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  • Subject Name : Nursing

Introduction to Reducing Stigma and Discrimination

Stigma is the process in which it is characterized by social processes like discrimination, separation, status loss, labeling, and hence, the context of power (Carabez, Eliason & Martinson, 2016). Discrimination is the act that is related to the unfair justice and action that the person faces based upon the medical condition, attributes, or perceived status. Stigma is caused by groups or individuals related to both health and non-health related factors. The stigma related to health condition is attached to the disease condition or health condition (Carabez et al., 2016). Such type of stigma is experienced by people in all the parts of world. However, stigma in healthcare institutions negatively affects people in seeking healthcare services when they are not well. It has been said that the documentation system related to stigma is also widely presented in reports ranging from the provision of sub-standard care, denial of care, verbal and written abuse, and other subtle forms related to stigma.

Moreover, stigma is known as a barrier to care, that prevents people in the treatment of acute care, disease prevention, and support to maintain quality of life. In the health system, stigma is associated with an impact on the health of individuals that are reluctant to provide safe and engagement of care (Dahlui et al., 2015). This paper will explore the discrimination and stigma that is faced by the people and the role of nursing professionals in reducing stigma and discrimination for providing healthcare services. Especially, the health conditions, interventions, and role of nursing professionals will be included to evaluate the quality and methods in the healthcare delivery system.

Discrimination in any form is very harmful to society as well as profession as it leads to the opposition of ethical codes and values in the nursing profession. A nurse is the healthcare professional who is designated with duties to deliver the services with respect, dignity, worth, and human rights of individuals. The common relation between stigma and discrimination is that both include a discriminatory stance for guiding in creating strategies for all populations in the nursing profession (Doka et al, 2017). The Australian Code of Ethics, 2020 has also recognized the progress and efforts to eliminate discrimination associated with socioeconomic status, gender, race, quality of healthcare, and attainment of health. The continuous efforts have been made to eliminate the discrimination and stigma from the country in all forms. The point where this discrimination starts is the nursing level within a healthcare organization. It is the responsibility of nursing professionals to recognize the impact of stigma and discrimination with the active and continuous efforts. This helps in actively promoting the inclusion of all people to promote healthcare quality in eradicating health disparities. This calls for equality and justice for all people by not ignoring discriminatory behavior an act leading to health disparities and negation of professional values (Farotimi et al., 2015).

Discrimination and stigma exist, when the person is treated unequally and unfavorably due to characteristics such as gender, caste, creed, religion, or illness. The beliefs and attitudes about personal characteristics are there in the form of bias, stereotyping, and prejudice that influences the behavior of an individual to act upon beliefs and attitudes. This form of behavior can result in implicit, unintentional, detrimental, or intentional discrimination. The Healthcare system was always a complex system for the treatment of patients' condition with the primary focus. The Aboriginal people are therefore highly discriminated and stigmatized in Australia in availing healthcare needs (Feyissa et al., 2019). Earlier, in the nursing profession, it was experienced that Aboriginals and Torres Strait Islanders experience worse health services than non-Indigenous people. They continue to suffer from morbidity and mortality and hence this automatically continues to rise hospitalization rate in having poor health outcomes and low access to health interventions. Till now healthcare is the underserving area by remaining a significant problem for Aboriginal and Torres Strait Islanders.

Accessing health systems among individuals is the compromising factor due to social and cultural factors due to which they have to experience discrimination and stigma in the healthcare system (Fokuo et al., 2017). As per the background is concerned these people use to reside in remote and regional areas which are mostly socioeconomically disadvantaged groups and experience lots of disease burden due to lack of illness and preventive care management services. They are also influenced by socio-political factors along with socio-economic status so there is a high prevalence of health risk factors among them. The Healthcare system is also not paralleled between Indigenous and non-Indigenous people because there are large performance gaps of the health system in addressing health needs by all the health professionals especially nurses (Kabbash et al., 2018). Communication barriers are there that lead to adverse events and poor quality of patient care. This refers to both written as well as verbal communication, cultural differences, and low health literacy, hence these are proven to be the barriers to health outcomes of Aboriginal and Torres Strait Islanders. Each patient is believed to have their own beliefs and needs that are expected to meet by them. So, nursing professionals are the designated front line professionals who apply their knowledge of social determinants in mitigating the health risks to a vulnerable group.

