Month: November 2021

Throughout my clinical experience, I have taken care of a variety of patients, all from many different backgrounds. The care that I provide to my patients is all the same, no matter what. However, not all health care workers are the same. During clinical, I took care of a patient who is homeless who had suffered from cardiac arrest at a pop-up clinic and was then admitted to the hospital. This patient is a “frequent flyer” on the floor that I am on and not all of the staff necessarily liked this patient. When going in to care for this patient, I tried to think of the hardships that he must have gone through and the obstacles that could interfere with him reaching optimal health.

Homelessness is a health hazard in society and individuals in this population may be predisposed to worsening health outcomes and challenges to access healthcare. Demographically, homelessness can affect men, women, and children of all races and ethnicities. According to American Family Physician, there are more than 610,000 people who are homeless in the United States on any given night (2014). Their situations are anything but simple. Health problems among homeless individuals can result from various factors such as barriers to care, lack of access to adequate nutrition, lack of proper resources, lack of transportation, unemployment, lack of education, and limited services. Unemployment can go hand-in-hand with homelessness and can be associated with food insecurity, inability to pay for healthcare, and poor social capital. These individuals are unable to buy nutritious foods or pay for the healthcare that they need. This could decrease the probability of this population seeking healthcare. Due to the social determinants of health that homeless individuals may go through, they are prone to both mental and physical illnesses. Homeless people are prone to many chronic conditions including arthritis, asthma, chronic obstructive pulmonary disease, diabetes, HIV/AIDS, hypertension, vascular disease, pneumonia, STIs, and tuberculosis. Mental health disorders that homeless individuals are prone to include bipolar disorder, dementia, depression, personality disorder, PTSD, and schizophrenia.  The homeless population is also susceptible to substance abuse disorder and increased risk of injuries and violence. It is essential that health care providers keep the hardships that this population may go through in mind when caring for a homeless patient.

In my experience caring for a patient who was homeless, there were assumptions about him prior to me even meeting him. Health care workers would warn me before going into the room that he is frequently a patient and “doesn’t do anything to help himself”. I found this really difficult to hear, especially after meeting this patient. He was a great guy who was just in a tough place and was scared because he does not have the access to the resources he needs to take care of himself once he is discharged from the hospital. I am proud of how I handled this situation. Even though, I was told negative things about this patient prior to taking care of this patient, I did not let it affect how I cared for this patient. I think that the stigma behind the homeless population needs to be changed and the health care system needs to do something to help them. We, as a society, are failing the homeless population. Something needs to be done to help provide these individuals with adequate health care, regardless of the social determinants they may face.

When we were asked to create a project on vulnerable populations in health care, both of our minds automatically went to people suffering from a mental illness. Even though we are not even nurses yet, we have both been in situations in hospitals where we have seen mistreatment first hand. If we both have seen this mistreatment, then just think about how often this happens. We feel strongly that this is an issue that needs to be worked on and addressed throughout healthcare. We created an outline (which is linked below) which answers questions regarding this topic, and facts about it as well. Along with the outline, we prepared a 15 minute podcast briefly going over this topic and what we put in our outline. We tried to have a real conversation on the podcast, talking about information that was not even in our outline. We used examples from what we have seen as well as movies we have seen to give people a better insight on the effects of this issue. We talked about the ethics in health care and how this goes against it as well as hospital/ state policies and patient rights as well. We feel strongly that a change needs to be made regarding the treatment of this population in health care.

I have never really thought about death with dignity and my thoughts on it because I hope to never be in a position where that is an option that I am considering. However, when asked, my initial thoughts are that I have no idea my thoughts on it are, whether I believe it is right or wrong. I feel that it is impossible to really have a viewpoint on it unless you are in the patient’s shoes. I know that if I was in a position where my daily life function would slowly deteriorate, I would not want people to remember me that way. As I thought more of this idea, I began to support the idea that, when faced with a terminal illness with only a certain amount of time left to live, the patient should have the option to pass with dignity or live all the way until their last day. Once it gets to the point where no turnaround is possible, it should be an option for patients. This is a view on it as a free American citizen. On the other hand, my viewpoint on it as a health care provider, I would struggle with the fact of giving a patient something that would kill them. I know that there is so much more that goes into this process but putting it in simple terms of killing the patient is something that I would greatly struggle with.

The first ethical principle, non-maleficence, or do no harm is directly tied to the nurse’s duty to protect the patient’s safety. These principles dictate that nurses do not cause injury to our patients. The death with dignity does challenge these principles because as nurses we are supposed to promote health and wellness of our patients. Death with dignity goes against everything within our scope of practice. As nurses, we are supposed to take care of our patients with individualized care plans to keep them comfortable and alive. It my final year of nursing school, the death with dignity concept has never been talked about until now. We are always told to respond to end of life commentary with therapeutic responses and not actually collaborating with physicians to give patients medications that will grant their wishes. My take on death with dignity is conflicted by my beliefs as a human being and my beliefs as a nurse.