THE USE OF THE “VULNERABI LI TY” CONCEPT I N THE NURSI NG AREA
Lucia Yasuk o I cum i Nichiat a1 Mar ia Rit a Ber t olozzi2 Ren at a Fer r eir a Tak ah ash i2 Lislaine Apar ecida Fr acolli2
Nichiat a LYI , Bert olozzi MR, Takahashi RF, Fracolli LA. The use of t he “ vulnerabilit y” concept in t he nursing area.
Rev Lat ino- am Enfer m agem 2 0 0 8 set em br o- out ubr o; 1 6 ( 5 ) : 9 2 3 - 8 .
The obj ect iv e of t his ar t icle w as t o br iefly r et r iev e t he m eaning of t he v ulner abilit y concept , w hich has been used in t he healt hcare area; also, t o discuss how it has been used in t he Nursing area. Am idst several different focuses and obj ect s, st udies have been at t em pt ing t o overcom e t he classical reasoning of risk in epidem iology, adv ancing t ow ar ds t he discussion of t he social det er m inant s for t he pr oduct ion of healt h pr oblem s.
DESCRI PTORS: nur sing; v ulner abilit y
LA UTI LI ZACI ÓN DEL CONCEPTO “VULNERABI LI DAD” POR ENFERMERÍ A
Est e art ículo t uvo por obj et ivo hacer un breve rescat e del concept o de vulnerabilidad que viene siendo ut ilizado en el ár ea de la salud y discut ir com o v iene siendo ut ilizado por la enfer m er ía. Los est udios, en m edio de la diversidad de enfoques y obj et os, han buscado superar el raciocinio clásico de riesgo en epidem iología, avanzando par a la discusión de los det er m inant es sociales en la pr oducción de los agr av ant es de las enfer m edades.
DESCRI PTORES: en f er m er ía; v u ln er abilidad
A UTI LI ZAÇÃO DO CONCEI TO “VULNERABI LI DADE” PELA ENFERMAGEM
Est e art igo t eve por obj et ivo realizar breve resgat e do conceit o de vulnerabilidade que vem sendo ut ilizado na ár ea da saúde e discut ir sua ut ilização pela enfer m agem . Os est udos, em m eio à div er sidade de enfoques e obj et os, t êm buscado superar o raciocínio clássico de risco em epidem iologia, avançando para a discussão dos det er m inant es sociais na pr odução dos agr av os.
DESCRI TORES: en f er m agem ; v u ln er abilidade
Universit y of São Paulo School of Nursing, Brasil: 1
Ph.D. in Nursing, Assist ant Professor, e- m ail: izum [email protected]; 2 Free Lect urer, Facult y, e- m ail: m rbert [email protected], rft [email protected], [email protected].
I NTRODUCTI ON
T
he t erm vulnerabilit y is recurrent ly used in scient ific healt hcar e lit er at ur e w it h sever al m eanings. Sin ce t h e 1 9 8 0 s, in cr easin gly m or e st u dies dealin g w it h v ulner abilit y as a concept hav e been obser v ed. The pr esent st udy discusses, based on t he scient ific lit erat ure, how research in t he nursing area has used t he concept of vulnerabilit y. The lit erat ure review was per for m ed in Medlin e an d CI NAHI L, sin ce t h ese ar e t he t wo m ain dat abases in t he healt hcare and nursing areas. The keywords vulnerabilit y and vulnerable were used, associat ed t o nur sing, in quer ies on t it les and abst r act s. The 1996- 2006 per iod w as consider ed.I n Me d l i n e , t h e u se o f v u l n e r a b i l i t y a n d
n u r si n g y i e l d e d 1 5 0 a r t i cl e s, a n d v u l n e r a b l e a n d
n u r sin g y ield ed 3 7 4 . I n CI NAHI L, v u ln er ab ilit y an d
n u r sin g y ielded 2 0 4 ar t icles. Sin ce t h is is a r ev iew ar t icle, it w as r est r ict ed t o 25 r efer ences.
A n i m p o r t a n t c o n s i d e r a t i o n a b o u t t h e lit er at ur e r esear ch is t hat sev er al publicat ions, such as books, j ournals, t heses and ot hers, are not indexed in t hese dat abases. Therefore, t he scient ific product ion about vulnerabilit y addressed in t his lit erat ure review should not be consider ed as t he exist ent t ot alit y.
