DiversityNursing Blog

Stairs Are Not A Problem For This Wheelchair

Posted by Erica Bettencourt

Wed, Oct 09, 2019 @ 02:09 PM

 

scewobroThe Centers for Disease Control and Prevention estimates 61 million adults in the United States live with a disability and 13.7 percent of those people have a mobility disability with serious difficulty walking or climbing stairs.

In Switzerland 10 master students from the Swiss Federal Institute of Technology wanted to develop a new generation wheelchair that would provide more accessibility and freedom for it's users to go wherever life takes them.

The biggest challenge for wheelchair users is stairs. So the students created the Scewo Bro wheelchair.

The Scewo Bro is an electric, stair-climbing wheelchair with self-balancing, segway technology to make it easier for the user to rotate on the spot and to drive over curbs without getting stuck. It is controlled by using your smartphone or the integrated touch screen and joy stick.

This amazing wheelchair uses rubber tracks to safely climb stairs, even spiral staircases. In a BBC article, one of the student designers, Thomas Gemperle, explained “Stairs are climbed sitting backward and driven down in the forward position. The tracks adapt to the angle of the stair automatically and keep the user level at all times."

Thomas also added, “With our special drive-train we have a wide stand on the stairs which makes it impossible to tip over in any direction."

Another feature of the Scewo Bro is “elevated mode”. This feature raises the wheelchair up for an eye level conversation or for reaching objects up high.

eyelevelscewo

The Scewo Bro charges in 5 hours with any household outlet and folds down into a compact size to fit in the smallest of cars.

Jose Di Felice

According to a CNN article, Jose Di Felice from Switzerland, was paralyzed in both legs and 1 arm after a high-speed motorcycle accident 3 years ago.

He discovered the Scewo Bro on Youtube and requested a test drive. Di Felice test drove the wheelchair at his town hall. He told CNN, "It was really emotional to go up these stairs, and look down there and say that it's possible."

It is anticipated the Scewo Bro wheelchairs will be distributed to users by the end of 2019. Di Felice will be one of the first to receive this life changing wheelchair.

Topics: scewo bro, wheelchair uses stairs

Domestic Violence And How Nurses Can Help Victims

Posted by Erica Bettencourt

Fri, Oct 04, 2019 @ 01:56 PM

domesticviolenceDomestic violence does not discriminate. Anyone of any age, race, education level, socioeconomic status, sexual orientation, religion or gender can be a victim OR perpetrator.

According to the National Coalition Against Domestic Violence ncadv.org, Domestic violence is the willful intimidation, physical assault, battery, sexual assault, and/or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. It includes physical violence, sexual violence, psychological violence, and emotional abuse. 

Often at the beginning of a relationship, you can’t tell if it will become abusive. Typically, in the early stages of the relationship, the abusive partner is perfect in every way. Signs of controlling behaviors and obsessiveness emerge and intensify as the relationship goes on.

Domestic Violence Statistics

According to the CDC,

  • On average, nearly 20 people/minute are physically abused by an intimate partner in the United States. In 1 year, this equates to 10+ million women and men.
  • 1 in 3 women and 1 in 4 men have experienced some form of physical violence by an intimate partner.
  • 1 in 7 women and 1 in 25 men have been injured by an intimate partner.
  • 1 in 7 women and 1 in 18 men have been stalked by an intimate partner during their lifetime to the point in which they felt very fearful or believed that they or someone close to them would be harmed or killed.
  • 1 in 10 women have been raped by an intimate partner. Data is unavailable on male victims.

Nurses have an important role to play in assisting victims of abuse/violence in a domestic situation.

Abused victims say that a compassionate inquiry from a caring Nurse helped them disclose their abuse and find the best intervention services. By recognizing the signs of abuse and caring to ask questions, the patient recognizes the Nurse is knowledgeable about domestic violence and validates domestic violence as a legitimate health care issue.

