Safeguarding Concerns in Nursing Practice

This essay will incorporate a discussion in two sections. The first part is reflection on my experience in practice where escalation of safeguarding concerns played a significant role in safeguarding a child who is neglected. I have also discussed the responsibility of healthcare professionals such as children's nurses when escalating such concerns. I have applied the Nursing and Midwifery Council's (NMC) reflective accounts form to describe the nature of my experience, reflect on what I learnt because of this and how I could improve for future professional development (NMC, 2018). For those seeking healthcare dissertation help, it is crucial to understand the significance of these reflections in a broader context. The second part of this assignment will provide an emphasis on the importance of escalation during safeguarding and what the current government or delegated authorities have put in place to ensure healthcare professionals escalate safeguarding concerns appropriately.

On my first placement, a child was admitted onto the ward for a planned tonsillectomy accompanied by her mother. The mother did not disclose any social or safeguarding concerns to myself or my mentor. In my opinion, the child presented with poor hygiene and malnourished which raised concerns and I felt uncomfortable with the situation, but I did not feel competent or experienced enough to escalate these concerns and felt that my opinion may not be valid. As a student nurse, I am required to abide by the NMC code which states that I should act without delay and escalate where there may be a risk to patient safety or the public (NMC, 2018). According to the General Medical Council (GMC) (2018), escalating safeguarding concerns involves raising and acting on concerns in relation to patient safety and taking appropriate action. With this in mind, I escalated my concerns to my mentor by informing her about how I felt about how the patient had presented and realised the necessity of escalating safeguarding concerns immediately. After the child’s surgery, the mother did not return onto the ward and therefore safeguarding measures were implemented and a referral was made to social services. I soon recognised that although I lacked experience and competence, it was essential to familiarise myself with local escalation policies and procedures to preserve patient safety as well as lead and manage their care effectively.

The leadership in nursing is referred to influencing others to enhance the care quality along with direct effective participation in clinical care of the patients (McDougall, 2016). As asserted by Christmals et al. (2019), effective leadership in nursing include environment where clarified vision of care is present, as well as the staffs, are empowered and motivated to deliver care. In the current situation, there was effective presence of leadership as I had clarified vision of care to be delivered which is offering support to the girl for tonsillectomy. Moreover, I was empowered in making care decision appropriate for patients through presence of effective information which I did by referring the girl in the absence of her parent to the social services. As argued by McDougall (2016), lack of good nursing leadership leads to hindered patient mortality, lower-quality care and satisfaction to the patient and reduced staff well-being. However, in the situation, there was presence of good nursing leadership as enhanced quality care based on the health condition of the child is provided that improve care quality and satisfaction for the patient.

As a student nurse, I acknowledged that there was a safeguarding concern for my patient in respect of neglect which needed to be escalated. I knew that I should inform someone in a position of responsibility to prevent the child from experiencing significant harm (Green, 2019). For that reason, I shared my concerns with my mentor promptly who then escalated the matter and followed measures as set out by trust guidelines to lead and manage this patient’s care appropriately (NMC, 2018). My mentor was able to check the system to search for any previous concerns and found that the child had missed several hospital appointments. According to the NSPCC (2013), missing medical appointments and follow-up treatment is an indicator of neglecting physical care. A report carried out by Wolfe et al (2014); 'Why Children Die' also highlights this as an indication of poor outcomes in the future for children.

In hindsight, I learned that escalation in relation to safeguarding is crucial when leading and managing care of patients; especially in a hospital environment where paediatric nurses are responsible for assessing the holistic needs of patients (NHS England, 2013). This is because in 2008, a seven-year-old named Khyra Ishaq died as a result of starvation and neglect. A serious case review found that this death could have been prevented if professionals raised their concerns and escalated them accordingly (Bowcott, 2010). Similarly, in 2011, a young boy by the name of Kieron Barley sadly died at the hands of his mother’s boyfriend who physically abused him. A serious case review concluded that this was a missed safeguarding opportunity by health professionals based on previous concerns not being escalated (Oldham, 2017).

