This essay will attempt to make clear the nursing


This essay will show the nursing responsibility of attention with respect to the vulnerable patient, sing the demands and outlooks of that patient and his apprehension of the state of affairs he is in and the options that are available to him. Our patient, Jack, is 83 old ages of age lives entirely and is inclined to forgetfulness. Surgery has been arranged to better his hapless mobility, but his GP has explained that there are considerable hazards associated with the process that is planned for him. His girl, recognizing the benefits to her male parent if he has the surgery has told her male parent that she thinks that the surgery is a good thought. Jack, nevertheless, as the clip of the operation gets of all time closer, is experiencing more and more discerning and is now non every bit certain as he was, that he wants the process. Fighting with his doctor’s recommendation, the possibility of better mobility Rifilato ( 2008 ) and his girls apparent enthusiasm for the surgery against his ain fright and uncertainness, Jack has turned to his nurse to assist him make up one’s mind what determination to do. This is a sensitive and hard place to be in. Asa nurse, trusted and respected by Jack, there is no uncertainty that her sentiment will transport a batch of weight. Merely to reiterate the physicians warning of possible hazards of surgery to be weighed against the advantages of better mobility will non assist, nor would it be appropriate to present personal feelings or dispositions to Jack. This minute, possibly, is the clip to trust on the sensed wisdom for covering with such delicate and finely balanced state of affairss. Careful survey and apprehension of a nurses function in back uping her patient while defying the urge to act upon their determination from a personal point of view, are important in guaranting a nurse can present appropriate attention efficaciously. The place of the medical professionals involved with Jack ‘s attention and the positions of his girl will besides necessitate to be factored into any treatment she has with the patient.

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Henderson states that:“The function of a nurse is to help an single sick or good in those activities lending to wellness or recovery or a peaceable decease that the person would execute unaided if the individual had the necessary strength, will or knowledge to make this in such a manner as to assist the individual to independence every bit shortly as possible”( Henderson 1966 p.15 )

This is an early reminder of the nurse’s function, and the accent should in this instance possibly be on the word ‘assist’ instead than to take over the state of affairs such as a determination for or against surgery, for a patient. It besides highlights the fact that a complete apprehension of the constructs of unwellness, wellness, independency, demand and ability in the context of a patient, be to the full understood by the nurse if she is to hold the cognition necessary to efficaciously nurse her patient. Cutliffe and McKenna ( 2005 p. 349-361 ) show that nurses agree that ‘concepts’ are the manner that people relate to their community and show that concepts as units of significance are cardinal in developing and put to deathing nursing patterns. It is widely agreed that, as in about all other subjects, the development and reading of constructs are the corner rocks of good nursing practice at all degrees. The Ontology of conceptualism nevertheless, can be hard to understand, and should be studied with attention and merely if to the full comprehended, set to practical usage. Careful survey and appreciation of constructs in a nursing context will doubtless assist nurses heighten their pattern.

Mary de Chesnay ( 2008 p.21 ) reminds us, possibly polemically, that in caring for the vulnerable in society a nurse does so without any outlook of personal aspirations, fiscal wages or personal safety. Indeed this sector of any society is the sector that can easy be overlooked, as a ungratified universe hastes past them. In covering with exposure the first indispensable apprehension is between the vulnerable person and the individual made vulnerable by virtuousness of being a member of a vulnerable group. The old and vulnerable airs a peculiar challenge. Their individualism and accomplishments in life are sometimes masked by their failure to retrieve or to maintain gait with modern life, and it would be easy for a nurse to seek to take over in all facets of their attention and determination devising when her function should instead be to back up. Discreet enquiry into a patient’s literacy can besides be of great aid in understanding how much of the literature he has been given by assorted wellness professionals he is likely to understand. This may be a job of hapless oculus sight or of basic literacy but is an of import point to clear up in trying to demystify the procedure for the patient. In Jacks instance his confusion could easy take to his nurse and others with whom he is in contact sweeping aside his expostulations as they remind him that he was keen on the thought ab initio. Nursing answerability, every bit far as the jurisprudence is concerned, is dealt with by Dimond ( 2008, p.3-5 ) . In order to be to the full effectual in the attention of a patient and in nursing pattern in general it is indispensable that a nurse be cognizant of the jurisprudence and how it pertains to her responsibilities and behavior. Ignorance of the jurisprudence is seen as no defense mechanism and it is of import to pattern within the bounds of the jurisprudence while understanding the powers that it affords. In covering with the aged baffled patient it is even more indispensable that every attention be taken to be as transparent in your traffics as possible go forthing no possibility for misinterpretations to originate.

