Reflection and 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

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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

Reflection and the client, the physician immediately drew back from examining, quickly wrote a

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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

Reflection and may elicit negative feelings from health care professionals that transcend into unfair

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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).

Reflection and 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

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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?

Reflection and 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.

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