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Hot Topic: ‘We need to protect our patients from abuse and those who will inflict it’

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How would you define abuse? And what happens when a member of staff is accused of abusing someone in your care? Dealing with it may be difficult but even small matters cannot be ignored.

How would you define abuse? And what happens when a member of staff is accused of abusing someone in your care? Dealing with it may be difficult but even small matters cannot be ignored

I feel so guilty. How could it have happened? Surely it did not have to happen? Could I have had more control and stopped it? Those poor, vulnerable people.

What am I talking about? Have I behaved badly and abused somebody? No, I have not – but one of my staff has and I have been dealing with the consequences.

Obviously I cannot go into the details of what happened but, in short, a new carer reported what seemed to be an abusive act by another member of staff. This took an enormous amount of courage – the carer had only been here for a few weeks and was relatively inexperienced in the care environment. The accused, on the other hand, was a nurse who would have been seen as ‘senior’ by the new carer.


An investigation was started and, while it was proceeding, staff mentioned other incidents. They were abusive acts. Residents with dementia had been pinched and slapped on the hand. The residents were not seriously injured and all were unmarked but, due to their condition, they had been unable to report what had happened to them.

All relevant information was immediately sent to the appropriate people and relatives were spoken to. The accused was interviewed several times and given the chance to explain the events. In the end, the individual’s contract was terminated and they left the area.

From my point of view I have, so far, done what was needed. I have made sure that the adults who were vulnerable have been made safe by ensuring that the abuser is no longer in contact with them. I have also spoken to the relevant services. All procedures have been followed and all the residents made safe. So why am I feeling guilty and agonising over what has happened? I suppose it is because I’m the manager and am responsible for what happens here. The residents are in my care and I have built up a trusting and supportive relationship with both them and their families. This relationship has been built by the whole team but has now been damaged by the actions of one person.


Because of the way the investigation had to be carried out, staff were not made aware of what had happened. This was a problem as individual members of staff were unaware there was more than one incident and some felt I had been harsh in my treatment. I was unable to confirm or deny anything and, for a period of time, relationships were strained.

Could I have prevented it happening? I am not sure that I could but this does not ease my guilt. No previous concerns had been raised about the staff member and it appeared that the abuse had been a recent occurrence.

Thank goodness the new carer felt able to report the incident. I think that was because we have a very open management system and are approachable and visible. It is made very clear to staff that there are good reporting systems in place in the home, within the company and externally.

I feel responsible for the residents who have been abused and am angry that somebody could do that to them, knowing they have dementia and have no way of reporting what has happened. I feel for the staff who have been involved and the worries they have had. I have also agonised about the abuser and whether I was doing the right thing. Had I been fair and impartial? Did I have all the evidence? How did I feel about destroying the person’s career?


Not an easy thing to do.I do not think any abuser ever started out by killing somebody. Abuse starts as small incidents and escalates. If a harsh word or a slapped hand bring no censure, what comes next? This person was a nurse and was due to receive their PIN. This means they would be in charge of staff in the future. What would they consider acceptable behaviour by their staff towards residents? Does it escalate to the point where staff cease to see their charges as people and treat them as pieces of meat? And what happens then?

I am not convinced that abusers reform. Unfortunately, like cancer, the ability to abuse exists and, like cancer, it needs to be dealt with at the earliest opportunity.

I am proud that my staff felt able to report this as they did.

I’m sad that it happened but satisfied that, having followed all the processes, there is one less person able to abuse adults who are vulnerable.

Author’s name has been withheld


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