vulnerability matilda dzaja shannon macfarlane mandy wallace tawnya werb matilda dzaja shannon...

VULNERABILITY

Matilda DzajaShannon MacFarlane

Mandy WallaceTawnya Werb

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Vulnerability:

Susceptibility of any kind of harm, whether physical, moral or spiritual, at

the hands of an agent or agency; related to disempowerment and

consequences of diminished autonomy

Little, Paul, Jordens & Sayers (2000)

To be vulnerable:

One must be vulnerable to something; one must be susceptible to bad outcomes whether

physical, emotional or spiritual

Little et. al (2000)

Video Testimonial

Nurses can recognize how clients feel vulnerable by understanding

the following factors that lead a client to vulnerability:

A) The illness, injury or impairment and related interventions

Irurita (1999)

“You might fall off the edge and disappear – I was sure I was going to die.”

B) Dependence

Irurita (1999)

“It’s really hard to be bedridden… I’m normally so active. I couldn’t even just get up and go to the toilet by myself, I needed someone to do that… and so I had to ring for someone… sometimes it was a great length of time.”

C) Age-Ageism

Irurita (1999)

“The nurses didn’t go and sit with the older people and talk, the sort of age barrier…..”

D) Abuse of Power

Irurita (1999)

“As far as she (the nurse) was concerned, the fact that I had messed up the whole bed, was that I was a dirty old man… it was degrading.”

E) Lack of preparation or information

Irurita (1999)

“ A lack of information was perceived to be a problem for patients….”

F) Loss of identity

Irurita (1999)

“As a person, a human being, who in my mind I’m quite intellegent, I can make decisions – run a business – and then to have someone over-ruling me.”

• Type 1

-Individual has the opportunity to take actions that have a reasonable chance of providing some protection

3 Risks of Harm

• Type 2:

-Individual must rely for protection on the actions of others

• Type 3:

- Individual powerless to protect him or herself regardless of the actions of others.

- Harms that occur as unexpected or unanticipated events

There are three main themes of vulnerability that emerge from the related literature:

Social Vulnerability

Psychological Vulnerability

Physical Vulnerability

(Scanlon & Lee, 2007)

Social Vulnerability

Demographic Economic Cultural

Includes variables such as sex, age, marital status, earnings, educational attainment, religion, racial heritage

Refers to a person’s basic statistical data in relation to their potential for illness.

Psychological Vulnerability

LOSS OF ROLE or IDENTITY Put individuals in a foreign environment (hospital) and doubts/uncertainties arise and damage a person’s capacity to cope

(Irurita, 1996)

CONTROL Through hospital routines and protocols The individual can feel dominated and subordinated

→ alienation & internalized oppression

LOSS OF AUTONOMY Lack of choice de-individualizes the person

Physical Vulnerability

A person’s impaired resistance to further harm caused by a weakened state of disease, ailments or trauma.

Individual becomes more susceptible to harm

(Irurita, 1996)

Video Testimonial

How is Vulnerability Relevant?

The Family

Health Care Professionals The Health Care System

How is Vulnerability Relevant?The Family

Families with a chronic condition historically have been recognized as vulnerable because of the added demands of care.

Effects are noted in four distinct areas:

•Biographical Areas•Partner-Patient relationship consequences•Illness-Related Problems•Everyday Burden

Kuyper & Wester (1998)

Shepard et al (2002)

How is Vulnerability Relevant?

Biographical Areas

• Consequences for partner & patient

• Painful losses

• Feelings of guilt

Kuyper & Wester (1998)

How is Vulnerability Relevant?

Partner-Patient Relationship Consequences

•Contradictory Feelings•Partner or patient?

•Communication between partners

Kuyper & Wester (1998)

How is Vulnerability Relevant?

Illness-Related Problems

• Information Dissemination

• Feelings of fear & powerlessness

Kuyper & Wester (1998)

How is Vulnerability Relevant?

Everyday Burden

•Coping

Kuyper & Wester (1998)

How is Vulnerability Relevant?

