Addressing Health Inequity Through Nursing Science

Nursing science and practice focus on health promotion, disease prevention, supporting across the trajectory of acute chronic conditions, including palliative end-of-life care. We include individuals, families, communities lifespan who are diverse in many ways often suffer from inequities associated with multi-level social environmental factors, racism. The National Institute Research others have supported research training focused topics relevance to populations for whom we care through recent initiatives addressing self- family management, symptom care, “precision health” other relative broad domains nursing discipline. This provided critical knowledge about these phenomena interventions has improved or potential improve groups settings. However, contributions determinants equity concerns related remain important, but under-addressed areas science. Ongoing emphasize biological processes that may explain phenomena. For example, studies addressed “omic” underpinnings symptoms e.g., (Cashion et al., 2016Cashion A.K. Gill J. Hawes R. Henderson W.A. Saligan L. Institutes Health Symptom Science Model sheds light patient symptoms.Nursing Outlook. 2016; 64: 499-506https://doi.org/10.1016/j.outlook.2016.05.008Abstract Full Text PDF PubMed Scopus (31) Google Scholar), (Corwin Ferranti, 2016Corwin E.J. Ferranti E.P. Integration biomarkers advance precision life span.Nursing 292-298https://doi.org/10.1016/j.outlook.2016.04.007Abstract (9) self-management (Hickey 2019Hickey K.T. Bakken S. Byrne M.W. Bailey D.C.E. Demiris G. Docherty S.L. Grady P.A. Precision health: Advancing science.Nursing 2019; 67: 462-475https://doi.org/10.1016/j.outlook.2019.01.003Abstract (28) clinical imaging (Ielapi 2020Ielapi N. Andreucci M. Licastro Faga T. Grande Buffone Serra Medicine Nursing: Era Biomarkers Health.International Journa General Medicine. 2020; 13: 1705-1711https://doi.org/10.2147/IJGM.S285262Crossref (4) Scholar) as components health. While this is compelling consistent emphasis approaches medicine, social, behavioral, also elements signal risk serve modifiable targets intervention 2019Corwin E. Redeker N.S. Richmond T.S. Pickler R.H. Ways knowing health.Nursing 293-301https://doi.org/10.1016/j.outlook.2019.05.011Abstract (12) Scholar; Hekler 2020Hekler Tiro J.A. Hunter C.M. Nebeker C. Health: Role Social Behavioral Sciences Vision.Annals 54: 805-826https://doi.org/10.1093/abm/kaaa018Crossref (18) Scholar). A phenomena, addition biology, discipline's longstanding emphases reflected our meta-paradigm links humans, health, nursing, environment (Fawcett, 1984Fawcett metaparadigm nursing: present status future refinements.Image Journal Scholarship. 1984; 16: 84-89https://doi.org/10.1111/j.1547-5069.1984.tb01393.xCrossref (132) justice, equity, (Dumitrascu 2020Dumitrascu D.I. David Dumitrascu D.L. Rogozea Florence Nightingale bicentennial: 1820-2020. Her improvement.Medical Pharmacology Reports. 93: 428-430https://doi.org/10.15386/mpr-1799Crossref (2) activism (Florell, 2021Florell M.C. Concept analysis activism.Nursing Forum. 2021; 56: 134-140https://doi.org/10.1111/nuf.12502Crossref Weitzel 2020Weitzel Luebke Wesp Graf M.D.C. Ruiz A. Dressel Mkandawire-Valhmu Nurses Allies Against Racism Discrimination: An Analysis Key Resistance Movements Our Time.Advances Science. 43: 102-113https://doi.org/10.1097/ANS.0000000000000290Crossref (10) factors emphasized by (Nightingale, 1860Nightingale F. Notes What it Not.First American ed. Appleton, New York1860Google COVID-19 pandemic, clear effects structural racism access during pandemic (Tan 2021Tan S.B. deSouza P. Raifman Structural USA: a County-Level Empirical Analysis.Journal Racial Ethnic Disparities. https://doi.org/10.1007/s40615-020-00948-8Crossref (11) urgency address discrimination manifested Black Lives Matter movement events bring fore disparities (differences health) need understand (unfair avoidable differences (Srinivasan Williams, 2014Srinivasan Williams S.D. Transitioning agenda: time now.Public HealthRreports (Washington, D.C.: 1974). 