Role of the Healthcare Assistant in Caring for the Elderly and Dying

 INTRODUCTION

 

Healthcare Assistants are becoming increasingly important and prominent members of the general practice team. As a healthcare trainee, we are required to understand the value of the care. The purpose of this assignment is to give a good understanding on caring of the older person and the dying person including their families. For this purpose we are going to:

Outline the role of the healthcare assistant in the day to day provision of care for the older person

Explore the range of needs of the older person in relation to Maslow’s Hierarchy of Needs

Outline the needs of the dying person, their families and the role that the healthcare assistant plays in promoting positive attitude

Explore the needs of the care staff who are caring for a dying person, in preparing the client for death and dying

Identify the cultural differences in the preparing the body after death in Irish context and one other culture

Provide evidence of effective communication with client, their families and the multidisciplinary team.

 

The Role and Responsibilities of the Healthcare Assistant

A HCA should work alongside other care practitioner such as nurses, doctors, etc. and they have a duty to assist them with additional duties by providing holistic care to the client so that the client could meet their potential. They should attend mandatory training, implement the individual care plan of the client, and adhere to all policies and procedures provided by the employers.

Assisting the client with Activities of daily living, dignity, privacy and choice

Consists to help the client with physical, emotional, social and spiritual needs such as to bath, getting dress, feeding them, taking them for a walk e.g. if HCA goes to the client room, knock and wait for their consent before entering to respect their dignity, privacy. Once the consent is given he should introduce himself and explain the procedure, and give them choice of the kind of assistance they going to provide. Allow them to express their feelings, promote self-work. Facilitate meeting with family and friends.

      2.  Communicate effectively with client, families and colleagues

By allowing the client to speak without any interference, listen to the client attentively, also use word that can be understood easily. He should liaise with the family by reporting the client evolution and communicate for any decision taken, also to have a good connection, interaction with colleagues in order to give a decent treatment e.g. when communicating with the client, decent eye contact and always be alert with body language.

      3. Document and record information

Everything given or administered to the client should be recorded. This is to facilitate communication with colleagues coming on different shift. Keep record of any change in their skin e.g. how much food the client was given, fluid intake, the elimination. A good record is also important as a protective mechanism against lawsuit.

 

      4. Promote the client independence protect client privacy and dignity

Encourage and let the client do some work by themselves if they wish. That can be corporal or general work e.g. if the client wants to comb or shave their hair, brush their teeth by themselves he should encourage them. If they wish to remain alone, we should respect and protect their privacy.

      5. Read and implement individual care plan and assisting with different tasks

The HCA is expected to scan and use the care plan as created to direct him on how they should practice. It has a directive and will explain the area which is appropriated to meet the needs of the client e.g. the client’s nutrition, mobility, personal hygienic, sleeping condition and medication.

       6. Facilitate client’s choice

In order to promote dignity, asking the client their intention of choice is something positive e.g. when comes to dress the client after bath, it is good to ask for their choice of clothes and let them choose.

       7. Provide for individual client needs consists in providing a better quality of life to the client. This can be by helping them with cleaning, shopping or help them out of bed. To assist them with mobility by taking them out for walk as some enjoy walking in the park. They should be assisted in practical care and personal care.

       8. Respect Confidential

The client record should be always kept confidential. The HCA has not right to disclosure or tell to other people about the client’s condition e.g. the client’s sickness, medications should be kept confidential. If their condition is revealed this could impact their care in a negative way.

       9. Identify changing needs of the client

Some clients may not be able to identify or speak out about their skin breakouts, bruises but it is the HCA duty when assisting them to identify that change in order to avoid infection. Bruises are very common for the elderly e.g. if a client falls and no report is done, it will be difficult to the nurse to deal with or identify bruises.

       10. To recognize and report abuse

Any sign of abuse either by the client or work colleagues should be reported to the employer. If a client reports an abuse from the staff, even if that client has cognitive impairment, the allegation should be reported to the director of nursing prior to investigation e.g. if feel that the instruction given by the nurse is an abuse, he/she should call the nurse aside and explain with respect why he/she refuses to obey.

        11. Observing and monitoring client

Client’s health should be kept in close eyes due to illness, ageing process. The HCA should be checking the client pulse, temperature, blood pressure and weight respectively to avoid heart disease, sudden fever. Every assessment made should be recorded.

        12. Encourage to improve the quality of life

He should promote the independence and autonomy of the client. Help the client with the ability to conserve their personal identity, to keep social relationship network with people around them. He should facilitate the client with opportunity for self-expression, provide privacy e.g. if the client request a privacy room, they should be given that space. (McGivern, Y., 2006, p19-20)

           13. Be professional, good listener, be calm, understanding and empathetic

He should to listen attentively to their client, the families and friends in order to provide a holistic care. The HCA should be calm when assessing the client and always putting themselves in the client’s shoes.

 

            14. Be conscientiousness and non-judgmental

The HCA has to be a non-judgmental person by judging their client capabilities, ages or illness. They should be aware of every action they take. This can be by the way they assisting their client to bath, to eat, and to drink.

