Models of Nursing for Safeguarding Vulnerable Adults

The articles chosen to be evaluated, compared, analyse and reflected upon are Nursing models and Contemporary Nursing: their development, uses and limitations, Nursing models and contemporary nursing: can they raise standards of care and lastly Safeguarding vulnerable adults. The reasons for selecting the topics above are based on exposure to the subject matter in university and familiarity with the safeguarding vulnerable adults during the many years spent working as a Health Care support worker within the community. Most of all, the ultimate reason choosing these topics is sheer interest in finding out how effective the usage of these integral topics can improve holistic nursing practice and give the service user or patients a better experience. Supporting evidence for this report were sourced from various mediums i.e. Through the internet and from credible websites such as the Royal College of Nursing, Nursing Times and article catalogue banks such as CINHL and Medline.

Murphy, F; Williams, A and Pridmore, J (2010) Nursing models and contemporary nursing 1: their development, uses and limitation. Nursing Times 15 June, 2010, vol 106, No 23pp18-20.

Pridmore J et al (2010 Nursing models and contemporary nursing 2: can they raise standards of care? Nursing Times 21st June, 2010 Vol 106, Number 24.

These articles are suitable for the education, training and informing Healthcare Professionals about the prominence of their field. The articles are presented in a good and coherent fashion, this makes the reading experience enjoyable. The two-part series analyses the worth of nursing models and deliberates whether the essential concepts, principles and ethics about nursing in these models are pertinent to contemporary procedures. This first article provided an outline of nursing models; how and why they were established; and some poignant criticisms. The second article examined the models in the framework of modern nursing practice, with specific attention placed on current initiatives intended to reform nursing and to improve the standards of care.

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The authors of these articles are experienced and seasoned professionals in their fields of expertise. Fiona Murphy, for example, is a nurse who has held clinical positions as a Sister, staff nurse and clinical teacher in acute hospitals nursing all over the United Kingdom. She has taught and lectured at the University of Swansea since 1992 and worked on a variety of undergraduate and post graduate nursing and midwifery programmes. (Dockerty, 2013) Julia Pridmore, is also a Nurse Lecturer and programme manager for BSc (Hons) Health and Social Care at the University of Swansea. Julia has been a practicing nurse since the 1980s. She specialises on quality improvement, governance and patient safety (Pridmore, 2010). Their experience in practice and teaching combined, validates their knowledge of the subject and also authenticate the issues raised in the articles.

The authors, gave a very insightful historical background about the technological boom which triggered the development of nursing models in the early 1960’s in the United States, but it failed to examine the reasons why it took more than a decade for the same to be adopted in the United Kingdom. One could be identified with the difficulty in acclimatizing to an entirely different concept, but the impediment to change as described by (Kenny 1993) ‘reflecting on the approach and attitude towards change and the bureaucratic environment of the NHS, also questioned if models really stood any chance at all’. This statement speaks a lot of volumes but completely void of proofs or facts. The National Health Service have been a driver for change and modification since inception. The Nurses Act of 1949, for example was established to modernise the role of nursing by providing the catalyst for modification to nursing education and training, 1940s and 50s saw nurses uniform begin to become more standardised, in 1955 the nursing auxiliary or nursing assistant role achieved formal recognition and Enoch Powell’s Hospital Plan recommended that teaching hospitals should act as district general hospitals and that student should be taught where patients required treatment in 1962. Prior to the adaptation of models in the United States the National Health Service was in its twentieth year of reformation, one can conclude Kenny 1993 quote on attitude to change and bureaucracy within the environment of the NHS is possibly a hypothesis.