REVI EW OF THE VULNERABI LI TY CONCEPT
The t er m v ulner abilit y is fr equent ly used in g en er al lit er at u r e, ap p lied in t h e sen se of d isast er and danger. I t is derived from t he Lat in verb vulnerare,
w hich m eans “ t o cause dam age or inj ur y ”( 1).
According t o t he keywords used in t he Birem e d at ab ase, w h ich is t h e Collab or at in g Cen t er of t h e Pan - Am er ican Healt h Or gan izat ion f or u pdat in g t h e t er m i n o l o g y r el at ed w i t h t h e h eal t h car e sci en ces,
vulnerabilit y is defined as: a) degree t o which a given p o p u l a t i o n i s e x p o se d t o su sce p t i b i l i t y o r r i sk o f d a m a g e ca u se d b y n a t u r a l d i sa st e r s; b ) r e l a t i o n exist ing bet ween t he int ensit y of t he result ing dam age an d t h e m ag n i t u d e o f a t h r eat , ad v er se ev en t o r accident ; and c) pr obabilit y t hat a giv en com m unit y or geographic area has of being affect ed by a pot ent ial t h r eat or r i sk of d i sast er, est ab l i sh ed i n t ech n i cal st udies ( Mat erial I I I – Minist ry of Social Act ion, 1992) . Degree of loss ( 0 t o 100% ) is a result of a pot ent ially h ar m f u l ph en om en on .
I n t u r n , v u l n e r a b l e: a ) A s e c t o r o f t h e popu lat ion , especially ch ildr en , pr egn an t or n u r sin g
w o m en , t h e el d er l y, t h e h o m el ess, w h o ar e m o r e p r on e t o d isease an d n u t r it ion al d ef icien cies. Th ey are t he ones who suffer t he m ost in disast er sit uat ions, and b) a gr oup of people w hose possibilit y of choice is sev er ely lim it ed, fr equent ly subj ect t o coer cion in t heir decision.
I n t hese definit ions, t her e ar e r efer ences t o people w ho pr esent som e alt er at ion of a sit uat ion of biologic “ norm alcy”, referred t o t heir life cycle or t heir social condit ion. As such, t he gr oups t hey belong t o ar e u n der st ood as def icit ar y, or som eh ow dam aged i n h o w t h e y l e a d t h e i r l i v e s. Th e k e y w o r d s a l so m e n t i o n t h e e t h i c a l d i m e n s i o n , i n t h e s e n s e o f pr ot ect ion and defense of t hese gr oups.
Th ese k ey w or d s h av e v er y com p r eh en siv e def in it ion s. Th e t er m v u ln er abilit y, in t h is sen se, is not differ ent fr om t he concept of r isk, being used as sy nony m s in sev er al st udies.
Epidem iology has t radit ionally considered risk as t he cor e of it s st udies. Ov er all, t he epidem iology st u dies at t em pt t o iden t ify ch ar act er ist ics in people w ho place t hem at higher or low er r isk of ex posur e, j eopar dizin g t h em phy sically, psy ch ologically an d/ or socially. The pr obabilit y and higher or low er chances of populat ion gr oups falling ill or dy ing due t o som e healt h pr oblem ar e also calculat ed( 2).
Wh en differ en ces bet w een v u ln er abilit y an d risk are discussed, it is considered t hat t hey are closely relat ed, but st ill dist inct . As such, risk has a very solid iden t it y in t r adit ion al epidem iology st u dies, w it h an em inent ly analy t ical charact er. Vulnerabilit y, in t ur n, as an em er ging concept , is focused on t he sy nt het ic ch ar act er( 2 ).
Theoret ical inst rum ent s have been built in t he epidem iological concept of risk, capable of ident ifying associat ions am ong event s or condit ions, pat hological o r n o t . S t u d i e s i n t h i s p e r s p e c t i v e s e a r c h f o r “ p h e n o m e n o l o g i c a l i s o l a t i o n ” , i . e . i s o l a t i n g t h e p h e n o m e n o n , a s s o c i a t i n g t h e d e p e n d e n t a n d independent variables, t hrough a st rict cont rol of t he degr ee of uncer t aint y about t he non- r andom ness of t he est ablished associat ions( 2 ).
