SAFEGUARDING ADULTS, CHILDREN AND YOUNG PEOPLE

The Care Act (DH, 2014) sets out a legal framework for how local authorities should protect adults at risk of abuse or neglect, such as implementing preventative measures through a multi-agency approach, enquiring in cases of suspected abuse or neglect, reviewing cases of neglect or abuse, engaging independent advocates where necessary and establishing Adult Safeguarding Boards to share multi-agency safeguarding strategies. It is the responsibility of all health professionals to safeguard against poor practice, harm and abuse of individuals that they care for (DH, 2013). Generally, safeguarding can be defined as ‘the function of protecting adults and children from abuse or neglect’ (Office of the Public Guardian, 2013). More specifically, child protection can be defined as ‘the process of protecting individual children identified as either suffering or likely to suffer significant harm as a result of abuse or neglect’

(Department for Children, Schools and Families, 2010).

All adults, children and young people have the right to be protected. It is acknow- ledged that safeguarding cannot be provided by one single discipline, it requires a multi-agency, collaborative approach. Community nurses are in a unique position to safeguard adults, children and young people as their contact with patients and families allows them to recognise and respond to issues of abuse.

There are many forms of abuse which can be described as a violation of an individual’s human and civil rights. Adults at risk (vulnerable adults) are more at risk of abuse if they are isolated, and have limited contact with family and friends; have communication difficulties, are dependent on someone as a carer or if their carer has alcohol or drug addiction issues (DH, 2015a). It is essential therefore that nurses are aware of and can recognise the potential signs of abuse. There are different forms of abuse including, physical, financial, sexual, psychological/emotional, neglect, discriminatory or institutional abuse (Age UK, 2015a). With an ageing population, it is thought that the number of older people at risk of abuse will rise, particularly among those with memory or communication problems (Age UK, 2015b). Similarly, maltreatment of children can manifest in many different ways, including signs of physical, emotional and sexual abuse, neglect and fabricated or induced illness (NICE, 2009). Recent evidence suggests that all four countries in the United Kingdom have seen the number of sexual offences against children increase (Jutte et al., 2015). There are certain factors which may increase the risk

Reflect upon an older person you have visited recently. Consider their home environment and identify any hazards that may impact on their health and well-being. Discuss with a colleague ways that you can advise this person to keep himself or herself safe.

With the older population increasing, it is recognised that the consequences of frail individuals falling will pose a greater challenge to both health and social care services. Find out about the falls prevention service in your area. Identify the criteria for referring a client.

for child abuse including living in an environment where domestic violence takes place, having parents with mental health or substance misuse issues, or living in poverty (GMC, 2012). It is important to remember however, that these issues do not necessarily lead to abuse or neglect, as child abuse exists in all areas of society.

In some instances, abuse may result in children being taken into care where a small number of them remain at risk of abuse, neglect or poor standards of care from those who are looking after them (Biehal et al., 2014). In the longer term, when compared with their peers, ‘looked after children’ generally have poorer outcomes in terms of education and mental health. Many experience poverty, isolation and housing and employment problems in adult life. A child protection issue or concerns regarding the possibility of abuse may arise in a variety of nursing encounters, even when the initial encounter has a completely different focus. It is possible that nurses who are new to the community environment may have received little training and preparation for this element of their role.

Furthermore, nurses must recognise the importance of working collaboratively with other health professionals, so that if a nurse suspects that a child is subject to harm or neglect, the nurse has a responsibility to refer their concerns to appropriate personnel (DH, 2015b). This can be a very difficult area of nursing practice which needs to be addressed in a sensitive manner, and with appropriate education and training.

All employers have a duty to ensure that the workforce is competent in the area of adult abuse, child protection and safeguarding. All staff should know what to do if they suspect abuse, or a possible child protection issue and should be able to recognise key indicators that suggest that the individual is a risk of harm or neglect (RCN, 2014; Commissioner for Older people for Northern Ireland, 2014). Often, inter-agency training is delivered, as it is thought to improve collaborative working processes between professionals involved in child protection issues (Charles and Horwath, 2009). The key principles of safeguarding adults include the following:

•

Empowerment – Focus on person-led decisions and informed consent

•

Prevention – Better to take action before any harm occurs

•

Proportionality – The least intrusive response appropriate to the risk presented

•

Protection – Support and representation for those in greatest need

•

Partnership – Communities working together as they have a role to play in preventing, detecting and reporting neglect and abuse

•

Accountability – Accountability and transparency in delivering safeguarding (DH, 2013)

Working Together to Safeguard Children (DH, 2015a) suggests that all training in safeguarding and promoting the welfare of children and young people should be child centred, promote the participation of children and their families in the process, value collaborative working, respect diversity and promote equality (DH, 2015b). Effective communication and partnership working are recognised as key areas in the identification of vulnerable children and protecting them from abuse (Welsh Government, 2014).

