Bucks Uni NS522: Broadening Perspectives - Safeguarding in Nursing

This report examines safeguarding practices within the context of an adult nursing placement, focusing on a case involving an 84-year-old patient with cognitive impairment and a history of falls. The student utilizes the Driscoll model of reflection to analyze the scenario, highlighting instances of potential negligence and discriminatory abuse related to the patient's care. The report emphasizes the importance of patient-centered care, adherence to NMC guidelines, and the ethical considerations involved in safeguarding vulnerable individuals. It discusses the principles of safeguarding, including empowerment, protection, prevention, proportionality, partnership, and accountability, and how these principles apply to the case study. The report also addresses the Mental Capacity Act 2005 and the Care Act 2014, emphasizing the need to respect patient preferences and prevent harm through effective communication and therapeutic relationships. The student reflects on their own actions and proposes strategies for future practice, including prioritizing patient needs, advocating for their dignity, and collaborating with other healthcare professionals to ensure comprehensive safeguarding measures.

Running Head: BROADENING PERSPECTIVE IN PRACTICE
BROADENING PERSPECTIVE IN PRACTICE
Name of the student:
Name of the university:
Author note:

1BROADENING PERSPECTIVE IN PRACTICE
Reflection in the healthcare setting is demarcated as a process used to review, analyze,
and evaluate the experiences, which is drawn upon the previous learning or the theoretical
concepts. Reflection helps to avoid future mistakes to provide better medical care to the patient
(Mulcahy et al., 2018). In nursing, reflection helps the nurses to accomplish the influence of
taking care of the patient regularly. This essay focusses on the patient which I have encountered
during my adult nursing placement. The main aim of this essay is to evaluate the strategies that
can be used to implement safeguarding in mental health nursing. According to the Nursing and
Midwifery Council (2015), all nurses are required to respect the right of the patient by
maintaining their confidentiality (Tobiano et al., 2015). Hence to support that, a pseudonym will
be used in the essay.
According to Howatson-jones (2016), reflection model assists in identifying the essential
stages which help to improve the effectiveness of the reflective practice (Howatson-Jones, 2016).
This essay is written based on the Driscoll model of reflection which consist of 3 stages which
include, what?, so what?, and Now What?. The drsicoll model is used, as it one of the most
common model used in reflecting the experience with the help of three steps tagt helps in deeper
analysis of the incidents and the action is proposed accordingly.
During my adult nursing placement, I was assigned to take care of a patient who has been
admitted to hospital to the Department of Accident and Emergency as her carer found her laying
on the floor, who stated that she has become more disorganized than the normal. She is an 84-
year-old woman and has the past medical history of cognitive impairment, previous fall, and
osteoarthritis and replacement surgery of the left hip. After admission to the Accident and
Emergency department, she has been referred to the clinical team. The clinical group was
assigned to take care of her urinary tract infection. When the patient had been admitted, he was

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in the conscious state and hence, her son was enquired about the current and the past medical
history of the patient. The patient came to the conscious state after some time but was not able to
move by herself and support to proceed. While taking care of the patient, the nurse used
incontinence pants for the patient as she was not able to move frequently on her own. The pants
use to irritate her, and it agitates her, and she has stated this to her nurse twice, but the nurse did
not take it seriously. After some time, it is observed that the patient has been affected by urinary
tract infection. When his son got to know about this, he was outraged and stated that her mother
is allergic to those pants which have been mentioned in the paper he has provided in his past
medical history section.
This reflection is focused on the safeguarding issue to evaluate the way of treating a
patient. Safeguarding is well demarcated as the measures which are used to protect the mental
and physical wellbeing of the child and the adults and to protect their human rights to provide
them with an environment where they can live their life free from harm, neglect, and abuse
(Northway & Jenkins, 2017). There are mainly six principles of the safeguarding, which should
be followed to ensure the safeguarding of the patient. First is empowerment, where the
individuals are provided with support and are also encouraged to make their own decision, or
before making any decision, the informed consent of the patient is taken. Second is protection
where the individual or the patient in this case who are in the greater need should be protected.
The third is prevention, where the risk factor is to be considered and is minimized or avoided
before; actually, the harm occurs. Fourth is proportionality, where minimal intrusive response
and the appropriate proportionate is provided for the risk. The fifth is a partnership, where the
care of the patient also includes solutions to the abuse and negligence from the local service

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centre and communities. Sixth is accountability, which encourages transparency and accounting
of the delivery of the safeguarding. (El-sol & Mohmmed, 2018).
Here, it is observed that the patient was at the risk of harm because of his cognitive
impairment. The environment in which the patient is unfamiliar to him also and the surrounding
is also not very much supportive. In the scenario, the safeguarding has been the issue has been
arising as the patient has not received proper treatment. The patient has received undignified and
degrading treatment, which was not appropriate and also degraded the further health of the
patient (Dresser, 2018). The harm which has occurred to the patient could be avoided if the nurse
had listened to her ad had provided a better care plan to her. The categories of the abuse
according to the safeguarding issue has been included in the case study is the negligence as the
concern of the patient has been neglected in the scenario and also the discriminatory abuse, based
on her moving disability and due to her cognitive impairment (Hood et al., 2017). In the health
care treatment, it is unfair to treat a patient based on their sex, age, mental status and disability as
it can lead to poor treatment of the patient (Reichenberg & Seligman, 2016). In the scenario, I
realised that the patient needs safeguarding to get proper treatment from the patient. From the
situation, it can be stated that the patient has received negligence and discrimination based on her
disability, which should be prevented according to the fifth principle that is the partnership of the
safeguarding. Partnership ensures that patient care should also include a solution to the abuse and
the negligence. The concern of the patient has been neglected as according to the general
practitioner the patient is not able to decide on her own due to her cognitive impairment and
hence ignored her concern which leads to harm of the patient. The age and the disability of the
patient are also considered as a factor due to which they ignored the need and preferences of the
patient. It is considered as an issue under the anti-discriminatory and safe healthcare practice.

