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This scenario is about Jessie a 20 year old Asian woman, who has been disowned by her family and now lives alone. She has recently been admitted following a small overdose of ten Paracetamol tables. She is well known to the service as she has presented artificial cuts to her wrist. Some of the staffs have prevailing belief that she is a ‘bed blocker’ and she is aware of this. In relation to this scenario I will be discussing the concepts of vulnerable people with reference to the NMC code of professional Conduct. I will illustrate how the scenario represents professional values which could be used by the staff to empower their patients, respect them and also maintain their dignity. I will also exploring anti- discriminatory practice and suggest ways of how it could be promoted. To end my essay I will be reflecting on what I have learnt from completing this assignment.
Vulnerability is dynamic. It is a general concept meaning ‘susceptibility’ and it is specific connotation in the terms of care is ‘at risk for health problems’. (Caring for the vulnerable) However, according to the Department of Health a vulnerable adult is defined as , “A person who may be in need of community care services by reason of mental or other disability, age or illness; and who is or maybe unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation. (DH 2000 restates 1997 definition) Whether or not a person is vulnerable in a certain cases will depend upon surrounding circumstances, environment and each case must be judged on its own merits. (http://www.surreycc.gov.uk)
These definitions have help to show why Jessie is vulnerable. As she is currently suffering from so form of mental condition which causes her to self harm and try to commit suicide. She has been exposed to forms of emotional hurt which in turn have made her very fragile and have caused her to act in such a self abusive way. She is allowing herself to search and probe the past for unresolved emotions, feelings or grief responses that lay at the root of current immobilized emotions, feelings or actions. (www.livestrong.com)
She is seen as a discredit to her family for refusing to marry her first cousin and runaway not knowing what the outcome will be, to a unknown place where she does not know anyone, may not even have a stable income for food and shelter.
Especially running away from a family that usually function as a unit like most Asian family do, making her even more vulnerable as this may have been the only time that she has been alone to deal with her problem without the help of her family making her feel selfless. These factors make her seem weak and emotional unstable which all make her fit in with the definition of vulnerability as she is unable to safeguard herself and maintain a normal life without the aid of health professionals and services.
Jessie needs helps and her overdosing was the only way she was going to get it she is well known to the ward as she has previously be admitted for artificial cuts nothing was done to help which could have made her more vulnerable. Going to hospital and being around health care professionals could have helped her to understand the bases of her care. She is more vulnerable if she is alone then surrounded by other people. Some people with mental health problems lack the capacity to make certain decisions for themselves, so is it right for the nurses who believe that she is a ‘bed blocker’ to sender away where she is unable to care for herself. This will just make her more vulnerable.
The Nursing and Midwifery Council, is the main regulatory body its purpose is to protect the public through professional standards which was set up by the parliament to ensure health professionals provide the highest standard of care. (www.nmc.co.uk).
As a nurse we must demonstrate professional values on the ward, for example ‘treating people as individuals and with respect’, Jessie is not treated as an individual as she is given the same menu as other on the ward but is not given the right to choose her own food, disempowering her and making her feel like she is not equal to others on the ward.
As health professional ‘we are not to discriminate’, but Jessie cultural needs are not taken into to consideration such as her deity needs for example, is she a vegetarian or does she require halal meat.
The nurses on the ward seemed to view her as a burden and therefore did not treating her with respect. They think that nothing can be done for her the staff has given up on her before trying to help her recover.
Nurses are ‘to treat people kindly and with consideration’ and ‘also must speak openly and honestly with their patient’, but the nurse on this ward believe that she is a ‘bed blocker’ and talk behind her back which show how unprofessional they are as they have resulted to ‘gossip’. Health provides ‘must provide access to relevant health and social care information and support’, in the scenario the nurse are too busy trying to get rid of her and are not even attempting to her to help her, they could ‘make a referral if it is in the best interest of the patient’, but if Jessie is move into out patient care, is that in her best interest as she is very vulnerable as she has some form of mental disorder and she lives alone where she may end up committing suicide and succeeding. Finally nurses must ‘deliver care based on the best available evidence or practice’, for example have they try talking to her, maybe trying to refer her to talk to a psychologist. Her condition is not known maybe identifying her condition could help significantly in her care.
