The patient in Case Study 2 – is vulnerable because depending on the severity of her condition (cerebral palsy) it may render her totally dependent on her family and care-workers for her entire life. She is an adolescent and could be experiencing puberty and be unsure of what is happening to her body. She could be confined to a wheelchair and have mobility issues. Having a learning disability could also impede her communication skills and prevent her participating in decisions concerning her treatment and care. She is also vulnerable to neglect, as she may not be able to relay her experiences to anyone or be able to protect herself from physical or sexual abuse. For example, if she is aspirating food into her lungs, health workers might be reluctant to feed her, because they fear the repercussion should the food go into her lungs.
They also have a black-African/Caribbean background and they may have language barriers and different food choices. They could have experienced racism from care workers in the past and this could have developed into feelings of low self-esteem and mistrust of health care workers generally.
According to Johnstone (1998) as cited in Fry and Johnstone (2008) professional values convey the essential standards that are expected to be upheld by a professional group. The essential standards that are required by nurses are reflected in the Nursing and Midwifery Council (NMC) code of conduct. According to Field and Smith (2008) the purpose of the NMC is to protect the public and avoid the abuse of patients. With reference to the NMC code of conduct (2008) I would demonstrate professional values and empower the patient and her family by finding out if there are any language barriers and if there is a need for an interpreter. I would also reassure them that their daughter will receive the highest quality of care whilst in hospital and I would establish a good rapport with them by being open and congruent. Rogers (1967:51) defined the term congruent as: “…..whatever feeling or attitude I am experiencing would be matched by my awareness of that attitude.” Being congruent helps the other person experience you as dependable and trustworthy.
I would find out from the parents the best way to communicate with their daughter. I would also ask them if she has any special dietary requirements. If I am concerned about feeding her, because of her condition, I would speak to my superior and request a more experienced nurse feed her or perhaps I could be trained or supervised. I would demonstrate that I am listening empathically by having appropriate eye contact, body language and checking with them that I have understood what they are saying. Body language has many elements that involve, gestures, facial expressions, gaze, posture and body space proximity (Dimbleby & Burton 1992 as cited in Ellis et al 2003).
I would explain with sensitivity in a private room the percutaneious endoscopic gastrostomy (PEG) procedure, so they are aware of the positive and negative aspects of having the operation, making sure they have all the relevant information and listening to their concerns. If I was unable to explain the procedure effectively or was unable to respond to their concerns, I would arrange for someone more senior to do so. According to deChesnay and Anderson (2008) empowering the patient is best accomplished by supporting them to be an active participant in recognising concerns.
I would also find out if the parents have a support network and if required, recommend community services that are available in their area. According to the Department of Health (2004) National Service Framework for Children, Young People and Maternity Services. Parents with children that are facing a long-term condition, may need support, because they experience a higher level of stress and ill-health than other parents.
I would maintain the patient’s dignity by making sure she has privacy by closing curtains between beds when necessary and ensuring she is covered up to avoid exposure. I would maintain respect for the patient and her family by treating them as individuals and respecting their cultural and religious needs. “The main components of care are maintaining a person’s dignity, treating the person with respect and giving the person privacy.” (Field and Smith 2008:28). I would address them by their first or family name, or whichever name they feel more comfortable with. I would explain that what they discuss with me is confidential except if I think the information they have told me could be harmful to themselves or other people. I would also make sure they give informed consent before any procedures are performed.
Anti-discrimination laws have also been passed to protect the vulnerable. However, you do not have to be vulnerable to experience discrimination.
The definition of discriminate is:
“1. recognize a distinction; differentiate...” 2. make an unjust or prejudicial distinction in the treatment of different categories of people or things, especially on the grounds of race, sex or age..,” (Pearsall J 2001:527).
According to Thompson (2006:12) “The literal meaning of to discriminate is to identify a difference.” It is human nature to recognise differences in everyday life. For example it is useful to discern dangerous or safe behaviour when crossing the road. However, it is unlawful to discriminate against people based on their: age, disability, gender, race, religion/belief or sexual orientation (Equality and Human Rights Commission 2008). According to Cuthbert and Quallington (2008) treating people unfairly is more intolerable when it involves prejudices and discrimination. We all have prejudices based on beliefs and values acquired from primary and secondary socialisation and the stereotypical images from the media. Therefore it is important for health care workers to be aware of any prejudices they personally hold. It is also important to be aware of any prejudicial practices that have been adopted by working in a new environment. Because individuals working in small groups have more of an inclination “to develop particular sets of practices and behaviours.” (Charles Handy 1997 as cited in Cuthbert and Quallington 2008:28).
The patient and her family in the case study is from a black African/Caribbean background. Racial discrimination can be direct, indirect, victimisation and harassment. (Equality and Human Rights Commission 2008). It is vital that the patient is treated fairly and not treated unfavourably based on the colour of her skin or her ethnicity. This can be demonstrated by accepting the patient and her family’s diversity by giving them the opportunity to have an interpreter, different food choices and encompassing the care they receive with respect to their religious and cultural beliefs. For example, if they are muslins, they might request a female doctor or nurse provides care for their daughter. They could request a longer gown or request a quite room where they can pray and request meals be arranged before or after pray times.
The patient has a learning disability and she is possibly confined to a wheelchair. According to Directgov (2008) – the official government websites for citizens. The Disability Discrimination Act (DDA) (2005) gives disabled people the right to access health and social care services. Therefore hospitals should have adapted facilities to ensure wheelchair users can gain appropriate access; such as having ramps, wider door- ways, elevators and support rails. To help her understand the procedure she is having they can also provide important written material in large print or in some cases different languages. She is thirteen years of age and despite her learning difficulty she might be able to understand an explanation of the procedure she will be having. If this is the case she should be included during the consultation. She should not be discriminated against based on her age.
Researching for this essay has taught me that being a patient can be a daunting experience, because you are totally reliant and in some cases dependent on strangers to care for you in an intimate way. This experience can be exacerbated if you are vulnerable for other reasons. For example, if you have a learning difficulty, mental health issues, a disability or are from an ethnic minority background. As nurses we are trusted with the care of the most vulnerable people in our society. “It has been claimed that the way in which we treat the most vulnerable in society is a reflection of the values, ethics, compassion and standards of that society.” (Seedhouse 1998 as cited in Cuthbert and Quallington 2008:142). Therefore it is paramount that we have the highest professional values and ethics to care for patients with a moralistic approach. Although according to Fry and Johnstone (2008) this can be a conflicting area, because we all have different belief systems. Thus nurses should have ongoing self-development training to be aware of the values and beliefs they hold. This can be accomplished by knowing and understanding the diverse cultures we have in this country. How a patient is approached is significant too, therefore developing my interpersonal communication skills will assist in how I approach patients, especially when engaging with vulnerable people. I have discovered it is very important to treat patients and their families with humility and to have an individualist genuine approach to their care and rehabilitation. With an emphasis on preserving their dignity and empowering them to be interdependent. According to Cuthbert and Quallington (2008) caring for someone is not just a practical act, it involves authentic concern for the health, protection and well-being of the patient.
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