a. What macrosocial antecedents (as defined on the article) did Representative Underwood
discussed during her interview? Select one and Explain why it is important and support
your comment with evidence.
Antecedents regarding patients’ advocacy are previous occurrences that necessitate
nursing action to promote patients’ rights. On the macroscopic level, antecedents may involve
poverty, racism, availability of health care services, and the overall complexity of the healthcare
environment (Xu & Jezewski, 2006). As U.S. Representative Lauren Underwood noted in her
interview with the Oncology Nursing Society (2020), the city of Chicago published statistics
indicating that 70% of Covid-19 deaths were African American. Next efforts were expected to
include increased Covid-19 testing in communities of color to determine who is sick and perform
the necessary contact tracing to limit the spread of the disease in those communities; however,
this did not occur. Conversely, when nursing homes saw an increase in Covid-19 cases and
deaths, a "policy choice" was implemented to test all nursing home residents in affected
communities. That "policy choice" was not realized in vulnerable, medically underserved, and
communities of color. While I agree with Representative Underwood that this failure to act is
"unfair" and "immoral," I question who is responsible for this "policy choice." Residents of
nursing homes are paying for a health care service. It is the duty of the nursing home to maintain
and protect their residents' health to the best of their ability. If Covid-19 becomes rampant in
that community, the nursing home has a fiduciary responsibility to care for its residents.
Vulnerable and underserved communities should have access to health care and local clinics;
however, judging an established medical infrastructure, i.e., nursing homes, with a health care
system that should be there but is not, is not the same issue. This seems like an unfair analogy to
make a point.
Still, according to a retrospective cohort study undertaken by Escobar et al. (2021), nonwhite race/ethnicity was the most significant indicator of a person's probability of contracting
Covid-19 and increased hospitalization, even after controlling for age and comorbidities.
However, African Americans did exhibit higher incidences of comorbidities compared to other
racial communities also. Of note, race was not associated with increased mortality. Increased
testing should have been implemented, but this is an epidemiology concern as well. Why are
Covid-19 infections amplified in non-white communities, particularly African Americans?
Representative Underwood made an excellent point when she remarked that many African
Americans were essential workers who were forced to continue working without the proper
personal protection equipment (PPE) (2021). This lack of PPE still reflects poorly on the
inequitable allocation of resources. Some of PPE shortage was also to blame on the previous
administration's failure to recognize the immensity of this disease and ramp up domestic
production of PPE when they had the opportunity to prepare. When the reality set in of the
devastation this disease would trigger, there was already a shortage of PPE, and healthcare
workers were prioritized frontline personnel. Consequently, those determined to be essential
employees outside of the hospital did not get the much-needed PPE and became ill in record
numbers. This lack of PPE was not exclusive, however, to non-healthcare essential workers.
Many hospitals in various communities lacked PPE, with many hospital employees also
becoming ill and their families in turn. According to researchers at Massachusetts General
Hospital, frontline healthcare personnel were 12-times more likely to test positive than the
general public (Marquedant, 2020). Hospital employees with deficient PPE supply were at a
23% greater risk.
These racial disparities must be addressed and resolved. Beyond the apparent inequitable
distribution of resources during Covid-19, this mismanagement of medical assets furthers the
imparity of treatment and compounds the black community's skepticism with the healthcare
system and research. While many African Americans have personally experienced racism and
inattention from their healthcare providers and hospitals, there is a long-standing mistrust that
dates back to historical knowledge of medical exploitation, predominantly related to the
Tuskegee Syphilis Study that allowed infected African American men to go untreated for
observational purposes for 40 years. Consequently, many African Americans, especially men,
are less likely to seek treatment and delay routine care, leading to decreased quality of life and
increased deaths from preventable diseases. Mistrust in healthcare organizations increases with
decreasing socioeconomic status and access to medical insurance (Idan et al., 2020). Trust must
be established, to end needless health complications, to include Covid-19 now that the vaccine is
widely available. According to research conducted by Waren et al. (2020), only 3% of vaccine
trial participants were Black, while they represent 13% of the total U.S. population and 21% of
Covid-19 deaths. As of May 2021, the Centers for Disease Control and Prevention has reported
that only 28% of the Black community has received at least one dose of the Covid-19 vaccine.
As vaccines are becoming widely available to more age groups, the federal government must
make a concerted effort to make the vaccines easily accessible to vulnerable, medically
underserved, and communities of color.
b. What barriers has Representative Underwood encountered in her government position
and how has she addressed them?
