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8/17/2019 A2-ashlynsfeedback

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Assignment Two !

How are Our Healthcare Providers Affected by the Various Characteristics of

Discrimination?

Samantha Sealey


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Assignment Two #

Introduction

I am sure you have been to a hospital, doctor’s office, an outpatient clinic, or

some place to seek medical attention at some point in your life. When you visited at least

one these places I’m sure you noticed that not all of the medical providers were of the

same race, gender, or ethnicity as you. Sitting there, observing this, have you ever once

thought or felt that the quality of your medical care would be any different because of

those factors or others? What if you are seen by a physician assistant or nurse practitioner

rather than a doctor? Would these discriminative factors of our healthcare providers make

you think less of them or assume they were not qualified enough to do their job?

As we go through our everyday lives, we never really realize the importance of

our healthcare or the problems that go on with it. Our healthcare field is surrounded by

numerous of doctors, nurse practitioners, physician assistants, and registered nurses that

are in various specialties; these occupations are also known as our healthcare providers.

As a society, we also generally do not understand the complexity of our healthcare

providers and how each differs or relates to one another. A nurse practitioner and

physician assistant both work underneath a doctor which arouses some patient skepticism

of their work and intelligence. This is one of the many factors that are discriminated upon

to our healthcare providers. Other factors may include ethnicity, gender, race, spoken

language, visual appearance, etc. Throughout this paper I will be researching patient

skepticism and how they discriminate upon our healthcare providers.

Before progressing further into this paper it is necessary that I state my

relationship to this topic I have chosen to research and I should also include any biases

that I may have with it as well. This topic does have a significant importance to me

Comment [SS1]: Flip the last and third paragraphs

right now, your intro ends with your bias and leave

the reader hanging as to your "thesis." I know you

thesis is embedded in the third paragraph, but we

need to see that as kind of a conclusion to theintroduction.


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Assignment Two $

because I am wanting to eventually pursue a career in the health field, specifically a

Physician Assistant. With this being such a personal interest could also bias my research

of the other healthcare providers. I grew up being introduced to the medical field when I

was young. With my mother being Registered Nurse, at times she would allow me to tag

along with her at work and I enjoyed every minute of it. Seeing what she did at work and

helping people in ways others could not really inspired me. Looking up to her motivated

me to eventually become a Physician Assistant. For a couple of my sources used in my

inquiry, I included an interview with Wendy Wrenn, RN and an observation of Amy

Berry, PA. This is where another bias could step in. Wendy Wrenn, RN is my mother and

Amy Berry, PA is my godmother; my connections with these people is what could also

bias my research. With my research involving patients and people’s opinions of their

healthcare providers and discriminations upon them could cause some readers to believe I

have written in favor of my chosen career path rather than proportionately to the

occupations discussed.

The focus for my research will involve gathering opinions from people inside and

outside of medical facilities. Reasons why I plan to gather opinions from random people

outside of a medical facility is to discover if prejudice acts and judgments are still made

upon society to our medical professionals than just patients. This research I am interested

in conducting is in seeing how patients in various medical treatment situations respond to

the health care providers treating them. The average person may not think a topic like this

is important but as you continue to read, you will learn the similarities and differences of

our healthcare providers and how people judge them whether their inside or outside of a

medical facility from the study .

Comment [SS2]: The third paragraph of your intro, mention that you are trying to determine "if prejud

or judgement acts upon society...", and I think you

need to rephrase your proposed focus a bit. Ther

no question that every person makes judgements

in and day out about the people that are around th

and these not necessarily prejudicial

judgements. Example: I often have to determine o"judge" whether a student is truthful in submitting that is his/hers and not someone else's, but this

doesn't necessarily mean that I am being

prejudiced. What I would recommend you revise t

statement/focus to is something like "I am interest

seeing how patients in various medical treatment

situations respond to the practitioners treating

them. How are patients making certain judgemen

that may affect how they take the practitioner's adwhether or not they receive follow up care, etc."


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Literature Review

In today’s society, we depend on healthcare for various reasons. Whether we are

getting a cold, yearly check ups, prescription refills, emergency needs, etc. We always go

to some type of clinic or hospital to find answers to resolve our medical problem. In order

to receive these answers, we must rely on a doctor, physician assistant, nurse practitioner

or a nurse’s decision of diagnoses. With such a developing field, there are also a diversity

of races, ethnicities, religions, genders, spoken languages, body appearances, etc. All of

the factors can play a role with each other in the opinion of patients and people. There are

going to be people who are would rather been seen by a doctor as their healthcare

provider versus a nurse practitioner or a physician assistant; and they’re are some who

simply do not have a preference. Also, there are going to be patients or people who are

going to questions one’s ability and qualities of their profession because they are a

difference race, ethnicity, gender, religion, etc as themselves.

