Nurses see people at their most vulnerable, and are often the first professionals to notice signs of abuse or neglect: in emergency departments, maternity units, children’s wards, clinics and homes. Safeguarding means protecting people’s right to live in safety, free from abuse and neglect. Every nurse has a professional duty to act on concerns, and regulators such as the NMC include safeguarding in their codes. Laws and reporting systems differ between countries, so learn your local procedures.
Types of abuse
- Physical: hitting, shaking, burning, inappropriate restraint.
- Sexual: including exploitation and abuse online.
- Emotional or psychological: threats, humiliation, isolation, controlling behaviour.
- Neglect: failure to provide food, warmth, hygiene, medical care or supervision.
- Financial: theft or misuse of money or property, especially of older people.
- Domestic abuse, including coercive control.
- Harmful practices such as female genital mutilation (FGM) and forced or child marriage.
- Modern slavery and trafficking, including labour exploitation.
Warning signs in children
- Injuries that don’t fit the explanation, or the child’s age and development. Bruising in a baby who is not yet mobile is a red flag.
- Injuries in unusual places (ears, neck, cheeks, buttocks, inner thighs), patterned bruises or burns, multiple injuries of different ages.
- Delay in seeking care, or changing stories.
- Frightened, withdrawn or overly compliant behaviour; or sexualised behaviour inappropriate for age.
- Poor growth, hygiene and repeated missed appointments or immunisations.
Warning signs in adults
- Unexplained injuries, especially in older people or those with dementia or disabilities.
- A partner or carer who won’t leave the patient alone, answers for them, or controls their access to care.
- Pressure ulcers, malnutrition or dehydration in someone cared for by others.
- Fear of a particular person; sudden changes in finances.
- Repeated attendances, especially in pregnancy (domestic abuse often starts or worsens in pregnancy).
If someone discloses abuse
- Listen calmly; don’t show shock or disbelief.
- Let them talk; don’t ask leading questions or investigate yourself.
- Reassure them they were right to tell you, and that it is not their fault.
- Don’t promise to keep it secret. Explain that you may need to share information to keep them (or others) safe.
- Ask privately, away from a partner or carer, and use a professional interpreter, not a family member.
- Ensure immediate safety and treat any injuries.
Recording and reporting
- Document facts accurately: what you saw, what was said (in the person’s own words), injuries (size, location, colour; body maps), who was present, and actions taken. Date, time and sign.
- Report through your organisation’s safeguarding procedures: usually the nurse in charge and the safeguarding lead, and statutory services (such as children’s social care or police) as required by law.
- In immediate danger, call the police or emergency services.
- You don’t need proof to raise a concern: if in doubt, discuss it with your safeguarding lead.
- Where laws require reporting (for example, FGM in under-18s in England must be reported to police by health professionals), know your duty.
Information sharing
Confidentiality is important, but it is not absolute. Sharing information to protect someone from serious harm is generally lawful and expected. Share only what is necessary, with the right people, and record what you shared and why.
Safeguarding colleagues and patients from staff
Abuse can come from health workers too. If you have concerns about a colleague’s behaviour towards patients, raise them through your organisation’s speaking-up or whistleblowing procedures.
Related: Consent and capacity · Nursing documentation · Burns (including non-accidental injury)
Based on WHO guidance on responding to child maltreatment and intimate partner violence, the NMC Code, and UK intercollegiate safeguarding guidance. Not legal advice: reporting duties differ between countries.