Vulnerability as a Lack of Capacities to Activate Resources to Cope with Stressors - Essay Example

Vulnerability Introduction Vulnerability is an issue that has continued to receive widespread scholarly attention. The issue has also been on the political front for quite a long period of time. Various perspective have emerged on how the issue should be viewed with some arguing that humans by their very nature and vulnerable. Vulnerability in scholarly literature has been extensively covered because of its link to health issues and the need to protect people, communities and the nation against harm. According to Kramer (2011) vulnerability is “a lack of capacities to activate internal or external resources to cope with stressors.” They argue that vulnerable people do not have the capacity to react to possible stressors and thus have a high risk of harms or losses. Rogers (1997) on the other hand defines vulnerability as “susceptibility to health problems, harm or neglect.” He argues that vulnerability is used to mean a certain level of danger or threat to the person, and maybe concrete reality-based or a feared threat. From these two definitions it is possible to note that vulnerability is a propensity to harm and makes people helpless, making them need some form of protection. Mr Brown, the subject of this paper is vulnerable because of his mental condition and his inability to make decisions and thus needs protection. In defining vulnerability, the term can be viewed in two dimensions. The first is vulnerability as a noun (etic) and the second is vulnerability as an adjective (emic). In the first perspective, vulnerability is taken to mean susceptibility to or possibility of harm and is thus externally evaluated by and individual who sees another as in need of protection from harm (Spiers, 2000). The second perspective, emic, vulnerability is viewed as a state of being threatened and a feeling of fear of harm. This is internally evaluated by the individual as a result of experiences that makes the individual feel vulnerable. Etic vulnerability has received wide scholarly attention in the medical field as well as in other fields. Emic vulnerability is less explored in the medical field (Spiers, 2000). This paper seeks to explore the issue of vulnerability through the eyes of a patient named Brown. It will look at the factors that made the individual to be considered vulnerable by looking at how and why he was feeling vulnerable. It will also look at practices and experiences that made the individual vulnerable before looking at the ways in which he could be protected from being vulnerable. Why and How Mr. Brown was Vulnerable The first reason that made him vulnerable was his mental state. When Mr. Brown was admitted to the hospital, he was initially diagnosed with constipation. His medical records showed a history of depression and a hip replacement. Mr Brown was later diagnosed with a bowel obstruction that required surgery. Secondary to his infection, he became confused and his condition was deteriorating. After careful observation, it was realised that he was unable to make decisions on his own which meant that the surgery was going to be difficult. Legally, according to the mental capacity Act (2005), Brown lacked the capacity to make health decisions (Dimond, 2008). He did not have the paperwork which could support his wishes of not undergoing another surgical operation. The act could not actually protect him because he was deemed unable to make any decisions and this way he became vulnerable. Only the doctors could determine his fate despite his rights to make a decision being enforced by the act, as he was deemed unfit to make any decision. Secondly, was his medical history, which left him helpless. Brown had a history of depression. Initial observations show that he was very low in mood; he informed the staff that he felt depressed and he had suicidal thoughts. He was also very tearful in the absence of his wife. The depression rose higher following his hip replacement six months ago. This medical history made him vulnerable because even after explaining himself to the staff, it seemed that he was not aware of his present state and thus he could not make decisions for himself. He was helpless in this state and any decision was left to the caregivers who were supposed to make health decisions for him. In essence, his condition already made him vulnerable due to the fact that his wishes could not be upheld as a result of the caregiver’s perceptions of him as unable to make any decision. This can be viewed as a form of discrimination as he is perceived already as mentally incapacitated and thus delinked from effective decision making. Socially, he is viewed as medicalized and thus the doctors have power over him in his present state, making him vulnerable (Thompson, 2011). The third reason that made him vulnerable was his past experiences at the hospital where he went to have hip replacement. At the onset of the diagnosis he mentions that he would not want to ever undergo another operation in his life. The reason for this is because of the fact that he had a bad experience at the hospital after the operation. He mentions that the nurses were horrible to him and thus he would not wish to be in that situation again. Bad experiences to patients are common in hospitals and this may be caused by a number of factors. First it may be as a result of the patient present state which could be difficult for the nurses to handle and thus a bad experience cannot be avoided (Cockerham, 2010). Secondly are the issues of discrimination at the hospital that may be as a result of social, economic or political factors. As much as the concept is abhorred in nursing practice, it still happens (Thompson, 2011). Third is that, bad experiences can be as a result of nurses perceptions of the patient in terms of their social worth. Thus, it becomes a bad experience for the patient as the nurse makes time and resource decisions based on this perception and thus care is compromised (Abbey, 2011). The progress of the situation in Brown’s case