioned and installed to
and Lifting minimise any risks
Equipment • used safely, that is the work is
Regulations (1998) planned, organised and performed
– continued by competent people
• subject to ongoing thorough
examination and, where
appropriate, inspection by
competent people
Management www.opsi.gov. These regulations explain to 1338/2008/EC Unit 3 Health, safety
of Health and uk managers and employers the and security in health
Safety at Work measures they must take in order to and social care
Regulations 1999 keep staff and users of the service
safe
Main focus is risk assessment;
regulations explain how to conduct
a risk assessment and what the
assessment should contain
Manual Handling www.hse.gov. These regulations include: 90/269/EEC Unit 3 Health, safety
Regulations (1992) uk • preparing the environment before and security in health
moving or handling anything and social care
• checking equipment is safe before
use
• safe moving and handling of
patients
• safe moving of equipment/loads
Mental Capacity www.opsi.gov. This empowers and safeguards 2005/36/EC Unit 2 Equality,
Act 2005 uk vulnerable people who are unable to diversity and rights in
make their own decisions health and social care
Deals with the assessment of a Unit 11 Safeguarding
person’s capacity and protects those adults and promoting
who lack capacity independence
It created two new public bodies: a
new Court of Protection and a new
Public Guardian.
Mental Health Act www.opsi.gov. This Act updates the Mental Health Unit 2 Equality,
2007 uk Act 1983 diversity and rights in
The main changes are: health and social care
• 16 and 17-year-olds can accept or Unit 11 Safeguarding
refuse admission to hospital and adults and promoting
this decision cannot be overridden independence
by a parent
• patients who are detained in
hospital under a section of the Act,
are entitled to an independent
advocate who will speak for them
at a review to decide on their future
• the introduction of Supervised
Community Treatment Orders
which mean that patients who are
discharged will be visited at home
by a mental health professional
to ensure that they take their
medication
464
Nursing and www.nmc-uk. These codes state the standards for 2002/58/EC Unit 22 Research
Midwifery Codes org conduct, performance and ethics methodology for
of Practice 2008 required of qualified nurses and health and social care
midwifes
Police and Justice www. This Act requires Police Authorities 91/477/EEC Unit 2 Equality,
Act 2006 homeoffice. to monitor their forces in respect to diversity and rights in
gov.uk Human Rights health and social care
Unit 11 Safeguarding
adults and promoting
independence
Protection of www.scotland. A parallel scheme to the 2005/36/EC Unit 9 Values and
Vulnerable gov.uk Safeguarding Vulnerable Groups Act planning in social care
Vulnerable Groups 2006 in England and Wales which: Unit 11 Safeguarding
(PVG) (Scotland) • gives guidelines for the barring adults and promoting
2007 of individuals from working with independence
vulnerable groups
• provides protocols for the
maintenance of registers of
those barred from working with
vulnerable groups
Race Relations www.standards. Requires all public bodies, for 2000/43/EC Unit 2 Equality
(Amendment) Act dfes.gov.uk example Health Authorities and diversity and rights in
2000 Primary Care Trusts to: health and social care
• review their policies and Unit 11 Safeguarding
procedures adults and promoting
• remove discrimination from these independence
policies and procedures
• remove the possibility of
discrimination from their policies
and procedures
• actively promote equality
In Health and Social Care, this means
that all support must be designed
and delivered in such a way that no
individual will be treated less fairly
because of their race or ethnicity
Regulations of www.scotland. Regulates placements for vulnerable 2005/36/EC Unit 11 Safeguarding
Care (Scotland) gov.uk adults over the age of 18 in a home adults and promoting
Act 2001 of a person who is not a relative independence
Reporting of www.hse.gov. This outlines procedures for: 89/391/EEC Unit 3 Health, safety
Injuries, Diseases uk • reporting accidents and injuries and security in health
and Dangerous objectively and accurately and social care
Occurrences • reporting diseases to the
Regulations (1995) appropriate bodies
RIDDOR • reporting dangerous occurrences
to the appropriate bodies
• completion of relevant paperwork
465