The value of respect and dignity are fundamental to care practice. As a health profession you should respect boundaries, the rules outlined in code of conduct. The main concern here is the values and attitudes associated with ‘respect for persons’ and their influence on your behavior and practice. (Values for Care Practice) In the scenario the nurses clearly have no respect for the patient as they talk about her behind her back and make her feel like she is less deserving then others on the ward. Maybe, if they talk to her about her needs and helping her to get discharged in a way that primarily helps her and also the nurses. Dignity in care means ‘the kind of care in any setting which supports and promotes, and does not undermine a person self respect regardless of any differences.’ (Values for Care Practice) The nurses should treat Jessie’s with dignity by not undermining her and support and promoting her care regardless of differences.
This is why Empowerment is an important aspect of a patients care, as it can be ‘determined by how much capacity a person has in making choices and the transform those choice in desired certain and outcome.’ (Class notes) The NMC is committed to empowering individual so that they can play a greater role in their own care.
The nurse could empower her by simply ask her how she felt once in a while and asking if she felt ready to go home or would like to self- discharge if they had made the appropriate referral which will assist in her care further. They could for ask when she was being admitted if she had a special dietary requirements as she may want food the is cultural specific. This would have help here to feel more respected at she is getting helped and treated with dignity by not being rudely treated and talk about behind her back. While Jessie is receiving care they could help to give her the choice to make decision of her own care if she is capable.
There are many different forms of discrimination, but much of discrimination focuses particularly on vulnerable groups like for example, older people, those with mental health problems or those of different race. (Values for care practice)
‘Discrimination literal means identifying differences, it not always negative for example discriminating against good food and harmful poison is clearly a good thing.’ (Anti-discriminatory practice) But when the term is use in a legal, moral or political sense it generally relates to unfair discrimination. It refers to a process where a difference has been identified and is used a bases of unfair treatment and this person could suffer a disadvantage. ‘ (Anti-discriminatory practice) For example, in a hospital where a nurses holds a some form of prejudice against a Jessie so they treat her unfairly by not giving them a option to choice their own food, which will have a bad implication on their health as she may refuse to eat all together.
Prejudice is unconsciously held and can thrive in environment such as care setting and might not be recognized by those who belong to a group. For example, in Jessie case some of the nurses have residing views that she is a ‘bed blocker’. Not all nurses in general so if a new nurse joins the ward she may adopt this view unknowingly and it will become a part of everyday practice.
That why good practice is anti- discriminatory practice (ADP), it an approach to practice which seeks to reduce, undermine or eliminate discrimination, specifically in the terms of challenging sexism, racism, ageism and disablism. ADP is an attempt to eradicate discrimination from our own practice and challenge them in the practice of other and institutional structure in which we operate. (Anti-discriminatory practice)
Treating patient fairly is one of the care duties of a care practitioner. Unfair treatment increases vulnerability and cause disadvantage. This is why ADP is a positive way of ensuring that people are treated as individuals, in a fair and equal way. For example, in Jessie’s case nurses should ensure that she has equal access to resources maybe asking her if she wants to read a book or watch TV or even take part in group activities, so that she engage more with other people on the ward.
Principles have emerged from literature regarding how discrimination can be tackled in practice for example, by framing differences so that sharing different views and accepting different choice are positive, this can help patients and staff enhances their knowledge and experience.
Nurses have to work with many patients some of whom they may not like, but it is possible to find a redeeming feature or some attribute that you can admire, therefore nurses should focus on the positive not the negative. In the case of Jessie they should hold against her reason why she has been admitted previously, they should acknowledge that factor she needs help and give it to her by talking to her, listening to her and taking into consideration her care needs.
All discrimination should be challenged, question and refused to take part in. Power is often exercised by those who engage in discrimination, so if we can help to empower those who are seen as venerable to help empower those who are seen as vulnerable, can help to break the cycle against discrimination ( Twelvetree, Values for care practice)
As a nurses your should follow the Nursing and Midwifery Code of Conduct
“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) As a nurse you should not condone discriminatory behavior that reinforces stereotypes and prejudice. So, if one nurse on the ward hears the other nurses call Jessie a ‘bed blocker’ it should question it so that it not reinforce.
Reflection -define and say what I have learnt!!
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