According to a Crisis Prevention article, when assessing a victim, be aware of the following physical signs of injuries that may be related to domestic violence:

  • Bruising in the chest and abdomen
  • Multiple injuries
  • Minor lacerations
  • Ruptured eardrums
  • Delay in seeking medical attention and
  • Patterns of repeated injury

However it is unlikely the victim will be seeking help for a physical injury. More likely they are seeking help for issues such as:

  • A stress-related illness
  • Anxiety, panic attacks, stress and/or depression
  • Drug and alcohol abuse
  • Chronic headaches, asthma, vague aches and pains
  • Abdominal pain, chronic diarrhea
  • Sexual dysfunction, vaginal discharge
  • Joint pain, muscle pain
  • Sleeping and eating disorders
  • Suicide attempts, psychiatric illness or
  • Gynecological problems, miscarriages, chronic pelvic pain

The victim may also:

  • Appear nervous, ashamed or evasive
  • Describe their partner as controlling or prone to anger
  • Seem uncomfortable or anxious in the presence of their partner
  • Be accompanied by their partner, who does most of the talking
  • Give an unconvincing explanation of the injuries
  • Be recently separated or divorced
  • Be reluctant to follow advice

After assessing the patient, try not to jump in too fast with suggestions and solutions. Encourage the patient to talk, and then listen carefully. After you have a better understanding of the patient's current state, you can help by providing appropriate resources for them to find safety. Some of these resources include…

The National Domestic Violence Hotline
1-800-799-7233 (SAFE)
www.ndvh.org

National Sexual Assault Hotline 
1-800-656-4673 (HOPE)
www.rainn.org

National Resource Center on Domestic Violence 
1-800-537-2238
www.nrcdv.org and www.vawnet.org

Futures Without Violence: The National Health Resource Center on Domestic Violence 
1-888-792-2873
www.futureswithoutviolence.org

National Center on Domestic Violence, Trauma & Mental Health
1-312-726-7020 ext. 2011
www.nationalcenterdvtraumamh.org

Childhelp USA/National Child Abuse Hotline 
1-800-422-4453
www.childhelpusa.org

Domestic Violence Initiative 
(303) 839-5510/ (877) 839-5510
www.dviforwomen.org

INCITE! Women of Color Against Violence 
incite.natl@gmail.com 
www.incite-national.org

Casa de Esperanza 
Linea de crisis 24-horas/24-hour crisis line 
1-651-772-1611
www.casadeesperanza.org

Asian and Pacific Islander Institute on Domestic Violence 
1-415-954-9988
www.apiidv.org

Institute on Domestic Violence in the African American Community 
1-877-643-8222
www.dvinstitute.org

 

Topics: domestic violence, treating domestic violence patients, domestic violence victims

Blind Engineer Creates a Smart Cane Device

Posted by Erica Bettencourt

Wed, Oct 02, 2019 @ 11:06 AM

wewalk2

According to the World Health Organization, approximately 1.3 billion people globally live with some form of vision impairment.

 

With regard to Distance Vision

  • 188.5 million people have mild vision impairment
  • 217 million have moderate to severe vision impairment
  • 36 million people are blind

With regard to Near Vision

  • 826 million people live with a near vision impairment

Kursat Ceylan knows the struggles of being blind and wanted to make life easier and more convenient for others who face the same challenges. He created WeWalk. WeWalk is an innovative cane which includes built-in speakers, voice assistance, Google Maps, a Bluetooth system and more.

 wewalk1

According to a Design Wanted article, the device features dual sensors that vibrate to alert the user of upcoming danger at ground & chest level. The battery can be charged via a USB and works up to 5 hours. The cane can connect to apps like Uber and Lyft allowing access to convenient transportation. Google Maps provides an accurate navigation system when walking. It also features an LED light to assist partially sighted people. 

 

Kursat Ceylan told CNN "As a blind person, when I am at the Metro station I don’t know which is my exit, I don’t know which bus is approaching, which stores are around me. That kind of information can be provided with the WeWalk.”

 

Ceylan's device has competition with other products such as the Smart Cane Device, the BAWA cane and the SmartCane, but the fact that WeWalk utilizes and incorporates existing technologies (voice assistance, Google Maps, and Bluetooth synchronization), makes it a completely new idea.

