Nursing student perceptions of racism and health disparities in the United States: A critical race theory perspective.

BACKGROUND: Limited research has been done on nursing students' awareness of racial disparities and their readiness to address bias and racism in clinical practice. PURPOSE: This study investigated nursing students' perceptions of how racial disparities affect health outcomes, including maternal outcomes, in the United States. METHODS: Interpretive description was used and supported by the critical race theory as a framework to guide the data collection, analysis, and interpretation to understand participants' perceptions surrounding racism and health disparities. DISCUSSION: Nurse educators should guide students to look beyond individual behavioral and risk factors and consider systemic issues as a leading contributors to health disparities. CONCLUSION: The most critical finding was the lack of participants' understanding of systemic racism and its impact on health disparities. While they often attributed racial disparities to low socioeconomic status and lack of education, they did not understand the relationships between social determinants of health and systemic racism.

Communication Between Pregnant People of Color and Prenatal Care Providers in the United States: An Integrative Review.

INTRODUCTION: Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected, and ignored. The purpose of this integrated review was to identify studies that examined communication between pregnant people of color and their prenatal care providers and evaluate the factors and outcomes arising from communication. METHODS: We searched the PubMed, Embase, CINAHL, and PsychINFO databases for studies published between 2001 and 2023. Articles were eligible for inclusion if they reported on primary research conducted in the United States, were written in English, and focused on patient-provider communication with a sample that included pregnant people of color, defined as those who self-identified as Black, African American, Hispanic, Latina/x/e, Indigenous, American Indian, Asian, Asian American, Native Hawaiian, and/or Pacific Islander American. Twenty-six articles were included in the review. Relevant data were extracted and compiled into an evidence table. We then applied the rating scale of the Johns Hopkins Evidence-Based Practice model to assess the level of evidence and quality of the studies. Themes were identified using a memoing technique and organized into 3 a priori categories: factors, outcomes, and recommendations. RESULTS: Two overarching themes emerged from our analysis: racism/discrimination and unmet information needs. Subthemes were then identified as factors, outcomes, or recommendations. Factors included provider behaviors, language barriers, structural barriers, provider type, continuity of care, and fear. Outcome themes were disrespect, trust, decision-making power, missed appointments, and satisfaction with care. Lastly, culturally congruent care, provider training, and workforce development were categorized as recommendations. DISCUSSION: Inadequate communication between prenatal care providers and pregnant people of color continues to exist. Improving access to midwifery education for people of color can contribute to delivering perinatal care that is culturally and linguistically aligned. Further research about digital prenatal health communication is necessary to ensure equitable prenatal care.

What nursing chooses not to know: Practices of epistemic silence/silencing.

Drawing from a keynote panel held at the hybrid 25th International Philosophy of Nursing Conference, this discussion paper examines the question of epistemic silence in nursing from five different perspectives. Contributors include US-based scholar Claire Valderama-Wallace, who meditated on ecosystems of settler colonial logics of nursing; American scholar Lucinda Canty discussed the epistemic silencing of nurses of colour; Canadian scholar Amelie Perron interrogated the use of disobedience and parrhesia in and for nursing; Canada-based scholar Ismalia De Sousa considered what nursing protects in its silences; and Australian scholar Janice Gullick spoke to trans invisibility in nursing.

Beyond "patient-provider race matching." Black midwives clarify a vision for race-concordant care to achieve equity in Black perinatal health: A commentary on "Do Black birthing persons prefer a Black health care provider during birth? Race concordance in birth".

Racial concordance has been identified as a potential strategy to improve the perinatal health of Black women and birthing people by mitigating implicit bias and improving mutual trust, healthy communication, and satisfaction. In a recent article published in BIRTH: Issues in Perinatal Care, Bogdan-Lovis et al. surveyed 200 Black women to determine whether they possessed a race and gender practitioner preference for their birth practitioner and examined whether race and gender concordance was associated with greater birth satisfaction and perceived respect, trust, practitioner competence, empathy, and use of inclusive communication. In this commentary, written by a group of Black midwives, we respond to the study and offer a vision for race-concordant care that encompasses cultural safety provided in a community-based setting.

Decolonizing nursing education and research to address racial disparities in maternal health.

PURPOSE: In this paper, we discuss the need to move beyond theoretical explorations of social determinants of health (SDoH) to addressing systemic racism and its effect on Black maternal health outcomes. We also address the importance of connecting nursing research, education and practice and offer suggestions on how to transform the teaching, research and clinical practice specific to Black maternal health. KNOWLEDGE DEVELOPMENT: A critical analysis of current Black maternal health teaching and research practices in nursing informed by the authors' experience in Black/African diasporic maternal health and reproductive justice. DISCUSSION: There is a need for nursing to be more intentional in addressing the effects of systemic racism on Black maternal health outcomes. In particular, there is still a substantial focus on race rather than racism as a risk factor. The focus on racial and cultural differences rather than systems of oppression continues to pathologize racialized groups while failing to address the impact of systemic racism on the health outcomes of Black women. CONCLUSION: Using a social determinant of health framework to examine maternal health disparities is useful; however, focusing on SDoH without challenging systems of oppression producing these disparities does not produce substantial changes. We suggest adding frameworks grounded in intersectionality, reproductive and racial justice and moving beyond biological assumptions about race that pathologize Black women. We also recommend a deliberate commitment to reshaping nursing research and education to centre anti-racist and anti-colonial practices that value community knowledge and practices. NO PATIENT OR PUBLIC CONTRIBUTION: The discussion in this paper is based on the author's expertise.

Decolonizing nursing through the lens of Black maternal health.

