Safeguarding Alert Case Study
This paper will discuss Mrs Smith’s safeguarding alert concerns, by taking into account professional, legal and ethical aspects of care. The legal requirements will explore the Mental Health Act 1983, as amended 2007, the Mental Capacity Act (MCA) 2005, Human Rights 1998 Act principles, safeguarding vulnerable adults from abuse and the deprivation of liberty safeguards (Dols). A range of research literature and theories on dementia, recovery for older people, partnership and collaborative practice will also be incorporated. The paper will further explore ethical issues that may arise in the intervention process and discus how these be addressed. Nursing and Midwifery Council (NMC) standards of conduct, performance and ethics will also be acknowledged
…show more content…
within the discussions (NMC, 2008).
Mrs Smith has been admitted under section 2 of the Mental Health Act 1983, amended 2007 guidelines. The Act provides provisions for the compulsory detention for people with mental health needs in England and Wales. People are admitted to a suitable hospital for 28 days’ assessment under Section 2 in relation to a mental disorder or disability of the mind – such as a profound learning disability or dementia. A Section 2 application is made by an approved mental health act professional (AMHP) or the nearest relative.
Under Section 2, Mrs Smith cannot refuse treatment. However, she cannot be treated with electroconvulsive therapy (ECT) without her consent or relevant procedures. Within the Mental Health 1983 Act, if Mrs Smith lacks capacity she can be treated under the Act’s guidelines without her consent, if it is in her best interest. Mrs Smith has the right to appeal to a tribunal against her detention during the first 14 days of her detention. The tribunal may discharge her from Section 2 if criteria for Section 72 requirements are not met. Although Mrs Smith’s nearest relative can request her discharge, this can be overruled by the responsible clinician, again if this is in Mrs Smith’s best interest.
Ms Smith is also entitled to see an independent mental health advocate (IMHA), who could help her express any concerns regarding treatment. Mental health nurses have a role in promoting Mrs Smith’s rights within the law (NMC, 2008). In other words, she must be given patients’ rights leaflets or access to advocates or to make complaints. Nurses must also ensure Mrs Smith understands her rights by reading them out to her.
The report suggests Mrs Smith has suddenly become unresponsive and is showing signs of stroke. In addition, bruising and swelling to her left thumb was noted by a nurse following emergency admission at the Accident and Emergency (A&E) hospital department. As a result, a safeguarding alert has been raised. The Human Rights Act (1998), which introduced the European Conviction of Human Rights into British law, is relevant in this regard.
This requires laws for the protection of vulnerable groups or harm inflicted on them by others. For example, Article 3 of the Act prevents inhumane treatment which causes intense physical and mental suffering. Furthermore, this Article suggests an official and efficient investigation to be carried out where there are reported allegations of serious ill-treatment or abuse. Under the Human Rights Act 1998 principles, Mrs Smith has the right to live free from abuse in accordance with the principles of dignity, respect, equity and privacy.
The Department of Health’s (2010) clinical governance suggests that in abusive cases an alert form must be completed in line with local procedures and sent to the safeguarding team. The referral must be sent to the adult protection co-ordinator to instigate an investigation. The investigator is part of the Adult Safeguarding Board, which will generally co-ordinate with relevant agencies and investigate any concerns, if required. Safeguarding simply means protecting people’s health, human rights and wellbeing and enabling them to live free from abuse, harm and neglect (Care Quality Commission, 2013).
Safeguarding adults covers responses to where harm, abuse or neglect has occurred. The Department of Health’s policy document No Secrets’ (DoH, 2009) guidance encourages multi-agency working between health authorities, social services and the police in safeguarding vulnerable adults. A key principle of No Secrets is to prevent abuse and support individuals to live independently and make their own choices.
In Mrs Smith’s case, an alert has been raised with the National Health Service (NHS) safeguarding team.
However, a referral could be still made directly to the local authority safeguarding team if the NHS system is not progressing satisfactorily (DoH, 2010). The DoH document proposes that normal trust policies and procedures for follow-on actions will still apply and should be carried out in partnership with the safeguarding process.
Raising an alert involves expressing or passing on a concern (DoH, 2010). However, the safeguarding adults’ procedure involves making internal and external checks and contacts with relevant professionals and agencies in relation to initial risk assessments (Office of the Public Guardian, 2008). The relevant safeguarding team will determine whether Mrs Smith’s case requires an investigation under safeguarding procedures, or it will suggest another alternative way to address the concern.
In addition, a referral to the police must be made at any stage of the process if there is any reason to believe that a crime has been committed. Investigating and responding to suspected neglect or abuse often requires close co-operation between organisations (DoH, 2009). Safeguarding involves sharing personal information about Mrs Smith’s care within the ward in which she was admitted initially, personal healthcare records, hospital staff and other …show more content…
aspects.