Therefore, it is an analyt ical process, seeking t o produce obj ect ive knowledge based on probabilist ic a sso ci a t i o n s. As su ch , ep i d em i o l o g i ca l r i sk i s t h e probabilit y t hat an individual of any group exposed t o a given aggravat ion or condit ion has of also belonging t o anot her group, t he “ affect ed”( 2- 3).
t h e associat ed an d associable abst r act elem en t s t o t he pr ocesses of falling ill t o t heor et ical elabor at ion lev els t h at ar e m or e con cr et e an d par t icu lar, w h er e t he nex us and m ediat ions bet w een such phenom ena becom e t he obj ect of k now ledge about v ulnerabilit y. Un lik e t h e st u dies abou t r isk , it seek s u n iv er salit y, not t he increased reproducibilit y of it s phenom enology and inference. According t o t he aut hors, “ vulnerabilit y m eans t he pot ent ials of falling ill/ not falling ill relat ed t o each and ev er y indiv idual liv ing in a giv en set of condit ions”( 3- 4).
I n t he v ulner abilit y per spect iv e, ex posur e t o healt h problem s and even diseases t hat lead t o deat h r esu lt s b ot h f r om in d iv id u al asp ect s an d collect iv e co n t e x t s a n d co n d i t i o n s w h i ch p r o d u ce a h i g h e r s u s c e p t i b i l i t y t o a g g r a v a t i o n s a n d d e a t h a n d , si m u l t a n e o u sl y, t h e p o ssi b i l i t y a n d r e so u r ce s f o r coping wit h it( 3- 4).
Th e o n s e t o f t h e A I D S e p i d e m i c w a s a d e t e r m i n i n g p h e n o m e n o n f o r r e s e a r c h e r s a n d healt hcare professionals t o ret hink t he concept of risk and adv ance t he discussions about v ulnerabilit y.
I t i s p r o p o se d t h a t t h e e p i d e m i c ca n b e i n t e r p r e t e d a cco r d i n g t o t h e i n t e r a ct i o n o f t h r e e d i m en si o n s: i n d i v i d u a l , p r o g r a m m a t i c a n d so ci a l . Acco r d i n g t o t h e a u t h o r s, t h e ch a n ce o f p eo p l e’ s ex posur e t o disease is under st ood as r esult ing fr om a g r o u p o f a sp ect s, n o t o n l y i n d i v i d u a l , b u t a l so collect iv e, cont ex t ual, causing higher suscept ibilit y t o in f ect ion an d disease an d, con com it an t ly, h igh er or lower availabilit y of resources of all orders t o becom e pr ot ect ed fr om bot h( 5).
The abilit y of individuals and gr oups t o fight an d r ecov er f r om v u ln er abilit y can be f ou n d in t h e sam e pr ocess( 6 - 7 ). I t is su ggest ed t h at v u ln er abilit y sh o u l d b e u n d er st o o d as t h e i n t eg r at i o n o f t h r ee dim ensions( 8), t hese being: ent it lem ent, t he right s t hat p e o p l e h a v e ; e m p o w e r m e n t, t h e i r p o l i t i c a l a n d i n st i t u t i o n a l p a r t i ci p a t i o n ; a n d e co n o m i c p o l i cy, referring t o hist orical- st ruct ural organizat ion of societ y and it s consequences.
I n t h e con cept of v u ln er abilit y, t h er e is n o way t o avoid considering it s int erdisciplinary charact er. I n t he analy t ic m odel based on t he ident ificat ion of t hr ee lev els t o ident ify t he v ulner abilit y of people t o t he HI V virus, t he int ersect ion sought is bet ween t he so ci o - st r u ct u r al an d so ci o - sy m b o l i c d i m en si o n s o f people w it h t heir lev els of social cour se, int er act ion and social cont ext . I n t he socio- st ruct ural dim ension, in t he int ersect ion wit h t he social course, t he life cycle,
so ci a l m o b i l i t y a n d so ci a l i d en t i t y a r e t a k en i n t o con sider at ion , am on g ot h er s. Th e ch ar act er ist ics of t he par t ner can be found in t his sam e dim ension of t he int ersect ion w it h t he level of int eract ion ( such as a g e, ser o l o g i c st a t u s, et c) , t h e sp a ce w h er e t h i s i n t er a ct i o n o ccu r s, et c. Fi n a l l y, st i l l i n t h e so ci o -st ruct ural dim ension, in it s int ersect ion wit h t he social con t ex t , t h e cu r r en t social st an d ar d s, in st it u t ion al n or m s, gen der r elat ion s, in equ it ies ar e con sider ed, am ong ot her s( 8).
