Vulnerability - Essay Example

?Nursing: Vulnerability Introduction Vulnerability needs to be addressed effectively for quality nursing care, because the quality of the treatment suffers when the patients feel that they have no control over the issues related to their life and unable to protect themselves against the actual or perceived threats. The assessment of the level of vulnerability, the patients’ physical and emotional strength and their cultural background to deal with the situations is necessary for proper intervention to make the patient more confident and satisfied. Vulnerability is an important factor ingrained in the human nature and needs to be understood well as it is common both to the nurses and the patents in the practice of nursing. To engage effectively with the patients, the nurses should be conscious of their own vulnerability and should have the ability to put themselves in the place of the patients for better understanding of their vulnerable position in providing care to them. Daniel, L. E. (1998, p. 192) has concluded in a paper “To be authentic, nurses must be aware of their own vulnerability, recognize themselves in others, and be willing to enter into mutual vulnerability. If nurses deny the opportunity to be vulnerable, they deny the opportunity to participate in humanness and are more likely to dehumanize others”. In this paper, Adult Case Study of Miss Jaya has been taken up for analysis. Concept of vulnerability Ruof, M. C. (2002, p. 2) states “the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them… European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity.” In the present case, the analysis of the patient’s condition, integrity and response to the situation reveals that the patient is unable to retain control over her life situation. This is reflected in the statement “she is becoming un-communicative and reluctant to eat.” The patient is physically and emotionally weak and very aged too, which is accentuated by the prevailing attitude and the nurses feel that they can do little to meet her needs given the staffing levels. It could be understood that the social and cultural background of the patient prevents her from reconciling to the vagaries of life, to be precise, unexpected and uncontrollable events or changes which have an influence on a situation. (Cambridge Dictionaries Online) It would be pertinent to note the observations of Barker, P. (2005) in an editorial in Whitireia Nursing Journal on Vulnerability: “Stripped of my usual day-clothes, wearing attire that may be as revealing as it is unfashionable, I feel vulnerable. I am embarrassed and self-conscious. This may well pass, as I habituate to my situation, but my status as a person has been diminished and will need some rehabilitation”. All people are vulnerable to some extent in one way or the other in our lives. The problems of the patient gets aggravated if the attitude of the staff is not positive and they feel that they can do little to meet her needs. In spite of the staffing constraints to provide quality care to the fullest satisfaction of the patient, often the empathy and understanding displayed on the part of the staff is bound to go well with the patient. The human touch to the issues in nursing practice is crucial in providing quality care which weighs more than the comforts provided by the infrastructural facilities. The women in the Hindu society, in spite of its heterogeneous nature, generally face several social pressures and injustices, and their dress code is very conservative especially with regard to displaying of the parts of the body. Miss. Jaya needs counseling to overcome the mental stress caused due to the incident. Since this being the root cause of the problem, if it is handled tactfully, the other attendant problems like communication and food will get resolved in due course of time. The emotional support and proper guidance to the patient to avoid such incidents in future would encourage her to plan her stay well and interact with the people in a normal manner. If she understands that cooperation on her part is very important to make the things easier in life, the problem is half-solved. Professional values According to the Nursing & Midwifery Council, the practice of nursing calls for adhering to the following tenets with regard to the professional values. Make the care of people your first concern, treating them as individuals and respecting their dignity, Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community, Provide a high standard of practice and care at all times, and Be open and honest, act with integrity and uphold the reputation of your profession. The basic principles enshrined in the code and the council’s rules and regulations are accountability and compliance with the legal formalities to ensure continuance of practice. Ethical provisions in relation to nursing include: Preserving and protecting patient autonomy, dignity and rights, Acting as a patient advocate, Maintaining a therapeutic and professional patient-nurse relationship, Demonstrating a commitment to self-care, Participating on ethics committees and contributing to resolving ethical issues of patients, colleagues, or systems, Reporting practices that are illegal, incompetent or impaired, and Demonstrating sensitivity to diverse cultural needs (The New York State Nurses Association) In the light of the recommendations and the various guidelines, the nurses need to interact with Jaya by responding to her concerns and preferences, making arrangements to meet her needs in respect of communication and sharing information she need to know about the issues related to her health and conditions with reference to her illness in a way she can understand, for efficacy in treatment. Empowering the patient “The word empowerment has been broadly defined as an enabling process through which individuals or communities take control of their lives and their environment”. (Hong Kong Med J, 2002, p. 372) Vulnerability is very complex in real life situations in nursing practice. The problem of vulnerability is not restricted only to biological threats. The vulnerability has several dimensions such as social, psychological and spiritual which are closely interrelated and cannot be dealt with separately. The good perception of the cultural and social background is very important in empowering the patients as it makes the professionals to approach the patients with tact and confidence in tune with the values in their life. When the patients are not cooperative, clinical supervision needs to be stepped up for effective care. The nurse-patient relationship becomes emotional and the pain and sufferings of the patients affects the nursing professionals greatly. Age profile of the patient is an important factor in deciding the treatment. For instance in the present case, comfort and relief from pain to the client is more important which outweighs the side effects of the medicine in long term in view of her age, and symptomatic treatment or palliative care is very important. Involving patients in the treatment process by respecting their views, assisting them in making decisions and providing autonomy through mutual interaction in decision making is very important in empowering