Marian Barnes, Professor of Social Policy, University of Brighton Marian.Barnes@brighton.ac.uk

1. Negotiating relationships across professional and lay boundaries: An ethic of care approach Marian Barnes, Professor of Social Policy,University of BrightonMarian.Barnes@brighton.ac.uk

2. Evidence and ethics • Evidence based practice • Values based practice • Values based research • Ethics as a framework for developing and assessing research and practice • Disputes/tension re nature of evidence and professional ethics • Lay, practitioner, professional perspectives

3. Interprofessional ethics • Ethical principles and norms for interprofessional working. • Study of the ethical issues in interprofessional working. • Developing dialogic and relational practices between practitioners and service users.

4. Universality of care. Both an activity and a disposition. Caring about; taking care of; care giving; care receiving. A moral practice: ‘a mode of acting in which participants perceive and interpret care needs and act upon those needs.’ (Sevenhuijsen) Interpretation and acting relates to context and relational dynamics of actors – both givers and receivers. Caring orientation acquired through engaging and reflecting on caring practices. What is care – an ethic of care perspective

5. Attentiveness • Meeting needs is not possible without awareness of and attentiveness to needs. • Ability to suspend one’s own goals, and ambitions to be attentive to others, AND • To recognise and understand one’s own needs for care

6. Responsibility • Taking responsibility for action • Embedded in cultural practices rather than a set of formal rules. • Does not presuppose a particular type of action

7. Competence • Caring work should be competently performed. • This presupposes an awareness of the outcomes.

8. Responsiveness • Awareness of potential for abuse in situations of more or less vulnerability. • Consider the position of the care-receiver from their perspective. • How are they responding to care?

9. Trust • Recognises the significance of power within caring relationships. • A willingness to use power in a positive and creative way.

10. Implications • Do not prescribe a precise form of practice nor define procedural guidelines. • Focus attention on the care-giver, the care receiver and the relationship between them. • Requires continual negotiation between those providing and receiving care. • Can accommodate a range of caregivers. • Provides a language in which to talk about the help that is needed and how it can be provided.

11. Illustrations/applications • Research exploring practice of social workers and CPNs working with people with dementia. • Understanding what caring means to lay carers and relationships with paid care. • How do families develop plans in family group conferences. • Developing ethical research practice between university, voluntary organisation and older peer researchers.

12. Negotiating ethics in dementia care • Negotiating residential placements or community support packages. • Attentiveness – reaffirming agency of pwd. • Responsibility – building up relationships, do all involved take responsibility? • Competence – reviewing care based on reaction to it. • Responsiveness – evaluating care outcomes by the impact they have on pwd.

13. Brannelly’s conclusions • “Acknowlege the interdependency of care givers and receivers. Including people with dementia, lay carers and practitioners; • Encompass a range of agendas in a situated context to facilitate negotiated care outcomes; • Participate in collaborative care with other practitioners, lay carers and people with dementia; • Ensure that the emphasis of the quality of care is considered from a service user perspective.”

14. Making sense of care: carers’ narratives • Giving care emphasises the importance of receiving care and care of self. • Carers’ stories highlight personal and cultural contexts in which responsibility for care is accepted and enacted. • Importance of situated knowledge in being attentive and understanding care receivers’ response. • Moral dilemmas associated with care giving in the everyday – ‘messy moral dilemmas’. • Frustration when support workers and other practitioners do not enter into dialogue on these issues.

15. Good care involves: • Listening and talking, rather than wordless tasks • Emotional attachment rather than detachment • Reconciling treating all service users equally with responding to uniqueness • Spending time building up trust rather than ‘sticking to the schedule’. • Going beyond boundaries of a professional relationship • Working through relationships not rules • Seeing company and friendship as priorities.

16. Conclusion • Integration is not only about inter-professional working. • It requires attention to ethical as well as organisational issues. • It highlights the importance of addressing relational dynamics of situations: service users, carers, different practitioners. • It requires a language in which meanings and values can be discussed to determine the ‘best’ response. • An ethic of care provides such a language.

17. Sources: • Barnes, M (2006) Caring and Social Justice, Basingstoke, Palgrave. • Brannelly, T (2006) ‘Negotiating ethics in dementia care’ Dementia, vol. 5(2), 197-212 • Sevenhuijsen, S (1998) Citizenship and the Ethics of Care: Feminist Considerations of Justice, Morality and Politics, New York and London, Routledge. • Stone, D (2000) ‘Caring by the book’ in M Harrington Meyer (ed) Care Work: Gender, Labor and the Welfare State, New York, Routledge. • Tronto, J (1993) Moral Boundaries. A Political Argument for an Ethic of Care, New York and London, Routledge. • Ward, L and Gahagan, B (2010) ‘Crossing the divide between theory and practice: research and an ethic of care’ Ethics and Social Welfare, vol.4 (2) 210-216.