Majority of the time when we go to the clinic, we normally are seen by a nurse

first then a doctor or sometimes a physician assistant or nurse practitioner. The

expectation is that the substitution of PAs or NPs will reduce costs and doctor's workload

while maintaining quality of care (Van Vught, Hettinga, Denessen, Gerhardus,

Bouwmans, Van Den Brink, & Postma 2015). This is one of the many important factors

of a physician assistant and nurse practitioner. They are both very qualified professionals

that not only help increase the quality of care of patients but to help doctors. With the

idea of substituting a doctor is the thought that inclines people have judgments of

distrusting PA’s and NP’s.

Comment [SS3]: Great work overall summarizing y

sources, BUT there needs to be some

restructuring/adding of paragraphs throughout the

review.

Comment [SS4]: There needs to be some sort of b

introduction to the literature review. Tell your read

what the main topics are for the lit review and whayou intend to provide background on. For examp

intro could start something like this, "Before analysome of the potential biases patients can have

concerning their healthcare providers, it is necessa

to trace the where this conversation is being. In s

we need to understand some basic key principles

(and then list the main topic themes that you havedivided up your source materials by).


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Assignment Two &

A physician assistant and nurse practitioner are similar but are also different. Both

occupations require a master’s degree but while in school, a nurse practitioner is allowed

to alter his or her clinical experiences to their chosen specialty while a physician assistant

just requires a clinical rotation through all specialties without a chosen specialty (Freda

2000). This is also a factor that could cause people not to want to substitute a doctor. If

people choose to believe a PA or NP aren’t as specialized as a doctor, then they choose

not to trust their judgments. This is one reason why we need to teach society the

importance of a physician assistant or nurse practitioner and how significantly qualified

they are to make medical decisions with or without a doctor. These occupations are very

helpful in our healthcare field. From observing a physician assistant, I learned what they

do during the day. Physician assistants normally work with doctors and have patients like

they do. They also refill prescriptions, diagnose patients, provide care and can receive

help from their supervising doctor if need be (Berry 2016).

This is where a physician assistant and nurse practitioner can begin to differ. A

nurse practitioner is an academically advanced and experienced registered nurse and is

not required to work under a doctor like a PA but they are allowed to (Cresswell 2013).

Thus, nurse practitioner programs are based off of a nursing foundation, which makes

them similar to a registered nurse in certain ways. Each of these occupations strive to

ensure better patient outcomes, as so do other medical professions.

A registered nurse is only a two year accredited nursing program (Wrenn, 2016).

Registered nurses only require two years of nursing school because they are not of a

higher level like the other careers mentioned. Since registered nurses are at a lower level,

they aren’t allowed to diagnose their patients but they are skilled to check vitals, fill out

Comment [SS5]: Right after (Berry 16), the sentenc

that starts with "This is where PA and nurse

practitioner begin to differ" represents a slight shif

subject--you need to start a new paragraph here.


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Assignment Two '

lab requests, calling in prescriptions, and helping assist doctors (Wrenn, 2016). A nurse

practitioner and physician assistant can both be under the supervision of a doctor, which

can make them seem skeptical to their patients. Some might think since they do not have

the label of a doctor could mean they do not have enough experience or education,

especially if the person has no clue what a PA or NP is.

A physician/doctor obviously has the most education out of all of these

professions. In order to become a doctor one must earn their doctorate degree, go through

several years of residency, and take their board exams. This is what allows them to be at

the top because they have more education and experience. This is the main reason for

patient skepticism with healthcare providers. Further more, could there be other factors

that play a role besides their education and experience? On average, a nurse practitioner

or physician assistant will spend about 12 minutes face to face with there patient which is

more than the averaged 7.5 minutes from the doctor, they also spend more time

diagnosing and filling out prescriptions (Venning, Durie, Roland, Roberts, & Leese

2000). Although patients tend to prefer a doc tor, they often do not know that PA’s and

NP’s spend more one on one time with their patients than a doctor. This is one major

characteristic in receiving positive patient outcomes.

