Reflection and 1

Reflection and Professional Growth Journal

As a resident of downtown and a registered nurse, I now feel an individual does

not have to venture across the world into a war torn, displaced third world community to

see human disparity as it is evident only footsteps away. To say the least, my experience

at Streetworks has been absolutely incredible. It has been a great eye opening experience

that I believe would be unforgettable to any individual fortunate enough to have such an

opportunity.

Significant Issue

From the very first day at Streetworks, a prominent issue that has emerged within

many client interactions is the discrimination present in health care institutions. Many

clients have identified negative experiences present in emergency rooms based on

feelings of discrimination and unfair treatment. It is an unfortunate and surprising

realization for me as I am a firm believer in social justice and equality.

The most detailed and profound example I had encountered was with a particular

homeless male client I had met on the Streetworks van. On an initial assessment, the

condition of the client’s legs warranted an emergency room visit. The client’s legs were

edematous, red in color, shiny in appearance with multiple open and purulent abscesses.

He explained to us that he was injecting substances through his lower leg veins and both

legs had gotten increasingly tight and painful over the last twenty four hours. The

outreach worker and I attempted to convince the client to seek medical attention. The

client stated he refused to go to an emergency room. He went on to explain his last

encounter at an emergency room. He stated that while an emergency room physician was

examining his legs, he told the physician that he was hepatitis C positive. According to
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the client, the physician immediately drew back from examining, quickly wrote a

prescription for antibiotics and threw the paper at the client. The client went on to explain

the physician alerted him that he was discharged and to stop using drugs. No attempts at

recovery center referrals or follow-ups were discussed. No attempts at assessing the

client’s hepatitis C management were discussed. The client was adamant on not going to

the hospital after the incident. This is only one amongst the many examples I have

encountered where clients refuse to seek medical attention based on past negative

experiences.

Evidenced Analysis

Although Streetworks is primarily dedicated to injecting drug users and sex trade

workers, there is still a prominent number of homeless persons it also serves

(Streetworks, n.d.). The notion of homelessness conjures many different images within

society from alcoholics, bums and vagrants to poor, lazy and stupid (Reid, Berman, &

Forchuk, 2005). Stereotypes, stigmas and derogatory images contribute to

misunderstandings regarding the social and political contexts of homelessness (Reid et

al.). Sadly, these misunderstandings have a profound ability to infiltrate the delivery of

health care.

The accounts of discrimination against Streetworks’ vulnerable population can be

due to a variety of reasons. According to Maze (2005), prejudice and discrimination

continue to exist and have negatively affected the health care system and the nursing

profession. Feelings of fear may arise due to the potential harm the nurses perceive the

patient may cause them or perhaps because nurses feel they could possibility be in the

same individual’s situation at some point in their lives (Maze). Preexisting prejudices
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may elicit negative feelings from health care professionals that transcend into unfair

treatment and delivery of health care. According to Maze, the historical background of an

individual’s educational training, values, age, and life experiences may contribute to a

predisposition to discriminatory treatment. Moreover, in the present climate of changing

health care and health care reform, delivery constraints result in mounting ethical

conflicts for health care providers and unfortunately, moral uncertainty becomes

commonplace thus, unethical treatment may be the result (Zrinyi & Balogh, 2004).

A qualitative research study by Zrinyi and Balogh (2004) produced disturbing and

troublesome results. The study “revealed that various health professions, including

nurses, restricted marginalized and homeless clients in their constitutional right to seek,

obtain and properly utilize health care” (p. 335). As well, Reid et al. (2005) explains

“negative responses ranging from subtle forms of disrespect and innuendo to more blatant

expressions and acts of hostility on the part of health care professionals have been

reported” (p. 242). The question remains as to how health care systems can sever the

cycle of unjust and unfair treatment.

Research proposes that education has a great potential to influence moral

discourse and ethical dilemma resolution (Zrinyi & Balogh, 2004). Educators are in a key

position to ensure that students are aware of specific strategies for dealing with moral

distress through role-modeling and classroom studies (Zrinyi & Balogh). Moreover,

being aware of one’s own values and biases can provide a basic point of objective care.

When caring for disenfranchised populations, nurses can provide proper care if they

understand their own value systems and biases while valuing diversity and uniqueness of

others (Maze, 2005).

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Influence on Personal and Professional Practice

This experience has provoked a stark reality of injustices whereby front line

health workers have a profound ability to influence primary health care’s principle of

accessibility. This realization has influenced my practice by allowing me to examine my

own personal beliefs, values, and biases; furthermore reflecting on how nurses can

influence the health of populations across the lines of diversity without judgment. It has

allowed me to reflect on what experiences I can bring back to the acute care settings and

how sharing my experiences may influence the practice of other nurses. On a personal

level, it has opened my eyes as to how human disparity can elicit discrimination resulting

in moral injustices and unequal treatment even in advanced societies. It has allowed me

to consider my own upbringing and life experiences. Furthermore, questioning how these

factors can influence the development of my own personal biases and how easy it is to

allow formed judgments to influence my professional practice and the maintenance of

human dignity.

Conclusion and Questions for Future Learning

This paper has examined discrimination in health care and how it negatively

influences access to health care for vulnerable populations. Research shows that early

education in institutions such as nursing schools have the ability to influence ethical

resolutions skills and equality of care. Bearing that in mind, I question how much does

personal experience storytelling influence others’ nursing practice? How can seasoned

nurses become cognizant of their potent ability to negatively influence access to health

care? How can organizations influence institutions to best promote equality of care and

the right of all persons to respect and human dignity?

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References

Maze, C. D. (2005). Registered nurses’ personal rights vs. professional responsibility

in caring for members of underserved and disenfranchised populations

[Electronic version]. Journal of Clinical Nursing, 14, 546−554.

Reid, S., Berman, H., & Forchuk, C. (2005). Living on the streets in Canada: A

feminist narrative study of girls and young women [Electronic version]. Issues in

Comprehensive Pediatric Nursing, 28, 237−256.

Streetworks. (n.d.). About Streetworks: What we do. Retrieved May 15, 2007, from

http://www.streetworks.ca/client/aswwhatwedo.html

Zrinyi, M., & Balogh, Z. (2004). Student nurse attitudes towards homeless clients: A

challenge for education and practice [Electronic version]. Nursing ethics, 11,

334−348.