Understanding social determinants such as socioeconomic status, race, and different “isms” is crucial in healthcare because they are influential factors that impact patients’ health outcomes. Race is not just a biological factor; it involves social constructs that can impact an individual’s access to opportunities and resources, which in turn affects their access to care. Similarly, socioeconomic status is tied to the income of an individual, which plays a huge role in determining the quality of care they get. Other “isms,” which include different types of bias and discrimination, also enhance health disparities. They lead to differential treatment of patients and access to care, which in turn creates a myriad of challenges for patients who belong to marginalized populations (Rosenblum & Travis, 2009). Recognition of these factors is important for healthcare providers to provide equitable and quality care. This paper discusses how discrimination in social determinants such as class, race, and violence contribute to healthcare disparities. The ways in which these factors impact both patient and nursing experience are discussed. The paper also provides recommendations on strategies that can be used to address these challenges.
Discrimination and Disparities in Healthcare
In healthcare, discrimination forms a significant challenge that affects both nurses and patients. Rivenbark & Ichou (2020) define discrimination as prejudicial and unjust healthcare treatment that is given to individuals based on race, socioeconomic status, gender, and other inherent factors. On the other hand, disparities are the differences in access to healthcare, treatment as well as healthcare outcomes among different populations. There are many forms in which discrimination can manifest, including delayed care, unequal treatment, or insufficient attention based on the identity or background of the patient (Rivenbark & Ichou, 2020). Individuals from marginalized ethnic or racial groups, for instance, may face stereotypes that are likely to impact the type of care that healthcare provides. There was a time we attended a Hispanic patient who had chest pain and shortness of breath. The team leader attributed the symptoms to lifestyle factors and did not bother to conduct a thorough examination. Fortunately, one of the team members talked to the leader, and the patient was eventually able to receive a proper diagnosis. Nurses also can face discrimination in the form of biased evaluations, unequal opportunities, and micro-aggressions, which are likely to affect their professional experience and workplace environment (Rivenbark & Ichou, 2020). For instance, a nurse from a minority group can face barriers when it comes to promotions at the workplace because of systematic bias. In my clinical experience, I have heard colleagues share experiences they have had with subtle discrimination influencing their professional growth and job satisfaction.
Discrimination and disparities have a huge negative impact on healthcare. This is because it causes compromised healthcare outcomes for patients. Unequal treatment can cause delayed or wrong diagnosis, inappropriate interventions, and, eventually, low-quality care. These disparities lead to a continuous cycle of inequities in healthcare, enhancing the difficulties that marginalized communities face. Nurses who are discriminated against may struggle with job stress, reduced satisfaction in the workplace, and limited opportunities for progression (Rosenblum & Travis, 2009). In turn, this impacts the well-being well-being of patients and the healthcare workforce due to a less inclusive workforce.
The Role of Social Determinants
Race, socioeconomic status, class, and disabilities are some of the social determinants that shape healthcare access and delivery. When these factors are combined, they impact access to quality care, healthcare resources, and overall health outcomes. Healthcare providers should understand the impact that disabilities, race, and class can have on healthcare to offer equitable and effective care. Race, which is more than a biological classification, holds a significant impact on health outcomes. People from minority races may experience systematic barriers, which include but are not limited to lack of access to facilities of healthcare, treatment disparities, and cultural bias (Rivenbark & Ichou, 2020). These difficulties can lead to delayed care and inadequate interventions, causing overall negative health for people from these races.
The socioeconomic status tied closely to the social and economic standing of an individual can also have an impact on healthcare outcomes. Rosenblum & Travis (2009) explain that patients from low socioeconomic status are likely to face barriers that include lack of access to preventive care, barriers in affording treatment and medication, and even higher chronic stress rates. All these eventually lead to a continuous trend of health disparities, which impact people with fewer economic opportunities and resources.
Disabilities also enhance health inequities. According to Davidson et al. (2016), patients with disabilities may face barriers when it comes to having access to services that are customized to their particular needs. One time during my clinical experience, we were attending to a patient with mobility impairment. The patient required special rehabilitation care and service, but the facility did not have proper accommodations. This impacted the patient’s access to post-operative care, which is very important. Physical obstacles, stigmatization in society, and lack of accommodation can also affect the ability of people with disabilities to receive appropriate and timely healthcare services.
Violence in Healthcare and Resilience and How to Address It
In healthcare, resilience means the ability of both patients and healthcare providers to recover and adapt to challenges and situations that are challenging, keeping a state of emotional and mental well-being despite the challenges. Hollywood & Phillips (2020) write that resilience is the ability to adapt to the demanding nature of healthcare for nurses. It is the capacity to manage conflicts, cope with stressful situations, and recover from difficult scenarios, contributing to professional well-being (Hollywood & Phillips, 2020). On the other hand, for patients, resilience is the ability to cope with challenges in healthcare, successfully go through difficult medical situations, and still keep a positive view of healthcare after such challenges.
Violence, whether it is manifested in a direct or structural form, can negatively impact healthcare outcomes and the nursing workplace environment. Phillips (2016) explains that direct violence includes the use of verbal or physical harm, which is directed either to patients or nurses. I have witnessed cases of patients becoming violent toward nurses, especially when frustrated by their medical condition. They end up becoming verbally abusive. In one particular case, there was too much tension to the extent that the patient became physically aggressive and lashed out by pushing the nurse, making her fall. Structural violence, on the other hand, includes systematic injustices and inequalities that contribute to disparities in both access and outcomes of healthcare (Phillips, 2016). This can cause marginalized populations to face barriers in access to essential healthcare services, causing health inequities.
