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Discussion Topic/ Nursing Shortage and Nurse turn-over

This is a discussion post, about 250 words, tittle page not require In- text citation is required original work please, reference source, website source strongly preferred.

QUESTION 3: Compare how you would expect nursing leaders and managers to approach nursing shortage and nurse turn-over, support your rationale by using the theories and, principles.

Journal of Health Disparities Research and Practice, Volume 6, Issue 2, Summer 2013

patients on the central plateau of rural Haiti not to finish a full-course of tuberculosis (TB) treatment. Practitioners attributed this to local beliefs related to alternative medicine held by followers of Voodoo. Farmer and colleagues (1999) conducted a study to determine if this was the case. What they discovered was that non-biomedical beliefs of the etiology of disease had no impact on whether a patient finished the full-course of TB treatment; rather, access to the TB medicine and having support from community health workers to monitor patients were the key determinants of whether the patients were “compliant.” Elsewhere, Farmer and colleagues (2005) observe that “those least likely to comply are usually those least able to comply.” Understanding the history, political economy, and culture of Haiti allowed the Harvard-affiliated, non-profit health and social justice organization, Partners in Health, to subsequently effectively treat TB. It is common for providers to blame noncompliant behavior on cultural dictates that are unintelligible to them as outsiders (e.g., Voodoo), but this approach under-appreciates both cultural dynamics at work and the influence of contextual factors. Moreover, the culture-as- problem framework for understanding health disparity often merely serves to legitimize and underscore narratives that devalue the poor and communities of color as irrational and therefore deserving of what they get. The fear experienced by Hispanic immigrants in the ID related to cultural disconnect is a reflection of larger inequities within the system. In the ID, provider cultural incompetence and the resulting cultural disconnect have the effect of making patients fear discussing alternative treatments, whether they take them or not. The fear that results from cultural disconnect reduces a patient’s ability to receive proper medical treatment and further puts the patient as risk when they do seek care. When patients hide their use of or belief in alternatives to provider-based medicine and do not tell their healthcare provider what alternative treatments they are using, they risk having a reaction with pharmaceuticals prescribed by the physician. The violence perpetrated upon individuals with alternative beliefs and behaviors in terms of stress, lack of attention to medical problems and the potential for serious drug reactions reflects structural inequality, and reproduces and accentuates existing health disparity. CONCLUSION

Structural Violence and Fear Although diabetes is a national health problem, the burden of the disease and its consequences are not shared equally. Statistics show that Hispanics are at particular risk. While we know how to prevent diabetes through a healthy diet and regular physical activity, and how to maintain the health of people with diabetes through a regimen of care from a provider, we have not been able to develop meaningful strategies to encourage prevention or “compliance”, especially in contexts of disparity. Although the social determinants of health approach for understanding chronic disease has improved our conceptualization of how individuals are embedded in contexts and environments that influence their ability to make healthy choices, live a healthy lifestyle, and seek or have access to healthcare, we continue to lack a more integrated understanding of the nature of social practices that impact health and how social determinants operate to produce health disparities. Unpacking the dynamics of this process requires further expanding our theoretical repertoire. We proposed that applying a structural violence framework to understanding diabetes health disparities in a Hispanic immigrant community in Albuquerque would provide significant insights into the processes that produce and encourage disparity. A structural violence framework takes into consideration the extent to which people’s lives are affected by institutionalized inequality, influencing and often governing individual experience. Political, economic, and social inequalities limit the personal agency of an individual to live a healthy life

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