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.
Alongside the general need for hospice nurses and palliative care nurses, these opportunities may include:
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.
This means that minority nurses can be better equipped to offer culturally relevant care to patients with similar backgrounds. In effect, these culturally competent nurses are likely to impact patient experiences and outcomes positively.
Actionable Community Knowledge
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.
Conclusion
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.
Black women are almost twice as likely to experience infertility as their white counterparts, but only 8% of Black women seek fertility treatment, compared to 15% of white women. Statistics like these, compounded by the fact that Black women are three times as likely to die from pregnancy-related causes, highlight inequalities in reproductive healthcare that the medical community must address.
The higher incidence of infertility among Black women is due in part to a higher prevalence of uterine fibroids, ovulatory dysfunction, and tubal disease. Studies show that Black women also have higher rates of pregnancy loss, including miscarriages and stillbirths when compared to white women. This is likely because Black women have higher rates of risk factors that are associated with pregnancy loss, such as obesity, diabetes, and low socioeconomic status.
For Black women, the isolation of infertility is compounded by various factors (for example, cultural stigma, socioeconomic barriers, and racial bias) that prevent them from getting the care they need. Those who do end up seeking care often find themselves feeling deeply uncomfortable in the medical space, which is still predominantly white.
Diversity in Healthcare Providers
People of color need to have access to BIPOC (Black, Indigenous, and People of Color) healthcare providers because it provides a sense of comfort and familiarity. This can encourage patients to access available fertility care and can even improve treatment outcomes. BIPOC healthcare providers possess culturally specific knowledge, skills, and experiences that help with communication and health management processes involving people of color.
Diversity in providers also helps reduce barriers to the patient-physician relationship for racial/ethnic and linguistic minority patients. In many situations, seeing someone who looks like you and understands your cultural background offers reassurance.
Many studies have demonstrated better health outcomes when BIPOC providers see patients of color. A result of this is increased trust and communication developed between the patient and provider. The patient may feel more comfortable sharing sensitive information with someone who has an unspoken understanding of what the patient might be going through. Research has shown that Black women who have a provider with a similar cultural history may feel more comfortable speaking up and advocating for themselves.
Many people of color have a (warranted) sense of mistrust when it comes to our healthcare system due to historical practices based on racist ideals. As healthcare providers, we must remain dedicated to bridging the gap to improve outcomes for patients of color.
What Factors Most Impact Black Patients?
Long-held beliefs, stereotypes, cultural stigma, and other issues continue to uphold these racial disparities around fertility and family-building. Here are some examples of the various factors that contribute to widening the gap in care for Black women:
Structural racism: This heavily contributes to racial disparities in fertility and maternal healthcare in various ways, as structural racism goes beyond the individual. It refers to inherently racist laws, rules, economic practices, and cultural and societal norms that are embedded in the system itself.
Implicit or unconscious bias: This occurs automatically and unintentionally, affecting our judgments, decisions, and behaviors. For example, a white doctor might downplay complaints of pain after surgery from a patient of color due to engrained, inaccurate stereotypes about the strength or pain tolerance of BIPOC people, only to discover the patient is genuinely experiencing discomfort.
Accessibility: Many people of color encounter barriers to accessing the healthcare they need due to a lack of insurance or insurance coverage that excludes fertility treatment. Financial roadblocks and accessibility to quality reproductive care are often limited by location (rural or underserved areas may not have fertility clinics nearby) and employment (not everyone can take time off of work to go in for morning monitoring appointments, which are often required during fertility treatment).
The myth of hyperfertility: The long-held myth that Black women (and men) are “hyper-fertile” causes considerable harm, leading to a resulting cascade of issues.
Religious beliefs: Many people in the Black community are taught to “pray your way” through difficult situations. And while it’s wonderful to have faith, sometimes it’s necessary to seek professional help. Trusting that a higher power will correct infertility leads some people to delay or avoid treatment altogether.
Harmful stereotypes: Black women are thought of as being incredibly strong ― and we are ― but when we are elevated to “Superwoman” status and need to take off our proverbial capes to ask for help, we are often judged harshly or perceived as weak.
