Palliative care can be equally rewarding and challenging. Patients are navigating the emotional and physical turbulence of terminal illness. The right professional can be instrumental in ensuring patients’ needs are met to make their period of care more comfortable.
So much of who people are impacts their experience of the palliative journey. This includes the nuances of their cultural, racial, and socioeconomic identities. It should be no question, then, that minority nurses are an invaluable resource at this time. Yet, the current state of palliative care suggests that the industry doesn’t quite reflect this.
Let’s explore the intersection of minority identity and palliative care nursing. What are the opportunities for minority nurses, and why are they so vital in addressing the challenges related to this sector?
The Opportunities for Minority Nurses
There’s no question that the medical sector, in general, is in greater need of nurses from various backgrounds. However, it’s also essential to look at the disparities within specializations. The needs of patients taking their palliative care journey suggest that minority nurses can find plenty of opportunities in this field.
The changing demographics of the aging population reflect this. It’s worth noting that there is relatively little research into the racial and ethnic disparities in palliative care staff. Nevertheless, there is some evidence that suggests a need for change. A Journal of Palliative Medicine study reported that over the next 20 years, the population of older minorities is expected to grow by 160%. This is far more than their white counterparts. The same study also cited a bereaved families survey that found “African Americans were less satisfied with the quality of end-of-life care.”
This data tells us there are opportunities for minority nurses to contribute to the specific needs that aren’t being met for the growing population of minority patients who will be seeking palliative care in the future.
Palliative nurse practitioners (NPs): Given the disparities in minority palliative care, there must be greater diversity in care leadership roles. Minority NPs can influence strategic decisions that ensure care plans are more relevant and positive for a broader range of patients.
Palliative educators: Palliative care is an emotionally and technically challenging field. Therefore, it requires skilled educators to guide professionals in developing appropriate medical, cultural, and empathic abilities. Nurses from minority backgrounds have invaluable perspectives to provide here.
Certainly, minority nurses themselves can seek the opportunities and talk to one another about them. However, it’s also important to encourage administrators and industry leaders to engage a diverse range of professionals more actively. This should involve pitching palliative care to minority students and nurses looking to shift careers. There must also be more significant financial and psychological support that makes palliative care a practical and attractive option.
Addressing the Challenges
There are clear opportunities for minority nurses in palliative care. But on a practical level, it’s important to establish what specific challenges these professionals are well-equipped to address. Firstly, this helps nurses better serve patients. But it’s also valuable information that care providers and administrators can use to pitch palliative care to minority nurses who may not have considered specializing in it.
Culturally Relevant Care
Palliative care deals with the end of life. Naturally, various cultural nuances influence this experience. One recent report outlined a significant variety of cultural differences related to the just treatment of pain during palliative care. People’s ethnicities, religious beliefs, and even generational demographics can influence how pain at the end of life is both perceived and managed.
Palliative care doesn’t always occur within hospice facilities. Nurses can also treat patients in their own homes. Patients from different cultural and socioeconomic backgrounds can face challenges related to the areas in which they live. Minority nurses can use community knowledge to identify issues and integrate solutions into care processes.
For instance, patients living in heavily industrialized communities may be subjected to poorer air quality. One study found that Black and Hispanic citizens bear 56% and 63% more air pollution, respectively, than they produce. Nurses with greater familiarity with these communities may better understand the signs of air pollution in the home. These may be environmental changes, like unpleasant odors, or additional medical symptoms, such as coughing and congestion. As a result, minority nurses can respond swiftly with preventions and treatments that improve palliative patients’ comfort.
Knowledge of the Practical Barriers
Let’s face it: Nobody better understands the barriers presented by cultural disparities than those subjected to them. Therefore, minority nurses can be powerful allies in improving the palliative care protocols that give hurdles to both patients and professionals.
A continuous commitment to process improvement is vital in any industry. Regularly assessing protocols reveals inefficiencies, issues with regulatory compliance, and tasks ripe for streamlining. It’s important to involve a greater diversity of nurses in mapping out and analyzing care processes. A team with a broader range of perspectives is more conducive to spotting barriers to good care that a more culturally limited one would miss. This enables a positive collaboration for redesigning processes to meet all patients’ needs.
Palliative care is one of the most challenging medical specializations. It deals with a particularly turbulent time for patients and their families and all the more reason, then, to ensure that culturally, racially, and socioeconomically diverse professionals are leading the way.