In nursing, violence causes workplace stress, burnout, and job dissatisfaction. These effects go beyond individual healthcare providers and impact the whole workplace environment, potentially causing reduced quality of patient care (Phillips, 2016). Violence towards patients can cause delayed treatment, delayed recovery, psychological stress, and even impact relationships with nurses, leading to a negative experience in healthcare as a whole.
Resilience is a tool that can be used to mitigate the effects of violence in healthcare. Corresponding to Hollywood & Phillips (2020), resilient nurses are better equipped to handle stress and challenges at work, which reduces burnout risk and enhances job morale. Also, resilient patients are more likely to engage actively in their treatment and persevere through any difficulties, making it advisable to cultivate resilience in patients.
To create a resilient environment for healthcare, it is important to implement support strategies for healthcare professionals, including programs to train on stress management, debriefing services, and counseling services. When it comes to patients, healthcare providers can help foster resilience through emotional support, education, and encouragement of self-care strategies. Being able to address the root cause of violence can help to promote a resilient culture and, in turn, create a more conducive and supportive environment for healthcare professionals and patients (Hollywood & Phillips, 2020).
Importance of Being an Ally
In nursing, being an ally is about being a supporter and advocator of vulnerable populations and encouraging an equitable and inclusive environment of healthcare. It is not just acknowledging the disparities in healthcare but taking measures to address them (Weitzel et al., 2020). Being an ally is important because it leads to the recognition of common challenges faced by vulnerable populations and making a commitment to use the influence and privilege that one has to make a positive change in healthcare. It is about standing together with people who face discrimination and biased treatment because of actors like gender, race, and social class. Weitzel et al. (2020) emphasize that it is also about listening to the concerns and needs of vulnerable populations and advocating for practices and policies that address these concerns. Nursing allies continuously take part in education to train on cultural competence and to ensure that they offer care that is patient-centered and values and respects the diversity of individuals.
As a nurse, it is important to always reflect on the support given to vulnerable people. This includes challenging discriminatory policies, advocating for a change in practices that perpetuate disparities as well as fostering a culture that values inclusivity and diversity (Weitzel et al., 2020). Also, it can involve encouraging open communication where people from vulnerable backgrounds feel valued, respected, and heard, leading to a more supportive nursing community.
Strategies for Addressing Inequities in Healthcare
An important strategy for addressing inequities in healthcare is implementing training and education programs in healthcare to promote cultural competence. Such programs are likely to create awareness concerning biases and lead to a better understanding of patients with diverse needs (Serchen et al., 2021). Providing knowledge and tools to healthcare professionals can help mitigate policies and practices that are discriminatory and enhance the care quality provided to patients from diverse environments. The other strategy to eliminate inequities is implementing policies that completely prohibit discrimination. Serchen et al. (2021) state that clear guidelines and consequences should be established for any individual who is involved in discriminatory behavior. The policies should then be updated and reviewed on a regular basis to make sure they are effective in reducing discrimination and disparities.
In summary, healthcare is a very complex field that requires a thorough understanding of factors such as race and class and how they contribute to discrimination and disparities in healthcare. Discrimination impacts not only patients but also nurses, which affects the overall health outcomes and experiences at work. Race and socioeconomic status are factors that have been revealed to contribute to huge inequities in healthcare. A strategy that has proven effective in helping address such challenges is resilience. Resilience also helps to manage and reduce the impact of violence in healthcare. Apart from that, being an ally in nursing can help reduce discrimination and disparities in healthcare and, in turn, eliminate inequities. Other strategies for reducing inequities in health that have been discussed also include education, changes in policies, and encouraging a diverse workforce.
References
Davidson, P. M., Rushton, C. H., Dotzenrod, J., Godack, C. A., Baker, D., & Nolan, M. N. (2016). Just and realistic expectations for persons with disabilities practicing nursing. AMA Journal of Ethics, 18(10), 1034-1040.
Hollywood, L., & Phillips, K. E. (2020). Nurses’ resilience levels and the effects of workplace violence on patient care. Applied nursing research, 54, 151321.
Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England journal of medicine, 374(17), 1661-1669.
Rivenbark, J. G., & Ichou, M. (2020). Discrimination in healthcare as a barrier to care: experiences of socially disadvantaged populations in France from a nationally representative survey. BMC Public Health, 20(1), 1-10.
Rosenblum, K. E., & Travis, T. M. C. (2009). The Meaning of Difference: American Constructions of Race, Sex (Vol. 52, No. 53, p. 54). McGraw-Hill.
Serchen, J., Doherty, R., Atiq, O., Hilden, D., & Health and Public Policy Committee of the American College of Physicians. (2021). A comprehensive policy framework to understand and address disparities and discrimination in health and health care: A policy paper from the American College of Physicians. Annals of Internal Medicine, 174(4), 529-532.
Weitzel, J., Luebke, J., Wesp, L., Graf, M. D. C., Ruiz, A., Dressel, A., & Mkandawire-Valhmu, L. (2020). The role of nurses as allies against racism and discrimination: An analysis of key resistance movements of our time. Advances in Nursing Science, 43(2), 102-113.
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