Patient Confidentiality and Addressing Domestic Abuse

The NMC Code of Conduct mentions that confidentiality and privacy of the patient are to be ensured (NMC, 2018). The pseudonym M is used to indicate the patient. M is a 78-year-old female suffering from lung cancer who lives with her married son. M has been a smoker for 20+ years. M was admitted to the hospital due to report of coughing out blood and unexpected weight loss. While providing care, it was seen by the nurses that M had bruise marks on her chest, arms, and legs. The health diagnosis of M reported coughing out of blood was not due to exacerbation of lung cancer, but because of external force that led to cause damage to the M’s windpipe. M reported being physically abused by her son due to her inability to participate in household chores and earn money for living.

The health inequality being focused on is low income. According to the Kings Fund (2015) “Our health is determined by a complex mix of factors including income, housing and employment, lifestyles and access to health care and other services.” This patient is unemployed and receives her main source of income through benefits which she gives to her son to cover her living costs.

The lower-income also creates stress among the family members which makes them neglect and become abusive towards other members of the family (Lugova et al., 2021). This is because lack of money makes individuals unable to meet the needs and demands of their family members along with personal needs required for enhanced living. However, the people with higher income and social status have adequate finances to be spent in arranging required healthcare resources and others which creates lower stress among them and avoid neglect or abusive incident in the family (Hosseinpoor et al., 2018). Thus, lower-income status leads to create health inequality and influences occurrence of abuse in the family.

In case of M, she is found to be living in poverty with her son. M used to work part time receiving a small wage however this stopped when she became unwell. It led the poverty-stricken family facing further financial complications as her son remains the only earner also working on low wage. The lack of finances may have led M’s son and his wife finding it difficult to manage the family and feel M has become a burden. It may have led M to experience abuse from her son so that the additional cost regarding her diet and living can be reduced by making her leave. The abuse led to hindered health of M as it was reported she experienced coughing out of blood due to injury to the lungs. Low income in the family of M Led her to experience abuse and neglect that could be avoided if the family has higher income status leading to create health inequality between the rich and poor.

One of the relevant policies to be included to improve quality of nursing care for M is Safeguarding Vulnerable Adult Policy (SVA). The SVA mentions that the focus of nursing care should be identifying and endeavouring strategic actions to meet the desired needs of the adults to limit their abuse or neglect in the society. It also mentions that every individual has the right to live without fear, abuse and neglect (associationofcarers.org.uk, 2014). This is because continuous harm or abuse in care would lead the adult face worsened health conditions and at times it may be fatal for them. According to this part, the nurses caring for M are required to focus on creating non-abusive living environment for her so that no further injury is received by her which is required for her quality well-being. Consequently, care home facility is to be provided to M as she has no place to live apart from her son so that avoidance of abuse and harm towrads her can be established to ensure improved safe care.

The SVA mentions that safeguarding adults from abuse is the responsibility and duty of all individuals in the care and society (associationofcarers.org.uk, 2014). This aspect of the policy would improve safety of care for M by ensuring all the healthcare staffs are equally contributing to ensure she is provided adequate care without any abuse or neglect while being cared at the hospital. The SVA informs that public awareness must be raised with the help of communities and professionals regarding safeguarding of adults so that each professional can play effective role in identifying as well as preventing neglect and abuse towards the adults (associationofcarers.org.uk, 2014). This aspect of policy impacts to improve safety of nursing care for M by ensuring the professionals have better knowledge regarding the way to limit her from any further abuse and lead life with better well-being.

The SVA policy mentions that preventive actions are to be taken prior to the occurrence of any abuse or neglect. This is because it would help to enhance quality of care for the patients as well as ensure their safety (associationofcarers.org.uk, 2014). As argued by Piri et al. (2018), failure to prevent abuse by taking preventing actions leads to worsened health consequence of the patient. This is because the further abuse deteriorates patient’s health and makes them vulnerable to experience fatal condition. In case of M, the implication of the aspect of the policy would lead the nurses involved in taking prior actions to ensure prevention of any further abuse of the patient.

The SVA policy mentions partnership with communities are to be made to ensure detection, reporting and prevention of abuse among the patient (associationofcarers.org.uk, 2014). This aspect of the policy improves safety of care for M by ensuring multi-disciplinary individuals to be involved from the community in supporting the care to be free of abuse and harm. The SVA policy ensures that caregivers are accountable for caring of adults and maintain transparency while delivering safeguarding care to the adults (associationofcarers.org.uk, 2014). This aspect of the policy on including in nursing care improves safe support for M as it ensures nurses to be accountable to effectively play their role and responsibilities in care so that no concerns are raised that may hinder the well-being of the patient. The SVA policy also informs empowering the patients in making own decision and provide informed consent regarding their care (associationofcarers.org.uk, 2014). It leads to improve safety of nursing care for M as empowering her to report her needs and decision regarding care would make nurses determine the nature of support to be provided to the patient which would avoid inclusion of unnecessary and hindered care support.