Nevertheless, addressing the growing disparities in care for those of minority identity needs immediate action. This is likely to require meaningful collaboration. Minority nurses can actively pursue palliative care and advocate for the systemic changes that make a genuine difference. However, administrators and industry leaders have a role in ensuring sufficient respect, support, and resources to make this a viable and enriching option for nurses.
Nurses are integral to every community, and not just from the perspective of simply providing critical medical services. Your field experiences have likely made it clear to you that you impact patients’ lives through your empathy, social sensitivity, and hard-earned knowledge.
One of the often overlooked areas in which nurses are influential is helping to address injustice, even environmental racism. Given how urgent and potentially destructive the climate crisis is, it’s important to understand better this issue and how nurses can help counter it.
The Consequences of Climate Change
Environmental racism occurs when Black and other traditionally marginalized communities are disproportionately affected by climate change, pollution, and other environmental issues. This counters the traditional concept of environmentalism, which states that everyone is affected by ecological disasters. However, more evidence indicates that marginalized communities get the brunt of these disasters due to systemic injustices, which may affect the public health of these communities.
For instance, fossil fuel companies primarily tend to set up shops near minority communities, with 68% of African Americans living within 30 miles of a coal-fired power plant. Emissions from these plants can result in community exposure to respiratory and other health issues.
However, such wellness challenges are not limited to the better-known respiratory and cardiovascular risks. The climate can impact vision and eye health, too. People living in neighborhoods exposed to pollution can be more likely to experience glaucoma. Indoor pollution is also an issue, with those who may be unable to invest in adequate filtration systems at risk of experiencing long-term eye damage due to exposure to small particulate matter.
Even with these exacerbated health issues, marginalized communities may not receive proper treatment. One recent Pew Research study reported that 63% of Black Americans polled believe that their diminished access to quality medical is one of the reasons behind poorer health outcomes. Even if specific communities have access to medical care, the plethora of climate change-related health concerns places a greater demand on the healthcare system already underserving these communities.
Community Education and Outreach
The consequences of climate change concerning environmental racism are concerning. Indeed, such systemic issues can feel so large that it’s often difficult to see what individuals can do to help. Yet, as a nurse, you can powerfully impact the communities you serve.
One of the most important forms of assistance you can provide is improvements in relevant health literacy for minority communities. Once community members know the impacts of climate change on their health, they can be more empowered to make informed decisions surrounding their care and day-to-day preventative measures. Therefore, it’s essential to ensure patients have data about local negative environmental influences, the potential impacts, and steps they can take to safeguard their health.
This may involve working with local public health services to find the right literature addressing your community’s concerns. You might also consider engaging with community outreach programs. Spending time at community centers, workplaces, schools, and universities can be helpful to forums for education, where you can answer questions concerning this issue.
Collaboration on Change
Unfortunately, health literacy is unlikely sufficient to counter environmental racism alone. As with so many forms of social injustice, meaningful change happens at a systemic level. Your perspectives and insights as a nurse in minority communities can be a powerful contribution if you collaborate with initiatives that reduce ecological inequality.
This may be most effective on a regional level. You can identify local organizations that are dedicated to taking action to address environmental justice. These actions may involve coordinating efforts to provide qualitative data and testimony as supporting evidence of climate-related illness to present to governmental agencies tasked with assigning public health budgets, planning facilities, and creating healthcare policies.
Alternatively, you can offer insights as a medical professional to organizations dedicated to blocking the local introduction of new hazardous industrial businesses. Grassroots organizations like the Mothers of East L.A. have proven successful here. Your assistance can be invaluable as efficacy tends to rely on research and expert testimony.
This isn’t just effective concerning budget assignment and healthcare policy but also in encouraging the adoption of other resources that directly and indirectly affect the environmental connection to health.
For instance, the rise of the digital age has seen the emergence of inventions that can help combat climate change. If local or state governments adopt ambient carbon capture technology to remove carbon dioxide from the air or invest in distributed energy resources (DERs), there’s a chance to mitigate the health issues that disproportionately impact minority communities. As a nurse, you could play an influential role in representing the medical importance of these tools to local government decision-makers. Advocate for how climate-protecting technology makes a difference in community health and could reduce pressure on care resources.
Nurses may not always think about environmental racism in their daily routines, but it’s a hidden undercurrent in the healthcare system. Nurses have a profound potential to stop this injustice before it worsens.