The individuals receive this type of discrimination based on their characteristics, that exhibits poorer psychological and physical health. There is a strong link between stigma and discrimination as they affect health, mental status, healthcare service delivery, and health conditions. Effect of discrimination and stigma is caused in the way of not receiving optimal care, ongoing stress, delayed treatment, difficulty in adhering to the treatment plan, and internalized racism (Makhado et al., 2016). These all cause health disparities due to socioeconomic conditions that have been considered. This poses a greater risk to several metabolic disorders and the individual becomes at the greater risk of getting severe heart diseases. Health disparities have been caused in the health system that has a long association with discrimination on the part of service attainer and service provider. Some of the authors described that discrimination and disparities in the health system are caused majorly due to demographics, illness, racism, and ethnicity (Nagothu et al., 2018). Australia is the country where the population is divided into two groups such as the Indigenous population and the non-Indigenous population.

Indigenous populations are the Black Australians that receive very less care in all terms than White Australians. These Black Australians are Aboriginals and Torres Strait Islanders who experience disparities in the health system due to low-income level, racism, and cultural factors. They experience lots of discrimination such as they are not allowed to avail healthcare services, are not allowed to participate in public affairs, are not allowed to marry their children, and many more (Natan Drori & Hochman, 2015). Being a nursing professional, I had observed that Indigenous people have poor health than non-Indigenous people because they are counted in disadvantaged and poor people. So, this led to less life expectancy and an increase in health disparities. Racism is the major issue that is found to be the leading cause of poor health of Indigenous people. Racism towards Indigenous people is found to be interpersonal and institutional in health services. Indigenous people find these attributes incorporated in their living experience by lowering the sense of self-worth and lowering expectations (Vorasane et al., 2017).

The nursing experience is related to racism as that is varied by the socio-economic status in Australia. There was an individual admitted to the hospital who requires care because he was suffering from diabetes. After the admission into hospital, the professionals did not attend him because they found that he has low-socio-economic status. This status is measured by educational attainment, household income, and being a part of the labor workforce (Doka et al., 2017). This is the same status of others residing in Australia as unemployed people, tend to face discrimination. These findings relate with the literature, the study done by some authors state that there are high levels of racism prevalence among Indigenous Australians of low socio-economic status. This is higher among people with a low socioeconomic status that has to be managed because the people continue to face minorities within a minority (Dahlui et al., 2015).

The experience relates to the access of healthcare emergency services by Aboriginal people in the healthcare delivery system in Western Australia. His story highlighted the elements that he experienced at the time of receiving emergency medical care. He was not allowed to attain services within the hospital because of racism, intimidation, stigmatization, harassment, deep fear, and language difficulties. He met with a large number of problems while admitted to the emergency department of the hospital such as the need for attentive, specialized, and comprehensive care, access to a doctor, immediate treatment, and laboratory investigations. He also presented that other people of the community also faces the same barriers in healthcare institutions in attaining medical services. Hence, this means that people like him all come across barriers as limited access to specialized care, understanding of medical jargon, and barriers in communication, and especially interaction with healthcare professionals. This has affected the quality of services to Aboriginal people in Australia and participants in taking decisions to serve them with the best patient care (Carabez et al., 2016).

On discussing with him, he also revealed that the healthcare professionals handled him in a judgmental manner and expressed that emergency staff is not concerned with test results, health conditions, and even more waiting time. This made him and other Aboriginals experience discrepancies in availing healthcare services. The major element found through the experiences is that distrust and tension are marked between the healthcare delivery system and Aboriginal people (Gyamfi et al., 2018). Moreover, this also relates to misunderstandings with the healthcare system, loss of privacy, neglection, lack of access to traditional healing practices, discrimination, and loss of privacy. The patient stated that in having access to care, the first thing that exhibits is past negative experiences to the healthcare system. These have allowed them to suffer from health disparities and inequities in the healthcare system.

The stigma is also related to mental illness, cancer, leprosy, diabetes, and many more illnesses. Here is an example of a patient suffering from a mental illness. There is a high risk of depression in Aboriginals and Torres Strait Islanders that with an interview and nursing experience with them, they state that they are not treated equally due to culturalism and racism. There is inappropriateness in mental health treatment and care for Indigenous people. Though, the reports made in the mental health department presented that there was no procedure for screening and effective treatment of depression that is found in the Aboriginals group. Moreover, one of the pregnant Aboriginal described that she is not screened for distress. However, this procedure was conducted on non-Indigenous people for the welfare of both mother and baby (Fokuo et al., 2017).

