Problem/Issue

Every person is in need of quality healthcare services for better outcomes. However, inequalities exist in terms of status of health and access to various healthcare services (O’Donnell et al., 2016). Such disparities reflect economic and social divisions in the society. In most cases, the inequalities affect people who are marginalized due to their gender, poverty, social values, race, ethnicity or discrimination (O’Donnell et al., 2016; Pega et al., 2017). These include racial or ethnic minorities, disabled, chronically ill, elderly, military veterans, mentally challenged, , drug users, refugees, immigrants, indigenous peoples, socio-economically disadvantaged persons, sex workers, and gay, lesbian, bisexual and transgendered (GLBT), (Pega et al., 2017; Baah et al., 2019). The marginalized groups experience elevated rates of disease as well as death. Many of the people who belong to these groups live with various chronic conditions, including diabetes, hypertension, heart disease, stroke, and certain types of cancer. They also get affected by mental health problems such as depression and anxiety.

Many of the marginalized groups live in poverty. As a result, they cannot afford health care insurance cover (O’Donnell et al., 2016). This means that they are not able to access quality healthcare services for their conditions. Some marginalized people live in very remote areas that are underserved by healthcare professionals and healthcare facilities (Pega et al., 2017). Under such circumstances, it becomes difficult to access even basic care.  Majority of the people who are part of the marginalized groups are illiterate (Pega et al., 2017). Due to this, they are not able to read and understand important health information. It is also important to note that some of the marginalized groups are discriminated by some healthcare providers (O’Donnell et al., 2016). For instance, GLBTs and those who have mental challenges are sometimes ignored.

Relationship between Findings, Topic and Intervention

Marginalized groups are in most cases affected by healthcare disparities as a result of the social disadvantaging that they are subjected to. Poverty, homelessness, language barrier, illiteracy, discrimination and other factors make it difficult for the groups to access quality healthcare services for their different conditions (Baah et al., 2019). As a result, they contribute to the highest rates of morbidity, hospitalization, and mortality (O’Donnell et al., 2016; Pega et al., 2017). Although recent advancements in the treatment and diagnosis of chronic diseases have led to improved disease control and prevention, marginalized groups continue to receive care services of low or poor quality. The situation calls for a sustainable intervention that can help to effectively address the issue of high prevalence of disease among the groups. This can lead to improved patient outcomes among the marginalized people.

The diseases affecting the marginalized groups can be effectively prevented and controlled through an initiative that aims at promoting an equitable health system. For this to be achieved, there is need to put in place effective healthcare policies (Ward et al., 2018). These include policies that target vulnerable groups in the society. For instance, health financing policies should be scrutinized for the purpose of ensuring that they support the idea of equitable access to various health services (Ward et al., 2018). This can enable the marginalized persons and undeserved people to access care. It is also important to quantify health disparities that occur within the health care system (Mitchell, 2013; Titler et al., 2016 ). This can help to ensure that their root cause is effectively understood. Moreover, the vulnerable groups need to be engaged since the proposed change will directly affect them (Institute for Healthcare Improvement, 2021). This is achievable through empowerment of the groups in order for them to have a voice in the process of making decisions.

Objectives  

The current capstone change project derived from the following objectives:

(i.) To ensure that there is a comprehensive change initiative.

Change that involves promoting the health of marginalized groups in the society is not a simple process. It is rather a comprehensive process that requires professional expertise and support in order for the projected outcomes to be achieved.

(ii.) To determine the implementation of evidence-based practice in nursing practice.

Working on the improvement of the health of marginalized groups is part of nursing practice. There is need to ensure that the knowledge and skills acquired by nurses through research work are effectively incorporated into such an important change initiative

(iii.) To ensure interprofessional collaboration in provision of care services.

Like other healthcare professions, nursing is changing rapidly. Nurses are increasingly finding it necessary to collaborate with other healthcare professionals in order to provide quality healthcare services to patients for the achievement of better or positive treatment outcomes.

(iv.) To determine the role of nursing leadership in promoting healthcare change.

Nursing is one of the healthcare professions that give one a chance to demonstrate effective leadership skills. A nurse can demonstrate such skills by initiating a change that is aimed at improving the health outcome of various marginalized groups that are affected by health disparities.

(v.) To examine the impact of organizational factors on nursing practice.

Any effective change should have the support of the organization in which is it implemented. Therefore, the success of the change whose goal is to enhance the health of marginalized people depends on the kind of support it receives from the entire health care system.

Rationale

The proposed project and its objectives play an important role in advocating for the autonomy and social justice for both individuals and diverse groups. In this case, the project is concerned with marginalized populations. Populations in such groups can be treated either as individuals or group members.  In terms of promoting social justice, the proposed project can help to ensure that the marginalized people access quality healthcare services for their different health problems (Mitchell, 2013; Ward et al., 2018). This is necessary for realization of better patient outcomes. Provision of quality services to these groups is the best way of ensuring equity in the distribution of healthcare services to diverse groups in the society. It helps to reduce discrimination and other forms of social injustice that interfere with the provision of healthcare services in the society.

In terms of promoting autonomy, the change project can empower the marginalized groups by ensuring that they access various healthcare services. Putting in place effective policy changes can help to ensure that the areas inhabited by these people have enough healthcare facilities as well as healthcare workers (Ward et al., 2018). This will in turn enable them to access a wide variety of care services. Another way through which marginalized communities can be empowered is by ensuring that they access health information (Institute for Healthcare Improvement, 2021). Getting relevant information about various aspects of health is of great importance to these groups. it can enable them to make informed health decisions that can have a positive impact on their health outcomes and well being.

References:

Baah, F. O., Teitelman, A. M., & Riegel, B. (2019). Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health – An integrative review. Nurs Inq., 26 (1): e12268. doi: 10.1111/nin.12268.

Institute for Healthcare Improvement. (2021). Science of Improvement: Testing Changes. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nurs Manag (Harrow), 20 (1): 32-37.  doi: 10.7748/nm2013.04.20.1.32.e1013

O’Donnell, P., Tierney, E., O’Carroll, A., Nurse, D., & MacFarlane, A. (2016). Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. Int J Equity Health, 15 (197). https://doi.org/10.1186/s12939-016-0487-5

Pega, F., Valentine, N. B., Rasanathan, K., Hosseinpoor, A. R., Torgersen, T. P., Ramanathan, V., Posayanonda, T., Röbbel, N., Kalboussi, Y., Rehkopf, D. H., Dora, C., Montesinos, E., & Neira, M. P. (2017). The need to monitor actions on the social determinants of health. Bulletin of the World Health Organization, 95 (11), 784–787. https://doi.org/10.2471/BLT.16.184622

Titler, M. G., Conlon, P., Reynolds, M. A., Ripley, R., Tsodikov, A., Wilson, D. S., & Montie, M. (2016). The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S. Appl Nurs Res, 31:52-9. doi: 10.1016/j.apnr.2015.12.004

Ward, M., Schulz, A. J., Israel, B. A., Rice, K., Martenies, S. E., & Markarian, E. (2018). A conceptual framework for evaluating health equity promotion within community-based participatory research partnerships. Evaluation and Program Planning, 70: 25-34. https://doi.org/10.1016/j.evalprogplan.2018.04.014