Furthermore, information can be shared with other people and agencies within the Data Protection Act 1998 guidelines. However, verbal or written consent must be acquired from Mrs Smith and recorded on her case by the person dealing with the case enquiry. In other words, Mrs Smith’s wishes and views must be acknowledged and respected.
In relation to consent, if Mrs Smith refuses or is unable to consent, an assessment of ‘best interest’ may still justify further enquires (MCA, 2005), whereby questions involving the public interest may justify overriding her views. In other terms, if Mrs Smith lacks the capacity to safeguard herself, others will be required to make decisions for her, in accordance with the Mental Capacity Act 2005 (MCA) code of practice. Best interest decisions must be taken by taking into consideration Mrs Smith’s past and present beliefs and values.
The MCA creates a crucial framework of good practice in the treatment and care of people who cannot make decisions for themselves. Furthermore, it strikes a balance between their fundamental rights to liberty and autonomy in tandem with the need to protect them when they lack the capacity to make decisions. However, Mrs Smith has been sectioned under the Mental Health Act (MHA) 1983, as amended 2007. As a result, she is not covered by MCA (2005) legal framework guidelines.
The Mental Capacity Act is only relevant for people not already detained under the Mental Health Act, although good practice will suggest the involvement of Mrs Smith’s views and values in all aspects of her care (NMC, 2008). This is echoed by the National Institute of Clinical Care’s (NICE, 2006) guidance, which encourages health and social care professionals to seek valid consent from people with dementia health needs.
In the course of the safeguarding investigations, if the relevant safeguarding team establishes significant abuse and neglect to have occurred, then a safeguarding strategy meeting (SSM) will be planned within five working days of the safeguarding adults referral (DoH, 2010). This may involve the police, hospital managers, nurses, IMCA, allocated workers and/or others.
If the SSM establishes levels of risk and abuse to have occurred, a safeguarding plan will then be initiated, agreed among the respective professionals and agencies and then implemented to prevent or decrease the risk of further neglect or abuse within the ward. The police may also press charges or carry out a criminal investigation and prosecute, if necessary.
Having briefly explored the safeguarding vulnerable adults within the intervention process, the next paragraphs will focus on the challenges around working in a dementia ward setting. In an attempt to practice from anti-discriminatory perspective (Thompson, 2006), this paper will discuss the intervention process from different angles. This is also due to the limited information of the case study. A wide array of researched literature, including Kitwood and Dewing’s work on dementia, Beauchamp and Childress’s ethical principles, legal frameworks, Department of Health Documents (DoH) and National Institute of Clinical Excellence (NICE), will be incorporated. The paper will then draw a conclusion.
Dewing (2008) suggests four theoretical approaches to understanding dementia, namely the biomedical, psychological, geronotological and social approaches. For example, the biomedical perspective assumes that dementia is a clinical syndrome involving progressive deterioration of the brain and normal daily functioning including cognitive abilities. Furthermore behavioural and cognitive impairments pose significant challenges to individuals with dementia, along with their caregivers and family members.
Alzheimer’s and vascular dementia are the most common causes of dementia, and early intervention will enable Mrs Smith to access proper diagnoses, computerised tomography (CT) scans, cognitive and mental screening and the most appropriate therapeutic interventions (Lingard & Milne 2004).
The psychological perspective of dementia recognises that individual’s life experiences and personality are contributory factors to dementia (Dewing, 2008). The geronolotogical approach explores stereotypical attitudes of society, stigma and ageism towards people with dementia. Brooker (2004) shares this notion and mentions that gernotological nursing needed to shift away from past history (institutionalised or routinised) in order to develop a person-centred
practice.
Negative discourses used to describe people with dementia include aggression, distress, incontinence, ‘dements’ and others (Kitwood, 1997). Although some of these symptoms may relate to clinical syndrome, as explored above, in some cases Kitwood reported that they can be exacerbated by the psychosocial environment of the ward. Milne (2004) agrees and explains that the core needs of people in the early stages of dementia include emotional support and a therapeutically safe environment, including drug treatments and social support, to combat stigma and isolation.
Mrs Smith is presenting with early symptoms of dementia. Evidence suggests that many health conditions such as delirium, depression, strokes and urinary infections may have symptoms (confusion, personality changes, withdrawal) similar to dementia (Kitwood, 1997). As a result, nurses should not just assume that an individual has dementia when these symptoms are present. Laboratory tests, including blood and urine tests, and neurological assessments must be carried out to identify possible illnesses which may be responsible for the presenting symptoms.