The self-management initiative in care helps the patients to have regulation and control over own actions and thoughts to care for themselves without being burden of care (Frankland et al., 2019). The self-management initiative to be taken by M is having positive affirmation in leading life. This is because any form of abuse leads the individuals to feel low regarding themselves and undergo mental trauma which they are unable to forget. It creates self-sabotage of relationships as the abused individuals cannot believe others to access support and involve in self-harm to end life (Ferrer and Cohen, 2019). However, positive affirmative thinking leads the individual who is abused gain power and supremacy over their negative and vulnerable thoughts to develop zeal in rebuilding their own lives with added support (Hughes and Hammack, 2019). Therefore, M by being positively affirmative would be able to embrace self-power and agency in rebuilding personal life with the help of nurses.

The ethical principle of beneficence mentions nurses have role to protect as well as defend the rights of the patients (Ellis, 2020). It relates to role of nurses for empowering patients like M in taking care by making them realise their available rights and way to use them on their own to arrange and ask for care for themselves during any hindered health condition. The beneficence mentions nurses have the role to remove condition which posses harm towards the patients (Butts and Rich, 2019). It relates to nurse’s role to empower patients like M because removing harmful condition which acts as safety issue for the patients makes the patients feel relaxed which makes them realise and use authority along with power to determine the care required by them. Beneficence mentions the nurses have the role to rescue person from any harmful environment to ensure their good health and well-being (Ellis, 2020). It relates to role of the nurse in empowering patients like M. This is because by making the patients like M withdraw from the abusive environment into normal care where they regain ability to use their authority and power for decision-making without fear of being supressed by others. The ethics of beneficence mentions that nurses are to assist people with disability for opportunity to experience enhanced quality care (Butts and Rich, 2019). It relates to the role of nurse’s role of empowering patients as the nurse’s act as assistance for the vulnerable patients in gaining their authority to make decision.

The United Nation’s (2015) Sustainable Development Goal(s) informs to reduce inequality in health and ensure good health as well as well-being of the patients among other goals. The current study concludes that use of Safeguarding Vulnerable Adult policy is effective to avoid and control abuse and neglect towards the adults that helps in fulfilling good health assurance towards the public as goal of the UN. The study concludes that low income and social status act as one of the key determinants of health that influences creation of health inequality and required to be controlled so that reduction of health inequality as goals of the UN can be achieved. The study also concludes that to achieve enhanced health of the patients, safe care is to be ensured which in case of adults can be accomplished through following of safeguarding vulnerable adult policy.

References

• Associationofcarers.org.uk 2014, Safeguarding Vulnerable Adults Policy and procedure, Available at: https://associationofcarers.org.uk/wordpress/wp-content/uploads/2016/07/SVA-Policy-and-procedure.pdf [Accessed on: 11 October 2021]
• Butts, J.B. and Rich, K.L., 2019. Nursing ethics. Jones & Bartlett Learning.
• Ellis, P., 2020. Understanding ethics for nursing students. Sage.
• Ferrer, R.A. and Cohen, G.L., 2019. Reconceptualizing self-affirmation with the trigger and channel framework: Lessons from the health domain. Personality and Social Psychology Review, 23(3), pp.285-304.
• Frankland, J., Brodie, H., Cooke, D., Foster, C., Foster, R., Gage, H., Jordan, J., Mesa-Eguiagaray, I., Pickering, R. and Richardson, A., 2019. Follow-up care after treatment for prostate cancer: evaluation of a supported self-management and remote surveillance programme. BMC cancer, 19(1), pp.1-18.
• Hansson, R.O. and Carpenter, B.N., 2018. Relational competence and adjustment in older adults: Implications for the demands of aging. In Stress and coping in later-life families (pp. 131-151). Taylor & Francis.
• Hosseinpoor, A.R., Bergen, N., Schlotheuber, A. and Grove, J., 2018. Measuring health inequalities in the context of sustainable development goals. Bulletin of the World Health Organization, 96(9), p.654.
• Hughes, S.D. and Hammack, P.L., 2019. Affirmation, compartmentalization, and isolation: Narratives of identity sentiment among kinky people. Psychology & Sexuality, 10(2), pp.149-168.
• Lugova, H., Andoy-Galvan, J.A., Patil, S.S., Wong, Y.H., Baloch, G.M., Suleiman, A., Nordin, R. and Chinna, K., 2021. Prevalence and associated factors of the severity of depression, anxiety and stress among low-income community-dwelling adults in Kuala Lumpur, Malaysia. Community mental health journal, pp.1-10.
• NMC 2018, The Code, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 11 October 2021]
• Piri, N., Tanjani, P.T., Khodkarim, S. and Etemad, K., 2018. Domestic elder abuse and associated factors in elderly women in Tehran, Iran. Epidemiology and health, 40.pp.56-90.

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