Social Advocacy

August 16, 2000

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Imp49: This morning I learned at a CME lecture at Egleston Children's Hospital in Atlanta that the Georgia Medicaid approval time for therapeutic procedures costing more than $400 takes 4-8 weeks. Could you comment on that disappointing fact?

Ann Connor: No, I cannot. I don't know anything about that conference. I apologize. At the end of this conference I can give you a website, and perhaps someone there can answer that question.

Linda: Empowerment is a term that is used in multiple settings; can you define this term and its implications in healthcare settings?

Ann Connor: I don't have a dictionary in front of me but think of empowerment in some ways as helping people find their own voice. It's interesting to me because the root of advocacy is to have voice. I often think of those as similar terms. It's important to just not speak in behalf of vulnerable populations but to support them in finding their own voice. That's a whole different way of approaching the care we typically give rather than the "let me give you the answer." I think given the speed at which we must deliver care in most settings, finding ways in traditional institutions is very challenging. I think as nurses we continually need to try to move from our hearts and follow the sense of call, which probably brought us to nursing in the first place, and then challenge the obstacles. Talk with other nurses and other providers and try to find instrumental ways to assist folks around the issues of empowerment. Personally, I think most change happens like that, very slowly and incrementally. Every little thing does make a difference. I often use the image of taking a birthday candle into a cave. It's just a birthday candle but can shed a lot of light into that vast space. Do what you can; it can often make a difference even if you don't see the result.

MissQ: Is this now specialized field in nursing?

Ann Connor: I don't think of it as a specialized field. One will find conferences and chapters in textbooks. There is at least one textbook out. There are nurses that only provide care to homeless, so in that sense it may be specialized. Healthcare for vulnerable populations has enough similarities, so whether you're working with homeless, or vulnerable, or abused children you will have some similarities, but not so much that it would separate into a different type of work. My experience is that it's community nursing with a particular focus on this population, but much of it would transfer to other vulnerable populations.

A23: What have been the most effective means for getting people of lower income to comply with medical treatment plans?

Ann Connor: I'm speaking from my experience and it has to do with people feeling a sense of ownership, of having resources or having supportive ways of getting resources. Usually the homeless that I work with, by the time they've reached homelessness, they have almost no supportive circles around them. I look at my own life and I see family, friends, work, community and lots of things that hold me up. By the time someone is at the margins in our culture, there is very little supportive network left around them. Any problem you face with marginalized populations is that you have to help them rebuild their circles of support. That's a very big piece of work, and that's why we've focused with smaller numbers. You can help them rebuild their circles of support. If you have to deal with 300 people you may not be able to do the same things as if you were dealing with smaller amounts of people. I think there are so many other things going on in someone's life that the payoff for following treatment protocol isn't there. Many people who are at the margin live day to day. If they don't feel bad it doesn't register to take their medicine and not important to comply. It's not just about poverty, but also about priority. I think some of the stuff has nothing to do with income or education. We all know, as nurses, people who have plenty of education and money who don't adhere to treatment modalities. It's so complicated, with culture and all sorts of variables.

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