This reflection paper examines a nursing practicum experience in which a homeless patient, referred to as Mr. E, faced significant stigma and bias from medical staff due to his housing status. The paper describes how the student nurse's preceptor modeled holistic patient advocacy by uncovering the socioeconomic barriers behind the patient's medication non-compliance and taking concrete action to resolve them. The paper argues that effective nursing care must address the full range of a patient's social, cultural, and economic circumstances in order to promote lasting health outcomes, rather than focusing solely on immediate clinical symptoms.
I was deeply moved by an event that transpired during my nursing practicum — one that reinforced for me that nurses are healers who, in their finest form, approach patient care holistically, addressing the socioeconomic, cultural, and emotional dimensions of their patients' lives. During my internship, a homeless patient (referred to here as Mr. E) was admitted to the hospital and subjected to a significant amount of stigma and bias in his treatment from medical providers due to his housing status. The stigma that homeless persons endure in medical settings, as well as in society at large, has been well-documented; witnessing Mr. E's experience provided a harsh real-world example of this stigma in action. The response of my preceptor offered a complementary example of how nurses can directly confront that stigma and act as advocates for patients' rights.
It was clear when Mr. E was admitted that he had not been compliant with the medical regimen prescribed for a serious medical condition. Mr. E is a 39-year-old male with eight stents in his heart, indicating the extreme severity of his condition. The prescribed medication is effective in treating the condition, but Mr. E was clearly not taking it, based on the symptoms he was experiencing at the time of admission.
Many of the nurses on the floor where Mr. E had been staying spoke poorly of the patient, suggesting he had caused his own problems by not taking his medication and not taking care of himself. When my preceptor and I arrived on the floor and received Mr. E's chart from the night nurse, she described his medical non-compliance in a judgmental tone. No one had taken the time to find out why Mr. E had not been taking his medication. My preceptor did take that time, however, and discovered that the patient was homeless and unable to afford his medication, as it was not covered by Medicare. It is, indeed, an expensive medication — but it is essential to Mr. E's survival. The social determinants of health, including housing and income, directly shaped this patient's ability to follow his prescribed treatment plan.
"Preceptor secures medication, housing aid, and food for patient"
"Argument for treating the whole patient, not just symptoms"
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