caring for vulnerable populations week 2

Do No Harm (The First Rule Of Medicine)

A principle that emphasizes the importance of avoiding harm to patients during the course of receiving care, extending beyond physical injury to include aspects like dignity and respect. It involves minimizing risks, providing full information, and respecting patients’ autonomy in decision-making processes.

Two Types of Bias Disrupts Principle of “Do No Harm”

Explicit (conscious cognitive shortcut) and Implicit Bias (unconscious cognitive shortcut)

Explicit Bias

Refers to conscious attitudes, beliefs, or stereotypes that influence decisions and actions; is intentional and often manifests into discriminatory behaviors or practices.

Explicit Bias Examples

overly denying care to specific groups or providing unequal treatment bases on race, gender, body size, religion, sexual orientation, etc.

Implicit Bias

refers to the attitudes, beliefs, or stereotypes that influence decisions, actions, and care outcomes without conscious awareness; can be positive or negative.

Where do we start to unlearn our biases?

1. practice self-reflection and cultural humility

2. use data to identify and address disparities

3. evaluate the impact of social determinants of health on patient outcomes

4. commit to ongoing professional development

healthcare disparities

Differences in access to or quality of care and health outcomes between different groups, often based on factors like race, income, or location.

structural inequities

Structural inequities are systemic imbalances in society that create unequal opportunities and outcomes for marginalized groups.

ANA Position Statement

The Nurse’s Role in Addressing Discrimination : practicing and promoting inclusive strategies in practice settings, policy, and advocacy

microaggressions

a subtle but offensive comment or action directed at a minority or other non-dominant group that is often unintentional or unconsciously reinforces a stereotype. A term used for brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative prejudicial slights and insults toward any group.

special features of microaggressions

unintentional, not limited to race, easily dismissed, etc.

microassault

an explicit derogation; verbal / nonverbal; e.g. name-calling, avoidant behavior, purposeful discriminatory actions.

microinsult

communications that convey rudeness and insensitivity and demean a person’s racial heritage or other identity; subtle snubs; unknown to the perpetrator; hidden insulting message to the recipient of non-dominant or minority groups

microinvalidation

communications that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person belonging to particular group

microassault examples

racial epithets and symbols, homophobic / transphobic / ableist / mysogynistic language

microinsult examples

ascription of attributes based on race / gender / national origin / sexual orientation, etc; pathologizing cultural values / communication styles

microinvalidation examples

colorblindness; meritocracy / bootstrap myth; assuming that visible racial / ethnic minorities are foreigners

effects of microaggression

• recognize that most microaggressions are done without ill intent by good people.

• However, impact > intent

• can cause mistrust and alienation

• can undermine efforts for inclusiveness and feelings of belonging

• can affect self esteem and self-worth

• can reinforce internalized bigotry

• individual instances seem harmless, but studies suggest that a lifetime of these slights can have adverse impacts on mental and physical health

microaffirmations

conscious actions that one can take in order to make the people around the mfeel welcomed, included, and engaged; Can be behavioral; can be environmental