Protecting the Vulnerable: How Nurses Must Place Patient Safety at the Forefront of Practice

Nurses work with many vulnerable populations. It's our job to care for these patients with sensitivity, skill, and above all use - protection. Discover the definition of vulnerable patients, recent headlines, and strategies to keep your patients safe. Specialties General Specialties Article

Protecting the Vulnerable: How Nurses Must Place Patient Safety at the Forefront of Practice

Nurses care for vulnerable populations each day. Patients might be considered vulnerable because of economic, social, or political standings or because of an illness or disability. Regardless of the reason for the patient's vulnerability, it’s the nurse’s role to care for these patients with sensitivity, skill, and above all us - protection.

Breaking Headlines

If you’ve watched television in the past week or so, you probably saw a story about a nursing home patient who gave birth to a baby at the end of December. When this story first circulated, there were questions about the patient’s mental capacity and who might be the father. A few days after the initial coverage, a nurse, Nathan Sutherland, was arrested and charged with assault and abuse of a vulnerable adult. Sutherland cared for this patient in the nursing home and willingly took a DNA sample, which is allegedly a match with to the patient’s newborn baby boy.

As this story unfolded, questions flooded the minds of people across the country. How does this happen in a facility where care providers are working around the clock? What systems failed to protect this patient? And, how can a patient in a long-term care facility deliver a full-term baby, but no one seems to know that she was even pregnant?

The answers to these questions aren’t available yet. However, as nurses, it’s our duty to learn from these situations and consider what patients, family members, or loved ones might be susceptible to the same or similar behaviors at the hand of healthcare providers.

Vulnerable Patients 101

Our healthcare culture might have us more concerned about reimbursement models, readmission rates, and patients with comorbid conditions over those who can’t speak up in the face of abuse, neglect, and general misconduct. Definitions of vulnerable patients vary based on organizations, locations, and use of the system. One population might be considered vulnerable in one setting, but doesn’t meet the definition in another.

A few populations that are generally considered to be vulnerable include:

  • People 60 years or older with physical, mental, or functional limitations in their ability to care for themselves
  • Adults 18 years of age who:
    • Are unable to make medical decisions and might have a guardian
    • Live in a nursing facility, rehabilitation center, group home, or other facility licensed by a state
    • Have developmental disabilities
    • Receive in-home services such as hospice, home care, or individual providers
  • Children under the age of 18

Making Sense of the Dichotomy

At the end of 2018, nursing was selected as the most trusted profession again for the seventeenth consecutive year. Nursing has earned this designation because this is how the general public views nurses - trusted. Why are we so trusted?

Nursing staff help bring babies into the world. Often nurses are there when the aged, ill, and injured take their last breaths. Imagine any significant life event in the middle of birth and death, and there is probably a nurse supporting, caring for, or educating patients, family, and other caregivers. Nurses speak up when patients have no voice. They fight for the wounded and underprivileged. Yet, this incident happened in a facility filled with nurses.

How does this dichotomy live on the spectrum of nursing? I must admit - this story has been hard to understand. And, while it’s essential we remember that Mr. Sutherland hasn’t been found guilty at this time, this situation can make you lose a little faith in humanity.

However, being an optimist (most of the time), I feel that this is an excellent time to review ways to keep vulnerable patients safe.

Safeguarding Against Abuse and Neglect

There are a few things all nurses caring for patients can do to ensure you’re keeping those entrusted into your care safe at all times.

Learn the signs of abuse

The symptoms of abuse are different depending on what’s happening. Having stellar assessment skills is one of the best ways to protect against any form of abuse. If you notice new bruises, injuries, burns, or a change in the patient’s reaction to care, this might be a sign that something out of the ordinary is happening.

If patients are being neglected, you might notice weight loss or gain, poor dental and physical hygiene, and the presences of new pressure sores. When neglect is happening, patients may wear the same clothes for days at a time, even when they are torn or visibly soiled. You might also notice changes around food, such as begging or scarfing down food as though they haven’t eaten in quite some time.

Speak Up

If you suspect neglect or abuse of a patient, it’s your responsibility to speak up right away. If you’re in a facility, bring your concerns to your manager or the Director of Nursing. When caring for patients in the community, know your employer’s policies and when you should contact the police or other agencies such as adult protective services or children services.

If you’ve ever had to file a report of suspected abuse or neglect, let us know about the situation in the comments below. Do you have other ways nurses can protect vulnerable patients from dangerous situations?

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Melissa Mills

About Melissa Mills, BSN

Workforce Development Columnist

Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. You can see more of her work at www.melissamills.net.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

First off, I appreciate the spirit in which this article was intended. We have a special role as nurses in caring for the lives of human beings and that fact can not be stressed enough. However, I take a bit of an issue with the word "vulnerable" being used to apply to certain populations alone. In my eyes, all patients who are entrusted to our care are vulnerable. They are all vulnerable to harm based on our actions. All our patients put their entire trust on us that we will give them the right treatment and many times they'll have to take our word for it. That includes an act as simple as giving them their medications. Patient safety is a broad matter of utmost importance and can take many different directions to discuss and address.

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Specializes in Workforce Development, Education, Advancement.
21 hours ago, juan de la cruz said:

First off, I appreciate the spirit in which this article was intended. We have a special role as nurses in caring for the lives of human beings and that fact can not be stressed enough. However, I take a bit of an issue with the word "vulnerable" being used to apply to certain populations alone. In my eyes, all patients who are entrusted to our care are vulnerable. They are all vulnerable to harm based on our actions. All our patients put their entire trust on us that we will give them the right treatment and many times they'll have to take our word for it. That includes an act as simple as giving them their medications. Patient safety is a broad matter of utmost importance and can take many different directions to discuss and address.

Hi, Juan de la Cruz - I completely agree with you that all patients receiving care have a certain level of vulnerability. Even when my mother who is 100% capable of making her own decisions is in the hospital - a family member is always there to offer an extra level of protection. However, I do believe with experts who consider specific patient populations more vulnerable to harm. Those who can't make their own decisions regardless of age are left at our mercy and when in the wrong hands can be injured not just by a mistake, but by intentional acts. This is when the level of vulnerability is placed on a different plane than those who are cognitively capable of making decisions.

Thanks for your thoughts and engagement.

Melissa

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When I worked in case management, you would think that when you called adult protective services, all kinds of magical things would happen, but they would not.

I have seen more elderly members with adult family members, that did not work, living off them...not working and taking their money, not getting needed prescriptions..and most seniors are afraid to tell them to leave because they don't want to lose their home by going to a facility and are afraid to stay at home alone. Courts...won't do anything about it.

We can arrange dental services, but they have no way to get there. Once they leave the hospital, there is no real system in place to follow them.

Social services has a very low bar for neglect....as long as there is a working toilet, refrigerator, heat in the home, hot water....it's rare they will remove a child. There is more neglect in my region than abuse...kids left to their own devices because they are on drugs. What is even worse, is physicians that cater to ridiculous requests based on nothing...just to appease the parents. We had one in the hospital whose parent requested at least six different formula changes because she was convinced her daughter was allergic to milk (she wasn't)...the problem is the formula change upset her system...the mother could not be convinced to allow the child to transition...yet the physician kept writing for the changes to "keep her happy" even though the kid was miserable.

We also need a system in place to protect patients from incompetent physicians. Right now hospitals are far more quick to get rid of a nurse, even several of them...in order to protect one incompetent physician. Reporting = retaliation. Policies don't equal reality.

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