Delivery in day(s): 5
Impact of Marginalization Health Care Assignment
Marginalisation is the relegation of some individuals or groups in the society due to a lack of access to resources, rights and opportunities. It is also referred to as social exclusion. Marginalisation is a principal cause of vulnerability which describes exposure to a range of potential harms and inability to deal with them appropriately (Rovny, 2014). These groups of people are basically nominated as potential criminals because of their lack of self-control and their presumed simmering umbrages against the society. However, these people often face feelings of guilt, fear and other limitations. Financial management constraints, skill deficiency, lack of tolerance by the public at large and difficulties in transport accessibility renders them unable to participate in communal activities (Weisz & Quinn, 2017 ) Even in the health care sector, these groups may be treated differently because of who they are and how estranged they are from the society. The marginalised groups in society (vulnerable groups) include people with mental health problems, the homeless, drug addicts or alcoholics, prisoners or offenders. This paper assesses the nature of care provided to homeless people in a health care institution.
Homelessness in Australia
Most Australians’ standards of living are relatively high, life expectancy in the country is also high while the rate of unemployment is fairly low. More than two thirds of people in Australia own their own homes or are on the verge of purchasing one. In other words, Australia is a prosperous country (Herault & Johnson, 2016). However, alike to many other countries, Australia still experiences a difficulty with homelessness. Homelessness is more than just sleeping rough (in uncomfortable conditions); a homeless individual has no secure tenancy over stable housing. It includes couch surfing, lack of a fixed address, sleeping rough and housing in shelters. It is exceptionally rare that a person ends up homeless by choice. This state is generally a result of a composite combination of inadvertent and often disastrous circumstances.
Effects of Stigmatization of the Homeless in Health Care
Stigmatization is the laying of some mark of infamy or disgrace. The society regard homelessness as something to be ashamed of thus the homeless are unfairly viewed as a disgrace.Homelessness is perceived as a controllable stigma, that is, an aspect that is within the individual’s control. Homeless people are therefore likely to experience highly legitimized forms of discrimination. Despite the fact that homeless individuals are professed as needing compassion and care, they are also perceived as being incompetent and not fully human. This adversely affects their wellness and wellbeing as well as their functioning in the society (Pachankis et al., 2018). They experience prejudice and contempt from various people in the society, even in health care settings (Johnstone et al., 2015).
Nurses’ Standards of Performance, Professional Conduct and Ethics require them to show lack of prejudice or discrimination towards patients irrespective of their economic status. However, there is still an existence of negative attitudes towards the homeless by nurses which impact the quality of care received by this particular group of patients. Nurses’ bigotry is also a barrier to homeless people’s accessibility to medical care. Furthermore, this leads to the homeless not receiving comparable attention as other patients during heath care interactions.
Nursing Strategies for a Better Hospital Experience
A thorough understanding of the discrimination experience in health care settings and the accompanying utilization of health care facilities is the very first step towards coming up with policies, principles, conventions and interventions that address health discrepancies among the homeless (Skosireva et al., 2014). Some strategies that can be incorporated in improving the experience of the homeless in hospitals are:
The driving forces of the decisions made during health care are the patient’s specific health requirements and the desired care outcomes. Health care providers recognize patients as partners in their care and treat them from a financial, social, emotional and mental perspectives in addition to clinical perspective. In our situation of a homeless man who has sustained injuries, patient-centered care is important as it will enable the health care provider to understand the man and thus offer the best care possible (Uhlmann, Pizarro & Diermeier, 2015). Being homeless does not mean that one is not capable of making their own health care decisions and require a certain level of health outcome (Koh & O’Connell, 2016).
Change of Attitude towards the Homeless
The nurses should try as much as possible to extinguish the urge to judge their homeless patients. Judgments and negative attitudes blinds the care providers so that they are not able to provide quality care that they would have otherwise delivered. Instead, it is they should put an effort towards understanding the circumstances of the homeless individual and what led them to lose their home or not have a home at all (Dempsey, Reilly & Buhlman, 2014). This understanding modifies their attitude as they grasp the fact that some homeless people are not drug addicts or criminals while some are working but cannot afford to pay rent. It is very rare that homelessness is a result of one’s choice.
Challenges of Health Literacy for the Homeless Patients
Patient health literacy has a significant effect on health care including understanding prescriptions and diagnosis as well as providing informed consent. Among the homeless people, most of them would not be literate health-wise and therefore may misunderstand the instructions given at the hospital which could adversely affect their health. Upon discharge the health care professional provides the patient with directives on how to manage their condition at home or how to take the medicine they are offered. The patient may feel unsatisfied by the treatment extended to him or her since he or she does not recognize that it is their right to ask any questions concerning their health.
Low levels of health literacy are associated with poorer overall health status, less remembrance of information after a clinic visit, higher levels of hospitalization and hospital readmission and higher probability of making errors with medication (Johnson, 2014). Among the homeless it also reduces life expectancy due to the fact that they cannot afford frequent hospitalization or readmissions in the hospital. In addition, limited health literacy is a prerequisite to social gradient and can further fortify existing health inequalities for the homeless (WHO, 2013). Social gradient in health describes the fact that inequities in health status are related to disproportions in social status.
Nursing Strategies to Promote Health Literacy
Educating the Patients
The nurses should make an attempt to inform their patients about their health conditions. This may include their rights, importance of their consents in the treatment procedure and the significance of following the instructions given. The health care providers should begin with explaining to the patient the details of their treatment and the risks involved and ensuring that this information is clearly understood. Upon discharge, nurses or other service providers should make certain that the instruction and directions given concerning medication are undoubtedly grasped (Kennedy et al., 2013).
