and because of this recognition practice tends to be in strict accordance with universal
precautions. Universal precautions are a standard set of guidelines for dealing with
bodily fluids on the assumption that all bodily fluids might carry potentially harmful
organisms. While adopting universal precautions is considered to be the essence of
good practice it is clear that many nurses working outside of identified high-risk areas
do not conform to the guidance. Paradoxically, this appears to have the effect of placing
them at greater risk of harm.
Similarly, nurses working in mental health units are acutely aware of the potential risk
of physical harm from violent incidents (a common feature of mental health work).
Training in the management of aggression is mandatory for mental health nurses with
the aim of recognizing and diffusing potentially violent situations. This perception of
being vulnerable to physical harm by virtue of working with clients with mental health
problems equates to the identification of a type 1 risk. The individual nurse can take
self-protective actions to reduce the likelihood of harm (of course, it is also a type 2 risk
of harm as there are institutional protective actions taken at least in in-patient facilities).
In contrast, general nurses (with some notable exceptions such as those working in
accident departments) do not expect to be faced with violence despite the increase in
reported incidents of violence to hospital staff (Winstanley and Whittington 2004).
Hence the perception of not being at risk increases the nurse’s vulnerability. One thing
that might be said then is that nurses are more vulnerable to certain sorts of risk of harm
just by being nurses because working as a nurse brings with it a number of risks; risks
which those who do not work as nurses are not exposed. However, because, generally
speaking, nurses are not compromised in their capacities for self-protection they remain
ordinarily vulnerable albeit with an increased exposure to type 1 risks of harm.
Nurses witness the more-than-ordinary vulnerability of others on a daily basis
The expression ‘bearing witness to suffering’ is common in some accounts of nursing. It
is noted as a factor in, amongst others, accounts of the experiences of nurses working in
emergency departments (Malone 2000) and in accounts of palliative care nursing
(Boston et al. 2001). Malone notes that in the nursing literature vulnerability is most
often considered to be essentially negative (something to be avoided or prevented) but
that there are some who consider vulnerability as positive. One form of this positive
approach to vulnerability is expressed by Daniel as “.. .a trait to enjoy; for through it,
humans celebrate the authenticity of what it is to be human” (Daniel 1998 p. 191) and
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