Mental health: Shame, guilt, or anxiety about how people in our community may react prevents or delays many women of color from seeking infertility treatment. The stigma of mental illness is also a concern when addressing infertility. Many people coping with infertility experience depression, anxiety, and grief, and cultural norms can discourage people from sharing that they are struggling with their mental health.
Isolation: Many people hesitate to talk about their personal experiences with infertility, which often leaves Black women with the impression that they are alone in their struggles or that infertility is a reflection of their character or a personal failing. That’s why sharing fertility stories is so important, especially in communities of color.
Black Maternal Mortality Rates
Many women of color might lack insurance coverage for maternal health or be afraid to advocate for themselves with their doctor. But the starkest evidence of the healthcare system failing people of color is Black maternal mortality rates in the United States, which are alarmingly high.
Studies have shown that Black women are three times more likely to die from pregnancy-related causes than white women. Worse yet, even though multiple factors contribute to this disparity, most are preventable. These factors include access to quality healthcare, underlying chronic illnesses, and two of the most easily preventable: implicit bias and structural racism. As a healthcare system, we need to focus on listening to the concerns of patients of color without allowing unconscious bias to play a role in our treatment decisions.
Responsibility to Patients
In vitro fertilization (IVF) and other fertility treatment options can be very expensive, which makes it exponentially more challenging for individuals with lower median household incomes to afford this path to parenthood. With lower incomes in comparison to white and Asian couples, Black and Hispanic couples may have a hard time affording fertility care if they have to pay out-of-pocket.
Knocking down the roadblock of affordability often goes beyond the scope of the medical community’s responsibility. However, bridging the gap of distrust with people of color and providing culturally competent care does not. One important step hospitals and health systems can take is to increase the diversity of providers within reproductive health specialties. Collectively, we must work to dismantle structural racism, educate ourselves, and listen to people of color. Only then will we start to make progress toward lessening racial disparities in fertility and maternal healthcare.
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.
Conclusion
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.
“At a time when one in five pregnant people experience mistreatment during childbirth, and up to 40 percent of Black and multiracial patients report discrimination while receiving maternity care, it is imperative that interventions like TeamBirth are made widely available,” says Ahrin Mishan, Executive Director of The Rita and Alex Hillman Foundation. “We are proud to support the expansion of this important intervention.”
Developed by Ariadne Labs – a joint center for health systems innovation at Brigham and Women’s Hospital and Harvard’s T.H. Chan School of Public Health – TeamBirth is a care process innovation that ensures people giving birth and the clinicians who are caring for them have shared input and understanding into decisions during labor and delivery. Using such easy-to-implement components as team huddles and a patient-facing whiteboard, patients and clinicians alike have credited TeamBirth with making the labor and delivery process more person-centered and, most importantly, safer.
After an initial feasibility trial at four sites in 2018, TeamBirth is on track to be integrated into more than 100 U.S. hospitals by the end of this year. Building on this momentum and a growing evidence base, HID funds will enable Ariadne Labs to pursue innovative strategies for maximizing the reach and impact of TeamBirth.
“Funding from The Rita and Alex Hillman Foundation comes at a critical time,” says Amber Weiseth, DNP, MSN, RN, Director of the Ariadne Labs’ Delivery Decisions Initiative and the principal investigator of the HID grant. “This partnership and support will be vital in ensuring that more parents-to-be have access to dignified, equitable, and safe birthing experiences.”
The Hillman Innovation Dissemination program, established in 2017, amplifies the scaling efforts of successful interventions with proven outcomes that target the needs of marginalized populations. See a roster of previous HID grant recipients here.
Nursing has always held health equity as a critical value in many ways. Nurses strive to deliver the best care to all patients, independent of socioeconomic status, gender, race, or other factors.
Health equity arguably gets even more attention than in the past. And that attention also occurs in nursing schools, where nurses are presented with the concept of health equity.
In this article, we examine how various schools teach health equity. But first, let’s define the term.
