Burbank (2006) highlighted that even though these groups are ordinarily classified as high-risk, it may be a case that the individuals within these groups are not vulnerable. It varies on the environment and the circumstances that surround the individual. For example a Black African woman living in South-East London, England may not experience racism or discrimination because there is a large Black African community in the South London area and it is socially accepted. Conversely, if she were living in Southern Italy, she could be subjected to physical and verbal abuse, as well as the unlikely hood of being integrated in society e.g. employment. This may be because of religious and cultural views in that area may not accept Black African people.
However, according to DeChesnay and Anderson (2008) vulnerability does not always have a negative effect. It can be a positive implication that enhances progression and change. In the area of race and ethnicity, legislation has been created to enforce the equal rights of minority groups, be it in the working environment or in society. Because of these legislations vulnerable people as a whole have been more integrated and accepted within society allowing them to gain independence and access to support and resources
The patient (Case 6) is a mother of two young children and it may be that since her marital break down to her husband two years ago she has found it very difficult to cope being a single mum, thus the reason for her children being in care. She admits guilt for being unable to look after her children and this may add to her depressive state. She is also vulnerable to neglect and loneliness. Neglect from health professionals as they may feel that she is the cause for her own illness and loneliness from her family who have disowned her as they feel she is to blame for children being placed into care.
Finally the patient is very vulnerable as she is displaying patterns of self harming as she has fresh cuts on her arms. It may be that she is seeking attention by harming herself in order to gain access to help, as she may not or find it difficult to voice her opinions.
The main focus of the NMC Code of professional conduct is to protect patients and ensure their safety, avoiding abuse. Referring to the NMC code (2008) the staff in the case 6 has not showed professional values by not treating her as an individual. Staffs have discriminated against the patient by allowing their personal views to affect the level of care given. Dignity in care can be encouraged or weakened by the environment, organisational culture, attitudes and behaviour of health care professionals as well as how care is given. (RCN 2008). Ensuring that patient information is kept confidential, including discussing their care and passing on information. Unless it was in the patient’s best interests, information about the patient should not be discussed or passed on, especially to those who are not involved in her care.
I would demonstrate professional values and empower the patient by making time for the patient to talk through her distress/crisis and finding out ways to help her. Interacting with the patient by regularly checking on her and stimulating conversation will make her feel at ease and at the same time ensure she is treated as an individual and not isolated. I will also find out if there were any language barriers and whether there was a need for an interpreter, as well as acknowledging, valuing and allowing her to express her culture in her own way.
“Culture has been defined as.... guidelines which is inherited by individuals of a particular society that tells them how to behave and view the world in relation to others. The use of symbols, language and art provides them with ways of relaying their guidelines to the next generation.” (Helman, 1994 p.2)
I would speak to her family and encourage them to visit and support the patient as well as finding out and helping implement support networks that may be available in her area.
Because the patient is of a Black Afro Caribbean background she is more susceptible to discrimination. Racial discrimination can be direct, indirect, victimisation and harassment (Equality and Human Rights Commission 2008). It is important that the patient is treated fairly and not unfavoured because of the colour of her skin or ethnicity. This can be demonstrated by acknowledging or valuing cultural differences and diversity e.g. offering a variety of food choice or the opportunity to have an interpreter or just by respecting their religious, cultural or health beliefs. Sector (1996) highlights the importance of understanding health beliefs. She states “We have to find a way of caring for the client that matches that client’s perception of the health problem and its treatment…the needs most difficult to meet are those of people whose belief systems are most different from the “mainstream” health care provider culture.” (Sector, 1996, p.4)
It could be argued that the society we live in is one where racial discrimination is so deeply enshrined into our systems that even those who are impartial somehow become separated from personal beliefs and instead get drawn into processes, behaviours and attitudes which discriminate through ignorance or stereotype, which has a disadvantage on ethnic minorities.
The patient is suspected of self harming. The NMC Code of Conduct states that people should be treated equally, People who self harm should receive the same level and quality of care that a person with accidental similar injuries would receive. The patient also has a right to participate in decisions regarding their care. She should be consulted to whether she would benefit or if a psychological assessment is needed. If the patient is too distressed to give an informed choice then a doctor should be consulted in order to provide the best care in the interest of the patient.
Researching this essay has reiterated the fact that being a patient can be a very scary experience, especially in the case where total dependence is required. For those who are vulnerable this is worsened for a variety of reasons. For example if the patient is from an ethnic minority background, has mental health issues or social or physical disability. As nurses we should never undervalue how important maintaining and displaying to patients, particularly those who are vulnerable that we care. That is why the NMC Code of Conduct exists and we must uphold the professional values to the highest at all times.
I have realised and beginning to understand the true role of a nurse, one of much more than a physical element of care. According to Cuthbert and Quallington (2008) caring is not just a practical act, it involves a real concern for the health, protection and well being for the patient. I have learned how easy it can be for nurses to allow their personal views to somehow conflict with the care given to the patient. Upon initial reading in the case discussed I found myself being unsympathetic to the patient as I have little tolerance for those who have abandoned their children or allowed them to be taken into care. This is why nurses should have ongoing self-development training to be aware of the values and beliefs they hold. This can be achieved by looking at the different cultures in this country and trying to know and understand them.
How a patient is approached is very significant, therefore developing my interpersonal and communication skills will help in how I come into contact with patients, especially those who are vulnerable. As a black African woman who has grown up in Britain we live in a society where the colour of the skin attracts discriminatory behaviour, intentional or unintentional. My experience shows that difference is only accepted as long as it fits in with the dominant race world view with some differences (e.g. Notting Hill carnival, Jerk Chicken, Reggae music etc) being acceptable and even desirable while others (free expression, family structures, religious beliefs) are much less tolerated.
On the other hand maybe referring the patient to the medical social worker may beneficial in an attempt to regain interdependence allowing a way for her children to return. Medical social workers typically work in hospital and work with patients and their families in need of psychosocial help. It may be that the patient needs additional help and services after discharge, such as psychotherapy, support or grief counselling, expanding or initialising networks for social support or connecting the patient to necessary resources (Hospital Social Work Beder J (2008).
The importance of reflection as part of the learning experience and using reflection as a means of impairing one’s professional skills and future performance by evaluating the situations and the mistakes. Advantages of reflection in dealing and a way to improve professional approach. (Reflective practice)
References
. African and Caribbean Mental Health Commission (ACMHC): Improving the mental health of the population. Towards a strategt on mental health for the European Union. A response from the green paper. March 2008
Racism and Mental Health: Prejudice and suffering. Edited by Kamaldeep Bhui 2002. Jessica Kingsley Publishers Ltd London, Printed in BG by Athenaeum Press, Gateshead.
Ethics in Nursing Practice: A guide to ethical decision making. 3rd edition. Sara T Fry and Megan-Jane Johnstone. 2008 Blackwells publishing.