This issue needs training of healthcare services and the use of appropriate tools to address the gap for Indigenous women. Best practices and screening tools will assist the practitioners in adapting to remote Indigenous settings and serving at the world level to limit the profile of effectiveness. Appropriate pathways need to be included with a range of services within the healthcare sectors such as workforce, education, and justice. However, the improvement of mental health care to Indigenous people should be promoted to close the gap for sorting out the gap of discrimination and stigma. People should be screened with the risk of mental illness by assisting and supporting them in the provision of care and appropriate services from the healthcare system (Fokuo et al., 2017).

Nursing professionals are found to be serving in healthcare institutions to widely dispersed geographical areas in clinical practice. They provide care for the health and wellbeing of people through death. It has been observed that nursing professionals are positioned to impact the health and well-being of people. The recognition and value for nursing care are underestimated among policymakers, governments, and healthcare institutions at international, national, and local level (İnan, Günüşen et al, 2019). The nursing profession has now completely changed and found to be contributing to the positive outcomes of patients. The problem of discrimination and stigma is also due to human and economic costs associated with poor access to quality nursing care. However, nursing professionals are substantially contributing to the reduction of morbidity and mortality. Nursing professionals are doing interventions that are cost-effective and investing to pay for themselves. Through giving care and surveillance, interventions, and education prevent the occurrence of health outcomes and keeping people well (Ihalainen‐Tamlander et al., 2016). Nursing professionals are contributing to the healthcare of the community and the overall health of the nation. Investments in nursing care return to the use of expensive healthcare resources and better health outcomes. The benefits extend with the walls of healthcare settings and recover from health illness. This will thus contribute to the health and outcomes of community and nation.

Nursing professionals have a great role to play in casting their gaze towards perpetuating inequalities. There are a variety of reasons why Aboriginals are not able to access healthcare services such as blames, poor socioeconomic status, and lack of capacity building. The only thing that is required to improve the status is attention towards structural injustices that are presented as barriers in the healthcare system (HassanpourDehkord et al., 2016). These are automatically causing stigma and discrimination in creating poor health outcomes. Inequalities in the healthcare system for Aboriginal people are not possible to be addressed only by practicing cultural competence at the individual level. First of all, access to services should be there for the whole population, then education based on social justice in preparing for future health needs at the local, regional, national, and international levels. Education among professionals tends to be agents for compassion and change in citizens of the world. This is the log run concern of Aboriginal people that needs to work upon for capacity building and creating fruitful ideas. The enclosure of the inequities gap is the political and ethical responsibility to take action on time (Gyamfi et al., 2018).

Conclusion on Reducing Stigma and Discrimination

Investment in nursing care provides returns on better health outcomes and lessening the use of expensive health care resources. Such type of benefits extends beyond the walls of healthcare settings and recovering patients from illness. There are some types of risks associated with the ongoing failure to value the nursing contribution. The risk is not only to the patients but also it is to nursing professionals who work without considering the needs of people. The examples presented above show that there is an urgent need to educate healthcare professionals about the safe and sensitive practices of Aboriginal and Torres Strait Islanders Health. An increase in the number of Aboriginal healthcare service workers is the urgent need to experience health equity and thus ensuring sustainability in the environment. Knowledge and linking theories should be the practice sponsored to Aboriginal healthcare professionals to get rid of discrimination and stigma. The narrative therapies need to be included to improve communication and a better understanding of the complexity and richness of lived experiences by nursing professionals. The health system should be such that it ignores structural discrimination based on various factors. This is the long and arduous journey for which all the members of the country have to join to build humane and sensitivity in the healthcare system. However, the trend is changing, and the gap of inequities will be closed by following ethical and political appeals of the community to take action.

