Substandard health care for minorities? - page 4

I thought this article was rather disturbing. Comments? (You have to register with the NY times to view the article, but registration is free).... Read More

  1. by   eldernurse
    Is it socio-economics or stupidity? If you get medical advice and don't follow it, whose fault is it? If you use the ER as your primary physician, whose fault is it? If you are transported to the ER more than twice a year for cold symptoms, who is misusing the medical resources of this country?
    I work in a large city ER and we don't even roll our eyes (where you can see) when these people come in. We do the best we can to take care of the problem that we can and direct them to agencies or clinics that will help them. It is not our job to follow up. People have to be responsible for their choices.
    Minorities who don't get care don't seek care. It is there.
  2. by   Q.
    Originally posted by eldernurse
    Minorities who don't get care don't seek care. It is there.
    This is a tricky statement, and I will warn you in advance that you will pay for that statement by some BB members here.

    I feel as you do; the care is there, even if inappropriately used, such as the ED. But studies have identified factors that decrease care: some is cultural (ie some Hispanics don't believe in primary care) some is mistrust of physicians (for primary care only, certainly not under extreme situations - which is contradictory, but whatever) some is lack of transportation, some is knowledge deficit. Studies have shown (and I am not commenting on the validity of the study here) that the American way of educating people isn't "culturally sensitive" therefore, if we educate a patient in the ED about signs and symptoms of an infection, we do in an Americanized way so there is a high probability that they won't understand, or follow the instructions. Thereby, increasing acuity and no follow-up.

    I see it as no win situation. I realize there are cultural differences that should impact care, but there are too many subcultures of subcultures of subcultures that we can't keep up with what is right for that subculture, and we offend someone or miss someone. There needs to be more personal accountability on the part of the patient, as well as culturally sensitive care givers, to increase access to care.
  3. by   fergus51
    Have any of you ever had any inservices on culturally sensitive care? I work L&D, (which is fulll of cultural beliefs and traditions!!!) and we had a woman from our town's immigrant services come to talk to us about different cultural groups traditions and preferences regarding childbearing. Things like how some cultures think colostrum is bad for the baby, some refuse to shower right after birth, some believe a new mother should not do any work for at least a month after birth, etc. It was really interesting and helpful for us to be able to understand why some people are so confusing to us and how we can work with them.
  4. by   Q.
    We haven't had an inservice at the hospital, but rather, this information was presented in my BSN curriculum (imagine that!)

    We do have handbooks on the unit as well. But it has been my experience that the inservices and handbooks don't cut it. We've offended many individuals by lumping them in any category. It's impossible to keep up.
  5. by   live4today
    Originally posted by fergus51
    Have any of you ever had any inservices on culturally sensitive care? I work L&D, (which is fulll of cultural beliefs and traditions!!!) and we had a woman from our town's immigrant services come to talk to us about different cultural groups traditions and preferences regarding childbearing. Things like how some cultures think colostrum is bad for the baby, some refuse to shower right after birth, some believe a new mother should not do any work for at least a month after birth, etc. It was really interesting and helpful for us to be able to understand why some people are so confusing to us and how we can work with them.
    Hi fergus!

    In the college I attended, our nursing program had a separate nursing class on teaching cultural diversity and sensitivity to various ethnic differences. Nurses should have this training long before they begin working as nurses, and be updated on any changes during their nursing days in the way of CEU classes within the hospitals.

    I've worked with more ethnic groups than most of the nurses I personally know, and this is a subject matter that is so real and so necessary to be educated in -- and not just through reading about statistics because by the time those statistics hit public print, it's old news anyway. The best way to learn about ethnic and cultural diversity is by observing and asking questions from those IN THOSE ETHNIC GROUPS, and not just the ones who have studied about them.

    There were so man UNTRUTHS written in the nursing textbooks that I studied in college about certain ethnic groups I know that I reported those 'falsities' to the College Dean. That particular textbook in question was removed from the program and replaced with a more recent up to date textbook that at least presented the various ethnic groups more truthfully.
  6. by   fergus51
    We had it in school too. They called it transcultural nursing, but it is impossible to fit in the groups that you need because you won't know who you'll be working with. That's why inservices are great. We have nurses from as far away as Australia and South Africa, who didn't get to learn about the cultures that make up our community.