In assisting Jack with his determination as to whether or non to undergo surgery his nurse must first understand his perceptual experience of his unwellness ; Lloyd, Hancock and Campbell ( 2007, p.12 ) . A patient’s response to his unwellness and his perceptual experience of the benefits he can derive from intervention for that unwellness will act upon his responses and the picks he makes. There are five cognitive dimension of unwellness as described by Lloyd et Al. They are:

  • The name of the disease/diagnosis and the symptoms.
  • The sensed cause, which may be either biological or psychosocial.
  • How long it will last: Is it acute or chronic?
  • Restricting Consequences: physical, emotional, fiscal or those restricting. effects originating from intervention.
  • Controllability e.g. whether a disease can be controlled and treated by oneself as in the instance of grippe, or needfully has to be managed by other, e.g. malignant neoplastic disease.

In guaranting that Jack’s rights in the determination devising procedure are promoted and maintained, his nurse can utilize treatment with him to set up that he to the full understands what intervention is proposed for him and to chase away any mistakes he has. She may assist him to explicate to his girl or physician what his frights are and in the instance of his physician aid him to explicate the right inquiries to inquire to assist him do his head up.

In sing her professional behavior in her traffics with this patient, his nurse must be to the full familiar with TheStandards of Conduct Performance and Ethics for nurses and accoucheuses.This standard requires that nurses

  • Make the attention of people in their attention their first concern, handling them as persons and esteeming their self-respect.

In covering with Jack this is peculiarly of import as with his neglecting memory he struggles to come to footings with and retrieve all that is being said to him.

  • Work with others to protect and advance the wellness and good being of those in their attention, their households, carers and those in the wider community.

With Jack’s girl convinced that the operation is the right thing for her male parent, a careful reconciliation act pulling on professional criterions of behavior will be needed to guarantee that harmoniousness is maintained between Jack and his girl.

  • Supply a high criterion of attention at all times

Again, in the instance of a baffled and scared patient like Jack, this is particularly of import, so that he feels that his attention will non be compromised whatever determination he makes, that he is reassured, for illustration, that the physician will non be annoyed if he does make up one’s mind non to travel in front with the surgery.

  • Be unfastened and honest, act with unity and uphold the repute of your profession.

It is particularly of import that in a instance such as Jack’s where he is fighting with a hard determination, he is non misled with respect to the possible drawbacks of a hazardous surgery. Making visible radiation of possible hazards is non responsible as to do an informed determination Jack deserves to hold all the facts at his disposal. If a nurse, in a place of trust is found to hold exaggerated or otherwise mis-represented a state of affairs, the bond of trust between her and her patient will be irrevocably damaged. It would be really alluring to rede Jack to travel in front with his operation given the considerable benefits he would bask if all went good, but this is non the nurse’s determination to do and a complete and honest representation of the state of affairs is the lone professional and ethical class she can take.

This act besides offers clear way for intercession on behalf of a patient:

  • You must esteem and back up a patient’s right to accept or worsen intervention or attention.

This is of import in Jack’s instance and his nurse must be ready to step in and assist Jack to worsen his intervention if he comes to that determination.

  • You must be cognizant of the statute law sing mental capacity guaranting that people who lack mental capacity remain at the Centre of decision-making and are to the full safeguarded.

