Critical Incident Report

Elderly abuse is mentioned as a repeated act of intentional failure in safeguarding elderly people by the family and friends which result them facing the risk of harm or injury. The current essay would discuss and examine the role of nurse in safeguarding elderly across their lifespan and implementing policies and legislations for decision-making. Thereafter, way to assess risk and evaluate abusive situations are to be discussed and the actions taken to overcome the abuse is to be evaluated. The essay would be based on elderly safeguarding with focus on ensuring safety to elderly from financial abuse. In this purpose, theories and models are to be used.

The NMC Code of Conduct mentions that the personal information of the patients is to be kept confidential and their privacy is to be maintained (NMC, 2018). Thus, the pseudonym Jack is to be used for indicating the patient. Jack is 88-year-old who is presented to the hospital with complications of painful urination and pain in the penis. He was diagnosed with prostatitis and admitted to the Department of Medicine in the hospital. Jack has hypertension and experiences steady weight loss as other existing health problem and has family history of prostrate cancer with no other known health complications. Jack lives in his own home and is currently admitted to the hospital for treatment of prostatitis, sudden weight loss and hypertension. Jack was a financial manager at a reputed firm and sustains on his life savings and pension. Monica who is 45 years old and his step-sister is responsible for managing his care and be his financial controller as Jack’s daughter lives in the city for job purpose. Jack has appointed Monica to be his financial controller due to his inability to manage finances out of age and frailty along with she lives nearby his home.

Vulnerability is referred to inability of an individual to resist any harm or abuse due to their frailty and physical or mental health issue making them exposed to need assistance in executing their everyday living activities (Barbosa et al., 2019). In contrast, safeguarding is protecting an individual’s right, health and well-being to ensure they live without abuse, neglect or harm (Sharma, 2019). This indicates that vulnerable individuals are in need of safeguarding for promoting their enhanced health and well-being in society. According to Human Rights Act 1998, abuse indicates violation of civil and human rights of a person which makes the individual lack liberty in making own decision and face negligence (legislation.gov.uk, 1998). The UK government reports that 1 in 5 people (22%) in the UK who are above the age of 65 years are reported to experience abuse (lordslibrary.parliament.uk, 2021). Thus, discussion regarding abuse of Jack in any regard is important as being elderly, he is found to be increasingly prone to get abused and effective actions are to be taken to limit abuse for ensuring his enhanced well-being.

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Financial abuse is regarding as fraud, theft or coercion of financial elements and affairs of people in relation with their property, will, financial transaction and others which lead their finances to be inappropriately used others (ukfinance.org.uk, 2021). Alternatively, the study by Lloyd-Sherlock et al. (2018) mentions financial abuse as stealing money from any individual without their permission. The impact of financial abuse is that it leaves the individual with no financial support and leads them to be deprived of basic essential due to lack of money which makes individuals develop hindered well-being (Fenge and Lee, 2018.). As per reports in the UK, it is mentioned that 57,000 individuals above the age of 65 years’ experience financial abuse by care workers, relative or friend (CPA, 2021). Thus, discussion regarding financial abuse of Jack is important to determine the person responsible for causing the abuse and the way to resolve it for supporting his enhanced well-being.

Jack is suffering from financial abuse is determined by the nurse while caring for him at the hospital. It is evident as when the nurse engaged Jack to interact with her to understand his cause of hypertension, he disclosed that he is currently experiencing lack of finances to maintain hygienic household. He reported lack of heating at his home with presence of moulds and bacterial clusters to be occurring at the washroom due to reduced availability of finances to be paid to professionals for cleaning his home. He reported that Monica has increased control of his finances and does not let him use the money to appoint cleaners at his home. He also reported being losing weight and remaining hungry due to lack of availability of enough food as Monica reports they do not have adequate money from Jack’s pension which Jack defy to accept. Moreover, Jack informed Monica is currently showing increased interest towards his property and home as well as is secretive on the way his pension is spent. This lack of ability of Jack to control his finances and fear of misuse of property by Monica has led to his increased stress and hypertension.

The study by Sadrollahi et al. (2020) mentions that elderly individual faces difficulty in reporting abuse mainly from family members or relatives. This is because elderly fear of retribution towards family members which could lead them to remain alone to be cared by external care providers. As argued by Kempen (2018), the elderly fail to report abuse due to their lack of knowledge regarding the way to report harm. This is evident as elderly often lack effective physical and cognitive ability to make decision regarding care and determine process of reporting any maltreatment to authorities which leads them to remain to be abused. As asserted by Mehra et al. (2019), financial abuse on elderly remains unreported due to their effective and timely detection. This is because the elderly do not have enhanced cognitive capability in differentiating abuse apart from care. In contrast, the study by Andela et al. (2021) mentions that elderly fail to report financial abuse because of lack of detection of such abuse by the nurses and care providers. It leads the elderly fail to raise safeguarding concerns to be protected by appropriate authorities. In case of Jack, his financial abuse was found to be initially unreported due to his hindered ability to detect and report the abuse.

