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Lloyd SL, Foy CG, Caban-Holt A, Gwathmey T, Williams KL, Starks TD, Mathews A, Vines AI, Richmond A, Byrd GS. Assessing the Role of Trust in Public Health Agencies and COVID-19 Vaccination Status Among a Community Sample of African Americans in North Carolina. J Racial Ethn Health Disparities 2024; 11:1730-1740. [PMID: 37273163 PMCID: PMC10241131 DOI: 10.1007/s40615-023-01646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Mistrust of the government and medical establishments are prominent reasons for vaccine hesitancy among African Americans (AAs). As COVID-19 research evolves in real time with some uncertainties remaining, AA communities may be less trusting of public health agencies. The purpose of these analyses was to assess the association between trust in public health agencies that recommend the COVID-19 vaccination and COVID-19 vaccination status among AAs in North Carolina. METHODS A 75-item cross-sectional survey, the Triad Pastors Network COVID-19 and COVID-19 Vaccination survey, was developed and administered to African Americans in North Carolina. Multivariable logistic regression was used to examine the association between levels of trust in public health agencies who recommend the COVID-19 vaccine and COVID-19 vaccination status among AAs. RESULTS Of the 1157 AAs included in these analyses, approximately 14% of AAs had not received the COVID-19 vaccine. These findings indicated that lower levels of trust in public health agencies significantly decreased the odds of getting the COVID-19 vaccination compared to those with higher levels of trust among AAs. The most trusted source for information on COVID-19 included federal agencies among all respondents. Among the vaccinated, primary care physicians were another trusted source of information. Pastors were another trusted source for those willing to be vaccinated. CONCLUSIONS Despite the majority of the respondents in this sample receiving the COVID-19 vaccine, subgroups of AAs remain unvaccinated. Federal agencies have a high level of trust among AA adults; however, innovative approaches are needed to reach AAs who remain unvaccinated.
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Affiliation(s)
- Shawnta L Lloyd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA.
| | - Capri G Foy
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - TanYa Gwathmey
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Kelvin Lamonte Williams
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Allison Mathews
- COMPASS Initiative® Faith Coordinating Center, Wake Forest University School of Divinity, Winston Salem, NC, 27109, USA
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Alan Richmond
- Community-Campus Partnerships for Health, Raleigh, NC, 27605, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
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Izumi S(S, Garcia E, Kualaau A, Sloan DE, DeSanto-Madeya S, Candrian C, Anderson E, Sanders J. Advance care planning as perceived by marginalized populations: Willing to engage and facing obstacles. PLoS One 2024; 19:e0301426. [PMID: 38557983 PMCID: PMC10984538 DOI: 10.1371/journal.pone.0301426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Health disparities exist in end-of-life (EOL) care. Individuals and communities that are marginalized due to their race, ethnicity, income, geographic location, language, or cultural background experience systemic barriers to access and receive lower quality EOL care. Advance care planning (ACP) prepares patients and their caregivers for EOL decision-making for the purpose of promoting high-quality EOL care. Low engagement in ACP among marginalized populations is thought to have contributed to disparity in EOL care. To advance health equity and deliver care that aligns with the goals and values of each individual, there is a need to improve ACP for marginalized populations. AIM To describe how patients from marginalized populations experience and perceive ACP. METHODS We used an interpretive phenomenological approach with semi-structured qualitative interviews. Participants were recruited from four primary care clinics and one nursing home in a US Pacific Northwest city. Thirty patients from marginalized populations with serious illness participated in individual interviews between January and December 2021. Participants were asked to describe their experiences and perceptions about ACP during the interviews. RESULTS The mean age of 30 participants was 69.5; 19 (63%) were women; 12 (40%) identified as Asian/Pacific Islanders, 10 (33%) as Black; and 9 (30%) were non-native English speakers. Our three key findings were: 1) patients from marginalized populations are willing to engage in ACP; 2) there were multiple obstacles to engaging in ACP; and 3) meaningful ACP conversations could happen when clinicians listen. Although participants from marginalized populations were willing to engage in ACP, a fragmented and restrictive healthcare system and clinicians' biased behaviors or lack of interest in knowing their patients were obstacles. Participants who felt their clinicians took time and listened were encouraged to engage in ACP. CONCLUSION Patients from marginalized populations are willing to engage in ACP conversations despite a common belief otherwise. However, obstacles to meaningful ACP conversations with healthcare providers exist. Clinicians need to be aware of these obstacles and listen to build trust and engage marginalized patients in mutually meaningful ACP conversations.
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Affiliation(s)
- Shigeko (Seiko) Izumi
- School of Nursing, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Ellen Garcia
- School of Nursing, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Andrew Kualaau
- School of Nursing, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Danetta E. Sloan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Susan DeSanto-Madeya
- College of Nursing, University of Rhode Island, Providence, Rhode Island, United States of America
| | - Carey Candrian
- School of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Elizabeth Anderson
- Pacific Institute for Research and Evaluation, Louisville, Kentucky, United States of America
| | - Justin Sanders
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Frie K, Timm J. Developing Cultural Humility Through an Interprofessional Clinical Education Experience. Nurse Educ 2023; 48:E153-E157. [PMID: 36807285 DOI: 10.1097/nne.0000000000001379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND An interprofessional clinical education model operating student-led, faculty-guided clinics partnered with rural Midwest American communities lacking health care access. PURPOSE To evaluate how an internship, guided by the Theory of Cultural Humility, during the COVID-19 pandemic supported development of cultural humility in interprofessional health profession students. APPROACH Nursing, exercise science, public health, and social work participants completed an internship during early phases of the COVID-19 pandemic, despite many experiences being suspended. Quantitative evaluation using pre-/postadministration of Foronda's Cultural Humility Scale was completed across 3 periods measuring change in cultural humility. RESULTS Total scores of Foronda's Cultural Humility Scale increased for all 3 periods (n = 11, n = 74, and n = 44), demonstrated by aggregate data and statistical analysis. The largest change occurred in the first period. CONCLUSIONS Engaging interprofessional students in experiential learning during real-life, real-time public health events creates reflection of complex practice issues while developing cultural humility.