“Equity should mean that people have the opportunity to get what they need when they need it,” notes Alicea-Planas, associate professor of nursing at Egan and practicing nurse at a community health center in Bridgeport, CT. “That’s something that has historically been lacking for certain communities within our healthcare system.”
Health equity means that “everyone has the ability and opportunity to be healthy and to access healthcare to help them maintain health,” says Latina Brooks, PhD, CNP, FAANP, associate professor at Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Brooks also directs the MSN and DNP programs at Frances Payne.
Beyond Accessibility
The CDC notes that achieving health equity requires ongoing efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.
Health equity isn’t just about access to healthcare, notes Elaine Foster, PhD, MSN, RN, vice president of nursing, Education Affiliates. It can also relate to whether a diabetic patient, for instance, knows what to get checked. “I think sometimes we’ve put a very narrow description on health equity, and I think if you were to flesh it out, it goes beyond that accessibility,” Foster notes.
“You can even take health equity that next step and say, Do you have an advocate or do you have someone who knows to push the envelope?” says Foster. “We have to be active participants in our healthcare these days to get what we need.”
Besides accessing resources, health equity involves “understanding how to navigate our healthcare system,” says Alicea-Planas. “It is understanding the information that’s being provided to us by healthcare providers and being able to use it for patients to do well on their health and wellness journey.”
Teaching Equity
At various schools, health equity is integrated throughout the course of study. For instance, at Adelphi University College of Nursing and Public Health, Long Island, New York, health equity is threaded throughout the undergraduate and graduate curriculum in various courses, notes Deborah Hunt, PhD, RN, Dr. Betty L. Forest dean and professor. For example, in the school’s community health course, there is a focus on vulnerable and underserved populations. In the childbearing course, Hunt notes, there is a focus on health disparities and maternal and infant mortality.
Foster notes that health equity is threaded into the curriculum at the 21 nursing schools within the Education Affiliates system. Likewise, at Frances Payne Bolton, health equity is integrated into courses. However, Brooks notes that some courses go more in-depth, such as discussing health equity in vulnerable populations.
At Egan, introductory courses talk a lot about health equity and social determinants of health, notes Alicea-Planas, as do clinical courses. “I think a big part of understanding health equity is also understanding social determinants of health,” says Alicea-Planas. “I am super excited that now in the nursing curriculum, we have lots of conversations around those social determinants of health and how they influence people’s ability to attain their highest level of health.”
The Takeaways
One crucial learning that Alicea-Planas hopes students take away is that for students who haven’t been exposed to many people from different backgrounds, it’s essential “to understand how historically our healthcare system has treated certain communities of color. That factors into people’s feelings about how doctors or nurses treat them, influencing their ability to seek care.”
Foster hopes that students learn that no matter what the patient’s background, “Everyone is entitled to good, nonjudgmental care within the healthcare system.” Students must learn “not to impose our beliefs, our judgment on someone. Because until we get rid of that type of judgment, we will never overcome issues with health equity because we’ve got to first check our beliefs and opinions at the door and say I’m going to give the best care possible to these patients.”
SWAT RNs serve as expert consultants and mentors to nurses working as bedside leaders in various clinical settings. With clinical practice experience of five or more years in the areas of critical care, emergency nursing, and flight nursing, these nurses enjoy the adrenaline rush that comes with quickly assessing patients at risk for condition deterioration.
SWAT RN Role
The role of the Specialized Workforce for Acute Transport Registered Nurse (SWAT RN) has evolved in national healthcare organizations. Early detection of patients experiencing physical decline is the hallmark of the SWAT RN role. Having identified an early condition decline, bedside nurse leaders working in various clinical settings collaboratively work with SWAT RNs to promptly stabilize and prevent patient injury and death.
Susan Dresser, Cynthia Teel, and Jill Peltzer, in their 2023 article entitled, Frontline Nurses’ Clinical Judgment in Recognizing, Understanding, and Responding to Patient Deterioration: A Qualitative Study, noted that nurses who work at the bedside are essential in the recognition of patients’ decline and initiating contact with the SWAT RN. Hence, the SWAT RN is a nursing role that is instrumental in the promotion of the nursing process and the National Council of State Boards of Nursing’s 2019 Clinical Judgment Measurement Model within the acute care setting, as they work collaboratively with bedside nurse leaders to facilitate positive patient outcomes.