2014; 129 Suppl 2: 71-76https://doi.org/10.1177/00333549141291S213Crossref There intervene “the conditions which people born, grow, work, live, age, wider set forces systems shaping daily life. These economic policies systems, development agendas, norms, political systems” (World Organization 2021World (2021). Determinants Health. Retrieved https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1Google nursing. Examples stability, quality education neighborhood built environments, community contexts, inclusion, non-discrimination (Control, 2021Centers Disease Control. https://www.cdc.gov/socialdeterminants/index.htmGoogle World Although not new, fact account between 30-55% outcomes underscore nurses conduct rigorous innovative will practice, policy, influence inequity. requires researchers, nurses, understanding develop evaluate evidence-based solutions driven largely economic, Even when medicine” primary treatments, there attention perceptions (Yeh 2020Yeh V.M. Bergner E.M. Bruce M.A. Kripalani Mitrani V.B. Ogunsola T.A. Griffith D.M. Can Actually Help People Like Me? African Hispanic Perspectives Benefits Barriers Medicine.Ethnicity Disease. 30: 149-158https://doi.org/10.18865/ed.30.S1.149Crossref Enhancing cultural intelligence (McMillian-Bohler Richard-Eaglin, 2021McMillian-Bohler Richard-Eaglin Uprooting Racism: Cultivating Improved Maternal Outcomes Women.Creative Nursing. 27: 61-65https://doi.org/10.1891/CRNR-D-20-00066Crossref (1) thoughtful consideration own biases recipients beneficiaries science, anti-racism. consider benefits all members society philosophical ethical perspectives underlie study (Gilmore-Bykovskyi 2021Gilmore-Bykovskyi Jackson J.D. Wilkins C.H. Urgency Justice Research: Beyond COVID-19.Trends Molecular 97-100https://doi.org/10.1016/j.molmed.2020.11.004Abstract (3) work be enhanced use frameworks contributors (e.g., family, society, policy levels) beyond individuals alone. example Minority Disparities framework describes multiple levels individual societal level (National Intitute 2017National DisparitiesNational Framework.2017https://www.nimhd.nih.gov/about/overview/research-framework/nimhd-framework.htmlGoogle been variations model, models developed depending context research. Critical race theory, methodology helps researchers attentive (Ford Airhihenbuwa, 2010Ford C.L. Airhihenbuwa C.O. Race Theory, public toward antiracism praxis.American Public 2010; 100 1: S30-S35https://doi.org/10.2105/AJPH.2009.171058Crossref (286) intersectionality, acknowledgement sources discrimination, important must inform work. ability meaningful addresses depends partnerships engagement groups, assure contextual meaning, relevance, ultimate uptake resulting interventions, programs, (Sadler 2012Sadler L.S. Larson Bouregy Lapaglia D. Bridger McCaslin Rockwell Community-university community-based research.Progress Community Partnerships. 2012; 6: 463-469https://doi.org/10.1353/cpr.2012.0053Crossref (22) Qualitative mixed methods useful obtaining key stakeholders reveal long-term success practices emerge research, information lacking traditional quantitative approaches. Conducting creativity application sophisticated new existing methods. require interdisciplinary partners, those biological, behavioral sciences, economics, history, data engineering, architecture, fields. short, incomplete, listing include:•Best assuring cultural, linguistic, engaged approaches, qualitative and/or methods•Methods measuring physical characteristics pollutants, light, noise, temperature) (housing quality, safety, availability green space), resources healthy food care) geospatial phenomena•Methods networks contexts within families communities•Data collection facilitate collecting “big data” sources, integrate into electronic medical records databases (Analytics, 2021Analytics IT Top Three Challenges Addressing Health.2021https://healthitanalytics.com/news/top-3-data-challenges-to-addressing-the-social-determinants-of-healthGoogle Scholar)•Statistical enable multi-variable large quantities obtained sources•Methods sophistication drive policy. U.S. throughout world. training, networking, sharing best practices, collaboration area. Council Advancement Science's (CANS) Advanced Methods Conference - “Inclusion Design: Approaches Diversity, Equity, Inclusivity, Accessibility Research,” offered virtually October 6, 2021 provide national forum timely topic. Please join us! My thanks Dr. Lois Sadler her comments