Of course, every patient in the medical world is important – but some need more protection than others. Patients who require extra support, whether this be physically or emotionally, are classed as vulnerable patients. The best medical staff are excellent at providing the appropriate care to vulnerable adults and children – but safeguarding procedures for nurses and doctors need to be implemented to make sure that those in a position of care look after vulnerable patients.
Vulnerable patients include:
- patients with mental health problems
- the disabled
- the elderly
- some chronically ill patients
- some terminally ill people
Children can sometimes come under the vulnerable patient’s category as well, but normally they have parents or guardians to look after and make their decisions for them. Vulnerable patients can be described as the elderly, children, the mentally ill, sedated and anesthetised patients, patients whose mental or cognitive ability is compromised and patients who are disabled and immobilised.
These patients may not be able to make decisions for themselves, they may need help with physical tasks like eating, or they might require severe emotional assistance.
Here are some specific vulnerabilities that come into play for each group.
People with Mental Health Problems
Safeguarding vulnerable adults with mental health problems is very important. These patients should be treated with as much care and respect as any other patient. The 2005 Mental Capacity Act (MCA) is a legal framework that, when safeguarding vulnerable adults with mental illness, allows someone to act on the mentally ill patient’s behalf; but it is very concise about exactly when this help is permitted to be administered.
The MCA states that:
- aid can only be provided if it is proved that the person does not have the capacity to make their own decisions
- the helper must guide the mentally ill person to make their own decisions when possible
- all decisions must be in the patient’s best interests, and treatment and care should be least restrictive of their rights and freedoms.
The act also helps people to decide on their preferred treatment and to identify a trusted person who could make decisions on their behalf.
People with disabilities, whether they are mental or physical, are some of the country’s most vulnerable citizens. Generally they are treated with respect, but sometimes incidents like this horrific bullying of autistic patients can happen. The report claims that one resident was assaulted, forced to eat chilies and thrown in a swimming pool. This highlights the need of safeguarding vulnerable adults with autism.
This incident is sadly not isolated – there was a similar one at the Winterborne View care home where residents were physically and mentally assaulted. These events point to the need to ensure that safeguarding adults in nursing practice is monitored.
There is a clear correlation between age and vulnerability; once someone reaches an elderly age they begin to need more aid to do simple tasks like eating and shopping, and may lose some of their mental capacity. There have been cases of the elderly being neglected in hospital where the staff have not given them assistance to eat or use the bathroom.
Elderly people are the most likely to suffer financial abuse; they could be bribed or blackmailed into giving someone a chunk of money or editing their will.
Chronically Ill People
A lot of illnesses can be chronic; and a chronic ailment does not necessarily make someone vulnerable. However, some chronically ill people rely on others to administer their medication, do errands for them, and sometimes help them with personal jobs like getting dressed and using the bathroom.
Because of this, chronically ill people can be at risk of physical, emotional, sexual or financial harm by their care worker or even their relative.
Terminally Ill People
Terminally ill people could suffer similar abuse to chronically ill people; they could be victims of any type of abuse, and could also see themselves susceptible to financial abuse from those around them. They could suffer this kind of abuse from care workers, doctors or nurses.
If a child has stable parents who makes their decisions for them, they are not generally considered vulnerable. However, if there is any evidence that said parent may be abusing or neglecting them then children can quickly fall into the vulnerable category.
How are these vulnerable patients safeguarded?
There are two steps when safeguarding vulnerable patients; monitoring the character types of people who attain the positions of care, and reporting and effectively resolving problems if the vulnerable patients do fall victims of abuse.
People who have intimate relationships with vulnerable patients include:
- care workers
- friends and relatives
These people could either commit abuse or be the integral person when spotting ill-treated patients.
To become a nurse, the prospective student must provide details of any criminal convictions. Each case is studied individually and whether the student is permitted on the course depends on the conviction. There is no blanket rule on whether past crimes prevent someone from nursing.
Every nursing student also needs to submit a DBS check to prove that they do not have any hidden records. Once on the course, learning how to safeguard adults is a significant part of training.
The safeguarding nurse role means that people in this position are trained to look out for signs of abuse or neglect in their patients. These include, but are not limited to: unexplained bruises, a withdrawn mental attitude, loss of weight and anger or sudden outbursts.
Persons wishing to become doctors follow similar procedures; they must declare any criminal convictions and submit a DBS check to begin medical training. They are also subject to criminal record checks throughout their career.
Doctors are trained to keep an eye out for vulnerable patients and evidence of abuse. A scheme in Scotland is funding a program for doctors, vets, hairdressers and other professionals to accurately identify mistreated persons. Hopefully this will become more widespread in the next few years.
Confidentiality is a significant part of the doctor’s role; if someone visits a doctor about an ailment, they are generally not allowed to discuss it with others. However, MDU Notes states that “confidentiality is not an absolute duty”.
The doctor is permitted to breach confidentiality if:
- The patient lacks capacity to make their own decisions, and is at risk of harm or death.
- They have capacity but someone else is at risk of harm or death.
Safeguarding vulnerable adults with capacity is a little different. If they have capacity and they are the only one facing harm, yet they still ask the doctor to not tell anyone then the doctor must respect the code of confidentiality, even if it means that the patient could be facing serious injury or death.
Care workers have similar responsibilities to nurses. They are almost always the people who will spend the most time with a vulnerable patient, which has a dual significance. They will be the first people to spot any signs of abuse, but they are also in prime position if they were an abuser. Therefore, care working training and people working as care workers must be very stringently monitored to check that they are not inflicting any abuse on vulnerable patients.
This heartbreaking account of how two men verbally and physically assaulted a 95 year old woman with dementia is just one example of how vulnerable patients can be abused. There are many, many more incidents. Lynne Nuttall, the daughter of the victim, thinks that surveillance cameras are the only real answer to being able to accurately track whether care workers are abusive.
Friends and Relatives
Friends and relatives can sometimes be perpetrators of emotional, physical, sexual or financial abuse when they are caring for a vulnerable patient. Their close capacity and the ‘trust’ that is in the relationship puts them at prime position to be exploited.
This is called mate crime and it happens when the perpetrator uses the patient’s vulnerability to their advantage. It can also happen online, with someone that the victim has befriended on social media or on a chat room.
On the other hand, friends and relatives are in an ideal position to watch out for any abuse committed by care workers, nurses or other people in close proximity to the vulnerable person. Marks on the body and unusual behaviour are the first signs to look for, but there are many others that depend on the type and scale of abuse. Safeguarding Somerset has a great booklet about the effective safeguarding of vulnerable adults.
If you’re worried about a friend or relative, assess what kind of harm they are in. If they are in immediate harm, call 999. If they are the victim of immediate money laundering or fraud, get in touch with Action Fraud.
If they are not in immediate danger, you could contact professionals who know them; such as their GP or social worker. If it is a crime, the police should be alerted. Most regions also have their own safeguarding authorities – so search for the appropriate care in your area.
Sadly, abuse of vulnerable patients still occurs throughout the medical profession and at home. While many procedures are still in place to protect them, more awareness is still needed; it is vital that more people in positions of care are trained to spot signs of abuse and neglect and anything suspicious is reported immediately. Isolated incidents may not seem significant, but reporting them could save someone’s life.