Understanding Racism as a Historical Trauma That Remains Today: Implications for the Nursing Profession

2021 ◽  
Vol 27 (1) ◽  
pp. 19-24
Author(s):  
Roberta Waite ◽  
Deena Nardi
Keyword(s):  
Nursing Students ◽  
White Supremacy ◽  
Code Of Ethics ◽  
Health Care Systems ◽  
Racial Diversity ◽  
Historical Trauma ◽  
The United States ◽  
Nursing Profession ◽  
Starting Point ◽  
Care Systems

In order to promote health equity and support the human rights mandate contained in the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements, the nursing profession must understand historically the creation of race, white supremacy in the United States, and entrenched racial terror and brutality toward black and brown racialized populations. Considering the limited racial diversity in the nursing profession despite its stated mission to increase diversity, the profession must build a path to understanding antiblack racism as a historical trauma that remains to this day, a path that encompasses antiracist ideology. Antiracism education is critically needed at the pre-professional and professional levels, for nursing students, providers, educators, administrators, and researchers to inform our own understanding of bias within the contexts of our educational and health-care systems. Dismantling racism requires an enduring commitment to the ultimate goal of social justice for ourselves, our patients, and our communities. This article presents antiracism actions that nurses should employ to dismantle racism, focusing primarily on personal-level initiatives, with self-work as the starting point.

Evaluating the Impact of a North American Nursing Exchange Program on Student Cultural Awareness

2011 ◽  
Vol 8 (1) ◽  
Author(s):  
Alice F. Kuehn ◽  
Andrea Chircop ◽  
Barbara Downe-Wamboldt ◽  
Debbie Sheppard-LeMoine ◽  
Lucille Wittstock ◽  
...  
Keyword(s):  
Nursing Students ◽  
North American ◽  
Cultural Awareness ◽  
Health Care Systems ◽  
The United States ◽  
Nursing Programs ◽  
Exchange Program ◽  
Effective Teaching Strategies ◽  
Care Systems ◽  
The Impact

As the demand for cultural awareness in the provision of nursing care continues to increase, nursing programs must develop creative and effective teaching strategies and curricula to address this need. The evaluation of a five year, funded, North American nursing exchange project developed and implemented by six partner universities in Canada, Mexico and the United States of America is described in this article. The project was designed to enable nursing students to increase cultural awareness, redefine their role relationships with nurses from the partner countries, and increase knowledge regarding the health care systems and role of the nurse in those countries. Findings provide evidence that teaching nursing through a prism of cultural awareness, using both a jointly taught online course and student and faculty exchanges across the three countries is an effective strategy to increase the level of cultural awareness in nursing students.

A Call for Healing: Transphobia, Homophobia, and Historical Trauma in Filipina/o/x American Activist Organizations

Hypatia ◽  
2017 ◽  
Vol 32 (3) ◽  
pp. 696-714 ◽  
Author(s):  
Karen B. Hanna
Keyword(s):  
Interpersonal Violence ◽  
White Supremacy ◽  
Historical Trauma ◽  
Intergenerational Conflict ◽  
The United States ◽  
Acting Out ◽  
Economic Survival ◽  
Geographical Space ◽  
Personal Trauma ◽  
Activist Organizations

I argue that for those who migrate to other countries for economic survival and political asylum, historical trauma wounds across geographical space. Using the work of David Eng and Nadine Naber on queer and feminist diasporas, I contend that homogeneous discourses of Filipino nationalism simplify and erase transphobia, homophobia, and heterosexism, giving rise to intergenerational conflict and the passing‐on of trauma among activists in the United States. Focusing on Filipina/o/x American activist organizations, I center intergenerational conflict among leaders, highlighting transphobic and homophobic struggles that commonly arise in cisgender women majority spaces. I contextualize these struggles, linking them to traumas inherited through legacies of colonialism, feudalism, imperialism, hetero‐patriarchy, capitalism, and white supremacy. I inquire: how does historical and personal trauma merge and shape activist relationships and conflict, and what are activists doing to disrupt and work through historical trauma? I advocate for a decolonizing approach for “acting out” and “working through” trauma and healing collectively. By exploring conflict in organizations shaped by dominant Filipino nationalist ideologies, I resist romantic notions of the diaspora. Revealing the ways that dominant Filipino nationalism perpetuates a simultaneous erasure of nonnormative histories and bodies and epistemological and interpersonal violence among activists, I reject homogeneous conceptions of nationalism and open up possibilities for decolonial organizing praxis.

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

2010 ◽  
Vol 28 (27) ◽  
pp. 4149-4153 ◽  
Author(s):  
Scott R. Berry ◽  
Chaim M. Bell ◽  
Peter A. Ubel ◽  
William K. Evans ◽  
Eric Nadler ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Systems ◽  
The United States ◽  
Drug Costs ◽  
Cancer Drug ◽  
Cancer Drugs ◽  
Care Systems ◽  
Effective Treatments

Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy. Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared. Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Accounting for the Rising Caesarean Section Rate in Canada: What Are the Roles of Changing Needs, Practices, and Incentives?