    The presentation was by someone from the ethnic group we were interested in, not an outsider. I used to volunteer there and asked one of my classes if anyone would be interested in speaking to a group of nurses. The lady that volunteered was "honored" to be asked to speak to a group of "sisterly nurses"

    I have found I avoid offense by saying right away "I like to ask all my patients to tell me how they see their birth proceeding and any beliefs you think I should know about to be a better caregiver" or something like that. I have never had anyone get mad offended, most people are very tolerant if you just explain you don't have a lot of knowlege about them and are interested in learning.
  7. by   live4today
    Originally posted by fergus51
    We had it in school too. They called it transcultural nursing, but it is impossible to fit in the groups that you need because you won't know who you'll be working with. That's why inservices are great. We have nurses from as far away as Australia and South Africa, who didn't get to learn about the cultures that make up our community.

    The presentation was by someone from the ethnic group we were interested in, not an outsider. I used to volunteer there and asked one of my classes if anyone would be interested in speaking to a group of nurses. The lady that volunteered was "honored" to be asked to speak to a group of "sisterly nurses"

    I have found I avoid offense by saying right away "I like to ask all my patients to tell me how they see their birth proceeding and any beliefs you think I should know about to be a better caregiver" or something like that. I have never had anyone get mad offended, most people are very tolerant if you just explain you don't have a lot of knowlege about them and are interested in learning.
    You sound like an excellent caring and compassionate nurse, fergus! I like your comments above! :kiss
  8. by   fergus51
    Aw...shucks...:imbar you too....:kiss
  9. by   Peeps Mcarthur
    Blacks uderserved? I think patients getting hosed by thier HMO's is a statistic that knows no skin color. If you think about it can you REALLY believe that a hospital(corporation) cares what skin color the person with the billable insurance has?
    Pollsters have been skewing data to show anything they want since........well, since there were polls to skew.
    The Democratic vote seems connected to the next election somehow.........Huuuumm......I wonder if party afilliations have anything to do with such an inflammatory, sensational piece of "reporting"? The supplement industry has been enduring this kind of attack for years. There are no credible facts yet the tall tales about heart conditions, cancer, kidney and liver damage and so on plague my conversations with almost every customer.
    I've looked, but there's never a source. There's never any clinical data. It's always "could be connected" or "you might be at risk" and the ever popular "we reviewed the numbers or the "incidents"and this is what we found" Gee.....thanks for thinking for me since I can't do that for myself. I think I'll just go shoot myself in the head now and get it over with. Thanks to fine reporting and your thirst for the truth you've saved me many years of suffering.

    There's no honor in jounalism. There hasn't been for a long time.

    A new era of discrimination lawsuits has begun. Let he who is without a conscience throw the first stone.
    Last edit by Peeps Mcarthur on Mar 23, '02
  10. by   fergus51
    Do you really think it's all bunk Peeps? It seems to be from a reliable source to me (The Institute of Medicine prepared the report for congress right?) I don't know why the Institute of Medicine would be making it up. I think the majority of the disparity comes from indivual practitioners and situations, but it does seem that coorporations do treat minorities differently:

    --Among 15,578 people who sought care in an urban emergency room, blacks were 1.5 times more likely to be denied authorization by their managed-care providers.

    The report said the differences exist even when insurance, income, age and the severity of the disease are the same for both groups.
  11. by   fergus51
    I've attached a Health Canada link. Health Canada now takes the view that health is determined by a variety of social factors (the social determinants of health) which include:
    Income and Social Status Social Support Networks Education Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills
    Healthy Child Development Biology and Genetic Endowment
    Health Services Gender and Culture.

    Culture is where we are concerned with minorities. In Canada the most studied minority group has to be our aboriginal population and their health status as a group is apalling. Pick any disease and chances are it's higher among them than the general population despite the fact that they are garanteed free health care. So access is not the absolute solution.

    http://www.hc-sc.gc.ca/hppb/phdd/det...ts.html#income

    It has some good hard stats if you want them Peeps. Though I know Canada and the US are not the same.
  12. by   donmurray
    Does the term "Institutional Racism" translate? Where the system functions in such a way as to discriminate against minorities.
  13. by   wrightgd
    I think the point about skewed data is on target... The data for reports such as these are often derived from pre-determined fact finding missions which intentionally lead toward the desired results, or intentionally ignore other pertinent factors such as the cultural preferences that some others here have mentioned.

    The short of the matter is that if all citizens are afforded equal opportunity to competent care, then there is no one to blame, except the patient, for not seeking the medical attention that he/she needs. It seems to me that this report misses it's mark. The authors of this report attempt to convince us that there is rampant racism in American healthcare. Anyone who utilizes healthcare in America, knows that this issue goes farther than race, gender, and ethnicity... This is not a diversity issue. It is, and always be a MONEY issue.

    George

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Substandard health care for minorities?