 

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Topics: smart cane, disability devices, WeWalk

Frontier Nursing University Virtual Event to Focus on Healthcare Team Communication and Perinatal Mental Health

Posted by Frontier Nursing University

Wed, Sep 25, 2019 @ 12:28 PM

frontierVERSAILLES, Ky.—National Midwifery Week is the first week of October, and Frontier Nursing University (FNU) is celebrating by hosting a virtual event dedicated to nurse-midwifery. Featured topics include healthcare team communication and perinatal mental health. Nurse-midwives, prospective midwives and others can participate online at Frontier.edu/MidwiferyWeek

From September 29 to October 5, the Empower 2019 FNU Virtual Event: Nurse-Midwives Improving Patient Care Through Teamwork will bring together leaders in nurse-midwifery to present the following sessions:

·         Celebrating National Midwifery Week - Susan Stone, CNM, DNSc, FACNM, FAAN, President, Frontier Nursing University and President, American College of Nurse-Midwives (ACNM)

·         It’s a Beautiful Day in the Neighborhood: A Community-Based Approach to Improving Perinatal Mental Health - Kalena Lanuza, DNP, MSN, APRN, FNP-C, PHN, CLCI 

·         We’re All in It Together - Midwives, Nurses and Physicians: A Team Solution for a Team Problem - Cathy Collins-Fulea, DNP, CNM, FACNM, Faculty Member, Frontier Nursing University

·         Maybe there is an “I” in TEAM: IPECS - Audrey Perry DNP, CNM, Clinical Director, Women’s Health Care Nurse Practitioner and Nurse-Midwifery programs, Frontier Nursing University and Mark B. Woodland, MS, MD, Chair, Department of OBGYN, Reading Hospital 

·         I Wanna Be Part of the Team! Becoming a Nurse-Midwife - Tonya Nicholson, DNP, CNM, WHNP-BC, CNE, FACNM, Associate Dean of Midwifery and Women’s Health, Frontier Nursing University

Dr. Collins-Fulea will present a certified nurse-midwife-designed quality improvement project aimed at decreasing the length of stay in an obstetrical triage unit. She will discuss how improved team communication and patient engagement and the use of nurse-driven orders decreased patient time in triage and increased client and staff satisfaction. 

Dr. Lanuza’s session will explore how empowering women through a shared decision-making process, coupled with community collaboration, can improve the implementation of effective perinatal mental health practices in the obstetric setting and society at large. Perinatal Mood and Anxiety Disorders (PMADs) can occur in up to 20 percent of women during the perinatal period and are among the leading cause of complications associated with childbearing.

The 2019 virtual event is sponsored by Southern Cross Insurance Solutions. National Midwifery Week was created by the American College of Nurse-Midwives (ACNM) to celebrate and recognize midwives and midwife-led care. ACNM and its 7,000+ midwife members, physicians and women’s health organizations observe National Midwifery Week each year. FNU President Dr. Susan Stone is currently serving as president of the ACNM Board of Directors. 

Frontier Nursing University is the birthplace of nurse-midwifery in the United States and has 80 years of experience in delivering graduate nursing and midwifery programs. This is the fifth consecutive year FNU has hosted a virtual event in support of National Midwifery Week. 

Register for the virtual event and learn more at Frontier.edu/MidwiferyWeek

Topics: nursing school, Frontier Nursing University, FNU, healthcare team communication, Perinatal Mental Health, National Midwifery Week, Midwifery

Racial Disparities in Maternal Health

Posted by Diversity Nursing

Tue, Sep 24, 2019 @ 10:28 AM

pregnancyWomen of color in the United States suffer unacceptably poor maternal health outcomes, including high rates of death related to pregnancy or childbirth.

The Pregnancy Mortality Surveillance System started in 1987 and since then, the number of reported pregnancy-related deaths in the United States increased from 7.2 deaths per 100,000 live births to 17.2 deaths per 100,000 live births in 2015.

Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2015, the pregnancy-related mortality ratios were—

  • 42.8 deaths per 100,000 live births for black non-Hispanic women.
  • 32.5 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
  • 14.2 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
  • 13.0 deaths per 100,000 live births for white non-Hispanic women.
  • 11.4 deaths per 100,000 live births for Hispanic women.

Variability in the risk of death by race/ethnicity indicates that more can be done to understand and reduce pregnancy-related deaths.

