Safeguarding Adults The Role of the Nurse/Care Worker

Aims and Objectives  This session looks at the role of the nurse/ care worker in the safeguarding of adults  By the end of the session you will have an awareness of: –Types of abuse and who is a vulnerable adult –Prevalence of abuse –Responsibilities –Legislation and essential standards

Introduction  Safeguarding means protecting people’s health, wellbeing and human rights –Enabling them to live free from harm, abuse and neglect  It is fundamental to creating high-quality health and social care

What is Abuse?  Several definitions  ‘a violation of an individual’s human and civil rights by any other person or persons’  ‘deliberate and intended injury to another person or way of treating an individual so as to cause them harm’  It can be single or repeated acts

Acts of Abuse  Physical  Sexual  Psychological  Discriminatory  Institutional  Neglect  Financial

Acts of Abuse  Physical –Physical mistreatment or non-accidental injury  Sexual –The involvement of an adult in any sexual activity to which they either cannot or have not consented  Psychological –This includes threats of harm, abandonment, isolation or humiliation, which may result in the adult feeling miserable, undervalued and perhaps unnecessarily dependent

Acts of Abuse  Discriminatory abuse – e.g.: –Exclusion from services available to all citizens –Failure to respect cultural preferences –Denial of rights to religious and cultural preferences

Acts of Abuse  Institutional abuse – e.g.: –A failure to promote respect, dignity, choice, independence or privacy –Inappropriate or poor care –Poor professional practice –Denial of access to toilet or bathing facilities –Restriction or denial of right to medical or social care –Lack of response to complaints

Acts of Abuse  Neglect  This includes deliberate or unintentional failure to respond to an adult’s basic medical, physical, spiritual, social or developmental needs  Financial  Including theft or misuse of finances/ property

Who is a Vulnerable Adults?  ‘someone who is or may be in need of community care services by reason of mental or other disability, age or illness and …..  who is or may be unable to take care of himself or herself, or unable to protect himself or herself against significant harm or serious exploitation’

Who is a Vulnerable Adults?  ‘someone over 18 years of age who has a physical or mental condition that increases dependency. It affects their ability to protect themselves from significant harm and the increased risk of mistreatment, exploitation and abuse by other people’ (Gateshead Protection of Vulnerable Adults Multi-Agency Committee (2005))

Prevalence of Abuse  There is a lack of nationally collated statistics  Some recent research concluded that reported cases were only the tip of the iceberg –Brown and Stein (1998) Looked at 2 counties over 12 months Found 135 reported abuses against people with learning disabilities

Why are Clients Vulnerable?  Lack of control over their lives  Additional vulnerability factors –e.g. old age  What other factors can you think of?

Nurses who Abuse  Nursing and Midwifery Council –Complaints of misconduct against registered nurses, midwives and health visitors have continued to rise (NMC (2002) –29% of proven offences were physical or verbal  Nurses face a dilemma - in reporting abuse they will be reporting a fellow nurse

Nurses’ Responsibilities  Nursing and Midwifery Council  The NMC - ‘zero tolerance' of nurses who abuse  Nurses have a role to play in the prevention, detection and reporting of abuse –This is set down in national policies –Staff should receive training –There should be a local policy

Factors that Contribute to Abuse  Nursing and Midwifery Council, 2002 –Staff attitudes (condones or tolerates) –Supervision (lack of or ineffective) –Resources (lack of or inappropriate)

Whistle Blowing  “refers to a warning issued by a member or former member of an organisation to the public about a serious wrongdoing or danger created or concealed within the organisation” (Dougherty 1995: 2552)

Why Doesn’t Everyone ‘Whistle Blow’?  Community and District Nursing Association (2003) –Little or no training has left nurses with concerns on dealing with abuse  Pillemer and Hudson(1993) –Unqualified nurses feel ‘powerless’ to prevent abuse  Mulholland (2003) –66% of community nurses had received no adult protection / abuse training

Adult Protection v Safeguarding  Adult protection focuses on responding to abuse after it happens  Safeguarding adults involves the systems, processes and practices to enable people to live a life that is free from abuse and neglect  The role of the care worker and nurse is to safeguard

The Role of the Care Worker/Nurse 1. Having a thorough awareness of issues about the abuse of adults 2. Preventing people from experiencing abuse in the first place 3. Recognising and acting appropriately when there are allegations of abuse 4. Supporting the person who has experienced abuse

The Role of the Care Worker/Nurse 5. Ensuring that all working practices focus on safeguarding clients 6. Having an understanding of how mental capacity and deprivation of liberty impacts on safeguarding issues 7. Reporting all incidents of abuse  This list is not exhaustive

Care Quality Commission (CQC)  Responsible for registration, review and inspection of certain health and social care services in England –They take action where providers or managers fail to meet the requirements (there are a range of sanctions)

Care Quality Commission (CQC)  The Health and Social Care Act 2008 requires the CQC to assess performance against indicators of quality (set or approved by the Secretary of State)  The CQC can also carry out other special reviews and investigations (and must do so if the Secretary of State requests it to do so)

Care Quality Commission (CQC)  Safeguarding and Safety  CQC will focus on Outcome 7 Safeguarding and Safety (Regulation 11 of the Health and Social Care Act 2008)  It is important to understand that effective safeguarding requires compliance with a whole range of outcomes –Not just the regulation that explicitly covers safeguarding

Mental Capacity Act 2005  Legislation that contributes to safeguarding includes the Mental Capacity Act 2005  This provides a framework for decision making in relation to mental capacity and two legal offences of mistreatment and wilful neglect in respect of people who are thought to ‘lack mental capacity’

Mental Capacity Act 2005  The five key principles of the Mental Capacity Act need to be embedded in everyday practice when safeguarding decisions are being considered  All staff need an understanding of this piece of legislation

Deprivation of Liberty Safeguards  Deprivation of liberty safeguards (part of the Mental Capacity Act) came into effect April 2009 –Applies to care homes and hospitals –All staff need to be aware of the implications of these safeguards

Deprivation of Liberty Safeguards  Human rights:  Any care or treatment (given to a person without mental capacity to give consent) that restricts liberty to the point of deprivation is a breach of human rights –Unless a DoLS authorisation has been made

Summary  Abuse is more than a deliberate act, word or behaviour  Abuse takes on many forms  Health and social care workers have a duty to protect (safeguard) adults in their care –Demonstrated in all aspects of care delivery  Abuse should always be reported and investigated

References  Ahern, K. and McDonald, S. (2002) The beliefs of nurses who were involved in a whistleblowing event. Journal of Advanced Nursing 38 (3)  Brown, H. and Stein, J. (1998) Implementing Adult Protection Policies in Kent and East Sussex. Journal of Social Policy 27 (3)

References  Community and District Nursing Association (2003) Survey into Elder Abuse. London: CDNA  Dougherty, C. J. (1995) Whistleblowing in Health Care. In Reich, W. T. (Ed.) Encyclopaedia of Bio Ethics. New York: Simon & Schuster Macmillan  Mulholland, H. (2003) Nurses want training on abuse. Nursing Times 99 (7) 5  Nursing & Midwifery Council (2002) Professional conduct annual report London: NMC  Pillemer, K. & Hudson, B. (1993) A Model Abuse Prevention Programme for Nursing Assistants. Gerentologist 33 (1)

References  Care Quality Commission (CQC)   Health and Social Care Act 2008  Available at: ents  Mental Capacity Act 2005  Available at:  nts