Ethnic and Racial Disparities: Negative Ethnicity - Essay Example

Behavior Modification Project Negative ethni Ethnic and racial disparities have been identified as among the major problems faced by the modern day healthcare practices. In this case, differences in race and ethnic backgrounds have been identified in care access, receipt of the medical care needed, the preventive services, as well as in the lifesaving technologies. Westen and Weinberger (2005) define a race as a group of individuals with similarities and differences in biological traits, which are regarded by the society having social significance. This means that people have to be treated differently on the basis of their different racial backgrounds. It can be observed that whereas the similarities and differences in the eye color are not seen as socially important, there has been a significant importance attached to the skin color of the different individuals (Taylor, Austin and Mulroy, 2005). Weil (2005) observes that too many exceptions made towards this kind of grouping have been seen to make the racial categorization a viable aspect of the society. It is obvious that certain physical differences exist among different people. However, it is unfortunate when such differences, which are involuntarily acquired, form the basis upon which social discrimination and prejudice is done. The differential treatment and consideration fostered by racism and ethnicity is meant to show that certain people in the society are inferior, or superior to other people based on their racial differences (Sunstein, 2003). During my hospital placement, I came across certain cases in patient care that clearly demonstrated the racial and ethnic rift existing between patients and the care providers. I met this patient, whom I will refer to using a random name Mr. Kelly for the purpose of anonymity. Kelly was probably the most unpleasant patient I ever had a chance observe in my hospital experience. I had always felt proud for having the opportunity to attend to him no worse or better than I did with all other patients. Kelly had been admitted to the hospital following depression diagnosis. During the time the first venesection was done to him, he became so concerned about the practice, but eventually insisted that he did not care what was going to be done with his blood, provided it was not given to a Jew. He decided to confide his racist views to me. Majority of the fellow patients in the ward originated from the minority ethnic groups and did not hide their displeasure in this. This prompted a bed rearrangement in order to ensure there was enough protection for the patients, and a Caucasian corner created for him. After Mr. Kelly was discharged, there was the German nurse who raised complaints of her encounter with the patient, especially after he had made antisemic statements and Nazi salutes anytime she passed. The scenario is evidence of how racial intolerances and negative ethnicity impacts on the delivery of health care services to the patients. It is almost inevitable that Mr. Kelly was bound to receive incompetent or no service care from the German nurse, due to the strong enmity created by the tensed racial differences between them. Lafferty and Davidson (2006) suggest that doctors, together with all other healthcare professionals have the obligation of remaining courteous while handling their patients. They have to maintain calmness and use their personality in promoting positivity in care provision. Among the most powerful scenarios in the therapeutic relationship include those where the care provider has sufficient confidence in providing the needed care by the patient (Weisz, Hawley and Doss, 2006). The study demonstrates the interpersonal dynamics involved in the patient and nurse interaction, based on the ethnic and racial differences and the need to satisfy the patient requirements for quality care. From the perspective of quality improvement, there is a need to have measurement instruments which have sufficient sensitivity to ethnic and racial differences. Wampold and Brown (2005) highlight of the three racism levels, which include personality-mediated racism, institutionalized, and the internalized racism. In this case, the instutionalized racism, which is manifested in differential access to services and other opportunities based on the people’s race, is the most dominant within the healthcare delivery system. For instance, the minority population has traditionally been denied access to, or been offered low quality health care (Yamashita, Forchuk and Mound, 2005). The differential health insurance access is an example of this, and it has impacted negatively on the effectiveness of communication between healthcare providers and patients who perceive differential treatment from the otherwise “superior” racial group of healthcare practitioners. As noted by Lambert and Ogles (2004) institutionalized racism does not need personal bias that is commonly linked with the racism term. On the other hand, the personally-mediated form of racism is the prejudice and discrimination presented in differential assumption of motives, abilities and intentions of others based on their respective races, as well as differential actions to other people based on their races (Walton, Bedford and Dezateux, 2006). Discrimination and prejudice are thus manifested in the form of disrespect, failure to communicate and poor services. The case presented in the hospital I was an intern is an ideal example of personally-mediated form of racism, where the patient does not believe in the ability of a certain race to competently provide the service quality he desires. From the reactions of the personally-mediated racism, two important points can be noted (Bruera, Palmer and Rosales, 2002). For example, it could occur subconsciously, and this implies that individuals could have assumptions about people that give the reflection of the societal norms. On the basis of theory of social science, every individual applies the social categorization strategy in order to get an understanding, prediction and control the environment within which one exists, as well as facilitating processing of information (Handsley and Stocks, 2009). Unfortunately, Pinikahana (2003) observes that this process results in exaggeration of the perceived negative differences between different racial groups, leading to stereotypes and over-generalization through prejudice and bias. Similarly, despite the fact that the form of discrimination could be subconscious, it has a very powerful impact. The internalized form of racism is manifested through acceptance of stigmatization by the members of the undermined race, as expressed by the perceived superior groups of individuals (Davison and Goldenberg, 2003). This internalized racism leads to helplessness, devaluation of self, and