II. The understanding relationship between the model of nursing theory and the Maslow’s theory

Before the ageing process and chronic or terminal illness, the client could perform all 12 ADL by themselves without any assistance but when the ageing process caught up or illness, they are unable to meet their needs to full potential. Maslow in 1954 in his theory, stated that people’s most basic need is for physical survival, and this will be the first thing that motivates people’s behavior then move to psychological to self-fulfillment needs. He decided to develop an assessment which consists of the 3 stages mentioned above for every person to reach their potential. 3 nurses Roper, Logan and Tierney came up with the idea to create a map called model of nursing in order to complete the holistic care. The model is based and reflected on Maslow hierarchy of human needs and also called 12 ADL. It is used to assess the holistic needs care which are physical, psychological, social and spiritual needs on how the client is able to perform their ADL by themselves and how much assistance they require from the HCA and MDT to promote them to reach their potential. After assessment, a care plan is created to assess their need which is called person centered approach.

III. Correctly outlined the needs of the dying person, and their family

In terms of physical comfort needs taking care of their skin by providing a good personal hygiene daily; mouth care by keeping their mouth clean, moist and teeth washed; eye, ear, nail and nose care by respectively check eyes to prevent thickness on eyelid and observe for ear wax that could impair the client’s hearing, trim nose hair, nails and apply a smear of Vaseline; give them what they want to eat and report any digestive problems; adjusting the room temperature.

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In terms of psychological/emotional comfort needs, as the dying person goes through the 5 stages of grief, he should encourage them to express their feelings. Allow them to express dissatisfaction, anger, and resentment. HCA presence itself will be a valuable resource even if he does nothing or say nothing. Being around to assist or provide company put away their fear of abandonment. (Hospice Foundation of America, 2005, P7)

In terms of social comfort needs ensure the connection with family, friends, church, pets and social group as this will help with loneliness, depression and anxiety. Meaningful items such as family pictures, cards, flowers should be provided to the client. Be around their family helps to comfort them emotionally and socially. Allow organization group to visit.

In terms of spiritual comfort needs, if the client is religious, privacy during his religious practice should be granted and his/her religious objects such as bible, candles, and medals should be placed in his/her room. Be able to help the client attend a religious service, see a faith leader, be with family and friends or spend time in nature.  Also encourage the client to find their own diaries, especially ones that have worked for them in the past. This may include doing things they enjoy, writing down thoughts and feelings, and finding ways to relax such as listening to music or having a massage. Give them permission to discuss spiritual issues if they want. (Hinshaw, D.B., 2002, P566)

For their family, just like the patient, the family also goes through the 5 stages of grief. So the care team should provide necessary assistance to help them manage the pain. He should communicate with family regarding the patient’s wish, the care that being provided, change in condition of the client and as well as the dying process. He should also facilitate and enable the family to be included in the care of the client for decision making and give prompt and precise information to the family so that they can make knowledgeable choice and provide support. Facilitate them with venue if they wish to have a family meeting. (Bascom, P., Tolle S,. 1995, p293)

IV. Show an understanding of the needs of staff looking after a client who are dying

It is emotional and psychological problem for a carer looking after a dying client. Before caring for the client, it is advised for self-care first. Meeting all his physical needs is recommended such as enough sleep, a well-balanced diet, regular exercise, walking in a fresh air each day. It is advised to see the GP as soon as possible if feel very depressed or anxious. He should make sure to have more time for himself to relax or do something just for his wellbeing such as watch TV, reading, music, and going out; try to keep contact with friends, family or any social activity etc. (betterhealth.vic.gov.au)

V. Identify the cultural differences in the preparing of the body after death in Irish context and one other culture

In Irish context, when the client dies, the nurse will check the vital signs and call the GP to confirm, note the time of death, if family is not present, notify the next of kin, inform staff death has occurred and should be mindful of other clients, when family arrives, take them to a private room to prepare them to view the deceased, inform the time of death, give refreshment, use of phone etc. then accompany them to client’s bed side and remain until family settles. Personal care should be carried within two hours of the person dying to preserve their appearance, condition and dignity. Clean the mouth and clean and replace any dentures, cover any wounds with a clean dressing, close eyelids, remove tubes, replace dressings with clean ones, change continence pads, place hands by side. Return jewelry to NOK, return patient’s belonging in designated hand over bag (hospicefoundation.ie)

The wake: if the client dies, their home is traditionally where the wake will be held or to a close relative’s home. All clocks in the house will be stopped at the time the client died, the mirrors should be covered or face the wall. The deceased body will be placed in a different room and the window should be left opened to allow the spirit to leave the house. Family will stay with the deceased all time. (Yourirish.com)

The Burial: the coffin is carried by family members or close friends. If the deceased was a religious, religious culture will be then take place. (Yourirish.com)

In the Congolese context: when the client dies, the family will call the local nurse for confirmation. The elders will allocate the person within the family who will wash and dress the deceased. The washing of the deceased should be carried out by those of the same sex. It is strictly forbidden to cut the hair and nails or shave the deceased. The body will be placed in a matt washed 3 times with soap start from the feet to the upper body.  Once done the body will be dressed in a traditional cloth provided by the elders. To provide a spiritual and physical cleansing, every member who has participated in the washing takes a shower afterwards. Tools used and deceased clothes worn during the procedure should be burned. If the person dies in care settings, the elders will allocate somebody within the family who will partake in preparing the body.

