For the critical discussion of a topic, criticism is characterized by careful evaluation and judgment (Word Web, 2004), and discussion is consideration or examination in speech or writing (Word Web, 2004).
A transition is the act of passing from one place to another, or an event that results in transformation (Word Web, 2004); loss is the act of losing, a euphemism for death, or the disadvantage that results from losing something (Word Web, 2004).
According to Waine and Henderson (2003), a frontline manager is someone who manages people who have face to face contact with service users. A frontline manager may or may not be a practitioner in that or a similar field.
The first thought when examining this essay topic is that the these definitions of transition and loss can immediately be intimately related to the rapidly changing environment in which health and social care is provided (Clarke, 2003), which in turn necessitate health and social care services moving fast to negotiate this and continue to provide a service (Aldgate and Dimmock, 2003). Such a thrust towards organizational change has its own implications for workers in health and social care and how they are to deal with it (Skye et. al., 2003); and the manager is centrally placed to manage this change (Rogers and Reynolds, 2003).
There are two different elements to ideas of transition and loss – that which happens in the normal course of an individual’s life (such as death, divorce, and crisis); and that which can be caused by change within an organization (such as change in or loss of role, confusion about organizational change, feelings of disconnectedness from the service for both the worker and for the service user). Transition and loss are normal psychological responses to change and within health and social care many different people are affected by them: service users, workers, and even managers themselves. Consideration of this subject in this essay will be made in terms of a residential unit offering rehabilitation to adults aged between 16 and 65 who are recovering from a mental health crisis.
The frontline manager is more intimately aware of people’s psychological experiences by their very nature of working daily with service users and their families and with workers (Seden and Katz, 2003). As one manager noted (Seden and Katz, 2003) the personal crises or life-changing events felt by staff can affect their performance at work. Diagnosis with a mental illness has many implications for the individual service user and for the family concerned. Not least is the stigma attached to the diagnosis, and the concomitant loss of social meaning and of social role as a consequence of experiencing an episode of mental ill-health (Townsend et. al., 1992). People who experience mental ill-health may be shunned by their neighbours or their peers, or they may lose their job – the frontline practitioner who understands this form of loss is well-placed to coordinate services which may enable the individual’s return to the community and to raise their self esteem, in the form of coordinating return to employment resources for example.
Seden and Katz (2003) point to research which suggests that managers in residential care work with many fluctuating issues. They argue that whilst it is important to recognize that the manager him or herself is a human being, it is as important to acknowledge that whilst a manager’s activity is to some extent guided by policies, they need to actively respond to contain and support the life crises, transitions and uncertainties which are a part of the lives of other people. It could be said that this is an important part of being morally active as a manager (Dawson and Butler, 2003). Understanding people is an important element of building a team and getting the most from them (Katz et. al., 2003). As Skye et. al. (2003) observe, such concern for others can readily be construed by the most cynical as manipulative; and the same authors warn that knowledge which a manager has about people can as easily be misused as not.
Loss leads to painful feelings in two ways – the pain of physically being without someone or something; and the pain caused by the adjustment to this absence which is often forced upon the individual (Seden and Katz, 2003). The latter can be said to be the process of transition. Seden and Katz (2003) highlight three main theories of attachment of loss. Bowlby’s attachment theory initially examined feelings of anxiety at being separated from somebody to whom an individual is particularly close (i.e., ‘attached’) such as child to mother, adult to significant other. The authors also observe that Bowlby’s theories have been extended to notions of culture and place. Colin Murray Parkes talks of how the extent of losses and transitions is often defined by their social dimensions. He argues that some life events are more difficult than others, for example if they necessitate the individual overhauling their previous view of the world; if the events are lasting rather than short-lived; and if they are unexpected so that there is no opportunity to prepare for them. The world which we believe we know changes and we are forced to adapt to the changes.