A Hypothetical Case Study
The following hypothetical case study provides an opportunity to explore the SWAT RN role and examine how this role collaborates with bedside leaders to improve patient outcomes.
Case Presentation
Bernard Salzo is a 38-year-old male employed as a carpenter and painter. Unable to sleep and experiencing restlessness accompanied by shortness of breath for the last two days, Mr. Salzo presents to the emergency department (ED) at 3:00 a.m. with difficulty breathing. The triage nurse obtains his vital signs: blood pressure 134/82 mm Hg, respirations 30 breaths per minute, heart rate 102 bpm, temperature 99.8 F, and oxygen saturation on room air, 94%. The patient appears anxious and restless, requiring redirection as the triage nurse processes him. The patient states, “I have not been sleeping that well. I kind of feel discombobulated.”
History and Assessment
Mr. Salzo’s medical history is significant for childhood asthma and hypertension. His hypertension is managed with an ACE Inhibitor, Lisinopril 15 mg PO daily, and diuretic Furosemide 10 mg PO daily. Prescribed Montelukast sodium 10 mg PO once daily and a Proventil HFA inhaler twice daily and as needed for asthmatic symptoms. Mr. Salzo’s asthma has been stable for the past ten years. Mr. Salzo is a nonsmoker and abstains from alcohol.
Mr. Salzo is triaged, assessed by an ED nurse, examined by an ED provider, and admitted to a Medical-Surgical Unit. The nurse in the Medical-Surgical Unit suspects worsening respiratory distress, noticing that Mr. Salzo has become increasingly anxious and is moving about restlessly in bed during the admission assessment. Oxygen therapy via nasal cannula 2 L O2 is placed on the patient, and the nurse contacts the SWAT RN, who arrives in less than 5 minutes.
The SWAT RN provides a rapid assessment of the patient and reports their findings to the patient’s healthcare provider and bedside nurse leader.
Alert and anxious, use of accessory muscles of respiration, respiratory distress
RR- 32 breaths per minute and labored, BP- 143/88 mm Hg, T- 100.3 F (temporal), oxygen saturation- 90% on room air (sitting)
Peak flow- 185
HEENT, Skin, Neck
No bruits, nor thyromegaly or adenopathy
Bilateral tearing of the eyes noted with conjunctivae that are edematous and inflamed
Pharynx with clear postnasal drainage; nasal mucosa edematous with clear discharge
Fundi without lesions
Skin is supple, diaphoretic, pink, and flushed
Lungs
No egophony or fine crackles (rales); scattered coarse crackles present
Expiratory phase is prolonged with wheezes auscultated bilaterally
Diaphragm percusses low in the posterior chest with 2 cm; chest expansion is limited
Cardiac
No clicks or gallops
Tachycardia, regular
Notable slight systolic ejection murmur (SEM) at the left lower sternal border (LLSB) without radiation
Abdomen, Extremities, Neurologic
Capillary refill at 3 seconds, no clubbing, no edema; extremities clammy
Bowel sounds present, no hyperactivity; abdomen non distended
Liver percusses 2.5 cm below the right costal margin, but overall size 8 cm, no tenderness or masses
Cranial nerves intact; DTR 2 + and symmetric; sensory intact; strength 5/5 throughout
Preliminary Laboratory Results
pH- 7.48; PaO2- 70; PaCO2- 33 mm Hg
HCT- 33.0% and HgB- 7.2 g/dL
WBC- 7,680
PLTS- 246,000
Bedside Nurse Leader and SWAT RN Collaboration
The SWAT RN maintains closed-loop communication with the bedside nurse leader assigned as the primary care nurse for Mr. Salzo. The bedside nurse leader and SWAT RN discuss the patient’s time of initial decline, treatment approaches that were effective, and next steps. The SWAT nurse respectfully acknowledges the bedside nurse’s prior knowledge about the patient’s health history and recent health status change while modeling clinical judgment in managing the clinical case scenario.
