Running head: VULNERABLE POPULATION 1

Vulnerable Population
Jack Arnold
Ferris State University




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Vulnerable Population
Vulnerable populations exist in all types and varieties. In some way, shape or form, all of
us belong to some form of a vulnerable group. Vulnerability refers to being susceptible to harm,
either physical, mental, or emotional. It could also be the result of low income or having or
being at risk for a disease process. The purpose of this paper is to identify a vulnerable
population and discuss the bias and attitudes toward this population.
Risk Factors for Vulnerability
The population identified for this paper was patients that utilize the use of the emergency
department (ED) for non-urgent care who receive Medicaid benefits. Factors that cause
vulnerability can range dramatically. The first factor identified was the non-urgency of the
patient complaint (Honigman, Wiler, Rooks, and Ginde, 2013). This can potentially place the
patient at risk for substandard care and treatment due to the fast nature at which the patient may
be treated and discharged. The second identified factor was the lack of insurance or benefits
received from public assistance (Honigman et al., 2013). This is a risk factor due to the inability
to pay or perceived wastefulness of a non-urgent visit. Does this risk factor limit the amount or
type of treatment the patient will receive? According to the national survey by Honigman et al.
(2013), over 87% of the non-urgent patient visits received some form of imaging, diagnostic test,
procedure, or medication. This risk factor also increases use of the ED because patients without
insurance feel they have no other alternative but to use the ED. The third factor was
transportation (Nelson, 2011). Lack of transportation places someone at risk since they are
unable to potentially drive to a primary care provider; they are forced to utilize what health
care is available, thus the ED. A fourth identified factor is the lack of knowledge of the non-
urgent use patient (Shaw, Howard, Clark, Etz, Arya and Tallia, 2013). Many believe they
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receive faster more immediate care at the ED instead of at their primary care provider. They feel
the wait time is less and they are able to be seen the same day, without having to make an
appointment. Also more immediate testing and results are available with a faster end result to
what brought them there in the first place. Lastly, this population is at risk because they are
unaware of any other health care availability in their area (Nelson, 2011). Large portions of this
population utilize the ED because it is the closest health care facility to them and feel it is more
convenient and accessible.
My personal experience with this population stems from two years of current work in
Grand Rapids largest and only level one trauma center ED in the western half of Michigan. I
have personally heard and witnessed biased against this population, from comments referring to
insurance status and minor complaint of visit; to a five minute assessment and treatment from the
physician. The attitude toward the non-urgent use of the ED is notably parallel amongst all
disciplines within the department, from radiology and ultrasound to physicians and nurses. I
have found myself sharing in the bias attitude against this population as well. While I do not feel
it has affected my care, it has affected my thought process and maybe I am a little less attentive
and do not realize it.
Demographics
Demographics among this vulnerable population tend to vary within the research. In
Nelsons (2011) article based on EDs situated in small, rural areas, including her own place of
employment; a district general hospital with 300 inpatient beds, 88% of the surveyed population
lived within 15 miles of the ED and 54% lived within a five-mile radius. Also, all respondents to
the survey were of Caucasian race. The reason was unclear to the researchers but was listed as
potential selection bias. Northington and Brice (2005) results showed demographics of 36%
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privately insured, 32% uninsured, and 9.7% Medicaid patients. Also, the median age was 37.4
years with a fairly even split among sex and 59% being Caucasian and 37% being African
American. Shaw, Howard, Clark, Etz, Arya and Tallia (2013) found in their survey 53% were
unemployed with 68% of these having public insurance and less than 1% was uninsured. No
questions or statistics of race was posed or offered in the article. These statistics are all based on
local levels at varying size hospital emergency departments. Honigman, Wiler, Rooks, and
Ginde (2013) conducted a national study of non-urgent use of EDs and found of the estimated
110 million annual visits, 10.1% were categorized as non-urgent, 46.9% were between the ages
of 18-44, 56.7% were non-Hispanic white, and 29.1% were Medicaid recipients.

Effects of Research
After conducting and evaluating the research retrieved on the vulnerable population I
have come to the conclusion that my bias is not against the Medicaid patient who uses the ED for
non-urgent care, but the non-urgent use patients in the ED in general. What the research has
shown me is that while the ED is utilized frequently by Medicaid patients, there are many more
extenuating reasons why patients observed as non-urgent use the ED. After this research, I have
discovered most people visit the ED because of the perceived severity of their symptoms and
location proximity and access. I have alleged this non-urgent use as wasteful of resources and
valuable time of health care workers. What I have realized is that as a future nurse, it is part of
my responsibility to educate and assist this population in health care processes. To provide
accurate information for them to obtain a primary care provider if they do not have one and
assure they receive proper medical treatment when they do visit the ED. I need to be a patient
advocate and make sure all their concerns are alleviated before they are discharged and if they
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have concerns, these must be addressed in a timely and appropriate manner, regardless of their
chief complaint or insurance status.
Knowledge of Bias
Knowledge of a bias is not easy to admit. It requires self-reflection and acceptance of
ones own short comings. Without knowledge of this bias, it may affect how a healthcare
provider will interact with a patient. Regardless of personal beliefs, every patient deserves equal
access to health care services, respect, adequate assessment by a physician, and proper testing
and treatment. This is why we need to educate patients and provide more and better access to
primary care. Patients typically come to us because of pain and it is our responsibility as health
care providers to provide answers as to the reason for the pain and relieve it as best possible.
I cannot say if my own bias has affected my interaction with patients in my current job
position. It is my responsibility to educate my co-workers around me about the facts of non-
urgent use of the emergency department and help them to reflect on the care they provide. While
a third of ED patients are Medicaid recipients, it is not this reason alone why the EDs across the
United States are so busy. Medicaid was put in place to provide health coverage for less
fortunate members of our communities, and to place them or anyone else who uses the ED for
non-urgent use at a disadvantage with personal bias is unacceptable.


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References
Honigman, L. S., Wiler, J. L., Rooks, S., & Ginde, A. A. (2013). National study of Non-urgent
emergency department visits and associated resource utilization. Western Journal of
Emergency Medicine, 14(6), 609-616. http://dx.doi.org/10.5811/westjem.2013.5.16112
Nelson, J. (2011). Why patients visit emergency units rather than use primary care services.
Emergency Nurse, 19.1, 32. Retrieved from
http://emergencynurse.rcnpublishing.co.uk/resources/
Northington, W. E., & Brice, J. H. (2005). Use of an emergency department by nonurgent
patients. American Journal of Emergency Medicine, 23, 131-137.
http://dx.doi.org/10.1016/j.ajem.2004.05.006
Shaw, E. K., Howard, J., Clark, E. C., Etz, R. S., Arya, R., & Tallia, A. F. (2013). Decision-
making processes of patients who use the emergency department for primary care needs.
Journal of Health Care for the Poor and Underserved, 24(3), 1288-1305.
http://dx.doi.org/10.1353/hpu.2013.0140