Safeguarding www.dh.gov.uk Provides regulations to set out the 2005/36/EC Unit 10 Caring for
Vulnerable Groups very serious offences which will result children and young
Act 2006 in an individual being barred from people
working with vulnerable people Unit 11 Safeguarding
The individual will not be able to adults and promoting
appeal against the decision independence
The individual cannot apply to have
their case reassessed
Sex Discrimination www.opsi.gov. The Amendment expands the 2004/113/EC Unit 2 Equality,
Act 1975 uk definition of gender harassment and diversity and rights in
(Amendment) gives: health and social care
Regulations 2008 • greater rights to pregnant women
who are employed
• protection against transgender
discrimination in employment
• further protection against sexual
harassment
Vetting and www.isa-gov. Extends the safeguards provided 2005/36/EC Unit 10 Caring for
Barring Scheme org under the Safeguarding Vulnerable children and young
2010 Groups Act 2006 in England and people
Wales, to include the barring of Unit 11 Safeguarding
individuals from a wider range of adults and promoting
activities and jobs independence
Introduces a duty to share
information about individuals who
pose a threat to vulnerable groups,
with prospective employers
Introduces new criminal offences;
it will become a crime for a barred
individual to seek employment with
vulnerable groups and to employ
such a person
466
Glossary
A Assertion – Assertion is different from both submission and
aggression. It involves being able to negotiate a solution
Absorption – The taking up of substances to be used by the to a problem.
body cells and tissues.
Assumption – An idea that we think is true or correct without
Abstract – A new piece of writing that brings together (or bothering to check. In relation to research, it is the
summarises) various points made in an existing piece of conditions that apply to a situation but which are not
writing. investigated. It is good practice to be explicit about the
Abstract logical thinking – The ability to solve problems using assumptions being made.
imagination, without having to be involved practically; an Atherosclerosis – A thickening of the artery wall caused by
advanced form of thinking that does not always need a cholesterol deposits.
practical context in order to take place.
Attitudes – Assumptions that we use to make sense of our
Abuse – Treat with cruelty or violence, especially regularly or social experience.
repeatedly.
Autonomic nervous system – Part of the nervous system
Action research – Research in which the researcher is a responsible for controlling the internal organs.
participant in a situation that occurs, regardless of
the research, but from which information is collected
systematically. The purpose is to gain a better
understanding of the situation so that knowledge,
B
Baseline – A starting point against which to make comparisons.
understanding or practices in that context can be
enhanced. Belief systems – The assumptions we use to make sense of our
lives. Out belief systems often include our values.
Adenosine diphosphate (ADP) – A chemical left after ATP has
released its stored energy to do work. Beliefs – An acceptance that something exists or is true,
especially without proof.
Adenosine triphosphate (ATP) – A chemical in mitochondria
that is capable of trapping lots of energy in the last Benchmark – A measure used as a standard against which
chemical bond: for example, A-P-P~P, where P is a comparisons can be made.
phosphate group (an ordinary chemical bond) and ~ is a Beneficence – Something that does good or has a beneficial
high energy bond. effect.
Adolescence – A general stage of lifespan development that Bias – A situation in which an investigation produces results
includes puberty. that are influenced by unacknowledged factors, perhaps
Advocate – A person who speaks, or pleads, on another because of the way the investigation was designed, errors
person’s behalf, sometimes in court, or for a person who were ignored or how the results were interpreted.
cannot defend themselves. Bibliography – A list of all the sources that have been used to
Allergen – A substance that can cause an allergic reaction in provide information and background knowledge about the
sensitive people when their immune system recognises it topic.
as ‘foreign’. These substances cause no response in most Biological programming – It is argued that our genes can
people. ‘program’ the amino acids which influence our body cells.
Anaesthetic – Used to cause unconsciousness during Human development and behaviour are not ‘programmed’
operations. by genes, although development may be influenced by
genes.
Anonymity – Keeping the identity of an individual hidden from
others. Biomedical model – An approach to health and illness that
identifies health as ‘the absence of disease’ and focuses on
Antagonistic muscles – One muscle or sheet of muscle diagnosing and curing individuals with specific illnesses.
contracts while an opposite muscle or sheet relaxes.
Body system – A collection of organs with specific functions in
Antioxidants – Substances that are especially good at the body.
destroying free radicals (harmful molecules that damage
cells and DNA and can contribute to ageing, heart disease Bourgeoisie – In Marxist theory, the bourgeoisie are the
and cancer). Antioxidants are therefore thought to lower powerful social class, who own factories, land and other
the risk of developing cancer and heart disease. capital and are able to organise the economy and other
important social institutions to their own advantage.
Argument – A point of view that aims to persuade others to
the same view by presenting supporting evidence. An Bullying – When an individual or group of people intimidate or
argument is more than a statement of fact. harass others.
Arterial blood – Blood flowing through arteries that are coming
from the heart, usually carrying oxygenated blood to the
tissues.
C
Capitalist – Another word for a member of the bourgeoisie.
Artery – A blood vessel coming from the heart, usually carrying Care Quality Commission – The independent regulator of
oxygenated blood to the tissues. health and social care services in England.
467
Caring presence – Being open to the experience of another Conflict model – A sociological approach first associated with
person through a ‘two-way’ encounter with that person. Karl Marx, which sees the institutions of society as being
Cell – The basic unit of living material. organised to meet the interests of the ruling classes.
Central nervous system – The brain and spinal cord. Continent – Able to control the bladder and bowels.
Charter – A written constitution, written by the legislative Continuing professional development (CPD) – This is learning
power of the country. acquired after qualifying as a professional.
Chemotherapy – Treatment for cancer using drugs. Continuous data – Data that can have any value. Weekly
changes in body weight or changes in body temperature
Chromatin network – The dark tangled mass seen in the over a day would both generate sets of continuous data.
nucleus of a resting cell.
Covalent bond – A bond in which two atoms are connected to
Chromosomes – Long threads of DNA and protein seen in a each other by sharing two or more electrons.
dividing cell. They contain the genetic material or genes
responsible for transmitting inherited characteristics. Covert discrimination – Hidden discriminatory actions or
words.
Clinical waste – Waste contaminated with blood or other body
fluids, which are potentially infectious. Cristae – Folds of the inner layer of mitochondrial membrane
on which the enzymes responsible for the oxidation of
Cognitive abilities – Ways in which you think, using your glucose are situated.
knowledge and experience.
Critical incident – An experience that enables significant
Cognitive changes – Changes to a person’s thinking, memory learning. It may be a one-off emergency but may often
or mental abilities that influence their behaviour. arise from more routine activities that trigger specific
Cognitive impairment – Difficulty in thinking clearly and learning or flashes of understanding (insight).
logically. Cross-contamination – Germs being spread from one food to
Collagen – A structural protein, generally in the form of fibres, another.
for added strength. Cultural variation – Communication is always influenced by
Commission – The process by which an organisation requests cultural systems of meaning. Different cultures interpret
and funds another organisation to carry out work on verbal and non-verbal communication behaviours as
their behalf. For example, the Department of Health may having different meanings.
commission a university to conduct research on a specific Culture – The collection of values, beliefs, behaviours
topic. In the UK public sector, the commissioning process language, rituals, customs and rules associated with a
usually requires the organisations to tender competitively particular society or social group that might make it distinct
against others. from others.
Common Induction Standards – These standards cover all the Cytoplasm – The word means ‘cell material’; the cytoplasm
training needed during the first few weeks working in a refers to anything inside the cell boundary and outside the
care setting. nucleus.
Communication barrier – Anything that stops the development
of understanding when people interact.
Communication cycle – Most important communication in care D
work involves a cycle of building understanding using an Dangerous occurrences – These include fire, electrical
active process of reflecting on, and checking out, what the short-circuit, needle-stick injury and collapse of lifting
other person is trying to communicate. equipment.
Communication disability – A difference that may create Data – A plural word for ‘information’. Strictly, a single piece
barriers between people with different systems of of information, fact or statistic is ‘datum’ but because data
communication. usually consists of more than one piece of information, this
term is rarely used.
Complex – Influenced by many inter-related factors.
Data set – A series of quantitative measurements of the same
Concrete logical thinking – The ability to solve problems
variable, recorded under the same conditions.
providing you can see or physically handle the issues
involved. Decubitus mattress – A mattress designed to share the weight
evenly and reduce pressure ulcers.
Conditioned response – A new, learned response to a
previously neutral stimulus that mimics the response to the Deductive reasoning – Arguing logically from the general to
unconditioned stimulus. the specific.
Conditioned stimulus – A neutral stimulus that, when paired Delayed development – When a child’s development lags
with the unconditioned stimulus, produces a conditioned behind the developmental norms or developmental
(learned) response, just as the unconditioned response milestones for his or her age.
used to. Demographic statistics – These are statistics relating to
Confidentiality – Keeping information, such as research populations. In the UK, statistical information is collected
data or personal or hidden information. In relation to continuously by various agencies but particularly by
research, the information needed for the purpose of the government departments through information about
research is only made available to the health or social care UK residents gathered from e.g. tax collection, driving
researchers. licences, passports, the ten-yearly Census, schools, GPs’
records, etc.
468
Deoxyribonucleic acid (DNA) – A nucleic acid found only in disengage because of reduced physical health and loss of
the chromatin network and chromosomes of the nucleus. social opportunities.
DNA is responsible for the control and passing on of Distribution of data – An indication of the range or spread
inherited characteristics and instructions to the cell. between the lowest and highest value of actual measures
Dependent variable – A variable whose value is dependent in a data set measuring the same variable.
on that of another variable. The dependent variable is Dysfunctional family – A family that is not working well, and
associated with the phenomenon being measured. not providing all of the support and benefits associated
Development – Complex changes including an increase in with being in a family.
skills, abilities and capabilities.
Developmental norms – Description of an average set
of expectations with respect to an infant or child’s E
development. Egalitarian society – A society without hierarchies, where all
members are regarded as equal.
Deviant – Someone who does not conform to the norms of a
particular society or group. Egestion – The process involved in eliminating waste material
from the body as faeces.
Diagnosis – The medical condition a person has.
Ego – The part of the mind whose function it is to moderate the
Dialect – Words and their pronunciation, which are specific to demands of the id and prevent the superego being too
a geographical community. For example, people who live harsh. It operates on the reality principle.
in the north of England might use a different dialect from
Londoners. Electron microscope – A very powerful type of microscope
needed to see inside cells.
Difference – A point or way in which people or things are
dissimilar. Empathy – The ability to develop a deep level of
understanding of another person’s experience.
Diffusion – The movement of molecules of a gas or a liquid
from a region of high concentration to a region of low Empowerment – Making someone stronger and more
concentration. confident. This enables a person who uses services to
make choices and take control of their own life.
Digestion –The conversion of food into simple, soluble
chemicals capable of being absorbed through the Emulsification – This occurs when an emulsifier causes oil or
intestinal lining into the blood and being utilised by body lipids to be suspended as a large number of tiny globules
cells. in water.
Digestive disorders – Conditions affecting the stomach or gut Enzymes – These are biological catalysts that alter the rates of
leading to symptoms like nausea (feeling sick), vomiting, chemical reaction (usually speeding them up) but which are
diarrhoea, wind and/or bloating. themselves unchanged at the end of the reactions.
Dilemma – The difficult decision between alternative choices. Equity – The quality of being fair and impartial.
Disability – Sociologists will often refer to disability as the Ethics – Written statements, relating to what is acceptable and
restrictions that arise for a person with an impairment unacceptable, that reflect the morals of a society. Morals
because of the attitudes and the lack of appropriate may be modified over time, so ethical codes tend to
services and facilities to meet their needs. evolve to reflect these changes.
Disabling environment – A social context where adaptions and Experiment – A test designed specifically to test the validity
other facilities are not in place to ensure that people with (truthfulness) of a hypothesis.
impairments can take a full part in social life. Extensors – These carry out extension, which increases the
Disadvantage – Unfavourable circumstance or condition that angle between two bones; for example, the triceps (an
reduces the chances of success or effectiveness. extensor) straightens the forearm after flexion.
Discrete data – Factual information presented in numerical Extract – A section of text taken exactly as written from an
form; the data can only have specific values, e.g. male or existing piece of writing.
female, smoker or non-smoker, those born in 1980, those
born in 1981, etc.
Discrimination – The unjust or prejudicial treatment of different
F
False consciousness – In Marxist theory, false consciousness is
categories of people, especially on the grounds of race, the taking on, by the proletariat, of the views and beliefs
age or gender. of their class enemy, the bourgeoisie. They do not realise
Discrimination – Treating some people less well than others that, by working hard, they are serving the interests of the
because of differences. capitalists much more than their own.
Disease incidence – The number of new cases of a specific Findings – The overall conclusions of an investigation.
disease occurring in a population during a specified period First language – The first language that a person learns to
of time. speak is often the language that they will think in. Working
Disease prevalence – The total number of cases of a specific with later languages can be difficult, as mental translation
disease in a population during a specified period of time. between languages may be required.
Disempowerment – Make a person or group less powerful or Fit for purpose – A product or object that performs its
confident. intended function well.
Disengagement – A theory that older people will need to Flavonoids – The pigments in plants that function as
withdraw from social contact with others. Older people will antioxidants.
469
Flexors – These carry out flexion, which decreases the angle Impairment – The restrictions on day-to-day activity caused
between two bones; for example, the biceps (a flexor) by a physical or mental dysfunction or abnormality, such
raises the forearm. as the loss of a limb, a sensory impairment or a learning
Formal care – Care provided by workers who are part of a difficulty such as Down’s syndrome.
health or social care service organisation. Implementation – The process of actually carrying out the
Functionalism – A sociological approach that sees the actions identified in a plan.
institutions of society as working in harmony with each Incontinence – The inability to control the bladder or bowels.
other, making specific and clear contributions to the Independent – Free from control, capable of thinking or acting
smooth running of society. for oneself.
Independent variable – A variable whose value is not
G dependent on that of another variable. Time and
temperature are common independent variables in
Group values – Group members need to share a common
system of beliefs or values in order for the group to scientific experiments.
communicate and perform effectively. You may be able to Inductive reasoning – Arguing logically from the specific to the
identify these values when you watch a group at work. general.
Growth – An increase in some measured quantity, such as Infant mortality rate – The number of deaths occurring in
height or weight. infants under one year old per 1000 live births.
Guideline – A statement of a policy or procedure to help you to Informal care – Care provided by family, friends or neighbours
follow regulations. without payment or necessarily involving health or social
care providers.
H Informed consent – Being provided with all relevant

