Veteran’s Administration Hospital, Coursework Example
Activities associated with health promotion and disease prevention require an effective understanding of the challenges and consideration s of cultural diversity, language difficulties, communication barriers, and other concerns. Various population groups require individualized care and attention to accommodate their specific needs; therefore, it is important to address these concerns and to consider the impact of programs and other efforts that will contribute to positive outcomes in reducing health disparities and other barriers that are prominent with many culturally diverse populations. In particular, veterans face critical health challenges that must be addressed effectively in order to overcome barriers and to improve health outcomes over the long term. For example, heart disease and its complications are often grounded in social barriers and limitations that lead to difficulties in accessing healthcare services, such as language difficulties and culturally diverse circumstances. These issues must be addressed openly to ensure that veterans are treated with care and respect to achieve positive health and wellbeing and to preserve their heart health as best as possible.
For veterans facing heart disease, it is more important than ever to identify barriers and other limitations that prohibit greater health and wellbeing within this population, including language barriers, disadvantaged status, lack of communication, lack of adequate insurance and related services, and other concerns. The following discussion will address some of the most common issues related to health disparities, particularly for veterans facing the risks associated with heart disease. In particular, barriers associated with health promotion and disease prevention will be considered as a means of evaluating current challenges and the opportunities that are available to improve the health status of these individuals over the long term, such as language barriers, lack of knowledge, and cultural discrimination, amongst other issues. These problems will be considered through a detailed literature review in order to identify the root of these concerns and the possible solutions that exist throughout healthcare practice and society as a whole. Due to the prevalence of heart disease within the veteran population, it is important to identify the issues that are most prevalent and to demonstrate the potential to minimize barriers to support effective cardiac outcomes.
Research and evaluation regarding healthcare disparities for veterans has increased n recent years in response to gaps in knowledge and a lack of understanding of the perils of veterans seeking healthcare options. Cultural diversity is a key component of healthcare practice; therefore, this requires professionals to take the steps that are required to embrace multicultural populations and the barriers that they often face (Alegria et.al, 2010). The reduction of healthcare disparities is one of the primary focus areas of Healthy People 2020 and considers the impact of reduced quality of life across many disadvantaged populations, including the increased risk and prevalence of heart disease throughout the United States (Thomas et.al, 2011). Unfortunately, with the Veterans Health Administration, these disparities are evident in significant numbers, particularly for female veterans, as they often lack the same level of care and attention as their male counterparts (Bastian et.al, 2013). In addition, it is important to address the high risk of cardiovascular disease in the veterans’ population for both males and females to bridge existing gaps in research and treatment (Bastian et.al, 2013). Similarly, many female veterans have not received the same level of treatment in managing diabetes as male veterans, thereby creating a challenging treatment environment for this group (Vimalananda et.al, 2011).
Within the Veterans Administration health system, there appears to be fewer disparities when considering race in contrast to non-VA systems (Tsai et.al, 2013). This is largely based upon access to insurance services, disability payments, and level of need, amongst other variables (Tsai et.al, 2013). Therefore, it is necessary to consider these challenges and the availability of healthcare services on decision-making within this population (Tsai et.al, 2013). In some ways, the availability of healthcare services through VA facilities serves as a safety net for many veterans, even though the quality of care is often limiting within these locations (Tsai et.al, 2013). It is also known that veterans possess considerable health concerns in contrast to civilians, including smoking, heart disease, alcohol abuse, obesity, and diabetes, amongst others (Hoerster et.al, 2012). Therefore, it is necessary for veterans-based healthcare organizations to place a greater emphasis on improving the health behaviors of veterans through increased programmatic efforts and attention to this population and their specific healthcare needs (Hoerster et.al, 2012).In this study, it was noted that “Veterans and National Guard/Reserve members were more likely to have cardiovascular disease than civilians…Veterans were more likely than civilians to have received diagnoses of arthritis and cancer. Veterans were more likely than civilians to report a history of depressive and anxiety disorders and to report a history of depressive disorder than National Guard/Reserve members” (Hoerster et.al, 2012). Therefore, it is important to recognize the most prevalent health-related issues for veterans and the disparities that they face (Hoerster et.al, 2012). For veterans facing the risk of heart disease, it is necessary to address these concerns through a platform that is dependent upon generating statistics regarding this condition and its impact on care and treatment options.