According to a report from the Centers for Disease Control and Prevention, African American mothers die at a rate that's 3.3 times greater than whites, and Native American or Alaskan Native women die at a rate 2.5 times greater than whites.

Pregnancy-related mortality rates are also high among certain subgroups of Hispanic women. A Science Direct article says, pregnancy-induced hypertension was the leading cause of pregnancy-related death for Hispanic women.

The CDC report also shows roughly 3 in 5 pregnancy-related deaths are preventable. But, the health care system fails to listen to diverse population's health concerns and so the maternal mortality rate keeps rising.

According to the Healthy People Final Review, Approximately 25% of all U.S. women do not receive the recommended number of prenatal visits.  This number rises to 32% among African Americans and to 41% among American Indian or Alaska Native women.

An article from the Center for American Progress believes there is little research on what social factors contribute to poor delivery and birth outcomes for American Indian and Alaska Native women because of the small population size and racial misclassifications. But they do know these women face many barriers when it comes to getting healthcare.

The National Partnership for Women & Families explains African American women experience more maternal health complications. 

  • African American women are three times more likely to have fibroids than white women. Fibroids are benign tumors that grow in the uterus and can cause postpartum hemorrhaging. Also the fibroids occur at younger ages and grow more quickly for African American women.
  • African American women display signs of preeclampsia earlier in pregnancy than white women. Preeclampsia involves high blood pressure during pregnancy and can lead to severe complications including death if not properly treated.
  • African American women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, this makes pregnancy riskier at an earlier age.

The CDC report also shows that more than a third of pregnancy-related deaths were due to cardiovascular conditions. Cardiovascular disease is more common among black women and can occur at earlier ages than in white women.

It is very clear that health disparities have a lot to do with racism. Until it is addressed and programs are put in place to combat racism in healthcare, mortality rates will continue to rise.

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Topics: health disparities, Maternal Mortality Rate, maternal health, racism in healthcare, racial health disparities, pregnancy related deaths

Will No Nurse Documentation Become a Reality?

Posted by Erica Bettencourt

Mon, Sep 16, 2019 @ 10:12 AM

documenting

We found this inspiring Pilot Program we think will be of interest to you. Healthcare provider, AdventHealth, rolled out an unusual program last year that hopes to “revolutionize” the way patient care is delivered around the country.

 

The goal of the pilot program, started in 2018, was to free up Nurses to provide more patient-centered care without the constant interruption of writing down the care as it was given. Nurses were paired with a Care Team Assistant (CTA) to document patients’ medical care at the time it was provided. This was done under the Nurse’s supervision and they worked as a team.

 

“This pilot is helping me be the type of Nurse that I dreamed of,” said Christine Reyes, a Registered Nurse at AdventHealth Altamonte Springs. “I became a Nurse because I wanted to show compassion to people who need it most, and this pilot is allowing me to do that even more.”

 

Results of the pilot program

·         Staff responsiveness (a measurement of the patient experience) improved by 12%.

·         Lab turnaround time improved by 13%.

·         73% of nurses said they feel they are able to spend more time with patients when assisted by a CTA.

 

Eric Stevens, CEO of acute care services for AdventHealth in metro Orlando said "AdventHealth is committed to finding innovative solutions to health care problems. We created this model to improve the way we work to make it easy for both our patients and staff. Our Nursing staff is key to providing compassionate, whole-person care. A hospital stay can be an unnerving experience. This program helps our Nurses spend quality time with our patients and their families to focus on supporting them while they heal."

 

AdventHealth is building on the success of the pilot and expanding it to other units.

 

What do you think of this program? Is it a good idea to implement at other hospitals? Share your ideas here.

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Topics: pilot study, nurse documenting, hospital study

ICU Nurse Donates Part of Her Liver to Save 8-Year-Old Boy

Posted by Erica Bettencourt

Thu, Sep 05, 2019 @ 12:26 PM

brayden4

Nurses are selfless, always giving as much of themselves as they can for their patients. Thanks to one extremely selfless Nurse, 8-year-old Brayden Auten of WI is alive and well and starting a new school year. 

 

One day last April, Brayden, a busy and active child, came home from school very sick. The following evening, he was at Children's Hospital in Milwaukee where doctors discovered an aggressive unknown virus attacking his liver.

