I’ve been fortunate enough to have worked as a nurse at an intercity hospital for the past nine years. I started to develop my professional identity the first day I started working on the busy medical ward, and have obtained an understanding of the importance of continued growth and development as I progress through my Masters of Health Studies program and further advance my career. I’ve gained a greater understanding of the importance of fostering inter-professional connectedness to encourage a team-based approach to care and improved patient health outcomes.
Most often I care for individuals suffering from complex chronic illnesses which may be exacerbated by substance use. They are often part of a marginalized or homeless population who struggle to maintain a connection with health care professionals and as a result often require multiple admissions and extended length of stay. The Canadian Observatory on Homelessness (2012) has defined homelessness as “the situation of an individual, family or community without stable, safe, permanent, appropriate housing, or the immediate prospect, means and ability of acquiring it” (p.1). It has been suggested that health is not only a result of the individual’s circumstance, but also attained due in part to the community and the resources provided (Oleribe et al, 2018). A modern definition of health focuses on an individual’s “fullness of life” and recognizes that health is both complex and dynamic, often coexisting with disease (Bradley, Goetz, & Viswanathan, 2018).
Through this course I have gained a greater insight into how the key determinants of health heavily influence the treatment and health outcomes of individuals, more specifically this particularly unique population. A well-developed sense of professionalism from the caregiver aspect is essential when providing care to this specialized population. I consider professionalism as part of a critical approach to the care of my patients, and place great value on its impact on their care.
Understanding of Determinants of Health
Many individuals who are homeless suffer from chronic health conditions and live on the fringe of society, either neglecting or being denied adequate access to health care. Often the accompanying challenges of psychological, mental health, or substance use issues take them out of the mainstream of society, making it more challenging to access appropriate care. There are many factors that can influence an individual’s health and health outcomes (Mago et al., 2013). The Government of Canada (2018) has identified the following as determinants of health: Income and social status, employment and working conditions, education and literacy, childhood experiences, physical environment, social supports and coping skills, healthy behaviors, access to health services, biology and genetic endowment, gender, and culture. Upon reflection, it is easy to see that every one of these factors has the ability to have a significant influence on the health of a homeless individual. A lack of education can impact the health literacy and diminish an individual’s capacity for full understanding of how and when to access health care services (Mago et al., 2013). Poverty can also play a significant role in influencing an individual’s health outcomes as many of the determinants of health (access to food, water, sanitation etc) are not consistently available (Mago et al., 2013). Substance use, a history of abuse and mental health issues can also cause members of the homeless population to demonstrate behaviors that are often difficult for the general population to understand and can result in a significant social divide. It is not uncommon for homeless individuals to be estranged from family members and childhood friends (Urban Matters CCC & The BC Non Profit Housing Association, 2018). Additionally, mental health and substance use issues often lead this population to be ostracized from their “traditional” community. This leaves them socially isolated and in greater danger of increasing health problems. An indepth understanding of these many factors increases the need for health care professionals to be well versed in providing trauma informed, comprehensive care.
Impact of Professionalism and Provision of Care
Brennan (2016) defined professionalism as “engendering trust by doing the right things, for the right reasons, in the right way, and at the right time.”. Part of maintaining my professional standing is being a registered member of the British Columbia College of Nursing Professionals (BCCNP) as well as the Canadian Nurses Association (CNA). Both organizations regulate my practice at a provincial and national level and ensure standards of care are met. I recognize my professionalism through my approach to meeting professional standards of practice and providing patient care. I respect the rights and decisions of all individuals in my care and provide individualized, culturally sensitive, and trauma informed care.
Substance use, a history of abuse and mental health issues can also cause members of the homeless population to demonstrate behaviors that are often difficult for the general population to understand and can result in a significant social divide. Often the population I care for struggle with substance use and require me to draw on a specialized body of knowledge to provide the most comprehensive and holistic care that is within my scope. Continuity of low barrier, trauma informed, culturally sensitive care can also be difficult to obtain due to individual’s behaviors, logistical challenges and transitory movements (Medcalf & Russell, 2014). Often the patient’s care needs extend beyond my scope of practice, leading me to liaise with other members of the health care team.
Team Based Approach to Serving a Vulnerable Population
The complexity of the chronic health issues associated with a homeless individual or population requires a multifaceted approach to address all levels of factors that contribute to this significant health issue. Homelessness as a health issue, is well situated to involve a team based approach to care. Team based care is defined as an approach by two or more providers, working collaboratively, to provide services to individuals, families, and/ or communities to the extent that they require (Schottenfeld et al., 2016). This enables providers to achieve quality care and accomplish goals made with input from the patient or their caregivers (Schottenfeld et al., 2016) As I reflect on the many determinants of health that affect this vulnerable population, I see the value and importance of treating patients in a team-based approach. Members of the homeless population often experience feelings of suspicion or mistrust of the health care system, due to their background, culture or previous relationship with the system (Rae & Rees, 2015). Physicians, nurses, social workers, dieticians, physical therapists etc. all play an essential role in fostering a sense of trust towards the health care system. Every team member is regulated by their governing organizations and practices within their scope, allowing the patient to experience an individualized health care experience. In addition, other stakeholders in care may involve unregulated care providers such as peer support workers, community outreach providers, religious organizations and shelter providers. Understanding the potential of each team member in creating a support network for homeless individuals with chronic conditions is critical to creating an infrastructure that addresses their definition of health. My role within the team is to support the synergy of other members and ensure that culturally safe and trauma informed care is accessible when required. I believe that, it is only through working in a team based environment that the trajectory of health for the homeless population can be improved.
References
Bradley, K., Goetz, T., and Viswanathan, S. (2018). Toward a Contemporary Definition of Health. Military Medicine , 183, 204-207. Retrieved on February 8, 2019, from https://academic.oup.com/milmed/article/183/suppl_3/204/5194600
Brennan M. D. (2016). The role of professionalism in clinical practice, medical education, biomedical research and health care administration. Journal of translational internal medicine, 4(2), 64–65. doi:10.1515/jtim-2016-0017
Canadian Observatory on Homelessness (2012). Canadian definition of homelessness. Retrieved from: https://www.homelesshub.ca/sites/default/files/COHhomelessdefinition.pdf
Government of Canada (2018). Social determinants of health and health inequalities. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Mago, V. K., Morden, H. K., Fritz, C., Wu, T., Namazi, S., Geranmayeh, P., ... & Dabbaghian, V. (2013). Analyzing the impact of social factors on homelessness: a Fuzzy Cognitive Map approach. BMC medical informatics and decision making, 13(1), 94.
Medcalf, P., & Russell, G. K. (2014). Homeless healthcare: raising the standards. Clinical Medicine, 14(4), 349-353.
Oleribe, O. O., Ukwedeh, O., Burstow, N. J., Gomaa, A. I., Sonderup, M. W., Cook, N., Waked, I., Spearman, W., … Taylor-Robinson, S. D. (2018). Health: redefined. The Pan African medical journal, 30, 292. doi:10.11604/pamj.2018.30.292.15436
Rae, B. E., & Rees, S. (2015). The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care. Journal of advanced nursing, 71(9), 2096-2107.
Schottenfeld, L., Petersen, D., Peikes, D., Ricciardi, R., Burak, H., McNellis, R., & Genevro, J. (2016). Creating patient-centered team-based primary care. Rockville: Agency for Healthcare Research and Quality.
Urban Matters CCC & The BC Non Profit Housing Association (2018). Vancouver homeless count 2018. Retrieved from: https://vancouver.ca/files/cov/vancouver-homeless-count-2018-final-report.pdf
Comentários