Description
comment 1: (120-150 words)
As a mental health nurse I am familiar with multiple situations where human rights are impacted. In a mental health facility patients are placed under an involuntary hold and their human rights are impacted in many ways including lack of privacy, inadequate treatment, but the most common I’ve been witness to involves the improper use of seclusion or restraints. The improper use of seclusion and restraints poses ethical and human rights concerns. Seclusion and restraints restrict the patients right to be free from torture, cruelty and degrading treatment is a fundamental human right that applies to those receiving treatment, including mental health care. The importance of upholding a patient’s dignity and autonomy is especially essential in this field.
Patients that experience improper treatment, or violations of their human rights may experience an trauma, which can in turn hinder their well-being and trust in mental health services and may prevent the patient from seeking help in the future fearing they’ll be mistreated. There are several additional variables that contribute to health disparity. Cultural beliefs towards mental health can influence how our patients are treated as mental health issues may lead to discrimination and patients. Another variable includes economic determinants. Patients with lower socioeconomic statuses may face financial barriers that can limit access to mental health services. One of the ways international stakeholders collaborate to support vulnerable groups and support health equity is by utilizing technology and offering telehealth solutions, including telepsychiatry and digital mental health interventions, to expand access to mental health services.
Example
Hi Yvette
I completely agree with your concerns regarding the impact on human rights in mental health facilities. The improper use of seclusion and restraints can be a violation of a patient’s right to be free from torture, cruelty, and degrading treatment. Upholding a patient’s dignity and autonomy is crucial in the field of mental health. It’s disheartening to hear that patients who experience improper treatment or human rights violations may suffer trauma, which can further hinder their well-being and trust in mental health services. This fear of mistreatment may prevent them from seeking help in the future. Cultural beliefs towards mental health and economic determinants can also contribute to health disparities and discrimination.
comment 2: (120-150 words)
Early in my nursing career (over 15 years ago), I remember having a patient admitted to the hospital for whatever reason, and he was in a same-sex relationship and was HIV positive. Some staff (mainly CNAs) made a big deal out of him being HIV positive, and some male caregivers do not want to care for him because of his same-sex relationship and differing comfort levels and beliefs. His human rights were impacted by the care he received. I am sure some staff were rude to him and his partner, making them uncomfortable or making them not want to seek healthcare. The CNAs caring for him always wore gloves when entering his room. I am not sure if they completely understood the transmission of HIV, but they would wear gloves even when taking meal trays or entering to do vitals.
The patient and his significant other’s health was influenced by their experience and willingness to share and identify as being in a same-sex relationship. If you have a poor experience or do not trust your healthcare team, you might not seek care when needed, and you might not get appropriate treatment for HIV. Lack of education and treatment for HIV and sexually transmitted diseases (STDs) can negatively impact everyone involved and have poor patient outcomes. Globally, lack of education, testing, and treatment can have detrimental effects, and transmission can spread rapidly.
In this situation, there were educational determinants by the medical staff, and social determinants were impacted by who wanted to care for him and his relationship status. Economic status could be a factor as well. Discrimination and social stigma are also factors. Lesbian, gay, bisexual, and transgender (LGBT) are considered a sexual minority and have special medical needs (Baptiste-Roberts, 2017). Lack of health insurance from being in a same-sex relationship can also impact patients’ decisions to get care (Baptiste-Roberts, 2017). Culturally, according to the Human Rights Campaign (2017), Latino and Black gay men have a higher incidence of getting HIV at some point in their lives. Gender inequality is also common and shown by restricted access to education, gender-based violence, gender norms, and restrictions to obtain services (Be in the Know, 2023).
Education and funding are essential for international stakeholders to help promote health equity and support vulnerable groups. There is a need for staff sensitivity training, provider LGBT training, and cultural competence training (Baptiste-Roberts, 2017). International free support groups can help others feel supported and help determine when to seek care. Free clinics would also be a consideration if possible due to funding. As advanced practice nurses, we need to provide education globally related to HIV and same-sex relationships. Global education is essential. The Centers for Disease Control and Prevention (CDC) is working on ending the U.S. HIV epidemic (2022). Surveillance and knowledge sharing globally could help end the worldwide HIV epidemic.
Example
Hey Robin,
I enjoyed reading your post. I agree with your perspective throughout your post. The society we live in now is a lot more forgiving and accommodating to same sex relationships as it is more widely discussed. I also agree that when a patient does not rust the team caring for them the patient might be less likely to share needs and requests with the care team. This might prevent the patient from receiving the best care or the most appropriate treatment. Education is critical in these moments. If more members of the care team felt comfortable with the HIV diagnosis, transmission, and related treatment, they might have felt more comfortable caring for the patient.
comment 3: (120-150 words)
Describe the situation and explain how human rights were impacted.
When I was a new graduate nurse I was precepting under an experienced nurse who had worked in the emergency department for many years. I was extremely eager to learn and really looked up to her. However, one day we were assigned to patients in the overflow psychiatric unit. Patients admitted with psychiatric complaints automatically received a PRN order set that included Ativan, Seroquel, Haldol, Tylenol and Benadryl. The nurse I was precepting under told me that she administers the PRN Seroquel to each patient first thing in the morning to keep them from “acting up”. I must have looked surprised when she said this because she continued on to say that the emergency department wasn’t the place for psychiatric patients, and that sedating them was for our safety and their own.
How were individual health and global health influenced by this situation?
The individual health of patients was undoubtedly affected by this decision. Does keeping them sedated negatively impact their care? How will they appropriately and genuinely interact with those responsible for determining their course of treatment? Additionally, it speaks to the state of global psychiatric care. I am living and working in America, one of the wealthiest and most privileged nations in the world and this is the state of our acute psychiatric care? I can only imagine what kind of care, or lack of, there is in other countries.
Discuss additional variables that contributed to health disparity in this situation, such as cultural, social, economic, or educational determinants.
I believe the culture of the hospital system contributes to this behavior from the nurse. Having worked in a variety of emergency departments, there is little to no support when patients suffering from mental illnesses have outbursts and cause harm to themselves or others. I am in no way condoning her actions, but this nurse was most likely burnt out and acting out of self preservation. Additionally, lack of proper education regarding appropriate psychiatric care and interventions for these patients may have negatively impacted her decision making as well.
How might international stakeholders collaborate to support vulnerable groups and support health equity?
Patients suffering from mental illness are extremely vulnerable. The 2030 Agenda for Sustainable Development highlights the efforts of international stakeholders to address this vulnerability and disparity. Target 3.4 specifically emphasizes mental health stating, “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”. Other organizations like the World Health Organization have also made efforts to address these disparities. International stakeholders can support health equity by staying informed and even becoming involved directly with these efforts through global and local organizations.
Example:
Calley,
This situation must have been confusing to you as a new nurse. It is easy to get caught between the “real world” and the “ideal world” of nursing making it difficult to navigate and find your way. I agree with you that giving these patients Seroquel prn just to keep them calm for the nurse’s benefit is not ideal. Would you say this affects the patient’s right to autonomy? Patients have the right to know what medication they are being given and they have the right to refuse if that is what they desire. In my past experiences, I have seen where nurses give elderly confused patients sleeping medication to help their shift go more smoothly, and not only does this affect their health, but also their human rights as well.
