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Vulnerable Persons Module
A Case study of exploring challenges in the care and management of Safeguarding a potentially Older Adults (vulnerable Patients)
Human beings are potential to vulnerability and this is even more visible as they turnold age. This is because many will encounter significant health challenges related to their cognitive, psychiatric and physical problems. This assignment critically explores the challenges in the care and management while safeguarding an older adult as identified in the appendix. Solutions to safeguard the Vera James will be discussed by using a multi-disciplinary approach.
Vulnerability in adults broadly includes those who require or will require services of community care for disorders that may affect mental health or other forms of disability or illness (Social Care Policy, 2011). Culo (2011) discusses vulnerability as any adult with conditions that include psychosocial, cognitive and physical problems. However, these do not include the preferences of such adults, for this “adult at risk” or “harm” was defined by the Law commission as it encompassed the necessity to identify the circumstances of the adult rather than just disability to consider an individual as “vulnerable” (Wiltshire, 2013).
Nurses are responsible in offering critical care to older people as they are vulnerable to physical illness and also harmed psychologically (Baillie, 2009). However, nurses largely depend on of care which places emphasis on physical problems but largely ignore the complex, reciprocal and interpersonal nature of care. Hence, the individual may not be seen as ‘a whole’ (Doyle, 2010). The Mental Capacity Act (2005), The Equity Act (2010) and The Human Rights Act (1998) all state that older adults have a right to make decisions regarding their treatment, safety and care. This is to empower approaches for safeguarding vulnerable adults.
Information derived to predict harm or the likelihood of it occurrence along with obtaining and analysing such information so as to identify specific risk factors of an individual is known as risk assessment (Wales Interim Policy & Procedure, 2010). In this case, VERA JAMES has the potential for vulnerability pertaining to the social, psychological and biological aspects of aging (Jenkins, RIJ, 2015) that in turn would affect her overall quality of life. First socially, being an older woman, VERA JAMES is unable to confront her loneliness. Both she and her family have concerns with reference to ongoing health needs and risks of further morbidity and mortality. She was prone to further chances of chest pain/angina. VERA JAMES has recently been diagnosed with dementia which over time will decrease her decision making capabilities. New changes made to her living arrangement may cause anxiety, psychologically affecting her further. This also makes VERA JAMES more liable to be restricted as her children may employ an approach to her long term caring that can across as overprotection or overbearing. In a study by O’Keeffe et al, it was shown that 33% of the abuse experienced by the elderly was caused by close family members (O’Keeffe et al., 2007). This can also be a result of the limitations that VERA JAMES’s well-meaning children may impose on her. This can hence, lead to her isolating herself from her family so that she has her freedom. This type of care approach taken by her children can be considered as abuse or excessive kindness that leads to restriction (Matthew, 2013).
The Wales Adult Protection Policy and Procedures states that the adult protection process must involve the right of the older adults to take decisions about the care, safety and welfare unless they have been deemed as mentally unable to make any decision (Four Adult Protection Fora, 2010). Risk factors of vulnerability can be reduced by recognising all the factors that affect VERA JAMES and then addressed issues to maintain her independence and exercising autonomy in her care, especially as VERA JAMES does not consider her-self vulnerable and wishes to resume living alone. Therefore, as nurses, the approach is to balance the risks and advantages of her independent residence and respecting VERA JAMES’s views on the same.
The multidisciplinary team (herein referred to as MDT) approach has been widely recommended approach to assess all aspects of risks as MDT enables holistic assessment using evidenced methodologies and thereby makes professional recommendations and plan and provide care for older adults (National Health Service, 2011). Since, VERA JAMES required the Cardiac Rehabilitation there is a need for a complete MDT where upon returning home she will receive a functional capacity test and psycho-social assessment and if in case she requires any support from the hospital/clinic, there will be access to communicate. However, in order to make this effective, there is a need for effective communication across the team members and to the patient to ensure seamless care. This is because, the breadth and depth of work has been extensive ranging from individual negotiation to communication skills, and therefore, team members should develop these skills successful leadership to make the service more patients centred (National Health Service, 2011). In this case, ‘VERA JAMES’ family should be involved in care planning to understand their perspective thereby it ensures balance that each person feels fully engaged in every decision making process. Therefore, a rehabilitation program must be in place that enables the independent living of VERA JAMES for however long she is able to and that which also provides support to both her as well as her family when she cannot do so anymore.
The evaluation of care would be based on the independence level retained by VERA JAMES, and also her ability to live a complete and functional life. Given that a greater number of older patients to support with many complex and multiple needs, and with higher expectation, care and support should deliver. The MDT comprises the care staff, midwives and nurses who together provide care and support to vulnerable patients by using 6Cs which are competence, care, communication, compassion, commitment and courage (Ndoro, 2014). In conclusion, there is a need for strong emphasis of 6Cs at every level of work that the team engages. Firstly, there is a need for strong leadership to set clear expectations and to manage performance in the delivery of the 6Cs. Secondly, 6Cs should be embedded at all levels of staffs related practices including recruitment, selection, training, appraisal and organizational culture. Thirdly, promoting the right environment culture, communicating the vision at every level of staff to create positive change, emphasizing collaboration at all levels and across settings, supporting health and well-being of staff, shared decision making and communication with patients and people, and releasing time to care and finally reducing bureaucracy.
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Baillie, L. (2009) Patient dignity in an acute hospital setting: a case study. Journal of Nursing Studies. 46 (1), pp. 23–37.
Culo, S. (2011) Risk assessment and intervention for vulnerable older adults [online]. BCMJ. 53 (8), pp. 421–425.
Doyle, S.J. (2010) Being-in-the-World-of-Care: The lived Experiences of older people Receiving Community aged care packages in Queensland. [online]. Queensland University of Technology. Available from: http://eprints.qut.edu.au/44155/1/Susanna_Doyle_Thesis.pdf.
Four Adult Protection Fora (2010) Wales Interim Policy & Procedures for the Protection of Vulnerable Adults from Abuse. [online]. Available from: http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/1143/Safegaurding Adults.pdf.
Matthew, L. (2013) Professional Care for the Elderly Mentally Ill. Springer.
National Health Service (2011) Multidisciplinary Working: A Framework for Practice in Wales. [online]. Available from: http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/1143/Multidisciplinary Working - A Framework for Practice in Wales 2011.pdf.
Ndoro, S. (2014) Effective multidisciplinary working: the key to high-quality care. British Journal of Nursing. 23 (13), pp. 724–727.
O’Keeffe, M., Hills, A., Doyle, M., McCreadie, C., Scholes, S., Constantine, R., Tinker, A., Manthorpe, J., Biggs, S. & Erens, B. (2007) UK Study of Abuse and Neglect of Older People Prevalence Survey Report. Available from: http://www.natcen.ac.uk/media/308684/p2512-uk-elder-abuse-final-for-circulation.pdf.
Social Care Policy (2011) Safeguarding Adults: The role of Health service practitioners. [online]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215714/dh_125233.pdf.
Wiltshire (2013) Policy and Procedures for Safeguarding Adults at Risk in Swindon and Wiltshire. [online]. Available from: http://www.wiltshire.gov.uk/policy-and-procedures-for-safeguarding-vulnerable-adults-2006-sept.pdf.
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