Philosophical Perspectives on Trustworthiness and Open-mindedness as Professional Virtues for the Practice of Nursing: Implications for he Moral Education of Nurses

Ambiguity in use

Looking in from the outside, current use of the adjective seems to include just about
everyone. It spans the entire age range of human existence; as in ‘the vulnerable child’,
‘the vulnerable family’, ‘the vulnerable adult’, and ‘the vulnerable older person’: as
well as different patient groupings; ‘the vulnerable ITU patient’, ‘the vulnerable cancer
patient’ and so on. While all these groupings may share common features of
vulnerability what the descriptions fail to do is to say anything about what these patients
or groups of patients are vulnerable to. Hence the potential for ambiguity. By way of
illustration, health visitors consider the ‘vulnerable child’ as one who is, in older
terminology, ‘at risk’ (Appleton 1994) and this is quite a different meaning from that
used when claiming that children should be thought of as a ‘vulnerable group’ when it
comes to being research subjects (RCN Research Society 2003). While it is true that the
meaning of the vulnerability in each of these examples can be determined by the
context, it nevertheless remains a distinct possibility that confusion and
misunderstandings could occur, especially in the context of interprofessional working.
This suggests that the term vulnerable is insufficiently precise; it may have some value
in generally parochial and rather vague understandings but it does not identify the
source of the risk of harm. A person described as vulnerable is usually at risk of harm
from specific and predictable sources.

Individual patients, different susceptibilities

Recognising the inadequacy of the adjective ‘vulnerable’ and replacing it with more
accurate terminology does not of itself remove the problem of imprecision. For even if
one accepts that all patients are more-than-ordinarily vulnerable it remains true that not
only are individual patients more susceptible to harm in different ways and at different
times but also that some patients are more vulnerable to particular risks of harm than
others. Generally speaking, but not invariably, individuals who are unconscious are
likely to be more vulnerable than those who are conscious; and the same is probably,
but not always, true for people with cognitive or physical incapacities. Despite
variations it is nonetheless possible to say with some certainty that the unconscious
patient is more-than-ordinarily vulnerable because to be unconscious is to have an
absent capacity for self-protection in some very specific ways. Thus we know that a
patient who is unconscious is at risk of harm from a blocked airway and protection from
this specific and predictable source of harm is an important and necessary action for a
nurse to undertake.

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