• Barbara Pieper.
• College of Nursing, Wayne State University, Detroit, Michigan 48202, USA. bpieper@wayne.edu
• Ostomy Wound Manage. 2009 May 1;55(5):24-37.

AbstractRace/ethnicity, immigration, health insurance, and literacy--along with patient-provider communication and understanding of and adherence to treatment protocols--are societal factors that affect the provision of optimal healthcare. Wound care practitioners should be aware of the need to address these factors in vulnerable groups, including the effects of racial/ethnic care disparities, immigration, low income, uninsured or underinsured status, and literacy/health literacy on health and wound care. The literature shows that care is not always perceived to be or equitably provided across different ethnic and economically diverse populations. Hence, clinicians must strive to listen to and interact non-judgmentally with vulnerable patients. Each patient's physical and psychosocial concerns must be assessed without malice and clinicians must work with community, state, and federal agencies to enhance access to necessary services. Wound care patient teaching materials need to be developed that consider the literacy and language skills of the community served. Once the type of wound and its appropriate treatment are determined, wound care practitioners must consider patient teaching, vulnerability, cultural, and economic constraints of care, along with strategies for prevention of complications and hospitalizations.

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