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|Assignment Title | |Protection of Vulnerable people |
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| | | | | | | | | | | | | | | | | | | | | |Word Count | |2 |1 |899 |9 | |Due Date | |24 |45 | |0 |5 | | |1 |6 | | | | | | | | | | | | | | | | | | | | | | | |Extension Agreed | | |Yes | | |No |/ | |(If YES provide Reference Number below) | | | | | | | | | | | | | | | | | | | | | | | |Date of extension | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |Student with | | |Yes | | |No |/ | |(If YES provide Reference Number below) | |Disability | | | | | | | | | | | | | | | | | | | | | |
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Protection of vulnerable people

The aim of this essay is to identify how an older individual with dementia can be vulnerable in health and social care. The essay will explore their needs and the issues concerned with dementia, both external and internal factors that can cause their vulnerability and their experience as vulnerable individuals in society, It will also discuss the agencies and legal frameworks that are responsible for safeguarding this particular group of people and the nurses role working in partnership within a multidisciplinary team to support the individual to reduce or prevent vulnerability.

Dementia is one of the most common type of disease in the elderly, it can be defined as a condition where an individual has lost some of their memory, their lack of thinking and language skills which results in behaviour changes (Donelly, 2005). According to the statistics from “Alzheimer’s society dementia report (2014)” it is estimated that by 2025 there will be over 1 million people in the UK with dementia and there is currently 850000 people who have dementia in the UK now.

vulnerability is difficult to define; (Bankoff,et al.2004) describes vulnerability as an individual who is subject to manipulation,temptation and even persuasion, although it could be argued that vulnerability is a complex concept that occurs when there is not enough valuable resources such as psychological, physical, social, cognitive, money and family support,This could potentially lead to poor health that may over time become worse (Aday 2001). This suggest that vulnerability is not a static state but one that is driven by internal and external factors (scanlon&lee 2007), because of this it is difficult to establish a clear definition of vulnerability.

No secrets Definitions (Department of health 2000) states that that a vulnerable adult is anyone 18 years and above and who is not capable of looking after or protecting themselves from significant harm or exploitation whether its due to their mental capacity, age, illness, or disability.

Dementia has a huge effect on the individual’s day of life. As the disease progresses the effect can be both physical and mentally. The individual with Dementia loses basic developing life skills to carry on normal activities through out the day which can make them vulnerable (Alzheimer's society 2007). This results in the affected individual becoming dependent on other people for their care as they increasingly become disorientated and frail, which can lead to susceptibility to abuse and exploitation due to this dependency (Foster&Herring&Doron 2014), The nature of the disease reduces their ability to acknowledge it or even report the abuse to someone.

The loss of mental capacity in people with dementia can socially isolate them. psychological and social are often linked and it is not unusual for older people with dementia to experience this, However as well as being vulnerable through social isolation it can also make them more open to financial abuse, low mood and depression.

Depression and can be easily missed or disregarded because of their incapability to communicate due to their impairment according to the (Review of Self-Management Interventions for People With Dementia and Mild Cognitive Impairment 2011). This can also have an impact on their appetite and worsen their behavioral changes, so their nutrition will more than likely suffer, making them more vulnerable to physical health problems such as weight loss and constipation (Alzheimer’s society 2013).

According to a UK study of abuse and neglect of people over the age of 65, 227,000 older adults have been mistreated by a care worker, close friend and a family member (O’keeffe 2007). in addition it was mostly people who suffered from dementia that were more at risk of elderly abuse (cooper et al,2008) and because of this impairment they depend on other people to look after them and it is because of this dependency they are prone to various types of abuse such as; financial, sexual and physical. furthermore it is not unusual for people with dementia at certain stages of the disease to act out aggressively, the characteristic of the condition makes them vulnerable.

