Clarke and Driever’s account of patient vulnerability
Clarke and Driever (1983) attempt to develop an account of patient vulnerability drawn
largely from social and developmental psychology. Their account is located within a
framework of what are claimed to be the central concepts of nursing theory. Fawcett
puts it thus: “A consensus now exists that the central concepts of the discipline of
nursing are person, environment, health, and nursing” (Fawcett 1983 p. 4). In fact, this
statement represents only one particular view of the central concepts of nursing and as
such cannot be held to provide the consensus claimed. Nevertheless, it is a claim that
permeates the work in the volume in which Clarke and Driever’s paper appears. As a
result their discussion of vulnerability is constrained and their account partial.
Clarke and Driever argue for a construct of vulnerability for nursing “... based on the
subjective perspective of the individual [and a]... perceived transaction between the
capabilities and environmental situations that determines the individual’s wellness-
illness status” (Clarke and Driever 1983 p. 210). In other words, their claim rests upon
the assumption that vulnerable people are vulnerable because they perceive themselves
to be vulnerable; and on the idea that such vulnerability is a function of an individual's
perception of a lack of capacity to protect themselves from the external environment.
They further claim the subjective nature of vulnerability has a psycho-somatic effect on
the health of the individual. Those with a perception of themselves as having a high
level of vulnerability lack the confidence to face the world and tend to react to their
environment in ways that are "... not conducive to healthy development..." (ibidp.
211). Whereas the "... individual whose self-perception is one of low vulnerability ...
tends to develop into a healthy, resilient, competent person.." (ibid). This is a highly
speculative claim and rests, as they rightly acknowledge, on an extension of the claims
of psychology. Thus, for Clarke and Driever, a low perception of vulnerability is a
prerequisite for flourishing.
They also suggest a need to distinguish vulnerability from risk and they do this by
conceptualising vulnerability as subjective and risk as objective. While superficially
attractive their failure to offer a defence of this characterisation of risk leaves the idea
unsubstantiated. Consequently their claim that “Risk, the objectively assessed potential
transactions between individual capabilities and challenging environmental situations, is
determined by others.” (ibid p. 212) is unconvincing.
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