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Vulnerable People - Adult Case Study

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1. Adult Case Study:

Miss. Jaya is an intensely private, 74 year old Hindu lady who is a patient on your ward. She has no relatives and has never married. Miss. Jaya used to work as a cleaner and lives alone in a small bungalow.

On her previous admission, she was very upset and embarrassed when a male member of staff entered the bathroom unexpectedly and unannounced and found her undressed whilst she was being given an assisted bath by a female nurse.

Some of the nurses remember the incident and the prevailing attitude is one where they feel that they can do little to meet her needs given the staffing levels. At hand-over, it is noted that she is becoming un-communicative and reluctant to eat.

Miss. Jaya has told you that she does not want to make a fuss but she is worried that the pain she is experiencing is not being relieved by the prescribed medication.

I will discuss in this essay, the issues surrounding the case study of Miss Jaya who is a 74 years old Hindu lady. From the case scenario, I will look in detail at the concept of vulnerability and whether Miss Jaya would be classed as a vulnerable patient or not. I will also explore the professional values with reference to the Nursing and Midwifery Council (NMC)'s Code of Professional Conduct, regarding the care provided to Miss Jaya. In doing so, I will look at whether the staff have empowered Miss Jaya and have demonstrated respect whilst maintaining her dignity. How the staff could have demonstrated competencies in accordance to the guidelines. I intend to discuss the anti discriminatory practice issues in the present case, the way it affects the care of patients and how anti discriminatory practice can be promoted. I will conclude my essay, by having a personal reflection as to how things could have been different and better for everybody concerned as well as the lessons learned.

The concept of a vulnerable person has been looked into and commented by various professionals in health care and several eminent researchers and authors. Though, there is clarity about who can be a vulnerable person, an eternal definition is impossible due to changing dynamics and the time in which it is viewed ( Brocklehurst, 2008). The categories of vulnerable person keep on changing with medical researches, new legislations and with the media. I believe that the core concept of vulnerability has remained the same, but it has to be tuned to reflect the specifics of the current society. An example is the life expectancy has allowed or perhaps forced people to be able to stay longer at work as from 2016. On the other hand, there are always changes to legislations which may affect the way care is provided. The enactment of the Safeguarding Vulnerable Groups Act 2006 and recently the Equality Act 2008 are such examples of legislation having an impact of the care provided.

Vulnerability is a very wide concept. The definition of vulnerable person as outlined in the Department of Health document "No Secret" (2000) would be my preferred definition as it covers a wide range of individuals and has a broader meaning. Any individual can be vulnerable at some point in time in their life, whilst they may be in need of community care services. At such weak point, they can be vulnerable to harm and exploitation because they are unable to protect themselves against it. Pritchard (2008) has identified that there are six physical aspects of harm which can be inflicted to vulnerable people. They are physical harm; sexual abuse; psychological harm; financial and material abuse; neglects and acts of omission as well as discriminatory abuse such as racist, sexist and disability abuse.

In the present case scenario, Miss Jaya is 74 years old, has worked as cleaner, lives alone in a small bungalow. She is a Hindu and is presently a patient receiving care in a ward as she is unable to take care of herself. She has previously and now had to rely on staff to give her a bath. These abovementioned factors may strongly hint about the vulnerability of Miss Jaya. The fact that she is not staying in her bungalow but, rather in the hospital would place her in an immediate vulnerable position. One would normally feel more comfortable within the precincts of his own dwelling than in a hospital setting. Miss Jaya has been subject to abuse as her privacy has been breached and her dignity not respected, in being seen naked by a male staff. She has never received any apology for it. She is not feeling any significant improvement in her health, felt being ignored by staff and has become at risk. The fact that a cleaner would be on a low salary would place Miss Jaya on a lower end of the economic status, hence defenceless. The lack of communication regarding her well being and the staff attitude towards her would place severe strain on her and may jeopardise her recovery. Stockwell (1972) stated that there is evidence that uncommunicative patient figure in the unpopular group, thus at risk from being prejudiced. Being a Hindu, believing in karma, she might be thinking that the care provided to her is what she deserved rather than questioning the standards. Goffman (1968) has defined social stigma as a severe social disapproval of personal characteristics or beliefs that are perceived to be against cultural norms. Here, the religious belief and not being able to communicate would place her in that category and make her exposed to harm. Smith (2006) states that the Goffman's mutuality in interaction could be intelligently helpful in a hindering world.

The NMC Code (2008) is regarded as the bible of nurses and primarily safeguards the health and well being of the public. The code should be strictly adhered to by nurses; otherwise, they may be subject to disciplinary proceedings. It states that a nursing staff must treat people as individuals and respect their dignity. The fact that the whole team think little can be done to meet Miss Jaya's need, can be perceived as they are judgemental and she is being prejudiced against. This would be contrary to the code and would certainly negatively influence the care she is receiving. There are impediments such as the staffing level which does not help in those kinds of situation. I feel that Miss Jaya's was not given the care an individual of similar characteristics ought to have received. Thereby, the autonomy and empowerment expected to be created in her would evaporate. The ward staff and the Trust could be found negligent in any clinical injury claim.

Sir Ian Carruthers (2009) stated that age can still have a negative impact on the level or quality of service they receive. If age, was a factor in failing to provide the standard of care to Miss Jaya, then this



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