Physical abuse: This is any form of harm caused to the body, which may include one or more episodes of aggressive behavior, usually resulting in physical injury with possible damage to internal organs, sense organs, the central nervous system etc.
Sexual abuse: This is when a sexual act is carried out without the consent or understanding of the service user involved. This can include sexual penetration of any part of the body, touching inappropriate parts of the body without informed agreement, sexual exploitation and/or threats regarding sexual activity.
Emotional / psychological abuse: service users being bullied, controlled, intimidated or taken advantage of . Service users needs being ignored, reports of shouting, screaming, swearing, scared of raised voices, distressed, being teased, being humiliated, un respected, not being given choice, opinion, dignity, privacy, being undermined.
Financial abuse: This can be the case when a third party is controlling or spending a service users money. Not being made aware of their own finances, family controlling service users money and not making it available for the service user to use, control of their finances being taken away even if able to deal with them, sudden changes in the service users will, personal belongs going missing, unusual spending patterns, others moving into the service users property. |
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Institutional abuse: This can occur in a care home, nursing home, acute hospital or in-patient setting and can be any of the following – For example, being made to do things not of the service user’s own free will, i.e. under duress, being forced into acts they are not compliant with (or being forced into behaviour they are not happy with) such as set meal times, set bedtimes, freedom restricted.
Self neglect: This is when a service user neglects their own basic needs, such as personal care – not eating/drinking, not taking medication, neglecting personal hygiene, neglecting appearance.
Neglect by others: This can occur when a third party neglects a service user, whether intentionally or via oversight. Neglect can involve not catering for the service user’s basic needs such as nutritional needs, healthcare/hygiene needs, leaving a service user without adequate finances, neglecting medication needs.
Identify the signs and/or symptoms associated with each type of abuse
The indicators or warning signs of abuse can be clues that something is happening in the life of the service user that should be looked into. Some indicators are obvious signs of abuse. Other indicators are subtle, requiring careful observation.
Signs/symptoms of:
Physical abuse – Bruises, Burns, Cuts or scars, marks left by a restraint, imprint injuries (eg., marks shaped like fingers, thumbs, hands, belts or sticks), missing teeth, bald spot in hair (from pulled hair) , eye injuries, broken bones ,sprains, abrasions or scrapes, sudden onset of psychosomatic complaints, sudden difficulty walking or sitting.
Sexual abuse – unusual sexual behaviour, blood or marks on underclothes, recurrent genital/urinary infections, loss of confidence, lack of interest in appearance, sleeping problems, feeling depressed, frequent complaints of abdominal pain.
Emotional/Psychological abuse – changes in the way affection is shown, sudden onset of nightmares, changes in sleep patterns, difficulty sleeping, sudden regression to childlike behaviors (i.e., bed-wetting, thumb-sucking), cruelty to animals, sudden fear of a person or place, depression, withdrawal, or mood swings – any unexplained change in behaviour.
Financial abuse – unpaid bills, no money for food, clothing, or medication, unexplained withdrawal of money from someone’s bank account, family member or representative refuses to spend money on the adult’s behalf, possessions disappear, family member or another person forces an adult to sign over Power of Attorney against their own will.
Institutional abuse – Inability to make choices or decisions, not being offered an advocate when needed, no awareness of own rights, agitation if routine broken, not person centred, care plans not available to service user, strict times for routines which MUST be adhered to, carer/company using policy and procedure as a reason for not doing something for the service user without making an effort to find another way to do it, lack of personal clothing or possessions, denial of visitors or phone calls, lack of privacy, lack of adequate procedures (e.g. for medication, financial management, controlling relationships between staff and service users, poor professional practice, high number of complaints, accidents or incidents. These are all signs that may be shown when institutional abuse is occurring.
Self neglect – Signs shown when self-neglect is happening to a service user are poor personal hygiene, no food in the cupboards or fridge, rapid weight loss
Neglect by others – When services users are being neglected by others signs that this is happening may be, they become ill, hungry, cold, dirty, injured, deprived of their rights and rapid weight loss may become evident.
Describe the factors that may contribute to a service user being more vulnerable to abuse
Vulnerable people may be more susceptible to abuse when carers have made changes to their lives that they are not comfortable with, when there is no family to support them, when they have more than one carer supporting them, when they do not know how/where to make a complaint, when they need more care than they are currently receiving, when their carers become dependent on alcohol or drugs, when living in housing which has no adaptations, are socially isolated or are not aware of their rights.
2. Know how to respond to suspected or alleged abuse
Explain the actions to take if there are suspicions that an service user is being abused
I would firstly observe the service user and if I became suspicious that he/she was being abused I would ask if they are okay. I would next inform my line manager of my concerns and discreetly document my concerns, but I would not ask the service user leading questions.