In 2007, Baby P also died out of timely and appropriate care support from the nurses to help him avoid getting abused by his mothers and her boyfriend (Shoesmith, 2016). In 2012, Daniel Pelka who was 4years of age died due to abuse from her mother Marius and her mother's partner. In 2010, when a health visitor first noticed bruise on Pelka's head failed to report it as the individual believed the baby feel and bruised. Moreover, when the child was taken continuously for managing fractures in the A&E department the nurses allowed to let her go without taking in steps by suspecting occurrence of abuse (Perera, 2016). These cases led me to now realise the importance of escalation in safeguarding a child in a timely effective manner and despite realising my knowledge is limited, I managed the situation by escalating the issues to my mentor as per NMC guidelines. The guidelines state that as a student nurse you have a responsibility to report any concerns from your practice that compromises the safety of people in your care (NMC, 2019).

Upon reflection, I have learned that nursing does not just focus solely on improving an individual's health concerns but looks at their holistic needs too (NHS, 2015). As a newly qualified nurse, I intend to expose myself to as many instances where escalation is necessary so that I can familiarise myself to the concept and action of escalating successfully. On my next placement, as part of my action plan, I intend to inform my mentor about my willingness to want to learn more about neglect and be part of at least one escalation experience during my time. If this is not possible, I would ask my mentor or colleagues to share their experiences on safeguarding concerns. This will enable me to develop my knowledge and skills in this area as well as lead and manage care effectively and deliver good care to my patients in a safe manner (NMC, 2018). I will also continue to abide by the NMC Code (2018) where I prioritise people and ensure that the holistic needs of my patients are being acknowledged, practise effectively by working within my own competencies and capabilities. Additionally, to preserve safety I am now confident in highlighting concerns and looking at my patients best interests immediately and promoting professionalism and trust by working within a multi-disciplinary team and aiming to fulfil duties within my role as a nurse (NMC, 2018).

The second part of this discussion will focus on neglect in the role of a paediatric nurse. Child neglect is defined as the inability of a parent or carer to meet the essential needs of a child or young person (Bradley, 2017). The NSPCC (2020) also defines agree child neglect as an on-going failure to meet a child’s physical and psychological needs and could be intentional or unintentional. NHS (2018) support these statements and add that neglect includes not being provided with enough food and not being assisted with a change of clean clothes or access to medical treatment. Child neglect is therefore considered as a parent or caregiver depriving their child of their basic needs to survive.

Everyone is born with the right to live in safety, free from abuse and neglect (NHS, 2018). According to Sandeman (2017) neglect is an issue which is commonly occurring and on the rise where there has been a 60% increase from 2012 to 2017. This rise in child neglect has risen stiffly due to substance abuse by parents where the parents responsible to take care of the child are psychologically and economically inefficient to provide appropriate care for the child (Biçakçi et al. 2016). As argued by Schilling and Zolotor (2018), domestic violence leads to child neglect by the parents. This is because the partners show inability to take care of child and abuse to get rid of them. Moreover, partner violence leads the mothers unable to ensure effective care of their child, in turn, resulting the child to face neglect (Sari and Handayani, 2016). In order to overcome the issues, at the present more knowledge and awareness on abuse and neglect of child are being spread and active involvement of police and social services are being done to determine unnoticeable signs of abuse and make intervention to resolve them (Elkin, 2020).

The cases of child abuse are underestimations due to many reasons such as misdiagnosed cause of death, abuse being a contributing factor and cause of death being unexplained (NSPCC, 2020). The UK Office for National Statistics (2019) report that adults cannot always detect the signs of child neglect taking place and cases of neglect can be missed due to the nature and signs of neglect not always being so apparent (School, 2010). Therefore, it is a professional obligation for health care professionals to know the signs of abuse and know what steps to take if they are concerned for the safety of a child or young person (Hocking, 2016).

