Each of you take out a sheet of paper. On the top of the sheet of paper write which side of the debate at this point you would support, the pro side: healthcare and nursing in the United States must provide medical services to all people no matter their citizenship through whatever means available or the con side: as U.S. citizens and healthcare workers, we have an obligation to implement financial regulations within our system to limit free care in order to stop the rising healthcare cost for those contributing to the tax system. Do these 5 critical concepts contribute to your decision? As the debate is presented, instead of agreeing with the initial side you have written, jot down thought, ideas or references to argue the opposite of what you have written. This is the objectives:
The US Department of Homeland Security (2011) published a derived estimate of over 10 million illegal aliens residing in the United States. These individuals are not eligible for citizenship or federal or state benefits, but are not always denied local educational and public health clinics and hospital services for their families with proof of residency. They may “borrow “ social security cards in order to obtain employment and thus subsidize federal and state programs and others' benefits.
http://www.irs.gov/businesses/small/international/article/0,,id=129236,00.htmlImmigration stats from department of Homeland Security as derived numbersCurrent annual legal immigration quotas are 226,000 family based and 140,000 employment based slots, 55,000 green card lottery winners, 90,000 refugees ( ½ European, need financial sponsor), 10,000 special status. These are Lawful Permanent Residents( LPR), hold a green card and a social security number and pay state, federal income and social security taxes. Immediate family members who travel to the US together may also be granted LPR status, thus increasing the effective annual legal immigration quotas to approximately 1 million per year. The estimated total LPR living in the United States were 12.6 million in January, 2010. They are not eligible for federal benefits such as Medicare and Social Security retirement and disability benefits. The process toward citizenship is variable and may be lengthy. These families work legally, and if well-employed may hold work-related health insurance benefits and are eligible for public health and educational services in most states.The US Department of Homeland Security (2011) published a derived estimate of over 10 million illegal aliens residing in the United States. These individuals are not eligible for citizenship or federal or state benefits, but are not always denied local educational and public health clinics and hospital services for their families with proof of residency. They may “borrow “ social security cards in order to obtain employment and thus subsidize federal and state programs and others' benefits.
What is your role as a nurse? Who must you treat? How must you treat them? These are some of the questions you should ask yourself as a professional and a person. Some topics as a nurse are difficult to address. There are times when you may feel a heavy burden with employer demands, patient demands, and societal demands of you and it is easy to become cynical and hard. But in order to maintain the professionalism of nursing, not reverting back to the days that nurses were not afforded an education, only training as a trade, we must analyze our role in our society. We must know why we do what we do and remember to practice an art of diminishing human suffering. Self reflection and realizing your stance in the healthcare system should be a part of your professional career.
Ael 667 group project 2
Immigration in the United StatesHEALTHCARE Immigration is one of the factors involved in the debate of reform:IMMIGRATION AND Are we the people too crowded to respond generously to non-citizens? Today we want to take the debate into our classroom for discussion with this critical debate question: SHOULD HEALTHCARE BE DENIED or PROVIDED FOR THE NON-CITIZEN RESIDENTS OF THE U.S.?
PRO CON Our national identity of generosity to The reality of radical inequality of those less fortunate; human kindness healthcare costs and access for U.S. , national philosophy “Give me your citizens---basic healthcare is not even a tired, your poor” right of citizenship Prevention of public health issues and The recent economic crisis has strained costs of disease from lack of taxpayers who are contributing the immunizations and safe, healthy most to support healthcare costs housing for thousands of residents who through high taxes and health are not eligible in some states insurance premiums Retail tax income from Lack of income tax and business taxes healthy, motivated employees to support health services directly for Increased healthy labor pool as illegal residents essential for some businesses to thrive Flood the country with immigrants To deny healthcare to immigrants needing healthcare displays racism and classism The national debt and obligation to Structural Violence through bringing protect those already here immigrants in to work the fields and A breech in national security work in nursing, but denying help to others
•To learn about immigration laws and healthcare cost•To better understand how social, political and structural systemsaffect healthcare systems•To learn how to engage in both sides of a debate and discoverevidence for your own nursing practice•To develop a true sense of holistic care•To address your own thoughts and feelings aboutracism, classism, structural violence, nationalism and silence andhow these pertain to your role as a nurse
5 Critical Concepts: Take out a sheet of paper. WriteNationalism Classism which side of the debate at this point you would Structural support. Silence Violence Do these 5 critical concepts Racism contribute to your decision?