The study by Phelan (2018) mentions that safeguarding concerns of the elderly mainly identified by the nurses while communicating with the patients. This is because during communication, effective disclosure of key needs and demands of the patients are made. RCN (2021) mentions that patient’s needs are identified and met by the nurses through their enhanced understanding and knowledge of the patients. The facts in both the studies are evident as financial abuse of Jack was identified by the nurse while communicating with him during his care in the hospital. The Care Act 2014 informs that it is duty of the multi-agency local safeguarding system and local authorities to review vulnerable adults in detecting their ability to get harmed or abuse so that active actions are taken to prevent such actions (legislation.gov.uk, 2014). In case of Jack, it is found that the local authorities and safeguarding system in the area on being made aware of his financial abuse execute enquiry regarding the complaint and confirmed Monica to be guilty of executing financial abuse of Jack.

The Safeguarding Vulnerable Groups Act 2006 informed that people experiencing harm are to be prevented from abuse by avoiding people who are involved in causing abuse to the vulnerable children and adults to have access to them through their work activity (legislation.gov.uk, 2006). Thus, Monica is determined to be avoided to provide further care to Jack as she was involved in causing financial abuse to him. However, the NMC Code of Practice mentions that patients are to be actively involved in deciding their care so that their autonomy and dignity is respected (NMC, 2018). In this regard, Jack was mentioned the way Monica could further hurt and abuse him financially and need for her to be avoided from providing care to him. He accepted the condition and allowed Monica to be avoided any access for caring towards him. As jack was medically fit to be discharged, the nurses and the safeguarding team implemented a password for him to be used so that any unauthorised people do have access to his care plan. Making Safeguarding Personal (MSP) is referred as integral initiative to develop enhanced outcome for safeguarding and caring for people to improve their living and health circumstances (local.gov.uk, 2021).

In order to arrange care for Jack, two informed decision was made following MSP one of which is transferring him to care home for permanent suport. The other care planned is to organise care package of daily support for him for three times a day in meeting his care needs and demands at home. The Department of Health (2010) emphasis allowing patients to make informed decision so that they can receive care as per their preference and develop satisfaction from the support (assets.publishing.service.gov.uk, 2021). In this regard, Jack was provided informed decision regarding both the care and he accept the second care delivery process where he would receive support and care while living at his home. Jack was also asked to mentioned power of attorney (POAs) in place for his financial management to be provided to any trusted person other than Monica or her family. He mentioned the power of attorney to be provided to his daughter who would manage her finances in supporting further care. Jack also mentioned to retain his grandson who is present in the city for his studies to be next-of-kin (NOK) to look after and provide care to him. His grandson was contacted regarding the responsibility to which he effectively mentioned participating to care for his grandfather.

The study by Northway and Jenkins (2017) mentions that safeguarding requirements for vulnerable patients sometimes make the carer develop ethical dilemma. This is because the carer feels the vulnerable adults unable to make effective rational decisions due to their hindered vulnerable condition. However, the Human Rights Act 1998 and ethical principle of autonomy by Beauchamp and Childress (2013) mentions patients to be provided ability to make their own decision through informed way by the carer without interference (Starke et al., 2020; legislation.gov.uk, 1998). Thus, allowing Jack to make the decision regarding POA and NOK on his own is ethically right and avoiding the action would lead nurses to face legal violation. The Normative Decision theory mentions that ideal decisions are those that are made in a given situation through effective rational conditioning (Małecka, 2020). In case of Jack, he mentioned to have stable cognitive and mental condition indicating he has enhanced rational ability to make decision which led to consider that providing him ability to make decision for his care was appropriate by the carer. In contrast, Paternalism is referred to the theory of decision making in which state or authorities make decision against the will of the individuals to ensure better care is provided to them (Nylund, 2020). However, the theory of decision making cannot be applied to Jack as it would lead to violate his autonomy which would ethical issue in care.

The care support planned for Jack was found to be considered positive by both the staff and the patient. This is because the care supported framed followed the key care principles of Care Act 2014 for the patient. Moreover, during the entire care, Jack was kept in the middle of the decision-making process and person-centred care approach was taken in deciding his care. The other positive aspect was that the person responsible for causing financial abuse to Jack was removed from care him with his due permission that was provided rationally due to effective information sharing by the carer. This indicated that beneficence and non-maleficence was focussed to be implemented through care arrangement for the patient. The care scenario has created a positive future approach to be used in managing financial abuse. This is because it mentioned the way patients are to be empowered and involved in making decision to develop safe care for their well-being. Thus, the strategies used in care fir Jack are to be further adopted in care and used in staff training to make nurses and carer understand the way they can develop satisfactory care and avoid financial abuse of the elderly.