Secondly, there were numerous complications in developing the models, the smallest of which was an absence of a definition of nursing. This led to Henderson’s description being regularly quoted, and it shaped the foundation of vast majority of deliberations. There were also calls to go back to the ideas of Florence Nightingale. Henderson defines both the independent and the co-dependent features of nursing practice, and stipulates the affiliation between nursing and medicine. This difference between independent and co-dependent practice is vital to appreciating the intricacy of nursing and its specific influence inside the multi-disciplinary teams within a health care setting. Nightingale’s emphasis on the advancement of health and healing as separate from the treatment of disease, and the harmony of the individual, well-being and the atmosphere, remain essential to contemporary explanations of nursing. Both philosophies and ideas resounds clearly in the models, a good indication of the advancements and strides made since the days of Florence Nightingale. In hind sight, going back on the ideas to reflect the idle of Florence Nightingale would be a complete retrogression, but rather using models as a framework to guide and reform the delivery of care and will directly improve the experience of the patient thereby affirming the professional outlook of the nurse within the healthcare setting.

Betts V; Marks-Maran, D and Morris-Thompson, T (2014) Safeguarding vulnerable adults. Nursing Standard. 28, 38 P37-41.

This article is suitable for the teaching, preparation and informing Healthcare Professionals about the importance and efficacy of safeguarding the vulnerable within the confines of the hospital and beyond. The article is presented in clear and comprehensible manner, this makes the reading experience very pleasant. The article examines more or less the matters surrounding safeguarding vulnerable adults, it reviews some of the correlated legislation and literature, and outlines the responsibilities of authorities or those who care for these patient groups. The article reveals how one hospital that is specialised in caring for individuals with early-onset dementia, Huntingdon’s disease and alcohol-related brain damage who need supplementary care, has provided staff with fitting evidence-based facts about safeguarding adults.

The authors of this article are knowledgeable and experienced authorities in their fields. Virginia Betts Previously a staff nurse at Forest Hospital, Nottingham and presently health visitor student at Derby University, Diane Marks-Maran is an honorary professor of nursing at Kingston University, London and St George’s, University of London, lastly, Trish Morris-Thompson director of quality and clinical governance at Barchester Healthcare, London. Their involvement in practice and education authenticates their understanding of the theme being examined i.e. Safeguarding Vulnerable Adults and also substantiate the issues raised in the article.

This is an evidence based literature which draws lessons and references from current events in Winterbourne View Hospital and Mid Staffordshire NHS Foundation Trust. This article failed to explore in to details the avenues of trainings, retraining, and refresher courses to ensure staff and healthcare professional are constantly reminded of the importance of safeguarding the vulnerable. Although, Nesbit’s warning that no structure or system of safeguarding would be able to pledge with certainty that abuse would certainly not transpire (Nesbit 2013) is completely a valid argument. It also very important to raise, continuous trainings and adequate reminders are the key to keeping this all important subject current and relevant to the healthcare professional. With the view of avoiding a repeat of the happening of Winterbourne View and Mid Staffordshire NHS Foundation Trust, the issue of training, retraining and refresher courses cannot be over emphasised.

Research and policy guidance advocates compulsory trainings for care home proprietors and executives in view of safeguarding responsibilities. ‘No secrets’ (DH/Home Office, 2000) also mentioned that all organisations must train all employees and volunteers at all levels of hierarchy within their agencies, organisation or companies, with respect to their responsibilities in the adult safeguarding procedures and processes. Kalaga and Kingston (2007) referred to the commendations of the enquiry into the delivery of services for individuals with learning difficulties at the Cornwall Partnership NHS Trust which specified that the Trust must: ‘as a priority, develop a programme of training, supervision and support for all staff which helps them deliver care in accordance with the principles of the Valuing People strategy’. (CSCI/Healthcare Commission, 2006, p 69) Organisations must ensure a safe environment in which all employees are trained in safeguarding, and authorities such as managers, supervisors and even team leaders be responsible for systematic official checks of the organisation’s safeguarding procedures, policies, processes and practices.

