DiversityNursing Blog

Health Care Cultural Considerations

Posted by Erica Bettencourt

Sat, Aug 29, 2020 @ 01:22 PM

diverseheadsIn our growing diverse society, health care workers need to understand that applying only traditional westernized medical practices isn't appropriate for many patients and families. Health professionals must have an awareness of different cultural practices and spiritual beliefs in order to reduce racial and ethnic disparities in health care.

According to the American Hospital Association, cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs.

There can be language barriers so make sure you know your patient’s preferred method of communication and arrange an interpreter. Non-verbal communication may differ across cultures. Don’t make any assumptions without knowing the person's customs.

Many cultures have special dietary considerations. Hospital staff should be educated about food culture, which is a term used to describe the non‐nutritive, yet nonetheless significant, aspects of food, such as when food is eaten and how it is served.

For example, Jewish patients do not eat pork or shellfish. Muslim patients also do not consume pork. Muslims will eat only permitted food (halal) and will not eat or drink anything that is considered forbidden (haram). Halal food requires that Allah's name is invoked at the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as long as a Muslim kills them and offers a prayer. Fish and eggs are also halal. Buddhist are mostly vegetarian, though Buddhists may eat meat if it has not been killed for them specifically.

Health care workers should use effective communication to increase their understanding about the patient's spiritual beliefs and practices. Your workplace should offer spiritual counselors like a chaplain or a rabbi. It is a good idea to have a non-denominational prayer and meditation room which can serve as an inclusive sacred space for staff and patients of all religious backgrounds.

Management should take an active role in promoting culturally competent workplace training courses and resources.

Our calendar of cultural dates is a great tool to assist staff with respectful scheduling and diversity celebrations.

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Topics: cultural competence, culturally competent care, racial health disparities, cultural considerations, ethnic disparities in health care

This Ballerina Is Shedding Light On Racial Bias In Healthcare

Posted by Erica Bettencourt

Mon, Aug 24, 2020 @ 11:16 AM

ingridsilva Ingrid Silva, a ballerina of The Dance Theatre of Harlem, is using the current closing of theaters and performance venues to expose racial bias in healthcare. In the past, Ingrid received praise and recognition for creating a line of ballet shoes in an array of skin tones for dancers of all races and cultures.

Silva founded a nonprofit organization called EmpowHer. EmpowHer NY is a social catalyst that ignites the conversation about women who break through the glass ceiling imposed by society and live authentically according to their truth.

Recently EmpowHer and The Bloc teamed up to create a video called 'The Call Project'.

According to Forbes, this project is an experiment where actress Corin Wells made multiple calls to a 24-hour Nurses health hotline. Wells used a white-coded name and voice as well as a Black-coded name and tone. The results showed that 77% of her “black” alias calls ended with a recommendation to go to an urgent care facility, a protocol for minor health issues. However, her “white alias,” using the same script, was advised to go to the ER, which is protocol for any patient with urgent symptoms of an appendicitis.

Empowher believes, "When it comes to getting proper healthcare, it shouldn’t matter what your name is or how you sound like. Your pain shouldn’t be underestimated because of biological myths that are not only scientifically false but also fantastical in nature."

The goal of this experiment is to address racial biases in healthcare and to make unconscious bias training mandatory for hospitals and healthcare to ensure quality healthcare.

Silva said, “It’s been past time for us to speak up on this matter for the black community worldwide. This is our way of saying enough already!”

You can join the movement in the fight for equality in healthcare. EmpowHer is offering a petition to make unconscious bias training a mandatory requirement for hospitals across the country. You can sign the petition here.

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Topics: racism, racism in healthcare, racial health disparities, Racial Bias In Healthcare, Racial bias

COVID-19 Racial Health Disparities

Posted by Erica Bettencourt

Wed, Jul 01, 2020 @ 12:33 PM

maskedpeopleCOVID-19 has shone a light on how systemic racism plays a role in health disparities among Black people. 