limitation of the individual’s rights to self-expression and self-determination. Socioeconomic status Socioeconomic status, as defined by Norcross, Beutler and Levant (2008), is a sociological and economic absolute measure of the individual’s or community social and economic position when compared to other members of the society, and these are determined by parameters that include education, occupation, and income. The socioeconomic position of an individual and the community is among the important aspects that have been embraced by the modern society, as being an important factor upon which people are judged or differentiated from the rest (Ell, Vourlekis and Xie, 2007). The modern healthcare access is characterized by significant aspects of inequalities, which are determined by a wide range of parameters. For instance, the unequal enjoyment of available healthcare services can be determined using mortality rates, the infant death rates, life expectancy, disability, and morbidity (Davison, Parker and Goldenberg, 2003). According to the psychosocial model of healthcare, social inequalities are bound to affect the way people feel, and this eventually affects their body chemistry. For example, Siminoff, Zhang and Zyzanski (2005) observe that stressful social circumstances result in emotional responses that cause biological alterations, which increase the likelihood of a heart disease. Among the psycho-social risk factors identified are autonomy, control and social support. Others are the balance between work and home, as well as the existing balance between rewards and the work done (Epstein and Street, 2007). While on my internship in a hospital, I encountered a case of a man with African origin who had been diagnosed with schizophrenia and depression. Mr. Moss developed the psychiatric conditions several weeks following a retrenchment from the job where he worked as the company driver for the past 7 months. Being an immigrant, he has found it difficult finding a permanent job to sustain his family, especially with his wife being jobless. The wife takes part in patient-centered care, in which medication use, restraints, teamwork, delegation, reflection, communication and assessments are involved. This case demonstrates the existing connection between mental disorders and social class, with the condition highly evident among the families in low social strata. As demonstrated by Davison and Goldenberg (2005), the efforts towards distinguishing socioeconomic status as a consequence or causative of mental illnesses focus on some very vexing problems in medical sociology and social demography. From the case of the patient highlighted above, it is evident that socioeconomic status could have a significant role in determination of who develops mental disorders in the society. The adversities linked to the low socioeconomic status could compromise the psychological functioning of people and play a major role in mental disorder etiology, and this is a topic that has been pursued by researchers in psychosociology in causation tradition (Ell, Vourlekis, Lee and Xie, 2007). If the social causation works alone, then it is suggestive that individuals from lower socioeconomic environment are bruised and battered by the social stressors linked with socioeconomy, hence the resultant high mental disorder levels. In cases of joint effects of social causations acting with other political or cultural factors, it demonstrates a greatly complex process, in which socioeconomic status-linked mental disorders make the afflicted person to fall more into the low social status, leading to increased exposure to more social stressors that accelerate the disorders. This constitutes a never-ending disadvantage cycle that could accumulate over an elongated life period. This incident confirms the depth at which socioeconomic status affects the state of personhood and patienthood in the society. The mental healthcare is particularly affected by the socioeconomic conditions of an individual, which inevitably influence the nature of personhood for the individual (Handsley and Stocks, 2009). The delivery of healthcare services in the healthcare facility is thus influenced by the socioeconomic factors of the patients. I observed that while providing the nursing care for the psychiatric patients in the hospital, the knowledge of their respective socioeconomic status was a key factor towards determination of the ideal regimen for their treatment. The nursing practices in this hospital are developed around the economic and social characteristics of the community around, with the intention of enhancing quality of care provided to the patients. Low socioeconomic status constitutes a key determinant for the development of patienthood, together with the general course of recovery. Individuals with low income have higher likelihood of developing illnesses, according to the observation by Feely, Sines and Long (2007). In this study, it is evident that socioeconomic status was a determinant of the nature of livelihood of the individual, and this was ultimately reflected in the individual’s health status. For instance, the patient observed in the hospital presents to the ward for admission with mental disorders in advanced stages, which shows that he had had to put up with the mental illness for a long period of time until it got inevitably impossible to carry on with the condition. This case justifies the observation by Goodheart (2006) that individuals with lower social status have lower likelihood of seeking for health care, and only do it when it is an emergency. Personhood as the status or standing bestowed upon human beings by others, within the context of social and relation being, where respect, trust, and recognition are implied. In this case, socioeconomic status emerges as an important determinant in construction of personhood in the modern society (Whelan, Gafni and Sanders, 2005). It emerges that the individual’s abilities and integrity are shaped by what he or she has in terms of financial possession, education and occupation. I find the reliance on social class as a determinant of the individual’s personhood a great and unfair impediment to accessing what should be rightfully available for all people. The inability of a certain group of people in the society to access deserving healthcare services is a psychologically disturbing aspect, which makes some people develop inferiority feeling about their own chances of life compared to other people. Patienthood is bound to be more problematic in certain groups of people, where some people have to put up with their disease conditions due to the need to work harder to sustain their livelihood when they feel sick. Ethics Ethics entails doing good and ensuring no harm while conducting any practice. However, the definition of what is regarded as ethical is widely variable