The wake: the funeral will be held in their house. Kids are not allowed to view the body. This is to allow the deceased spirit to go in peace. Overnight traditional songs will be played and family, friends and relatives will dance around the coffin. After the funeral, everybody should wash their hands after coming from the graveyard before they enter the house, to wash off bad luck.

The Burial: depends, if the person wasn’t of any religion, family will take the body straight to the cemetery for burial. However before they take the coffin down the elder and the partner will then wish the deceased a peace traverse. If the deceased was a religious, religious culture will be then take place.

 

VI. Provide evidence of effective communication with the client, family and the multidisciplinary team.

Communication by definition is ‘ a two-way process between two or more persons in which ideas, feelings and information are shared with, with the ultimate aim of reducing uncertainties and clarifying issues’.(kehpca.org)

With the client, it is important our posture, eye contact, facial expression, touch all match what we are saying. It is also important for the carer to lower at the same level with the client to open up communication opportunities. It allows him to establish the priorities and wishes of the client and help them make informed decisions. He should be polite and respectful by making sure to address the client as they wish to be addressed. Some may want to be called by their first name and some with a formal way. Initiate the client to communicate back by saying something encouraging to them e.g. ‘can you tell me more about it?’. If the client can’t speak or read, he should ask close question that have YES or NO as answer. Should be brief and concise (KISS).

With the family, he should be preparing them for what to expect as their loved one’s condition deteriorates can never be misjudged. Explain to them the real stage of life the client is at. What was to happen and how they can be supportive toward the client, what can be done at the end. Enable them enough visit because each family member may feel to spend time with the client on their own.

With multidisciplinary team, he should ensure his/her colleagues or nurse understand the given information about the client is confidential. When discussing cases with other staff, he should avoid revealing the identity of the patient and only relate the necessary information.

 

References

 

McGivern, Y., 2006, Improving quality of life for older people in long stay care settings in Ireland, Ireland: National Council on Ageing and Older People.

Bascom, P., Tolle S,. 1995, Care of the family when the patient is dying, USA: Bascom & Tolle

Caulfield, C., 2019, Care of the Older Person, Assessed in April 2019

Hospice Foundation of America, 2005, The Dying Process: A Guide for Caregivers, USA: Hospice Foundation of America

Hinshaw, D.B., 2002, Spiritual Needs of the Dying Patient, USA: Elsevier Science Inc.

Hospicefoundation.ie, Preparing the body after death in irish context, available at http://hospicefoundation.ie/wp-content/uploads/2013/04/8.Care-after-death.pdf viewed on 08/04/2013

Yourirish.com, The Wake and the Burial in Irish Context, available at https://www.yourirish.com/traditions/irish-burial-traditions  viewed on 17/01/2017

Betterhealth.vic.gov.au, The needs of the Staff who are looking after a dying client, available at https://www.betterhealth.vic.gov.au/health/servicesandsupport/looking-after-yourself-as-a-carer  viewed on February 2017

Kehpca.org, Communication, available at https://www.kehpca.org/wp-content/uploads/communication.pdf  viewed in April 2019

 

Infection Prevention and Control For Healthcare Assistant

INFECTION PREVENTIOn AND CONTROL

Learners Record 

Table of Contents

Introduction……………………………………………………………………………………2

Section One:

Staff Issues…………………………………………………………………………………….3

Travel Associated Infections……………………………………………………………….….3

Reflection on the local control measures for infection, prevention and control………………3

Section Two:

Reflection on Blood Borne Virus’s ………………………………………………………….…4

The main blood borne viral diseases …………………………………………………………..4

 Precautions used to prevent the spread of blood borne viruses……………………………….4

Section Three:

Reflection on the role of antibiotics and the importance of correct and safe antibiotic uses …5

Antibiotic resistance………………………………………………………………………..….5

Reflection on a situation from my work placement where antibiotic therapy was used………5

 

Conclusion………………………………………………………………………………….…6

Bibliography…………………………………………………………………………………..6

Webography…………………………………………………………………………………..6

Introduction

As part of the QQI Major Award Level 5 in Healthcare Support the trainee healthcare assistant (HCA) is required to reflect on the local control measures for infection, prevention and control (IPC). The learner will make reference to the local infection control team and the policies in relation to dress code, staff health and travel associated infections. I will also refer to a situation where as part of a team I was involved in dealing with a client who presented with a known infection and how the team dealt with the situation. I will also identify the main blood borne viruses which pose a threat and the methods used to prevent the spread of infection. I will refer to the viruses by name and discuss hazards that may have posed a risk and explain how these hazards were controlled and prevented. I will also reflect on the role of antibiotics and the importance of correct and safe use to avoid antibiotic resistance. In my response I will reflect on a situation where antibiotic therapy was used, how I felt about its use, how effective it was and any concerns I might have had about its usage. The methodology used in this assignment is independent research using the Internet and the text book Healthcare Support: A Textbook for Healthcare Assistants along with Tutor inputs and peer education.