In essence, the evidence presented for Forest Hospital in Nottingham inaugurated in 2013 to deliver expert care for individuals with early-onset dementia, Huntingdon’s disease and alcohol-related brain injury is exemplary, the institution have gone through a great deal of meticulous planning to encourage the retention of information and training pertaining to safeguarding. All employees new to the establishment obtain an information guide and commence e-learning induction sections on safeguarding vulnerable adults, followed by team deliberations on some of the subjects raised on the materials and guides given, and the sections. Throughout the segments and group studies, employees are familiarised with and well-versed on safeguarding vulnerable adults.

Responses, feedbacks and questions are given in writing and verbally from employees and shown that employees who had never worked in care homes or anything similar to care found the training on safeguarding adults educational and easy to comprehend. Employees identified that they valued the chance to utilize the learning tools on safeguarding adults in group discussions. They also mentioned that it was extremely beneficial having a written document to which references could be made when needed. This method of training is entirely innovative and worthy of emulation by every institution and NHS Trusts.

The only criticism about the training method in Forest Hospital is the fact the authors provided no detail concerning its frequency. It is vital to note, some of the issues in Mid Staffordshire NHS Trust according to the HealthCare Commission was not due to lack of training but rather lack of adequate training. As a firm believer in learning, unlearn and relearning, training a healthcare professional once or maybe twice in his or her career is not enough. Safeguarding just like manual handling require expiration in its certification. This will enable a continuous assessment of employee knowledge and practical skills with respect to safeguarding thereby delivering exceptional service to the patient.

In retrospect, one could say the article on Safeguarding focused mainly on physical abuse by so doing leaving a lot of safeguarding issues unaddressed. Abuse may be physical, psychological, financial or material, sexual, discriminatory, or an act of neglect or an omission to act. For example the involvement of exploitation and mistreatment is likely to have a major impact on a person’s health and wellbeing. By the very nature exploitation and utter abuse of power by one person over another has an enormous impact on a person’s independence and most times depresses their individualities, which are a breach of the rudimentary ethos of the Healthcare profession. Neglect on the other hand, was not mentioned, but it can stop an individual who is reliant on others for their fundamental necessities, exercising choice and control over the basic needs of life and can cause embarrassment, humiliation and loss of self-respect. All vulnerable adults have the right to be assisted to make their own choices and to give or deny consent on whatever they please, be it activities or even services. Consent is a strong sign of a readiness to partake in an activity or to receive a service. It may be gestured, verbal agreement, or in writing. No individual can or should give, or refuse, consent on behalf of a different adult except exceptional provision for specific purposes have been made and it generally by law.

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The main struggle dealing with abuse of vulnerable adults is knowing that it exists, because it’s multifaceted nature. DeHart et al (2009) cross-examined nursing home employees, policy makers and health care professionals to detect training needs of employees. They discovered that those at risk of abuse were residents who are silent, confused and incapable to communicating or those who have few visitors, as well as those who are non-compliant or with challenging behaviours. They proposed that one of the employees capabilities must be the skill ‘to identify residents’ vulnerabilities that increase the risk of their being mistreated’.

A key United Kingdom survey of more than 2000 individuals of age 66 and over living in private accommodations and households discovered a variety of risk factors, precise to the category of abuse: The risk factors for neglect encompassed being female from 85 years of age, in bad health or depression and the prospect of being in receipt of, or in touch with, services. The risk of financial abuse amplified for individual living alone, in receipt of services, in bad or very bad health, older men, and women who were divorced or separated, or lonely. The risk of relational abuse (physical, psychological and sexual abuse combined) was greater in women aged 66–74 (O’Keefe et al, 2007). O’Dowd (2007), in reporting on the above research, recommended the discoveries on risk factors, citing that it should be used by local authorities to observe and act on abuse by directing assistance where it is wanted most. Appointing full-time safeguarding leads or introducing training for all staff i.e. relevant training for all new staff, from auxiliary to consultant level, as part of its induction programme, and another where training is consolidated at handover times to keep it refreshed and serve as a constant reminder at all time.