It’s essential to be mindful of taking everything on your shoulders. Nurses already face a lot of pressure and often unrealistic expectations. When engaging in this social issue, seek support from colleagues, administrators, and community leaders.
Nurses face various challenges in their day-to-day activities, and one of the most prominent currently is the ongoing healthcare staff shortage. The shortage creates greater stress for nurses but can also affect patient outcomes, workplace safety, and meaningful career growth.
Administrators and industry leaders must commit to meaningful systemic changes to address the issue. However, nurses’ commitment to helping one another throughout this crisis is also essential. By offering support, guidance, and insights in key areas, nurses can empower one another to thrive throughout these challenges.
Communicate About the Causes
It is likely to be clear to all nurses that there are significant staff shortages in the healthcare industry across a range of roles. There are various reasons, including aging populations living longer, which has increased the demand for services. Many professionals are aging out of the industry. Toxic workplace cultures – resulting from stress, insufficient pay, and patient abuse – can also contribute to a lack of new nurses.
Nurses must understand these causes and what is causing specific staffing shortages in their area. With a clear idea of the root problem, it can be easier to have clarity on how to find solutions.
Perhaps most importantly, nurses should communicate with each other about staffing problems. Nurses representing traditionally marginalized demographics or interacting with minority communities can also highlight specific challenges. The better insights everyone can gain about the shortage causes, the more empowered everyone can be when navigating them.
A recent National Council of State Boards of Nursing survey found that 45.1% of nurses reported feeling burned out, contributing to many professionals leaving the industry. While burnout isn’t a diagnosable illness, it does have physical and psychological symptoms that can have long-term negative impacts. Relentless workplace stress and toxic working environments can lead to sleep loss, weight fluctuations, anxiety, and suicidal behavior. It’s no wonder nurses are leaving the profession rather than risk continued burnout.
Certainly, some of the root causes of burnout are related to systemic issues that administrators must address. However, from the perspective of nurses supporting nurses, one of the key contributions professionals can make is encouraging one another to prioritize self-care.
Prioritizing self-care is challenging, particularly given how busy working life as a nurse can be. This only emphasizes the importance of keeping colleagues accountable for taking care of themselves. Nurses must encourage one another to take breaks, eat healthy meals, and engage in hobbies. Committing to looking out for signs of exhaustion and stress in one another can open up conversations leading to effective resources.
Another key form of self-care as a nurse is advocating against inequalities and toxic environments contributing to burnout. Particularly among nurses from marginalized populations, the cumulative effect of microaggressions can be disruptive. One study found that 80% of nurses have witnessed workplace or nursing school discrimination. It is important to talk to one another about the presence of these elements and present a united front in highlighting the problem to administrators and demanding change in the workplace.
Influence Inclusive Recruitment
There are certainly recruitment issues that contribute to the healthcare shortage. It’s important to recognize that one of the most positive ways nurses can help one another address this is to be meaningfully involved in influencing recruitment. After all, no one has better insights into the challenges, benefits, and needs of the nursing industry than those who are a part of it. Importantly, nurses from minority backgrounds can ensure recruitment approaches are more accessible and welcoming to a wider proportion of the population. This can help bridge the labor gap and bring much-needed diverse cultural perspectives into the industry.
It can be helpful to encourage administrators to engage in meaningful community outreach. This may involve arranging formal opportunities for experienced nurses from various backgrounds to visit schools or community organizations. They can then discuss the options and provide practical advice on pursuing the path.
During outreach, it’s vital to share nurses’ experiences that have made later life career switches to the industry or pursued educational courses despite tough socioeconomic conditions. Nurses can also act as much-needed mentors among still under-represented minority communities. One recent study found that only 19.4% of registered nurses are from minority backgrounds. These outreach efforts give community members a sense that people with similar challenges can thrive in the industry, which may prompt engagement.
It can also be wise for nurses to have frank discussions with human resources (HR) personnel about facilities’ current recruitment processes. It’s common for systemic biases to result in recruiters overlooking ways to reach more diverse candidates. There can also be cultural hurdles that HR staff must be aware of. Providing these insights and suggesting solutions can help more potential nurses enter the sector.
Nurses committing to supporting one another through the healthcare staff shortage is essential. Communicating with one another about the causes of the shortages can aid well-informed approaches to addressing the issues. Promoting mutual self-care – including advocating against toxic workplaces – can help mitigate the potential for burnout. Engaging in more inclusive community recruitment can also positively impact greater nursing numbers and more diverse professionals in the field.