Th e s o c i o - s y m b o l i c d i m e n s i o n , i n i t s i n t e r se ct i o n w i t h t h e so ci a l co u r se , co n t a i n s t h e subj ect iv it ies, life pr oj ect s, per cept ion of t he fut ur e, et c. The int ersect ion bet w een t his dim ension and t he l e v e l o f i n t e r a c t i o n r e f e r s t o t h e s u b j e c t i v e r epr esent at ion one has about t he par t ner, t he use of condom s due t o t he serologic st at us, et c. I n addit ion, t he int er act ion bet w een t he sy m bolic dim ension and t h e s o c i a l c o n t e x t c o m p r e h e n d s t h e s u b j e c t i v e per cept ion of t he nor m s, t he per sonal int er pr et at ion and ex pect at ion of punishm ent , et c.
This m odel offer s im por t ant cont r ibut ions t o m ak e t h e social an d su bj ect iv it y dim en sion s v isible in t he issue of t he vulnerabilit y of m en t o HI V/ AI DS, e v e n t o t h e e x t e n t o f n o t i n g so m e i n t e r v e n t i o n possibilit ies.
I t is wort h not ing t hat t he t erm vulnerabilit y, in Brazil, originat ed in t he area of I nt ernat ional Hum an Right s Advocacy, and denom inat es, in it s origin, groups or indiv iduals w ho hav e becom e legally or polit ically f r a g i l e , r e g a r d i n g t h e p r o m o t i o n , p r o t e c t i o n o r guarant ee of t heir right s of cit izenship( 2- 3).
Therefore, for t he int erpret at ion of t he healt h-disease pr ocess, it is con sider ed t h at , w h er eas r isk r epr esent s pr obabilit ies, v ulner abilit y is an indicat or of social in eq u it y an d in eq u alit y. Accor d in g t o t h e au t h or s, v u ln er abilit y pr ecedes r isk an d det er m in es t h e d if f er en t r isk s of b ein g in f ect ed , f allin g ill an d dy ing( 3).
i n t e r f e r e i n t h e i r p r i v a t e b e h a v i o r s o r a cce ssi n g ex t er nal elem ent s – polit ical, econom ic, cult ur al and h ealt h car e ser v ice offer ed – w h ich can su ppor t an d d ir ect p eop le in a p er sp ect iv e of g r eat er or lesser self - pr ot ect ion .
Th e con cep t of HI V/ AI DS v u ln er ab ilit y h as been dev eloped since t he lat e 1980s, and ex pr esses t he effor t t o pr oduce and m ake know ledge available, as w ell as d eb at es an d act ion s ab ou t t h e d if f er en t degr ees and t ypes of suscept ibilit y of individuals and g r o u p s t o i n f e ct i o n , f a l l i n g i l l a n d d e a t h b y HI V, according t o t heir part icular sit uat ion, considering t he int egrat ion of t he social, program m at ic and individual aspect s t h at r elat e t h em w it h t h e pr oblem an d t h e r esour ces for coping( 3- 4).
Vulnerabilit y, in t his aspect , can be analyzed a c c o r d i n g t o t h r e e i n t e r d e p e n d e n t d i m e n s i o n s : in d iv id u al, p r og r am m at ic an d social. a) I n d iv id u al v ulner abilit y r egar ds indiv idual pr ev ent iv e act ions in t h e f ace of a sit u at ion of r isk . I t in v olv es asp ect s r e l a t e d t o p e r so n a l ch a r a ct e r i st i cs ( a g e , g e n d e r, et hnicit y, et c) , em ot ional developm ent , risk percept ion and at t it udes t ow ar ds t he adopt ion of self- pr ot ect ion m e a su r e s, a s w e l l a s p e r so n a l a t t i t u d e s t o w a r d s sex u alit y, acq u ir ed k n ow led g e ab ou t t r an sm it t ab le diseases and AI DS, experiences of sexualit y and skills t o n egot iat e safe sex u al pr act ices, r eligiou s beliefs, et c; b ) Pr o g r am m at i c v u l n er ab i l i t y r eg ar d s p u b l i c policies of coping w it h HI V/ AI DS, t he pr oposed goals a n d a c t i o n s i n t h e S TD / A I D S p r o g r a m s a n d o r g an i zat i o n an d d i st r i b u t i o n o f t h e r eso u r ces f o r p r ev en t ion an d con t r ol; an d c) Social v u ln er ab ilit y r e g a r d s t h e e co n o m i c st r u ct u r e , p u b l i c p o l i ci e s, esp ecially t h ose f ocu sed on ed u cat ion an d h ealt h , cult ur e, ideology and gender r elat ions, w hich define indiv idual and pr ogr am m at ic v ulner abilit ies.