It is likely for healthcare providers to gain trust if they spend more attentive time

with their patient. This will also lead to less confusion with patient diagnosis and

treatment, which indicates positive feedback. Patient treatment is a very important quality

in healthcare. How and what the patient are treated with is very important among their

diagnosis. For instance, a registered nurse could have a patient with specific symptoms of

a sickness. The RN is allowed to make assumptions but are not allowed to diagnose them;


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Assignment Two (

this is what a doctor, physician assistant, and nurse practitioner is for. The RN could then

send their patient to some type of medical practice where he or she would be seen by one

of those three medical professionals. If this scenario had gone different, the patient’s

treatment outcome could have been greatly affected. This is one reason why all

healthcare affiliations provide greater quality monitoring (Madison 2004).

Another factor that plays a role in patient skepticism is discrimination. We as

people tend to discriminate people in unmannerly ways. For instance, some patients tend

to discriminate against a healthcare providers race or ethnicity assuming he or she is not

as intelligent as their race, gender, or ethnicity. This tends to be more seen in hospital

settings. Many spoken languages from different cultures surround our healthcare field;

this allows us to have access to people with multiple linguistic abilities. Even though

patients tend to judge a book by its cover at times, these linguistic aspects of cultural

competence have been associated to decreases in racial/ethnic disparities in health and

health care (Johnson 2004). These negative stereotypes and discriminations are deeply

embedded in the culture and institutions of our society (Williams & Mohammed 2008).

Any cultures will more than likely continue to discriminate on others for several decades

because; societies seem to have a natural instinct to judge others. All of these

characteristics of skepticism definitely affect patient gratification. The development of

positive ethical conditions is important to the evolution of quality work environments and

quality patient outcomes (Pauly, Varcoe, & Storch 2009). Whether or not a patient would

be more satisfied with being treated from a doctor versus a nurse practitioner or physician

assistant, their providers race, gender, ethnicity, religion, should not be of any concern

unless it affects their medical tendencies in a negative way.

Comment [SS6]: I'm noticing 3 themes that your

sources fall in to: qualifications for PA, nurse

practitioner, RN, and doc, "who" can do what, and

patient skepticism. I want you to go back and

organize your sources into three distinct paragrap

according to these themes, and what you can do

add these themes to lit review intro where you idethe key issues associated with your topic.


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Assignment Two )

Entering the Conversation

Over the past several decades, our healthcare field has seemingly grown in the

amount of people that are becoming physician assistants and nurse practitioners over a

doctor. Even though they are highly qualified healthcare providers, patients seem to

believe that since they do not have as much experience or education as a doctor, there are

not as intellectual as a doctor. Although a doctor does have more education and

experience, a physician assistant and nurse practitioner are both qualified to diagnose,

prescribe medications, perform minor operations, etc. People also tend to discriminate

against their healthcare providers or nurses age, body appearance, ethnicity, hygiene,

gender, race, religion, spoken language etc. What factors do patients tend to discriminate

on more than others? Do patients judge their health provider’s label more or less than

discriminating their qualities? I would like to propose a study to determine if consumers

would prefer a doctor over a physician assistant or nurse practitioner. I would also

determine if this Also to determine if consumers discriminate and what factors they

discriminate on more than others.

This study will be conducted in three different settings in order to receive

opinionated answers to these questions. These different settings will be various hospitals,

outpatient clinics, and random people outside of the other two settings. In order to gather

answers, interviews must be taken place. There will be 12 different interviewers, four in

the hospital, four in the outpatient clinic, and four in the city outside of the clinic and

hospital. Since we are asking two different questions in this study, two of the four

interviewers in each group will be asking about their opinion on having a physician

Comment [SS7]: In your ETC, I want to know why i

that? How do you know that patients tend to

discriminate based on these criteria? Is this from

source? I would recommend citing a source here

Comment [SS8]: You seem to work very hard in the

ETC to not use "I" which is sometimes awkward.

instance, when you say "A study should beconducted" instead say something like "I would lik

propose a study that does x, y, and z."


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Assignment Two *

assistant or nurse practitioner as their healthcare provider and the other two interviewers

will be asking about what they tend to discriminate on with their healthcare provider or

nurse. While we are trying to find these answers, the interviewers will be dressed very

professionally but they will be of various races, genders, ethnicities, body appearance,

etc. since we are asking discriminative questions. Reasons to split the four interviewers

into two groups and have different settings is to avoid biased answers and to receive

different opinionated answers. More specifically:

• Each subgroup of two interviewers in the same four-interviewer group must be

man and woman; therefore, there will be a total of six women and six men

interviewing consumers. This is being done to keep track of different facial

expressions to the questions.