As a paediatric nurse, the individuals have the role to detect concerns related with neglect and abuse of the child so that they can voice their concerns to appropriate authorities for taking effective actions (NMC, 2015). The support to manage concerns of child neglect is provided by many organisations throughout the UK such as the Royal College of Nursing and NHS England by including the importance of escalating safeguarding concerns within their policies and procedures making registered professionals accountable for their actions (RCN, 2017; NHS England, 2015). Not only does this enable healthcare professionals to safeguard and protect patients, but also provide person-centred care which takes into consideration the holistic needs of a patient (Dean, 2019). As argued by Duron (2018), lack of legal authorities to take actions against child abuse leads children to face vulnerable situation. This is because the children during neglect without the authorities are unable to have required support to take actions against their abuser and avail resources required to overcome the neglected situations to ensure protection and safety.

In the UK, the government have put in policies for professionals of any workforce or background to be able to recognise and tackle concerns regarding neglect and have an organisational responsibility towards child neglect (Citizens Advice, 2019). One of such policy is The Children and Social Work Act (2017) that has enabled health and social care workers to improve decision making, support and look after children, promoted safeguarding through relationship and sex education at school and enabled better learning at local and national levels to improve practice in child protection (Gov, 2017). The activities mentioned in the Children and Social Work Act (2017) to assure child safety are executed by promoting principles of corporate parenting. This is the activity in which local authorities are made to form partnership with service providers and associate childcare agencies to collectively provide care in meeting the needs of the vulnerable and looked after children (Gov, 2017).

The corporate parenting principles mention acting in the best interest of the child, offering children ability to mention needs, taking account of child's care views, assisting children to develop aspiration and career and preparing them to be independent in living during their adulthood to avoid child neglect and promote well-being (childrenengland.org.uk, 2017). As criticised by Hamilton (2017), inability to identify and fulfil the needs of the vulnerable children during their care leads them to feel lack of value and oppressed. This is because the child is unable to report their concerns for which appropriate actions are to be taken in assuring their well-being and avoiding them face harsh condition any further. As argued by Tiyyagura et al. (2017), inability to promote independence of the child makes them have low self-esteem and lack of motivation to live. This is because the children are unable to be self-reliant in taking appropriate actions for their care to ensure safety from abuse and neglect making them feel lack of value towards themselves.

The consequences of ignoring neglect or not being able to escalate concerns regarding child abuse can be learnt from the case of Liam Fee. In the case, it was found that the two-year-old boy's mother Rachel and her partner Nyomi murdered him through continuous abuse and neglect. It was mentioned that Liam's childcarer has reported concerns of abuse towards the child at the Fife Child Protection Committee to execute review and take effective actions. However, they failed to ensure effective care and mentioned the child has been neglected to be reviewed by one of the fife social workers during the court session for the case of Liam (BBC, 2016). This indicates that failure to support concern of the child by childcare authorities during abuse or neglect would lead them to experience fatal condition. Another significant case which involved neglect of a child was the case of Tiffany Wright. Tiffany was a three-year-old child who died from bronchial pneumonia which resulted from starvation as she was often neglected and left in her room; who was then found dead two days after her death (Higgens, 2008). An inquiry was later launched to discover the circumstances surrounding her death and it was found that her parents were responsible for leaving her to die in worst condition by not providing her food and drink. Moreover, no involvement of childcare authorities was found in the incident to support concerns of Tiffany when she was alive (BBC, 2008).

In response to the rising cases of child abuse, the Working Together to Safeguard Children 2018 is framed. This is a statutory guidance issued by the Department of Education which provides guidance on how individual services should assess the needs of a child and provide help, responsibilities of the organisation, multi-agency safeguarding arrangements and safeguarding practice reviews (Department of Education, 2018). This regulation is essential to manage child abuse as without safeguarding from the vulnerable condition such as faced by Tiffany and Liam, the children prone to neglect would be unable to be protected and assured better living condition to ensure their well-being. As argued by Lloyd (2018), failure to create multi-agency working in copping child abuse, the authorities would be unable to deliver safety to the child. This is because the resources required to timely identify and prevent child exploitation would not be available in turn showing failure to assure safe and effective care for the child.