information that may influence the decision to give
Hazard – A hazard is anything that can cause harm, such as a consent to participate.
steep staircase.
Ingestion – The taking in of food, drink and drugs by the
Health hazards – Incidents leading to illness. mouth.
Helplessness – People can give up and become helpless when Interactionism – A sociological approach that focuses on the
they learn that they cannot control or influence important influence of small groups on our behaviour, rather than the
personal events. Helpless people can become withdrawn power of large institutions. Interactionists believe that our
and depressed. behaviour is driven by the way we interpret situations in
Holistic assessment – An approach to care that addresses the smaller groups, how we see ourselves in relation to other
individual’s physical, social, emotional and spiritual health, people in the group, how we see other members and how
attempting to meet the needs of the ‘whole’ person. they see us.
Holistic development – A person’s physical, intellectual, Interdependence – Dependent on someone else, depending
emotional and social development as a whole. on each other.
Development can be analysed under each of the individual Internalise – This is to do with the way we take in information
categories to help identify issues but, in life, the categories from the outside world and build it into our sense of self.
interact. It then becomes part of our feelings, thoughts and beliefs
Homeostasis – The process of maintaining a constant internal about who we are and what we expect from the world
environment despite changing circumstances. For around us.
example, the pH, temperature, concentrations of certain Interview – An interaction or conversation between a small
chemicals and the water content in the fluid surrounding number of people for the purpose of eliciting information.
body cells (the internal environment) must be kept within a
Intolerance – A condition in which a specific food causes
narrow range even when you are consuming acids (vinegar,
unpleasant symptoms such as diarrhoea, bloating and
lemon juice), are in a freezing climate, or are doing
wind. An intolerance is not the same as an allergic reaction.
vigorous exercise.
Homophobia – An extreme and irrational aversion to
homosexuality and homosexual people. J
Hyperthermia – Increased body temperature above the normal Jargon – Words used by a particular profession or group that
range of values are hard for others to understand.
Hypodermic needles – Needles used to give injections.
Hypothermia – Decreased body temperature below 35oC,
which can lead to death.
L
Labelling – Assign people to a category, especially inaccurately
Hypothesis (plural: hypotheses) – A hypothesis is a statement or restrictively.
that predicts an association between two variables. Language community – A social community of people that
has its own special ways of using language in order to
I communicate between group members.
Legislation – A law or group of laws.
Id – Part of the psyche we are born with. It operates on the
pleasure principle. Liability – Taking responsibility for something.
470
Life course – a life course is a map of what is expected to Non-participant observer – The individual is an onlooker and
happen at the various stages of the human life cycle. not part of the situation being observed.
Life expectancy – An estimate of the number of years that a Norms – The guidelines or rules that govern how we behave in
person can expect to live (on average). society, or in groups within society.
Lifestyle – How a person spends their time and money in order Nucleus – The central part of the cell, which is usually darker
to create a ‘style’ of living. than the rest because it absorbs stain quickly.
Nurture – Social, economic and environmental influences.
M Those human characteristics that are learned through the
process of socialisation.
Major injuries – These include fractures (except fingers
and toes), dislocations, loss of sight, unconsciousness,
poisoning, and any injury resulting in someone requiring
resuscitation.
O
Objective assessment – An assessment that is free from bias
Majority influence – A type of influence exerted by groups that and is based on evidence from independent sources.
is associated with the individual’s desire to be accepted. Observational learning – This occurs when we observe
Behaviour, beliefs and views are changed publicly in order someone behaving in a particular way and we remember
to be in line with the norms of a group, although privately this behaviour. We can learn positive and negative
they are unchanged. behaviours from observing others. For example, we
Maleficence – Causing harm. may observe someone going to the aid of a person who
Marginalisation – Treat a person or group as insignificant. collapses.
Matrix – Background material in which various types of cells lie. Organ – A collection of different tissues, such as the heart or
the brain, working together to carry out specific functions.
Maturation – When development is assumed to be due to a
genetically programmed sequence of change. Organelle – A tiny body inside a cell, which carries out its own
functions.
Mean pulse – The mean of a set of numbers is calculated
by adding the numbers and dividing by the number of Organism – A term for any living thing that can exist
numbers. If an individual’s pulse rates were 70, 68 and 64 independently, including bacteria and viruses.
beats per minute, then the mean would be 70 + 68 + 64 Osmosis – The passage of water molecules from a region of
÷ 3 = 67 (to the nearest whole number). As this calculation high concentration (of water molecules) to one of low
has considered three readings, it is more accurate than concentration through a partially permeable membrane
taking the first reading only. such as the cell membranes of simple epithelial cells.
Metabolism – The metabolism is the sum of all the chemical Overnutrition – A condition that results from eating too much,
reactions occurring in human physiology and these involve eating too many of the wrong things, or taking too many
using or releasing energy from chemical substances. vitamins or other dietary supplements.
Minimum standards – These define the minimum standard of Overt discrimination – Openly discriminatory actions or words.
practice required.
Mitochondria – Spherical or rod-shaped bodies scattered in
the cytoplasm and concerned with energy release. P
Participant – An individual who contributes information about
Modelling – The process of basing behaviour, attitude, style of themselves to a research project; the information may be
speech or dress on someone we admire or want to be like. qualitative or quantitative.
Morals – The unwritten codes of what a society considers to be Participant observer – The individual doing the observation is
acceptable or unacceptable. The morals of a society tend part of the process being observed.
to change over time.
Personal and professional development (PPD) – Learning
Morbidity rate – This refers to the number of people who have acquired from experience before qualifying as a
a particular illness during a given period, normally a year. professional.
Morbidly obese – When a person’s weight is causing disease, Phenomenon – A term used to describe an event or
and likely to shorten their life. observation, e.g. the rise in hospital-acquired infections.
Mortality rate – The number of people who have died in The plural is phenomena.
the population in a given year. The crude death rate is Photomicrograph – A photograph taken of an object
expressed as the number of deaths in a year per 1000 of magnified under a microscope.
the population.
Pilot study – An initial, small-scale (perhaps only 10 per cent
MRSA – Short for methicillin-resistant staphylococcus aureus, or the full sample number planned) exercise, in which you
sometimes known as a ‘superbug’ because it is resistant to use your research tools to see if they are fit for purpose. It
many antibiotics. is acceptable to make small amendments to improve the
reliability and validity of the data gathered in the main,
N full-scale study.
Policy – A statement of intent and responsibilities in relation to
Nature – Genetic and biological influences. Those human
characteristics that are genetically determined. a specific aspect of practice. A document explaining the
expected standards.
Neglect – Fail to care for properly.
471
Power – In the context of interpersonal behaviour, ‘power’ Reflection – A conscious process of thinking about a problem
means the ability to influence and control what other in order to understand it.
people do. Reflexes – A rapid automatic response to a stimulus.
Prejudice – Preconceived opinion that is not based on reason Regulation – A principle, rule or law designed to control
or actual experience. behaviour.
Pressure ulcers – These are caused by people sitting, or lying Reliability – A measure of the quality of the methods used to
in the same position for a long time, which reduces the generate the information. Relates to the extent to which a
oxygen supply to the skin and underlying tissue. In serious set of results can be replicated by repeating the test.
cases the tissue dies and turns black.
Reportable diseases – The reportable diseases most relevant
Primary data – New information generated by observation, to health and social care include hepatitis, HIV, tuberculosis
interviews, a survey or an experiment. (TB), and meningitis.
Primary research – Research that generates new data from Respondents – The individuals in the selected sample who
sources. actually complete the questionnaire and return it to the
Primary socialisation – The first socialisation of children that researchers.
normally takes place within the family. Response frame – The menu of answer options to an individual
Procedure – A step-by-step description of the processes question provided in a questionnaire.
involved in implementing the policy; instructions about Response rate – The percentage of respondents from the