With out doubt, the lack of health care treatments can make the elderly vulnerable because of the inherent ageism in our society (NMC guidance 2008). As people with Alzheimer’s are incapable of thinking for themselves and using their linguistic skills, they do not have the capacity to express their selves verbally in any decisions that is affiliated with their health, thus making informed consent hard to accomplish and making them vulnerable to mistreatment.

An important reoccurring problem to note is the concept of safeguarding with a elderly with dementia. Abuse happens in different settings whether it’s in a home, hospital and residential home and this can be inflicted upon by organizations or an individual within the organization, although a clear picture of these elderly abuses go unnoticed because of the lack of unreported cases according to Pritchard (2005), this can be due to the individual not acknowledging their right because of their mental capacity. According to the “care quality commission” safeguarding means protecting an individual’s health, well being and their human rights, and ensuring they can live safely from harm, neglect or abuse especially in circumstances that puts them under risk of harm. There is a lot of health care services that are made available to individuals who suffer from dementia in order to decrease their vulnerability, majority are provided by the NHS or has been set up by the local authorities whilst some have been provided privately such as care homes,and voluntary organizations like the Alzheimer’s society and age UK.

Multi disciplinary team help deliver comprehensive patient care, they convey a lot of benefit both to the patient and other professionals working within the team,these include GP’s, health visitors,occupational therapist and nurses. Their aim is to provide adequate care and treatment but with poor management the individuals psychological vulnerability increases and the capacity to heal is decreased, the primary care team that works alongside with the GP plays an important role in coordinating the individuals care, the GP is essential because they know the individual well and even before the disease so they are able to know what their preferences is and what benefits them most, The social worker will help assist the sufferer and their family and help the family member to manage the burden of looking after a loved one with the disease, They do this through counselling support group and crisis management,the occupational-therapist provides help both for the patient and caregiver by helping them deal with the disease through devices that assist them with eating,clothing and toileting, this helps with the patients dependency,further more an effective communication within the multidisciplinary team provides a holistic person centred plan of care for the sufferer (Hinchliff et al,2003).

The nurses role should be to act as an advocate and have a holistic way of caring for the individual through person centred care,whilst attaining the individuals dignity and respect for them and their family (Tschuin,2003). The nurse evaluates and manages the individual and the characteristic of the disease, as well as how the care giver is coping with the progression of the sufferer, This includes constant observation on the disease, responding to any problem in regards to medications given and to also educate and provide as much useful information to family members, and facilitating them with the progression of the sufferer. they also carry out test and assessment to help them establish the individuals psychological, biological and social needs,this is part of the 4 steps of care that nurses should abide to when providing quality care for dementia patients (Lloyd 2010).

The nurse makes sure that the individual is cared for in an environment they are most comfortable and familiarized with and in control of, so they are able to make their own decisions and continue with familiar routines which can have a positive outcome on their vulnerability but sometimes it is not intentional, in an attempt to help guide individuals who are perceived as becoming vulnerable due to their impairment, healthcare workers could contribute to their vulnerability in the first place.

In the fundamental concept of nursing accountability is really important in safeguarding a patient with dementia as nurses should always be accountable for their omissions and how they perform NMC CODE (2008). this is only to ensure an individual with any form of impairment will not be at risk of harm, nurses duty of care is to act out in beneficence “refrain from causing harm” and non maleficence”an ethical and legal responsibility to prevent harm” (Beauchamp & childress2008)

The mental capacity Act (2005) ensures that the individuals dependency are not taken for granted, the mental capacity act also states that an individuals mental capacity “should be assumed until it has been proved otherwise” however a mental capacity test is fully carried out to assess if an individual is capable of making their own decisions, Dementia patients are vulnerable at this stage and this is why a professional like the nurse must act as an advocate and work alongside with the doctor to assess the patients best interest and consent to treatments and care whilst adhering to the Human rights act (1998) “These rights include an absolute right not to be subjected to torture, inhuman or degrading treatment”,