Positive Outcomes for the Family

Family Strength

Shepard et al (2002)

How is Vulnerability Relevant?

Health Care Professionals & the System

Organizational level response:•Sustain ethical environment•Review & enact policies

Erlen (2006)

How is Vulnerability Relevant?

Health Care Professionals & the System

Nurse response – Advocacy

Personal / professional level:•Help Patients navigate the system •Increase the visibility of Nursing•Restore power imbalance

Erlen (2006)

Video Testimonial

Vulnerability & Nursing Praxis

Providing True Presence

• Is crucial for promoting health & enhancing quality of life• Allows the nurse to be with the patient as personal ways of living are expressed

Liehr,(1989)

Registered Nurses Association of Ontario (RNAO)

Best Practice Guidelines:Practice Recommendation # 1:

Nurses embrace as foundational to client centred care the following values and beliefs:

respect; human dignity; clients are experts for their own lives; clients as leaders; clients’ goals coordinate care of the heath care team; continuity and consistency of care and caregiver; timeliness; responsiveness and universal

access to care.

These values and beliefs must be incorporated into, and demonstrated throughout, every aspect of client care

and services.

Implementing recommendation #1 into practice:

By: respecting our clients wishes and concerns; treating each client as a unique individual;

allowing our clients be leaders and experts in their own care;coordinating goals of the client with goals of the health care

team;being consistent and timely;

and being universally accessible and responsive

We (as nurses) will be able to diminish our clients vulnerabilities!

RNAO (2006)

College of Nurses of Ontario (CNO):Components of the nurse client relationship:

#5) Power. The nurse-client relationship is oneof unequal power. Although the nurse maynot immediately perceive it, the nurse hasmore power than the client. The nurse hasmore authority and influence in the healthcare system, specialized knowledge, access

to privileged information, and the abilityto advocate for the client and the client’ssignificant others. The appropriate use of

power, in a caring manner, enables the nurse topartner with the client to meet the client’s needs.

A misuse of power is considered abuse.CNO (2006)

•Since the nurse has more power, it is easy for the client to be vulnerable to the nurse and health care system; although the misuse of power is considered abuse, the nurse often does not recognize or reflect on the patients perspective

* It is important to recognize this power inequity to make the patient less susceptible

to physical, moral or spiritual harm

“Vulnerability was increased when nurses abused their position of power, exerting inappropriate control over

patients” (Irurita, 1999).

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ReferencesErlen, J.A. (2006). Who Speaks for the Vulnerable? Orthopaedic Nursing, 25(2), 133-

136. Retrieved April 7, 2009, from CINAHL database.Irurita, V. (1996). Hidden dimensions revealed: progressive grounded theory study

of quality care In hospital. Qualitative Health. 6(3): 331-349.Iruria, V. (1999). The problem of patient vulnerability. Collegian, 6(1), 10-15.Kuyper, M.B., Wester, F. (1998). In the Shadow: The Impact of Chronic Illness on the

Patient’s Partner. Qualitative Health Research, 8(2), 237-253. Retrieved April 7, 2009, from CINAHL database.

Liehr, P.R. (1989). The Core of True Presence: A Loving Center. Nursing Science Quarterly, 2(1), 7-8. Retrieved March 13, 2009, from CINAHL database.

Little, M., Paul, K., Jordens, C. & Sayers, E. (2000). Vulnerability in the narratives of patients and their carers: studies of colorectal cancer. Health, 4(4), 495-510.

Scanlon, A. & Lee, G.A. (2007). The Use of the Term Vulnerability in Acute Care: Why Does it Differ and What Does it Mean? Australian Journal of Advanced Nursing. 24(3). 54-59.

Shepard, M.P., Orsi, A.J., Mahon, M.M., Carroll, R.M. (2002). Mixed-Methods Research With Vulnerable Families. Journal of Family Nursing, 8(4), 334-352. Retrieved March 13, 2009, from CINAHL database.

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