1. MARIAN BARNES, PROFESSOR OF SOCIAL POLICY, UNIVERSITY OF BRIGHTON MARIAN.BARNES@BRIGHTON.AC.UK Negotiating relationships across professional and lay boundaries: An ethic of care approach

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. What is care – an ethic of care perspective 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.

5. Attentiveness Meeting needs is not possible without awareness of and attentiveness to needs. Ability to suspend ones own goals, and ambitions to be attentive to others, AND To recognise and understand ones 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. Brannellys 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.