Veterans who face disabilities often experience serious disparities that limit their quality of life and wellbeing (Littman et.al, 2012). In particular, veterans with disabilities often face disparities that are not experienced by other veterans, due in large part to significant physical and emotional challenges (Littman et.al, 2012). It is often difficult for veterans with disabilities to access healthcare services due to physical limitations, in addition to the complexities of their health histories (Littman et.al, 2012). To be specific, “Many Veterans with disabilities, particularly VA users, have complex health histories such as physical and mental health disorders and alcohol and/or substance abuse and misuse that may render them at increased risk of diseases” (Littman et.al, 2012, p. 340). Therefore, it is important to address some of these concerns and to take the steps that are necessary to positively influence the care and treatment of disabled veterans, which also include the diagnosis and proper treatment of heart disease (Littman et.al, 2012). Many veterans face compounding health concerns that require multiple streams of care, including the disabled; therefore, additional efforts must be made to better accommodate these individuals and their specific healthcare needs and expectations over time (Littman et.al, 2012).
Patients often develop perceptions of healthcare practice that are not always favorable or appropriate, given the circumstances surrounding their cultural beliefs and expectations (Komaric et.al, 2012). In this context, it is often difficult for some cultural groups to obtain routine access to basic and more advanced healthcare services for a number of reasons, thereby contributing to disparities in healthcare practices (Komaric et.al, 2012). For veterans, it appears to be particularly difficult to access healthcare services, even with insurance provisions, is not always feasible. In addition, healthcare services provided to veterans often appear to be less than adequate. Therefore, it is important to recognize the need for expanded service opportunities and quality of care provisions for veterans with basic healthcare needs. Also, veterans with heart disease and increased risks are not always likely to adhere to recommended guidelines to preserve heart health, such as diet and exercise, and are even less likely if their access to healthcare services is limited.
Lynch et.al (2011) address the importance of diabetes self-management for veterans and compared two distinct populations, rural and urban. In general, there is a lack of cohesiveness in education and self-care frameworks across all veteran populations, thereby necessitating additional guidance to achieve greater outcomes in diabetes self-care (Lynch et.al, 2011). It is important to develop improved educational opportunities for diabetic veterans across all population groups in order to reduce disparities and to improve treatment outcomes for this group (Lynch et.al, 2011). However, it is particularly important for rural veterans to obtain advanced diabetes education and self-management guidelines because they are more likely to be diagnosed with the disease (Lynch et.al, 2011). It is necessary to consider improvements in diabetes education and self-management for rural and urban veterans due to the problems and complications of this condition and its impact on this patient population (Lynch et.al, 2011). In a similar context, Ohl et.al (2010) addresses the challenges associated with HIV infection in rural veterans, who often receive limited care and experience greater mortality rates than urban veterans. In general, “Barriers to care facing rural persons with HIV may affect both entry into care and the intensity and quality of therapy once in care. Therefore, it is important to understand rural-urban variation in care entry, care use following entry, and outcomes for persons with HIV in the modern antiretroviral treatment era” (Ohl et.al, 2010). In this context, veterans with HIV face critical problems that are difficult to overcome without greater attention and support from veterans’ healthcare providers to improve outcomes for rural patients (Ohl et.al, 2010). This type of health disparity is particularly challenging due to the stigma that surrounds HIV across all settings (Ohl et.al, 2010). As a result, veterans face a particularly difficult uphill battle with HIV, and those in rural environments face the most daunting challenges (Ohl et.al, 2010). Similar circumstances are likely to occur for veterans with heart disease and access to care and treatment in a timely manner is essential.