Though nurses’ contributions can be invaluable, it’s also important to take only part of the responsibility for meaningful change on their shoulders. Nurses are already overworked and face significant career stress. Recognizing personal limitations, setting strong boundaries, and seeking solid resources are essential for navigating this difficult time.
Many nurses commit to a long career in healthcare, so it’s essential to support aging nurses.
This longevity may be due to their continued passion for serving the community, or it can also result from the family of colleagues they’ve built around them. Nevertheless, having a long career or even joining later in life can see professionals in the field facing challenges related to aging.
This isn’t to say that nurses are no longer vital or relevant as they age—quite the opposite. One study of more than 900,000 patient admissions over four years found that more experienced nurses on wards improve patient outcomes. They also make invaluable mentors and can bolster community engagements with facilities. It is, therefore, imperative that facilities make significant efforts to meet nurses’ changing needs.
We will dive deeper into this idea and explore three considerations for supporting aging nurses.
Nurses, like everyone else, have changing needs as they get older. This may involve mobility challenges, mental or emotional wellness hurdles, or audio-visual issues. These elements don’t mean nurses are unable to perform their duties. However, there are expectations under the Americans with Disabilities Act (ADA) for employers to provide accommodations that may ensure nurses can perform duties more practically and effectively.
Facilities administrators should make accommodations provisions a positive part of workplace discussions. After all, most workplace injuries for registered nurses in most age groups resulting from overexertion and bodily reaction. Accommodations in everyday tasks minimize negative impacts on long-term wellness.
However, accommodations are also vital for challenges related to age. Human resources (HR) personnel should reach out regularly to nurses and invite discussions on the subject. Direct supervisors should also talk about employees’ developing needs during performance reviews.
That said, it’s wise to make older employees aware of their options rather than force these. The adverse treatment of resources may wind up contributing to the experiences of ageism that 82% of older Americans report living with.
Nurses, too, need to be open in talking about the resources they need to thrive in the workplace and care for their wellness. Asking for ADA accommodations at work can be a difficult experience for many people. Nurses should prepare for meetings on the subject with ideas of what resources could be helpful and how they might impact performance. They must also be clear that the requests are disability-related and therefore apply to ADA legislation. Nevertheless, solutions-oriented approaches tend to be more positively impactful.
Robust Wellness Programs
Aging nurses are fully aware of how vital maintaining health is and the imperatives for managing it as they age. Yet, more facilities must be more proactive in providing resources in the workplace and beyond to support nurses here. It is, therefore, vital for administrators to provide and for nursing staff to push for robust workplace wellness programs.
This can include collaborating with local businesses to offer nurses subsidized or employer-funded access to fitness benefits. Memberships for local gyms or sports facilities can benefit mental and physical wellness. Subscription services that provide nurses with fresh and nutritional meals can help them continue to eat positively. This is particularly useful when long shifts can make fixing healthy food less practical or desirable.
Any robust wellness program needs to include specific mental health resources, too. This doesn’t just mean options for dealing with crisis periods or burnout. Nurses must be able to use services regularly to maintain wellness rather than treat symptoms. For example, access to telehealth counseling or therapy services can be good for aging nurses to gain care without having to find time to travel during their breaks or days off.
Flexible Working Practices
One of the key considerations for aging nurses is that their priorities may change with their day-to-day roles. They may be looking for less stressful or intensely physical lifestyle routines. On the other hand, it may be the case that they want to shift toward focusing their time on outside interests as well as their nursing commitments. It is worth arranging for nurses to have the option of more flexible working opportunities.
Working from home as a nurse is an increasingly practical option for many roles. The rise in the adoption of telehealth means that professionals who prefer to work remotely can still interact with patients. If nurses want to shift to different specializations when working from home, there are options for telehealth physiotherapy, psychotherapy, and occupational therapy workers. In addition, travel nursing could align with the reduced schedule some nurses want to keep as they age.
Hybrid work can also offer flexibility for nurses while still being a core part of the facility environment. For example, they can attend to management or administrative elements at home or in a more comfortable coworking space. Then, part of their schedule can be focused on in-person patient interactions or training and mentoring roles.
Aging nurses remain an invaluable part of the healthcare landscape. However, facilities and nurses must collaborate on support solutions addressing changing needs. This should include discussing ADA accommodations where needed, providing robust wellness programs, and raising awareness of access to more flexible roles. These more experienced professionals positively impact patients, facilities, and colleagues, so ensuring they can thrive in the workplace is vital.