how to carry out a particular task. selected sample. For example, a 30 per cent response
Proletariat – In Marxist theory the proletariat are the ‘working rate is good in a survey in which individuals are sent a
class’, who have only their labour to sell. They work for and questionnaire by post.
are exploited by the bourgeoisie. Responsibility – The duties you are expected to carry out
Protected mealtimes – A policy whereby patients must not be within your job.
disturbed from their meals for treatments and tests. Results – Results from research are the data collected and
Protoplasm – The word means ‘first material’; the protoplasm collated into tables, graphs and charts.
refers to anything inside the cell boundary. Cell or plasma Return rate – The number of questionnaires returned, relative
membrane surrounds the protoplasm. to those distributed, expressed as a percentage.
Provision of services – This refers to health and social care Ribonucleic acid (RNA) – A nucleic acid found in both the cell
services which are provided, and how they are organised, and the nucleus. RNA is responsible for the manufacture of
in communities (e.g. hospitals, care homes, Sure Start cell proteins such as pigments, enzymes and hormones.
centres, etc).
Risk assessment – Carried out to anticipate danger and plan
Psyche – The structure of the mind, consisting of three dynamic how to reduce the risk of harm occurring.
parts.
Role conflict – This exists when the demands of the social roles
Puberty – The developmental process where hormones that we are expected to perform are not consistent with
prepare the body for sexual reproduction. each other, making it difficult and sometimes impossible to
meet all demands.
Q Role model – An individual who has characteristics that inspire
us to copy their behaviour (for example, because they are
Qualitative – Data that cannot be ‘measured’ quantitatively but
can only be described using words. prestigious, attractive or have high status).
Qualitative information – Information that is described using
words and images. S
Quantitative – Describes information that is directly Safety hazards – These include incidents leading to personal
measurable; quantitative data usually involves number injury or damage to equipment or buildings.
values and units of measurement, e.g. number of breaths Sample – In social research, the individuals selected to
per minute or weight in kg. participate in the research from the sample population.
Quantitative information – Information that is described using Sample population – The group of individuals in a population
numerical data (e.g. tables, charts and graphs). who are targeted for investigation, e.g. older people,
college students, etc.
R Secondary research – Research in which data is obtained from
sources that are already in the public domain, i.e. sources
Racism – Belief that all members of a race possess
characteristics that make that race inferior or superior to that have been published in journals, books, magazines,
another race. etc.
Radiotherapy – Treatment for cancer using radiation. Secondary socialisation – The socialisation that takes place as
we move into social settings beyond the family, such as
Raw data – Consists of the records of data collected from nursery, school and friendship groups.
research in the form they were originally generated.
Secondary sources – Sources of information that have been
Reference – An acknowledgement of a source used by published by others (e.g. a quotation from an individual
someone else to support a specific idea, opinion, that appears in a book or journal).
quotation, statistic, diagram, flow chart, etc. The reference
acknowledges the original author.
472
Security hazards – These include intruders, theft of property Socio-medical model – An approach to health and illness
or information, and individuals either being abducted or that focuses on the social and environmental factors that
leaving without consent. influence our health and well-being, including the impact
Self-actualisation – An innate tendency we all possess as of poverty, poor housing, diet and pollution.
human beings to become the best that we can be in Stereotyping – Fixed image or idea about a particular type of
all aspects of personality and intellectual, social and person or thing.
emotional life. Superego – Roughly equivalent to a conscience, the superego
Self-awareness – Being consciously aware of your own consists of an internalisation of all the values of right
strengths and limitations, how others may perceive you and wrong we have been socialised to believe in. It also
and how you may respond to different situations. contains an image of our ideal self.
Self-concept – The way we see ourselves. In early life this Surface tension – The downward pull of water molecules so
comes from what we are told about ourselves (e.g. that the surface of the liquid occupies the smallest possible
‘you’re so pretty’, ‘you’re a good footballer’, ‘what a area.
kind girl you are’). As we grow older, our ability to think Survey – A systematic process of gathering information from
about ourselves develops and we begin to incorporate several people, often using a questionnaire.
our own judgements (e.g. ‘I did well at that test – I’m
good at maths’, ‘I wasn’t invited to that party – I must be
unpopular’). T
Self-esteem – How we value or feel about ourselves. The Target behaviours – Those behaviours that have been defined
amount of esteem we give to ourselves. Someone with as being of benefit to the individual’s wellbeing.
high self-esteem will believe they are loved and lovable Transcript – An exact word-for-word written record (‘ums’ and
and that they are important and valued. By contrast, an ‘ers’ included) of what is said, both by the interviewer
individual with low self-esteem may feel themselves to and the interviewee, taken from an audio record of the
be worthless, of no value to anyone else, unloved and interaction.
unlovable.
Sensory impairment – Damage to sense organs such as eyes
and ears. U
Set point – The temperature of the ‘hypothalamic thermostat’, Uncertain – Where there are many unknowns, where there
when autonomic thermo-regulatory mechanisms start are considerable gaps in the relevant information, or the
to act to reverse the rise or fall and restore normal strength of different influences could be variable.
temperature. Unconditional positive regard – This refers to a totally non-
Sexism – Prejudice, stereotyping or discrimination on the basis judgemental way of being with and viewing a client. The
of gender, typically against women. therapist does not like or approve of the client at some
times and disapprove of them at others: they value the
Significant – A simple explanation of the term ‘significant’ in client in a positive way with no conditions attached.
this context would be whether the error was meaningful
and likely to distort any conclusions drawn. ‘Not significant’ Unconditioned response – A response that regularly occurs
means that the error can be ignored. when an unconditioned stimulus is presented, e.g. the
startle response resulting from the thunderclap.
Skills for Care – One of the sector skills councils for health and
social care that set standards for good practice in the UK. Unconditioned stimulus – A stimulus that regularly and
The other is Skills for Health. consistently leads to an automatic (not learned) response
from, e,g, a clap of thunder.
Slang – Informal words and phrases that are not usually found
in standard dictionaries but which are used within specific
social groups and communities. V
Social control – The strategies used to ensure that people Validity – Relates to the quantity of test results provided to
conform to the norms of their society or group. tackle the study in question. ‘Valid’ means true, sound or
Social institution – A major building block of society, which well-grounded.
functions according to widely accepted customs, rules or Value consensus – A general agreement as to the values and
regulations. The family, the education system and the legal beliefs of a society.
system are all social institutions. Values – Principles or standards of behaviour, a person’s
Social mobility – The process of moving from one social judgement about what is important in life that we use to
stratum (level) to another. Social mobility can be upward or guide our thoughts and decisions. They explain what we
downward. think of as important or valuable in terms of how we live
Social role – The social expectations associated with holding a our lives.
particular position or social status in a society or group. Variable – An entity or factor that can have a range of values
Social stratification – A term (borrowed from geology) that can be measured.
describing the hierarchies in society, whereby some groups Vegan – A diet that omits all animal products.
have more status and prestige than other groups. Vegetarian – A diet that omits all meat and fish, but includes
Socialisation – The process of learning the usual ways of dairy produce.
behaving in a society.
473
Vein – A blood vessel returning blood to the heart from the
tissues; the blood has left considerable amounts of oxygen
behind to supply the cells and is known as deoxygenated
blood.
Venous blood – Blood flowing through veins that are returning
blood to the heart from the tissues; the blood has left
considerable amounts of oxygen behind to supply the cells
and is known as deoxygenated blood.
Voluntarily – Doing something of your own free will, without
being forced, or coerced, into doing it.
Vulnerability – Being exposed to harm.
W
Working document – A document that is modified and
adapted at the same time as it is being actively used to
guide practice.
474
Index
absorption of food 166, 213 antagonistic muscles 189, 189 blood pressure 203
abstract logical thinking 140 anti-discriminatory practices 60–61 blood structure and function 205–206
abuse 56, 94, 119 active promotion of 77–80, 355–56 blood vessels 204–205
accidents 98, 100, 119–20 national initiatives promoting 71–77 body language 10–12