Explain the actions to take if an service user alleges that they are being abused
If a service user alleges that they are being abused I would need to stay calm, Listen very carefully, ensure that he/she is not in any immediate danger, call for emergency services if urgent medical / police help is required and be aware that medical and forensic evidence might be needed, encourage the person not to wash or bathe in a major incident of abuse as this could disturb medical/forensic evidence. I would next tell the person that they did the right thing in telling me, express concern and sympathy about what has happened, reassure that the information will be taken seriously and give information about what will happen next, let the service user know that they will be kept involved at every stage; that they will be told the outcome and who will do this. Give the service user contact details of somebody that is in a position to help further so that they can report any further issues or ask any questions that may arise. Next I would explain that I must tell my Line Manager, then inform my Line Manager of the situation immediately and explain what I have been told along with my concerns.
Identify ways to ensure that evidence of abuse is preserved
I would begin by making a written record of messages (e.g. answer-phone) to ensure they are not lost (including the date and time and sign them), ensure written records (notes, letters, bank statements, medication records etc.) are kept in a safe place. If this involves physical abuse I would not tidy up, wash clothes, bedding, other items, or try to clear/tidy anything up. I would try not to touch anything unless I have to for the immediate wellbeing of the service user – if I have to I would then make a record of what I have done. If any sexual abuse has been committed I would discourage the service user from washing, drinking, cleaning their teeth or going to the toilet until the police are present. I would then try to ensure that no one else enters the premises (apart from medical staff or necessary people in positions of authority until the police arrive. I would contact my Line Manager to try to ensure that the alleged perpetrator does not have any contact with the service user, record any physical signs or injuries using a body map or hand drawing and write a description of any physical signs or injuries including size, shape, colour etc. I would lastly sign and date my notes and any other records I have made.
3. Understand the national and local context of safeguarding and protection from abuse
Identify national policies and local systems that relate to safeguarding and protection from abuse
No secrets (Department of Health2000)
Safeguarding of Vulnerable Adults policy, (SOVA)
Care Quality commission (CQC)
Mental Capacity Act
Independent safeguarding authority (ISA)
National occupational standards
General social care commission
In safe hands
Local safeguarding children board
Explain the roles of different agencies in safeguarding and protecting service users from abuse
No secrets
Provides guidance to local agencies that have a responsibility to investigate and take action when a vulnerable adult is believed to be suffering from abuse. It offers a structure and content for the development of local inter-agency policies, procedures and joint protocols which will draw on good practice nationally and locally; and encourages partnership working between all statutory, voluntary and private agencies that work with vulnerable adults.
P.O.V.A List
The Care Standards Act 2000 introduced a list for the protection of vulnerable adults known as ‘the POVA list’ which listed care workers who were considered unsuitable to work with vulnerable adults. Section 82(1) of the Act provides that a person who provided care for vulnerable adults must refer a care worker to the Secretary of State if the provider had dismissed a care worker on the grounds of misconduct which harmed or placed at risk of harm a vulnerable adult.
Every child matter
Every Child Matters, the government’s vision for children’s services was published in September 2003 as part of the response to the death of Victoria Climbie. It proposed reshaping children’s services to help achieve the following five key outcomes for children and young people: Be healthy, stay safe, enjoy and achieve, make a positive contribution, achieve economic well-being. It focuses on supporting families and carers and prevent them reaching crisis point and prevent child abuse.
Care standards act 2000
The Care Standards Act 2000 came into effect in April 2002, replacing the Residential Homes Act 1984 and the Residential Homes Amendment Act 1991. The Act set up a new system of national minimum standards for services It established a major regulatory framework for social care to ensure high standards of care and will improve protection of vulnerable people. Implementation led to the establishment of the independent National Care Standards Commission (NCSC).
Quality Care Commission
Established through the Care standards Act, the care quality commission aim is to promote improvements in care via its triple functions of inspection, regulation and review of all social care services. It provides a comprehensive overview of social care in England and works at a local level, at a national level, and across all sectors. Regular reviews of social care provision are published.
General Social Care Council (GSCC)
The Care standards Act also established the GSCC, the first ever UK-wide codes of practice for social workers and employers were launched in September 2002. It is the regulatory body for the social care workforce in England. Their codes of practice provide a clear guide for all those who work in social work, setting out the standards of practice and conduct workers and their employers should meet. They are a critical part of regulating the workforce and helping to improve levels of professionalism and public protection.
Safeguarding Vulnerable Groups Act (2006) barring scheme
The Safeguarding Vulnerable Groups Act (2006) introduced a new vetting and barring scheme for those who work with children and vulnerable adults. The scheme was launched in autumn 2008 and replaced the Protection of Vulnerable Adults (POVA) arrangements. The scheme covers health and social care services. All new job applicants who will be working with children or vulnerable adults must have a Criminal Records Bureau (CRB disclosure) which gives prospective employers information about any criminal records history guiding their decision on the applicants suitability to work with children or vulnerable adults.
The Independent Safeguarding Authority’s (ISA)
role is to help prevent unsuitable people from working with children and vulnerable adults. We assess those individuals working or wishing to work in regulated activity that are referred to us on the grounds that they pose a possible risk of harm to vulnerable groups. There are two principal routes by which referrals are made to the ISA. Firstly, when a person applies for ISA registration, any convictions or cautions which are considered relevant would trigger a referral. The other way a referral would be made is where an employer or an organisation, for example, a regulatory body, has concerns that a person has caused harm or poses a future risk of harm to children or vulnerable adults. In these circumstances the employer or regualtory body must make a referral to the ISA.