in different contexts and different people. The knowledge for ethically acceptable practices is, however, shaped by beliefs, values and experiences gained by the nurse. Medical ethics has its basis on numerous ethical principles which have particular relevance to patient care and medical practice. The caring theory by Dr. Jean Watson is constituted by three key elements namely; transpersonal caring relationship, carative factors, as well as the caring moment or caring occasion (Trafimow, Conner and Finlay, 2002). The carative factor of nursing is aimed at honoring the dimensions of humanity together the inner life world, coupled subjective experiences gained from the patients served. In order to build the caring and trusting relationship, therefore, there is a need for self-awareness of any arising judgmental feeling, and any other feelings that could demonstrate unethical crossing into intimacy boundaries (Cegala, McClure and Post, 2000). I came across a case involving Mark, a 34 year-old patient. He had been worried for many years of developing Huntingtons chorea, which is a neurological disorder most evidenced at the ages of 30s and 40s in a person’s life, causing uncontrollable contraction and twitching, as well as irreversible progressive dementia. This condition results in death after around 10 years. Mark’s mother had died 3 years before from the same disease. Huntingtons condition is an autosomal dominant resulting in a 50 percent chance of the children born from the affected parents inheriting the condition. Mark had spoken to numerous people of his wish to die as opposed to enduring the illness progression. He drank heavily, was anxious, and exhibited intermittent depression, prompting him to seek psychiatric care. He had first experienced facial twitching over three months prior to his admission, and two neurologists confirmed the diagnosis of Huntingtons. Mark had explained the situation of his illness to the psychiatric and asked for help in commiting suicide. After the psychiatrist declined, Mark reassured her that he was not intenting to attempt suicide anymore. he had been discharged and after arriving home, Mark ingested all the antidepressant medicine prescribed to him after he had pinned a note on his shirt. On the note, he explained his actions, and refused any form of medical assistance that could be offered to him, citing his religion’s disapproval of the life-sustaining medical care. His wife, who was not aware of his condition, found Mark unconsciously lying on the floor and rushed him to the emergency room with the note still pinned on the shirt, and equally approved of Mark’s decision, saying her mother had been granted the same wish prior to her death. This case is an example of the conflicting preferences of the patients and the healthcare providers, where patients cite different cultural or psychosicial beliefs in choosing or declining to certain forms of treatment. In this case, Mark indicates through the note of his disapproval of the life-sustaining interventions. Such arguments by patients or their families could pose a significant problem to the delivery of healthcare. The personhood of the individual seeking medical interventions ought be respected during the course of patienthood. Human culture provides a variety of positions on values which have a direct effect on the clinician practices. For example, ignoring an individual’s feelings and will to how he should be treated, as well as demonstrating insensitivity to the religious beliefs, with no regard for the person’s confidentiality reservations and informed consent, or the disagreements in relation to the level at which the welfare check of a person would be allocated in healthcare, inevitably compromises the relationship between care providers and the patients (Dowling, 2006). The culture also influences the manner in which people should interact in different settings. For instance, competition is among the highly valued aspects of practice in healthcare profession due to its necessity in professional advancement (Goodheart, 2006). The different health service providers today recognize the potential significant effects of psychosocial problems on the patient health. Similarly, the understanding of the psychosocialogical nature of the patients enables formulation of the appropriate treatment plan. This understanding enables the healthcare provider to link the identified patient to the corresponding psychosocial care services as well as offering them with the appropriate support in management of their illnesses (Tanenbaum, 2005). In this case, the family member involvement in addressing the psychosocial needs of the patient is essential. Clinical practices involve confrontation with individual patient’s values. In many circumstances, there are gaps between what the patient value and what the healthcare provider considers important, and this could often lead to a direct clash between the goals of the clients and the culture and values of the care provider (Arora, 2003). Therefore, the clinical sociologists should have comprehensive knowledge of their respective values to understand other people’s value system (Norcross and Goldfried, 2005). This could involve the removal of communication barriers, which include unnecessary assumptions and value-driven double messages. The healthcare profession is guided by both personal and professional ethics codes, which dictate certain boundaries and limits that determine what is regarded as acceptable or unacceptable social behavior. It is on the basis of these professional organization ethics that the norms are established on the type of behaviors the members will be judged upon. Similarly, the modern psychological clinical practice has adopted various practice guidelines related to sexual orientation, multicultural practices, and the older adults in enabling the psychologists to tailor their practices to the diversity of their patients. While acting as a psychologist, one must be cognizant that access to additional resources could improve treatment effectiveness (Silverstein, 2006). When the evidence from researches demonstrates the adjunctive service value or when there is no progress among patients as expected, there is need for seeking consultation or making referrals. Alternative services that are culturally sensitive that respond to the contest of the patient and worldview could complement the psychological treatment. Consultation is considered as a means to monitor and make necessary corrections on the affective and cognitive biases. References Arora NK. “Interacting with cancer patients: The significance of physicians’ communication behavior.” Social Science and Medicine. 2003;57, no.5 (2003):791 Bruera E, Wiley JS, Palmer JL, and Rosales M. “Treatment decisions for breast carcinoma. 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