Nursing their way not our way: working with vulnerable and marginalised populations.

AIMS AND OBJECTIVES: This paper uses the findings of two studies to explore the nature of nurses practice when working with vulnerable and marginalised populations, particularly with regard to the attributes of holism and individualised care. A secondary analysis of the findings of two separate studies was undertaken, one on the elderly with delirium and the other with indigenous Maori women.

BACKGROUND: Often considered vulnerable and marginalised, elderly and indigenous experiences of health services are often fraught with their health needs not always identified or addressed. Nursing claims that holism and individualised care are pivotal attributes underpinning nursing practice. However, the secondary analysis of two research studies highlight how vulnerable and marginalised populations accessing health and nursing services experience needs that are neither acknowledged nor integrated into intervention and treatment plans.

DESIGN: A secondary analysis of one study with the elderly with delirium used a critical gerontological methodology informed by postmodernism and Foucaults understanding of discourse. The other study with indigenous Maori women utilised Glaserian grounded theory informed by a Maori-centred methodology.

METHODS: The research on the elderly with delirium analysed 20 data sources, including interviews with older persons who had experienced delirium, members of their families and health professionals. The research with 38 indigenous Maori women aged between 24 and 65 years, inductively analysed interview data using constant comparative analysis, theoretical sampling and saturation of the core categories to generate a substantive grounded theory.

RESULTS: The findings of each study showed that a problem focussed approach to health care is offered to patients that does not incorporate individual health experiences. In addition, the social context integral to peoples lives outside of the health care environment is ignored and as such the very foundations of nursing practice, that of holism, is merely a rhetorical construct.

CONCLUSIONS: Vulnerable and marginalised patients experience care that neglects their perceived health needs and the realities of their life circumstances.

RELEVANCE TO CLINICAL PRACTICE: Individualised care that extends beyond the presenting issue is vital, but raises challenges when working with those population groups considered vulnerable and marginalised to improve outcomes of their health experience.