Pe r h a p s t h e g r e a t e st co n t r i b u t i o n t o t h e debat e and act ions relat ed t o t he dist inct ion bet ween t he concept s of risk and vulnerabilit y lies in t he effort of r elocat ing t he not ion about individual r isk t ow ar ds a n e w p e r c e p t i o n o f s o c i a l v u l n e r a b i l i t y( 9 ). B y con sid er in g t h at ev er y h u m an b ein g is b iolog ically suscept ible t o HI V infect ion, or t hat t ransm ission can r e a l l y o c c u r d u e t o b e h a v i o r a l a c t s o f s p e c i f i c individuals, in t he perspect ive of im proving knowledge about t he epidem ic, such behav ior s place indiv iduals an d g r ou p s in h ig h er v u ln er ab ilit y sit u at ion s. Th is per m it s a gr eat er per cept ion of h ow in equ alit y an d in j u st ice, p r ej u d ice an d d iscr im in at ion , op p r ession , e x p l o i t a t i o n a n d s o c i a l v i o l e n c e a c c e l e r a t e t h e
dissem inat ion of t he epidem ic in differ ent count r ies. S o c i a l v u l n e r a b i l i t y i s r e l a t e d w i t h e x c l u s i o n , discr im in at ion or w eak en in g pr ocesses of t h e social groups and t heir abilit y t o react( 9).
THE UTI LI ZATI ON OF THE VULNERABI LI TY
CON CEPT AN D THE CON TRI BUTI ON OF
NURSI NG
Vu l n e r a b i l i t y i s a n i m p o r t a n t co n ce p t f o r nursing research, because it is int rinsically connect ed t o healt h and healt h problem s( 10).
Fo r t h e n u r s i n g a r e a , t h e r e l e v a n c e o f k n ow led g e ab ou t v u ln er ab ilit y t o h ealt h p r ob lem s, such as HI V/ AI DS infect ion, lies in t he im plicat ions it p r od u ces f or t h e h ealt h of v u ln er ab le p eop le an d , consequent ly, in t he ident ificat ion of t heir healt hcar e n e e d s , s o t h a t i n c r e a s e d p r o t e c t i o n c a n b e gu ar an t eed( 1 1 ).
The ut ilizat ion of t he vulnerabilit y concept t o u n der st an d it s obj ect by r esear ch er s in t h e n u r sin g area has t he purpose of bet t er responding t o t he goals of nur sing w or k .
The t er m v ulner abilit y is fr equent ly used in nur sing r esear ch( 10). How ev er, it is not oft en defined a d e q u a t e l y, a n d t h e r e i s n o co n se n su s a b o u t i t s m eaning and ut ilizat ion.
I n d e e d , i n t h e l i t e r a t u r e r e v i e w a b o u t v u l n e r a b i l i t y, i n t h e p a st 1 0 y e a r s, m o st a r t i cl e s r ef er r i n g t o t h e t er m w er e o b ser v ed t o d eal w i t h r esear ch r ep or t s, an d f ew b r in g d iscu ssion s ab ou t v u l n e r a b i l i t y i n t h e t h e o r e t i c a l p e r s p e c t i v e o f know ledge pr oduct ion about it s definit ion or concept . Sev er al nur sing st udies use v ulner abilit y as t he ident ificat ion of people or gr oups w it h som e sor t of deficiency, ex posed t o aggr av at ions. Vulner abilit y i s u s u a l l y r e f e r r e d t o a s t h e d i m e n s i o n o f t h e indiv idual, i.e. t hey br ing about lit t le, or do not deal w it h t he social dim ension and r elat ions( 12).
