The stench of stale urine was obvious as soon as we opened the door, and before we had even got round the corner to greet him, we heard "Please, I've wet myself". The clinician carried on, asking him how he was and what he had been up to since his last appointment, his only responses were "I've wet myself" and "Please, take me to the toilet".

Everything that could have gone wrong that day already had, we were running late, and this was the last appointment of the day. The clinician pushed on with the appointment, brushing off the man's requests. I assume she did this as she already knew this was just how his cognitive impairment manifested itself, and it had been a difficult day already. 

As we approached the bed, the carpet oozed under our feet. We all ignored this, and the clinician embarked on getting the man sat up in bed. I saw her wince as she sat on the bed to help him, but again she pressed on. The man couldn't maintain his balance sitting upright, his Parkinson's causing him to sway backwards, so the clinician asked me to clamber on to the bed and kneel behind him to help keep him upright. I realised why she had winced when she sat down, the bed was soaked. I felt cold urine seeping up from the bed to my shins, and from the man's trousers to me knees. Still we pressed on, and got him sat up in the transfer aid. 

"Are you taking me to the toilet now?" 

"No, X. We're going to do some standing exercises now"

"Please, I need the toilet"

" We won't be long. We'll take you when you've finished your exercises"

We wheeled him to the middle of the room so we could stand either side to support him.

"Come on, X. Let's try standing up now"

"But please, I need the toilet!"

"Lets just do five stands first. Come on, you can manage that can't you?"

So he pulled himself up, with a student supporting him either side. He managed three, getting slower each time, then he suddenly stopped, turned to face towards me, and contorted his face. The poor man had messed himself in front of all of us.

"Right, Hannah, go find a carer. We'll get X back to bed"

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I researched all the different organisations I could report my concerns to, and but struggled to decide which would be the most appropriate. I made a table on the pros and cons of contacting each, and tried to critically analyse whether I would be comfortable with actually going ahead and speaking to them. 

I discussed my reservations with the Hourglass Helpline, having been signposted there by NHS resources. They suggested speaking to my Line Manager at work as a first port of call, with a view to discussion with the man's GP and social worker to try and resolve the issues at hand, rather than going straight to regulatory bodies. I was very nervous about this as I didn't want to "rock the boat" during my placement, but realised that my ongoing guilt was indicating that this was the right thing to do.

I'm glad I weighed up the different options regarding who to speak to, as I found difficult to find a balance between being excessive or complacent in my concerns. Reporting to my line manager feels like one of the more conservative options in this case, but at least it will start the ball rolling to give this man the standard of care he deserves, and hopefully protect him from neglect in the future.

Learning to find an appropriate balance for reporting concerns will help, should I ever encounter further safeguarding issues in future, as it will help me to choose the most appropriate pathways on a case-by-case basis

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From exploring different definitions of abuse and neglect, I realised that they were not mutually exclusive, and that both had occurred in this case. Neglect had taken place, due to the lack of action taken to meet the man's hygiene needs, and abuse had occurred, as our actions lead to him being subject to distress and loss of dignity. I realised that this was the case for the carers, the clinician, and both of us as students, as we were all responsible for subjecting him to the distress and loss of dignity that he experienced. 

Learning this helped to resolve my confusion and discomfort, but did nothing to lift my guilt. I knew the only way I could do so was to report this to the appropriate bodies.

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