Leveraging Maslow's Hierarchy of Needs to Build Nursing's More Inclusive Future.

There is growing evidence that nurses have not seen meaningful change because of their employer's diversity, equity, inclusion, and belonging (DEIB) programs. At the same time, efforts are increasing to end DEIB programs and education in academic and work settings. These dynamics present a myriad of challenges negatively impacting any efforts to course correct and progress to build a diverse, inclusive, and pluralistic future. It is critical to urgently address these headwinds and challenges since there is evidence that discriminatory and racist acts germinate in schools of nursing. Almost half (44%) of nurses recently surveyed stated that a culture of racism in nursing schools exists; 60% of Black/African American respondents reported racism/discrimination and nearly 80% believed that more DEIB training was needed. The lack of diversity and inclusion in nursing conflicts squarely with an increasingly diverse and globalized health care consumer base. The overall goal of this article is to leverage a well-embraced framework such as Maslow's Hierarchy of Needs to generate more awareness, understanding, and acceptance of DEIB principles, which directionally sets up a positive future for everyone. Equality, diversity, equity, belonging, mattering, and human flourishing set up a more positive outlook for improved nurse and patient outcomes and for health care overall. With the harms that continue in nursing and society overall, comes emotion and discomfort that must be better understood, distributed, and not quelled. Aligning Maslow's Hierarchy of Needs and DEIB helps leaders recognize the human's needs in everyone and apply Maslow's theory to all therefore increasing inclusiveness.

Health equity: A concept analysis.

BACKGROUND: Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE: Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD: Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS: Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION: Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.

Disruptive Demographics: Their Effects on Nursing Demand, Supply and Academic Preparation.

The nursing profession faces both a labor shortage and a diversity problem. Nine proactive strategies-rooted in the disruptive demographic trends that are transforming our nation-are advanced to address these 2 critical issues.

Confronting the Nursing Profession's Workforce Challenges: Embracing Iceberg Demographics.

U.S. Supreme Court rulings on reproductive rights and affirmative action inadvertently present the nursing profession with a propitious opportunity to capitalize on the nation's rich mosaic of iceberg demographic identities-inherited and acquired traits that may not be visibly apparent-to address imminent challenges such as worker shortages and other perplexities within the workplace milieu.

Critical Race Theory: A Framework for the Re-Education of American Nurses.

The nursing profession has been predominantly white and female since the time of Florence Nightingale. The United States 2020 census revealed a changing demographic landscape in which white people are no longer the majority race; this shift will continue well into the future based on who is having babies. Calls to diversify the nursing workforce and address disparities and inequities in health care continue. Nursing faculty who shape curricula are challenged to create a more inclusive framework to teach students about care. Without focused attention on how to prepare future nurses to care for all people, patient safety and quality of care are at stake. This article suggests using critical race theory as a framework to re-educate American nurses.

The Impact of Racial and Ethnic Health Disparities in Diabetes Management on Clinical Outcomes: A Reinforcement Learning Analysis of Health Inequity Among Youth and Young Adults in the SEARCH for Diabetes in Youth Study.

OBJECTIVE: To estimate difference in population-level glycemic control and the emergence of diabetes complications given a theoretical scenario in which non-White youth and young adults (YYA) with type 1 diabetes (T1D) receive and follow an equivalent distribution of diabetes treatment regimens as non-Hispanic White YYA. RESEARCH DESIGN AND METHODS: Longitudinal data from YYA diagnosed 2002-2005 in the SEARCH for Diabetes in Youth Study were analyzed. Based on self-reported race/ethnicity, YYA were classified as non-White race or Hispanic ethnicity (non-White subgroup) versus non-Hispanic White race (White subgroup). In the White versus non-White subgroups, the propensity score models estimated treatment regimens, including patterns of insulin modality, self-monitored glucose frequency, and continuous glucose monitoring use. An analysis based on policy evaluation techniques in reinforcement learning estimated the effect of each treatment regimen on mean hemoglobin A1c (HbA1c) and the prevalence of diabetes complications for non-White YYA. RESULTS: The study included 978 YYA. The sample was 47.5% female and 77.5% non-Hispanic White, with a mean age of 12.8 ± 2.4 years at diagnosis. The estimated population mean of longitudinal average HbA1c over visits was 9.2% and 8.2% for the non-White and White subgroup, respectively (difference of 0.9%). Within the non-White subgroup, mean HbA1c across visits was estimated to decrease by 0.33% (95% CI -0.45, -0.21) if these YYA received the distribution of diabetes treatment regimens of the White subgroup, explaining ∼35% of the estimated difference between the two subgroups. The non-White subgroup was also estimated to have a lower risk of developing diabetic retinopathy, diabetic kidney disease, and peripheral neuropathy with the White youth treatment regimen distribution (P < 0.05), although the low proportion of YYA who developed complications limited statistical power for risk estimations. CONCLUSIONS: Mathematically modeling an equalized distribution of T1D self-management tools and technology accounted for part of but not all disparities in glycemic control between non-White and White YYA, underscoring the complexity of race and ethnicity-based health inequity.

Entrenched White Supremacy in Nursing Education Administrative Structures.

The National League for Nursing, the American Nurses Association, and the American Association of Colleges of Nursing each have published directives or position statements that support initiatives that would diversify faculty in nursing education; some initiatives very specifically address increasing diversity within nursing faculty leadership ranks. Despite support for these initiatives, there is a lack of faculty members of color in higher-level leadership positions in nursing academia. This article explores two questions that unfold contributing factors. Is the absence of faculty members of color due to historical exclusionary practices of institutional racism? Or is it due to components of internalized racism that may cause faculty members of color to devalue their own potential and ability to rise to leadership roles? Either answer helps explain how entrenched white supremacy continues to be a barrier to diversifying nursing academia. Are we strong enough to dismantle the obstacles to achieving diversity in nursing academic leadership?

Nursing sensitive databases: their existence, challenges, and importance.

The National Quality Forum uses the term "nurse-sensitive" care to describe health care quality that is influenced by nursing. Identifying this type of care requires useful data and development of measures. Establishing a case for nursing-sensitive performance measurement will facilitate a supportive climate for research and measure development. Interdisciplinary investigations will result in more adequate measures and wider acceptance of the measures in the provider community. This article summarizes existing data sources and recommendations for improving measures, data collection, and research on nurse-sensitive care.