 

According to a Wisconsin News article, within a week, young Brayden was fighting for his life. Ruth Auten, Brayden's mom said "Started talking liver transplant, and we just bawled our eyes out. We didn't think it was going to get that far."

 

The family posted Brayden's story online and the response was so huge, an operator was added to the unit to handle the volume of phone calls. Thankfully, Cami Loritz, an ICU Nurse in Milwaukee, answered their prayers. She was a perfect match and volunteered to be a living donor.

 

Brayden’s dad, James Auten said "What she did was completely selfless and she saved his life, plain and simple." Ruth said "We can't thank her enough. She's a true miracle. We consider her one of us, one of our family."

 

While Brayden was recovering in Milwaukee, the community back home in Wrightstown, WI came together for the family. "They set up fundraisers and everything for tournaments and just, it was really amazing to see the community support and the wrestling team came while we were gone and did our lawn and landscaping and came and saw him. It's been pretty amazing," said Brayden's dad. 

 

The Auten's are so thankful and grateful for the gift of life Cami gave to Brayden. To commemorate what Cami did for Brayden and his family, they organized a family photo shoot for them. You can see their bond in these photos. Cami, you are truly an amazing person!

brayden1

brayden2

brayden3

Topics: organ donor, ICU nurse, liver transplant, nurse organ donor

What Is A SANE Nurse?

Posted by Erica Bettencourt

Fri, Aug 30, 2019 @ 10:00 AM

SANENurse-1SANE stands for Sexual Assault Nurse Examiner and it is a qualification for forensic Nurses to conduct sexual assault evidentiary exams for rape victims. SANE Nurses are trained in the medical, psychological, and forensic examination of a sexual assault victim.

SANE Nurses are extremely important in making sure sexual assault survivors feel safe as they are treated in the emergency room.

These Nurses act as an advocate for patients by staying with them for hours as they gain trust, asking the difficult questions, conducting physical exams to check for evidence and injury, providing emergency contraceptives, and maintaining evidence for law enforcement.

In addition to the collection of forensic evidence, they also provide access to crisis intervention counseling, STI testing, and drug testing. A SANE will also supply medical referrals for additional medical care or possible follow ups to document how they are healing.

To become a SANE, you must first be a Registered Nurse (or Advanced Practice), preferably with 2+ years experience in areas of practice that require advanced physical assessment skills. The SANE training should meet the IAFN SANE Education Guidelines and will consist of both classroom and clinical components.

After beginning practice as a SANE, Nurses who have obtained SANE training and meet the clinical practice requirements have the opportunity to take a board certification examination through the Association. There are 2 different credentials available under the SANE certification:

1)       SANE-A -- for Adult and Adolescent Examiners

2)       SANE-P -- for Pediatric victims

Not all, but many SANE programs are coordinated by rape crisis centers in place of a hospital. Some programs are employed by law enforcement and conduct their exams at stand-alone sites, not in an Emergency Department (ED).
 
SANEs are on call 24/7 and may arrive at the hospital ED within an hour of a sexual assault victim’s arrival. Some programs will wait until the patient has had a medical screening exam (MSE) and subsequently have law enforcement bring a stable patient to the sexual assault response team (SART) site for their exam. If the patient is in critical condition and admitted to the hospital, the SANE can perform a 'mobile exam' and bring their exam supplies and camera to the hospital.

Resources

National Protocol for Sexual Assault Medical Forensic Examinations of Adults and Adolescents 

Approved SANE Courses

Sexual Assault Nurse Examiner Education Guidelines, Adult and Pediatric

National Training Standards for Sexual Assault Medical Forensic Examiners

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Topics: sexual assault, SANE, forensic Nurses, SANE Nurses, Sexual Assault Nurse Examiner

DIY Medical Innovations Created By Nurses in Pop Up Labs

Posted by Erica Bettencourt

Thu, Aug 22, 2019 @ 02:39 PM

makerhealthNurse's innovative ideas are coming to life thanks to pop-up labs through a company called MakerHealth. MakerNurse, powered by MakerHealth, with support from the Robert Wood Johnson Foundation, was launched in September 2013 with the goal of examining Nurse innovation in U.S. hospitals and identifying tools and resources that could help more Nurses bring their ideas to fruition and lead improvements in patient care. Their solutions, informed by this research, are being adopted by institutions across the country. 

