Leadership and Management CH4

Promoting Equity and Inclusivity

Caring in Nursing

  • Caring: Core concept of nursing involving understanding and connection between nurse and client.

  • ANA Code of Ethics Provision 1: Nurses practice compassion and respect for every person's dignity and uniqueness.

  • Fundamental to Nursing Practice: Caring integrated throughout NCLEX test plans.

    • Defined as respectful and trusting interactions.

    • Nurse provides support and compassion.

Attributes of Caring

  • Sister Simone Roach's Seven Cs of Caring: Illustrates the appearance and behaviors of a caring nurse.

Culturally Congruent Practice

  • Inclusion in ANA Standards (2015): Standard 8 emphasizes practice congruent with cultural diversity.

  • Definition: Applying evidence-based practices aligned with clients' cultural values to reduce health disparities.

  • Cultural Humility: Continuous self-evaluation to address personal bias and healthcare inequities.

    • Develop partnerships with communities for mutual benefits.

Population Trends

  • Demographic Changes: Significant increases in minority and older populations.

    • 2019 Census: Minorities comprise 37% of U.S. population; projected 57% by 2060.

    • Older adults (65+) projected to increase from 16% to 23% by 2060.

  • Federally Defined Minority Groups:

    • Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and other Pacific Islander, Indigenous Peoples and Alaska Native.

Economic and Social Changes

Link to Health Issues

  • Economic Challenges: Increased unemployment, homelessness, and poverty affect minority groups more severely.

  • Mental Health Impact: Problems linked to anxiety, depression, substance abuse, violence.

Access to Opportunities

  • Upper/middle class have better access to education, employment, property ownership compared to minorities.

  • Poverty Rate (2019): Over 12% of the U.S. population affected.

    • Substandard environments perpetuating the cycle of poverty.

Violence and Discrimination

  • Rising violence associated with poverty; young men and women more prone to violence.

  • Attitudes toward cultural diversity vary widely, affecting healthcare delivery.

  • ANA Position Statement (2019): Advocates culturally congruent care for LGBTQ+ populations.

    • Issues of discrimination and societal stigma hinder access to healthcare.

Social Determinants of Health

Definition and Impact

  • Social Determinants: Conditions influencing health inequities; correlate with socioeconomic status.

    • Focus on where people live, work, play, and worship.

  • Five Domains (U.S. Department of Health and Human Services):

    1. Neighborhood and built environment.

    2. Healthcare access and quality.

    3. Social and community context.

    4. Education access and quality.

    5. Economic stability.

WHO Examples Influencing Health Equity

  • Employment/income, education levels impacting accessibility to healthcare.

Addressing Inequities in Health

Call for Systemic Change

  • Research Necessity: Identifying healthcare disparities at local levels through data.

    • Lack of data is a barrier to understanding healthcare inequalities.

  • Nurse Responsibilities: Assessing impact of social determinants and implementing health promotion strategies.

Promoting Equity in Education

Strategies for Nursing Education

  • Diversity Focus: Identifying minority faculty recruitment strategies; cultural mentoring.

  • Empowerment of Nursing Students:

    • Integrate content on social determinants of health across the curriculum.

    • Provide inclusive learning opportunities and identify classroom racism.

    • Support faculty and student diversity in nursing programs.

Enhancing Diversity in Nursing Workforce

Importance of Diversity

  • Diverse workforce crucial for providing culturally competent care.

  • As of 2017, only 19.2% nurses were from minority backgrounds; men at 9.1%.

  • Recruitment of diverse nurses can help fill nursing shortages.

Supportive Practices for Nurses

  • Retention and Employment Trends:

    • Flexible scheduling, better environments, strategic use of resources to enhance working conditions.

    • Educate on implicit bias in hiring processes.

Evidence-Based Practice (EBP)

Definition and Importance

  • EBP: Utilizing current knowledge and research for clinical judgment and client care.

  • ANA Code of Ethics Provision 7: Nurses advance the profession through research and standards development.

Key Components for Nurses

  • Entry-level competencies include:

    • Advancing nursing scholarship.

    • Implementing best evidence into nursing practice.

    • Promoting ethical research conduct.

Strategies for New Nurses

  • Stay current with new evidence from multiple resources.

  • Support interventions with established evidence and clinical guidelines.

Positive Outcomes of Using EBP

Benefits for Healthcare

  • Improved client outcomes, reduced care costs, high-quality delivery.

  • Promote Inquiry: Encourage questioning traditional practices unsupported by evidence.

  • Collaboration: Work with local/global networks to enhance evidence-based decision-making.

Barriers to EBP

Recognizing Challenges

  • Lack of knowledge, support, time, and resources as blockers.

Promoting EBP Effectively

  1. Cultivating inquiry.

  2. Ask clinical questions using PICOT format.

  3. Evaluate evidence validity and applicability.

  4. Measure outcomes of practice changes.

  5. Disseminate findings.

Support and Ethical Practices in Research

  • Ensure environment supportive of evidence-based practices.

  • Institutional Review Boards (IRB) protect the rights of research participants.

  • Informed consent is required for studies to ensure participant understanding of rights.