Reducing racial and ethnic disparities in healthcare

“Reduction of health disparities and advancement of health equity in the United States require high-quality data indicative of where the nation stands vis-à-vis health equity, as well as proper analytic tools to facilitate accurate interpretation of these data.Although much is understood about the role of social determinants of health in shaping the health of populations, researchers should continue to advance understanding of the pathways through which they operate on particular health outcomes. There is still much to learn and implement about how to measure health disparities, health inequities, and social determinants of health at the national level, and the challenges of health equity persist.”

Penman-Aguilar A, Talih M, Huang D, Moonesinghe R, Bouye K, Beckles G. Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity. J Public Health Manag Pract. 2016 Jan-Feb;22 Suppl 1(Suppl 1):S33-42.

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What are the considerations for experienced nurses transitioning to practice?

“Global workforce shortages and rising healthcare demands have encouraged registered nurses to move into new clinical settings. While a body of literature reports on the transition of newly qualified nurses, evidence surrounding the transition of more experienced registered nurses to new clinical areas remains poorly explored. There is some evidence to highlight the initial shock and emotional stress experienced by registered nurses during transition to a new clinical area. However, the influence of formal and informal support systems for such registered nurses is far from conclusive. Further research is needed, to examine registered nurse transition into a variety of clinical areas to inform workforce support, policy and practices.”

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What factors lead to resilient healthcare teams?

Psychological resilience, “the human ability to adapt in the face of tragedy, trauma, adversity, hardship, and ongoing significant life stressors,”[1] is thought to be a state of internal balance where “we are at our best, able to learn, solve problems, and work effectively with others”, resulting in better patient outcomes, and less employee burnout and turnover.[2]

Leadership techniques for team resilience training have been researched. One study found that managers addressed difficult situations by “facilitating teamwork through goalsetting, problem-solving and circumventing the technical systems’ limitations”, noting that increased team collaboration is supported by “team members’ abilities to predict the behavior of each other.”[3] Other strategies include “those that: a) foster connections within the team; b) provide education and training to develop behaviors that assist in controlling or limiting the intensity of stress, or aiding recovery; and c) assist in processing emotion and learning from experiences.”[4]

Additionally, in workshops, medical residents found greater personal strength from the group experience when they reflected on difficult cases and discussed them as a group, along with reviewing the “4 S’s” of resilience (Supports, Strategies, Sagacity [what wisdom did they gain], and Solutions to the problem).[5]

Resiliency is a factor for team success outside of healthcare as well. A Harvard Business Review survey[6] of 2,000 National Collegiate Athletic Association (NCAA) basketball coaches found that,

The “characteristics of a resilient team are:

  • They believe they can effectively complete tasks together.
  • They share a common mental model of teamwork.
  • They are able to improvise.
  • They trust one another and feel safe.”
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Executive Leadership During COVID-19

Members of the Advisory Board of the Washington, DC-based Nursing Executive Center offer “5 Executive Actions to Engage Staff Amid COVID-19:

  • Ensure that staff are safe and feel safe when working.
  • Reinvigorate your staff input channels and act on what you can.
  • Do not sugarcoat the challenge ahead.
  • Plan for your worst-case scenarios so you do not go back on even one commitment.
  • Transition your leaders from sprint mode to marathon mode.”

Berkow S, Virkstis K, Herleth A, Whitemarsh K, Rewers L. An Executive Strategy to Support Long-Term Clinician Engagement Amid the COVID-19 Pandemic. J Nurs Adm. 2020 Dec;50(12):616-617. doi: 10.1097/NNA.0000000000000946. PMID: 33181597.
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Can donor human milk improve exclusive breastfeeding rates during the birth hospitalization?

“Use of pasteurized donor human milk in the well newborn population has become increasingly common over the last 2 decades. This is in part due to concerns that formula use in the neonatal period is associated with decreased breastfeeding duration as well as concerns about the effect of exposure to formula on infant intestinal microbiota and oxidative stress. In alignment with recommendations by the World Health Organization and the American Academy of Pediatrics , the Joint Commission Perinatal Care Core Measures call for avoiding formula use for breastfed infants during the birth hospitalization but do not discourage the use of DHM. Infants who receive DHM meet the definition of exclusively breast milk fed used by these groups.”

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How can the medical record be used as an effective tool for patient and clinician communication?

“Electronic medical records comprise management of patients’ care, the clinical data repository, order entry and clinical decision suppor. EMRs can contain various components, including patient portals, secure messaging, and computerized physician order entry.”  “Clear communication is important to ensure safe and effective patient care in hospital settings. The adoption of EMRs in hospitals affects the ways in which health professionals communicate with patients and families.”

Manias, E.,et al E. (2020). Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review. International Journal of Medical Informatics., 134, 104036.
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What factors increase successful dental care of ventilated patients?

Dental plaque colonization may be exacerbated in the absence of adequate oral hygiene care in critically ill, mechanically ventilated patients. Dental care is made more difficult due to the presence of the endotracheal tube, which may create:

  • mechanical injury of the mouth or respiratory tract
  • increased likelihood of dry mouth[1]

Using visual research and interviews, oral access and delivery of care for mechanically ventilated patients was analyzed, resulting in the following recommendations.

Recommendations to improve oral access and care delivery.

Dale CM, Angus JE, Sutherland S, Dev S, Rose L. Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study. J Clin Nurs. 2020 Jun;29(11-12):1920-1932. doi: 10.1111/jocn.15014. Epub 2019 Aug 20. PMID: 31342565.
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