In line with Working Together to Safeguard Children, NHS England (2015) produced a safeguarding policy which supports this legislation and encourages healthcare chiefs to enable professionals on the frontline of care to escalate and address cases of neglect. This policy sets out that local authorities have a duty to take realistic measures to reduce the risk of children in their authorities suffering from ill-treatment or neglect (NHS England, 2019). This is because the frontline workers and local authorities are key professionals who take initial steps to identify and act against child abuse to prevent the child from further deteriorated condition out of neglect or harm. However, social care workers, child carers, childcare organisations and others as seen in cases of Tiffany and Liam if fails to take effective actions would lead the children to face fatal consequences out of lack of appropriate safeguarding (BBC, 2016; BBC, 2008).

The paediatric nurses are also required to provide a child-centred approach in relation to the care of child and focus on their holistic needs in accordance with the Working to Safeguard Children 2015 legislation (NHS England, 2019). This is because it would offer to provide specific care to the vulnerable child in assuring the individual’s safety. In relation to nursing, the Children’s Society state that the implementation of Working to Safeguard Children 2018 legislation helps to prevent the impairment of a child's health or development; with this in mind, nurses and other professionals working with children will be able to receive appropriate mandatory training to notice signs of neglect (The Children's Society, 2019). This would be effective in timely and early noticing of abuse or neglect towards in child, in turn, allowing the healthcare staffs or social workers take effective actions to ensure safeguarding of the child's condition from being worsened. As criticised by Barclay (2019), lack of early and continuous support to children facing abuse or neglect leads them to face deteriorated health condition. This is because different level of need of the child and their families remain unfulfilled that hinders the overall effectiveness of care. In Working to Safeguard Children 2018 legislation, it was seen that appropriate for early and continuum of support for child under abuse or neglect are mentioned which ensured greater safeguarding and health of the child out of meeting of their different care needs (GOV, 2018).

The Working to Safeguard Children 2018 legislation provides information regarding the way referral of any child suffering abuse is to be made by others concerned regarding the incidence to the local authorities (GOV, 2018). This is an effective approach to allow noticing the vulnerable children who out of fear or lack of knowledge may avoid reporting their concern to authorities for availing services to overcome abuse. As criticised by Omar et al. (2016), lack of sharing of information among the social workers often creates risk for them being unable to make timely identification of child abuse or neglect to support the child's concern. This is because without sharing of information make the social workers remain confused and show misjudgement in certain cases to detect child neglect. However, the issue has been resolved through the implementation of the Working to Safeguard Children 2018 legislation as it clearly informed the way to share information by the care workers to appropriately identify, assess and respond to risks of safety concerns for child (GOV, 2018). This strengthens the need to reinforce the protection of patients from nurses by not only assessing and addressing their health care requirements whilst in hospital but also looking at their overall needs too (Dean, 2019).

Safeguarding and protecting children and young people from neglect is never going to be straightforward; especially when signs of neglect are not always apparent (NSPCC, 2019). High profile cases such as Khyra Ishaq, Kieran Barley, Victoria Climbié and Tiffany Wright portray the fatalities of missed opportunities where professionals have failed to protect children from neglect and abuse. My experience as a student which involved safeguarding concerns enabled me to learn about the importance of a nurse being aware of his/her role to meet the safety of my patients and put this into the heart of their perspective and practice. In hindsight, the government and their delegated authorities have come to the consensus that escalating safeguarding concerns and assessing and addressing neglect is all a part of the wider picture in improving patient care immensely (Bernard and Harris, 2016).

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