Nurses are natural problem solvers and spot any barriers in providing the best health care. So it would be in everyone's best interest to support Nurse's ideas and provide them the tools to create.

MakerHealth Space is situated inside a hospital. It provides Nurses and other health care professionals direct access to robust tools and materials, from 3D printers to Velcro, to create new and better devices that improve the way they care for patients. 

According to the company's website, the MakerHealth Space is stocked with adhesives and fasteners, such as Velcro and zip ties; textiles and electronics, including sensors and microcontrollers; and a range of tools, from pliers and sewing needles to 3D printers and laser cutters. The space is divided into a series of workstations, each equipped to address a specific medical challenge, such as fluid control or assistive technology.

PICU Neonatal Transport Nurse, Brittany Hruska, started researching and creating earmuffs for babies in the neonatal intensive care unit a couple years ago. 

"In the NICU, we have a lot of noise that we can't eliminate between the ventilators and just talking that happens. There's been tons of research on how damaging it is to babies. It's bad for their growth, development. It's bad for their brains," said Hruska.

A MakerHealth pop-up lab was set up at Blank Children’s Hospital and helped her improve her invention. Hruska said, "Before I was hand cutting these. They would take me about an hour to make a set of them. The MakerNurse program had people who helped me learn how to do computer aided design software and we 3D printed molds and they helped me find liquid foam, so now I can make lots of these pretty quickly."

The first MakerHealth Space was at John Sealy Hospital at The University of Texas Medical Branch at Galveston. According to the Robert Wood Johnson Foundation, Jason Sheaffer, Nurse manager in that burn unit, used PVC piping with 3D printed connectors to make a modular irrigation system to attach to the burn unit tub, creating a shower system that will help Nurses more efficiently and effectively treat burn patients. Dolly McCarley, from that Medical Surgical unit, laser cut acrylic attachments for patient IV poles to keep supplies closer at hand. Debra Flynn, from that Labor and Delivery Unit, fabricated protective sleeves for patient IVs using an impulse sealer, vinyl and string. Dell Roach in Cardiothoracic Surgery designed a template for placing 12-lead EKGs on pediatric patients.

To learn more about MakerHealth and their MakerNurse program, click here.

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Topics: nurse innovator, MakerHealth, medical innovations, MakerNurse, pop up lab

The American Academy of Pediatrics Release Policy Statement on the Impact of Racism on Children's Health

Posted by Erica Bettencourt

Tue, Aug 13, 2019 @ 03:25 PM

aapThe policy released by AAP defines Racism as a “system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call ‘race’) that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”

Dr. Maria Trent, a professor of pediatrics at Johns Hopkins School of Medicine, who was one of the co-authors of the statement, called racism a "socially transmitted disease. It is taught and it is passed down, but the impacts on children and families are significant from a health perspective."

According to the statement, The impact of racism has been linked to birth disparities and mental health problems in children and adolescents.6,2430 The biological mechanism that emerges from chronic stress leads to increased and prolonged levels of exposure to stress hormones and oxidative stress at the cellular level. Prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that predispose individuals to chronic disease.31 As an example, racial disparities in the infant mortality rate remain,32 and the complications of low birth weight have been associated with perceived racial discrimination and maternal stress.25,33,34

The statement directs pediatricians to consider their own practices from this perspective. “It’s not just the academy telling other people what to do, but examining ourselves,” Dr. Trent said.

It is imperative that pediatric clinical settings make everyone feel they are welcome. You can display images of diverse families on your walls and post signs in multiple languages. The toys, books, and videos in the waiting room should be multicultural as well.

 

Care should be provided in different languages. Does your staff represent the diverse patient populations they are treating? Everyone from the reception desk to the clinical staff seeing patients in the exam rooms should be trained in culturally competent care. Ask yourself, have you created a safe and welcoming space for all patients?

 

Clinical staff must examine and acknowledge their own biases as well as embrace and advocate for innovative policies throughout their communities.

 

To read the full statement policy by AAP, click here.

Topics: racism, children's health, health disparities, The American Academy of Pediatrics

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