Chapter Two: Health Disparities and Health Equity
Practical Application
Setting the Scene
A 37-year-old male comes to a community clinic complaining of unintentional weight loss of 20 pounds over the last 2 months, abdominal bloating, severe fatigue, and persistent Gastroesophageal Reflux Disease (GERD). The provider determines that the patient needs a colonoscopy. The patient is uninsured and, on further discussion with the provider, shared that he is a DACA recipient and is currently unemployed. He states that he tried to get health insurance through the healthcare exchange but was denied due to his DACA status.
Think About It
Imagine you are the nurse assisting this patient.
- How would you (or would you not) proceed with offering care to this patient? Why?
- What other health disparities might this patient experience due to his DACA status?
- What additional health disparities might this patient experience if he were part of other marginalized groups, such as racial minorities or LBGTQIA+?
- What impact does being a part of multiple impacted communities have on the health disparities an individual might experience?
- How might addressing health disparities among underserved populations of people, like this patient, help promote health equity on a larger scale?
Practical Application: Additional Guidance
Exercise Title
Addressing Health Disparities in Underserved Populations
Objective
This exercise aims to engage nursing students in critical reflection and decision-making regarding the provision of care to individuals facing multiple health disparities, including those related to immigration status and other marginalized identities.
Preparing for the Exercise
- Introduction: Provide background information on the scenario, emphasizing the patient’s presenting symptoms, healthcare access barriers, and marginalized status as a DACA recipient.
- Discussion Starter: Encourage students to reflect on their own attitudes, beliefs, and ethical considerations regarding the provision of care to underserved populations, particularly those facing immigration-related challenges.
Exercise Components:
- Patient Care Decision: Prompt students to consider how they would proceed with offering care to the patient in the scenario. Encourage them to explore the ethical principles of beneficence, nonmaleficence, autonomy, and justice in their decision-making process.
- Identifying Health Disparities: Guide students in identifying potential health disparities experienced by the patient due to his DACA status, such as limited access to healthcare services, financial barriers, and heightened stress and anxiety.
- Intersectionality Analysis: Facilitate a discussion on how the patient’s experiences of health disparities might be compounded if he belonged to other marginalized groups, such as racial minorities or LGBTQIA+ individuals. Encourage students to consider the intersecting impacts of multiple marginalized identities on health outcomes.
- Promoting Health Equity: Challenge students to reflect on the broader implications of addressing health disparities among underserved populations, like the patient in the scenario, in promoting health equity on a larger scale. Encourage them to explore the role of nurses in advocating for policy changes, providing culturally competent care, and addressing social determinants of health.
Evaluation and Assessment
- Critical Reflection: Assess students’ critical thinking skills and ability to articulate their reasoning for their patient care decisions and reflections on health disparities and health equity.
- Engagement in Discussion: Evaluate students’ active participation in discussions, including their contributions to identifying health disparities, analyzing intersectionality, and exploring strategies for promoting health equity.
Integration into Curriculum
- Alignment with Course Objectives: Ensure that the exercise aligns with course objectives related to community health nursing, cultural competence, social justice, and health equity.
- Sequencing: Determine the appropriate timing and sequencing of the exercise within the course curriculum to complement other content and activities.
- Integration of Theory and Practice: Emphasize the application of nursing theory and ethical principles to real-world scenarios, fostering the development of culturally sensitive and socially conscious nursing practice.
Resources and Support
- Learning Resources: Provide students with access to relevant literature, articles, and resources on health disparities, immigration health, intersectionality, and social determinants of health.
- Faculty Support: Offer guidance, feedback, and support to students as they engage in the exercise, addressing any questions or concerns they may have about the scenario or related topics.
Conclusion
By following these guidelines, nurse educators can facilitate a meaningful and thought-provoking practical application exercise that challenges nursing students to confront health disparities faced by underserved populations, critically reflect on their role as advocates for health equity, and develop culturally competent and compassionate patient care practices.
Role-playing/Communication Exercise
Scenario Title
Addressing Health Disparities in Primary Care
Objective
To enhance students’ communication skills in providing equitable care to patients from diverse socio-economic backgrounds while addressing health disparities.
Roles
- Primary Care Nurse
- Patient 1: Low-income individual with limited access to healthcare
- Patient 2: Middle-income individual with average access to healthcare
- Patient 3: High-income individual with privileged access to healthcare
Scenario Setting
Primary care clinic
Background
Each patient presents with the same health concern (hypertension) but has different socio-economic backgrounds affecting their access to care and health outcomes.