recording/reporting 108–109, 125 personal beliefs & values 80–82 body mass index (BMI) 372
see also incidents & emergencies anti-harassment policies 76 body, organisation of 178–96
action plans 268–69, 270–71 antioxidants 377 body organs 191–92
for a research project 441 anxiety 24, 356 body systems 192–97
action research 410 arguments 439 and energy metabolism 198–215
active listening 357–59 arrested development 145 body temperature
activity theory of ageing 171 arterial blood 186 effect on heart rate 219
adenosine diphosphate (ADP) 181 arteries 192 fluctuations in 362, 363
adenosine triphosphate (ATP) 181 arthritis 166 measuring 229–32
adolescence 137–38 assertiveness 30–31 regulation of 221–25
adult social services 288–89 assumptions bone tissues 188
adulthood 138 and communication barriers 25–26 bourgeoisie 313
advocacy/advocates 35, 75, 78 in research 439 Braille 15
affirmative action 76 asthma 149, 362 breathing 206, 208–209
age discrimination 66, 73 atherosclerosis 164, 387 emergency first aid 124–25
ageing 163 attitudes 157 breathing rate
final life stages 139 authenticity of research 421 measuring 229
physical changes 163–66 autonomic nervous system 189, 193, 203, regulation of 219–21
psychological changes 167–71 218, 219–20, 352 British Sign Language 14
see also older people autonomy 347 brittle bone disease 149
aggression bronchi, lungs 207
barrier to communication 25 babies, body temperature 224–25 bullying 153–54
diffusing 32–33 Bandura, Albert 344
discrimination causing 69 bar charts 451, 452 calcium 385
safety issues 122–23 barriers to communication 21–28 calories, recommended intake of 387
AIDS (acquired immunodeficiency ways of overcoming 29–35 capitalists 313
syndrome) 105 baseline 255 carbohydrates 380–82
alcohol 387 beaches, health & safety issues 99–100 cardiac cycle 202, 203, 218
barrier to communication 28 befrienders 37 cardiac output 202
energy values 387 behaviour see psychological perspectives cardiovascular system 164, 199–206
recommended intake 388 behaviourist perspective 338–40, 354–55 care homes see residential care
alimentary canal 210–12 belief systems 26 care practice 264
allergies, food 391 beliefs 56, 154–55 Care Quality Commission 104, 105, 108,
ambulance trusts 287 of older people 169 285–86
amino acids 382 personal 80–81, 262, 264–65, 281 Care Standards Act (2000) 72
anabolism 198–99 benchmark 256 care value base 265
anaesthetics 95 beneficence 77, 415 committing to 81
anaphylactic shock 391 Beverage’s five giant evils 318 and personal goals 280
anatomy and physiology 175–77 bias in research 421, 453 seven principles of 60
body organs 191–92 bibliographies 252 careers 258, 265–67, 281, 298
body systems 192–97 biological determinants of behaviour caring presence 23
cardiovascular system 199–206 351–52, 361–63 cartilage 187
cells 177–83 biological influences before birth 150 catabolism 198–99
data presentation & interpretation biological programming 146 cataracts 165
233–34 biomedical model of health 322 cells 177–83
digestive system 210–16 birth and infancy 136–37 challenging behaviour, understanding
energy metabolism 198–99 Black Report, The (Townsend) 327–28, 356
homeostatic mechanisms 217–26 329 changes 274
measurements 227–33 bleeding, first aid for 125 in health & social care services 284–85
respiratory system 206–10 blood cells 185–87 role of research in monitoring 412
tissues 183–90 blood glucose levels, regulation of charters 74–75
anonymity 416 225–26 charts 223–24, 450–52
475
chemicals, exposure to 91, 105, 121 of research participants 416–17 development 134
chemotherapy 95 conflict model 310 arrested 145
childhood 137 conflicts, dealing with 80 delayed 144
childminding, health & safety issues connective tissues 185–88 emotional 143
95–96 consent, informed 416, 443 holistic 135
children contemporary issues 412–13 intellectual 140
abuse of 119 continent 113 language 141–42
dietary needs of 387–88 continuing professional development norms of 361–62
risk assessment 115–16 (CPD) 242, 298 physical 136–39
services for 288 continuity theory of ageing 171 social 142–43
cholesterol 383 continuous data 449 deviance 307
chromatin network 180 Control of Substances Hazardous to diabetes mellitus 390
chromosomes 180 Health (COSHH) 2002 regulations diagnosis 103
chronic obstructive pulmonary disease 104–105 dialect 9
(COPD) 164 conventions, anti-discriminatory 71–73 diary-keeping 276–77
circadian rhythms 362–63 covalent bond 382 diet 370
cis fats 383 covert discrimination 55 and activity levels 394, 401
civic emergencies 124 Criminal Records Bureau (CRB) checks cultural diversity 50–51
Civil Contingencies Act (2004) 105 106, 115 of different groups 387–88
classical conditioning 338–39 criminality and discrimination 69 during pregnancy 150
clinical waste 91 crisis situations see incidents & lifestyle influences 401
clinics, health & safety issues 95 emergencies quantitative analysis of 400–401
codes of practice 73–74, 262–63, 297, cristae 181 strengths & weaknesses 401
424 critical controls 114 see also food
coeliac disease 148–49, 390 critical incidents 276 dietary conditions 390–93
cognitive abilities 244 cross-contamination 102 dietary habits 393–94
basis of discrimination 67 cultural variation dietary intake guidelines 374–75
changing with age 165 and communication 17, 26–27 dietary reference values (DRVs) 373
cognitive behaviour therapy (CBT) 360 and support provision 78 differences 54
cognitive impairment 110, 115 culture diffusion 183, 209–10
cognitive perspective 350–51, 359–61 basis of discrimination 65 digestion 213
collagen 188 benefits of diversity 50–52 alimentary canal 210–12
colleagues, communicating with 6–7 effect on behaviour 342–43 food absorption & breakdown 212–13
collectivism 318 influencing development 154–55 liver & pancreas 212
colon 191, 211–12, 215 personal background 80 major products of 214
commisioners of research 420 and socialisation 306–308 role of enzymes in 213–14
commission 409 cystic fibrosis 148 digestive disorders 92
Common Induction Standards 108 cytoplasm 179, 180 digestive system 210–16
communes 306 dilemmas, ethical 418
communication 1–9 dangerous occurrences 103 disability 324
barriers to 21–39 data barrier to communication 24
effectiveness of 40–41 collection 447, 448–49 basis of discrimination 65–66
environmental factors 21 definition of 412 legislation 72, 73
interpersonal interaction 9–14 presentation & interpretation 233–34, and risk assessment 115
language needs/preferences 14–17, 64 439–40, 449–52 disabling environment 324
skills 259 use and misuse of 418–20 disadvantage 55–56
theories of 18–21 Data Protection Act (1998) 72, 103–104, discrete data 449
communication barrier 22 423–24 discrimination 54–55, 155
communication cycle 18–19 day care settings bases of 65–67
communication disability 24 equality, diversity and rights 59 effects of 69
communication passports 16 health and safety 95 identifying and challenging 80
community-based services 284 decubitus mattress 113 legislation 72–73
community settings, health and safety deductive reasoning 419 practice of 67–68
issues 97–98 defence mechanisms 346 disease incidence/prevalence 326
complaint procedures 76 deficiency, dietary 370 disempowerment 69
conception 136 delayed development 144 disengagement theory of ageing 170
concrete logical thinking 140 dementia 166 distribution of data 450, 451, 452
conditioned response 339 demographic statistics 440 diversity 48, 54
conditioned stimulus 339 deoxyribonucleic acid (DNA) 180 benefits of 49–52
confidentiality 29 dependent variable 434 domiciliary care 59
organisational policies 77 depression 24, 360 doubt 347
practical implications 61–62 determinism 146 drug interactions 121
476
duodenum 211, 215 safe storage of 111 self-prescribed supplements 376–77
dysfunctional family 154 equity 54 supply of 396
Erikson, Erik 346–47 Food Safety Act (1990) 102
early experiences 345–46 errors and bias in research 453 Food Safety (General Food Hygiene)
eating patterns 394–95 ethics 415 Regulations (1995) 102–103
economic factors ethical approval for research 417 Food Standards Agency 373, 381, 387,
influence on dietary intake 395–96 ethical dilemmas 418 394, 397, 398
see also income ethical principles 77, 415–17 formal care 290
education 157, 294–95 ethnicity, and patterns of health/illness formal communication 6
and cultural diversity 51 330–31 formal evidence 275
for healthy eating 396–98 evaluation of research project 453–55 Freedom of Information 64
egalitarian communities 306 evidence 275–76 Freud, Sigmund 344–46
egestion 213 exercise functional skills 248–49
ego 346 and food intake 394 functionalism 310–12, 319
electron microscopes 178 and nutritional plans 401 funding of services 290–91
emergencies see incidents & experiential learning theories 243–46
emergencies experimental research 433–34 gaseous exchange 209
emotional development 143 extensors 195 gender
emotional problems 359–60 basis of discrimination 67
empathy 24, 357 facial expression 11–12 and patterns of health/illness 329–30
emphysema 164 false consciousness 313 General Social Care Council (GSCC) 74
employees family dysfunction 154 generalisations 419–20
health & safety role 108–10 fats (lipids) 382–83 genetic factors
responsibilities of 111–12 fear, hierarchy of 354 affecting development 148
employers, role of 107–108 feedback influencing behaviour 351–52
employment and low income 156 control systems 217 predisposing to certain disorders 362
empowerment 27, 57, 60–61 during communication 18, 259 genetically modified (GM) foods 376
emulsification 212 during learning 248, 252, 253 Gessell, Arnold 351
endocrine system 193 feeding, loss of independence 392–93 gestures 11
influence on behaviour 352 feminism 315–16, 320 global food inequalities 380
energy fever 225 glucagon, role of 225
balancing 371 fibre 381 goals, personal 267–71, 280–81
dietary sources 385, 387 findings, research 453, 454–55 graphs 223–24, 450–52
forms of 198 finger spelling 15–16 groups
laws 198 fire, health & safety issues 123 communication in 5, 19–20
measuring 387 first aid 124–25 effect on behaviour 341–42
