Vulnerable populations are groups of people that are at an increased risk for poor health status and/or lack of access to healthcare when compared to the rest of the population. Factors that contribute to the status of being considered vulnerable are low income/poverty, racial and ethnic minorities, the uninsured, the elderly, the homeless, chronic illness and mental illness (Pitkin Derose, Escarce, & Lurie, 2014). In Vallejo, California the Hispanic Immigrant population represents a large vulnerable population.
Their immigrant status, lack of access to employment that provides healthcare benefits, deficient knowledge of the healthcare system in the United States and limited English proficiency all contribute to their vulnerability (Pitkin Derose, Escarce, & Lurie, 2014). In order to maximize patient health outcomes, decrease Emergency Department visits and hospital admissions in the Hispanic population healthcare staff must become aware of several factors. These aspects include those that contribute to health disparities, barriers in the workplace that are compounding gaps in medical care as well as the need to gain insight into Hispanic/Latino cultural health beliefs and behaviors.
Barriers in the Workplace that Create Disparities
Barriers to healthcare that were noted to create disparities in the Hispanic population at my place of work are lack of staff that speak Spanish working in the field on ambulances, deficient knowledge among staff of the cultural health beliefs and behaviors of the Spanish/Latino culture and an absence of access to programs in the workplace to address these issues. Approximately 41% of the American population identified themselves as a member of a racial or ethnic minority in the 2010 census. Half of the total growth of the American population between 2000 and 2010 was due to an increase in Hispanic/Latino minority groups. It is estimated by 2050 that this group will account for almost half of the population in the United States. Studies have shown that Latinos who did not speak English were substantially less likely to receive all the medical services needed for their care (Agency for Health and Research Quality, 2012). These statistics make it clear that there will be an increasing need for medical staff that are familiar with the Spanish/Latino language and culture.
Having to obtain medical information in the field on working an ambulance in stressful or emergency situations can be difficult in itself. A patient encounter where there is a language barrier is present makes circumstances even more challenging. It can easily lead to mistakes being made in one’s medical diagnosis and care. Accidental misinterpretation of words by healthcare workers that do not speak the language fluently can also have negative consequences. According to one study, an interpreter was not used in 46% of cases that involved patients with low English literacy (Flores, M.D., 2006). Dire consequences occurred due to not using an interpreter in this case involving an 18-year-old Hispanic male. Juan had stumbled into his girlfriend’s home, stated he was “intoxicado” and collapsed.
Paramedics were called, and the family repeated the term “intoxicado,” however, the paramedics did not speak Spanish and interpreted the meaning as nauseated. The patient spent over 36 hours in the hospital comatose with a diagnosis of a drug overdose before he was reevaluated and given a correct diagnosis of an intercerebellar hematoma with brainstem compression and a subdural hematoma secondary to a ruptured artery. The patient passed away, and the hospital subsequently had to pay $71 million dollars in a malpractice suit (Flores, M.D., 2006).
Patients who do not speak English are more likely to be labeled noncompliant when it comes to adhering to a medical plan of care, receive a diagnosis that is more severe than the condition really is, leave the hospital against medical advice and experience higher rates of readmission to the hospital (Flores, M.D., 2006). This may be due to lack of understanding of the patient’s culture by the physician. “Fatalismo” is a common health belief in the Hispanic culture. This is the belief where the patient believes that their health is already determined by God’s plan. Those that believe in fatalism do not seek preventative care or may not think that the doctor’s medical plan of care will have any effect on the outcome of their well-being.
Teaching Tool & Response
In order to shed light on healthcare disparities experienced by the Hispanic/Latino population in my workplace, I created a brochure and distributed it to the staff. The brochure contained information on vulnerable populations, gaps in healthcare present in the Hispanic/Latino population, cultural and health beliefs held by this minority group and resources available to refer staff and patient too. I also asked for any comments or feedback they might have about the brochure and/or how they thought we could address these issues so that we could work as a team to decrease these disparities. Responses received from the brochure were encouraging.
Many staff members did not know what vulnerable populations were or that such disparities existed. They were glad that it was brought to their attention. The concept of “fatalismo” received many comments and gave several staff members understanding of why patients may not be compliant with medical care. Others stated that there was a lack of incentive to learn Spanish as there is no pay differential for being bilingual. No programs are made available in the workplace to learn more about the Latino language or culture either (Caballero, 2011).
Action Plan with Integrated Course Concepts
An action plan was created to address these issues that incorporated concepts learned in the Nursing 440 course. These concepts are awareness of vulnerable populations, awareness of health behaviors and beliefs and disparities experienced by the Latino minority group. A request was made to management to create a pay differential for paramedics, emergency medical technicians (EMT’s) and nurses who became fluent in the language. Evidence was provided to management as to how making employees more fluent in the Spanish/Latino culture and language would benefit the company and prevent mistakes made by healthcare staff.
I have Spanish language program that I downloaded to the community computer at work. All of the employees have access to this computer and may use the program when they have downtime. An additional pamphlet explaining health behaviors and beliefs of the Hispanic/Latino community is being designed by a Human Resources employee. She is from Mexico and has an in-depth knowledge of the community in Vallejo as well as the cultural health behaviors and beliefs of the culture. I will be working with her to incorporate a more thorough coverage of the healthcare disparities experienced by the Hispanic/Latino community into the pamphlet.
This project was an eye opener, not only for me but for my fellow colleagues as well. I had made the assumption that most of the medical staff were aware of what a vulnerable population was because we have all been through some type of medical training in one form, or another. I was wrong. For the most part, EMT’s and paramedics were not aware of this concept as well as the concept of healthcare disparities. Many of the employees did not have an understanding of the consequences that these healthcare disparities can create either. It is my hope that bringing about awareness of these concepts to the employees at Medic Ambulance will increase cultural awareness of not only the Hispanic/Latino population but of other vulnerable populations as well so that healthcare disparities are decreased and all patients receive the medical services they require in a culturally competent manner.
Agency for Health and Research Quality. (2012). Disparities in Healthcare Quality Among Racial and Ethnic Groups. Retrieved from http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/minority.html Caballero, E. (2011). Understanding the Hispanic/Latino Patient. The American Journal of Medicine, 124(10), S10-S15. Retrieved from http://www.sciencedirect.com.ezproxy.apollowlibrary.com/science/article/pii/S0002934311006255 Flores, M.D., G. (2006). Language Barriers to Healthcare in the United States. The New England Journal of Medicine, 355(3), 229-231. Retrieved from http://www.nemj.org Pitkin Derose, K., Escarce, J., & Lurie, N. (2014). Immigrants And Health Care: Sources Of Vulnerability. Health Affairs, 33(8), 1258-1268. Retrieved from http://content.healthaffairs.org/content/26/5/1258.long