Therefore, the essay concluded that nurses have key role and responsibility of assessing the reported concern by the patients to determine their vulnerability, cause and person responsible for abusing them. The decision-making in care for elderly with enhanced cognitive efficiency are to be made by including them in care and providing them information in making the decision. Making Safeguarding Personal (MSP) is integral care approach to create patient-focussed outcome and is to be implemented in deciding care for the patients.

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References

Andela, M., Truchot, D. and Huguenotte, V., 2021. Work environment and elderly abuse in nursing homes: the mediating role of burnout. Journal of interpersonal violence, 36(11-12), pp.5709-5729.

assets.publishing.service.gov.uk 2021, Liberating the NHS, Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216980/Liberating-the-NHS-No-decision-about-me-without-me-Government-response.pdf [Accessed on: 26 October 2021]

Barbosa, K.T.F., Oliveira, F.M.R.L.D. and Fernandes, M.D.G.M., 2019. Vulnerability of the elderly: a conceptual analysis. Revista brasileira de enfermagem, 72, pp.337-344.

CPA 2021, Policies of Ageing, Available at: http://www.cpa.org.uk/cpa/policies_on_ageing.html [Accessed on: 26 October 2021]

Fenge, L.A. and Lee, S., 2018. Understanding the risks of financial scams as part of elder abuse prevention. British Journal of Social Work, 48(4), pp.906-923.

Kempen, A.K., 2018. Elderly abuse-the worst form of disrespect. Servamus Community-based Safety and Security Magazine, 111(4), pp.29-31.

legislation.gov.uk 1998, Human Rights Cat 1998, Available at: https://www.legislation.gov.uk/ukpga/1998/42/contents [Accessed on: 26 October 2021]

legislation.gov.uk 2006, Safeguarding Vulnerable Groups Act 2006, Available at: https://www.legislation.gov.uk/ukpga/2006/47/contents [Accessed on: 26 October 2021]

legislation.gov.uk 2014, Care Act 2014, Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents/enacted [Accessed on: 26 October 2021]

Lloyd-Sherlock, P., Penhale, B. and Ayiga, N., 2018. Financial abuse of older people in low and middle-income countries: the case of South Africa. Journal of elder abuse & neglect, 30(3), pp.236-246.

local.gov.uk 2021, Making Safeguarding Personal, Available at: https://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/making-safeguarding-personal [Accessed on: 26 October 2021]

lordslibrary.parliament.uk 2021, Domestic abuse of older people, Available at: https://lordslibrary.parliament.uk/domestic-abuse-of-older-people/ [Accessed on: 26 October 2021]

Małecka, M., 2020. The normative decision theory in economics: a philosophy of science perspective. The case of the expected utility theory. Journal of Economic Methodology, 27(1), pp.36-50.

Mehra, A., Grover, S., Agarwal, A., Bashar, M. and Avasthi, A., 2019. Prevalence of elder abuse and its association with psychiatric morbidity in a rural setting. Journal of neurosciences in rural practice, 10(02), pp.218-224.

NMC 2018, The Code, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 26 October 2021]

Northway, R. and Jenkins, R., 2017. Safeguarding adults in nursing practice. Learning Matters.

Nylund, A., 2020. Children’s right to participate in decision-making in Norway: Paternalism and autonomy. Children’s Constitutional Rights in the Nordic Countries. Leiden: Brill Nijhoff, pp.201-224.

Phelan, A., Fealy, G. and Downes, C., 2017. Piloting the older adult financial exploitation measure in adult safeguarding services. Archives of gerontology and geriatrics, 70, pp.148-154.

Sadrollahi, A., Khalili, Z., Ghorbani, M. and Mahmoodi, M., 2020. The prevalence of various abuse types and their associated factors in the elderly. Journal of Research and Health, 10(1), pp.59-66.

Sharma, P., 2019. Safeguarding the elderly. Dental Nursing, 15(10), pp.504-505.

Starke, G., De Clercq, E., Borgwardt, S. and Elger, B.S., 2020. Computing schizophrenia: ethical challenges for machine learning in psychiatry. Psychological Medicine, pp.1-7.

ukfinance.org.uk 2021, Financial Abuse Code of Practice, Available at: https://www.ukfinance.org.uk/financial-abuse-code-practice [Accessed on: 26 October 2021]


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