metabolism 198–99 first language 10 peer groups and socialisation 157
enhanced disclosures 106 ‘fit for purpose’ 441 values of 19
environmental factors 81 five-a-day programme 374 growth and development 129–31
and communication 21, 34 flavonoids 387 ageing 163–71
and food production 376 flexors 195 development 135–45
influencing growth & development floods 123–24 environmental influences 150–55
150–55 foetal alcohol syndrome 150 life factors 148–49
enzymes 210, 213–14, 215 food 370 lifestyle 158–59
epithelial tissues 183–85 advertising 377–78 major life events 159–61
equality, definition of 48, 54 allergies 391 nature versus nurture 146–47
equality, diversity & rights 45–47 availability of 393–94 prenatal influences 150
codes of practice & charters 73–75 breakdown & absorption of 212–13 socio-economic factors 155–57
conventions, legislation & regulations cost of 395–96 stages of 132–35
71–73 five food groups 374 growth charts 371
discriminatory practices 65–69 genetically modified 376 guidelines 101
diversity 48–52 global inequalities 380 dietary intake 374–75
in health & social care settings 58–59 hygiene 397 working within 82
individual rights 62–65 intolerances 390–91 see also regulations
loss of rights 70–71 labelling issues 375, 397 guilt 347
organisational policies & procedures nutrients 380–88
75–77 obesity treatments 377 Halal 51
promotion of equality and rights 59–62 organic 375–76 handwashing 120
terminology 52–58 preparation/processing 374–75 harm
see also anti-discriminatory practices production, environmental issues 376 and abuse 56, 94, 119
equipment recommended intakes 373 protecting individuals from 415–16
hazards 89 recording intake of 400 resulting from hazards 114
477
harm – continued private 287–88 information access 64, 423
right to be protected from 64 protected mealtimes in 388, 398 information literacy 436
Harvard step test 232–33 trusts 287 information processing perspective
hate crimes 56 housing, effects of poor quality 152 350–51
hazards 88 human aids to communication 16–17, information sharing 61–62
from equipment 89 35–37 informed consent 416, 443
from infections 89–91 human body, organisation of 178–96 ingestion 213
identifying 113–14 human rights 54, 66, 77, 418 initiative 347
in physical environment 88–89 Human Rights Act (1998) 54, 70, 72, 423 injuries
security systems 93 humanistic perspective 348–50, 357–59 causes of 93
substances 91–92 hyperthermia 225 first aid for 124–25
waste disposal 91 hypothalamus, role of 223–24 insurance cover 108
working conditions/practices 92–93 hypothermia 95, 225 playground 98–99
health 321–22 hypothesis, definition 434 regulations 103
basis of discrimination 67 hypothesis testing 444–45 see also accidents
education campaigns 397 insulin
genetic disorders 352, 362 ICT skills 260–61, 448, 449 and diabetes 390
and illness patterns 327–31 id 346 role of 225–26
measuring 326–27 identity 347–48 insurance 108
models of 322 ileum, small intestine 211, 215 integrity in research 418–19
personal 81 ill-health concepts 234–35 intelligence
health and safety 85–87 illness patterns 326–31 basis of discrimination 67
harm and abuse 94 immune system 195 Jean Piaget’s work 350
hazards 88–93 impairment 324 stages of developing 140
incidents and emergencies 119–26 see also disability interactionism 316–17, 320
influences 106 implementation 271 interdependence 57
issues for different groups 100 incidents & emergencies 119 internalisation, self-concept 349
legislation and guidelines 101–105 accidents 119–20 Internet 250, 436–37
policies and procedures 106–107 aggressive behaviour 122–23 interpersonal interaction
responsibilities 111–12 civic emergency 124 types of 9–14
risk assessment 113–18 exposure to chemicals 121 see also communication
roles 107–11 exposure to infection 120–21 interpreters 35–36
settings 94–100 fire and floods 123–24 interviews, research 432–33
Health and Safety at Work Act (1974) intruders 122 intolerance, food 390
101–102 loss of water supply 124 intruders 122
health & social care services see service recording/reporting 112 iron 385
provision responses to 124–26 irritable bowel syndrome (IBS) 390–91
health & social care workers 293–99 reviewing/improving policies 126
hearing loss 165 spillages 121–22 jargon 9, 10
heart rate 202–203 suspected or actual abuse 119 job roles & responsibilities 293–94
regulation of 218–19 income 155 journals, academic 437
heart structure 199–201 gender differences 330
helplessness 32 impact of low 156 Kelly, George 351
hierarchy of needs, Maslow 348–49 influence on diet 395–96 kidneys 191, 192
histograms 451, 452 incontinence 91 knowledge 257–58
HIV (human immunodeficiency virus) 105 independence 57 research extending 412
holistic assessment 321 independent variable 434 Kolb’s experiential learning cycle 244–45
holistic development 135 individual rights 62–65, 266
homeostasis 190, 217 positive promotion of 75 labelling
and blood glucose levels 225–26 promoting and balancing 79 discriminatory practice 55
and body temperature regulation individualism 342–43 of food 375, 397
221–25 inductive reasoning 419 lactose intolerance 391
and breathing rate regulation 219–21 industriousness 347 language
and heart rate regulation 218–19 infant mortality rate 326 barriers to 24
homophobia 58 infant schools, health & safety 95–96 benefits of learning 51
Honey and Mumford, theory of learning infection careful use of 81
styles 245–46 during pregnancy 150 and communication 35–36, 64
hormones exposure to 120–21 development of 141–42
and the menopause 164 hazards from 89–91 and speech 9–10
see also endocrine system informal care 290 language community 7
hospitals informal communication 5–6 learning 242–43
health & safety issues 95 informal evidence 277 difficulties/disabilities 115, 359
478
influences on 246–47 data presentation & interpretation influence on behaviour 352
opportunities 254 233–34 nervous tissue 190
skills for 247–52 of health and illness 326–27 New Right 319
support for 252–53 normal variations 232–33 NHS see National Health Service
theories of 243–46, 338–44 nutritional 371–73 non-judgemental approach 359
legislation pulse rate 227–29 non-participant observer 435
anti-discrimination 71–73 media non-starch polysaccharides (fibre) 381
children’s services 288 for research information 437–38 non-verbal communication 10–14, 33
civil emergencies 105 role in research ethics 418 norms
data protection 103–104, 423–24 medication of development 361–62
and dietary health 398–99 hazards of 121 of society 307–308
health and safety 101–104 safe storage of 111 notice of improvement 102
human rights 54, 70, 72, 423 melatonin and sleep-wake cycle 363 nucleus of a cell 180
influence on practice 262–63 menopause 139, 164 nursing care 59
levels of services 285 Mental Capacity Act (2005) 73 nurture versus nature 146–47, 309
liability 101 Mental Health Act (1983) 72 nutrients 370, 380
liberal feminism 316 mental health support 78–79 carbohydrates 380–82
life course 133–34 mentors 36 lipids 382–83
life events 159–61 metabolism 179 minerals 385, 386
life expectancy 133, 323 methodology see research methodology proteins 382
life stages 133–35 milestones, developmental 135 vitamins 384, 385
lifespan 139 minerals 385, 386 nutrition and health 367–69
lifestyle 158–59 minimum standards 89, 105, 286 characteristics of nutrients 381–88
and dietary health 394–95 mitochondria 181–82 concepts of nutritional health 370–80
and nutritional plans 401 modelling of behaviour 344 dietary conditions 390–93
lifting people, hazards of 93 models of health 322–23 dietary habits 393–94
lighting 89 monounsaturates 383 economic factors 395–96
limitations, recognising 263–64 morals 415 education 396–98
lipids 382–83 morbidity rates 326 information sources 400
listening skills 13–14, 357–59 mortality rates 326–27 lifestyle influences 394–95
literature reviews 438–39 motor neurone disease 164 recommendations for improving
liver 191, 212, 215, 225–26 MRSA (methicillin-resistant 400–401
local authorities staphylococcus aureus) 90–91 social policy 398–99
health & safety role of 110 multi-agency working 7–8 socio-cultural issues 396
social care services 288–89 multi-professional working 8
longevity 139 multidisciplinary teams 297 obesity 371
lungs, structure and function 207–208 muscle tissue 188–90 treatments for 377
lymphatic system 194 musculo-skeletal system 194–95 objective assessment 256
age-related changes 165–66 objects of reference 15
magnesium 386 observation 249, 434–35
major injuries 103 National Health Service (NHS) 285 observational learning 344
majority influence 341 NHS trusts, role of 110–11, 287 occupation, effect on diet 395
Makaton 15 public sector services 283 oils (lipids) 382–83
maleficence 415 in UK home countries 284 older people
malnutrition 370 see also service provision dietary needs of 388
Management of Health and Safety at national initiatives, anti-discrimination energy needs of 395
Work Regulations (1999) 104 71–77 final stages of life 139
Manual Handling Operations Regulations National Minimum Standards 89, 105, health & social care provision 171
(1992) 103 399 and patterns of health & illness 331
marginalisation 69 nature-nurture debate 146–47, 309 risk assessment 115
Marxism 313–14, 320 needs see also ageing
Maslow, Abraham 348–49 assessment of 29 one-to-one communication 4–5
mass media see media hierarchy of 348–49 operant conditioning 339–40
matrix 185 identifying 409 opportunities 54, 69
maturation 134 support for individual 79 for learning 254, 258
maturation theory 147, 351 negative behaviours 56, 58, 69 organelles 179, 180–81
meal patterns 393 negative feedback, control systems 217, organic food 375–76
mean, median and mode 450 226 organism, definition of 90
mean pulse 227 negative reinforcement 340 organs (of the body) 191–92
measurements 227, 435 negative thinking 24, 360 osmosis 184
body temperature 229–32 nervous system 193 osteoporosis 164, 168
breathing rate 229 effect of ageing 164 overnutrition 370
479
overt discrimination 54 predictable life events 159 question for research project 444
