You are a nurse at the local hospital. Michelle is hep C positive and has presented to your ward as a patient and is in severe pain. Michelle has disclosed her status previously to the doctor and her pain is unrelated to hepatitis C. You have called the doctor, however she has refused to come claiming that she has ‘patients in real need to care for and doesn’t like dealing with junkies looking for more drugs’. Michelle’s pain levels may have become almost unbearable and Michelle begins to shout for attention. Despite having no drugs present, or no indication of drugs, security guards at the hospital have assumed Michelle is on drugs due to her behaviour and have now searched Michelle and restrained her in the bed by holding her in position. When she asked another nurse to release her she was told ‘this was her own fault due to her lifestyle’. Her pain levels have now increased, however Michelle does not seem to be concerned about her treatment, claiming ‘she is used to this sort of thing’. Four hours have passed and the doctor is still non-responsive. What problems/barriers can you identify? What do you do?
Issues for discussion
- Why do many patients receive less quality of care due to ‘moral’ or legal issues, rather than their quality of care relating to their direct health?
- Do you think lifestyle judgements have any place in a health care setting? (Remember people also receive differential treatment due to cultural differences, sexual orientation, religious practices etc.).
- Patients in ‘real need’ addresses the issues of mistrust of people living with hepatitis C or people with a history of drug use. The assumption that certain groups of people lie about their medical conditions, or somehow are not deserving of medical treatment is of great concern in the sector.
- The refusal of pain management may be based upon factors of drug use discrimination. Refusal of pain management is often based upon opiate use and assumptions surrounding these practices.
Client issues
- How can you facilitate having Michelle’s health needs/ pain management met?
- Michelle’s lack of concern may be due to internalised discrimination. Considering the acceptance of stigmatisation how can you address these issues with Michelle in order to promote her basic rights?
- What support can you provide emotionally or referral support services?
Organisational issues
- General staff training may increase awareness and improve treatment for patients living with hepatitis C
- A doctor cannot refuse a patient care, and if refusal of care takes place, the doctor may be reported to the Health Rights Commission
- What internal policies/mechanisms can be utilised within the hospital?
- How can you address the attitudes of supporting staff?
- Training which challenges stereotypical images surrounding drug use and gave accurate information could also improve health care delivery.
- Make sure that clients are also aware of the complaint policy within the organisation.