Culture plays a significant role in healthcare practice. Therefore, it becomes necessary to address these challenges in the context of observation and effective communication in order to identify concerns and to move forward in supporting positive outcomes for these patients (Singleton and Krause, 2009). Existing strategies are not always successful in supporting sound and reasonable healthcare practices; therefore, nurses and other providers must understand how cultural and language barriers are important contributors to the challenges of modern healthcare practice (Singleton and Krause, 2009). These conditions require individual patients to be willing to embrace change and to learn how to effectively communicate with their healthcare providers by learning the primary language and influencing the response to care and treatment options in a favorable manner (Singleton and Krause, 2009). For patients who are also veterans, it is very important to address the issues that may contribute to improving health outcomes for these patients through expanded cultural awareness and understanding within VA clinics and in other organizations so that disparities are identified and potentially reduced within these areas. For veteran patients facing heart disease, it is particularly useful to develop strategic efforts that will minimize cultural barriers and limitations that could prevent some veterans from obtaining the type of care that they deserve.
Culturally competent care must be addressed as a possible opportunity to convey the importance of healthcare practice through interpreters, education that promotes cultural sensitivity, and other factors that contribute to greater health literacy within communities (Shaw et.al, 2008). The contributions made by culturally sensitive alternatives are instrumental in supporting greater acceptance and compliance with healthcare practice requirements to ensure that cultural norms are understood, while also demonstrating the importance of the chosen path of care and treatment (Shaw et.al, 2008). Veterans are from a variety of backgrounds, cultures, and speak many different languages; therefore, they must be able to express themselves and share their needs in a comfortable and engaging environment that is non-judgmental in nature.
When cultural barriers are strongly prevalent, basic healthcare services and treatment become more difficult to manage, and as a result, lead to limited support by patients in the areas of compliance and follow through (Shaw et.al, 2008). It is necessary to develop specific strategies for patients with heart disease because this condition may lead to high mortality rates under some conditions. It is important to demonstrate great concern for patients with heart disease in order to accomplish the desired behavioral outcomes that will lead to improved health and wellbeing. For veterans, the VA healthcare system provides ample opportunities to explore some of these disparities in healthcare practice and to consider the issues that are most common in the lives of veterans. The development of a culturally sensitive and aware knowledge base is likely to be an effective indicator of successful outcomes over the long term for veterans who otherwise would lack access to routine care and treatment in a given healthcare setting.
Similarly, the ability to successfully participate in common healthcare practices may be severely limited in some cases by cultural barriers and other concerns that may impact patient care and wellbeing (Lebrun and Dubay, 2010). When healthcare limitations exist, there is an increased risk of reduced success in care and treatment over a period of time, thereby creating even greater health concerns and disparities (Lebrun and Dubay, 2010). Through the identification of these barriers, it is likely that these individuals might obtain greater access to these services on a routine basis to ensure that their healthcare needs are met without delays and potential consequences to their health and wellbeing (Lebrun and Dubay, 2010). Veterans are a vulnerable population group that requires an astute level of attention to their healthcare needs in order to properly diagnose and treat these patients in an effective manner. Heart disease is a serious concern for many veterans and requires an astute level of attention and focus to reduce high risk behaviors which may contribute to heart disease, such as poor diet and lack of exercise.
There are a number of contributing factors associated with limitations and barriers in healthcare practice, including socioeconomic status and other related concerns (Marmot et.al, 2012). These conditions represent a series of challenges for healthcare providers in determining the nature of these barriers and how they limit the provision of care across many cultures and communities (Marmot et.al, 2012). It is suggested that healthcare practice must accomplish larger and more widespread objectives that will support the development of new practice methods and approaches to accommodate those patients within disadvantaged populations more effectively (Marmot et.al, 2012). These contributions must be accomplished without prejudice or discrimination so that the provision of healthcare services is achieved in the desired manner (Marmot et.al, 2012). Many veterans are vulnerable because of their socioeconomic status and often find it difficult to make ends meet. Their ability to access healthcare services is often limited under these conditions and they must be provided with guidance and a framework to access these services on a regular basis. If they have been previously diagnosed with heart disease, the lack of access to healthcare services may make the difference in quality of life and even mortality.
Cultural diversity is a unique component of society and the people that reside in communities. However, healthcare practice methods have often lagged behind in providing the level of understanding, care, and treatment that is required to reduce health disparities and limitations that often exist within these populations. It is important to identify the different challenges and expectations that have emerged in recent years as a means of supporting positive outcomes for patients. It is important for patients of all cultures to be provided with successful practice methods and a level of healthcare delivery that does not discriminate against different populations. Therefore, healthcare providers must work collaboratively in order to reduce these barriers and to demonstrate the importance of achieving positive outcomes in healthcare practice for all patients, regardless of their cultures, customs, or practices.