overweight, definition of 371 pregnancy 136 questioning skills 24–25, 40, 248, 249, 274
factors affecting development 150 questionnaires 428–32
pancreas 191, 212, 215 nutritional health 150, 388
role in regulation of blood glucose prejudice 55 racism 57
levels 225–26 premises radiotherapy 95
parasympathetic nervous system 203, damage to 94 rationale for research topic 445–46
218–20, 224, 352 security issues 93, 106 raw data 449
parks, health & safety issues 98–99 suitability of 106 reciprocal influence theory 161
participant observer 435 prenatal influences 150 recommended daily amount (RDA),
participants, research 427 pressure groups 326 nutrients 373, 384, 385, 386
partnership working 289–90 pressure ulcers 94 recreation, access to 153
past events, influence of 81 primary care 285 reference lists 252
patterns in health & illness 326–31 primary care trusts (PCTs) 287 reference nutrient intakes (RNIs) 373
peer groups, socialisation 157 primary data 250 reflection
peristalsis, digestion 213 primary research 427 on personal development 273–82
personal beliefs/values 80–81, 262, primary socialisation 307 research aiding 412
264–65, 281 primary sources 428–35 reflective listening 13–14
personal presentation 261–62 privacy, rights to 63 reflexes 136–37
personal & professional development private sector services 283–84 regional trends in health & illness 331
(PPD) 239–41 procedures see policies and procedures regulations 101
knowledge of services 283–99 professional bodies 295–97 anti-discriminatory 71–73
learning process 242–54 professional development see personal & and dietary health 398–99
planning & monitoring 255–72 professional development health and safety 102, 104–105
reflection on 273–82 professionalism 262 health & social care services 285–86
personality, effect on communication professionals reinforcement 340
24–25 communicating with 7–8 relationships, building 33
phenomenon, definition of 421 role in dietary education 397–98 relevance of research project 446
photomicrographs 178 project action plans 442 reliability 234, 250–51, 421–22
physical changes due to ageing 163–67 project planning 441–43 religion 154–55
physical development 136–39 proletariat 313 renal system 192
physical impairment 24, 115 protected mealtimes 388 reportable diseases 103
physiology see anatomy and physiology proteins 382 reports
Piaget, Jean 140, 350 protoplasm 179 key research publications 422–23
pie charts 451, 452 provision of services 409 own research findings 454–55
pilot studies 441 proximity 12 reproductive system 193–94
plagiarism 252 psyche 346 research methodology 405–407
policies and procedures psychodynamic approach 344–48, 356 conducting research 447–48
anti-discriminatory 75–77 psychological perspectives 335–37 ethical issues 415–24
health and safety 106–107 age-related changes 167–71 function of research 408–14
influence on practice 263 applications of 354–63 interpreting findings 448–55
research 424 behaviourist views 338–40 planning a research project 441–43
research informing 410 biological perspective 351–52 primary sources 428–35
reviewing/improving 126 cognitive/information processing secondary sources 435–40
pollution 150–51 350–51 topic selection 443–47
polypeptides 382 humanistic perspective 348–50 types of research 425–27
polyunsaturates 383 psychodynamic approach 344–48 research skills 249–52, 261
portfolio, PPD 275, 276 social learning theory 340–44 residential care
positive reinforcement 340 psychosexual stages, Freud 345–46 equality, diversity and rights 58
post-traumatic stress disorder (PTSD) psychosocial crises, Erikson 346–47 evacuation in event of flood 123
360–61 puberty 137–38 health and safety 94
postmodernism 317 public health, food hygiene 397 regulations 104
posture, body language 10 public parks, safety issues 98–99 respect 62, 124, 359
poverty 155–56, 327–29, 330 public sector services 283 respiratory system 164, 206–10
power pulse rate, measuring 227–29 respondents, questionnaire 428
abuse of 27, 68 response frames 428
empowerment 27, 57, 60–61 qualifications 267–70, 293–98 response rate 428
statutory 70 qualitative information 250 responsibilities 106, 111–12, 263–64
practice qualitative research 426–27 results from research, analysing 448–49
personal 262–65 quality issues 76 retail areas, health & safety issues 98
research informing 410–12 quantitative information 250 return rate, questionnaires 432
pre-schools, health & safety issues 95–96 quantitative research 425–26 reviews, literature 438–39
480
rheumatic disease 149 Sex Discrimination Act (1975) 72 demographic 440
ribonucleic acid (RNA) 180 sexism 58 health 326–27
RIDDOR (reporting of injuries, diseases shift work, effects on behaviour 362–63 mean, median and mode 450
and dangerous occurrences shops, access to 396 stereotyping 55
regulations) 103 sign language 14, 15 stomach 210–11, 215
rights 48, 54 significance, statistical term 228 strategic health authorities (SHAs) 287
individual 62–65, 266 skills 247–52, 258–62 stress 92–93
loss of 70–71 Skills for Care 108 stroke volume 202–203
promoting 29 skin structured interviews 433
risk assessment 104 effects of ageing 166 study skills 247–48
implementing 113–17 losing heat from 222–23 subject for research project 443–44
risks 88 structure & function of 221–22 submissiveness 25
assessing 113–16 slang 9 sugar substitutes 381–82
minimising 111 sleep-wake cycle 362–63 sugars 380–81
monitoring/reappraising 117 SMART principles 269 sunbathing, health issues 99–100
road safety 98, 100 smoking, effects of 150, 166 superego 346
Rogers, Carl 349–50 snacking 393 supplements, food 376–77
role conflict 308–309 social action 320 surface tension 207
role confusion 347 social care provision see service provision surveys 428–32
role models 355–56 social class 305–306 swimming pools, safety issues 98
role theory 343–44 basis of discrimination 66 sympathetic nervous system 203, 218–20,
effect on health/illness 327–29 224, 352
safeguarding vulnerable groups 105–106 social cohesion 51–52 synthesis 439
safety see health and safety; security social control 309 systematic desensitisation 354
issues social development 142–43
sample population, surveys 428 social disengagement, ageing 170 tables, data representation 450, 451
SAP approach, personal development social eating/drinking 394 target behaviours, shaping 355
256–57 social institutions 304 target group for research project 442
saturated fats 383 social learning theory 340–44, 355–56 team working 259–60, 297
schizophrenia 362 social mobility 305 technical skills 260–61
school lunches 398–99 social roles 308 technological aids to communication 16,
scientific experiments 433–34 social stratification 305 37–38
secondary care 285 socialisation 81, 306–309 temperature see body temperature
secondary research 427 socio-cultural influences on diet 396 tensions, dealing with 61
secondary socialisation 307 socio-economic factors 155–57 tertiary care 285
secondary sources 250–51, 435–40, 447 socio-medical model of health 322 theories
security issues sociological perspective 301–303 of ageing 170–71
community care workers 97 application to health & social care of communication 18–21
hazardous security systems 93 319–20 of learning 243–46, 338–40
selenium 386 collectivism 318 of psychological development 344–52
self-actualisation 348 feminism 315–16 of social development 340–44
self-awareness 256, 277 functionalism 310–12 timescales for research project 441–42
self-concept 349 health concepts 321–23 tissues, body cells 183–90
self-esteem 34–35, 69, 349 ill-health concepts 234–35 tolerance 51
effect of ageing on 167–69 interactionism 316–17 topic selection, research project 443–47
self-fulfilling prophecy 343 Marxism 313–14 touch 12
self-identity 69 the New Right 319 trace elements 385
sensory impairment 24, 115, 163, 165 postmodernism 317 trachea, structure & function 206–207
service provision 283–86 terminology 304–309 training 294–95
access to services 153, 291 trends in health & illness 326–31 communication skills 29, 259
gaps in 409 sodium 386 equality, diversity & rights 75
for older people 171 special health authorities 285 learning skills 247–52
planning of 409–10 speech 9–10 planning own development 255–72
providers 287–92 spillages 111, 120, 121–22 sources of support 61, 252–53
service users spina bifida 388 trans fats 383
calculating risks for 115 sport, health & safety issues 99 transcripts of interviews 433, 449
communicating with 7 spreadsheets 449 translators 35–36
hazards affecting 100 staff levels, minimum 106 transport, health & safety issues 100
health & safety issues 110 staff shortages 92–93 trauma support for staff 126
promoting rights of 29 standards 105, 108, 286, 398–99 trends in health & illness 326–31
set point 225 starch 381 triangulation 449
sex discrimination 67 statistics trusts, NHS 110–11, 287
481
tube feeding 392 personal 80–82, 262, 264–65, 281 loss of supply 124
Tuckman’s stages of group interaction see also care value base websites for research 436–37
19–20 variables 434 weight for height and gender 371–72
vegan diet 393 well-being, personal 81
uncertainty 273 vegetarian 393 work
unconditional positive regard 357 veins 192 effect of shift work 362–63
unconditioned response 339 venous blood 186 ethnic minority disadvantages 57
unconditioned stimulus 339 ventilation 88–89 in health & social care 293–99
unconscious mind, Freud 344–45 Vetting and Barring Scheme 106 working with others 259–60
undernutrition 370 visual impairment 165 working conditions 92–93
understanding others 357 vitamins 384–85 working documents 271
unemployment 156, 157 voluntary sector services 284 working practices
‘unfit for human consumption’ 102 vulnerability 56 hazardous 93
unpredictable life events 160 vulnerable people monitoring of 109–10
unsaturated fats 383 abuse of 119 see also policies and procedures
unstructured interviews 433 and research ethics 420 written communication 15
safeguarding 105–106
validity 234, 250–51, 421 x-rays 91–92
value base see care value base waste disposal 91
value consensus 311 water zinc 386
values 26, 56, 157 dietary consumption of 387
482

