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Use The Allegory of the Orchard to discuss how the political determinants of health negatively impact the health outcomes of a group of patients for whom you care. Why are you, as a nurse, the right person to become politically involved in addressing these determinants?
Applying this to a real-world scenario, consider a group of patients with Type 2 Diabetes.
The Poisonous Fruit: This could be the easy access to cheap, unhealthy food and sugary drinks in their community, a lack of safe spaces for physical activity, or low wages that make nutritious food unaffordable. These are not individual choices but rather the result of policies—or a lack of policies—that shape the environment in which people live.
The Sick People: These are the patients with uncontrolled blood sugar, high blood pressure, and related complications that lead to frequent hospital visits.
The Health Care Workers: As nurses, doctors, and other clinicians, we provide direct care. We manage their medication, educate them on diet and exercise, and treat their symptoms. However, our efforts are often a temporary fix because the underlying environmental factors continue to drive the disease.
Nurses are uniquely positioned to become politically involved in addressing these determinants for several key reasons:
Holistic Perspective: Nurses have a holistic view of patient health. We see beyond the diagnosis and understand the social, economic, and environmental factors that truly impact our patients' well-being. We see firsthand how poor housing, food insecurity, and lack of transportation hinder a patient's ability to manage their health.
Trusted Professionals: Nurses are consistently ranked among the most trusted professions. This trust gives our voices significant weight when we advocate for policy changes. We can speak from experience and provide a human face to complex issues.
Advocacy as a Core Competency: Advocacy is a core principle of nursing. We advocate for our individual patients at the bedside, and that same skill can be scaled to advocate for entire communities. We can use our knowledge to educate policymakers about the real-world consequences of their decisions and propose evidence-based solutions.
Direct Experience: We are the ones in the "orchard," witnessing the continuous influx of patients from the same flawed system. We are the right people to address the root of the problem because we understand the devastating health consequences of inaction better than anyone else.
The Allegory of the Orchard is a powerful metaphor that helps explain how political determinants of health negatively impact the health outcomes of a patient group.
In this allegory, the patients are like people in an orchard. Some people are getting sick from eating poisonous fruit, so a group of "health care workers" (nurses, doctors, etc.) is standing by the river, pulling them out and treating their symptoms. This is like the clinical care provided in hospitals and clinics. The problem is, they are still getting sick because the source of the problem—the poisonous fruit—remains unaddressed. When one of the health care workers asks why no one is addressing the problem at its source, they are told, "That's not our job. Our job is to pull people from the river."