meant that something close to this could happen and thus put him in a vulnerable position. The fourth reason that made him vulnerable was the delay in conducting the operation. A decision had to be made concerning Mr Brown. The decision would be against his wishes but could be a life saver. It was agreed that the patient should go through a psychiatric review to ascertain whether he had the ability to make any decision concerning his treatment. This was the first form of delay. The second delay was seen when it was decided the patient should be conservatively treated with intravenous antibiotics and putting the patient nil by mouth. Although this can be viewed as a form of treatment, it can be seen a measure to help him as the doctors waited for the psychiatrist report on his condition. The delay made him vulnerable to more infections and continued to worsen his condition making him dependant on their decision. Thompson-Moore and Liebl (2012) argue that there are a number of system vulnerabilities that could cause harm to a patient from the arrival at the emergency department through admission and transfer to intensive care unit and final discharge. From diagnosis to treatment a patient is vulnerable because of delays in examinations and decision making and these could impact negatively on the health of the individual. The last reason contributing to his vulnerability is his family. Upon admission at the hospital, Mr Brown mentioned that he felt depressed and had suicidal thoughts. He categorically said that he did not want this information to be discussed with his wife or with his children. He is also observed to be very tearful when the wife is absent. His wife mentions to the hospital staff that his husband stated that he did not want to have another operation in his lifetime after the post hip replacement operation. The fact that he did not share some of the information to his family made him vulnerable to decisions made at the hospital because there was no other option to involve his family. In this regard, his wife’s advocacy was in his best interest because his wife understood what he had gone through and his becoming tearful when she was away shows that he wanted to her to be present. By the fact that the family was away from him meant that he could not make any decisions of his own as he was already categorised as unable to do so. Processes and factors that contributed to Mr Brown’s vulnerability A number of issues can cause an individual to be vulnerable, the first of such issues is labelling. Labelling in the sense of it is calling someone names or assigning particular symbols to people meant to bring them out in a particular manner. It can be viewed as a form of discrimination as well as oppression. Mr Brown was labelled the “confused patient”. He was referred to by nurses using this name as a result of his deteriorating condition which made him confused. His low moods as well as signs of depression made him even more confused and thus he was viewed by doctors as unable to make sound health decisions. The effects of labelling on patients have been studied by scholars for quite some time. Mold, Hamm and Jafri (1999) argue that labelling causes a patient to take twice as long, on average to recover from a given illness. The psychological impact of the issue causes the patient to take longer to recover despite medication. They argue that, physicians should be careful in their choice of information to patients as this may adversely affect their recovery from acute illnesses. According to Thompson’s model of discrimination and oppression this falls under dehumanization, which in the sense of it creates powerless people. It undermines self-esteem and prevents acts of personal initiative (Thompson, 2011). Another issue is the lack of communication which essentially meant that the patient was shut away from the others. Mr Brown was considered unable to make decisions due to his poor mental status. The argument was because of his confusion and history of depression that made the doctors query his ability to make health decisions. Lack of communication is potentially dangerous for patients in the sense that they need care and people to talk to during the process of recovery (Chesnay, 2005). Mr. Brown was vulnerable because, he was already labelled confused and no one was talking to him. According to Thompson’s P C S model, anti-discriminatory and anti-oppressive practices occur on three levels, personal, cultural and societal. The personal level is concerned with interpersonal relationships, personal feelings, attitudes and self-conceptions, and interactions between individuals (Thompson, 2011). Communication is an essential part of the process and thus a lack of it can cause vulnerability not only in healthcare settings but also in social settings. Stigmatization and Stereotyping is a third force or issue that can be seen in Mr. Brown’s case. Society stigmatizes people due to a number of factors. In Brown’s case the overriding factor was his mental state where he was already labelled confused and sick. Stereotyping also occurs in society as a form of typifying a given group of individuals through a set of beliefs which are often misleading (Abbey, 2011). Many people view depressed individuals as mentally sick and thus Mr Brown was already categorised as a metal case and thus difficulty in getting attention. Thompson in his PCS model argues that cultural expectations, norms, stereotypes, representations and linguistic forms act as factors that devalue and disempower people (Thompson, 2011). People are often stigmatised because of certain illnesses and thus are at high risk of harms. The same situation exists at the hospital where stigmatization and stereotyping could lead to time and resource disadvantages for the patient in question (George Stein, 2007). This overall, contributes to poor patient care as well as risk of death among other complications. Mr Brown was thus vulnerable because of his perceive mental illness as well as his perceived inability to make decisions. The aspect of power on the other hand has been