Launching the Reduction of Peripartum Racial/Ethnic Disparities Bundle: A Quality Improvement Project.

INTRODUCTION: Health care organizations have a responsibility to reduce racial and ethnic perinatal health disparities. In the United States, Black women experience the worst perinatal outcomes. The process for successfully addressing this problem in clinical practice remains unclear. PROCESS: A community hospital implemented components of the Alliance for Innovation on Maternal Health Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle. The purpose was to collect and share perinatal disparities data, increase staff awareness of perinatal racial and ethnic disparities, and engage staff to address these disparities at the project site. Perinatal care data were reviewed by race and ethnicity and results were shared with staff. Staff were engaged through a series of activities including a Health Equity Party, implicit bias workshop, Snack and Learn sessions, online modules, 2 grand rounds, and the establishment of a Health Equity Committee. OUTCOMES: Racial and/or ethnic disparities were identified for perinatal outcomes and experience of care indicators including rates of cesarean birth, newborn mortality, and 30-day readmission. Of the staff 137 (65.9%) participated in project activities. The majority of participants were registered nurses (n = 82). Certified nurse-midwives (n = 10) were the profession with the highest rate of attendance (83.3%). Staff developed 26 new recommendations to address racial and ethnic disparities in care. After project implementation, mean scores of High Provider Attribution, an indicator of readiness to address health disparities, increased from preimplementation scores (P = .01). There was also a significant increase in the number of staff who reported engaging in activities to address the health care needs of racial and ethnic minority patients (P < .001). DISCUSSION: This quality improvement project demonstrated that interventions at the health care organization level can be effective in influencing health care providers and staff to address racial and ethnic perinatal disparities.

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?

Revolutionizing the Nursing Curriculum.

There have long been challenges associated with integrating knowledge about diversity, disparities, and determinants into nursing curricula. Villarruel, Bigelow, and Alvarez describe these concepts as the three Ds about issues of disconnects and discrimination. These disconnects are evidenced by years of communicating the desire to reduce or eliminate disparities, without improvement in the education of future nurse professionals to prepare them to help achieve this goal. Over 10 years ago, Allen reviewed the literature on evidence to guide teaching on cross-cultural care and antiracism in nursing education, yet very little has changed. It is essential that academic nursing weaves health equity concepts throughout all programs, and establishes and maintains competency in and commitment to addressing health disparities, inequalities, and inequities. This article provides evidence of continued bias and racism, and suggestions for curricular change and student and educator training, in order to rebuild and solidify a nursing curriculum that is nonbiased and inclusive. The suggestions include a deeper look at the structures of the organization and the systemic culture, to ensure that racism is being combated as well.

Strategies to Address Individual Level Social Determinants of Health Designed to Cultivate the Next Generation of Minority Nurse Leaders Committed to Health Equity.

In response to the need for increased racial and ethnic diversity in the nursing profession, the Duke University School of Nursing (DUSON) established the Academy for Academic and Social Enrichment for Leadership Development in Health Equity (Health Equity Academy). The aim of the Health Equity Academy is to improve the diversity of the nursing workforce by expanding nursing education opportunities for underrepresented minority (URM) students who are economically disadvantaged to prepare for, enroll in, and graduate from the DUSON's Accelerated Bachelors of Science in Nursing program. The goal of this program is to cultivate URM nursing graduates with advanced knowledge and leadership skills who can address health disparities and positively influence health care issues currently plaguing underrepresented populations. The article discusses the Health Equity Academy framework, which consists of two unique components: the Pre-entry Immersion in Nursing and the Pathway to Success in Nursing (PSN). These two components are designed to address the nursing student individual level social determinants which could be potential barriers to success as well as provide support in their academic and professional development goals.

Beginning with the end in mind: cultivating minority nurse leaders.

In response to the need for increased racial and ethnic diversity in the nursing profession, the Duke University School of Nursing (DUSON) established the Making a Difference in Nursing II (MADIN II) Program. The aim of the MADIN II Program is to improve the diversity of the nursing workforce by expanding nursing education opportunities for economically disadvantaged underrepresented minority (URM) students to prepare for, enroll in, and graduate from the DUSON's Accelerated Bachelors of Science in Nursing program. Adapted from the highly successful Meyerhoff Scholarship Program model, the program is to cultivate URM nursing graduates with advanced knowledge and leadership skills who can address health disparities and positively influence health care issues currently plaguing underrepresented populations. The article discusses the MADIN II framework consisting of four unique components: recruitment of students, the Summer Socialization Nursing Preentry Program, the Continued Connectivity Program, and the Succeed to Excellence Program, providing a framework for other academic programs interested in cultivating a pipeline of minority nurse leaders.

Relationship of neonatal treatments with the development of necrotizing enterocolitis in preterm infants.

BACKGROUND: Although many therapeutic interventions are necessary for the survival of the preterm infant, understanding the potential effects of these treatments is important to decrease the rate of necrotizing enterocolitis (NEC) in preterm infants. OBJECTIVE: The aim of this study was to examine the relationship between preterm infant treatments administered prior to the development of NEC, specifically the number of packed red blood cell (PRBC) transfusions, weeks of antibiotic therapy for nosocomial infection, and number of mechanical ventilation days, and the development of NEC in preterm infants. METHODS: A retrospective cohort controlled study design examining 4 years of raw data of preterm infants between the gestational ages of 23 and 30 6/7 weeks was used. Of the 549 infants, there were 65 cases of NEC. Using logistic regression, the relationship between NEC and PRBC transfusions administered prior to NEC, number of mechanical ventilation days prior to NEC, and number of weeks of antibiotic therapy for nosocomial infections experienced prior to NEC (proxy for nosocomial infection) were examined. RESULTS: Preterm infants from 23 to 30 6/7 weeks who developed NEC experienced significantly more PRBC transfusions and more weeks of antibiotic therapy for nosocomial infection prior to the development of NEC than did infants who did not develop NEC. There was no relationship between mechanical ventilation days and the development of NEC. DISCUSSION: Future research should focus on causal relationships between NEC and PRBC administration and the reduction of nosocomial infections in preterm infants to minimize risk for NEC in this population.