Safeguarding adults at risk understand neglect and how to promote care and compassion.

Officially, neglect is a form of abuse. Government guidance states that abuse can be 'neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating' ( Department of Health (DH) and Home Office 2000 ).

Frailty and its significance in older people's nursing.

The term frail is commonly used to describe older people, but reports on the care of older adults in hospital highlight that the clinical implications of frailty are not understood fully by all nurses. Frailty can be an indicator of older people's health status and healthcare needs. An understanding of frailty and its mechanisms will help nurses to determine care priorities, particularly the urgency for anticipatory, proactive, preventive and compensatory care to prevent unnecessary mortality and morbidity. This article discusses the significance of frailty in older people's nursing. It highlights the responsibility of registered nurses to recognise deterioration in health as a result of frailty and to implement appropriate interventions.

It is essential to support carers.

I read with interest the article about the launch of Kent County Council's Carers' Emergency Card (Nursing Older People, February 2009).

The concept of frailty and its significance in the consequences of care or neglect for older people: an analysis.

Older people, and particularly those of advanced age, become increasingly vulnerable to the consequences of abuse or neglect and, since the birth of specialist services for older people, researchers and clinicians have sought to understand the reasons for this. Multi-agency work across the UK is developing innovative strategies, protocols and tools to support investigation into situations of possible neglect in formal care settings. Emerging within this work has been a dilemma concerning which terminology should be used to most accurately describe care in specific situations, for example should care be described as 'inadequate' or 'poor', or as 'neglect'. One key element in this decision is the consequence, or consequences, of the care for the vulnerable person, i.e. its impact on the individual. Because of the complex changes which accompany ageing, and particularly older age, this is not straightforward. Is a person's health deteriorating as a consequence of ageing or disease? Are factors such as mental state or motivation impacting on their health? Is this the trajectory that their health would naturally follow? Or is the deterioration a direct consequence of the care that they have, or have not, been given? And, if so, to what degree? Identifying ways of addressing these questions could support the development of a lexicon of terms and definitions which could be used to accurately define specific categories of neglect in specific circumstances.This paper describes the practice based dilemmas that prompted this work. It briefly sets a historical context for contemporary understandings of the mechanisms that render older people particularly vulnerable to the effects of neglect. Some perspectives on defining neglect are offered. The paper then outlines the findings of a literature review and concepts analysis of the term frailty. It offers a new definition of frailty and explains the theoretical approach within which this nests. The paper concludes with a discussion on the implications of frailty as a consequence of care or neglect for older people.

The development of the West Sussex institutional care neglect risk assessment tool: a reflective analysis using Mezirow's transformative learning framework.

The protection of vulnerable people is becoming more understood internationally, and in the UK standards of care for frail older people is now receiving appropriate attention (CSCI 2009, The state of social care in England 2007-2008. Commission for Social Care Inspection, London). Although many people continue to live in their own homes, even when they are very frail, many receive long term care in institutional settings, and are dependent on the standards, practices, belief systems and culture of the staff who care for them. As society becomes more intolerant of sub standard services, more adult protection investigations are being carried out to establish whether frail people are being neglected. Within West Sussex England, the multi agency safeguarding team addressed the dilemma of how to assess the risk to other residents in a formal care setting, when concerns had been raised about a small number of people who are resident in that place. The Consultant Nurse, used intuitive and craft knowledge, including examination of clinical evidence as audit data, collected as part of her practice, to examine how to assess the risk to others in formal care settings where care had been identified as neglectful for some of the residents. This paper uses the reflective framework of Mezirow transformative learning theory (http://en.wikipedia.org/wiki/Transformative_learning) to examine the development of a neglect risk assessment tool and highlight the issues identified by a consultant nurse in examining concerns about poor care and neglect in formal care settings. The final section of the paper describes the new Neglect Risk Assessment Tool developed in West Sussex, England, and offers case examples illustrating its use in practice.

Shifting the focus: outcomes of care for older people.

Internationally there is commitment to work towards eradicating the abuse of older people and to develop services that promote their equality, dignity and human rights. The emphasis on service users is gradually increasing and, along with this, the focus within health and social care policy, service provision and professional practice is shifting. In UK health and social care policy the emphasis on service structure and provision is being replaced by a focus on outcomes for service users, including outcomes which patients themselves evaluate. The focus of UK Adult Protection services is also shifting from intervention to prevention through developing greater understanding of the factors which contribute to abuse, changing attitudes towards entrenched poor care, identifying preventative services and safeguarding vulnerable adults. Nursing literature is also beginning to acknowledge the evolution of an outcomes focus. This paper discusses the shifting emphasis in UK health and social care in the safeguarding of vulnerable people and in nursing practice. It offers an overview of literature on outcomes. The paper then describes a research study which sought to identify outcomes of care for older people living in UK care homes. The outcomes framework developed through the research is offered, along with a discussion of the advantages of an outcome-focused approach to care and some of the remaining challenges. A case example is offered to illustrate an outcomes-focused approach. Finally, the paper draws conclusions on how shifting the focus of care delivery from traditional problem-orientated approaches and ritualized practice towards the outcomes of care that individual older people choose and evaluate for themselves offers potential towards eradicating abuse and neglect in formal care settings.

Death duties a responsibility too far?

In the areas of acute surgery and medicine, the changing role of the nurse, which is constantly developing and being extended in order to accommodate the reduction in junior doctors' hours, is well documented. But the new roles being forced upon nurses who work in nursing homes go unnoticed.