Vulnerabilit y is defined as a dynam ic process, est ablished by t he int er act ion am ong it s com ponent elem ent s, such as age, et hnicit y, pov er t y, educat ion, social suppor t and pr esence of healt h aggr av at ions. Ea ch p e r so n i s a d m i t t e d t o h a v e a v u l n e r a b i l i t y t hreshold which, when crossed, result s in falling ill( 20). Br o a d e n i n g t h e d i scu ssi o n , so m e st u d i e s con sid er t h at som e seg m en t s of societ y ar e m or e v u ln er able t o diseases an d deat h t h an ot h er s, su ch as young or elderly people, wom en, et hnic m inorit ies, people w it h low social suppor t , lim it ed or no access t o educat ion, low incom e and unem ploy ed, and t hat t heir vulnerabilit y is great ly affect ed by t he percept ion t hat each possesses about t he healt h- disease process and about life( 11).
Ot h e r st u d i e s p r o p o se t h a t a g e , g e n d e r, et hnicit y, social suppor t , educat ion, incom e, lifest y le and m odifiable/ non- m odifiable risk fact ors can be used as v ar iables for analy sis. Vulner abilit y is defined not only by personal charact erist ics, but also by condit ions acquired t hrough life or result ing from a given lifest yle, st r at egy dev elopm ent and sk ills t o cope w it h t r aum a and disease( 11).
The degr ee of v ulner abilit y is consider ed t o change, depending on t he m odificat ion of t he social or en v ir on m en t al con dit ion . As su ch , t h e an aly t ical m od el p r op osed b y t h e au t h or, r ep r esen t ed b y an equilat er al t r iangle, is based on t he ident ificat ion of t he indiv idual and social com ponent s of v ulner abilit y. The assessm ent of vulnerabilit y can be useful t o ident ify charact erist ics or condit ions t o pot ent ialize t he av ailable r esour ces t o cope w it h t he disease( 21). Th e id en t if icat ion of con d it ion s, ch ar act er ist ics an d sit uat ions of pr ot ect ion and st r engt hening indiv iduals and groups against disease are one of t he different ials in t he concept of vulner abilit y( 4).
Ev e n t h o u g h s o m e s t u d i e s b r o a d e n t h e d i s c u s s i o n o f a c o l l e c t i v e d i m e n s i o n o f h e a l t h p h e n o m e n a , m o st st i l l e m p h a si ze t h e i n d i v i d u a l d i m e n s i o n . B e s i d e s , d e s p i t e t h i s g r e a t e r com pr eh en sion of t h e social issu es, it is con sider ed t hat sev er al st udies in t he nur sing ar ea do not deal w i t h t h i s d i m e n si o n cr i t i ca l l y e n o u g h , si n ce t h i s dim ension is underst ood in t he perspect ive of anot her elem ent , social su ppor t. Th is fr agilit y r efer s t o h ow social p h en om en a ar e an aly zed , su ch as v iolen ce, t he social role of t he wom en, t he influence of t he m edia ov er t h e cu lt u r e, h old in g a d iscu ssion ab ou t t h ese p h e n o m e n a t h a t i s co n si d e r e d su p e r f i ci a l , b e i n g lim it ed t o an analysis about t he appear ance of t hese p h e n o m e n a , a n d n o t d i scu ssi n g t h e i r p r o d u ct i o n
essence adequat ely. The st udies do not highlight , for exam ple, healt h service act ions in t he scope of public healt hcar e policies( 4 ).
Resear ch in Nor t h Am er ica, especially in t he n u r s i n g f i e l d , t e n d s t o u s e m e t h o d s l i k e phenom enology and sym bolic int eract ionism , and t his t y p e of ep ist em olog ical ap p r oach en d s u p f av or in g t h e f ocu s on t h e i n d i v i d u al . Si n ce Lat i n Am er i can r esear ch is in f lu en ced by Mar x ist t h eor et ical bases, st udies t end t o focus on social issues m ore crit ically( 22). Som e n u r sin g r esear ch in Br azil h as u sed t h e con cep t of HI V i n f ect i on v u l n er ab i l i t y, ev en i f in d if f er en t p er sp ect iv es, t o d iscu ss t h e p r ocess of f a l l i n g i l l a n d d y i n g i n r e l a t i o n t o o t h e r h e a l t h p h en om en a( 2 3 - 2 5 ).
