Reflective Writing

During my clinical experiences, I have frequently come across patient’s for whom social determinants play a large role in their reason for admission. Last semester, there were many “frequent flyers” who would be admitted back to back within the same month for months on end. I recall one patient who would explain their lack of housing, lack of money, lack of access to nutrition, lack of transport, and other basic needs. This patient would often present to the emergency department. These all play a role in their overall health and health maintenance. For example, we see a patient who is “not compliant” with their medication regimen. As part of the care team, nurses have to ask why this is happening. Is the patient unable to afford these medications? Are they unable to find transport to pick them up? Is there a language barrier? I think the community outside of the hospital has done a disservice to these patients who find themselves in and out of the hospitals like this. A lack of health resources and support in the community certainly perpetuates this.

The staff on the floor knew this patient well as a result of his reoccurring admissions. They acknowledged that he would take advantage of meals and shelter provided during his stays, making it appealing. My clinical instructor explained that this was a seemingly never-ending cycle for many patients. We discussed how it seemed the health system had failed in supporting the well-being of people like him outside of the hospital. Disease prevention and health maintenance are all part of a healthy life and reducing hospitalizations. My instructor also mentioned that people who do this have no means to pay for their stays, but will keep coming back as they cannot be denied care. In this moment, I felt saddened by how monetarily motivated healthcare is in this country…with all of these bills charged to patients, how can we not do better to prevent hospitalizations and promote health for communities?

Basic needs of the public should be addressed to prevent hospitalizations and ensure everyone has the opportunity to maintain their own health. Public health nurses play a critical role in this. This is where a community assessment comes into play. There is a dire need for intervention in the communities that these patients hail from. Free clinics, access to food, financial support, medication assistance, and transport to appointments would all be examples of beneficial changes. Of course this is easier said than done. However, in a country where healthcare is driven by money, implementing changes such as these would reduce the amount of resources being used on these patients who are hospitalized related to a lack of basic needs being met – especially when these patients are not paying for these resources regardless.

I think the healthcare team could continue to advocate for these changes and recruit involvement from outside officials and community health nurses. Especially on this specific floor, these nurses have first-hand experience with seeing the effects of a neglected community, as well as just how prevalent these deficits are. As a student, I engaged the nurses and my clinical instructor in conversation about my surprise at how many patients were hospitalized largely due to social determinants and a lack of access to health care outside the facility. The work of a nurse is not done at discharge in the case of these patients. Continued advocacy is the only way forward in creating change.