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Affiliation(s)
- Kathryn Frie
- Associate Professor (Dr Frie), Department of Undergraduate Nursing, and Associate Professor (Dr Timm), Department of Graduate Nursing, Winona State University, Winona, Minnesota
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Wall A. Practicing cultural humility toward Black and Brown communities in the ED. Nursing 2023; 53:41-44. [PMID: 36946637 DOI: 10.1097/01.nurse.0000920456.10204.1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT Recent studies indicate that practicing cultural humility versus cultural competency increases the quality of care for patients. This article discusses the differences between cultural competence and humility and explores the best practices for adopting and demonstrating cultural humility in nursing care.
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Affiliation(s)
- Aishia Wall
- Aishia Wall is a family nurse practitioner student at SUNY Brockport
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Curseen KA, Bullock K. Response to Fitzgerald Jones et al., Top Ten Tips Palliative Care Clinicians Should Know About Delivering Antiracist Care to Black Americans (DOI: 10.1089/jpm.2021.05021). J Palliat Med 2022; 25:345-346. [PMID: 35230895 DOI: 10.1089/jpm.2021.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kimberly A Curseen
- Division of Palliative Medicine, Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Karen Bullock
- North Carolina State University, College of Humanities and Social Sciences, School of Social Work, Raleigh, North Carolina, USA
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Tollinche LE, Rosa WE, van Rooyen CD. Perioperative Considerations for Person-Centered Gender-Affirming Surgery. Adv Anesth 2021; 39:77-96. [PMID: 34715982 PMCID: PMC8562883 DOI: 10.1016/j.aan.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
With more than 1 million people identifying as transgender in the United States alone, the likelihood of encountering a transgender patient and their family of choice in the perioperative setting is very high. A lack of data exists to equitably inform transgender-specific issues, as well as the associated morbidity during the transgender reassignment perioperative period. Anaesthesiologists should actively acquire the knowledge and skills needed to inclusively and respectfully manage these patients and be aware of their unique physiological and psychosocial needs. The pre-operative approach includes a detailed history, focusing on the patients cross-sex hormone treatment (CSHT) regimen and associated medical conditions. An in-depth understanding of commonly used hormones such as estrogen and testosterone and their effect in the perioperative periods is essential. The physical examination should be relevant to the anatomy that is currently present while taking into consideration feminising and masculinising procedures (e.g., genioplasty, thyroid cartilage augmentation), how these interventions alter the anatomy, and potential airway complications. Laboratory results should be interpreted with care – and with expert assistance if needed - as hormone therapy might affect reference values. In addition, risk assessment tools should be used with caution since they often include sex in their scoring system but do not account for the use of CSHT. Intraoperative considerations include urethral catheter placement, drug dosing, and drug interactions that are commonly encountered in the transgender patient. Special attention should be taken in transgender females who have undergone vocal feminization, as case reports have described unexpected difficult airway management. A multimodal approach, which includes regional blocks and attention to pre-existing chronic pain conditions, should be employed as part of the post-operative pain management plan. The post-operative nausea and vomiting risk has not yet been established in this population, requiring appropriate anti-emetic prophylaxis. Despite societal advances that improve transgender health, the medical community still lacks empirical evidence to effectively mitigate the distinctive challenges confronted by this at-risk population.
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Affiliation(s)
- Luis E Tollinche
- Department of Anesthesiology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA.
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Christian D van Rooyen
- Department of Anesthesiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
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Rezaee N, Mardani-Hamooleh M, Seraji M. Nurses' perception of ethical challenges in caring for patients with COVID-19: a qualitative analysis. J Med Ethics Hist Med 2020; 13:23. [PMID: 34055239 PMCID: PMC8141204 DOI: 10.18502/jmehm.v13i23.4954] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022] Open
Abstract
Nurses face several challenges in providing care for patients with coronavirus disease in 2019 (COVID-19). The study aimed to explain the nurses' perception of ethical challenges in this regard. The qualitative study was carried out using a content analysis method. Individual and semi-structured interviews were conducted with 24 nurses. Inductive content analysis was used to categorize the data. Nurses' narratives indicated that ethical challenges in caring for patients with COVID-19 included threats to professional values and the absence of a holistic COVID-19 care approach. The first category was subcategorized into the risk of declining quality of patient care and a stigmatized public image about COVID-19 care. The second category was divided into poor spiritual care, poor compassionate care, and lack of family-centered care. Health care managers must develop protocols for nurses that address these issues to alleviate the ethical challenges of COVID-19 care.
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Affiliation(s)
- Nasrin Rezaee
- Associate Professor, Community Nursing Research Center, Department of Psychiatric Nursing, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Marjan Mardani-Hamooleh
- Associate Professor, Nursing Care Research Center, Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Seraji
- Assistant Professor, Department of Health Education & Health Promotion, Zahedan University of Medical Sciences, Zahedan, Iran
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