Given his forgetfulness the possible struggle between Jack and his girl about his holding the operation, if an deadlock is reached this is potentially a really of import intercession that may be required to be taken by his nurse, in guaranting that he is non in anyhow railroaded into the operation by others’ enthusiasm, his ain uncertainties around his memory of what he has been told or his perceptual experience of the operation, it’s hazards and consequences.

The codification of behavior besides deals with the country of confidentiality and Jack’s nurse will necessitate to maintain this really much in head as Jack wrestles with his determination. His girl may desire to cognize inside informations that Jack does non desire her to and may anticipate his nurse to portion everything she knows about her male parent with her. This state of affairs needs delicate handling as Jack’s girl may impeach his nurse of maintaining information from her and hence forcing her male parent into doing a determination against surgery. The guidelines on this affair are really clear naming on the nurse to protect an persons confidentiality at all times, to do certain that the patient understands, why, if you have to, information about him is being shared with other wellness professionals, for illustration if a community psychiatric worker is consulted over his preoperative depression. In the event that it is felt that a vulnerable individual is at hazard, it is a clear responsibility to unwrap this information to acquire aid for the patient. Jack’s girl may confound, as many people do, the information she would be given by the infirmary handling her male parent, as to his station operative status, for case, with her right to cognize everything about her father’s status in general. This is non the instance and she must inquire her male parent for any of his medical information.

In their paper on pre-operative depression Leung et Al ( 2005 1563-1568 ) conducted a survey amongst 65-year-old patient utilizing the Geriatric Depression Scale GDS ( hypertext transfer protocol: // ) to test them for marks of depression. These patients were non scheduled for cardiac surgery. Of the 219 patients they studied the average age was 73.6+6 old ages of age and 12 % of these preoperative patients had 6 or more marks of depression while 32 patients reported 3-5 depressive symptoms. It was found that the more preoperative symptoms the patients exhibited the higher their opportunity of postoperative craze was. This is an of import country for Jack’s nurse to be cognizant of. A certain grade of depression before an operation would be considered normal in any patient of any age, but in a vulnerable older patient like Jack needs to be monitored carefully and Jack’s nurse would necessitate to familiarize her ego with the difference between depression and anxiousness and how one impacted on the other so that, if the state of affairs became excessively critical, aid for Jack could be obtained from the community psychiatric squad and/or his GP.

While assisting Jack to come to his determination and throughout his pre and station operative attention, if he decides to travel in front with the operation, it is vitally of import that his liberty is preserved, that he does non experience like a ‘piece of meet’ being shunted from here to at that place without any control over his destiny.

In their paper for the BMJ Lothian and Philip ( 2001 ) raise the point that anecdotal grounds suggests that within the health care system older people’s liberty is being undermined with many wellness professionals holding a stereotypically pessimistic position of older patients. Headlines that item instances of older people left to lie in their ain waste, or left unattended and uncared for, and even naked on a bed without drapes drawn are all excessively familiar. In nursing the older patient it is obvious that if his self-respect is non maintained he will experience powerless in a state of affairs where he is at the clemency of others. It is vitally of import so, that nevertheless disabled, frail or confused the patient is, he should ne’er be talked down to or talked over, instead he should be included in determination devising every bit much as possible even if it takes a considerable length of clip to obtain his apprehension of the state of affairs. A patient, even in fortunes where he is incapacitated, will make better if he feels that he is being consulted and is retaining some liberty. In Jack’s instance this is critical, as, if he feels a loss of liberty his determination as to whether or non to hold his surgery may be influenced harmfully. His nurse will necessitate to exhibit considerable forbearance and apprehension in speaking to Jack and happening out what he wants to go on to him against what he fears may go on to him in the infirmary scene and afterwards. Jack’s nurse should hold the replies to any inquiries that he might hold about his infirmary stay, what happens earlier and afterwards, how long the operation will take, what the ward will be like, how he will travel to the lavatory and when he will be able to hold visitants. A careful ‘walk through’ of precisely what Jack can anticipate in infirmary may be all that he needs to do a determination for surgery. Fear of the unknown can be a powerful hindrance and a true and un embellished description of what is traveling to go on will surely assist a patient in the determination devising procedure. It would be a shame if Jack missed out on an operation that would give him a better quality of life merely because he had some misconceptions about the infirmary and what was traveling to go on to him at that place.