Seden and Katz (2003) also refer to the work of Marris, who suggests looking at loss from a sociological point of view. He argues that most people prefer predictability in their lives, which at the same time proves resistant to change. This so-called conservative impulse reduces uncertainty; but unfortunately from time to time it can be shattered by some life-events. Likewise, people attach meaning to objects and to people from early childhood and try to maintain this meaning into adulthood. Finally, Marris asserts that not only is grief the psychological process of adjustment to loss of the object, but it can also be the psychological process of adjustment, and adaptation, to the change in our understanding of our environment.
Loss is therefore a complex term, in that it is in one way a consequence of transition – for instance in the event of organizational change a worker must successfully complete the transition to a new role while at the same time experiencing the loss of a former role. The frontline manager is uniquely placed to facilitate this. A service user may die and this will evoke feelings of loss in fellow residents, in staff who in residential care have come to regard residents as family, and in carers (Katz, 2003). The manager is again uniquely placed to coordinate the response to this event, and to help all those involved to negotiate it in order that the transition through loss is successfully made. Managers may find themselves counselling residents who ask about the death and how to deal with it. In the event that the resident has a mental health crisis which necessitates admission to acute care, they will have to answer questions from other residents about the event, about the individual involved, and about what the individual’s sudden absence from their lives means to them. This is not to say of course that the manager him/herself does not experience such feelings. A dilemma for managers is to make sure their staff can attend to the needs of residents at the same time as being supported emotionally and practically themselves (Katz, 2003). In the author’s experience, staff were offered a confidential counselling service by the organization following the unexpected death of a resident.
All three outline theories of transition and loss are useful to the frontline manager. Aldgate and Dimmock’s (2003) observation that people who receive care are “just like” those who offer it is vital. While Seden and Katz (2003) suggest that managers need to show a humane aspect, health and social care work itself involves dealing with individuals all the time (Aldgate and Dimmock, 2003). Human beings are by their nature not a constant, and current government legislation such as the National Service Framework for Mental Health 1999 and the Health and Social Care Act 1999 emphasize the placement of service users at the centre of strategic health and social care planning. The model of care which is being implemented in the unit in which the author works is the Recovery Model (http://mhrecovery.com, 2004), which is intended to place the service user at the centre of the service so that it can be built around him or her. Theoretically, the Recovery Model is intended to take account of the service user’s ‘life-journey’, which by definition includes those life events which they have navigated and those they are yet to. Understanding theories of transition and loss are vital in empowering the service user to negotiate the ‘journey’ through their mental health difficulties, and in particular these theories invaluably assist the manager in the implementation of this model of care. The Recovery Model places particular emphasis upon the service user understanding their experiences and the effect of these (both practically and potentially) upon their mental health. Carers equally have their own experiences of loss with regard to those for whom they care and who experience mental health difficulties. Such loss can include a mother’s thwarted hopes for her child whom she fears is no longer able to go to college, for example, due to a mental health problem (Tucker, 2003).
Theories of transition and loss can contribute to a resident settling into a new unit. A frontline manager will be aware that the transition is smoother for the resident if they bring some of their own possessions into their new residence (Open University, 2003a). This corresponds to Marris’ assertion that the individual prefers to surround themselves with familiarity during times of change, even extending as far as familiar objects (Seden and Katz, 2003). Understanding the nature of a new resident’s feelings of loss can enable the frontline manager and the team to ease the transition for the service user (Open University, 2003b).
Obholzer (2003) observes how for any organization to function effectively managers must take into account the stresses on staff as a result of the work they are doing. A frontline manager is especially well-placed to be aware of these stresses. Workplace stress can be defined as a force which psychologically and physically drives people beyond their ability to adapt (Seden and Katz, 2003). Significant life events can cause this in workers as much as in service users. The same authors observe that workplace stress is unavoidable and critical in health and social care work. Put bluntly, stress is costly to a service in that employees go sick from work, and costly to individuals and families. Workplace stress can impair a service by diminishing the numbers of staff available to provide an appropriate level of service. Transition and loss often necessitate an increased staff presence in order to adequately facilitate a transition for residents (Seden and Katz, 2003).