witnessed in Brown’s case and is related his making decisions as concerns his health. In this case, Brown is viewed as incapable of making decisions on his own. The doctors in this case hold expert power and have power over him in his current state. This power over him comes in because he cannot do anything outside the doctor’s medical advice as his present conditions views him as unable to make any decision on his own. Therefore, the doctors have the ability to influence his behaviours whether he agrees with them or not (Lawson, 2001 ). The doctors also have power to come up with any treatment and strategies to help him get better and this is because they hold the expertise and dictate what is supposed to be done to get him back in good health. The doctors want him to go for a psychiatric review to determine his mental status. They also want him to get a surgical operation to remove the obstruction. This is evidence of the doctors power to make him do what they think is good for him. Both power to and power over make Brown vulnerable in the sense that, it is the doctors who dictate what should be done, the types of service he receives as well as what he is supposed to do to be in good health (Stein-Parbury, 2009). Power can be abused in such cases making the patient powerless and vulnerable. A number of issues contribute to this powerlessness and vulnerability and these include: dependency on the services; risk of living with consequences if they complain; despair as they think no one will listen; lack of knowledge on their rights; fear of threats; ambivalent feelings towards the abusers; fear of blames for complaining and low self-confidence and self-esteem (Lawson, 2001 ). Strategies to Reducing Vulnerability First is empowerment and education. It is important that vulnerable people such as Mr. Brown are empowered and educated on their rights as well as other important decisions concerning their health. A lack of this knowledge is what contributes to a feeling of fear among such individuals and also contributes to abuses by those that have power over them. With the information, they are empowered to make decisions and thus overcome situations that could possibly harm them (Lundy & Janes, 2009). Second is social and emotional support. As a nurse, it is important to be available for the patient to let them know of their condition and to help them cope with the illness. Labelling and discrimination only works against the patient making the process of recovery very difficult for them. The nurse has to provide social support so as to prevent loneliness on the part of the patient that makes them feel vulnerable (Cockerham, 2010). Research shows that loneliness is detrimental to health and that good health is positively correlated with building and maintaining satisfying relationships with other people (Stein-Parbury, 2009). The nurse should be involved in developing a social network that will ensure emotional support for the patient. Third is avoiding stereotypes and stigmatization. Stereotypes and stigmatization occurs as a result of the different cultures in which people live in. However, as a nurse it is critical that stereotypes are avoided and that stigmatization as a result of certain illnesses is avoided. Equal opportunities should be given to patients in terms of time and resources. Discrimination will only cause more pain and suffering to the patient (Abbey, 2011). Nurses are supposed to ensure that people who are stereotyped understand that this is only but a simplification of who they are and it is not at all related to their health outcomes. In so doing, they must give hope to the patient and ensure that they emerge from the illness. Fourth is effective communication. Nurses must ensure that patients who are vulnerable because of certain factors are not isolated from the rest. They must ensure that these patients receive information and that they are aware of their current condition and what is being done to treat them. It is important that they communicate with their families and any other person with whom they feel they need to talk to (Chesnay, 2005). Effective communication builds trust between the caregiver and the patient, in the long run, the patient is able to get better because he understands the situation, what is being done and how his needs are being met (Stein-Parbury, 2009). Conclusion Vulnerability is an important issue in healthcare. Throughout this paper, it has been possible to identify the various ways in which Mr. Brown was vulnerable and how contributing environmental conditions made him more vulnerable. A number of issues have come as important in understanding vulnerability. These issues include labelling, stigmatization and stereotyping, communication and power. It was possible to see that these factors act as processes that facilitate and increase individuals risk to vulnerability. It was also identified that vulnerability as a process is not easy to tackle and requires a holistic kind of approach to solving the issue. The most important strategies of tackling it include education and empowerment, social and emotional support, avoidance of stereotypes and stigmatization as well as effective communication. List of References Abbey, S. (2011). Stigma and Discrimination. Canadian Journal of Psychiatry, 56(10), 1-8. Chesnay, M. D. (2005). Caring For The Vulnerable: Perspectives In Nursing Theory, Practice, And Research. London: Jones and Bartlett Learning. Cockerham, W. C. (2010). The New Balckwell Companion to Medical Sociology. New York: Blackwell Publishers. Dimond, B. C. (2008). Legal Aspects of Mental capacity. New York: John Wiley and sons. George Stein, G. W. (2007). Seminars in General Adult Psychiatry. New York: RCPsych Publications. 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Thompson, Promoting Equality: working with diversity and difference (pp. 89-119). Basingstoke: Plagrave Macmillan. Thompson-Moore, N., & Liebl, M. G. (2012). Health care system vulnerabilities: Understanding the root causes of patient harm. American Journal of Health-system Pharmacy, 69, 431-436. Read More