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The other healthcare act which opposes the action taken by the healthcare practitioner in the
scenario is the mental capacity act 2005, according to which the consent of the patient is taken
into consideration as well as the patient is said to be mentally stable until it is not proved by the
mental assessment by the criteria of DSM5 (Kong & Keene, 2018). By observing the situation of
the patient, I realized that the age of the patient is 84 and is also suffering from a cognitive and
moving disability, but that does not mean the need and the preferences of the patient should be
neglected and discriminated. Assuming on its own that the patient is not able to make any
decision related to her treatment is against the principle of the safeguarding. It is imperative to
include the concern of the patient in their treatment to speed the recovery process of the patient
(Arakelian et al., 2017). If the preferences and need of the patient are added in to the care plan of
the patient, future harm can be prevented. In the case, apart from asking the carer and her son,
the patient should also be involved in the care plan. In the scenario, the carer is only asked
regarding the fall of the patient, but the patient has not been asked about the fall by saying that
the patient is unconscious. Even though the patient is unconscious, but it is the responsibility of
the general practitioner to ask her about the fall (Merriam & Grenier, 2019). She might have
provided better knowledge regarding the fall. Although involving the family of the patient seems
to provide benefit to the patient care, but it does not mean that the need and the preferences of
the patient should be neglected (Silverman, Kurtz & Draper, 2016). According to the care act
2014, the individual can take care of their wellbeing better as compared to any other individual
as it takes care of the feeling, wishes, beliefs, and views of the individual suffering from the
disease (Penhale et al., 2017). The care act (2014), suggests that the safeguarding issue of the
patient becomes exceptionally prominent when the patient is neglected or discriminated.

5BROADENING PERSPECTIVE IN PRACTICE
From the above scenario, it is observed that initially had been judged due to her
disability. I realised that such an issue might lead to an adverse effect on patient treatment and
hence, should be avoided. I felt that the need and preferences of the patient should be considered
even if the patient is suffering from cognitive impairment. I realised that assuming things or
stereotyping the patient might hamper the care plan and thus, should be avoided.
Being a nurse, it is my responsibility that the safeguarding issue of the patient is to be
considered. According to me, the best safeguarding action which I should find in this scenario is
preventing the harm of the patient as well as by considering the safety, need and preferences of
the patient in the care plan. From this, I also understood that to safeguard the patient; it is crucial
to maintain a therapeutic relationship with the patient. To maintain a professional therapeutic
relationship with the patient, communication, engagement, and interaction are required (Dooley,
Bailey & McCabe, 2015). Apart from that, I will at first consider the need and preferences of the
patient through effective communication, and after that, the concern of the family and friends of
the patient should be addressed. The NMC (2015) states that every nurse should empower the
patient and should encourage themselves to take part in the decision related to their treatment
(Fischer, 2017). Apart from these the NMC (2015), also suggest that all the appropriate
information regarding the treatment of the patient should be provided to the family of the patient
and along with that the consent of the patient should also be taken into consideration (Beattie et
al., 2018). I also acknowledged that the provision of the NMC focusses on the ethical principle
for the autonomy of the patient. It also suggests freedom of choice for the course of treatment to
the patient. I learned that the nurse should involve herself in the treatment of the patient to
provide patient-centred therapy to the patient. According to the Tobiano et al., (2016), the

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patient-centred care is the process of delivering better treatment to the patient which is focused
on the need of the patient and also encourages the patient to make their decision.
As a nurse, I will take care of the patient and also serve as a messenger between the
patient and the clinical team. As according to the NMC (2015), it is the responsibility of the
nurse to work with the other healthcare professionals who are one of the safeguarding issues also
that the healthcare professional should work in collaboration with other healthcare professional
and with the patient (Shepherd, 2017).
From the above scenario, I learned that stereotyping the patient might harm the future
health of the patient. Hence, in future treatment, I will never stereotype the patient based on their
physical and mental status. I will engage with the patient by the help of effective communication
to learn their needs and preferences and then intervene based on that. I will advocate for the
respect, dignity, and privacy of the patient and along with the other healthcare professionals to
ensure the safeguarding of the patient. I will also convey every information with the clinical team
to avoid any confusion. I will also update myself with the new policies and laws of the nursing
practice. I will never neglect or discriminate the patient. To conclude, reflective practice helps
me to understand the importance of safeguarding and how it can be applied in the nursing
practice.

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