Nursing: Caring for the Vulnerable - Case Study Example

Nursing: Vulnerable Introduction Modern nursing practice derives its perspectives from human experiences and needs. Most nursing theories are based on this paradigm, and are driven by motivation, human behaviour, and political, social and cultural components apart from the biological, psychological, sociological, and anthropological aspects. These elements form the basis for human needs, and nursing practice. Such broad conceptualisation therefore demands broader perspectives in meeting human needs, wants, desires and satisfiers in nursing practice (Kim and Kollak, 2006). In the above case study of Mrs. K, one can understand that nursing practice is not restricted to medical expertise or care but manifest beyond these boundaries stemming from patient and nurses vulnerable situations, and how these can affect effective nursing care delivery. Moreover, modern nursing theories emphasize on the appreciation and value of holistic care including personal values without compromising the strictures of professional conduct. How, one as a nurse, can address these aspects shall be discussed in the following sections. Discussion Caring for the Vulnerable The concept of vulnerability can be defined as "susceptibility to physical or emotional injury, susceptibility to attack, open to censure or criticism; assailable, liable to succumb, as to persuasion or temptation" (De Chesnay and Anderson, 2008, p.16). Although the concept of vulnerability is usually applied to nurses who are vulnerable to their environment, care setup and available resources, it can also be used to understand patient vulnerability. Vulnerability concepts define nurses as care-givers and patients as care-receivers. In the context of the above case study, Mrs. K is the care-receiver and the nurses are the care-givers. This relationship, according to De Chesnay and Anderson (2008), is governed by the nurturing attitude, commitment and responsibility of care-givers to the receiver. There is an inverse relationship between vulnerability and care relationship - the less care the receiver gets, the more vulnerable the individual becomes. Vulnerability is thus characterised by "sense of fright, despair, helplessness and the occurrence of lingering bad memories" (De Chesnay and Anderson, 2008, p.414). This has been clearly identified in the case study. Mrs. K is distressed and despaired by the nurses lack of care to her personal needs. She is not willing to confront the nurse because she is afraid of the lingering bad experience. This outcome is against the Nursing Service Delivery Model which mandates that nurses satisfy patient needs within the care environment by addressing patient characteristics such as stability, vulnerability, resiliency, complexity, decision making, and participation in care. Since nurses are positioned to interface vulnerability and change, they are equipped to respond to change in their patients by meeting their demands and needs, whether they are clinical care or psychological in nature. From a unitary nursing perspective, (Parker, 1993) Mrs. Ks vulnerability can be addressed through pattern appreciation. Pattern appreciation distinguishes experiences such as spiritual, physical, emotional, mental, social, cultural and biological affect individual energetic manifestations. Cognitive experiences such as knowledge and understanding can stimulate the individual while the non-cognitive appreciation such as feelings, values, beauty, friendship, love and esthetical enjoyment shape the experience. Mrs. K is vulnerable because she is not appreciated for her individuality. A perceptive nurse would understand her needs for dressing well and care for her appearance on a regular basis, as part of the recovery phase. As De Chesnay and Anderson (2008) indicate, the physical environment plays a critical role in transforming and shifting in the state of vulnerability of an individual. Increase in vulnerability lead to lack of confidence, low self-esteem and feelings of inadequacy. The patient feels despaired because they perceive the lack of attention and support required for regaining their balance in life. For this reason continuous support to the patient and developing a sense of control over their life, is required in the nurses care delivery. Patients like Mrs. K need the support of nurses like valuable information, care for their day to day needs, and developing caring relationships to overcome the change that had occurred in their lives with the incident of health changes. Professional Values According to NMC At the heart of health and social care is the values placed upon personal and professional conduct. There are a number of factors which affect care delivery. These are influenced by practitioners professional conduct and decisions. Value refers to the quality, standards, and concerns associated with health, welfare and well-being of the care-receiver. Care receivers are vulnerable by virtue of their condition, age, disability, pain or loss of confidence according to Cuthbert and Quallington (2008). They rely on carers knowledge, skills, expertise and care attitude to cope with the change in their lives. Value of care is determined by the qualitative nature of the service delivery. In nursing care delivery, this is defined by the standards and manner for delivery of care, as conceived by the society of acceptable behaviour, morals, practice and skills. In nursing professions this is outlined in the Code of Conduct (Cuthbert and Quallington, 2008). The Nursing and Midwifery Council Professional Code (2009) is the standards of conduct, performance and ethics for nurses and midwives, outlines that the health and well-being of patients are the responsibility of the nurses (and midwives). They should be treated and respected as individuals and their dignity maintained. As professionals, nurses are required to protect and promote the health and well being of those in their care as well as their families, carers and the community using high standards of practice and care at all times without discrimination (NMC, 2009). In the above case, for example Mrs. Ks vulnerable condition is the result of violation of this professional code of conduct. Instead of respecting Mrs. Ks right to personal care, the nurse has not responded to her concerns or preferences for clothes or appearance. As a professional, the nurse should have shared information with her daughter, and collaborate in improving her health. Moreover, her nurse had not respected her consent but dressed her in someone elses clothes and forced her to tie a pony tail, an appearance against her age and style. Clearly, this practice had been against the interest of Mrs. K or her decision. As a result she is distressed and unhappy, which, at her age, add to her stress level (NMC, 