Most legal immigration is classified into six immigration categories: • Immediate Relatives • Family-Based • Employment-Based • Refugees • Asylees • Lottery Admissions
Illegal Aliens:An individual who is not a U.S. citizen or U.S.national and resides in the U. S. without legalstatusLawful Permanent Resident (LPR):An immigrant who has been grantedapproval to reside and work in the U. S.without restrictions
Estimated at ~ 11 Millionabout 27 % increase in past decadeOf all unauthorized immigrantsliving in theUnited States in 2010,39 % entered in 2000or later, and 62 %were from Mexico.
Immigrant (LawfulPermanent Resident) ~ 12Million with immediatefamily members alsoeligible, ¾ are eligible fornaturalization process. Theprocess toward citizenship isvariable and may belengthy.These families worklegally, have a “green card”and if well-employed mayhold work-related healthinsurance benefits.Regardless of employmentthey are eligible for publichealth and educationalservices. Lawful Immigration Annual Quotas include 226,000 family-based, 140,000 employment-based, 90,000 refugee, and 10,000 special status for a total expected lawful immigration of about 1 million per year
The article we read by Holmes points out thedisparities between race, class and social positionin provision of healthcare. Facts that stand out: • Latino children have twice the death and hospitalization rates from pedestrian injury than do white children in the U.S. • Latino adults have lower rates of preventive medicine screening. • Latino immigrants face medical deportation on a daily basis by clinicians and healthcare workers who deem them as unworthy of assistance. (Holmes, 2006).
Formal Letter of Complaint Connections betweenDear Sir: public health policies and the development of long-Due to the difficult circumstanceswe find ourselves in this foreigncountry, we look to you asking forhelp in this case. We are enclosing acopy of the severe law that therailroad line has imposed on us lasting representations ofMexicans who work on the track,which we do not see as a just thing,but only offensive and humiliating. Mexicans as diseaseWhen we crossed the border into thiscountry, the health inspector carriers are demonstrated by the response to a 1916inspected us. If the railroad lineneeds or wants to take suchprecautions it is not necessary that typhus outbreak in Losthey treat us in this manner. For this,they would need health inspectorswho assisted every individual withmedical care and give us 2 rooms tolive, one to sleep in and one to cookin, and also to pay a fair wage to Angeles County.obtain a change of clothes and abar of soap. This wage they set is notenough for the nourishment of one The disease spread fromperson. Health comes from this andthese precautions are the basis for person to person, spurring the creation of localachieving sanitation. Health wehave. What we need is liberty andthe opportunity to achieve it. We policies derived from theneed a bathroom in each section ofcamp and that the toilets that arenow next to the sleeping quarters bemoved. Many times their bad smellhas prevented us from even eatingour simple meal. Furthermore, we premise that all Mexicanscan disclose many other detailswhich compromise our good healthand personal hygiene With no spread diseasefurther ado, we remain yours,graciously and devotedly, your (Molina, 2011). Medical deportationsattentive and faithful servants. Wethank you in advance for what youmay be able to do for us.Felipe Vaiz,José Martinez, FelipeMartinez, Adolfo Robles, were not uncommon.Alejandro Gómez, AlbertoEsquivel.
• Labor migration is a significant phenomenon throughout the world, from the most vulnerable illegals through the most educated STEM professionals (Farmer, 2005; http://www.nam.org/Issues/Employment-and- Labor/Workforce.aspx, 2011)• Mexico’s minimum wage is a little over $4.00 per day. (Minimumwage.com/international)• Agribusiness and manufacturing have long used immigrant labor to reduce costs and increase cooperation of employees when U.S. workers were not willing to tolerate minimum wage for hard labor without health insurance or other benefits.• U. S. businesses have legally relocated a portion of these jobs in other countries through NAFTA (Farmer, 2005, Loewen, 2007 ).• Some jobs have been taken to the other countries through NAFTA (http://www.nam.org/Issues/Employment-and- Labor/Workforce.aspx ).
What is the regulatory meaning and description of immigration in the U.S? What is the historical healthcare experience of immigrants, both legal and illegal, in the U.S.? What is the best role of the nursing profession in serving the immigrant population?
