Nurses claim vulnerability as a central and important concept within nursing
]. There have been countless studies that have identified the concept of vulnerability as a key factor in determining health status of individuals, groups and communities
]. With few exceptions, however, nurse theorist have not elaborated upon the concept of vulnerability, resulting in an underdeveloped concept
] that is narrowly defined, lacking “an archaeology of the social, political and economic”
] dimensions that produced ideologies and sustain certain structures that determine health. Nurse scholars tend to view vulnerability as a source of stimuli to which individuals respond or as the interactional arena in which individual’s accommodate, assimilate, or adjust to the prevailing social customs and expectations of society’s dominant ideology.
With a tendency to concentrate almost exclusively upon the adaptive capacity of individuals, nursing theories do not encompass explanations for persons, groups or populations who refuse to reject accommodation to vulnerability that present intolerable or unacceptable social, political or economic conditions. There are contexts where vulnerability has worked to incite social or political movements. Within these contexts, there are people who refuse to accept perceived injustices or who refuse to adjust or adapt to the societies dominant ideologies. Nursing theories lack substantive explanations for contexts where vulnerability is deeply rooted and social movements arise whereby the structure of society is challenged. Examples of such movements include the women suffrage, labour, liberation and anti-racism movements.
Although nurses are aware of the root causes of person’s vulnerability that may cause or potentiate health problems, they often approach these origins of vulnerability from epidemiological perspectives
]. That is, the patient is examined for causative agents that underlie the health issue. Factors such as toxic agents, microbes, viruses or other potential health hazards are considered as acting on the individual and threatening an individual’s health and well-being
] argues that the concept of environment is not analyzed as social landscape, as geography, and lacks the archaeology of the social, political, and economic worlds that influence clients states and nursing roles. It is my view that the concept of vulnerability can be housed in Chopoorian’s view of environment.
While the concept of vulnerability is given attention in nursing, it is the concept of the person that holds the paramount place in the conceptualization and therefore I argue in the same vein as Chopoorian, that the concept of vulnerability within nursing lacks consciousness in the larger arena of social, economic and political affairs. As a result, nurses have not been provided with the framework to view vulnerability from a social, economic or political lens and consequently do not regularly lobby or otherwise participate in local, national or international political offices, such as participate in policy formation, or sit on committees/ boards that address policy in relation to these levels. Yet, nurses have frontline experience to the most detrimental effects of vulnerability on the fate of particular individuals, groups and populations.
It was not until I began to work as a nurse in Mozambique within the international aid community that I came to realize my own deficiency of understanding how social, economic and political structural factors intersect and shape people’s ability to be healthy. Consequently, I was a naïve nurse, lacking the knowledge and skill on how to engage with the concept of vulnerability at a practice level within a context of widespread vulnerability. At first I engaged with vulnerability through the lens of individualism, which has been influenced by basic principles of neoliberalism, the dominant paradigm guiding both the West and international development policy today
]. This naïve view of vulnerability clashed with my on-the-ground experience in Mozambique where vulnerability is widespread, directly resulting from historical, social, economic and political dimensions, rending whole populations vulne-rable with dominant power-structures acting as barriers rather than supportive openings where people are able to access supports to overcome their own state of affairs. For this reason, I realized the need for nursing to expand its view of vulnerability and challenge the current conceptualizations of vulnerability in nursing.
On this basis I seek demonstrate how the concept of vulnerability in nursing has been shaped within two basic premises of a Western-based neoliberal paradigm, namely: individualism and economic rationality. The purpose of this paper is threefold: (a) to review the origins of the term vulnerability; (b) to explore how vulnerability has been constructed within nursing and influenced by a Western-based neoliberal paradigm; and (c) to engage in a dialogue about the potential hazards of maintaining a view of vulnerability in nursing confined to an individualism paradigm. These hazards include, but are not limited to, re-colonizing practices that ignore structural factors that impede people’s ability to make rational choices, undermining meaningful efforts to promote social justice within a global context. Finally, I will offer suggestions as to how we as nurses might broaden our view of vulnerability in order to transcend our Western-based analysis and change our practice both within and beyond our Western borders, with the hope that this knowledge will assist other nurses from being, like myself, the naïve nurse.