However the No secrets white paper (department of health 2000)was put in place with the idea of the local authorities taking on the duty of coordinating multi agency policy systems and procedures, later on the Bichard Enquiry 2004 was launched after the failure to safeguard vulnerable children and adults which as a result of this, the safeguarding of vulnerable adults act was put in place. The Authorities publicized a order of reports and policies that would help accomplish a number of outcomes in safeguarding adults who were vulnerable from abuse and any form of exploitation,some of this included the 6 principles of safeguarding; empowerment, protection, prevention, proportionality, partnership and accountability. This act also implemented the vetting and barring scheme, in where the (ISA) replaced POVA (2008)to regulate the suitability of people who can work both with children and vulnerable adults.

The (ISA) works alongside with the criminal records bureau, which has now changed to disclosure and barring services (DBS), this was implemented in 2009 and their aim to bar individuals who are unsuitable to work with children and vulnerable adults for example an employer of an organization can can make a referral to the (ISA) regulatory body to raise concerns if they feel an employee has or will cause harm to a vulnerable individual.

The safe guarding vulnerable group act (2006) acknowledges that if you are an adults and being looked after under a health setting you are therefore vulnerable even though there is no clear definition of vulnerability, as they are more at risk of harm when receiving care than anyone else. This is also agreed within the Care Act (2014) as it states an adult is someone over the age of 18 who requires both support and care needs, and is experiencing or at risk of neglect and abuse due to their care needs and are not capable of protecting themselves from it, section 42 and 45 of this act are embedded into the adult safe guarding law where a safeguarding inquiry is made by the local authority to establish whether action must be taken to stop abuse, neglect or harm and then being supplied with enough information (SAB) to understand what went wrong in order to put a stop to the abuse. These risk should be sufficiently distinguished and assessed by health professionals around the individuals care and at first contact. although these policies can minimize the risk of harm, It cannot put a stop to it as the predicament would be that some dementia patients are cared for by a family member or an informal carer that are not associated with healthcare and abuse can occur and continue for a very long time till someone from outside the home notices it or if the carer seeks help, when this does occurs it is good practice and vital to make certain that the carer gets as much help as they require to put a stop to the abuse. According to the carers (Recognition and Services) act 1995, carers are at liberty to their own assessment of needs. These policies also helped healthcare professionals recognize what roles they played in safeguarding individuals and identifying harm, neglect, abuse and how to tackle the issue.

In conclusion, I believe from my findings that vulnerability will always play a vital role in an elderly with Alzheimer’s life compared to an elderly who does not have this disease. As student nurse in practice it will be my responsibility as well as other professionals I work alongside with to act as an advocate to make sure that the right decisions is made on behalf of this type of vulnerable group under the (mental capacity act 2005) and to also be alert of potential harm and safeguard them from it, as safeguarding is everyone's business and also as a student nurse it is my business also.(age uk policy section 5)

BIBLIOGRAPHY

cousley, A. (2015) ‘Vulnerability in perioperative patients: a qualitative study’, Journal of Perioperative Practice, 25(12), pp. 247–248.

Hubbard-Green, T. and Society, A. (2007) What is dementia? - Alzheimer’s society. Available at: https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=106 (Accessed: 18 May 2016).

Foster, charles, Herring, J. and Doron, I. (2014) The Law and Ethics of Dementia. Bloomsbury (p.254)

Shub, D., Bass, D.M., Morgan, R.O., Judge, K.S., Snow, L.A., Wilson, N.L., Walder, A., Murry, B. and Kunik, M.E. (2011) ‘Irritability and social isolation in dementia patients with and without depression’, J Geriatr Psychiatry Neurol, 24(4), pp. 229–234. doi: 10.1177/0891988711427039.(Shub et al., 2011)

Smith, E. (2015) Section 42: Safeguarding Enquiry. Available at: http://www.southernhealth.nhs.uk/knowledge/clinical-support-services/safeguarding/care-act-2014/s42-enquiry/ (Accessed: 23 May 2016). In-line Citation: (Smith, 2015)

THE SAFEGUARDING VULNERABLE GROUPS ACT 2006 AND THE ISA/ VETTING AND BARRING SCHEME (2013) Available at: https://www.noda.org.uk/writeable/editor_uploads/files/nodafacts/Vulnrable%20Groups%20V3%20July%202013.pdf (Accessed: 23 May 2016).