Inequalities in Global Market: The nursing shortage of the 2000’s caused hospitals to recruit foreign nurses as a means to provide fill the gap in trained professional nurses Hospitals employed companies to go to developing countries and seek out nurses to come to the US by offering them wages that sounded great but were actually much less than American born nurses were making. Foreign nurses are recruited from poor developing countries depleting their healthcare labor force
Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the U.K. and the US. Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labor. This tendency is currently exacerbated by nursing shortages in developed countries (Ross, Polsky & Sochalsky, 2005). Countries that provide most nurses are highly populated poorer nations (Ross et al, 2005).
Overcoming language barriers Dealing with discrimination Adopting U.S. nursing practices Adjusting to U.S. social customs Becoming accustomed to U.S. culture Reconciling work ethics. (Lin, 2009)
Is it ethical to entice nurses from poorer countries to come to developed countries to practice nursing? What produces the most tension in the debate of issues of immigration ?
Why do immigrants fail to seekhealth services on a regular basis?1. Social Barriers › a. lack of social support › b. limited English proficiency › c. immigration status › d. fear2. Health Care Delivery Barriers › a. financial cost › b. lack of child care › c. lack of transportation › d. lack of time
› Immigrants use the language of silence to express themselves.› Parin Dossa (2003) tells us that silence does not rule out speech. She tells us that much can be "said" through the silent gaps between words.› In her Migratory Tale of Social Suffering and Witnessing, Dossa shows how Zahra uses the silent language of the body (her symptoms) to tell her story.› Witnessing makes it necessary for us to listen to the language of silence.› Many immigrants keep silent in hopes of staying "invisible" and not stirring up any questions, especially if they are illegal.
Audre Lorde (1980) says that "silence and invisibility go hand in hand with powerlessness.“In research about postpartum depression (PPD) in Hispanic women, it was foundthat most of them will not admit to or acknowledge the fact that they areexperiencing any form of depression. Hispanic women feel ashamed and thatdepression should be kept silent. There are many women that simply wont sayanything. Many female immigrants keep silent out of fear. Fear ofauthority, deportation, or in many cases their husbands (depending on theirculture.) A PERSONAL STORY: I had a patient one night on postpartum from Saudi Arabia. I was told in report that she spoke no English. She had delivered her baby earlier in the evening and her husband, who did speak English and interprets for her, had left for the night. I went into her room to get her vital signs and do her assessment. This was before we started using the language lines or had material printed in other languages. I wasnt sure how I would communicate with her. When I entered her room, I spoke to her and told her my name. She just looked at me. Then she said, in very plain English, "Your hair is so pretty." I said, "Oh. I didnt think you could speak English." She said, "Oh, yes. I speak English." She could speak and understand English very well. Her husband did not know that and we did not tell him. Her secret was safe with us.
Nursing encompasses an art, a humanistic orientation, a feeling for the value of the individual, and an intuitive sense of ethics, and of the appropriateness of action taken. ~ Myrtle Aydelotte We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering ~ Elisabeth Kubler-Ross
Callister, L.C., Beckstrand, R.L., & Corbett, C., (2011). Postpartum Depression and Help-Seeking Behaviors in Immigrant Hispanic Women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(4), 440-449.Dossa, P. (2003). The Body Remembers, A Migratory Tale of Social Suffering and Witnessing. International Journal of Mental Health, 32(3), 50-73.Farmer, P. ( 2005). Pathologies of power: Health, human rights, and the new war on the poor. Berkley, CA: The University of California Press.Holmes, S. (2006). An ethnographic study of the social context of migrant health in the United States. PLOS Medicine (3) 10. p 1776-1793.Lin, L. (2009). A synthesis of the literature on Asian nurses work experiences in the United States. Research & Theory for Nursing Practice, 23(3) p 230-45.Loewen, J.( 2007). Lies my teacher told me. New York, NY: The New Press.Lorde, A. (1980). The Transformation of Silence into Language and Action. J. Pinkvoss & S. Brawn (Eds.), The Cancer Journals (pp. 16-22). San Francisco: aunt lute books.Molina, N. (2011). Borders, laborers, and racialized medicalization: Mexican immigration and US public health practices in the 20th century. American Journal of Public Health. 101(6).National Manufacturer’s Association ( 2011). Retrieved from http://www.nam.org/Issues/Employment-and-Labor/Workforce.aspxRoss, S., Polsky, D. & Sochalsky, J. (2005). Nursing shortages and international nurse migration. International Nursing Review. 52(4) 253-62