The fundamental mission of every healthcare provider is to first do no harm. Unfortunately, however, for far too long systemic inequities in the healthcare system have perpetrated and perpetuated harm.
Both implicit and explicit biases have strongly determined healthcare processes, including informing how patient pain is understood, diagnosed, and treated. Stereotypes relating to gender, race, and ethnicity have contributed to a pattern of delayed and erroneous diagnosis and inappropriate or insufficient palliative care. And as a result, untold numbers of female and minority patients have been consigned to suffer needlessly.
But there is hope, and nurses are helping to provide it. By prioritizing workforce diversity, qualified healthcare professionals enjoy greater career opportunities, and diverse patients increasingly receive the pain control they need. This article examines the importance of diversity in the healthcare industry and its implications for improving palliative care for diverse patients.
Biases and the Treatment of Pain
Generally, healthcare providers enter the field because they genuinely want to help people. Of course, financial security and social prestige are a perk, but no matter your particular role, the work is incredibly emotionally, cognitively, and physically demanding. Nevertheless, it is a profession you enter or remain in with a sense of a higher calling and a deeper purpose.
But, no matter how well-intentioned, healthcare providers are still very much human, and as such, they are shaped, both consciously and unconsciously, by the society in which they live. And that means that systemic biases have almost inevitably seeped into the care provider’s consciousness, contributing to the formation of false and dangerous stereotypes.
Research has shown, for example, that racial stereotypes concerning African-Americans have contributed strongly to the mismanagement of Black patients’ pain. These stereotypes are generally rooted in misperceptions of biological differences between African-American and Caucasian patients. This includes the false belief that Black patients have a higher pain tolerance than whites and the false presumption that Black patients are more likely to abuse drugs.
Implicit and explicit gender biases are also ubiquitous in modern medical practice. For example, female patients complaining of pain are more likely to experience treatment delays than male patients reporting the same or similar symptoms. Women’s pain symptoms, for instance, are significantly more likely to be attributed to emotional or psychological etiologies than men’s. This increases the likelihood that their pain will go untreated or under-treated, and severe disease symptoms will go unrecognized, thus delaying treatment.
Diversity and Cultural Competence in Healthcare
Nurses are at the front lines of patient care. They provide the majority of hands-on patient care, and, in general, their interactions with patients are more frequent and substantive than those of physicians.
For this reason, diversity in the nursing sector is particularly critical in redressing inequities in treating patients’ pain. Culturally competent patient care almost inevitably ensures that nurses derive from various ethnic, racial, socioeconomic, and gender backgrounds.
More specifically, this means that nurses with high cultural competence will better understand, recognize, and respond to culturally-specific manifestations of patient pain.
For instance, women or patients from specific cultural or religious backgrounds may feel reluctant or unable to express their symptoms, especially if these pertain to “taboo” areas. Nurses from similar backgrounds are more likely to have the cultural competence to identify and overcome these cultural taboos.
This enables them to formulate strategies that help patients express their concerns in more comfortable and culturally acceptable ways. In addition, by enhancing the dialogue with patients, nurses can provide physicians with more comprehensive and accurate case notes, increasing treatment efficacy.
Addressing Medical Anxiety
Promoting diversity in nursing doesn’t just equip healthcare teams to understand and address cultural differences among patient populations effectively. Diversity also enables healthcare teams to recognize and remediate systemic healthcare disparities’ profound and long-enduring impacts.
There is mounting evidence, for example, that minority patients are far less likely than Caucasians to be satisfied with their quality of medical care. Deficiencies in minority patient care can be linked to various factors, from the lack of healthcare access to a shortage of interpreters for patients who do not speak English.
These care deficiencies can instigate severe medical anxiety in patients, particularly for those who have experienced significant physical or emotional trauma in past medical encounters. Nurses from similar backgrounds may have also experienced such challenges in the healthcare system, whether for themselves or someone they love. And as such, they are more likely to be able to accurately anticipate or ascertain signs of medical anxiety in female and minority patients.
Equipped with such insight, diverse nurses can lend a measure of patient support and empathy that comes from understanding and experience. And, importantly, they can more effectively advocate for patients and their unique needs, particularly in treating pain.
Disparities in the healthcare system have for too long led to deficiencies in palliative care for minority and female patients. By promoting diversity in the nursing profession, however, the needless suffering to which diverse patients have been subjected can finally end.
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