the patient. Informed consent of the patients through proper disclosure norms will make the patients participate in their care and in the decision making processes. This will enhance the confidence level of the patient as they understand the options available and the risks involved. This needs to be achieved through training, guidance and support to the patients. Anti-discriminatory practice Anti discriminatory practice in nursing is about equality in treatment irrespective of ethnicity, religion, race, age, gender, sexual orientation and disability. Access to medical care should not be denied on these grounds and the aim behind this principle is promoting social inclusion. The development of anti-discriminatory and anti-oppressive practice in health and social care has gathered momentum over the period of time and strengthened by legislations in various countries. Carter, S. in his paper on Anti-discriminatory practice highlights “2.2. You are personally accountable for ensuring that you promote and protect the interests and dignity of patients and clients, irrespective of gender, age, race, ability, sexuality, economic status, lifestyle, culture and religious or political beliefs.” (NMC 2004: 5) The practice should be consistent at personal level, cultural level and structural level and not prejudicial in cognitive (attributes), affective (attitude) or behavioural plane either based on personality or social variables. Not understanding the psychological, social and cultural background not only impairs the judgment on the part of the nursing professionals but give way to bias in dealing with the situations. It is necessary to learn the background of the employees with involvement to ensure that the decisions are taken in the best interests of the patients which will go a long way in enriching the knowledge and skills of the nursing professionals. European Anti-Discrimination Good Practice Guide aims to improve the antidiscrimination interventions, promote good practices and combat discrimination based on sex, racial or ethnic origin, religion or belief, disability, age or sexual orientation. Bousetta, H. & Modood, T. (p. 12) states “discrimination is combated by the EU on the grounds that it hinders the flexibility and mobility of the workforce and because it threatens simultaneously the economic growth potential of the Union”. In the present case, Miss. Jaya has told that she does not want to make a fuss but she is worried that the pain she is experiencing is not being relieved by the prescribed medication. However, some nurses feel that they can do little to meet her needs given the staffing levels. Consequently she is becoming un-communicative and reluctant to eat. Though it could not be treated as discrimination on the part of the nurses, due to vulnerability of the patient on account of her cultural background, the patient is need of additional care, reassurance and counseling. Also, empowerment of the patient through proper guidance, advice and support would enable her to cope up with the situation on her own to the extent possible. This will greatly reduce the burden of caring to the nurses which is caused due to ignorance and lack of understanding on the part of the patient. It is very important in the profession to send right signal to the public about anti-discrimination in the larger interest of the profession and the society. Going by the details of the case, the patient Jaya may also need psychosocial care which could be organized in consultation with her friends and relatives. The psychosocial care plays an important role in reducing the distress and improving the quality of life of the patients. Though the patient lives alone, there may be friends and relatives, and this initiative on the part of the hospital, since the nurses may not be directly involved in the process, will dispel the notion of discrimination. There are various pressure groups within the society who keep watchful eyes on discrimination of any sort in the society. Alleged institutional racism can damage the reputations of the organizations. The professional code of ethics in nursing practice in all countries strictly forbid discriminatory practices, and the hospitals also take precautions to ensure that there is no room discriminatory practices in the profession. Conclusion All people are vulnerable including nursing professionals and more so in the case of patients in the hospital setup as vulnerability is entrenched deeply in human nature and the societies. The development in technology, telecommunications, internet and social networks paved way for awareness among the public about health care. The nursing professionals need to make use of these developments as an opportunity to empower the patients by involving them in the decision making processes. By respecting the preferences of the patients after disclosing the options available and the risks involved, the confidence level of the patients increase though their active participation in the process. The study has been useful in understanding the importance of following core concepts fundamental to nursing care and essential in nursing practice. The learning with regard to assessment of vulnerability, physical and emotional strength of the patients in the backdrop of the patient’s ability to retain control over their life situation is considered crucial in protecting the patients against threats to the integrity. Accumulation of knowledge about the patients and their background in dealing with vulnerability would naturally dispel anti-discriminatory sentiments and aids empowerment of the patients. References Barker, P. (2005), Editorial: Vulnerability, Whitireia Nursing Journal on Vulnerability, http://findarticles.com/p/articles/mi_qa4138/is_200501/ai_n15935751/ Bousetta, H. & Modood, T., Anti-Discrimination Good Practice Guide, University of Bristol, http://www.dorsetrec.org.uk/Static/Docs/ELibrary.pdf Carter, S., Anti-discriminatory Practice, University of Surrey, http://docs.google.com/viewer?a=v&q=cache:iOupSc1EezIJ:portal.surrey.ac.uk/pls/portal/url/ITEM/471DCE929BD02150E0440003BA296BDE+Anti-discriminatory+practice+surrey.ac.uk&hl=en&pid=bl&srcid=ADGEESj_arSKg-sZAVWJ5FEIjG9XfzaxRp1mHxH22de17kv9nx3IAFY8SdpLSoQAK0DuW2e4lfWM1wMTWPwGK8zZi3DgcYwmvQobD--pjeRFk6CvIh8ZtMOC8wDYdk7OZYOHlZnyqQ4p&sig=AHIEtbSjxid15YgTccVQ2MweOgs4ezam1A Daniel, L. E. (1998), Vulnerability as a Key to Authenticity, Journal of Nursing Scholarship, June 1998, Volume 30, Issue 2. Hong Kong Med Journal (2002), Patient empowerment—a patient-centred approach to improve care, October 2002, Vol 8 No 5, http://www.hkmj.org/article_pdfs/hkm0210p372.pdf The New York State Nurses Association, Role of the Registered Professional Nurse in Ethical Decision-Making, http://www.nysna.org/practice/positions/position6.htm Nursing & Midwifery Council (2010), The Code: Standards of conduct, performance and ethics for nurses and midwives, http://www.nmc-uk.org/Documents/Standards/nmcTheCodeStandardsofConductPerformanceAndEthicsForNursesAndMidwives_TextVersion.pdf Ruof, M. C. (2002), Vulnerability, Vulnerable Populations, and Policy, Scope Note 44, National Reference Center for Bioethics Literature, http://bioethics.georgetown.edu/publications/scopenotes/sn44.pdf Read More