Nursing older people like Jack, has it’s ain challenges. The danger is that in aged groups who suffer from dementedness, confusion or forgetfulness the perceptual experience of the person will be lost, as the sick person becomes one of a homogeneous group. Surveies have shown that nurses engaged entirely in the attention of older patients achieve the ability to individualize each patient far more successfully than those engaged in the attention of a cross subdivision of the population at big. It is true that viewed as a group, possibly in a nursing place scene, older people, particularly those with mental aptitude jobs can look to hold ‘lost their individuality’ and to ‘all act the same’ . The nurse of the older patient is tasked with seeing the person in every patient she treats. In a chronic attention or community puting this may be easier to accomplish, as it will be possible to pass more clip acquiring to cognize a patient and their household, who may be able to ‘colour in’ facets of the patient’s personality, lost to confusion or dementedness. Spending clip with an aged patient is the lone manner to trust to derive some understanding into their thought procedures. Myerscough. P.R. , Ford, M.J. , ( 1996 p.4 ) write a really interesting history of the consequence that communicating, good and bad has on doctor/patient relationships mentioning the fact that most ailments about physicians are about their inapproachability. The nurse, in her place, is ideally placed to counterbalance for her medical co-workers defects in this regard. If their address is slow or laboured a patient may experience that they are being raging to anyone listening to them and hence keep silent. The successful nurse will, through her forbearance and kindness, coax the patient to speak to her. In what is today a really pressured working environment it is hard to do clip for vulnerable patients, but unluckily there is no cutoff to understanding the issues that an aged patient has with his intervention other than to take the clip to listen and understand what he has to state. Older people may besides acquire distressed when they try to speak about something that is upsetting them. A nurse must be prepared to reassure the patient that they are safe and that what they have to state is of import. She must soothe without surrounding in order to acquire the best possible consequence from her communicating with her patient.

In back uping and nursing the vulnerable patient the nurse must be of all time argus-eyed to the patients exposure and ne’er assume that they understand something without holding been told.

In 2009 new statute laws to protect the vulnerable patient will come into consequence. This vetting and blackball system will use to those desiring to work with kids or vulnerable grownups. In the comprehensiveness of clip all practicing nurses will be required to fall in this. ( Staines 2008 July ) . The new Independent Safeguarding Scheme ( ISA ) will spearhead this new statute law, which was brought into being following the deceases of Holly Wells and Jessica Chapman ( hypertext transfer protocol: // retrieved 4/1/09 ) . The ISA was set up in January 2008 and will replace statute law in the societal attention sector widening it to the NHS for the first clip. The ISA registry will run on a positive instead than negative degree, intending that merely those whose names appear on it will be allowed to pattern in their preferable countries of work.

For nurses on the frontline, the acceptance and execution of this new codification of working, due to come into consequence in October 2009 will, ab initio, have as it’s foremost campaigners, new employees. However the strategy will widen by 2010 to bing NHS staff working with kids or vulnerable grownups whether or non they have been CRB checked. The nursing community has, in general, welcomed this new testing procedure cognizant, as they are, of the dangers that the vulnerable in the community face from unscrupulous persons.

In decision, Jack’s nurse has several factors to see in offering the best attention she can to her patients. First his indecisiveness as to whether or non he wants to hold the surgery that he has been offered. It is true that the surgery will assist him be more nomadic and hence more independent but he has had the hazards of surgery explained to him and is nervous. His nurse must happen out utilizing the tools at her disposal, what is doing him nervous, are at that place implicit in concerns about the unknown nature of the infirmary, the process, the after effects? She must analyze the job from all angles for Jack, from the construct of unwellness and how he perceives his status, to his relationship with his girl and other wellness attention suppliers. She must, with tact, discover if jobs with literacy or hapless sight have affected his apprehension of the literature about the operation that he has had to read. She must seek to detect to what extent he is depressed about his operation. If her careful account of what he can anticipate and what the infirmary is like and how his process will travel make nil to promote his temper she must look into other avenues for him possibly by naming on co-workers in psychiatric attention or his General practitioner to assist him over this apprehensible reaction to his forthcoming surgery. She must assist Jack to recover his assurance and do an independent determination about the surgery that he feels able to transport through and remain set on to the twenty-four hours of his admittance. While it is indispensable for a patient to do these determinations, a patient continuously hovering from one determination to the opposite stance may necessitate further aid from the community psychiatric squad.

