NMC CBT Safeguarding Vulnerable Adults and Children 2 — Questions and Answers
Question 1: Under the Children Act 1989 and 2004, what is the overriding principle for decisions about a child's welfare?
- Parents' wishes are paramount
- The child's welfare is the paramount consideration (Correct answer)
- Financial cost of intervention comes first
- Local authority resources determine intervention level
Correct answer: The child's welfare is the paramount consideration
The Children Act 1989 established the paramountcy principle: the child's welfare is the paramount consideration.
Children Act 1989 Section 1: paramountcy principle. Children Act 2004 (after Victoria Climbie inquiry) strengthened safeguarding: Local Safeguarding Children Boards (now Safeguarding Partners); Children's Commissioner; agency cooperation duty; 'Every Child Matters' (be healthy, stay safe, enjoy and achieve, positive contribution, economic wellbeing). For nurses: safeguarding children takes priority over all other considerations.
Question 2: A nurse suspects elderly patient neglect in a care home. Which signs most strongly indicate neglect?
- Asking for more food at mealtimes
- Unexplained weight loss, untreated pressure ulcers, poor hygiene, soiled clothing (Correct answer)
- Preferring to spend time alone
- Mild confusion consistent with age
Correct answer: Unexplained weight loss, untreated pressure ulcers, poor hygiene, soiled clothing
Multiple signs including weight loss, untreated conditions, poor hygiene, and soiled clothing indicate failure to meet basic care needs.
Physical: poor hygiene, dirty/inappropriate clothing, weight loss/malnutrition, untreated conditions/pressure ulcers, dehydration. Environmental: dirty/unsafe conditions, inadequate heating. Behavioural: withdrawal, anxiety, depression, passivity. Institutional neglect: inadequate staffing, lack of person-centred care, rigid routines. Nurse must: document; raise safeguarding concern (Care Act Section 42); inform designated safeguarding lead; continue providing care.
Question 3: What is the role of a Designated Safeguarding Lead (DSL) in an NHS organisation?
- Investigate all concerns independently
- Provide expert advice, ensure policies are followed, act as point of contact, and liaise with external agencies (Correct answer)
- Decide whether to report to police
- Manage all safeguarding training
Correct answer: Provide expert advice, ensure policies are followed, act as point of contact, and liaise with external agencies
The DSL provides expertise, coordination, liaison with external agencies, and guidance to staff on safeguarding matters.
DSL roles: expert guidance to staff; policy compliance with statutory requirements; organisational point of contact; multi-agency liaison (local authority, police, social services); training oversight; audit and governance; safeguarding supervision for frontline staff. In urgent situations, staff should act immediately and not wait for the DSL.
Question 4: A child presents with injuries inconsistent with the explanation given. Which injuries raise the highest suspicion of non-accidental injury?
- A shin bruise on a walking toddler
- Multiple bruises of different ages on a non-mobile infant, particularly on non-bony prominences (Correct answer)
- A playground graze on the knee
- A forehead bruise on a 4-year-old who fell off a bicycle
Correct answer: Multiple bruises of different ages on a non-mobile infant, particularly on non-bony prominences
Bruises on a non-mobile infant are highly suspicious. 'Those who don't cruise rarely bruise.' Non-bony prominences (ears, neck, buttocks, trunk) are particularly concerning.
Assessment considers: age-appropriateness (pre-mobile babies should not have bruises); location (non-bony prominences more concerning); pattern (different ages = repeated injury; object shapes); consistency with explanation and developmental stage. Actions: document meticulously with body maps; follow Trust safeguarding pathway; refer to children's social care; do not confront the accompanying adult.
Question 5: Under the Domestic Violence, Crime and Victims Act 2004, what offence was created?
- Failing to report domestic violence to police
- Causing or allowing the death of a child or vulnerable adult (Correct answer)
- Financial exploitation of a vulnerable person
- Verbal abuse towards a vulnerable person
Correct answer: Causing or allowing the death of a child or vulnerable adult
Section 5 created the offence of causing or allowing death (amended 2012 to include serious physical harm) of a child or vulnerable adult.
Section 5: applies to household members who had frequent contact with the victim, were aware or should have been aware of significant risk, and failed to take reasonable steps to protect. 2012 amendment extended to 'causing or allowing serious physical harm' (not just death). Addresses situations where a child or vulnerable adult is harmed within a household and members claim not to know who was responsible.
Question 6: A 14-year-old discloses a sexual relationship with a 25-year-old. What is the nurse's obligation?
- Respect confidentiality and take no action
- Recognise this as child sexual abuse, make an immediate safeguarding referral, and inform the DSL (Correct answer)
- Advise ending the relationship and provide contraception
- Contact parents before taking other action
Correct answer: Recognise this as child sexual abuse, make an immediate safeguarding referral, and inform the DSL
Sexual activity with a child under 16 is a criminal offence. The age difference raises exploitation concerns. Make an immediate safeguarding referral.
Sexual Offences Act 2003: age of consent is 16. A 14-year-old with a 25-year-old raises concerns about sexual abuse and child sexual exploitation (CSE). Actions: listen calmly; explain information must be shared; document using the child's words; immediate referral to children's social care; inform DSL; do not investigate independently; do not inform parents before consulting social care; continue compassionate care.
NMC CBT Safeguarding Vulnerable Adults and Children 2
Under the Children Act 1989 and 2004, what is the overriding principle for decisions about a child's welfare?