Section One

Preventing healthcare associated infections (HCAI) is one of the main challenges for hospitals and nursing homes today, an example of an HCAI is methicillin-resistant Staphylococcus aureus more commonly known as MRSA. The Tallaght University Hospital (TUH) Infection Prevention and Control Team (IPCT) play a vital role in stemming the outbreak of infection by providing training, and information on how to best manage an outbreak. The role of the IPCT is to promote the best infection prevention and control practice in order to ensure the delivery of a quality service for staff, patients and visitors by providing expert advice to hospitals and nursing homes about infected patients and other infection control issues that may arise. Infection prevention and control nurses are available Monday to Friday 7:30 to 4:30 and a Consultant Microbiologist on call 24 hours a day seven days a week. [Tuh.ie] (Mc Guill, U. 2018 Tutor Handout) (Healthcare Support: A Textbook for Healthcare Assistants)

 

 

 

Work Practice: Policy & Procedures regarding IPC

My work placement is in a private nursing home in Co. Dublin. It takes the matter of infection prevention and control very seriously. For example, on my first week I was asked to become familiar with all the facilities policy and procedures including their policy regarding infection prevention and control.

 

Work Practice: Staff Issues & Dress Code

In my work placement all staff must wear short or turned up sleeves (bare below the elbow principle) and each member of staff is appropriately dressed, and all personal protective equipment (PPE) is readily available to minimise the potential for any staff to suffer damage to their own clothing or the spread of infection.Staff must change uniform/clothes immediately when they become visibly contaminated. Finger nails should be kept short, smooth, clean and free of nail varnish and false nails and staff should maintain a high level of personal hygiene.Uniform/ clothing should not be regarded as PPE. Good hand hygiene is one of the single most effective way to stop/reduce the risk of cross contamination and hand hygiene must be performed after removing PPE. There are three types of hand hygiene Social Hand Hygiene, Antiseptic Hand Hygiene, and Surgical Hand Hygiene the one used will be determined by the risk of infection. Designated changing facilities to change into a clean uniform/ clothing each day and staff wash uniforms/clothes at the hottest temperature for the fabric.All healthcare workers should be offered hepatitis B vaccine and seasonal influenza vaccination are kept up-to-date.Measles, Mumps, Rubella (MMR) vaccine should be offered if not already immunised.

Travel Associated Infection

Tuberculosis (TB) is a disease caused by a type of bacteria that usually affects the lungs, symptoms of TB include a cough that last three weeks or longer, pain in the chest, chills, coughing up blood or sputum, weakness / tiredness, weight loss, lack of appetite, fever, and sweating at night. It has an incubation period that will vary between two and twelve weeks. Travelers who go to areas of Africa, Asia, and parts of Central and South America are at greatest risk of contracting TB, but it is on the rise in Ireland. TB is spread from one person to another either by direct or indirect contact or through microscopic droplets released into the air like coughs, sneezes, saliva, and contaminated blood. [nc.cdc.gov]

 

Ebola virus disease (EVD) was declared in the Democratic Republic of the Congo in West Africa. Symptoms of EVD include fever, rash, pharyngitis (inflammation of the pharynx), conjunctivitis, weight loss, headache, and fatigue. EVD has an incubation period of between three and eight days. EVD is spread through direct and indirect contact with body fluids, mucous membranes, contaminated surfaces and materials. [medscape.com]

 

Infections in travellers returning from an international destinations are a common problem for the healthcare industry. With the rise of travel to international destinations in recent years people have a higher chance of contracting an exotic infection like malaria, dengue fever, and typhoid fever.        

 

Section Two

Exposure to blood borne pathogens or blood borne infection (BBI) poses a serious risk to health care workers. I will review the risk of human immunodeficiency virus (HIV) of which there are two categories type one and two, also the hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in nursing homes and hospitals and also discuss current methods for preventing the spread of the forenamed pathogens. To minimize the risk of blood borne pathogen transmission from health care workers to patients, staff and visitors all staff should adhere to standard precautions, including the appropriate use of the seven step hand washing technique, protective barriers like gloves and aprons, and care in the disposal of needles, razors, and other sharp instruments into a sharps disposal container. Care must be taken in the segregation and disposal of contaminated soiled linen and the use of alginate bags where applicable. The types of transmission of these pathogens are numerous and it is of vital importance that standard based precautions be used regardless of suspected or confirmed infection status. Transmission based precautions are used with residents with documented or suspected infection of a highly transmittable pathogen. Below is an image of the chain of infection and its mode of entry to infect a susceptible host.

(Mc Guill, U. 2018 Tutor Handout)

[ncbi.nlm.nih.gov]

                                                                                                                      [Google Image]

Section Three   

Antibiotics namely penicillin are powerful medicines that fight certain infections, discovered by Alexander Fleming in September 1928, it was also Fleming who predicted the rise of antibiotic resistant bacteria almost 70 years ago. “Then there is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to non-lethal quantities of the drug, make them resistant.”

