Introduction
Nursing care offered to migrant farmworkers and lesbian, gay, bisexual, transgender, queer, questioning, intersex and asexual (LGBTQIA) communities should be fair, professional, and deprived of any stereotypes and biases. This presentation aims to analyze two major cases, including the Amaro family (Mexican-American migrants) and John (a transgender individual). The principles of cultural diversity and gender identity are critical for examining the cases. It is necessary to clarify the rights of vulnerable populations and underline the role of nurses. The goal is to increase nursing competence in working with migrants and LGBTQIA patients and formulate clear staff responses and attributes.
Amaro’s Case
Each member of the Amaro family has certain issues for concern to be raised by a nurse. Milagros experiences pain during urination, right-sided flank pain, and fever and wants to discuss family planning. Reynaldo has a hernia in a particular area, making him conscious about examination. Grandmother Rose has to care for three children when the parents are at work. The family has limited records about their vaccinations and problems reaching all hospitals they addressed due to their transient lifestyle.
Staff’s Response to Milagro’s Health Records
The response of the staff to Milagro’s incomplete health records is characterized by frustration and the desire to strengthen their understanding of the situation. The nurses want to ensure that children are properly and timely vaccinated to predict the development of diseases like polio, human papillomavirus (HIV, influenza, measles, and other preventable diseases (Charania et al., 2020). However, they cannot obtain the necessary information because the mother does not have full recordings. Milagros is ready to cooperate and retell their care services and preventive activities. Unfortunately, this approach is not professional for gathering credible information. Not all family members participate in the discussion, which frustrates care providers. The staff’s response should include support, promote confidentiality, and demonstrate respect for the family.
The assumptions underlying the staff’s response are closely related to the existing stereotypes and biases toward migrant farmworkers without a regular care provider. First, a migratory lifestyle is associated with such stereotypes as a lack of housing or homelessness, poorly developed ethical standards, and language barriers (Kersey-Matusiak, 2018). Sometimes, the illegal presence of migrants provokes additional biases about the patient’s cultural diversity, the absence of documents for health recording, and neglect of healthcare and public obligations. Finally, the Amaro family is of an extended type, where three children should be cared for by an older adult when parents earn a living. Problematic parental involvement would result in poor education and limited care services, which are obligatory for young children.
Nurse practitioners (NPs) should ensure the best communication strategies during cooperation with the father of the family, Reynaldo. The main characteristics of the assessment process are based on the values of respect, privacy, and confidentiality. The NP demonstrates a positive attitude toward the patient and his concerns about his health. The man might have some questions or demands, so when nurses introduce themselves and explain the situation based on the wife’s talk, they need to ask if the patient wants to know something more. A supportive environment is important for migrant patients to stay calm and confident. Explaining the existing cultural differences or the initiation of small talk could help. The patient should understand the condition well and be prepared for a step-by-step examination with brief but clear explanations.
Confidentiality and Privacy
Attention is to the principles of confidentiality and privacy in Reynaldo’s case because the man shows his concerns about a hernia in the groin area. It is not pleasant and convenient for a man to discuss such problems with anyone, including a professional NP. Reynaldo and the NP’s relationship is developed to ensure all privileged information remains protected and is treated with respect. Disclosing information is the major restriction for the nurse in this case. Privacy issues include the patient’s responsibility for and control of his life. He decides how to share information, what diagnostic tools are less damaging to his mental health, and what information to reveal. The man should know that his condition can threaten his wife, which makes it possible for him to allow the wife to access his medical history.
Health-Related Issues in Care for Migrant Agricultural Workers
Migrant farmworkers are exposed to various internal and external hazards that negatively affect their health. The most common chronic diseases are human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), tuberculosis (due to no timely vaccination), diabetes (untreated obesity and poor nutrition), and hypertension (sun exposure, workload, and poor hygiene) (Kersey-Matusiak, 2018). In addition, there are many occupational injuries and traumas that usually remain untreated or neglected. Cuts are the sources of uncontrolled infections, poor skin conditions provoke the immune system, and musculoskeletal problems lead to fatigue and exhaustion (Arcury & Quandt, 2011). Eye injuries may be uncommon, but their prevalence cannot be ignored in the agricultural sector.
Importance of Health Care Issues
It is important to identify all health-related issues when caring for migrant agricultural employees for several reasons. First, this step proves the worth of education about health threats for migrants. Second, people learn the current statistics and understand that they belong to a vulnerable group. Then, migrants understand that most illnesses and injuries can be prevented if certain recommendations are followed. The next benefit of improved awareness is related to creating favorable environments for all immigrant workers with limited resources. Finally, any care process is based on patients’ histories and subjective data. When people know what they should focus on first, they facilitate nursing assessments and avoid biases.
Nurses’ Attributes to Consider with Migrant Workers
Nurses should understand their attributes in working with migrant agricultural workers, including medical and nursing knowledge, to inform patients about their health conditions and current problems. Applying professional skills helps nurses cooperate, obtain information from patients, and deliver the necessary facts to doctors and other care practitioners (Kersey-Matusiak, 2018). In addition, health professionals need to become solid advocates for migrant workers to promote community education and informal counseling when people would like to know more about their opportunities (Centers for Disease Control and Prevention, 2018). Simple communication with clear information and supportive behaviors is expected, paying attention to cultural differences and promoting competence in collaboration.