Health Materials in Written Format
Care providers should write the instructions down for the patient or at least for those with a hard time comprehending. Written hospital materials act not only as evidence of the treatment that has taken place but can also help the patient in recalling the advices given at the hospitality management. Many homeless people may not remember the guidelines once they leave the hospital thus the nurse should write down the instructions for all of them (Johnson, 2015).
Follow Up Calls
The service providers can also write down their number to be contacted whenever there is confusion with medication or on availability of questions concerning the prescription (Jacobs et al., 2016).
Encourages Patients to Ask Questions
The best way to ensure effective treatment is by active interpersonal communication (Johnson, 2015). The care providers should be cautious not to have a monologues with their patients but to commune effectually with their providers. Effective communication involves questioning any point that is not well understood and nurses and other health professionals should encourage this.
The Concept of Moral Judgment
Moral judgments refer decisions that have moral element. They are used to evaluate situations, people, behavior and courses of action. The two key ingredients in moral judgment is reason and emotion. In a situations involving a lot of emotions, reasoning plays a restricted though significant role in moral judgment. Automatic emotional mind processes tend to dominate in these situations. The emotions influence moral judgment but are not certainly determinative, that is, they can be overcome by reason. Both overly strong feelings and a deficit of emotions have the ability to distort moral judgment. Both emotions and reason should thus not be divorced from moral judgment. Emotions such as sympathy and compassion can go a long way in ensuring quality care for patients in health care settings (Glick, 2018).
Health care professionals should learn to balance emotion and reason in order to provide quality services to their patients. They should not let their overwhelming emotions overrule the decisions they make concerning the health care of their patients and for the betterment of their careers in health. On the other hand they should not be completely emotionless as this may lead to a neglect for their patients’ needs.
In the third criteria the health professional should recall the mission of medical care which is to diagnose, comfort and cure the patient, and leave the rest to the police and the justice department. In matters of ethics, health care professionals must disregard the personhood of patients and provide them with the best possible medical care. In caring for the shooter in this scenario, the health professionals should pay close attention to the medical ethics of beneficence and non-maleficence. Beneficence defines actions that promote the wellbeing and care of the patients and their family. Non-maleficence, on the other hand, pronounces that the health care provider should not harm the patient (Kulju et al., 2016). It is important in this situation that the care providers disregard their emotions and observe medical ethics to provide quality care to the alleged offender.
In summary, it is evident that stigmatization is an issue in our contemporary society including in health care settings. It is usually directed towards the marginalised groups in the community such as the homeless, people suffering from mental illnesses, the prisoners or offenders and also drug and substance abusers. Stigmatization affects their functioning in the society and their participation in community activities. These groups also experience feelings of guilt and shame in which they have no control over. In the medical care settings the attitudes of the nurses and other health care professionals significantly affect the quality of care that the marginalised groups in the society receive. These people do not receive as much attention as other patients in the medical center. It is therefore important for care providers to try as much as possible to put their emotions and judgments aside in order to provide the best medical care possible to the patients who belong to these disadvantaged groups. Nurses should also direct their effort towards trying to understand their patients and offer them advice or education as a way of enhancing their experience in the hospital.
1. Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: real-world strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142-151.
2. Glick, S. M. (2018). Commentary on ‘Wearing humanism on your sleeve’. Journal of medical ethics, medethics-2018.
3. Herault, N., & Johnson, G. (2016). Homelessness in Australia: Service reform and research in the 21st century. European Journal of Homelessness _ Volume, 10(3).
4. Jacobs, R. J., Lou, J. Q., Ownby, R. L., & Caballero, J. (2016). A systematic review of eHealth interventions to improve health literacy. Health informatics journal, 22(2), 81-98.
5. Johnson, A. (2014). Health literacy, does it make a difference? Australian Journal of Advanced Nursing, 31(3), 39.
6. Johnson, A. (2015). Health literacy: how nurses can make a difference. Australian Journal of Advanced Nursing, 33(2), 21.
7. Johnstone, M., Jetten, J., Dingle, G. A., Parsell, C., & Walter, Z. C. (2015). Discrimination and well-being amongst the homeless: the role of multiple group membership. Frontiers in psychology, 6, 739.
8. Kennedy, B., Craig, J. B., Wetsel, M., Reimels, E., & Wright, J. (2013). Three nursing interventions' impact on HCAHPS scores. Journal of nursing care quality, 28(4), 327-334.
9. Koh, H. K., & O’Connell, J. J. (2016). Improving health care for homeless people. Jama, 316(24), 2586-2587.
10. Kulju, K., Stolt, M., Suhonen, R., & Leino-Kilpi, H. (2016). Ethical competence: A concept analysis. Nursing ethics, 23(4), 401-412.
11. Pachankis, J. E., Hatzenbuehler, M. L., Wang, K., Burton, C. L., Crawford, F. W., Phelan, J. C., & Link, B. G. (2018). The burden of stigma on health and well-being: A taxonomy of concealment, course, disruptiveness, aesthetics, origin, and peril across 93 stigmas. Personality and Social Work Psychology Bulletin, 44(4), 451-474.
12. Rovny, A. E. (2014). The Welfare State’s Effects on Marginalized Group Outcomes.
13. Skosireva, A., O’Campo, P., Zerger, S., Chambers, C., Gapka, S., & Stergiopoulos, V. (2014). Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC health services research, 14(1), 376.
14. Uhlmann, E. L., Pizarro, D. A., & Diermeier, D. (2015). A person-centered approach to moral judgment. Perspectives on Psychological Science, 10(1), 72-81.
15. Weisz, C., & Quinn, D. M. (2017). Stigmatized identities, psychological distress, and physical health: Intersections of homelessness and race.
16. World Health Organization. (2013). The Solid Facts. Heath Literacy. World Health Organization report.