Alexander Fleming Nobel Prize acceptance speech in 1945

Antibiotics such as penicillin one of the several types of antibiotics kills or slows down the growth of bacteria but they cannot fight against viral infections like a common cold or flu. People will usually take antibiotic prescription by mouth but in some circumstances doctors can administer them by injection or applied directly to the infection, and the antibiotic will start combating the infection within the first few hours of the treatment. It is recommended that the course of antibiotic treatment is finished so bacteria will not become resistant to future treatments. Reactions to antibiotics are very serious and can be fatal (anaphylactic shock) and some side effects might include the swelling of the tongue and face which in turn will cause difficulty with breathing, or an outbreak of a rash, diarrhoea, nausea, and vomiting. Although I did not experience any residents taking antibiotics, I do believe the time for antibiotic treatment is over with growing numbers of bacteria’s becoming resistant to treatments other methods should be explored like gene editing techniques design them to target a single bacterial species.

[Medicalnewstoday.com]

Conclusion

Infection Prevention and Control will be extremely important to a learner training to be a Healthcare Assistant (HCA) by providing information, techniques, policies and procedures in a workplace environment to help stop the spread of infection .This assignment has touched on some of the infections a HCA will be faced with, and the control measures used to nullify the risk associated with the mentioned hazards.

Bibliography

Healthcare Support: A Textbook for Healthcare Assistants

Webography

Medicalnewstoday.com accessed 8/11/18

Medscape.com accessed 12/11/18

Ncbi.nlm.nih.gov accessed 10/11/18

Nc.cdc.gov accessed 9/11/18

Tuh.ie accessed 9/11/18

Roles and Responsibilities of a Special Needs Assistant (SNA)

Introduction
For this assignment I am going to discuss and evaluate the role and responsibilities of an SNA and the legislation that is in place to protect people with disabilities.  All children have a right to an education whether they have a Special Need or not.
In this project, I will cover all the topics that are relevant to the job of an SNA and the information, that all the people working with children with special educational needs should have. I will also carry out a questionnaire with 2 SNA professionals to find out their perceptions and view of the job. I will write about legislations and policies that are relevant to the profession, good practice guidelines, theory that applies to the Special Education and all aspects of the SNA profession. These include stressors in the workplace, the role of the SNA, and the qualities that an SNA should have. Through completing this assignment, I will learn the theory which supports strategies. This I can use to offer children with Special Needs, care and support specific to them.

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Aim
My purpose of doing this assignment is to provide the reader an overview of a Special Need Assistant (SNA).  Also, to understand that, to do the job well as an SNA you must be equip in the knowledge about the area, understanding the role of the job and what it entails and how they can help meets the children’s needs. Knowing the current legislation, theory and knowledge about Irish Educational system is vital to become a competent and effective Special Needs Assistant.
“According to Flood all children have needs, e.g. Physical, safety, security, love and belonging, praise and encouragement. Children with Special Needs have these same needs together with some additional ones. Special Needs can be defined in different ways. They are often categorised according to the area of development affected with their Needs. (Flood, E., (2013) 
Rationale
From doing this assignment I will gain the information that is related to Special Education and have a better understanding of Special Needs Assistance. The knowledge I will gain from the completion of this assignment will help me to do my job effectively.
Role of an SNA
Special Needs Assisting provide care and support role that is non-teaching in nature and works under the guidance and supervision of the Principal or class teacher, to provide the best care necessary for the child in a safe and caring environment. (National Council for Special Education (NCSE) (2014).

 “Special needs assistant (SNA) works with children with either significant care needs or severe emotional or behavioral needs in either mainstream, special class or special school setting”-  (Flood, 2013).

In addition, The Special Needs Assistant needs to be qualified in Special Needs area and has experience in working with children.  Also, The Department of Education and Skills outlines the role of an SNA as, assisting children with special needs in various situations like:

To board and take off children from school buses;
During out of school visits;
With clothing, feeding, toileting;
With typing or writing for students with physical disabilities (NCSE, 2014).

The roles and responsibilities of an SNA consists of assisting the class teacher in:

Preparation and tidying up the classroom where a student with special educational needs is being taught;
Accompanying individuals or small groups who may have to be withdrawn temporarily from the classroom.
Supervision of students with special educational needs during assembly or play;
Duties of non-teaching nature (SNA cannot substitute the teacher at any circumstances)

(Department of Education and Skills, 2019)
In general, all these definitions are accurate, although it can be argued the role of a Special Needs Assistant is underestimated within this definition. Even though the role of the SNA is to meet the needs and facilitate student’s learning in school, this is a very difficult task without the following additional abilities. The SNA must have huge knowledge about the student and their condition and have the skills to be able to work effectively with the pupil.  Also, the SNA’s must have qualities, that will make their work more efficient, some of them includes: Being caring, patient, calm, flexible, non-judgmental, consistent, fair, organized, open to new ideas, reliable and professional. (Flood, 2013)     
From doing my questionnaire my respondents confirmed that all above qualities are very important in their work, a person not having those qualities cannot effectively work as an SNA.  As for the role of the SNA, it depends on the setting, as one of my respondents stated role is exclusively meeting the needs of the child, while the other replied that her role in addition to meeting the needs is also taking part in the planning and organizing activities for children.
Key principles in Education
Each educational institution having contact with children and young people must have appropriate policies, that determine good practice, that must be used by staff, also by the SNA (Flood, E., (2013). Below I will outline some principles which are most important, and which should be applied in each organization catering for children:

