characteristics into account when planning and implementing care for that particular
patient. It requires recognition of the unusual as well as knowledge of the general. If the
unconscious person is harmed because the nurse has failed to take cognisance of the
unusual but knowable then she or he has failed in her role as protector of the patient.
For the unconscious patient, my competence to provide care rests not only on my
knowledge of potential and predictable risks of harm but also on my capacity to
recognise the specific as well as general vulnerability of a given individual patient and
to act in suitably protective ways.
If it is the case that one of the functions of nursing in general and of individual nurses in
particular is to protect clients from harm then any actions which restrict the flourishing
of more-than-ordinarily vulnerable persons is inconsistent with the practice of nursing.
This seems an obvious point and an oft stated intention. Yet while there seems to be a
high level of public trust in nurses the fact is that not only do some nurses sometimes
act in ways that result in harm to individual clients but also that the UK regulatory body
for nurses believes it necessary to publish guidance on protecting clients from harm
(NMC 2002b). Moreover, this guidance is primarily aimed at the protection of clients
from the activities of abuse of nurses.
Activities of abuse
The phrase 'activities of abuse' is taken to mean any activity or group of activities,
whether deliberate or not, that results, or is likely to result, in the harm to an individual
or group of individuals. Abuse in this sense is taken to include those harms outlined
below in the definition offered by the Department of Health.
"physical abuse, including hitting, slapping, pushing, kicking, misuse of
medication, restraint, or inappropriate sanctions;
sexual abuse, including rape and sexual assault or sexual acts to which the
vulnerable ... [person] ... has not, or could not, consent and/or was pressured
into consenting;
psychological abuse, including emotional abuse, threats of harm or
abandonment, deprivation of contact, humiliation, blaming, controlling,
intimidation, coercion, verbal or racial abuse, isolation or withdrawal from
services or supportive networks;
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