• Each group of four interviewers has two subgroups of two interviewers. One

subgroup will be asking the Interview Questions A (see questions bulleted below)

about their opinion on having a physician assistant or nurse practitioner as their

healthcare provider versus a doctor and the other subgroup will be asking

Interview Questions B (see questions bulleted below)about the discrimination of

healthcare providers and nurses.

• All of the patients being interviewed must be ages 18 and up because younger

patients may not understand the questions or why they’re be interviewed. Two

interviewers must ask 50 random patient Interview Questions A and the other two

must ask 50 random patients/people Interview Questions B as well but they

cannot be the same person asked for Interview Questions A.

Comment [SS9]: When you first mention "Interview

Questions A" and "Interview Questions B" put in

parenthesis "See questions below" or some other

similar note referring to the questions.


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• The four interviewers inside the outpatient clinic will be interviewing random

patients that is either waiting in line or leaving the clinic from their appointment.

Two interviewers asking 50 random patients Interview Questions A will be at a

different outpatient clinic than the other two who are asking 50 random patients

Interview Questions B. This is being done so we can have a variety of people and

not asking one person two sets of questions.

• The four interviewers inside the hospital will be interviewing random patients that

are just in the general care unit. Two interviewers asking Interview Questions A

will be asking 50 random patients and the other two interviewers asking Interview

Questions will be asking 50 random patients as well but they must be different

from the patients than the ones asked for Interview Questions A.

• Lastly, the other four interviewers will be going to other places in the same

county as the clinic and hospital to interview 50 random people Interview

Questions A and 50 random people Interview Questions B that are not currently

being patients inside a facility.

Also, people are going feel very strong about their opinion and some are going to care

but not feel strong on their opinion. When a patient or person states their judgment,

the interviewer cannot change their facial expression or states their opinion. This

could create tension between the interviewer and the applicant. As for the healthcare

provider being discriminated upon should make their statement on how qualified and

determined they are before their patient decides if they want a new provider or not.

Interview questions A:


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Assignment Two !#

2. If your healthcare provider were of a different gender, would you feel like you are

treated with the same level of care as a provider of the same gender as you?

3. If your healthcare provider were apart different religion, would you feel like you are

treated with the same level of care as a provider of your religion?

4. If your healthcare provider had a difference appearance than you, for example is

covered in tattoos and looks different than any other provider you’ve had before,

would you feel like you were treated with equal level of care?

5. If you answered yes to any of these questions, could you explain why you would

discriminate that factor with their level of intelligence and providing equal care?

After conducting all of these interviews we now compare the results of each

question in each category. First, we will divide the answers to the questions according to

setting where they we interviewed. Next, we will categorize the answers for each

question into sections with the same answers. Then, we will calculate the same answers

in each question and divide that number by the total number of people who answered that

question. Doing this will give us the percentages for each question according to setting.

Lastly, before calculating the percentages, separate the patients interviewed by category

with their age. Dividing the answers according to the interviewee’s age will determine if

the ages of the patients affect how they respond to their healthcare professionals in

various medical treatment situations. Once the percentages for all of the answers are

found, you can then compare the answers to one another. From this, you can discover the

percentages of which discriminating factor is used more than others. You can also

determine the percentages of how many people prefer a doctor, nurse practitioner, or

physician assistant, or if they simply do not have a preference. Calculating all of these

Comment [SS10]: I still don't know HOW you are

analyzing the data, and what you are doing with th

data. How do you calculate the percentages? An

how will you use the answers that you have found

Will you create a presentation? Will this be a trainmodule that healthcare professionals could take to

help with them with patient care? Addressing the

questions as a part of the analysis is key.


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Assignment Two !$

differences will develop a reasoning as to why people discriminate on certain factors, and

why people tend to trust the label of a nurse practitioner or physician assistant less than a

doctor. Once these calculations are finished, a module could be created in various

languages. This module could be kept with the medical professionals to have when the

time is needed, will be at any medical facility for the public, and will be available online

for the public to access.

