1.

Have you experienced, or heard of a situation, where a patient was not treated fairly due his or her minority status or because of inclusion in a vulnerable population? What happened and how did you feel being placed in the situation?

I cared for a patient about two weeks ago who came to the hospital for a colostomy reversal. She left the OR at 1100 and stayed at the recovery area (PACU) up to 1750. When I came in to work for the night shift, the day shift nurse had just admitted this patient to our unit, and in her report to me, stressed that the nurse at the PACU said patient had a history of drug abuse, and had been requesting pain medication frequently at the PACU, then threw a fete when pain medication was not immediately brought to her, pulling out a penrose drain that was put in place at the OR. So I was warned to be ready to deal with a difficult patient. Ironically, this patient turned out to be my least busy patients that night. When I assessed this patient the first time I went to her room, she rated her pain as 6 on a scale of 0-10, and I gave her 10mg of oxycodone and explained to her that she could have it every 4hrs PRN, and morphine every 2 hrs PRN for break through pain. Then the patient explained to me that the nurses down at the PACU were very mean to her. Said when she came out from the OR, she was in a lot of pain and when she requested pain medication, the nurse said to her that you know you were cut open, so its going to hurt, then asked her, do you still do drugs? to which she said no, but the nurse said that oh, any one could tell, it showed on her face. Then warned her that she was not going to be running the pain medication every minute. She also explained to me that her drain came out because she was getting out of bed to go use the rest room, and then mistakenly, the drain got hooked in the bed, but the nurse reported to the doctor that she pulled out her drain because she wanted pain medication. Patient told me in teers that she got addicted to pain medication when she was treated for back injury that she sustained at work, but that she had kicked the habit more than 2 years ago. She complained the nurse treated her very unfairly. The patient was very calm and cooperative through my shift, and accepted need for pain medication only twice during that shift. From my evaluation, I suspected that this nurse had seen the history of drug abuse in the patients history and then stereotyped her for someone with cravings for drugs. Putting myself in the patients place, I felt so bad for her. I took down the PACU nurses name from the patient, and passed the report on to my patient care manager in the morning for appropriate follow-up and intervention on the matter.
2. Examine a piece of health information or instructions from your workplace. Is it appropriate for a low-literacy client? How can it be made better?

At my place of work, the form that is given out for patients to fill out to complete their admission profile contains some very cumbersome phrases that a patient with low-literacy will find a hard time to make any sense out of it or interpret it in the intended sense. For instance, one of such questions goes thus: Do you have any personal, cultural, or religious beliefs that you would want the hospital to know? We do get some patients who did not finish middle school, but even for some high school graduates or even some post high school educated patients may find a hard time making out the intended sense in this question. What this question seeks to find out here is whether the patient has some cultural or religious rituals such as concerning prayers, foods, blood products and more of this like. To make this easier for the patients, I usually highlight this question, and use simple examples to illustrate the question better and thus help them understand the question better enough to answer it appropriately. For example, I usually tell them that, when we admit patients, some people say they are Muslims and will not want to be served pork in their food, others say they are Jehovah witnesses and will not want to have a blood transfusion, while others still say they will not want to be disturbed between a certain time period because that is their time of prayers. Explained this way, the patients understand the question better and answer it appropriately. I figure out the question is posed in this admission form in such a cumbersome manner because of the need for brevity. To make it easier for patients, rather than be brief and vague, the questions should rather be made lengthier and simpler for the patients understanding and comfort.