Th e r elev an ce of k n ow ledge con t r ibu t ion is undeniable, built upon vulnerabilit y in renew ing AI DS prevent ion m easures, especially due t o t heir “ pract ical aspir at ion s”( 2 ).
The analysis of vulnerabilit y perm it s knowing and underst anding t he differences experienced in t he h e a l t h - d i s e a s e p r o c e s s , b o t h i n d i v i d u a l l y a n d collect iv ely. Th e con st r u ct ion of m ar k er s t h at cou ld be used t o ev aluat e t he life and healt h condit ions of in d iv id u als an d g r ou p s is p r op osed , so t h at it can s u p p o r t t h e i n t e r v e n t i o n s o r i e n t e d t o w a r d s t h e det er m iner s of t he st at e of v ulner abilit y( 4).
One of t he scopes of t he concept is y ielded by it s pot ent ial of increasing over t he com pression of t h e h ealt h ph en om en a, r esu lt in g of t h e cr ossin g of behavior s w it h individual and subj ect ive exper iences; social, p olit ical an d cu lt u r al con d it ion s, alon g w it h h e a l t h c a r e a c t i o n s f o c u s i n g o n p r e v e n t i o n a n d aggr av at ion con t r ol.
Anot her scope is t he possibilit y of confer r ing g r e a t e r i n t e g r a l i t y t o h e a l t h c a r e a c t i o n s , b y st rengt hening int ervent ion proposals t hat consider t he t h r ee dim en sion s of v u ln er abilit y, in cor por at in g t h e influences ex er t ed by it s com ponent s.
Th e m u lt idisciplin ar y ch ar act er is im plied in t he social det erm inat ion perspect ive of healt h- disease and v ulner abilit y, w hich is fundam ent al w hen dealing wit h healt h problem s or necessit ies, as t he com plexit y o f t h e h eal t h o b j ect co m p l ex i t y r eq u i r es d i f f er en t t h eor et ical- m et h od olog ical v iew s. I f t h at d oes n ot h a p p en , t h e a ct i o n s ca n b e r ed u ced t o p u n ct u a l , em ergency “ t asks”, which do not change t he st ruct ure of t he web of causalit y( 2,4).
have inst rum ent s and t heoret ical m odels t o direct t heir p r a c t i c e s o f r e s e a r c h a n d h e a l t h i n t e r v e n t i o n . Ho w e v e r, su ch t h e o r e t i ca l m o d e l s sh o u l d n o t b e underst ood as a “ rigid and im m ut able” st ruct ure. From a d ialect ic p er sp ect iv e, t h e t h eor et ical m od els ar e in st r u m en t s t h e st u d y ob j ect s can b e d r aw n f r om , w hich ar e alw ay s under const r uct ion.
By a d o p t i n g v u l n e r a b i l i t y a s t h e co n ce p t r e f e r e n c e f r a m e w o r k i n a r e s e a r c h s t u d y, i t i s im port ant t o keep it from t urning int o a reproduct ion o f t h e s t a t u s q u o d u e t o t h e n a t u r a l i z a t i o n o f oppr ession, since r esear ch m ust pr oduce k now ledge f o r t h e em a n ci p a t i o n o f p eo p l e a n d g r o u p s. I t i s
i n d i s p e n s a b l e t h a t t h e p o l e o f “ d e b i l i t y ” i s n o t em ph asized. Lik ew ise, it is im por t an t t o em ph asize t h e p ole of r esist an ce an d cr eat iv e cap acit y of t h e indiv iduals( 2, 4).
Suggest ing t hat t he nur sing ar ea use som e o f t h e a f o r e m e n t i o n e d t h e o r e t i ca l m o d e l s w o u l d co n t r i b u t e t o a w i d e r sh a r i n g o f d e b a t i n g o f t h e v u ln er abilit y con cept .
Th e u t ilizat ion of sim ilar t h eor et ical m odels w ou ld m ak e it p ossib le t o sh ar e k n ow led g e ab ou t v u ln er ab ilit y am on g n u r ses/ r esear ch er s of sev er al count r ies, w it h t he obj ect iv e of im pr ov ing k now ledge and nur sing pr act ice.
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