Preparation
- Provide background information for each patient’s role, including socio-economic status, health literacy level, and barriers to healthcare access.
- Brief the nurse on their role in addressing health disparities and promoting health equity.
Role-Playing Activity
The primary care nurse has three patients presenting for care related to hypertension.
- Patient 1 may present with financial barriers to medication adherence and healthcare visits.
- Patient 2 may have concerns about insurance coverage and time constraints.
- Patient 3 may request specific treatments or medications due to their financial resources.
Communication Skills Practice
- Active Listening: Students practice active listening skills to understand each patient’s unique situation and concerns.
- Empathetic Communication: Students demonstrate empathy and cultural sensitivity in their interactions, acknowledging the impact of socio-economic factors on health outcomes.
- Health Education: Students provide tailored health education and resources to address each patient’s needs while considering their socio-economic context.
- Advocacy: Students advocate for patients’ rights to equitable care and collaborate with them to overcome barriers to access.
Debriefing and Feedback
After the role-play, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- Provide constructive feedback on communication strategies, cultural competence, and advocacy efforts.
Reflective Practice
This activity could occur on a discussion board or by uploading a video using Flip or Canvas Studio.
Reflecting on your clinical experiences to date, consider a time when you observed or encountered a healthcare disparity. How did this disparity manifest, and what factors contributed to it? In what way did this disparity impact patient outcomes or access to care? Furthermore, how do you envision your role as a professional nurse in addressing and advocating for health equity within the healthcare system?
Interactive Module
Create an interactive escape room using Google Forms that challenges students to solve puzzles related to the chapter topic. These NCLEX-style questions can be a starting point.
- A community health nurse is conducting a needs assessment in a low-income neighborhood. Which factor is most likely to contribute to healthcare disparities in this population?
- Availability of public transportation.
- Presence of community health clinics.
- High level of health literacy among residents.
- Access to affordable healthy food options.
- A nurse is developing a plan of care for a patient from an underserved community. Which intervention is most appropriate for promoting health equity in this population?
- Scheduling regular follow-up appointments with a specialist.
- Providing written instructions in English only.
- Referring the patient to a private healthcare facility.
- Collaborating with community resources to address social determinants of health.
- A nurse is conducting health education sessions for a group of pregnant teenagers. Which action best demonstrates a commitment to addressing health disparities in this population?
- Providing pamphlets in English only.
- Offering free transportation to prenatal appointments.
- Recommending a private obstetrician for prenatal care.
- Focusing solely on medical interventions without considering social determinants of health.
- A nurse is caring for a patient with limited English proficiency. Which action is most important for ensuring equitable access to healthcare for this patient?
- Providing written instructions in English only.
- Using medical jargon to communicate effectively.
- Arranging for a professional interpreter during healthcare encounters.
- Assuming the patient understands without verbal communication.
- A nurse is assessing a patient’s readiness to participate in a cardiac rehabilitation program following a myocardial infarction. Which factor is most likely to influence the patient’s access to and engagement in the program, reflecting considerations of health equity?
- The patient’s history of tobacco use.
- The patient’s level of education.
- The patient’s family medical history.
- The patient’s willingness to adhere to the program.
Case Study: Addressing Health Disparities in a Rural Community
Background
You are a community health nurse working in a rural area with a population characterized by low socio-economic status, limited access to healthcare resources, and high rates of chronic diseases. The community is predominantly agricultural, with many residents working seasonal or low-wage jobs. There are few healthcare facilities in the area, and transportation options are limited.
Patient Profile
Marcel is a 55-year-old man who lives in a remote area of the community. He works as a farm laborer and has a history of hypertension and type 2 diabetes. Marcel struggles to afford his medications and has difficulty accessing regular medical care due to the lack of nearby healthcare facilities and limited transportation options. He also has low health literacy and speaks English as a second language.
Scenario
Marcel presents to the local clinic with complaints of worsening chest pain and shortness of breath. He admits to not taking his medications regularly due to financial constraints and difficulty obtaining refills. On examination, his blood pressure is elevated, and he appears anxious. The nurse suspects that Marcel may be experiencing a cardiac event and needs immediate medical attention.
Questions for Reflection and Analysis
- Identifying Health Disparities
- What are some of the health disparities evident in Marcel’s case, considering his socio-economic status, access to healthcare, and health literacy?
- Impact of Social Determinants of Health
- How do social determinants of health, such as income, education, and transportation barriers, contribute to Marcel’s health outcomes and ability to access care?
