Intentionality in reducing health disparities: Caring as connection

Abstract

Objective Inadequate health care quality may contribute to Native American health disparities through racial/ethnic discrimination by health care professionals. Nursing approaches to relationships and caring offer a means to understand health disparities through an unconventional lens. The study objective was to examine health disparities within the context of patient/nurse relationships. Design A descriptive‐qualitative method guided data collection and analysis. Eleven nurses who serve Native Americans were interviewed. They described attitudes, meaningful relationships, and nurse leadership. Results Nurses discussed their perceptions of and experiences with Native American patients. Four themes emerged: shared patient/nurse values, patient‐centered care, external forces, and stereotype‐driven care. Conclusions Are we ready for the challenge to advocate for, build, and sustain organizational structures that support caring relationships? Implications for public health nursing include being intentional about recognizing implicit biases and ethnocentrism; examining nurses’ complicit roles in perpetuating racism; and developing mechanisms to collectively advocate for improved Native American health.

What Native Americans want nurses to know: Attitudes and behaviors desired in client/nurse relationships

“…Native American participants valued and acknowledged the nursing roles of advocacy, support, and advice. This is consistent with research findings indicating that nurses who work with Native American clients report the importance of shared patient-nurse values, for example, connecting and advocacy, in the context of Native American health (Purtzer & Thomas, 2019). Clearly, both Native Americans and nurses express value for advocacy.…”

“…Nurses can enrich cultural competence by connecting at the point-ofcare through authentic relationships and focusing on patient's guidance and shared learning. Participant suggestions are supported by research that revealed the need for cultural-competence education that focus on nurse awareness, critical self-reflection, implicit bias and deeply held assumptions, and racism (Purtzer & Thomas, 2019).…”

“…Health disparities are due in part to discrimination in the delivery of health services. Nurses describe difficulties providing culturally competent care within the context of relationships with Native American clients (Purtzer & Thomas, 2019). The intent of culturally competent care is challenged by external forces (e.g.…”

The perspectives of health professionals and patients on racism in healthcare: A qualitative systematic review

“…Furthermore, some healthcare providers concurred that they viewed minorities as more intimidating due to their appearance which limited their effort to engage with them or offer therapy [ 8 , 42 ]. They acknowledged their failure to understand the differing needs of minority patients to administer individualized care [ 8 , 35 , 36 , 40 ]. Instances of overt racism were also reported by providers who observed that racial minorities were sometimes referred to using racially derogatory labels [ 47 ].…”

“…Providers frequently labelled minority patients as less compliant with treatment and felt that they lacked ownership over their health [ 27 , 35 , 43 , 45 ]. These providers tended to blame health disparities [ 27 , 36 , 45 ], or unsuccessful treatments [ 41 ], on minority patients’ poor behaviours, instead of unequal treatment arising from racism [ 35 ]. Some providers stated that they treated all patients equally [ 33 , 36 ], while others perceived minority patients to be oversensitive, holding the view that these patients misinterpret innocent health encounters as racist due to their past experiences of racism [ 26 , 43 ].…”