Conclusion

Throughout this paper, I have researched the similarities and differences of our

our healthcare providers they are discriminated upon. These discriminative factors

include diversity of races, ethnicities, religions, genders, spoken languages, body

appearances, etc. All of the factors can play a role with each other in the opinion of

patients and people. I also researched if patients tend to prefer a doctor versus a nurse

practitioner or physician assistant.

I discovered that there are going to be people who are would rather been seen by

a doctor as their healthcare provider versus a nurse practitioner or a physician assistant;

and they’re are some who simply do not have a preference. The results I found for

Interview Questions A, the amount of people who had no preference in their healthcare

provider and the amount who preferred a doctor were fairly even. I also discovered that

younger generations are more likely to not have a preference where as older generations

were more likely to feel more skeptical of having a nurse practitioner or physician

assistant. As for the results from Interview Questions B, I found that patients are more

likely to judge their healthcare provider’s quality and intelligence if he or she is not fluent

Comment [SS11]: I don't really see how the study

matters in the conclusion. It certainly DOES matte

but I don't see this connection made in the conclu

yet. Right now, the first paragraph reads similar to

your introduction, and I think you really need to m

case for why this research DOES matter.


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Assignment Two !%

in English as their spoken language regardless of their race. This was seen more in the

older generation. The younger generations were not far behind them but, they were more

likely to trust their judgments even if they were not fluent in English. This was the

number one discriminative factor I found at all locations (outpatient care, hospital, and

city). The factor that was discriminated the least was gender. Out of all the locations and

generations interviewed, gender was only mentioned a few times as a factor they

discriminated on.

This research conducted is really important to release to our society. It could be a

major role in leading our society to decrease or stop these prejudice acts within our

healthcare field. It is important for our public to have easy access to this module rather

than having it just at one place. They will be available online, in medical facilities, and all

healthcare providers will have to carry it with them at all times when doing their job. This

way anyone can learn about the results and know why it is important to stop prejudice

acts to our healthcare providers. Our patient’s who do make these verdicts may come to

realize that they their prejudgment remarks to their healthcare provider treating them are

redundant.

There will always be research involving patient skepticism with medical

professionals and treatment. Further research I would like to propose is if patient

skepticism affects the performance of our healthcare providers. Let’s say if a patient

refuses treatment from a physician assistant because he/she wants to be seen by a doctor,

would this affect the PA’s performance in a negative way at work? Another question I

would like to propose is how can our society’s knowledge of healthcare and medical

professionals be improved so that patent skepticism will decrease? A way I have thought


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Assignment Two !&

to conclude this is for everyone in high school and college to take a mandatory course

about healthcare, medical professionals, and ethics that revolve around them. This could

possibly improve our society’s knowledge involving healthcare. The medical field is full

of new opportunities and new technologies and I hope that there will be continuous

research involving the topics I have mentioned.


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Assignment Two !'

References

Berry, A., PA. (2016, February 5). Observing Amy Berry, PA [Personal observation].

Cresswell, S. (2013, December 23). What's The Difference Between a Physician

Assistant and A Nurse Practitioner and What Should You Choose?

Freda, C. E. (2000). Nurse practitioner versus physician assistant. Nephrology Nursing

Journal , 27 (2), 26.

Johnson, R. L., PA. (2004, February 27). Racial and Ethnic Differences in Patient

Perceptions of Bias and Cultural Competence in Health Care.

Madison, K. (2004, April 1). Hospital-Physician Affiliations and Patient Treatments,

Expenditures, and Outcomes. Health Services Research, 39, 2, 257-278.

Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009, September). Registered Nurses'

Perceptions of Moral Distress and Ethical Climate.

Van Vught, A., Hettinga, A., Denessen, E., Gerhardus, M., Bouwmans, G., Van Den

Brink, G., & Postma, C. (2015, September 17). Analysis of the level of general

clinical skills of physician assistant students using an objective structured clinical

examination. Journal of Evaluation in Clinical Practice, 21(5), 971-975.

Venning, P., Durie, A., Roland, M., Roberts, C., & Leese, B. (2000, April 15).

Randomized controlled trial comparing cost effectiveness of general practitioners

and nurse practitioners in primary care.

Williams, D. R., & Mohammed, S. A. (2008). Journal of Behavioral Medicine.

Discrimination and Racial Disparities in Health: Evidence and Needed Research,

32(1), 20-47.

Wrenn, W. (2016, February 9). Interviewing a Registered Nurse [E-mail interview].

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