BTEC Level 3 National Health and Social CA - Mary Whitehouse

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Published by Pearson Education Limited, a company incorporated in England and Wales, having its registered office at Edinburgh

Gate, Harlow, Essex, CM20 2JE. Registered company number: 872828

eBook edition first published 2014

British Library Cataloguing in Publication Data

ISBN 978 1 846907 46 3 (paperback)

Edited by Kelly Davis

Unit Credit value Unit title Author Page

1 10 Developing effective communication in health and Neil Moonie 1

4 10 Development through the life stages Neil Moonie 129

5 10 Anatomy and physiology for health Beryl Stretch 175

6 20 Personal and professional development in health Mary Whitehouse 239

21 10 Nutrition for health and social care Carolyn Aldworth 367

Legislation grid 459

All other images © Pearson Education

About your BTEC Level 3 National

What will you be doing?

Qualifications Credits from Credits from Total credits

Unit title Mandatory Optional

Unit 1 Developing effective All levels

Unit 4 Development through All Diplomas Certificate H&SC

Unit 5 Anatomy and physiology All Diplomas Certificate H&SC

Unit 6 Personal and All Diplomas

Unit 7 Sociological perspectives Diploma H&SC Certificate H&SC

Unit 8 Psychological Diploma H&SC Certificate H&SC

Unit 21 Nutrition for health and Certificate H&SC

Unit 22 Research methodology All Diplomas

How to use this book

divided each unit into a series of topics each related to

These introductions give you a snapshot of what to

Assessment and grading criteria

Assessment and grading To achieve a pass grade, the

each of the assessment criteria for each unit. For

each assessment criterion, shown by the grade

D2 Justify responses to a particular

03-BTEC_National_H&SC-Unit 3-ccc.indd 86 17/06/2010 08:29

Sam, 18 years old

Stuck for ideas? Daunted by your first assignment?

Personal, learning and

you develop during your course canbegin

There are also mini-case studies

life issues and situations.

in order to make a loving sexual attachment. This may beon holiday

Adulthood Intimacy Think about it!

Did you know? Did you know?

Further reading and resources Resources and

BTEC’s own resources

When you see this sort of activity, take stock! These 4

quick activities and questions are there to check 6

your knowledge. You can use them to see how

much progress you’ve made or as a revision tool.

Edexcel’s assignment tips

processes and really useful facts and figures.

Have you read your BTEC Level 3 National Study

Ask your tutor about extra materials to help you

Your book is just part of the exciting resources from

Assessment and grading criteria

P1 Explain the role of effective M1 Assess the role of effective

P6 Participate in a group interaction in

How you will be assessed

Daniel, 17 years old

1 Understanding effective communication

Changing the way you communicate

1.1 Contexts of communication Reflect

Fig 1.1: Interaction often involves a three-stage process