Tschudin, V. (2003) Ethics in nursing: The caring relationship. 3rd edn. Oxford: Elsevier Health Sciences.

Choices, N. (2015) What is the mental capacity act? Available at: http://www.nhs.uk/conditions/social-care-and-support-guide/pages/mental-capacity.aspx (Accessed: 23 May 2016).

The Bichard Enquiry report (2004) Available at: http://dera.ioe.ac.uk/6394/1/report.pdf (Accessed: 23 May 2016). In-line Citation#

About - disclosure and barring service (2015) Available at: https://www.gov.uk/government/organisations/disclosure-and-barring-service/about (Accessed: 10 April 2016). I

Care act2014,c. Available at: http://www.legislation.gov.uk/ukpga/2014/23/section/45/enacted (Accessed: 10 April 2016).

Southern, A. and Society, A. (2014) Dementia UK: Update - Alzheimer’s society. Available at: https://www.alzheimers.org.uk/dementiauk (Accessed: 10 April 2016).

Health, D. of (2001) National service framework: Older people. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198033/National_Service_Framework_for_Older_People.pdf (Accessed: 13 April 2016).

Grand, J.H., Caspar, S. and MacDonald, S.W. (2011) ‘Clinical features and multidisciplinary approaches to dementia care’.

Morgan, A. (2010) Clinical Governance and Adult SafeguardingAn Integrated Process. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_112341.pdf (Accessed: 18 April 2016). pg14

Donelly, M.-L. (2016) Behavioral and psychological disturbances in Alzheimer disease: Assessment and treatment. Available at: http://www.bcmj.org/article/behavioral-and-psychological-disturbances-alzheimer-disease-assessment-and-treatment (Accessed: 18 April 2016).

de Chesnay, M. and Anderson, B.A. (2011) Caring for the vulnerable: Perspectives in nursing theory, practice, and research. 3rd edn. United States: Jones and Bartlett Publishers. pg3

Brown, K. (2012) ‘People, place & policy online: Issue 1: Re-moralising “vulnerability”: Abstract’, pp. 41–53. doi: 10.3351/ppp.0006.0001.0005.

UKCEN: Ethical issues - ethical Frameworks (2011) Available at: http://www.ukcen.net/index.php/ethical_issues/ethical_frameworks/the_four_principles_of_biomedical_ethics (Accessed: 18 April 2016).

lucey, paula (2007) Social determines of health. Available at: http://www.healthpolicyfellows.org/pdfs/SocialDeterminatesofHealthbyPaulaLucey.pdf (Accessed: 11 May 2016).

Safeguarding older people from abuse and neglect. Available at: http://docplayer.net/66781-Safeguarding-older-people-from-abuse-and-neglect.html (Accessed: 11May 2016).

McCreadie, C. (2007) ‘The mistreatment and abuse of older people and the new UK national prevalence study’, Journal of Care Services Management, 1(2), pp. 173–179. doi: 10.1179/csm.2007.1.2.173.

royal college of nursing (2008) Dignity at the heart of everything. Available at: http://www.dignityincare.org.uk/_library/RCN_Digntiy_at_the_heart_of_everything_we_do.pdf (Accessed: 11May 2016).

times, nursing (2009) Psychological and communication issues in feeding post-stroke patients with dysphagia. Available at: http://www.nursingtimes.net/download?ac=1259695 (Accessed: 11 May 2016).

Carers (recognition and services) act 1995, c. Available at: http://www.legislation.gov.uk/ukpga/1995/12/section/1 (Accessed: 19 May 2016).