Safeguarding PDF
Safeguarding PDF
Safeguarding PDF
The synthesis of art and science is lived by the nurse in the nursing act
Josephine G Paterson
Abstract
This article explores some of the issues surrounding safeguarding
vulnerable adults, examines some of the related legislation and
literature, and outlines the responsibilities of those who care for this
patient group. The article describes how one hospital that specialises
in caring for people with early-onset dementia, Huntingdons disease
and alcohol-related brain injury who require additional support, has
provided staff with appropriate evidence-based information about
safeguarding adults.
Authors
Virginia Betts
Formerly staff nurse, Forest Hospital, Nottingham; currently health
visitor student, Derby University, Derby.
Diane Marks-Maran
Honorary professor of nursing, Kingston University, London, and
St Georges, University of London, London.
Trish Morris-Thompson
Director of quality and clinical governance, Barchester Healthcare,
London.
Correspondence to: marksmaran@btopenworld.com
Keywords
Abuse, duty of care, e-learning, patient care, safeguarding adults,
vulnerable patients
Review
All articles are subject to external double-blind peer review and
checked for plagiarism using automated software.
Online
Guidelines on writing for publication are available at
www.nursing-standard.co.uk. For related articles visit the archive
and search using the keywords above.
TABLE 1
Principles of safeguarding and implementation in practice
Principle
Implementation in practice
1 Empowerment.
Presumption of person-led decisions
and consent.
4Giving individuals relevant information about recognising abuse and the choices
available to them to ensure their safety.
4Giving individuals clear information about how to report abuse and crime, and any
necessary support.
2 Protection.
Support and representation for those
in greatest need.
3 Prevention.
Prevention of harm and abuse is
a primary objective.
4Understanding what abuse is, how to recognise it and what vulnerable adults can do
to seek help.
4Helping vulnerable adults seek help or informing them about what they can do to
seek help.
4Providing appropriate training and guidance to staff about how to recognise signs of
abuse and take any appropriate action to prevent it.
4 Proportionality.
Proportionality and least intrusive
response appropriate to the risk
presented.
4Helping vulnerable adults to feel confident that healthcare professionals will take into
account their preferred outcomes or best interests.
4Discussing with vulnerable adults and, where appropriate, partner agencies the
proportionality of possible responses to the risk of significant harm before any
decisions are taken.
5 Partnerships.
Local solutions through services
working with communities.
4Enabling vulnerable adults to feel confident that information about them will be
appropriately shared and that agencies will work together to find the most effective
responses for their situation.
6 Accountability.
Accountability and transparency
in delivering safeguarding.
4Ensuring the roles of all agencies and the lines of accountability are clear to vulnerable
adults.
4Ensuring healthcare professionals understand what is expected of them and others.
4Ensuring agencies recognise their responsibilities to each other, act upon them and
accept collective responsibility for safeguarding arrangements.
Literature review
As well as examining the legislation on
safeguarding adults and findings of independent
inquiries, the authors undertook a literature
search using CINAHL (Cumulative Index to
Nursing and Allied Health Literature). The
following keywords were used: safeguarding,
adults and nursing, and 28 relevant articles
were identified. Inclusion criteria were articles
related to safeguarding adults only, those
involving nurses and nursing, those based in
hospital and/or care home settings, and those that
emphasised awareness training in safeguarding
adults. Of the 28 articles, 16 were excluded from
the literature review because they focused on
news items rather than academic articles, children
and/or young adults, inter-agency training for
safeguarding, staff background checks or nursing
in community settings.
The abuse of adults may take many forms,
including physical abuse, neglect and acts of
omission, sexual abuse, financial abuse, verbal
and psychological abuse, and discriminatory abuse
(DH 2000, Nisbet 2013). Lawrence and Banerjee
(2010) identified several issues associated with the
safe care of older vulnerable people, particularly
in institutional settings, including an increased
incidence of dementia and physical disability, and
that most long-term care is provided in the private
sector, often by staff with minimal training in caring
for people with complex needs. Wang et al (2006)
found that 16% of staff in long-term care facilities
for older people committed acts of significant
psychological abuse, such as blaming people
verbally, ignoring their requests or refusing to accept
their opinions.
Since the independent inquiries into care at
Winterbourne View hospital and Mid Staffordshire
NHS Foundation Trust (CQC 2011, Francis 2013),
there is increased emphasis on ensuring institutions
that provide care for vulnerable adults address
safeguarding issues. The CQC (2011) stated that
such institutions must ensure systems, processes and
practices are in place to allow vulnerable adults to
live a life free from abuse and neglect.
There is a growing emphasis in the literature on
how healthcare institutions are acting to ensure
the safety of vulnerable adults by developing
policies, procedures and safeguarding practices.
Elvidge and MacPhail (2009) described the
Quality in Care model for safeguarding older
BOX 1
Safeguarding Adults Information Sheet
Safeguarding adults is everybodys business:
4Living a life that is free from harm is a fundamental right of every person. This handout may help you to identify
what may constitute abuse and explain the responsibilities of staff working with vulnerable adults. It will help
you to recognise and report any detected or suspected abuse. Staff should aim to prevent abuse by improving
the quality of life and care that vulnerable adults receive by providing better protection, patient empowerment,
support in raising concerns, and identifying and improving bad practice.
4All staff have a responsibility for ensuring they safeguard the interests of patients at all times. The misuse of
power within the staff-patient relationship can affect any patient regardless of age, gender, ethnicity, level of
ability, sexuality, culture or religious belief.
4Although illness and disability can make people vulnerable, some groups of patients are potentially more
vulnerable to abuse than others, for example those who are physically frail, or who have mental health
problems or learning disabilities.
4Staff must always treat patients with dignity and respect. This involves identifying the patients
preferences regarding care and respecting these within current standards of practice. Staff are
personally accountable for ensuring that they promote and protect the interests of patients in their care
in a non-discriminatory manner.
Abuse is violation of an individuals human and civil rights by any other person or persons (Department
of Health 2000).
Abuse whether intended or not can be carried out by any person. It may arise out of poor or ill-informed
practice, individual cruelty, negligence or neglect. Abuse may consist of a single act or repeated acts and
can occur between a staff member and patient or between patients. It may be physical, psychological,
sexual, financial, emotional or verbal. It may be neglect or an omission to act, or it may occur when a vulnerable
person is persuaded to enter into a financial transaction or sexual relationship to which he or she has not
consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to,
or exploitation of, the person.
Conclusion
Safeguarding patients has always been a professional
ethical issue. However, recent media coverage of,
and inquiries into, poor care have illustrated that
vulnerable patients may not be adequately protected
from harm and abuse. One way that all healthcare
providers can ensure that staff are fully aware of
References
Care Quality Commission (2011)
Review of Compliance: Castlebeck
Care (Teesdale) Ltd. Care Quality
Commission, London.
Cass E (2012) Commissioning Care
Homes: Common Safeguarding
Challenges. Social Care Institute
for Excellence, London.
Department of Health (2000) No
Secrets: Guidance on Developing
Multi-Agency Policies and
Procedures to Protect Vulnerable
Adults from Abuse. The Stationery
Office, London.
Department of Health (2011)