 Recognize children’s right to be protected, treated with respect, listened to and have their own views taken into consideration;
 Acknowledge that the welfare of children is a paramount;
 Adopt a child protection policy;
Adopt and consistently apply clearly defined methods of recruiting staff and volunteers
 Suggest that early intervention is important because it can prevent children not to be vulnerable to the abuse at later stage;
Provide child protection training for workers.
 Share the information about the concerned child with parents and other child care worker and protection agencies and professionals to achieve the best possible solution to the concern (Department of Health and Children, 2002).

Good practice guidelines in education
(Flood, (2013) states that the good practice principles include confidentiality, use of appropriate language, access and inclusion, independence, advocacy and boundaries.

Confidentiality is a foundation for everyone working with persons, who handle private information. Certainly, it is a duty of a SNA to protect child’s identity or not to discuss the issues work outside.
Use of suitable language is vital when talking about or to children with special needs. SNA should promote use of appropriate language because it affects self-image of children with special needs and other children will adopt our language.
Access is about letting the children with special educational needs into the mainstream schools, removal of physical barriers so children can get around within the school environment.
Inclusion is more about removing of the social barriers so the children can participate and avail their right to education.
Positive self-image is very important for children with special educational needs, because they are often made to believe that they are uncapable to achieve their goals because of their condition. Giving children bit of freedom (if the condition allows in it) will result in gaining more independence and the child will grow in their self-esteem.
Special Needs Assistant is working on behalf of the child therefore he/she needs to know the child and his/her condition so that the child can reach their best potential.

Having professional boundaries set is vital in any career but is especially important when working with children with special needs. Both SNA and the child with SEN needs to use of appropriate language. There should be physical boundaries set – physical contact kept to a minimum for carrying out task i.e. helping with writing.

Theories of Special Education
There is number of theories that applies to special education. Some of them are: Gestalt, Connection Theory, Gagne’s Conditions of Learning, L. Atincronbsch and R. Snow, Component Display Theory, Cognitive Load Theory, Sign Learning Theory, Vygotsky’s Social Constructivist Theory.
Vygotsky’s Social Constructivist Theory
Lev Vygotsky (1869-1934) He argued that children become competent learners through activities, interactions and experiences rather than sitting down in a classroom completing work sheets.
Vygotsky’s zone of Proximal Development focuses on three main ideas for learning:

Where is the student at?
What is the next point of their learning?
Teach in depth

These strategies are built on effective teaching where planning and curriculum includes being based on children’s knowledge, differentiating learning according to child’s needs, focusing on deep connected numeracy understanding.
Vital in working within a child’s ZPD is the role of the adult. The adult working with children lay the foundation for scaffolding.
“Scaffolding connotes a warm, pleasant collaboration between a teacher and a learner while the two are engaged in joint problem solving activity. During this collaboration the adult supports the child’s autonomy by providing sensitive and contingent assistance, facilitating children’s representational and strategic thinking and prompting children to take over responsibility for the task as their skill increases.” (Hayes, 2013)
Vygotsky believes in the importance of scaffolding and how much adults can be positive supports for children to learn.
He also put across the concept that both cognitive and social development work together and building on each other, learning leads development, through this, the child learns as social being, with the support of others.
Vygotsky argued that children’s learning takes place through the process of socialization. He therefore placed great emphasis on the role of adults and other children in a child’s learning. Because of the social aspect of Vygotsky’s learning theory, it is often referred to as a social constructivist theory.
Gagne’s Conditions of Learning
Robert Gagne (1916 –2002) was an American psychologist, who worked in the areas of human’s learning and memory. During his work, he identified 5 different kinds of learning, which to be effective, needs different kinds of instructions:

Verbal information – describing in own words what was taught, naming or listing. For this kind of learning to be successful, student must be provided in opportunities to practice, the context needs to be explained. In special education, this would also include amending the curriculum to make it more available for the child.
Intellectual skills – differentiating between various qualities, like two musical notes. In special education, this would be playing on child’s strengths and interests to make the learning process more effective.
Motor skills – to perform certain movements of the body to do something like writing, kicking ball, playing guitar. Observing a model doing a task and having plenty of time to practice is helpful to acquire the skill. In special education, this would be teacher or another child modelling how to do certain thing for the child with special educational need to learn.
Attitude – choosing to behave in a certain way. Modelling certain behaviors by observing others. Inclusion of children with special educational needs into mainstream schools allows them to observe their peer in an example for special education.
Cognitive strategy – creating ways to make the learning process easier to somebody. In special education providing a student to solve the problems using their strengths.