2021 ◽  
Author(s):  
Michael Baker ◽  
Maripier Isabelle ◽  
Mark Stabile ◽  
Sara Allin
Keyword(s):  
Caesarean Section ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Caesarean Section Rate ◽  
The United States ◽  
World Health ◽  
Strong Increase ◽  
Primary Determinant ◽  
Care Systems ◽  
Health Organization

In most high-income countries, including Canada, the share of births by Caesarean section (C‑section) has risen over the past decades to far exceed World Health Organization recommendations of the proportion justified on medical grounds (15 percent). Although unnecessary C-sections represent an important cost for health care systems, they are not associated with clear benefits for the mother and the child and can sometimes represent additional risks. Drawing on administrative records of nearly four million births in Canada, as well as macro data from the United States and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the main factors brought forward in the policy literature, including changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994–2011 occurred in the early 2000s. We suggest that some event or shock in the early 2000s is likely the primary determinant of the recent strong increase in the C-section rate in Canada.

scholarly journals Assessing COVID-19 Risk, Vulnerability and Infection Prevalence in Communities

2020 ◽  
Author(s):  
Amin Kiaghadi ◽  
Hanadi S. Rifai ◽  
Winston Liaw
Keyword(s):  
Health Care Systems ◽  
Principal Component ◽  
The United States ◽  
Infection Prevalence ◽  
Planning Tool ◽  
Harris County ◽  
Census Tracts ◽  
Medical Interventions ◽  
County Population ◽  
Care Systems

AbstractBackgroundThe spread of coronavirus in the United States with nearly one million confirmed cases and over 53,000 deaths has strained public health and health care systems. While many have focused on clinical outcomes, less attention has been paid to vulnerability and risk of infection. In this study, we developed a planning tool that examines factors that affect vulnerability to COVID-19.MethodsAcross 46 variables, we defined five broad categories: 1) access to medical, 2) underlying health conditions, 3) environmental exposures, 4) vulnerability to natural disasters, and 5) sociodemographic, behavioral, and lifestyle factors. We also used reported rates for morbidity, hospitalization, and mortality in other regions to estimate risk at the county (Harris County) and census tract levels.AnalysisA principal component analysis was undertaken to reduce the dimensions. Then, to identify vulnerable census tracts, we conducted rank-based exceedance and K-means cluster analyses.ResultsOur study showed a total of 722,357 (~17% of the County population) people, including 171,403 between the ages of 45-65 (~4% of County’s population), and 76,719 seniors (~2% of County population), are at a higher risk based on the aforementioned categories. The exceedance and K-means cluster analysis demonstrated that census tracts in the northeastern, eastern, southeastern and northwestern regions of the county are at highest risk. The results of age-based estimations of hospitalization rates showed the western part of the County might be in greater need of hospital beds. However, cross-referencing the vulnerability model with the estimation of potential hospitalized patients showed that part of the County has the least access to medical facilities.ConclusionPolicy makers can use this planning tool to identify neighborhoods at high risk for becoming hot spots; efficiently match community resources with needs, and ensure that the most vulnerable have access to equipment, personnel, and medical interventions.

scholarly journals Η επίδραση του θεσμικού, πολιτικού και διοικητικού περιβάλλοντος στη μεταρρύθμιση του τομέα της υγείας στην Ελλάδα, 1950-2005

2013 ◽  
Author(s):  
Ηλίας Γορανίτης
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Health Care Systems ◽  
Implementation Process ◽  
The United States ◽  
International Experience ◽  
Health Care Reforms ◽  
Care Systems ◽  
Veto Points ◽  
Theories Of Change

The Greek NHS, thirty years after its establishment, faces important performance deficiencies. With an ongoing economic crisis placing a further burden, a call for national health care reform is urgent. This doctoral thesis drawing upon (a) political theories of change, (b) institutional, political and administrative developments in Greece as well as (c) international experience, aims to provide a framework, in terms of planning and implementation process, for health care reform in Greece. The existing order of things, in every public policy system, impedes change and forces policies along specific paths, the deviation from which to a new policy paradigm is extremely difficult. The Greek NHS has never deviated from this path indicating the existence of strong interest groups, institutions with high set-up cost and limited political willingness or ability for strategic approach to overcome the ‘veto points’ of the reform in the system. In this thesis the way forward in reforming fragmented and path-dependent health care systems like the Greek NHS has been identified. By addressing big questions such as: How the Greek NHS reached this low performing level? What are the ingredients of a well performing health care system? What factors impede or promote successful reforms? How health care reforms in systems with multiple ‘veto points’ should be implemented? Political science and international experience from Spain, Portugal, Italy, the Netherlands and the United States provide important insights to our study.

