This essay will explore the concept of vulnerability, the type of people who can be vulnerable and its potential effects. It will then relate this specifically to the case of Miss Jaya an elderly Hindu lady who has no relatives and lives alone, and why she is perceived to be vulnerable. The essay will then go on to evaluate how a nurse can demonstrate professional values and empower the patient to help reduce their vulnerability, taking into account the Nursing and Midwifery Council (NMC) Code of Professional Conduct.
The case of Mrs Jaya indicates some discriminatory practice by those responsible for caring for her, this will be discussed and how the relevant anti-discriminatory practice could be promoted. In conclusion the essay will reflect upon the key learning points of this assignment. There are a number of definitions and theories in relation to vulnerable people. The World Health Organisation (WHO) suggest that the concept of vulnerability “ – has been widely used to denote a condition in which the physical and mental well-being required for a normal productive is impaired and at constant risk ” (WHO, 1992:11).
The reasons that can make people vulnerable are varied and often include age, ethnicity, illness mental health issues, religion and learning and physical disabilities. “A vulnerable person is a person who may be in need of community care services by reason of mental or other disability, age or illness, and who is unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation” (DOH, 2000, p8-9).
Miss Jaya is 74 years old and a patient in a hospital which suggests that she could be vulnerable as both an elderly person and that she is suffering from a form of illness or disability “Physical changes in old age reduce the ability to conduct activities of daily living and maintain independence” (Lyon, Kinney & Colouhoun, 2002, p. 183). The work of Kang and Ridgway (1996) and Matt and Dean (1993) highlighted other reasons which can increase the vulnerability of adults.
Their work focused on the relationship between vulnerability and older adults not having social networks and support groups. The Case Study states that Miss Jaya is ‘intensely private’ and has ‘no relatives’ and ‘lives alone’ which suggests that she might not have either a social network or support group which according to Kang and Ridgway (1996, p. 111) could increase her vulnerability “Older adults tend to be more vulnerable than the young because they are less socially integrated and more likely to be under stress”. Matt and Dean (1993, p. 91) indicate that the reason older people become more isolated and their support groups smaller is a natural occurrence as the death rate increases with age “Social isolation among older adults becomes more pronounced with advancing years. The 70 years and older age group have a lower level of friend support than 50-69 due to increasing mortality with age”. The Case Study goes on to state that Miss Jaya was ‘very upset’ and ‘embarrassed’ following an incident where a male member of staff entered the bathroom unexpectedly and found her undressed whilst being given a bath.
This incident appears to have caused Miss Jaya a great deal of stress and due to ‘staffing levels’ is something that is unavoidable. As a Hindu it is likely that Miss Jaya would prefer to be cared for by same sex staff “Modesty issues arise when service users are no longer able to dress or store clothes themselves, and many Hindu people prefer same sex staff for personal care “(Gibbs and Barnitt, 1999, p. 101). Following on from this incident the Case Study says that Miss Jaya has since become ‘un-communicative, reluctant to eat’ and she believes her medication is not ‘relieving’ her pain.
In addition to the fact that Miss Jaya is elderly, is now being cared for as opposed to looking after herself which she is used to and the incident mentioned above it suggests that they may have all contributed to Miss Jaya becoming depressed. Birrer and Vemuri completed a study in 2004 which indicated that many older adults suffer from depression “Studies found that about 30% of older adults struggle with depression. The failure to adjust to later life may cause older people to experience depression” (Birrer and Vemuri, 2004, p. 375). The fact that Miss Jaya is not eating could also be a result of her depression as she is neglecting herself “Many people neglect themselves; this can be for a range of reasons. People may be ill or depressed and unable to make the effort” (Nolan, 2005, p. 203). The Nursing and Midwifery Council (NMC) Code of Conduct identifies the professional values and best practice that health care professionals should follow when providing care to patients.
Throughout the NMC Code of Conduct the importance of respecting people’s dignity is highlighted, for example “You must treat people as individuals and respect their dignity”. A Dignified Revolution (ADR), an organisation established with the aim of improving the care of older people in hospital, suggests that in a nursing environment dignity is often associated with patients having a sense of; worth, well-being, being valued and having a sense of purpose. Cass, Robbins and Richardson (2010, p. ) suggested that in order to maintain a patient’s dignity a number of aspects are important “Dignity consists of many overlapping aspects, involving respect, privacy, autonomy and self-worth”.
In the Case Study there are incidents that suggest Miss Jaya was not treated with dignity and respect, for example when Miss Jaya’s privacy is lost and her wishes not respected. Miss Jaya’s privacy is lost when the male staff member walks in on her, without permission, when she is undressed. Woogara (2005, p. 3-36) supports the theory that privacy and dignity are interrelated, “Privacy allows people to uphold their autonomy and dignity”. In the Case Study when Miss Jaya’s privacy is lost this is an example of the Code of Conducts professional values not being met as Miss Jaya is not being treated with dignity, and as a result she may feel devalued. Another key theme throughout the NMC Code of Conduct is that of respect, which is also considered to be closely related to dignity. Respect in a nursing environment is often suggested as referring to the way that patients are treated taking into account their wishes or beliefs.