In the United States, there is a long history of racial disparities in maternal health, with Black women disproportionately representing poor maternal health outcomes. Black women are three to four times more likely to die from a pregnancy-related complication and twice as likely to experience severe maternal morbidity when compared to white women. Where are nurses in the development of knowledge to improve maternal health outcomes among Black birthing people? This dialogue discusses how decolonizing nursing can occur by examining the history of Black maternal health in the United States and using the works of nursing scholars of color to inform nursing education, research, and clinical practice.

What nurses of color want from nursing philosophers.

Scholars of color have been instrumental in advancing nursing knowledge development but find limited spaces where one can authentically share their philosophical perspective. Although there is a call for antiracism in nursing and making way for more diverse and inclusive theories and philosophies, our voices remain at the margins of nursing theory and philosophy. In nursing philosophy, there continues to be a lack of racial diversity in those who are given the platform to share their scholarship. Five nurse scholars of color attended the International Nursing Philosophy Conference in August 2022. We established a collective system of support by sharing our experiences as researchers, scholars, and educators with each other. The theory of emancipatory nursing praxis informed this process. In this dialogue, we reflected on what it is like to present at and attend predominantly white nursing conferences. We shared our experiences of how we exist as nurse scholars, our philosophical views, and our thoughts on how we create spaces where scholars of color can feel welcomed and acknowledged for their contributions to advancing nursing knowledge.

Global mental health experiences of single mothers: A mixed methods research synthesis.

AIM: The aim of this research is to synthesize findings from primary studies (quantitative and qualitative) that investigated the global mental health experiences of single mothers to provide a deeper understanding to better care and respond to the support needs of single mothers. DESIGN: Hayvaert et al.'s mixed methods research synthesis approach. DATA SOURCES: The search process in the following databases, CINAHL, PsycINFO, and Scopus resulted in eight high-quality studies (5 qualitative and 3 quantitative) published between June 2016 and July 2021. REVIEW METHODS: Descriptive statistics and instrument scores were provided in summary form. Themes were analysed using Krippendorff's content analysis. A joint display was provided to reveal a complementary relationship between two different data sets. RESULTS: A total of 348 single mothers participated. Amongst the pooled sample, women identified as: Japanese (n = 174), Israeli (n = 147), Black African (n = 18), African American (n = 9), Native American (n = 5), Burundian-Australian (n = 8), UK British (n = 12), Asian (n = 3), South Korean (n = 7), Indian (n = 2), Malaysian (n = 44), Hispanic/Latina (n = 1) and Eastern European (n = 3). Four themes were identified: (1) Learning to let go of the past, (2) It takes a whole village: Importance of social support, (3) Seeking a self-reliant life: Challenges with balancing career & childcare and (4) Finding strength within: Personal growth. Only one intervention utilizing creative group counselling was found to significantly decrease depression (p = .008), anxiety (p = .005), and stress (p = .012) whilst increasing self-compassion (p = .013). CONCLUSION: It is important for clinicians who care for single mothers, particularly if they recently immigrated, are multiparous, and an ethnic minority to encourage engagement in peer-initiated counselling and obtain mental health care as necessary. IMPACT: This study identified and addressed the mental health issues that single mothers face worldwide. This is also the first mixed methods research synthesis to report single mothers' ethnicity in nursing and midwifery literature. Thus, findings from this mixed methods research synthesis can help nurses worldwide build culturally-concordant programs in their respective community organizations and partners (e.g. community health centres, mother-child enrichment clubs), inform health policies, and promote safer spaces for many single mothers, particularly for those who will immigrate to the Global North (i.e. UK, US, Canada) and become an ethnic minority.

An Overdue Reckoning on Racism in Nursing.

ABSTRACT: In response to the killing of George Floyd on May 25, 2020, and with a sense of urgency, the authors created and conducted a unique approach-a reckoning-to confronting racism in nursing. The project began with a series of five online discussions centering on the voices of nurses of color, followed by further ongoing discussions aimed at building antiracist capabilities for all participating nurses. This article describes the implementation and early outcomes of the project and provides its underlying principles, which are based on insights from activists and scholars whose work has focused on antiracist guidelines.

The lived experience of severe maternal morbidity among Black women.

Black women are 3-4 times more likely to die from a pregnancy-related complication and twice as likely to experience severe maternal morbidity when compared to white women in the United States. The risks for pregnancy-related maternal mortality are well documented, yet Black women's experiences of life-threatening morbidity are essentially absent in the nursing literature. The purpose of this interpretive phenomenological study was to understand the experiences of Black women who developed severe maternal morbidity. Face-to-face, one-to-one, in-depth conversational interviews were conducted with nine Black women who experienced life-threatening complications during childbirth or postpartum. Five essential themes emerged (1) I Only Know What I Know; (2) How You Cared for Me; (3) Race Matters; (4) Faced with Uncertainty; and (5) Still Healing. These themes illuminate the complexity of Black women's subjective interpretations of severe maternal morbidity, and reveal ways in which racism, not race, places Black women at risk for poor maternal health outcomes. The author envisions greater equity for Black mothers entrusted to nursing care, guided by nursing theories informed by these study findings.

Educational outcomes of an online educational intervention teaching cultural competency to graduate nursing students.

Cultural competency has become an increasingly important learning outcome for advanced practice nursing students. Yet, despite a broad focus on teaching these skills, learning outcomes and student experiences. The purpose of this study was to describe the learning outcomes of a brief educational intervention used to teach cultural competency online to post-graduate students completing their master's degrees. A qualitative descriptive approach was used to analyze data obtained through course activities using Leininger's Sunrise Enabler to conduct a cultural assessment in a 15-week online course. It was found that Leininger's enabler has relevance in the online classroom and can be used to teach students to improve their knowledge, awareness, and ability to promote health through addressing culturally contextualized information. While it can be challenging to create meaningful online learning experiences, they can help improve patient-provider communication and provide opportunities for students to improve their clinical competence.