Representative Underwood did not explicitly discuss barriers that she has encountered in
her government position in her interview with the Fox Valley Chapter of Oncology Nursing
Society (2020). However, she acknowledges that she is a young black woman and has
experienced discrimination and racism. Regarding progress involving her objectives to increase
resources in vulnerable, medically underserved, and communities of color, she had to battle more
general indifference rather than forceful opposition. There was an awareness that African
Americans were dying from Covid-19 at rates far greater than any other population. It was
understood that testing in those communities needed to be increased, yet nothing was actually
done. The previous administration seemed to be in complete denial of the looming crisis, and, as
Representative Underwood pointed out, President Trump failed to effectively utilize the Defense
Production Act. Ultimately, the lack of supplies and coordination of distribution created a
struggle for resources. To help rectify this problem, Representative Underwood supported the
Heroes Act, which at the time of her interview had been passed in the House, but was waiting for
a response from the Senate (the bill is currently stalled in the senate). One of the crucial issues
for Representative Underwood was that the legislation appointed a much-needed medical
supplies specialist who could appropriately coordinate the distribution of supplies. If a targeted
effort was made to increase testing in African American communities, then contact tracing could
occur, and an effort could be made to prevent the spread of the disease.
c. What experience do you have as an advocate for health at your workplace, a professional
organization, or government?
As nurses, we often advocate for our patients without specific realization of our actions. I
am lucky that I have not found myself in a challenging situation in my brief career that required
aggressive advocacy that is sometimes seen as troublesome and rebellious behavior. I most often
have to advocate for better pain management, but it is rarely met with resistance once the
ordering providers are made aware of the full extent of the patient's circumstances. Strangely, the
biggest conflicts I have experienced are related to insulin dosage and diet in patients with
diabetes. Too often, I see patients whose blood sugars are out of control, and the primary care
team is often overly cautious, even when the patient has a higher dose insulin regimen at home.
My father is a type 1 diabetic and had a similarly disappointing experience in the hospital. His
blood sugars usually are well managed but were severely uncontrolled after his heart attack. My
mother eventually brought my father's insulin to the hospital, and he managed his blood sugar
independently without the hospital's knowledge. As a nurse, this is a concern that is very
important to me. It often feels like diabetes management is not a priority because that is not the
primary cause for the patient’s hospitalization. Sadly, there sometimes seems to be little regard
to the potential long-term damage the patient may suffer by not being aware of the patient as a
whole being rather than just a singular diagnosis.
References
Bu, X., & Jezewski, M. A. (2006, November 10). Developing a mid-range theory of patient
advocacy through concept analysis. Journal of Advanced Nursing. https://onlinelibrarywiley-com.proxy1.lib.tju.edu/doi/full/10.1111/j.1365-2648.2006.04096.x.
Escobar, G. J., Adams, A. S., Liu , V. X., Soltesz, L., Chen, Y.-F. I., Parodi, S. M., Ray, G. T.,
Myers, L. C., Ramaprasad, C. M., Dlott, R., & Lee, C. (2021, February 9). Racial
Disparities in COVID-19 Testing and Outcomes: Retrospective Cohort Study in an
Integrated Health System. Ann Intern Med. https://www-acpjournalsorg.proxy1.lib.tju.edu/doi/10.7326/M20-6979.
Fox Valley Chapter of Oncology Nursing Society. (2020). Live Video conference with U.S. Rep
Lauren Underwood. Vimeo. https://vimeo.com/425981946.
Idan, E., Xing, A., Ivory, J., & Alsan, M. (2020, February). Sociodemographic Correlates of
Medical Mistrust among African American Men Living in the East Bay. Journal of Health
Care for the Poor and Underserved. https://muse-jhu-edu.proxy1.lib.tju.edu/article/747778.
Marquedant, K. (2020, May 5). Study Reveals the Risk of COVID-19 Infection Among Health
Care Workers. Massachusetts General Hospital.
https://www.massgeneral.org/news/coronavirus/study-reveals-risk-of-covid-19-infectionamong-health-care-workers.
Ndugga, N., Pham, O., Hill, L., Artiga, S., Alam, R., & Parker, N. (2021, May 19). Latest Data
on COVID-19 Vaccinations Race/Ethnicity. Kaiser Family Foundation.
https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinationsrace-ethnicity/.
Warren, R. C., Forrow, L., Hodge, D. A., Min, D., & Truog, R. D. (2020, November 26).
Trustworthiness before Trust — Covid-19 Vaccine Trials and the Black Community. The
New England Journal of Medicine. https://www-nejmorg.proxy1.lib.tju.edu/doi/10.1056/NEJMp2030033.
