The crisis of unequal health outcomes between Americans of color and the Caucasian majority has risen to the forefront of today’s national health care agenda. Sweeping federal initiatives like former President Bill Clinton’s Initiative to Eliminate Racial and Ethnic Disparities in Health have spawned literally hundreds of intervention programs and research studies that focus aggressively on “closing the gap.” But, some minority nurse educators wonder, just how much of this activity is trickling down to nursing school classrooms, where tomorrow’s health care providers are being trained? Show
Sandra Millon Underwood, RN, PhD, FAAN, is trying to address this issue by holding workshops that train nurse educators to teach their students about the importance of eliminating minority health disparities. These workshops focus on disparities in cancer prevention and early detection and are funded by the National Cancer Institute. Underwood, the American Cancer Society Harley Davidson Oncology Nursing Professor at the University of Wisconsin-Milwaukee School of Nursing, has some doubts about how seriously the issue of health disparities is being taken. “It’s certainly a buzzword of the 21st century, but I don’t see us as educators addressing it,” she argues. “I would like to believe the situation is improving, but I don’t think it is. “Engaging nursing students in this issue is the most powerful way we can effect a change in the future,” Underwood continues. “We’re teaching the next generation so they can engage in practices that may reduce health disparities. If we would truly commit to doing what we can about this, we would see a change.” While you might expect the problem of racial and ethnic health disparities to be news to many white students, you may be surprised to find out how little minority nursing students may know about the issue. “I don’t even think many of my students think about it until it is brought to their attention,” says Edith Ramsay-Johnson, RN, EdD, professor of nursing at the University of the U.S. Virgin Islands in St. Thomas, a historically black university. As director of the Collaborative Minority Institutions in Alcohol Research Development project at historically black North Carolina Central University, the students taught by E. Joyce Roland, RN, PhD, are 85% African American. Yet she says she’s still met with surprised looks when she shares data showing higher mortality rates for black Americans compared to the white population. “Students hear about this on the news and they know what’s happening in their own family, but when the statistics are put in front of them and they’re staring at health disparity face-to-face, it can be shocking for them,” Roland explains. “Many of them were drawn into nursing because of health problems their family members have, but they often have no idea how widespread these problems are.” Give Them the Facts“The biggest mistake [nursing professors] make in teaching health disparity issues is not sharing scientific data with students,” Underwood believes. She recommends sharing national, state or regional, and local data. By doing so in her classes, she shows students that the gap of unequal health outcomes is not someone else’s problem. Students are able to see the impact the uneven playing field has in their own communities. Edith Ramsay-Johnson, RN, EdD“I try to share the information in such a way that students can see what the challenges are within their own area of influence,” Underwood adds. “I often ask them if they can identify persons from their community who are representative of the data. I ask them to comment on factors that may have influenced [these persons’] states of health. Then I ask them to identify reasons they believe the disparities exist and what nurses can do to effect a change.” This type of data and discussion can be worked seamlessly into lesson plans. Simply share the appropriate health disparity statistics as you go through planned coursework. “In my courses, I try to be more explicit with health disparity information,” says Ramsay-Johnson. She adds that she brought back a great deal of information from Underwood’s workshops that is now incorporated into her lectures. Ramsay-Johnson merges minority health statistics into her third-year medical/surgical nursing courses so that students end the year with an in-depth awareness of the race-based gaps that need to be closed. The course is broken down into two semesters: Fall concentrates on treating young patients while spring focuses on middle-aged and older patients. Discussion about health disparity issues falls into those categories, as well. “I use the statistics relevant to [the types of patients being studied],” Ramsay-Johnson explains. “We might discuss HIV/AIDS and its growing effect on young black women during the first half of the course. High death rates from heart disease and cancer are studied in the second semester.” While you should share data liberally, don’t assume that students are able to fully digest it alone. Underwood says she does occasionally come across students who are unable to interpret statistics, even at the upper-class levels. When introducing your first set of statistics, offer a primer on statistical interpretation and consider making yourself or other resources available for students having problems with data. Fill Your Information ArsenalOf course, to teach data, you must first have it. Chances are, you’ll need to look outside the standard nursing textbooks to find the most current and relevant research on minority health disparities. Underwood calls the IOM study a resource that every nursing instructor should have. “It’s an analysis of a large body of research that looks at health across a spectrum and summarizes the research,” she says. “It shows clearly that even when education and income are the same, the care that is provided to minority patients is not the same.” • Institute of Medicine, www.iom.edu/ • Centers for Disease Control and Prevention (CDC) Office of Minority Health, www.cdc.gov/omh • Office of Minority Health Resource Center, minorityhealth.hhs.gov/ • National Center on Minority Health and Health Disparities, http://www.nimhd.nih.gov/ • National Institutes of Health, www.nih.gov Go Beyond the NumbersWhile statistical data show the science behind minority health disparities, students must also know the reasons for unequal health outcomes and how to work within the health care framework to end them. To accomplish that goal, teach students where and how to find resources available in a community. “If you’re sick and you don’t go to a health care provider, you’re going to get worse,” says Roland. “If you have no insurance or money, you’re going to put off that visit. You may not know that there’s a community health center with a sliding scale or other resources available to help you.” Make It RealOut-of-classroom learning activities are another way to give nursing students hands-on experience in addressing the health care quality divide. Look for opportunities to expose your classes to specific minority health disparities and affected communities through both student projects and clinicals. Ramsay-Johnson works to make sure all of her students are exposed to different populations, even in the seemingly homogenous Virgin Islands. “Look for ways to enrich the experience of your students,” she advises. “Find a variety of experiences to help them see what other groups go through.” For example, she has used films and other class projects as one way to bring a different perspective to her students. Goeppinger recalls a class a few years ago where several students expressed the opinion that minority health disparities would disappear if the affected populations simply took better care of their health. She brought in scientific information showing otherwise and encouraged other students to share their thoughts on the issue. “Faculty members were then able to support students who challenged those [opinions],” she remembers. Find Your ProtégésOf course, one way to add to the body of knowledge on minority health issues is to increase the number of minority nurses involved in research. Educators should always be on the lookout for curious, bright nursing students who could become research stars. When those students show up, it’s vitally important to take the time to offer information, encouragement and mentoring. [ads:education] For Roland, one of the most effective ways of accomplishing this is to provide information about careers in nursing research and explain why it is so important for more nurses of color to become involved. She shares tangible information on how research works, including the funding process. She also encourages students to compete for research opportunities and, if graduate school is not in a student’s plans, to consider jobs related to research that might not require an advanced degree.
Which factors and conditions can lead to health disparities quizlet?Income status, health literacy, education level, ethnicity, and race are all factors or conditions that can contribute to health disparities.
Which factor is the nurse least likely to associate with health disparities among marginalized groups?Rationale: The nurse is least likely to associate self-care with health disparities. Self-care is not a factor that contributes to health disparities among marginalized groups. People in marginalized groups lack access to good quality health care, which predisposes them to health disparities.
Which topic would the nurse include in the discharge plan?A written transition plan or discharge summary is completed and includes diagnosis, active issues, medications, services needed, warning signs, and emergency contact information. The plan is written in the patient's language.
Which of these actions by the nurse is considered the first step in providing culturally competent care?The first step in reducing health disparities and providing culturally competent care is for nurses to assess their own cultural backgrounds, values, and beliefs, especially those related to health and health care. It is not acceptable for the nurse to judge the patient.
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