Dealing with Health Disparities in Nursing School
Health disparities, like racism, are difficult to discuss. As a health care professional and nursing faculty, I like to spend more time on how my students, the future nurses of America, can help. Health disparities were recently brought to light with the COVID-19 pandemic. The death rates of persons of color, particularly African Americans, were alarming. In Chicago, nearly 70% of COVID-19 deaths were Black people, although they only make up 30% of the population. In Louisiana, 70.5% of deaths have occurred amongst Black people who represent only 32.2% of the population (Yancy, 2020). The list goes on and on.
Health disparities are old news for African Americans. African American women are three or four more times likely to die in childbirth than white women (American Heart Association, 2019). Patients with Sickle Cell Disease in the African American community suffer from being labeled as drug addicts when they seek medication for their excruciating pain. Black women have lower rates of breast cancer incidence yet have 40% higher death rates than white women (Centers for Disease Control and Prevention, 2012).
I was pleased that our current textbook for Medical Surgical Nursing used at Pasadena City College actually addresses attitudes of health care providers, particularly nurses and cited a study where data supported the “need to improve the attitudes of health care professionals caring for individuals with Sickle Cell Disease, particularly nurses” (Hinkle and Cheever, 2018). Many textbooks shy away from these hard facts.
There are, of course, things to look and discuss such as pre-existing conditions and lifestyle, but we, as providers of care, must look at our own trends and actually listen to populations who express feelings of being unheard. I have had the honor to work on a documentary film since August 2019 that deals with African American infant and maternal mortality. We celebrate and hear testimony from amazing Black women and their families from varied socio-economic status who experienced stillborn and maternal death. We also interview Black women who had successful birth outcomes. Their sentiments were all the same: “My doctor did not listen to me when I complained of pain”; “I felt like the more questions I asked, the more they thought I had an attitude or I was bothering them”; “No one listened”; “I kept getting sent home”; “I knew something was wrong, but no one believed me.” High profile Black women such as Serena Williams have expressed the same sentiments. These factors indicate flaws within healthcare and how we deliver it.
I would love to teach nursing like everything is dandy and everyone is treated and cared for in the same manner and given the same amount of attention and seen as quickly and listened to with the same intent, but that feels to me like telling children we live in a perfect world where everything is awesome. All of these factors and sentiments, coupled with social determinants in many (not all) cases, such as residing in higher crime rate areas and less access to healthier foods as well as bias in care, contribute to health disparities.
In the documentary “Birthing While Black,” we are focused on presenting resources and solutions for Black women giving birth. We spotlight community support and doula centers specifically for Black women in areas where they reside.
In my own life and as an African American nursing faculty who lectures to cohorts who are less than 5% African American, it is imperative to teach them to know and present resources to patients. Look at patients in the eye, slow down, and listen. I will never forget the male Caucasian OBGYN I saw back in 2008, who was rushed, not friendly, and not listening to my concerns. He told me I had fibroids because I was “Black and 37 years old.” There actually turned out to be no fibroids, and upon blood test results, the fibroids he was seeing were not fibroids but my now eleven-year-old son.
In the clinical setting, I try to teach nursing students to be nurses who do not make assumptions. It is my job to make sure they are self-aware of any biases they may have that affect the way they deliver care and present ways to be more effective. Being a nurse is demanding enough without health disparities; however, if we are preaching treating patients as a “whole,” we must face and deal with health disparities head on to improve patient outcomes. It is my pleasure to work with my nursing students to improve the future of health care in America.
Resources to learn more on health disparities:
- The Minority Health Project: https://sph.unc.edu/mhp/about-the-minority-health-project-2/
- Black Women for Wellness: www.bwwla.org
- Birthing While Black documentary: https://www.facebook.com/Birthing-While-Black-Movie-105750677843998/
American Heart Association. (2019, February 20). Why are black women at such high risk of dying from pregnancy complications? https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-hig....
Hinkle, J.L., Cheever, K.H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, (14 ed.) Wolters Kluwer.
Centers for Disease Control and Prevention. (2012). Breast Cancer. www.cdc.gov/vitalsigns/breastcancer/index.html.
Yancy, Clyde W. (2020, April 15). COVID-19 and African Americans. JAMA. 2020;323(19):1891–1892. doi:10.1001/jama.2020.6548.
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