(www.theoryfundamentals.com, www.instructionaldesign.org).
Connectivism is a learning theory that explains how Internet technologies have created new opportunities for people to learn and share information across the World Wide Web and among themselves. These technologies include Web browsers, email, wikis, online discussion forums, social networks, YouTube, and any other tool which enables the users to learn and share information with other people (Flood, 2013).
A key feature of connectivism is that, much learning can happen across peer networks that take place online. In connectivism learning, a teacher will guide students to information and answer key questions as needed, in order to support students learning and sharing their own. Students are also encouraged to seek out information on their own online and express what they need.  A connected community around this shared information often results. This can be good way for all students to learn not just those with SEN (Flood, (2013).
Connectivism Theory
This a modern theory which stresses that digital technologies of today have impacted people’s life’s, that is, the way we communicate and learn. Important feature of this theory is that people are using the internet to study and to communicate via a network. This theory is relevant to special education, as the computer technologies can assist persons with special educational needs by making the learning interactive or helping people to overgrow own disability. For example, when persons with visual impairment can use audiobooks, or students with hearing impairment can communicate with their peers over the internet. (Flood, 2013).
Stressors in the workplace
Stress is an emotional factor that causes bodily or mental tension (MedicineNet, 2019).
Special Needs Assistants in their profession are exposed on different types of stress. These include; challenging behavior, lack of appreciation, lack of support, lack of resources, heavy workload, and isolation in the setting. (Flood, 2013) 
It is understandable that the lack of resources to do a good job can lead to frustration and stress. Sometimes educational institutions due to lack of funds does not have the financial resources to purchase materials or equipment to work with children. This is the obstacle, which is difficult to overcome and that stops the educators achieving certain educational goals. For example, the lack of money to buy art materials for child with visual impairment, who like to create art (Flood, 2013).
Sometimes SNA’s work is not seen as something important (Flood, 2013). They are excluded from the creation of an Individual Educational Plans or kept from contact with children’s parents.  The ECCE Quality Frameworks and Curriculum which talk about how parentership with parents for educators is very important in a child’s life.  SNA’s  who often work on a very  personal level with the children aren’t included in creating the IEP. Yes they are non teaching staff but in a whole holistic sence, a child’s physical needs, incuding toileting/feeding/personal hygiene/writing or scribing are just as important for providing an environment which allows for learning.  Maslow’s hierarchy of basis needs (Learner Resource Park (2016).
Teachers / SNA, this also leads to underestimation and stress.
Children with Special Educational Needs often display challenging behavior, that SNA must directly deal with. Sometimes due to lack of experience or training the SNA finds it difficult to manage. Often helpful in this situation can be support from other staff, but if not received this can lead to a sense of powerlessness and stress (Flood, 2013). This is confirmed in the survey conducted by me with two Special Needs Assistants since both of my respondents confirmed that dealing with challenging behavior would be the biggest difficulty in their profession.
Both physical health and mental health is important for people and good performance of work depends on it. Some professions are more vulnerable to stress associated with the job and some are less.
Some professions who regularly work with challenging behaviour, with little supports, opportunities for debriefing etc, are known to be very stressful. Professions are heavily exposed to stress in the workplace.
It is very important to have the ability to cope with stress, because its exposure to chronic stress can lead to serious disturbances in the functioning of the body (Flood, 2013)
There are many ways to help with managing stress, some of them includes:

Good self-care – healthy diet, mindfulness, sports;
Ability to “leave work at work”- this means to place a boundary to differentiate between personal and professional life;
Asking for help – support from co-workers is vital in dealing with stress, even having a simple chat about the problem will lead to clearing negative emotions;
Good work practices like setting boundaries between professional and child will help to avoid stressful situation. When everyone knows their responsibilities and duties it is easier to maintain balance.

(Learner Resource Park, (2016) 
Educational options for children with Special Educational Needs in Ireland
The Department of Education and Skills is responsible for educating in Ireland (Flood, 2013). The EPSEN Act 4 states that children with Special Educational Needs have the right to be educated among their peers, unless their condition doesn’t allow it. Children with SEN have 3 options for education in Ireland:

Special Education Settings – Advantages: children with SEN have access to appropriate educational materials due to better funding of those settings, low adult-child ratio, low level of education; Disadvantages: children with SEN are isolated, with no possibilities of contact with children without disabilities, no chance for inclusion into community.
Special classes attached to mainstream schools – Advantages: Children with SEN have the contact with their peers, Disadvantages: limited “mainstream” time, it can cause frustration when child needs to go back to the special class because there is time limit
Mainstream schools, that are having an inclusive approach to Special Education. There are advantages both for children with and without disabilities. It gives the children the true picture of society, it gives the children the true picture of society, it makes the children conscious, emphatic, friendly, openminded.  (Learner resource Park, (2016)