Professional Responsibilities of Nurses
Nursing professionalism plays an important role in the care processes offered to migrant workers. It is expected to organize a sufficient physical examination and promote health to predict serious illnesses and injuries (Biggerstaff & Skomra, 2020). Counseling, education, and care coordination are critical attributes for nurses to consider because they directly affect the patient’s understanding of the condition (Centers for Disease Control and Prevention, 2018). Finally, any care process should be based on the patient’s medical history to minimize medical errors and strengthen health outcomes.
Ethical Responsibilities of Nurses
Health promotion and patient safety are two critical elements in nursing care. The major ethical responsibility of nurses in their practice is to advocate for social justice for all patients (Biggerstaff & Skomra, 2020). Thus, NPs should follow the principles of nonmaleficence and autonomy to ensure their patients find themselves in a supportive environment. It is also necessary to exchange personal information in private so as not to violate confidentiality rules. Finally, working with migrants might require nurses to find a professional translator so patients understand all aspects of care.
The concepts of heterosexism/cissexism/homophobia/transphobia exist in modern health and nursing care. Despite increased awareness of identity changes and personal preferences, many people live in a world where heterosexuality is the only normal and acceptable sexual orientation. Such presumption provokes the creation of new conceptions and explanations to support LGBTQIA communities. For example, heterosexism is the idea that romantic/sexual relationships should only involve a man and a woman. Discrimination against LGBTQIA people and social oppressional are inevitable. When transgender people are marginalized, cissexism emerges and causes unfair and biased attitudes (Kersey-Matusiak, 2018). Homophobia is one of the oldest systems of belief that gay people are underserved populations. With time, transphobia has gained recognition as the impossibility of individuals to meet their gender role expectations.
Impact of “Isms” and “Phobias” on LGBTQIA Care
The existing “isms” and “phobias” concerning LGBTQIA people affect the level of care that can be offered. In most cases, social and behavioral risks are easily recognizable as the major causes of health problems (Gay & Lesbian Medical Association, 2006). Patients (lesbians and bisexual women in particular) report stress, depression, anxiety, and the inability to obtain medical care on time. Their avoidance of hospital visits results in poor health and increased readmission levels. Many LGBTQIA couples admit that at least one of the partners does not have health insurance and cannot afford regular follow-ups and counseling. With time, the development of chronic disease is hard to predict and prevent because many health issues among LGBTQIA individuals are neglected.
Steps to Address Biases
Heterosexism/cissexism/homophobia/transphobia biases cannot be ignored today, and the first step to addressing them is to recognize their presence and impact. Nurses should know the basics of LGBTQIA care and continue increasing their curiosity to ensure their cooperation with such patients is properly organized. It is necessary to accept the inevitability of transformations in some individuals because it is the only way to improve life quality and reduce emotional devastation. A nurse should explain each step during the examination to help the patient understand why these steps are taken. Appropriate questions are built to gather medical history and past experiences that might affect the person’s condition. Despite personal attitudes and positions, all nurses must demonstrate respect and loyalty in cooperating with LGBTQIA patients.
Ways to Elicit Information for Practical Assessment
The nurse should complete a practical assessment and obtain honest questions from the patient. The most sensitive ways to elicit information include placing John in a separate room, asking if other people know about John’s sexuality, and using kind words to demonstrate support and understanding. It is recommended that hospitals have special patient forms that reduce confusion about their gender roles and identities. Patients should feel safe during the examination and be confident their privacy rights are followed.
Conclusion
NPs should recognize the presence of various vulnerable groups that might need their care. Each patient deserves a special examination and a correct treatment approach. Migrant workers may not present enough personal information and medical history, and LGBTQIA patients face challenges due to discrimination and oppression. However, these biases and stereotypes should not affect nursing care but underline the worth of support and inequality for all people.
References
Arcury, T. A., & Quandt, S. A. (2011). Living and working safely: challenges for migrant and seasonal farmworkers. North Carolina Medical Journal, 72(6), 466-470.
Biggerstaff, M. E., & Skomra, T. S. (2020). Nurses as immigrant advocates: A brief overview. The Online Journal of Issues in Nursing, 25(2). Web.
Centers for Disease Control and Prevention. (2018). Migrant farmworker health. CDC. Web.
Charania, N. A., Gaze, N., Kung, J. Y., & Brooks, S. (2020). Interventions to reduce the burden of vaccine-preventable diseases among migrants and refugees worldwide: A scoping review of published literature, 2006–2018. Vaccine, 38(46), 7217–7225. Web.
Gay & Lesbian Medical Association. (2006). Guidelines for care of lesbian, gay, bisexual, and transgender patients. GLMA. Web.
Kersey-Matusiak, G. (2018). Delivering culturally competent nursing care: Working with diverse and vulnerable populations (2nd ed.). Springer.
Rowe, D., Ng, Y. C., & O’Keefe, L. (2017). Leadership initiatives in patient-centered transgender care. Federal Practitioner, 34(1), 8-14. Web.