If, holding had every facet of his intended operation explained and understood Jack decides that the surgery on offer is non for him, so his nurse has different duties. It is likely that Jacks’ girl will be really defeated at what she sees as a aureate chance for her male parent to be more independent, and may set force per unit area on him to alter his head. Jack’s nurse must work out the best scheme to pass on with Jack’s girl. In their bookTalking to Cancer Patients an Their RelativesFaulkner and McGuire ( 1994, ch.7, ch.9 ) trade with recognizing hard personal interactions and speaking to patients relations severally. Although this book is aimed at the malignant neoplastic disease patient and their relations every bit good as the relations of others with life endangering diseases it is acknowledged as an highly utile mention point in covering with and deriving a better apprehension of the accomplishments necessary to manage ambitious state of affairss affecting communicating with patient’s relations. His nurse will hold to be firm n her support of her patient. Careful readying of his determination with his nurse and the rebuilding of his assurance should assist Jack, at this point, to keep his ain with his girl and stick to his determination. In stating the medical squad caring from him, Jack may experience that he is in some manner, ’ allowing them down’ and it will be his nurse’s responsibility to reassure him that this is non the instance. He is non obliged to hold surgery, merely so that he does non ‘put out’ the physicians who plan to handle him.

With his determination made and his assurance bolstered, Jack and his nurse will hold the advantage of a cementing of their professional relationship with the patient’s trust for his nurse and her counsel enhanced. A nurse who has steered her patient through this peculiar scenario, pulling on her preparation, survey, compassion and professionalism will hold every ground to be satisfied with her public presentation, whatever the result.


Rifilato, A. ( 2008 ) Duke Study Says Knee Replacement Improves Mobility for the Elderly at Any Age, Institute for Health Technology Surveies

Henderson, V. ( 1966 p.15 ) The Nature of Nursing: A definition and its Deductions, Practice, Research and Education, Macmillan, New York.

Cutliffe, J.R. and McKenna, H.P. ( 2005 p. 349-361 ) The Essential Concept of Nursing, Elsevier, Toronto

De Chesnay, M. ( 2008 p.21 ) Vulnerable Populations, Vulnerable Peoples, Jones and Bartlett.

Leung, J.M. , Sands, L. P. , Sands, E. , Mullen, A. , Wang, Y. , and Vaurio, L ( 2005 1563-1568 ) The Diaries of Gerontology Series A: Biological Sciences and Medical Sciences60:

hypertext transfer protocol: // ( retrieved 4/1/09 )

Staines, R. ( 2008, July ) Can employee testing protect vulnerable patients? Nursing


Myerscough. P.R. , Ford, M.J. , ( 1996 p.4 ) Talking with Patients: Keys to Good Communication ( Oxford Medical Publications ) ( Paperback )

( hypertext transfer protocol: // retrieved 4/1/09 )

Dimond, B ( 2008 p.3-5 ) , Legal Aspects of Nursing 5th Ed, Longman

Lloyd, Hancock and Campbell ( 2007, p.12 ) Principles of Care, Wiley Blackwell

The Standards of Conduct Performance and Ethics for nurses and accoucheuses.

NMC’s Council on 6 December 2007 for execution on 1 May 2008

Lothian, K. Philip, I ( 2001 17ThursdayMarch ) Keeping the self-respect and liberty of older people in the health care puting. British Medical Journal.

Faulkner, A. , Maguire, P. ( 1994 ch.7 ch.9 ) Talking to Cancer Patients and Their Relatives. Oxford University Press.

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