2009). Instead, the NMC recommends its registered professionals to ensure that they treat individuals under their care with dignity and respect. They should not be discriminated in treatment but rather in a kind and considerate manner (NMC, 2009). This would help them understand and support their patient towards their recovery. By respecting individual choices, preferences and concerns, nurses can help patients to start caring for themselves and maintain their own health. The aim is to share information and knowledge about their health, so that patients can better care for their condition in the future. This, however, should be carried out with the consent of the patient, and involve them in decision making about their care (NMC, 2009). Anti-discriminatory Practice and Promotion According to the NMC Code of Conduct, a nurse "must not discriminate in any way against those in (their) care" (NMC, 2009). Clearly, Mrs. K is subjected to age discrimination. She is treated like an invalid without much understanding or knowledge of her surrounding. Her consent is overridden while she is expected to accept whatever care the nurses provide to her, even though they are below quality standard. This is perhaps because nurses are usually of the view that old age and diseases go hand in hand. The biological, social and health aspects deteriorate with age, and they tend to incur medical cost and time on the national health care. On the other hand, ageing, according to Taylor and Field (2007) is a natural biological process of change. Old age people may decline in health but they should not be treated with below standard level of health care because old people depend on their social and physical environment for transitioning into the old age. Furthermore, Taylor and Field (2007) indicate that ageing is a biological reality in which people tend to carry their health experiences and identities with them at each stage of change. To uphold Mrs. Ks identity her nurses should respect her preferences for her individualized appearance and identity. This is because at the age of 80 her social, cultural and economic experiences influence the way she respond to change. In her condition, she needs these values to support her in her health transition. Instead of treating her differently and over ride her decisions, efforts should be made to ensure that she does not feel displaced from her normal life. As Taylor and Field (2007) write: "The social process of ageing may thus become marked by a progressive emptying out of roles and activities and decreasing social integration within the wider community, and the loss of these may adversely affect self-conception and the sense of identity. This can have a detrimental effect on their morale, leading to lower performance of the immune system and physical illness. Conversely, valuing older people and recognising their worth can lead to better health, or at least to a more tolerable experience of illness" (p.116). A professional nurse should be able to detect her social construct and way of life, and collaborate with her daughter to bring Mrs. K back to normalcy through daily routines like conferring with her on her health care preferences, dressing up, engaging in conversation, socialising with family members and so on. She should not feel discriminated for her age but rather she should be made to feel as if she is participating in decisions and having control over her health and life. Reflection The nursing profession is a highly complex discipline as it deals with medical care, ethics, philosophical paradigms, social, cultural, political and management. From a clinical point of view, nurses are expected to deliver best care from evidence based practice. They are expected to maintain high level of professional ethics and morals. They are to operate within the boundaries of their profession, following The Code and legal frameworks. Yet at the same time they are expected to collaborate, understand and empathize with their patients. They need to engage in interpersonal activity to deliver care services with efficiency, effectiveness and competence. The quality of their professional expertise is determined by their implied behaviour, ethics and conduct which they uphold during their duties. These conflicting premises for nursing care are hard to balance. Nevertheless, nurses are expected to juggle between cognitive and non-cognitive dimensions of health care to ensure the well-being of their patient. In discussing the case of Mrs. K, the author has come to the conclusion that nurses operating environment is multi-dimensional. They are expected to act at the professional level as their discipline mandate as well as at the basic human level, understanding the needs and requirements of their patients. They are committed and responsible for the care of their patients at the medical, psychological, social, cultural, political and economic levels. Among these, the psychological and sociological aspects of care are most critical as these impact the patient implicitly. If a patient is disoriented in these spheres they become displaced in their physical status quo. They become vulnerable to their environment and subject to despair. The physical reaction to vulnerability can include deterioration of health, mental stress and long duration of recovery. In old age especially, patients are more vulnerable due to their age and experience, which make up their confidence, morale and strength for living. When they become ill, they are displaced from their normal state of existence. They therefore need elements that make up their normal life in order to recuperate. These supports can include family members, social circle, daily routines, emotional balance, and beliefs. They require support from all spheres to adjust to the health care environment and to survive the ordeal of recovery. In such times, the NMC Code of conduct has made provisions for nurses to deal with multiple aspects of care delivery. The NMC addresses various aspects including discrimination, ethics, legal framework, quality of care, behaviour and professional boundaries, which is why following it is imperative for every nurse. Bibliography Cuthbert, S and Quallington, J (2008) Health and Social Care Theory and Practice: Values for care Practice. Devon: Reflect Press. De Chesnay, M and Anderson, B.A.(eds),(2008) caring for the vulnerable: perspectives in nursing theory, practice and research,(2nd ed) Jones and Bartlett Kim, H.S. and Kollak, I. (2006) Nursing theories: conceptual & philosophical foundations. Springer. Nursing and Midwifery Council (2009) The Code. Online accessed on 6 November 2009 from: http://www.nmc-uk.org/ Parker, M.E. (1993) Patterns of nursing theories in practice. Jones & Bartlett Taylor, S. and Field, D. (2007) Sociology of Health and Health Care. Wiley-Blackwell. Read More