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Safeguarding Adults, Children and Young People To understand and identify significant harm to a child, it is necessary for health professionals to consider

•

The nature of harm, in terms of maltreatment or failure to provide adequate care

•

The impact on the child’s health and development

•

The child’s development within the context of their family and wider environment

•

Any special needs, such as a medical condition, communication impairment or disability, that may affect the child’s development and care within the family

•

The capacity of parents to meet adequately the child’s needs

•

The wider and environmental family context (DH, 2003)

Furthermore, it is paramount that the child’s needs are put first, and that health professionals ensure that children are listened to and understand the decisions that affect them (Scottish Government, 2014).

Please carry out the next activity to supplement your developing knowledge in this crucial area of practice.

The above text and activities are designed to assist you in developing your professional practice with at-risk groups. You will need to ensure that this aspect of your work is regularly updated in line with organisational processes and policies.

Find out who the lead person is for safeguarding and child protection issues in your organisation. Identify the local policy and guidelines, read them and discuss the referral process with a colleague.

ACTIVITY 4.6

Consider the following case studies and discuss any safeguarding issues or concerns raised with your team leader/mentor:

Jamie is a 3-year-old boy who you meet at the GP practice. He lives with his 20-year-old mother. It is a cold rainy day, but you notice that Jamie only has a thin shirt under his anorak. He is also wearing sandals. On speaking with his mother, she tells you that the staff at the nursery where Jamie attends have spoken to her about his increasingly aggressive behaviour towards some of the other children. Later, when discussing with your colleagues, you discover that Jamie has missed many of his regular, routine health checks, and is not up to date with his vaccinations.

Gladys is 75 years old and lives with her husband George in a bungalow. She has been visited several times by the nursing team over recent months. Gladys was diagnosed with dementia several years ago, and depends upon George for helping with her daily activities. You are visiting Gladys to assess a small laceration which she has sustained to her shin following a fall. During your visit and assessment, you notice that Gladys has some bruises on her upper arms. When talking with Gladys about the bruises she becomes upset and withdrawn. George also appears agitated and anxious.

ACTIVITY 4.7

CONCLUSION

After careful consideration of the issues addressed within this chapter, turn back to the learning outcomes at the beginning and think about each one in turn. Look back and reflect upon the notes made for the first activity at the beginning of this chapter.

If this chapter has raised any concerns for practice, it is important that they are discussed with an experienced community nurse, either informally or through clinical supervision channels. Some useful addresses can be found at the end of this section.

Remember that the majority of staff working in community settings enjoy a close partnership with their patients and clients. The health centre or surgery is at the heart of the local community and relationships may build over a number of years.

Visiting patients and clients in their homes is a privilege that greatly enhances the experience of community nursing. Taking practical precautions and taking time to think about the assessment of risk and preparation are crucial elements of nursing in the community.

FURTHER RESOURCES

www.cqc.org.uk – Care Quality Commission www.gov.uk – Department of Health

www.hse.gov.uk – Health and Safety Executive www.suzylamplugh.org – The Suzy Lamplugh Trust www.nmc-uk.org – Nursing and Midwifery Council www.npsa.nhs.uk – National Patient Safety Agency www.rcn.org.uk – The Royal College of Nursing www.unison.org.uk – Unison

http://www.unitetheunion.org/how-we-help/list-of-sectors/healthsector/

healthsectoryourprofession/cphva/ – CPHVA/Unite www.mind.org.uk – Mind Organization

www.alzheimers.org.uk – Alzheimer’s Society

www.mentalhealth.org.uk – Mental Health Foundation www.wales.gov.uk – Welsh Government

www.gov.ie – Irish Government www.gov.scot – Scottish Government

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Dalam dokumen A Textbook of - Community Nursing (Halaman 98-106)

SAFEGUARDING ADULTS, CHILDREN AND YOUNG PEOPLE