Complementary, Alternative, and Integrative Medicine

2019 ◽  
Author(s):  
Helene M. Langevin
Keyword(s):  
Alternative Medicine ◽  
Health Care Systems ◽  
Academic Research ◽  
The United States ◽  
Evidence Base ◽  
Potential Harm ◽  
Therapeutic Massage ◽  
Care Systems ◽  
Potential Benefits ◽  
Alternative Sources

Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Common CAM practices (e.g., acupuncture, meditation, and therapeutic massage) are gradually becoming incorporated into conventional care in response to patients looking to alternative sources for information and advice about health matters and increased understanding of various CAM methods through evidence-based testing. However, although the claims of some methods are supported with academic research, well-founded concerns remain in many popularized CAM practices regarding the lack of evidence and placebo effects. It is thus imperative for physicians to be comfortable in discussing CAM-related topics with patients and be able to appropriately and informatively guide them in a way that harnesses potential benefits and avoids potential harm. In this review, the major CAM therapies in the United States are examined, including the settings in which they are being used, evidence base status, and efficacy of some of the most commonly used modalities.  This review contains 5 figures, 21 tables, and 123 references. Keywords: Alternative medicine, complementary medicine, acupuncture, homeopathy, osteopathy, chiropractic, massage therapy, naturopathy

Inclusive Clinical Practice and Policy for Muslim Nursing Students

2019 ◽  
Vol 31 (1) ◽  
pp. 100-106
Author(s):  
Amanda F. Hopkins ◽  
Wendy Carter Kooken ◽  
Elyse Nelson Winger
Keyword(s):  
Clinical Practice ◽  
Nursing Students ◽  
The United States ◽  
Nursing Profession ◽  
Educational Policies ◽  
Research Articles ◽  
Reasonable Accommodation ◽  
Review Of Literature ◽  
Clinical Experiences ◽  
School Of Nursing

Purpose: Increasing diversity in nursing offers opportunities and challenges. This article addresses considerations for clinical and educational policies when working with Muslim nursing students and suggests changes to facilitate inclusive environments. Approach: This article describes the twofold response of a school of nursing where Muslim nursing students encountered potential limitations in clinical experiences. Faculty conducted a review of literature and examined policies to determine barriers to inclusivity for Muslim nursing students in clinical practice. Outcomes: Few research articles exist to guide construction of inclusive practices. The review of policies for the school of nursing and clinical agencies revealed problematic language and wording that could lead to exclusive practices. Clinical Relevance: For the nursing profession to embrace diversity, faculty must be aware of the discrimination and general lack of knowledge toward Muslim nurses/students in the United States and reasonable accommodation for cultural and religious beliefs.

scholarly journals Initial experiences of US neurologists in practice during the COVID-19 pandemic via survey

Neurology ◽  
2020 ◽  
Vol 95 (5) ◽  
pp. 215-220 ◽  
Author(s):  
Akanksha Sharma ◽  
Christina R. Maxwell ◽  
Jill Farmer ◽  
Diana Greene-Chandos ◽  
Kathrin LaFaver ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
The United States ◽  
Survey Study ◽  
Practice Model ◽  
Safety Measures ◽  
Public Health Emergencies ◽  
Care Workers ◽  
Rapid Changes ◽  
Care Systems

ObjectiveTo test the hypothesis that US neurologists were experiencing significant challenges with lack of personal protective equipment (PPE), rapid changes in practice, and varying institutional protocols, we conducted this survey study. The current coronavirus disease of 2019 (COVID-19) pandemic has caused widespread disease and death. Rapid increases in patient volumes have exposed weaknesses in health care systems and challenged our ability to provide optimal patient care and adequate safety measures to health care workers (HCWs).MethodsA 36-item survey was distributed to neurologists around the United States through various media platforms.ResultsOver a 1-week period, 567 responses were received. Of these, 56% practiced in academia. A total of 87% had access to PPE, with 45% being asked to reuse PPE due to shortages. The pandemic caused rapid changes in practice, most notably a shift toward providing care by teleneurology, although a third experienced challenges in transitioning to this model. Wide variations were noted both in testing and in the guidance provided for the exposed, sick, or vulnerable HCWs. Notably, 59% of respondents felt that their practices were doing what they could, although 56% did not feel safe taking care of patients.ConclusionsResults from our survey demonstrate significant variability in preparedness and responsiveness to the COVID-19 pandemic in neurology, affected by region, health care setting, and practice model. Practice guidelines from professional societies and other national entities are needed to improve protection for physicians and their patients, promote recommended practice changes during a pandemic, and optimize future preparedness for public health emergencies.

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