The development of the West Sussex institutional care neglect risk assessment tool: a reflective analysis using Mezirow's transformative learning framework.

The protection of vulnerable people is becoming more understood internationally, and in the UK standards of care for frail older people is now receiving appropriate attention (CSCI 2009, The state of social care in England 2007-2008. Commission for Social Care Inspection, London). Although many people continue to live in their own homes, even when they are very frail, many receive long term care in institutional settings, and are dependent on the standards, practices, belief systems and culture of the staff who care for them. As society becomes more intolerant of sub standard services, more adult protection investigations are being carried out to establish whether frail people are being neglected. Within West Sussex England, the multi agency safeguarding team addressed the dilemma of how to assess the risk to other residents in a formal care setting, when concerns had been raised about a small number of people who are resident in that place. The Consultant Nurse, used intuitive and craft knowledge, including examination of clinical evidence as audit data, collected as part of her practice, to examine how to assess the risk to others in formal care settings where care had been identified as neglectful for some of the residents. This paper uses the reflective framework of Mezirow transformative learning theory (http://en.wikipedia.org/wiki/Transformative_learning) to examine the development of a neglect risk assessment tool and highlight the issues identified by a consultant nurse in examining concerns about poor care and neglect in formal care settings. The final section of the paper describes the new Neglect Risk Assessment Tool developed in West Sussex, England, and offers case examples illustrating its use in practice.