Abuse - response

As nurses work with numerous people, they are likely to come across individuals who are experiencing abuse. See 'Abuse - identification' for an overview of the types, signs and symptoms of abuse.

Nurses who identify abuse need to know what to do and who they should inform, as well as the support available to them in these circumstances.  Responding to abuse in an informed way has the potential to improve, or even save, the life of the individual.

It is important that nurses foster cultures in their workplaces which prevent abuse from occurring. The processes and principles which guide the prevention, detection and response to abuse in care settings is collectively known as safeguarding.

There is a statutory duty for nurses to respond to a safeguarding concern to protect and promote the wellbeing of those they work with (Local Government Association, 2022).

The six principles which guide safeguarding in any care setting, for individuals of all ages, as outlined in the Care Act (2014) are:

1. Empowerment: enabling people to take control of their own lives
2. Prevention: creating environments which do not enable abuse
3. Proportionality: dealing with issues in a way which respects victims
4. Protection: for those who most need it
5. Partnership: working with others to detect, report and manage abuse
6. Accountability: taking responsibility for safeguarding in the workplace

When a nurse suspects abuse, they must make the right choices in a short space of time to prevent the abuse from continuing and/or to remove the person from the situation. Offering the individual a private and safe space to talk about their abuse offers empowerment and protection, as outlined in the key principles of the Care Act (National Institute for Health and Care Excellence (NICE), 2016).

There are also statutory duties for protecting

If nurses fail to respond to abuse, there is always a risk that the individual's situation will worsen. Responding to and dealing with abuse is difficult and requires some emotional labour on the part of the nurse.

Failure to act appropriately when recognising and responding to abuse means that the nurse is not fulfilling their statutory duty to promote and protect the welfare of the individuals they are working with (Local Government Association, 2015). There is a risk of being removed from the Nursing and Midwifery Council register if a nurse chooses to ignore abuse when they have identified it.

Nurses must understand how to report abuse when they identify it. Nurses also have a responsibility to seek emotional and psychological support when needed, to enable them to continue appropriately identifying and responding to abuse.

Nurses must address their manager or safeguarding lead when they have identified abuse, in accordance with their organisation's policies.

It is imperative that nurses accurately record what individuals have said to them in situations of potential abuse.

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2. Use evidence-based, best practice approaches to undertake the following procedures:

2.11 recognise and respond to signs of all forms of abuse

HM Government. Working together to safeguard children. 2018.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/942454/Working_together_to_safeguard_children_inter_agency_guidance.pdf (accessed 7 November 2023)

Local Government Association. Adult safeguarding and domestic abuse: a guide to support practitioners and managers. 2015.  https://www.local.gov.uk/sites/default/files/documents/adult-safeguarding-and-do-cfe.pdf (accessed 7 November 2023)

Local Government Association. Must know: how do you know your council is doing all it can to safeguard adults? 2022. https://www.local.gov.uk/publications/must-know-how-do-you-know-your-council-doing-all-it-can-safeguard-adults  (accessed 7 November 2023)

McDowall H. What causes domestic abuse and how can nurses effectively support abused women? Nurs Times. 2010;106(8):16-9.

National Institute for Health and Care Excellence (NICE). Domestic violence and abuse. 2016.  https://www.nice.org.uk/guidance/qs116 (accessed 7 November 2023)

National Institute for Health and Care Excellence (NICE). Child abuse and neglect. 2017.  https://www.nice.org.uk/guidance/ng76  (accessed 7 November 2023)

Nursing and Midwifery Council. The Code. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (accessed 7 November 2023)

Social Care Institute for Excellence. The Care Act: safeguarding adults. 2023. https://www.scie.org.uk/care-act-2014/safeguarding-adults/ (accessed 7 November 2023)