Indubitably, significant life events can propel the individual into feelings of stress. In the workplace this is not only due to personal life events, of which the frontline manager becomes aware of through the supervision and appraisal process (Sawdon and Sawdon, 2003; Pattison, 2003); but also a consequence of cultural change within the organization. In Bowlby’s terms, an individual worker may experience a ‘separation anxiety’ when their role within the organization undergoes a change: a transition which according to Marris offends the conservative impulse, and as Parkes would have it challenges the individual’s basic assumptions about the world they inhabit. It can therefore be seen from this analysis that all three theories of loss and transition can be relevant in understanding the way in which some workers may respond to organizational change. The government-directed move towards partnership of services can ultimately lead to some workers in organisations to feel they are losing their professional identity; a manager will find skills in managing change useful in this context (Charlesworth, 2003).
Feeling isolated from the manager can lead to low staff morale and in turn lead to a lack of motivation, disillusion and unwillingness to work (Seden and Katz, 2003). Henderson and Seden (2003) observe that frontline managers are more aware than most of the need to balance the corporate objectives which govern the service they provide with the professional, developmental and personal needs of staff. Ward (2003) has dealt elsewhere with the issue of building a team, and what a manager can do to facilitate team functioning. It is important for a manager to understand the individuals in and the dynamics of his or her team (Skye, et. al., 2003), and to know how to maintain and nurture the team (Ward, 2003). Theories of loss and transition can play an important role in maintaining the team insofar as the manager must interpret, resolve and anticipate difficult situations which adversely affect the functioning of the team and ultimately of the service.
Marshall (2003) offers an interesting perspective upon the sociological effects of the employing institution upon the psychology of the worker. She concurs with Obholzer (2003) insofar as suggesting that the individual worker unconsciously deploys the workplace in order to play out psychological issues, and that the worker in health and social care is at the same time an unconscious vehicle for society’s anxieties and stresses. A way of coping with such anxieties and stresses is to resort to the de-personalizing of service users, which has an adverse effect upon the service being provided, and to which the frontline manager needs to attend. Marshall (2003) continues to suggest that health and social care workers can feel suffocated by society’s expectations of them; one of the coping strategies which such workers employ is to hide behind the notion of professionalization, which permits them to impose rules upon the way in which they are carriers of other people’s anxiety. The institutionalization of such occupations as health and social care work is an indication of society’s inability itself to cope with social anxieties such as transition and loss. Therefore in this respect the need of the individual is subservient to the needs of society (Marshall, 2003). A manager who understands such a process will go a long way to supporting the individual worker at a time when they may be experiencing transition and loss, when the individual may feel that their own personal issues are not of importance in contrast to the significance of their professional role.
The author is of the mind that theories of transition and loss are essential for the work of frontline managers. A style of management bereft of such understanding is ‘macho’, and disrespectful to staff and to service users. Human relationships are important in the provision of care (Aldgate and Dimmock, 2003). The manager is a human being, and as such he or she is moral and discriminating at the same time as he or she is placed in the very challenging situation of being victim to the very same significant life events as befall others. They also have to balance their own needs and the needs of others with the needs of the service. A frontline manager is faced in their daily work with the feelings, emotions and reactions of both staff and service users towards all kinds of life events (Seden and Katz, 2003). Skye et. al. (2003) observe that many managers already have this body of knowledge but that it is not applied in a systematic manner. Significant life-events can have reactions which go much further than the individual, affecting for example user groups and communication within the team, as well as affecting the individual. The manager of a unit where a resident is threatening suicide after the loss of a loved one needs to understand why the resident feels this way, in order to deal appropriately with the situation; likewise, the manager of a unit where a team member is sullen and uncommunicative needs to understand the effect that organizational change is having on that individual. It is through theories of transition and loss that the frontline manager can make an active contribution to the lives of others, enhance the service, and anticipate difficulties. Kearney and Rosen (2000) assert that for many frontline managers the transition from practitioner to front line manager is extremely difficult. For a frontline manager to understand the theories behind this transition may help them to make the passage more smoothly. Theories of transition and loss are vital for the work of frontline managers in enabling them to facilitate transition and maintain and identify appropriate services.
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