Legislation Relation to Special Needs in Ireland
The need for understanding and acceptance of Special Needs in Ireland have come through 3 stages: neglect and denial; era of special schools and era of integration and inclusion (Learner Recourse Pack). The last one was made possible thanks to relevant legislation that was created and ratified in Ireland. Today there is lots of policies and legislation that would relate to Special Needs. Some of them are: Constitution of Ireland, Education Act 1998, Education (Welfare) Act 2000, The Equality Status Act 2000 & 2010; EPSEN (Education for Persons with Special Educational Needs) Act 2004; The Disability Act 2005; Vision Statement for intellectual disability in Ireland for the 21st century (2009); Childcare Act 1991 & 2001; United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) 2006; Aistear (2009); Siolta (2006) (Flood, E., (2013), (Learner resource Park, (2016)
Below I will discuss 3 selected legislations, which I consider most important.
EPSEN Act 2004
This is the most important piece of legislation, as it focuses exclusively on educational needs of persons with disabilities. The Act explains that “A child with special educational needs shall be educated in an inclusive environment with children who do not have such needs unless the nature or degree of those needs of the child is such that to do so would be inconsistent with,
The best interests of the child as determined in accordance with any assessment carried out under this Act, or the effective provision of education for children with whom the child is to be educated.” (Flood, (2013)
(EPSEN Act 2004), (Flood, (2013).
The Act emphasizes the right of children with special educational needs to be educated among their peers, where possible in an inclusive environment. It also makes available for parents to be more involved in education of their children. Moreover, the Act sets out services to be provided for persons with SEN, like assessments or education plans.
(Learner resource Park, (2016).
United Nation Convention on the Rights of the Persons with Disabilities (UNCRPD), (2006)
Ireland ratified the Act, which states that persons with disabilities have the same right to be educated and reach their full potential. Also, it says that persons with SEN should have an opportunity to access general education, to develop their talents and interests, and mental and physical abilities (UNCRPD, 2006).
The Disability Act (2005)
The Act was introduced by Department of Justice. The Act imposes an obligation on public authorities to allow access for people with disabilities to services and buildings. It also states that persons with special needs have the right to have their health and educational needs assessed. Likewise, it gives the right to complains. (Flood, 2013) 
Self -Reflection
Working on this project made me even more reflective in my practice as a childcare worker and wonder what other strategies can be introduced to create inclusive, nurturing and stimulating environment for all the children. All that I have learnt so far about the work of the SNA is very interesting to me.  I feel happy to find out more about the special needs and how to help children with SEN feel competent learners so that they can reach their potential. I am pleased that these days access to education for people with learning difficulties is recognized as the right it is, both in theory and in practice. This situation has been created via the creation of relevant laws and thus an inclusive approach to education. As an educator I believe that all people working with children should have an additional training in the area of Special Needs, because it allows a better practice and giving children with SEN better opportunities for learning and development.
I also think it was very necessary to conduct a survey with practitioners practicing SNA’s because it gave me ideas about the practicalities of the workload and practice of an SNA.
I carried out a questionnaire with 2 SNA’s, I asked each of the respondents 2 questions directly related to the work of the SNA.  I received very similar answers on most of the questions. Both respondents agreed that the important features of the efficiency of the SNA are: being caring, friendly, patient, approachable, fair, organized, non-judgmental and good observer. Respondents replied that the biggest challenges in their job, is dealing with challenging behavior and workload as well as work-related stress such as feeling powerless. Despite some challenges related to the job, both of my respondents seem to be pleased with their work. They speak of feeling that they are needed, that they are helping others, that they feel satisfaction and fulfillment from their roll. The questions to which answers were quite different was about the role of Special Needs Assistant and what it involves.  One of my respondents said that her role is only on meeting care needs of students, such as helping in the toilet and bringing them to the mainstream schools. On the other hand, the second respondent stated that his role is to accompany the child in the classroom, “keeping the child on track” during lessons and also assisting teacher to plan activities for the child.
The result of my survey shows that different schools allows the SNA’s in the classroom work, seeing them as valuable support to learners.
Conclusion
Starting this course, I was not fully aware of what to expect and what exactly will be involved in the course. I thought that it will be mainly focused on different types of disabilities and how to work with children with SEN so that they can reach their potential. The contents of this course positively surprised me and let me realize that in addition to knowledge the different conditions, it is also very important to have a backup information such as legislations and policies, education system, different options of education for children with disabilities, good practice guidelines.
When doing this course, I also learnt the role of an SNA in educational institutions. Until now I thought that SNA is involved in planning and carrying out educational activities. However, from the content SNA training and conducting my surveys I found out that the role of SNA is exclusively on meeting the needs of the child, such as the toilet, eating and dealing with challenging behavior. However, my other respondent stated that she is involved in planning, but her main job is to support the child. Surely, it depends on the setting and management in the place.  My overall view is that the content of this course is very relevant, and it’s prepares students for the role of an SNA.  In the future I will surely consider SNA as an extra career as I feel well prepared for this role.
References:

Flood, E., (2013) Assisting Children with Special Needs: An Irish Perspective. 2nd Edition, Dublin: Gill & Macmillan
Flood, E., (2010) Assisting Children with Special Needs: An Irish Perspective. 2nd Edition, Gill & Macmillan
Dare, A., O’Donovan, M., (2009) Caring for Children with Special Needs. 3rd Edition. Cheltenham: Nelson Thornes
Department of Health and Children (2002) Our Duty to Care: The Principles of Good Practice for the Protection of Children & Young People [Online] Available at:  Department of Health and Children, available at : https://www.dcya.gov.ie/documents/publications/ODTC_Full_Eng.pdf. Accessed on 9/9/19. 
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