which actions to take. Suchjudgment is an essential constituent of practical wisdom in
the Aristotelian tradition. The point here is that the judgments I make in relation to
actions are dependent upon, amongst other things, my experience of trust to date in the
social institutions which I take to function in order to protect individuals from harm.
Those clients who are the recipients of nursing practice are not always in a position
either to make judgments about protective actions or to know when they are being
exploited.
Nurses and protection of clients
I have suggested that one of the responsibilities of the nurse is to be able to provide
some measure of protection for clients who are by definition more-than-ordinarily
vulnerable and who have both a reduced capacity to protect themselves from type 1
risks of harm and an increased exposure to type 2 risks of harm.
The reduced capacity for self-protective actions increases a client’s dependency on
others to act on her or his behalf. Thus the client comes to rely on the actions of others
for protection from ordinary everyday risks of harm and on institutional protection from
type 2 risks of harm. This dependency is, of itself, an additional type 2 risk because the
client is left to trust that those others have her or his good as a primary consideration. If
those others do not have the client’s good as a general aim then the client remains not
only more-than-ordinarily vulnerable to the activities of abuse in general but also more-
than-ordinarily vulnerable to the activities of abuse of particular others; others in whom
trust is placed to offer protection from harm. This is why it is necessary for those
charged with the protection of clients to have certain sorts of dispositions, dispositions
that are consistent with the protection of more-than-ordinarily vulnerable people.
On this account protection of patients’ particular vulnerabilities is an essential feature of
nursing practice. Protection is necessary because patients are more-than-ordinarily
vulnerable in both general and specific ways. To return to an earlier example, one
general feature of being unconscious is an inability to maintain one’s own airway. Thus
protecting an unconscious patient’s airway is a standard feature of nursing practice.
However, there may be particular characteristics of a given individual patient that
makes them susceptible to other additional harms as a result of being unconscious. If
these characteristics are such so as to be identifiable without recourse to extra-ordinary
means then the nurse would be failing in their duty of care not to take these individual
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