References for Reducing Stigma and Discrimination

Carabez, R. M., Eliason, M. J., & Martinson, M. (2016). Nurses' knowledge about transgender patient care. Advances in Nursing Science39(3), 257-271. https://doi.org/10.1097/ANS.0000000000000128

Dahlui, M., Azahar, N., Bulgiba, A., Zaki, R., Oche, O. M., Adekunjo, F. O., & Chinna, K. (2015). HIV/AIDS-related stigma and discrimination against PLWHA in the Nigerian population. PloS One10(12), e0143749. https://doi.org/10.1371/journal.pone.0143749

Doka, P. J. S., Danjin, M., & Dongs, I. S. (2017). HIV/AIDS-related stigma and discrimination among health-care providers in a tertiary health facility. Journal of Medical Sciences37(2), 44. http://www.jmedscindmc.com/article.asp?issn=1011-4564;year=2017;volume=37;issue=2;spage=44;epage=49;aulast=Doka

Farotimi, A. A., Nwozichi, C. U., & Ojediran, T. D. (2015). Knowledge, attitude, and practice of HIV/AIDS-related stigma and discrimination reduction among nursing students in southwest Nigeria. Iranian Journal of Nursing and Midwifery Research20(6), 705. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700691/

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Fokuo, J. K., Goldrick, V., Rossetti, J., Wahlstrom, C., Kocurek, C., Larson, J., & Corrigan, P. (2017). Decreasing the stigma of mental illness through a student-nurse mentoring program: a qualitative study. Community Mental Health Journal53(3), 257-265. https://link.springer.com/article/10.1007/s10597-016-0016-4

Gyamfi, S., Hegadoren, K., & Park, T. (2018). Individual factors that influence experiences and perceptions of stigma and discrimination towards people with mental illness in Ghana. International Journal of Mental Health Nursing27(1), 368-377. https://doi.org/10.1111/inm.12331

HassanpourDehkordi, A., Mohammadi, N., & NikbakhatNasrabadi, A. (2016). Hepatitis-related stigma in chronic patients: A qualitative study. Applied Nursing Research29, 206-210. https://doi.org/10.1016/j.apnr.2015.04.010

Ihalainen‐Tamlander, N., Vähäniemi, A., Löyttyniemi, E., Suominen, T., & Välimäki, M. (2016). Stigmatizing attitudes in nurses towards people with mental illness: A cross‐sectional study in primary settings in Finland. Journal of Psychiatric and Mental Health Nursing23(6-7), 427-437. https://doi.org/10.1111/jpm.12319

İnan, F. Ş., Günüşen, N., Duman, Z. Ç., & Ertem, M. Y. (2019). The impact of mental health nursing module, clinical practice, and an anti-stigma program on nursing students' attitudes toward mental illness: A Quasi-Experimental Study. Journal of Professional Nursing35(3), 201-208. https://doi.org/10.1016/j.profnurs.2018.10.001

Ishimaru, T., Wada, K., Hoang, H. T. X., Bui, A. T. M., Nguyen, H. D., Le, H., & Smith, D. R. (2017). Nurses’ willingness to care for patients infected with HIV or Hepatitis B/C in Vietnam. Environmental Health and Preventive Medicine22(1), 1-7. https://environhealthprevmed.biomedcentral.com/articles/10.1186/s12199-017-0614-y

Kabbash, I. A., Ali, E. A. A., Elgendy, M. M., Abdrabo, M. M., Salem, H. M., Gouda, M. R., ... & Hamed, M. (2018). HIV/AIDS-related stigma and discrimination among health care workers at Tanta University Hospitals, Egypt. Environmental Science and Pollution Research25(31), 30755-30762. https://link.springer.com/article/10.1007/s11356-016-7848-x

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Nagothu, L. M., Tilekar, S. D., Sebastian, A. K., Fernandes, P. R., McCreary, L. L., & Norr, K. F. (2018). HIV-related stigma among nursing students attending a college of nursing that promotes non-discriminatory care in India. Journal of the Association of Nurses in AIDS Care29(2), 241-253. https://doi.org/10.1016/j.jana.2017.11.008

Natan, M. B., Drori, T., & Hochman, O. (2015). Associative stigma related to psychiatric nursing within the nursing profession. Archives of Psychiatric Nursing29(6), 388-392. https://doi.org/10.1016/j.apnu.2015.06.010

Vorasane, S., Jimba, M., Kikuchi, K., Yasuoka, J., Nanishi, K., Durham, J., & Sychareun, V. (2017). An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR. BMC Health Services Research17(1), 125. https://link.springer.com/article/10.1186/s12913-017-2068-8

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