On the Aspect of Nursing Models, Nurses do require a theoretical framework to serve as a guide and support. This is predominantly so now that we confronted economic, demographic and communal variation that will possibly “value the nurse out of the market”. Devoid of using theory to define what nursing is and does, it would extremely stress-free to demote the role of the Nurse to nothing else but just elementary tasks, when nursing is as a matter of fact, a multifaceted, vibrant and thought-provoking role demanding the mixture of understanding , knowledge, skills, familiarity and theory. The usage of nursing theories such as models assist nurses to make the difference amongst the contributions of the medical, nursing and other healthcare professionals and establish the worth of the nurse.

Nurses are acquainted with problem-solving methods such as ASPIRE (Assessment, Systematic nursing diagnosis, Planning, Implementation, Recheck and Evaluation). However, methods like this guides in care planning, they are short on detail on how to do it. For example, a problem-solving procedure is less likely to outline questions needs asking in the course of an assessment or the interventions to be made. Nursing model can drastically improve the methods of assessment and deliver better care. (Barrett et al, 2012)

Models can play a variety of roles in the career of the nurse. Take for example, the newly qualified nurse, a model will be a very import framework for the care planning process. A proficient nurse will have the ability cultivate their own diverse model, grounded on the fundamentals of different theories that fits their methodology and framework of care.

In conclusion, nursing continue to offer challenging roles in dynamic, evolving healthcare environments. However, the competitive workforce means that in order to first attract and then retain nurses, Authorities in Healthcare needs to ensure that practices are contemporary and innovative. It is also important to recognise that Nurses are part of a broader healthcare team and it is appropriate that to consider and assess the best way to work with other healthcare providers to provide quality patient care now and into the future.

Safeguarding adults is everybody’s business. Statutory agencies and all who work with Vulnerable Adults have the responsibility to safeguard the wellbeing and safety of Vulnerable Adults in different ways. “Safeguarding” when viewed in its wider sense of promoting the safety, wellbeing and opportunities of adults forms part of core business for all statutory agencies, for example, ensuring health and patient safety is the NHS responsibility, promoting independence and wellbeing is the responsibility of Adult Social Care, and protecting people from harm is the responsibility of the Police. For all professionals, “safeguarding” in its wider sense is part and parcel of everyday working life. However, it also refers to a very specific area of work- the reactive inter-agency response to protect Vulnerable Adults who are at risk of significant harm through abuse by another person or persons. Empowerment and choice need to be at the core of safeguarding policy and practice; this means working to enable adults at risk to recognise and protect themselves from abuse. It also means taking a risk enabling approach within services and ensuring that people who use services have genuine choice both of and within services.

Bibliography

Dockerty, R. (2013). Swansea nurse lecturer writes ‘Major Works’ book.Swansea University, Swansea nurse lecturer writes ‘Major Works’ book. [Online]. Available at: http://www.swansea.ac.uk/humanandhealthsciences/news-and-events/latest-news/swanseanurselecturerwritesmajorworksbook.php [Accessed: 6 November 2014].

Pridmore, J. (2010). Julia Pridmore. Nursing Times, Julia Pridmore | Nursing Times. [Online]. Available at: http://www.nursingtimes.net/julia- /148596.publicprofile [Accessed: 6 November 2014].

Choi, N.G. and Mayer, J. (2000) ‘Elder abuse, neglect, and exploitation – risk factors and prevention strategies’, Journal of Gerontological Social Work, vol 33, no 2, pp 5–26.

DeHart, D., Webb, J. and Cornman, C. (2009) ‘Prevention of elder mistreatment in nursing homes: competencies for direct-care staff’, Journal of Elder Abuse & Neglect, vol 21, no 4, pp 360–78.

Department of Health (2010) Prioritising need in the context of Putting People First: a whole system approach to eligibility for social care – guidance on eligibility criteria for adult social care, England 2010, London: Department of Health.