According to Scientific American, the overall death rate from COVID-19 is 2.4 times greater for African Americans than it is for white people. 

Camara Phyllis Jones, an Epidemiologist who recently served as president of the American Public Health Association said, “People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism.”

Hypertension, obesity, diabetes and other risk factors for severe coronavirus complications, are more prevalent in minority populations.

According to an article from STAT, Black people in the U.S. are more likely than white people to live in food deserts, meaning they have limited access to fresh fruit or vegetables. They are also less likely to be able to access green spaces, and more likely to live in areas without clean water or air.

Household spread is the most common form of virus transmission. Many people of color live in overcrowded homes and communities so it's difficult to social distance. It is also difficult to find an outdoor place to social distance as there are fewer publicly provided resources, such as parks and bike lanes, for minority-dense neighborhoods.

The best advice to fighting the virus is to stay at home but, unfortunately essential workers don't have this option. Not only are fewer Black and Latino adults able to work from home, but they're also overrepresented in essential jobs.

These health disparities are further worsened by an unequal healthcare system. People of color often have unequal access to care, and when they do receive care it is often poorer quality.

The National Academy of Medicine (NAM) released a report that found “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.”

In order for things to change, the entire health care field, from medical schools to hospitals and even medical device manufacturers, need to work to unravel and address racism within the healthcare system.

Progress will take time and efforts must occur on every societal level. This involves a wide range of actions, like improving wages and closing pay gaps, improving access to health insurance, providing better access to fresh foods and green spaces, and ensuring more diversity in the health care system so healthcare workers can provide culturally competent care.

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Topics: racial health disparities, COVID-19

Diabetes: Racial and Ethnic Disparities

Posted by Erica Bettencourt

Thu, Nov 14, 2019 @ 02:10 PM

daibetesNovember is Diabetes Awareness Month. This is the perfect time to discuss diabetes health disparities. Racial and ethnic minorities have higher prevalence rates, worse diabetes control, and a higher rate of complications, according to an article from the U.S. National Institutes of Health's National Library of Medicine.

According to the American Diabetes Association (ADA), compared to white adults, the risk of having a diabetes diagnosis is

·         77% higher among African Americans

·         66% higher among Latinos/Hispanics

·         18% higher among Asian Americans

The article from the ADA also notes, even though there is a high rate of this condition, minorities receive lower care quality and experience more barriers to self-management than white patients. They are less likely to receive advised services such as annual hemoglobin A1c (HbA1c) testing, annual LDL cholesterol (LDL-C) testing, and an annual retinal examination. 

Minorities are more likely than white people to live in areas of low socioeconomic status. These neighborhoods lack shared ideas about health promotion, access to healthcare services, healthy foods, and safe places to exercise. These are all needed to improve an individual’s management of their diabetes.

The Office of Minority Health (OMH) at the Food and Drug Administration (FDA) said they are teaming up with the American Diabetes Association and other groups to help people prevent and treat diabetes, and to specifically address the disparities in minority groups.

An article from the Food and Drug Administration said, "OMH's outreach work includes raising awareness of the need for more research in diabetes therapies that address racial and ethnic differences. OMH is also working to make sure minorities are included as subjects in clinical trials of medical products for the treatment of diabetes and other diseases."

The Centers for Disease Control and Prevention (CDC) started the National Diabetes Prevention Program (National DPP) which is a partnership of public and private organizations who work together to provide an affordable, evidence-based lifestyle change program to help people with prediabetes prevent or delay type 2 diabetes.

However, according to the CDC some racial and ethnic minority groups were enrolling in the program at lower rates than other groups. To help increase access, the CDC recently funded 10 national organizations to start new in-person programs in underserved areas (regions with fewer resources to address health disparities). In addition to in-person delivery, the program can also be accessed online, by distance learning, or through a combination of these formats.

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Topics: diabetes, health disparities, racial health disparities, diabetes awareness

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

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