The report stated that Mrs Smith has bruises on her thumb, although she was constant observations. According to the Department of Health (2010) abuse is a violation of an individual human and civil rights by other persons and this take place in different context. In other words, abuse is often perpetrated by the use of authority or power in ways that could be detrimental to the safety, health, and general wellbeing of a vulnerable person. Abuse may occur in any relationship and results in significant harm or exploitation of the person subjected to abuse (Straughair, 2011). The forms of abuse may involve physical, emotional, psychological, institutional, sexual or discrimination.
within the discussions (NMC, 2008).
Mrs Smith has been admitted under section 2 of the Mental Health Act 1983, amended 2007 guidelines. The Act provides provisions for the compulsory detention for people with mental health needs in England and Wales. People are admitted to a suitable hospital for 28 days’ assessment under Section 2 in relation to a mental disorder or disability of the mind – such as a profound learning disability or dementia. A Section 2 application is made by an approved mental health act professional (AMHP) or the nearest relative.
Under Section 2, Mrs Smith cannot refuse treatment. However, she cannot be treated with electroconvulsive therapy (ECT) without her consent or relevant procedures. Within the Mental Health 1983 Act, if Mrs Smith lacks capacity she can be treated under the Act’s guidelines without her consent, if it is in her best interest. Mrs Smith has the right to appeal to a tribunal against her detention during the first 14 days of her detention. The tribunal may discharge her from Section 2 if criteria for Section 72 requirements are not met. Although Mrs Smith’s nearest relative can request her discharge, this can be overruled by the responsible clinician, again if this is in Mrs Smith’s best interest.
Ms Smith is also entitled to see an independent mental health advocate (IMHA), who could help her express any concerns regarding treatment. Mental health nurses have a role in promoting Mrs Smith’s rights within the law (NMC, 2008). In other words, she must be given patients’ rights leaflets or access to advocates or to make complaints. Nurses must also ensure Mrs Smith understands her rights by reading them out to her.
The report suggests Mrs Smith has suddenly become unresponsive and is showing signs of stroke. In addition, bruising and swelling to her left thumb was noted by a nurse following emergency admission at the Accident and Emergency (A&E) hospital department. As a result, a safeguarding alert has been raised. The Human Rights Act (1998), which introduced the European Conviction of Human Rights into British law, is relevant in this regard.
This requires laws for the protection of vulnerable groups or harm inflicted on them by others. For example, Article 3 of the Act prevents inhumane treatment which causes intense physical and mental suffering. Furthermore, this Article suggests an official and efficient investigation to be carried out where there are reported allegations of serious ill-treatment or abuse. Under the Human Rights Act 1998 principles, Mrs Smith has the right to live free from abuse in accordance with the principles of dignity, respect, equity and privacy.
The Department of Health’s (2010) clinical governance suggests that in abusive cases an alert form must be completed in line with local procedures and sent to the safeguarding team. The referral must be sent to the adult protection co-ordinator to instigate an investigation. The investigator is part of the Adult Safeguarding Board, which will generally co-ordinate with relevant agencies and investigate any concerns, if required. Safeguarding simply means protecting people’s health, human rights and wellbeing and enabling them to live free from abuse, harm and neglect (Care Quality Commission, 2013).
Safeguarding adults covers responses to where harm, abuse or neglect has occurred. The Department of Health’s policy document No Secrets’ (DoH, 2009) guidance encourages multi-agency working between health authorities, social services and the police in safeguarding vulnerable adults. A key principle of No Secrets is to prevent abuse and support individuals to live independently and make their own choices.
In Mrs Smith’s case, an alert has been raised with the National Health Service (NHS) safeguarding team.
However, a referral could be still made directly to the local authority safeguarding team if the NHS system is not progressing satisfactorily (DoH, 2010). The DoH document proposes that normal trust policies and procedures for follow-on actions will still apply and should be carried out in partnership with the safeguarding process.
Raising an alert involves expressing or passing on a concern (DoH, 2010). However, the safeguarding adults’ procedure involves making internal and external checks and contacts with relevant professionals and agencies in relation to initial risk assessments (Office of the Public Guardian, 2008). The relevant safeguarding team will determine whether Mrs Smith’s case requires an investigation under safeguarding procedures, or it will suggest another alternative way to address the concern.
In addition, a referral to the police must be made at any stage of the process if there is any reason to believe that a crime has been committed. Investigating and responding to suspected neglect or abuse often requires close co-operation between organisations (DoH, 2009). Safeguarding involves sharing personal information about Mrs Smith’s care within the ward in which she was admitted initially, personal healthcare records, hospital staff and other …show more content…
aspects.
Furthermore, information can be shared with other people and agencies within the Data Protection Act 1998 guidelines. However, verbal or written consent must be acquired from Mrs Smith and recorded on her case by the person dealing with the case enquiry. In other words, Mrs Smith’s wishes and views must be acknowledged and respected.
