The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [19]
No Secrets (DH 2000) is currently under review but it defines a vulnerable adult as a person over the age of 18 years ‘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 him or herself, or unable to protect him or herself against significant harm or exploitation’ (DH 2000, p.8). Abuse is described as ‘a violation of an individual’s human and civil rights by any other person or persons’ (DH 2000, p.8). Abuse occurs not only when harm is caused as a result of wilful intent and therefore we need to consider that issues such as neglect and poor practice can also constitute abuse and should be reported in the same way.
If abuse is identified or suspected, it is important to escalate it to the most appropriate person. As abuse in many cases is a criminal act, any evidence must also be kept safe.
Dignity
One of the principles of the NMC Code is: ‘Make the care of people your first concern, treating them as individuals and respecting their dignity’. This involves:
not discriminating in any way against those in your care
treating people kindly and considerately
acting as an advocate for those in your care, helping them to access relevant health and social care, information and support.
(NMC 2008b)
An aspect of care that is relevant to everybody but has been raised specifically in respect of the older person is that of dignity. When Milburn (Milburn et al. 1995, p.1094) asked patients what care they would like from a nurse, one of the responses was ‘being acknowledged and treated as an individual’. Patients described this as being treated with respect, which meant kind, prompt care and regular contact from the nurses. Patients felt care was dignified not only when they were appropriately dressed or covered but also when there was adequate allocation of time, acknowledgement of their views and feelings and the demonstration of discretion and consideration of their feelings (Walsh and Kowanko 2002).
There has been much philosophical debate about the concept of dignity, particularly in the provision of care to a diverse population and the challenges of respecting the values, beliefs and practices of different cultures (Willis 1999), age groups and individuals (Coventry 2006). What does this mean in day-to-day nursing practice?
The most powerful tool a nurse possesses to maintain and promote dignity is herself, to work with feelings, use them constructively to understand patients and to treat them as valid, worthy and important at a time when they are vulnerable. In order to promote the dignity of another, feelings need to be clarified and understood, to ensure interactions and interventions are patient focused.
(Haddock 1996, p.931)
When performing a physical procedure for a patient, nurses can uphold the dignity of the patient by discussing with them:
if they would like the procedure to take place
when is the best time for the procedure to take place
where they would like it to take place
who they would like to be there
if they need any medication before it begins
if they have any questions
how much information they would like about the procedure.
(Adapted from Price 2004)
Patients need to feel that they have an equal and influential role in their own healthcare. One of the drivers for nursing practice today is the expectations of patients: ‘They are more knowledgeable and expect to be treated as partners and equals and to have choices and options available to them’ (DH 2006a, p.6).
We know that patients want more than just a person who can carry out a series of procedures and interventions dictated by their medical condition. Recent research has explored what patients want from their nurse (Milburn et al. 2009, Williams