DEI & Health Equity Week 6

Learning Outcomes By the end of this session, students will be able to: • Describe diversity as human difference within and across people, families, and communities. • Differentiate equality, equity, inclusion, health disparity, and health equity. • Explain how social determinants of health shape health opportunities and outcomes. • Recognize how bias, stereotyping, discrimination, and communication barriers can affect nursing care. • Identify beginning nursing actions that support respectful, person centered, and equitable care.

Diversity

human differences are present and recognized, including differences in identity, background, experience, perspective, and circumstance

Equity

people receive the resources, access, support, and opportunities they need to have a fair opportunity to achieve optimal health

Inclusion

people are respected, valued, supported, and able to participate meaningfully in decisions about their health and care

Equality (Differences from Equity)

receives the same resources or service

Equality vs Equity nursing example

Equality is giving every patient the same written discharge sheet. Equity is providing information in the patients preferred language and format, using a qualified interpreter, and confirming understanding with teach back

Why equitable care is not identical care

Same does not always mean fair when people begin with different needs, barriers, or opportunities. Equity asks what does this person need to have a fair opportunity for health

From Difference to Disparity to Equity pathway

Human difference leads to social and structural conditions, which lead to health care experiences, which lead to health outcomes, which lead to equitable action

What a measured disparity tells us

outcomes differ between groups

The Five SDOH Domains

economic stability, education access and quality, health care access and quality, neighborhood and built environment, social and community context

Economic Stability SDOH domain

employment, income, expenses, debt, food security

Education Access and Quality SDOH domain

early childhood education, literacy, higher education, language

Health Care Access and Quality SDOH domain

insurance, provider availability, health literacy, quality of care

Neighborhood and Built Environment SDOH domain

housing, transportation, safety, walkability, food and water access

Social and Community Context SDOH domain

social support, community engagement, discrimination, stress

Health disparity definition

measurable difference in health that exists between specific population groups, according to NIMHD

What a health disparity does NOT tell us

it does not by itself establish the cause

Health disparities 5 multilevel all interact to influence health outcomes

individual, interpersonal, health care, community, and society or policy levels

Stereotype

generalized belief or assumption about members of a group that can cause us to overlook the individual person

Bias

attitudes or associations that can influence perception, judgment, communication, and decisions

Discrimination

unfair treatment or disadvantage based on identity or group membership, occurring in interpersonal encounters and through systems or policies

Nursing response to bias and stereotyping

notice assumptions, seek the patients perspective, use objective data, communicate respectfully, question inequitable patterns

Intersectionality

person experiences overlapping identities, social conditions, barriers, and strengths at the same time, not one at a time

Communication is an Equity Issue: (4)

language access, health literacy, accessibility, respectful inquiry

Language access as an equity issue

use qualified medical interpreters when needed

Health literacy as an equity issue

use plain language, small amounts of information, and teach back
(avoid judging literacy by education or appearance)

Accessibility

ask what communication supports are needed, consider hearing, vision, cognition, mobility, and preferred formats

Respectful inquiry

ask open questions about preferences, beliefs, goals, names, pronouns, family roles, and decision making.

Why teach back matters

Do you understand is a weak assessment of understanding

Cultural humility

an ongoing practice of self reflection and learning

Cultural humility motto

listen first, ask rather than assume, partner rather than prescribe

The Nurses Role in Advancing Equitable Outcomes (6):

assess, listen, adapt, connect, advocate, and evaluate

Assess in the nurses role

ask about needs, strengths, barriers, preferences, and social determinants of health

Listen in the nurses role

center the patients voice and take concerns seriously

Adapt in the nurses role

individualize communication, teaching, and the plan of care

Connect in the nurses role

link patients with interpreters, social work, community resources, and supports

Advocate in the nurses role

speak up when policies, practices, or patterns create avoidable barriers or unequal care

Evaluate in the nurses role

ask whether the plan worked for this patient and whether outcomes are improving

Mr L case key lesson

A patient without a scale who works two jobs and shares a car illustrates how social determinants of health shape a discharge plan

Health equity definition

creating fair opportunities for people to attain their highest possible level of health

Four pillars of equitable health outcomes

access, quality, experience, and outcomes

Access pillar of health equity

people can reach and use needed care

Quality pillar of health equity

care is safe, evidence based, respectful, and responsive

Experience pillar of health equity

people are heard, included, and treated with dignity

Outcomes pillar of health equity

avoidable differences in illness, complications, function, quality of life, and mortality are reduced

Key takeaway on human difference

human difference is normal

Key takeaway on equitable care

equitable care is not necessarily identical care

Person-centered equity question

what matters to you, and what do you need from us to make this plan work