For example the way in which nurses communicate with patients is a key aspect related to respect “-appropriate use of language is essential to ensure that we communicate in a respectful manner. Overall, a lack of formality can cause concern for older people” (Chambers & Ryder, 2009, p. 71). As mentioned earlier it is likely that as a Hindu lady Miss Jaya would prefer same sex staff for personal care, the staff in the Case Study have either not considered or have ignored this demonstrating a lack of respect to Miss Jaya’s needs and cultural beliefs, which is also an example of professional values not being et, resulting in the patients dignity being affected. Another theme highlighted in the NMC Code of Conduct focuses on promoting the health and wellbeing of patients, for example “You must support people in caring for themselves to improve and maintain their health” and “You must recognise and respect the contribution that people make to their own care and wellbeing”. An important aspect of promoting the health and wellbeing of patients is to build a trusting relationship. Nolan (2008, p. 167) indicates that successful relationships can also help people to feel positive about themselves improving their confidence, self esteem and image.
If patients feel that they are able to discuss changes or make choices it will make them feel they can effectively contribute to their own wellbeing. deChesnay and Anderson (2008, p. 21) summarised the role of a nurse with regard to vulnerable patients and empowerment “-vulnerability is not a license for the nurse to rescue; it is rather an opportunity to encourage growth”. In order to empower Miss Jaya a simple action such as listening to her concerns and take appropriate action regarding her thought that her medicine not relieving her pain, are likely to make Miss Jaya feel valued and promote her dignity.
This type of action would help to empower Miss Jaya by working in partnership with her to make her feel like she is involved in the decision making processes which are used to identify the way she is cared for. The information in the Case Study suggests that Miss Jaya was likely to be very independent prior to needing health care and becoming vulnerable, in addition to ensuring her cultural beliefs are met, by empowering her it could be a step in making her feel better and reducing her apparent depression.
Discrimination can be defined as “- an act which has the effect of treating a person less favourably than another on the grounds of sex, race, religion or belief, disability, sexual orientation, age, mental health or learning difficulty” (NHS, 2006, p. 5). If an individual is subject to discrimination it is likely that their care will be at a lower standard to what it should be, which breaks the guidelines in the The Human Rights Act 1998 which suggests we all have the right to enjoy our rights free from discrimination on any grounds. The NMC Code of Conduct also stresses the importance of not iscriminating ‘You must not discriminate in any way against those in your care”. Discrimination can be reduced through the promotion of anti-discriminatory practice which can be defined as “-any form of practice that tries to prevent the recognition of difference being used as the basis for unfair discrimination, leading to oppressive consequences for people” (Thompson, 2002, p. 44). With regard to the case of Miss Jaya anti-discriminatory practice could be promoted to ensure that she is treated with dignity and respect and in line with the NMC Code of Conduct.
In addition to ensuring that Miss Jaya’s concerns where listened to as mentioned earlier it is important to ensure that her cultural; and religious beliefs are met. The Case Study says that the nurses “remember the incident” where Miss Jaya became embarrassed but can’t do much about it “given the staffing levels”. The fact that the nurses are not prepared to do anything about their practices despite recognising that they cause distress to Miss Jaya indicates both discrimination on religious and cultural levels and also potentially age as they do not value the patient enough to change their processes.
A study by McGlone and Fitzgerald (2005, p. 8) referred to incidents such as this as ageism which is defined as “- deeply rooted negative beliefs about older people and the ageing process, which may then give rise to age discrimination”. This is not a good example of nurses showing compassion or being prepared to change the way in which they perform their roles. Chambers and Ryder (2009, p. 8) suggest that it is important for nurses to play a key role in preventing discriminatory behaviour to ensure patients receive ‘dignified care’, “Nurses need to take a lead in challenging undignified care in themselves and others, and in challenging systems that compromise their ability to provide dignified care”. In this case the nurses could promote anti-discriminatory practice by ensuring that in the future tasks requiring Miss Jaya to undress such as baths or toileting are performed by same sex staff even this requires a change to working processes.
This will ensure that in the future Miss Jaya is not discriminated against on grounds of age, culture and beliefs and will maintain her dignity and respect. The NMC Code of Practice identifies the importance of teamwork, “Work effectively as part of a team”, an example of this in practice would be the nurses working together to ensure that Miss Jaya is cared for by same sex staff by working out things such as rotas, or sharing information amongst the team advising of a patients preferences or needs, as long as it maintains the patients confidentiality.
Anti-discriminatory practice could be further promoted by ensuring that nursing staff are kept informed of the procedures and standards they are required to follow such as the Human Rights Act, Equality Act and organisational procedures through training sessions or team meetings. In conclusion I have found this assignment very useful for a number of reasons. It has provided me with a detailed knowledge of the concept of vulnerability and the type of people and the many ways in which they can become vulnerable and also the signs to look out for which indicate vulnerability.
I have an improved understanding of the of the NMC Code of Conduct and the professional values that need to be demonstrated as a nurse, particularly the need to always respect patients and maintain their dignity. A key aspect of this is the need to build trusting relationships with the patient, which in addition to listening to their concerns would also provide the opportunity to get to know and understand their cultural and religious beliefs, which will help to identify their needs and prevent discrimination.
By looking at a specific example, the case of Miss Jaya, I have been able to learn how discrimination can take place in practice and identify the ways in which this can be prevented and the actions to promote anti-discriminatory practice.
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