Veterans are in a vulnerable position in society because they are challenged on many different levels. Access to healthcare services is a daunting task which requires the knowledge and support of the healthcare sector, including the Veterans Administration healthcare system. It is important to consider the types of improvements that could be made in the creation of healthcare practice initiatives that will support positive outcomes for veterans who have difficulties in accessing high quality services. A greater focus on this population group must demonstrate the positive impact of patient care and wellbeing on this population in order to meet its needs in a successful manner and to reduce health disparities across a wide range of areas, including heart disease.
Alegria, M., Atkins, M., and Stelk, W. (2010). One size does not fit all: taking diversity, culture, and context seriously. Administrative Policy in Mental Health, 37(1-2), 48-60.
Bastian, L.A., Bosworth, H.B., and Yano, E.M. (2013). Setting the stage: research to inform interventions, practice and policy to improve women veterans’ health and health care. Journal of General Internal Medicine, 28(Suppl 2), 491-494.
Hoerster, K.D., Lehavot,K., Simpson,T., McFall, M., Reiber, G., and Nelson, K.L. (2012). Health and health behavior differences: U.S. military, veteran and civilian men. American Journal of Preventative Medicine, 43(5), 483-489.
Komaric, N., Bedford, S., and van Driel, M.L. (2012). Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds. BMC Health Services Research, 12, 1-14, retrieved from http://www.biomedcentral.com/content/pdf/1472-6963-12-322.pdf
Lebrun, L.A., and Dubay, L.C. (2010). Access to primary and preventative care among foreign-born adults in Canada and the United States. Health Services Research, 45 (6 pt 1), 1693-1719.
Littman, A.J., Koepsell, T.D., Forsberg, C.W., Haselkorn, J.K., and Boyko, E.J. (2012). Preventative services in veterans in relation to disability. Journal of Rehabilitation Research & Development, 49(3), 339-350.
Lynch, C.P., Strom, J.L., and Egede, L.E. (2011). Disparities in diabetes self-management and quality of care in rural versus urban veterans. Journal of Diabetes and Its Complications, 25(6), 387-392.
Marmot, M., Allen, J., Bell, R., Bloomer, E., and Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. Lancet, 380, 1011-1029.
Ohl, M., Tate, J., Duggal, M., Skanderson, M., Scotch, M., Kaboli, P., Vaughan-Serrazin, M., and Justice, A. (2010). Rural residence is associated with delayed care entry and increased mortality among veterans with human immunodeficiency virus infection. Medical Care,48(12), 1064-1070.
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Shaw, S.J., Huebner, C., Armin, J., Orzech, K., and Vivian, J. (2008). The role of culture in health literacy and chronic disease screening and management. Journal of Immigrant Minority Health, retrieved from http://anthropology.arizona.edu/sites/anthropology.arizona.edu/files/u3/Shaw%20et%20al_JIMH_new.pdf
Singleton, K., and Krause, EMS (2009). Understanding cultural and linguistic barriers to health literacy. The Online Journal of Issues in Nursing, 14, retrieved from http://www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/vol142009/no3sept09/cultural-and-linguistic-barriers-.html
Thomas, S.B., Quinn, S.C., and Garza, M.A. (2011). Toward a fourth generation of disparities research to achieve health equity. Annual Review of Public Health, 32, 399-416.
Tsai, J., Desai, M.S., Cheng, A.W., and Chang, J. (2013). The effects of race and other socioeconomic factors on health service use among American military veterans. Psychiatric Quarterly, DOI 10.1007/s11126-013-9268-0, retrieved from http://rd.springer.com/content/pdf/10.1007%2Fs11126-013-9268-0.pdf
Vimalananda, V.G., Miller, D.R., Palnati, M., Christiansen, C.L., and Fincke, B.G. (2011). Gender disparities in lipid-lowering therapy among veterans with diabetes. Women’s Health Issues, 21(Suppl 4), S176-S181.
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