Local Safeguarding Children Board (LSCB)
Under the Children Act 2004, each local authority is required to set up a Local Safeguarding Children Board (LSCB). The legislation followed concern over high profile instances of child abuse, such as the Victoria Climbie case. LSCBs are responsible for local arrangements for protecting children and young people. They provide inter-agency guidelines for child protection Where someone has concerns relating to anyone who holds a position of trust or responsibility for children or young people, these should be discussed with and reported to the Local Authority Designated Officer (LADO).
3.3 Identify reports into serious failures to protect individuals from abuse
I have identified two separate reports into serious failures to protect individuals from abuse (below). The first is a link to the tv documentary Panorama and the second is an article reported in the daily mail on 23 November 2011.
http://www.bbc.co.uk/programmes/b011pwt6
The attached link from the BBC Panorama programme show how on the top floor of a special hospital, locked away from their families and friends, a group of men and women are subjected to a regime of physical assaults, systematic brutality, and torture by the very people supposed to be caring for them.
The victims are some of the most vulnerable in society – the learning disabled, the autistic, and the suicidal. In a Panorama Special, Paul Kenyon exposes the truth about a gang of carers out of control, and how the care system ignored all the warning signs.
Daily Mail – article printed 23/11/11 by Daniel Martin, Whitehall Correspondent
Cruelty of the carers: Damning report into home help for the elderly finds neglect so appalling some wanted to die
‘These small acts of cruelty are being enacted, possibly unthinkingly, every day’
Cancer victim, 76, had to struggle to kitchen to heat up a meal – because it was claimed health and safety rules meant home helpers could not operate a microwave
Another patient, her 90s, put to bed at 2.45pm
Read more: http://www.dailymail.co.uk/news/article-2064957/Elderly-people-abused-carers-Neglect-bad-pensioners-wanted-die.html#ixzz23Xe5Hjrp
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Identify sources of information and advice about own role in safeguarding and protecting service users from abuse
My company policies and procedures will outline my specific work role regarding safeguarding and protecting service users from abuse and the mandatory yearly ‘safeguarding of vulnerable adults training will make me aware of the legislations dedicated to abuse, and my role in safeguarding vulnerable adults.
4. Understand ways to reduce the likelihood of abuse
Explain how the likelihood of abuse may be reduced by:
Working with person centred values:
When taking a person centered approach the carer would be working with the service users, discussing their needs and preferences for care. This approach would enable the service user to gain trust in the carer, by having a caring person who they can talk to. The carer would then gain a deeper understanding of the service users preferences and beliefs. Thus, empowering the service user, upholding their rights and beliefs and reducing the risk for abuse.
Read more: http://wiki.answers.com/Q/How_adopting_a_person_centred_approach_which_offers_choices_and_upholds_rights_can_empower_an_individual_and_help_to_reduce_the_likelihood_of_abuse#ixzz23u4FTLNw
Encouraging active participation
Encouraging active participation builds self esteem, therefore the service user will refuse to tolerate abuse and will be more inclined to report it. They are also around other people when actively participating, which will help to build friendships in which they can share things – they may tell one of these friends if abuse should happen, which could lead to the service user obtaining help.
Promoting choice and rights
Service users have a right to dignity and freedom from discrimination. They should be treated with respect and shown that their feelings are considered in the care they receive. Service users should be empowered by being given choices and encouraged to make their own decisions, in this respect the likelihood of being abused by a carer is diminished.
Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse
Promoting choice and rights is also addressed by having an accessible complaints procedure. This may be included in a service user’s ‘welcome’ pack and backs up the service user’s rights, thus enabling the person to know who they can go to with a complaint or concern about any aspect of their treatment or care. This will give the person confidence in being able to file a complaint, who to complain to, the procedure to follow and what will happen when they have complained.
5. know how to recognize and report unsafe practices
Describe unsafe practices that may affect the well-being of service users
This can include a variety of practices, such as, carers not been properly/adequately trained for using equipment (eg hoists etc), carelessness, being too tired to carry out the role correctly, ‘cutting corners’ due to time restrictions, inexperience, faulty equipment being used.
Explain the actions to take if unsafe practices have been identified
If unsafe practices are identified they need to be reported to my immediate line manager so that the person identified can be retrained or the condition remedied to prevent further damage.
Describe the action to take if suspected abuse or unsafe practices have been reported but nothing has been done in response
The national minimum standards (NMS) calls upon all care providers to have whistleblowing arrangements (which my organization also has), which will protect me and my job when I report my concerns. Whistle blowing is about helping people working for an organisation, to raise legitimate concerns or worries about unsafe or bad practices. If my concerns are not acted upon or I feel they have not been dealt with correctly I can pass my concerns on to the Care Quality Commission (CQC) and know that they will respond appropriately. Depending on the severity of my concerns I may feel it necessary to alternatively contact my Local authority safeguarding team or the police.
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