WMU Bronson School of Nursing

NUR 4310: Community Health Nursing

Journal 3: Determinants of Health and Vulnerability

Answers can be submitted beneath each question. Submit to the course dropbox by 2/16/20
at 11:59 p.m.

1. Reflect on the above meme. Was there ever a time that you were the “middle
person” or the “smallest person” as shown in the meme as it relates to social
determinants of health? Describe the situation.
(3 points).
 I am grateful for the fact that I have been very fortunate in my life in regards
of access to healthcare, which was more often than not of good quality.
 The only time that I can think of that I felt as the “middle” or “smallest”
person as relating to the social determinants of health is during the time that
my mother and I were living in the U.S. as new immigrants, not yet citizens.
 During the first 90 days of our stay we were prevented from being covered by
insurance by laws and regulations. During the summer, about halfway through
the 90 day period, I had an extremely severe allergic reaction to poison ivy, a
plant I had never been exposed to before in my 8 years of life. Due to the
extremely high cost of visiting the doctor uninsured, with many courses of
documents and paperwork to go through just to be able to see a doctor, it did
not seem to make the most sense to see a doctor for an initial visit for well
over $300. My mother and I had also gone through very extensive health
screenings, tests, x-rays, immunizations, among other things to be able to
enter the country. We would have been lying if we said we weren’t nervous
 and hesitant to see an American doctor as new immigrants. However, the cost
due to an inability to have health insurance coverage was the biggest
prevention of us seeking medical care. I was young at the time, only 8 years
old with a poor understanding of the world around me. However now, as a 23
year old Ukrainian American citizen, I see how it was not an equitable or just
situation.
2. Elaborate on the experience. Explain if your experience was inequality or
inequity. How did the disparity make you feel? How does thinking about the
experience make you feel now? Explain if the disparity was resolved and how.
(5 points)
 I can only imagine how frustrating and scary this situation was for my mother,
a 28 year old recent immigrant from Ukraine the to United States with a child
who required a basic human need that could not be provided due to policy. As
new immigrants living within a specifically mandated 90 day period there
should be policies regarding things like healthcare and other basic needs. I
believe that it was a situation of inequity, because while all people regardless
of ethnicity and background deserve healthcare, immigrants and refugees
require special support in this matter.
 Once my mother married my step farther and more paperwork was done for
both of us, we were both able to be covered under his insurance and the
disparity somewhat “disappeared”. However, it was not until 2008 that my
mother and I became U.S. citizens after moving here in 2005. Due to my
Mother not being able to work full time, we would have not had health
insurance if she were to have divorced my stepfather during the 3 years we
were working on becoming citizens.

3. Analyze the experience. How does your experience parallel inequalities or

inequities in social determinants of health that may be experienced by other
population groups? What are the health implications for people experiencing
inequalities or inequities in the social determinants of health? Discuss from the
perspective of the assigned readings and video. (6 points).
 Looking back and analyzing this experience 15 years later truly has opened
my eyes to this experience. Today I realize that for a period of time my
Mother and I were members of a vulnerable population, a subpopulation such
as ethnic or racial minorities, the uninsured, those with HIV/AIDS, children,
the elderly, the poor and those who are homeless (Rector, 2018).
 I know that I am very fortunate for the fact that my social determinant of
health had a time frame and eventually I was able to have good quality
coverage under my stepfather’s coverage. However, this is not the case for
thousands of immigrants and refugees who come to this country. Inequalities
 and inequities in social determinants of health, “the conditions in which
people are born, grow, live, work, and age” (Rector, 2018, p. 920) make up an
immense issue which affects thousands and thousands of immigrants,
refugees, and citizens in this country every day. For families who immigrate
here and have to find full time work with coverage the wait time for health
insurance may be endless. Many places of work offer low paying full time
jobs to undocumented immigrants seeking asylum and a better way of life by
working under the table. “Unauthorized immigrants represent about 24
percent of all workers in farming, fishing and forestry and 15 percent of those
employed in construction, which is the industry that uses the most
undocumented immigrant workers overall, at 1.35 million” (Jordan, 2018).
While American born citizens can often receive partial average to good
quality health insurance by working part time in some places of work, many
immigrant families put in overtime for years and do not receive any coverage
due to the fact that they are working undocumented. According to Rector,
2018, The unequal distribution of these factors among certain groups is
thorough to contribute to health disparities that are persistent and pervasive.
 Health implications of those experiencing inequalities and inequities include
infant mortality, pregnant and new mother mortality, decreased life
expectancies, and morbidities from diseases which span all types of health
categories (Rector, 2018).

4. Reflect. How does this inform your nursing practice when caring for patients
from vulnerable groups or those experiencing significant bias or inequities?
 Being educated on the topics of social determinants of health and health
inequities and inequalities is immensely important to me as a new nurse. Each
patient is unique in their own way and being affected bias and inequalities
creates a barrier to appropriate and adequate healthcare. It is important for me
to educate myself on all of the resources that are available to better serve this
population and teach them on what is available for them as well.
5. Will your nursing practice change as a result? Will you try a new approach?
Learn more about the population’s perception and experiences? Or is your
nursing practice already meeting their needs?
 Being an immigrant myself serves as a benefit to me because I know the
experience of being a newcomer in a new country and culture. I hope that this
will help me be a more culturally competent nurse. After studying health
disparities and social determinants of health my new approach will be asking
more questions about what the patient and their family is struggling with,
what resources they have accessed, know about, and need help accessing.
 References

Jordan, M. (2018, December). 8 Million People Are Working Illegally in the U.S. Here's

Why That's Unlikely to Change. Retrieved from

https://www.nytimes.com/2018/12/11/us/undocumented-immigrant-workers.html

Rector, C. (2018). Community and Public Health Nursing: Promoting the Public’s Health,

9th edition. Philadelphia, PA. Wolters Kluwer.