Zero tolerance of abuse of people with intellectual disabilities: implications for nursing

Aims.  This paper explores the concept of ‘zero tolerance’ to abuse in the context of the professional responsibilities of all nurses. The workability of zero tolerance will be considered in light of findings of a study into abuse. Background.  Registered nurses are led to believe that zero tolerance of abuse of patients is the only philosophy consistent with protecting the public. However, the approach of zero tolerance is not without its difficulties. Staff, particularly registered nurses, who come into contact with people with intellectual disabilities have a professional responsibility to prevent and report all forms of abuse. Design.  This study used a multiphase, multimethod approach (literature review, survey and focus groups). Methods.  The results reported here relate to the focus group stage of the study. There were 70 participants in the focus group who worked either as direct care staff with people with intellectual disabilities or as investigators of abuse. Results.  Analysis of recurrent themes indicated that both individual (e.g. a positive value base) and systemic factors (e.g. environment) seemed to have an impact on how staff will respond to abuse. Conclusions.  This study found that a ‘hierarchy of abuse’ existed among staff who worked with people with intellectual disabilities. Individual staff members seemed to be ‘weighing up’ what they perceived as serious abuse before reporting areas of concern. This is in contrast to a philosophy of zero tolerance which registered nurses have to adhere to. Relevance to clinical practice.  There needs to be a consistent approach to abuse and nurses need to have appropriate training in which to gain confidence in their role in preventing, identifying and responding to abuse of patients or clients.