Breanna,
Thank you for your thoughtful discussion board post. It never ceases to amaze me that
the United States has such a high maternal death rate. According to the Centers for Disease
Control and Prevention (CDC), in 2018, the United States’ maternal mortality rate was 17.4
maternal deaths per 100,000 live births, with that number drastically increasing in the nonHispanic Black population to 37.1 maternal deaths per 100,000 live births (2020). Non-Hispanic
whites and Hispanics report 14.7 and 11.8 maternal deaths respectively.
In 2017, the World Health Organization ranked the United States 46th in the world for
maternal mortality (Amankwaa et al., 2018). It is evident that the U.S. is failing all women in
terms of maternal care. Furthermore, the CDC also reports that approximately 60% of maternal
deaths could be prevented (2019). Across the board, maternal deaths may be attributed to a lack
of nationally standardized obstetric practices, increased frequencies of gravid women with
comorbidities such as diabetes, hypertension, and obesity, and lack of maternal mortality review
boards in many states (Agrawal, 2015). These failings, however, do not address why women of
color are being neglected in revolting quantities. Is unconscious and conscious bias of race and
gender to blame? Lack of access to care and insurance due to socio-economic status certainly
plays a role, but when high-powered Black women like Serena Williams and Beyoncé are also
having critical medical issues dismissed during their pregnancy, it is difficult to argue that racism
is not the source of the problem (American Heart Association News, 2019).
References
Agrawal, P. (2015, March). Maternal mortality and morbidity in the United States of America.
World Health Organization. https://www.who.int/bulletin/volumes/93/3/14-148627/en/.
Amankwaa, L. C., Records, K., Kenner, C., Roux, G., Stone, S. E., & Walker, D. S. (2018).
African-American mothers' persistent excessive maternal death rates. Nursing Outlook.
https://www-sciencedirectcom.proxy1.lib.tju.edu/science/article/pii/S0029655418301441?via%3Dihub. Centers for
Disease Control and Prevention. (2020, January 30). First Data Released on Maternal
Mortality in Over a Decade. Centers for Disease Control and Prevention.
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2020/202001_MMR.htm.
American Heart Association News. (2019, February 20). Why are black women at such high risk
of dying from pregnancy complications? American Heart Association.
https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-high-risk-ofdying-from-pregnancy-complications.
Centers for Disease Control and Prevention. (2019, May 7). Pregnancy-related Deaths. Centers
for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/maternaldeaths/index.html.
Centers for Disease Control and Prevention. (2020, January 30). First Data Released on
Maternal Mortality in Over a Decade. Centers for Disease Control and Prevention.
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2020/202001_MMR.htm.
Katie,
Thank you for your thoughtful discussion board contribution. As you mentioned in your
post, racial disparities are a continuing issue in health care. Sadly, society has not achieved a
level of mutual respect for all people, but it is especially discouraging that a highly educated
profession whose first commandment is to “do no harm” is still overwhelmingly plagued by
bigotry. You addressed that African American women are more likely to die from complications
in pregnancy than white women. African Americans are also less likely to receive proper pain
management than other populations (Hoffman et al., 2016).
A great deal of this neglect is likely due to systemic prejudice; however, many medical
professionals still subscribe to the idea that African Americans are biologically different from
whites. A study led by Hoffman et al. examined the beliefs of laypersons, medical students, and
residents regarding black biology. Despite their medical education, many professionals hold
false beliefs concerning black and white biology that likely affects their judgment in treatment.
For example, research has shown that medical providers are more likely to underestimate the
pain of black patients. There are many reasons for this discrepancy, but the findings conducted
by Hoffman et al. found that over 10% of the medical professionals interviewed, from first-year
to residents, believed that the nerve endings of blacks are less sensitive than whites. Other false
beliefs include: 19% believed blacks have a more robust immune system than whites, 24%
believed black blood coagulates faster than whites, and 58% believed black skin is thicker than
white skin, to address just a few biological myths.
In the wake of the deplorable social injustices overwhelming our country, we must
advocate for our minority patients more than ever. Many of us have unconscious biases that we
need to better recognize and commit to addressing. We also need to help educate our peers of
their potential bias. As nurses, we are called to be advocates and leaders. It is imperative that
we take the initiative to improve the healthcare experience for our patients, who all deserve to be
valued equally.
References
Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016, April 19). Racial bias in pain
assessment and treatment recommendations, and false beliefs about biological differences
between blacks and whites. Proceedings of the National Academy of Sciences of the
United States of America. https://www.pnas.org/content/113/16/4296.