Mr. Salzo complains of chest tightness. Intravenous access via Mr. Salzo’s right arm in the cephalic vein was secured. The bedside nurse leader inquires about potential allergen exposure and the use of methylprednisolone (Solu-Medrol) intravenously. The SWAT RN and team decided to assess the patient’s response to a bronchodilator. The SWAT RN administers Albuterol nebulizer treatments. An electrocardiogram (ECG) reveals sinus tachycardia (Figure 2.). The elevated white blood cell count (WBC) is suggestive of infection. A chest x-ray shows a large area of opacity in the right lung. A sputum sample is obtained and sent for culture and sensitivity. Blood cultures were obtained as well.
Admitted to the Medical-Surgical Unit with the primary diagnosis of asthma exacerbation and pneumonia, Mr. Salzo starts the intravenous (IV) antibiotic ceftriaxone (Rocephin) 1 gm twice daily. On day 2 of antibiotic therapy, a repeat chest x-ray reveals the presence of a mass in the right lung. Further diagnostic tests reveal that the mass is a malignant neoplasm. Mr. Salzo was diagnosed with lung cancer adenocarcinoma.
Education
The unknown or atypical presentations are the driving factors in bedside nurse leaders utilizing clinical judgment in the decision-making process to ramp patient assessment to the level of consultation before rapid patient deterioration occurs. Mr. Salzo’s diagnostic presentation appeared typical for asthma. However, his elevated WBCs suggested infection was present. The resolving pneumonia treated with IV antibiotic therapy revealed a malignant tumor mass, adenocarcinoma.
Adenocarcinomas typically proliferate within the cells that line the alveoli. According to the Centers for Disease Control and Prevention (CDC), in 2022, 50% to 60% of lung cancers were diagnosed in patients with no smoking history. The CDC noted in 2022 that 10% to 20% of nonsmoker cancers are squamous cell carcinomas and 6% to 8% small cell lung cancers. The CDC also noted that risk factors associated with lung cancer include family history, pipe smoking, cigarette and cigar smoking, beta-carotene supplements in heavy smokers, human immunodeficiency virus (HIV), and environmental risk factors. Mr. Salzo’s dual occupation as a carpenter and painter, both environmental risk factors, likely placed him at risk for the development of lung cancer. Wood dust can be inhaled and enter the airway and lung tissues, causing scarring and irritation. The paint contains benzene solvents that, inhaled, can lead to oral and lung cancers.
The National Council of State Boards of Nursing Clinical Judgment Measurement Model provides the nursing profession with a roadmap for enhancing critical thinking, clinical decision-making, and clinical judgment within the clinical setting. SWAT RNs, because of their advanced clinical practice experience and knowledge, effectively role model closed-loop communication and evidenced-based practice clinical interventions and provide clinical expertise “in live-time” to bedside nurse leaders during emergent patient cases.
Conclusion
Mr. Salzo, transferred to an oncology unit, begins cancer treatment. The bedside nurse leader provides him with education about his new diagnosis. His clinical presentation to the ED for an asthmatic exacerbation and the combined efforts of all healthcare team members have contributed to Mr. Salzo’s diagnosis and current implementation of treatment for lung cancer. The early involvement of SWAT RNs is instrumental in supporting bedside nurse leaders (and nurses in other settings) with the provision of rapid assessments and necessary diagnostics in ensuring the consistent delivery of evidence-based practice care for patients entering healthcare systems. In the 2020 article, Using Benner’s Model of Clinical Competency to Promote Leadership, Barry Quinn discusses the novice to expert level nurse in clinical practice. Because the SWAT RN is an expert level nurse, their role is essential in developing leadership and competency of bedside nurse leaders in recognizing patients with rapidly declining physiological problems. Hence, SWAT RNs’ roles are beneficial in promoting clinical judgment in bedside leaders at all practice levels (e.g., novice to expert).