- Barriers to Healthcare Access
- Identify specific barriers that Marcel faces in accessing healthcare services and managing his chronic conditions. How do these barriers affect his health-seeking behaviors?
- Promoting Health Equity
- As Marcel’s nurse, what strategies would you implement to promote health equity and improve his access to healthcare resources and services?
- Collaborative Care Planning
- How can you collaborate with other healthcare providers, community organizations, and resources to address Marcel’s healthcare needs and reduce health disparities in the community?
- Cultural Competence
- Considering Marcel’s language barrier and cultural background, how would you ensure effective communication and culturally sensitive care delivery?
- Advocacy and Policy Implications
- What role can nurses play in advocating for policy changes and healthcare initiatives to address health disparities and promote health equity in rural communities like Marcel’s?
Case Study Follow-up
After discussing the case study questions, students can develop a comprehensive care plan for Marcel, considering his unique needs, socioeconomic factors, and barriers to care. They can also explore community resources and potential partnerships to address health disparities and improve health outcomes for Marcel and other residents in the rural community.
Simulation
Scenario
Addressing Health Disparities in a Community Health Clinic
Objective
To simulate a nurse-led intervention to address health disparities and promote health equity among patients in the community health clinic.
Learning Outcomes
- Recognize the impact of socio-economic factors on health disparities and health outcomes.
- Develop effective communication and cultural competence skills for providing patient-centered care.
- Utilize community resources and advocacy strategies to address barriers to healthcare access and promote health equity.
Background and Setting
The student is a registered nurse working in a community health clinic located in an urban area with a diverse population. The clinic serves individuals from various socio-economic backgrounds, including low-income families, immigrants, and homeless individuals. Many patients face barriers to accessing healthcare services due to financial constraints, language barriers, and lack of health insurance.
Preparation
- Provide patient demographics and clinic statistics for students to understand the population served and prevalent health disparities.
- Have students familiarize themselves with available resources and community partnerships for addressing health disparities.
Simulation Outline
- Patient Encounter
- Engage in a simulated patient encounter with a standardized patient (SP) representing a member of the clinic’s target population.
- The SP may present with a common health concern (e.g., diabetes management, prenatal care) affected by socio-economic factors and disparities.
- If your school does not have an SP program, students can serve as the SP, or you can use a high-fidelity mannequin.
- Assessment and Care Planning
- The nurse will conduct a comprehensive health assessment, considering the patient’s socio-economic status, cultural background, and barriers to care.
- The nurse will develop a tailored care plan in collaboration with the patient, addressing their immediate healthcare needs and long-term health goals.
- Communication and Education
- The nurse will use effective communication strategies to build rapport with the patient and establish trust.
- The nurse will provide health education materials in the patient’s preferred language and format, addressing their specific health concerns and promoting self-management skills.
- Resource Referral and Advocacy
- The nurse will identify community resources and support services available to assist the patient in overcoming barriers to care (e.g., financial assistance programs, language interpretation services).
- The nurse will advocate for the patient’s needs within the healthcare system, including assistance with navigating insurance coverage, accessing specialty care, or obtaining medications.
- Follow-Up and Evaluation
- The nurse will schedule follow-up appointments to monitor the patient’s progress and evaluate the effectiveness of interventions.
- The nurse will collaborate with interdisciplinary team members to ensure continuity of care and address any ongoing barriers or challenges faced by the patient.
Debriefing and Feedback
After the simulation, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- Discuss challenges encountered, successful strategies used, and areas for improvement in addressing health disparities and promoting health equity.
- Provide constructive feedback to peers based on their communication, assessment, and advocacy skills during the simulation.
Competency Assessment
Activity
Advocate for patients and communities to ensure equitable access to healthcare services and resources.
Demonstration
Students can demonstrate advocacy skills by identifying systemic barriers to healthcare access and working to address them through policy change, resource allocation, and community collaboration. This can be displayed by writing to government officials, major corporations, healthcare systems, or community partners.
Clinical Activities/Opportunities
- Create a health promotion campaign. Students can plan and implement various health promotion campaigns targeting specific health disparities prevalent in their communities. Students should utilize various media platforms and community outreach strategies to raise awareness and encourage positive behavioral changes.
- Students can participate in quality improvement projects within healthcare organizations to reduce healthcare delivery disparities and improve health outcomes for underserved populations. Students can help collect and analyze data, identify areas for improvement, and implement evidence-based interventions to address disparities.