In relation to consent, if Mrs Smith refuses or is unable to consent, an assessment of ‘best interest’ may still justify further enquires (MCA, 2005), whereby questions involving the public interest may justify overriding her views. In other terms, if Mrs Smith lacks the capacity to safeguard herself, others will be required to make decisions for her, in accordance with the Mental Capacity Act 2005 (MCA) code of practice. Best interest decisions must be taken by taking into consideration Mrs Smith’s past and present beliefs and values.
The MCA creates a crucial framework of good practice in the treatment and care of people who cannot make decisions for themselves. Furthermore, it strikes a balance between their fundamental rights to liberty and autonomy in tandem with the need to protect them when they lack the capacity to make decisions. However, Mrs Smith has been sectioned under the Mental Health Act (MHA) 1983, as amended 2007. As a result, she is not covered by MCA (2005) legal framework guidelines.
The Mental Capacity Act is only relevant for people not already detained under the Mental Health Act, although good practice will suggest the involvement of Mrs Smith’s views and values in all aspects of her care (NMC, 2008). This is echoed by the National Institute of Clinical Care’s (NICE, 2006) guidance, which encourages health and social care professionals to seek valid consent from people with dementia health needs.
In the course of the safeguarding investigations, if the relevant safeguarding team establishes significant abuse and neglect to have occurred, then a safeguarding strategy meeting (SSM) will be planned within five working days of the safeguarding adults referral (DoH, 2010). This may involve the police, hospital managers, nurses, IMCA, allocated workers and/or others.
If the SSM establishes levels of risk and abuse to have occurred, a safeguarding plan will then be initiated, agreed among the respective professionals and agencies and then implemented to prevent or decrease the risk of further neglect or abuse within the ward. The police may also press charges or carry out a criminal investigation and prosecute, if necessary.
Having briefly explored the safeguarding vulnerable adults within the intervention process, the next paragraphs will focus on the challenges around working in a dementia ward setting. In an attempt to practice from anti-discriminatory perspective (Thompson, 2006), this paper will discuss the intervention process from different angles. This is also due to the limited information of the case study. A wide array of researched literature, including Kitwood and Dewing’s work on dementia, Beauchamp and Childress’s ethical principles, legal frameworks, Department of Health Documents (DoH) and National Institute of Clinical Excellence (NICE), will be incorporated. The paper will then draw a conclusion.
Dewing (2008) suggests four theoretical approaches to understanding dementia, namely the biomedical, psychological, geronotological and social approaches. For example, the biomedical perspective assumes that dementia is a clinical syndrome involving progressive deterioration of the brain and normal daily functioning including cognitive abilities. Furthermore behavioural and cognitive impairments pose significant challenges to individuals with dementia, along with their caregivers and family members.
Alzheimer’s and vascular dementia are the most common causes of dementia, and early intervention will enable Mrs Smith to access proper diagnoses, computerised tomography (CT) scans, cognitive and mental screening and the most appropriate therapeutic interventions (Lingard & Milne 2004).
The psychological perspective of dementia recognises that individual’s life experiences and personality are contributory factors to dementia (Dewing, 2008). The geronolotogical approach explores stereotypical attitudes of society, stigma and ageism towards people with dementia. Brooker (2004) shares this notion and mentions that gernotological nursing needed to shift away from past history (institutionalised or routinised) in order to develop a person-centred
practice.
Negative discourses used to describe people with dementia include aggression, distress, incontinence, ‘dements’ and others (Kitwood, 1997). Although some of these symptoms may relate to clinical syndrome, as explored above, in some cases Kitwood reported that they can be exacerbated by the psychosocial environment of the ward. Milne (2004) agrees and explains that the core needs of people in the early stages of dementia include emotional support and a therapeutically safe environment, including drug treatments and social support, to combat stigma and isolation.
Mrs Smith is presenting with early symptoms of dementia. Evidence suggests that many health conditions such as delirium, depression, strokes and urinary infections may have symptoms (confusion, personality changes, withdrawal) similar to dementia (Kitwood, 1997). As a result, nurses should not just assume that an individual has dementia when these symptoms are present. Laboratory tests, including blood and urine tests, and neurological assessments must be carried out to identify possible illnesses which may be responsible for the presenting symptoms.
The report stated that Mrs Smith has bruises on her thumb, although she was constant observations. According to the Department of Health (2010) abuse is a violation of an individual human and civil rights by other persons and this take place in different context. In other words, abuse is often perpetrated by the use of authority or power in ways that could be detrimental to the safety, health, and general wellbeing of a vulnerable person. Abuse may occur in any relationship and results in significant harm or exploitation of the person subjected to abuse (Straughair, 2011). The forms of abuse may involve physical, emotional, psychological, institutional, sexual or discrimination.