Major events throughout history have impacted healthcare delivery and clinical caregivers: sequencing the human genome, development of MRI, smallpox being eradicated, DRGs, electronic health records, telemedicine, seat belts, advanced care directives, the first AIDS case, and the resultant HIV disease. Many of these events resulted in changes to the healthcare system to meet the needs of a marginalized population. Examples include the Patient Protection and Affordable Care Act, Health Insurance Portability and Accountability Act (HIPPA) and Medicare.
The impact of the murder of George Floyd and the resultant Black Lives Matter demonstrations and other social justice campaigns, which have and continue to occur across the country and locally in Spokane, have raised awareness of implicit bias imposed by caregivers on marginalized patient populations.
As civil unrest challenged our moral compasses, emerging data supporting negative health outcomes in the context of implicit healthcare bias and the resulting cry for justice have caused healthcare organizations to heighten focus on diversity, equity, and inclusion approaches for all patients and caregivers.
Through gap analysis, a group of nursing professional development practitioners and Specialists at Providence Holy Family Hospital in Spokane, Washington assessed the need for diversity, equity, and inclusion (DEI) training for new caregivers.
Our approach to address DEI was inspired by NPD’s attendance at ANPD’s virtual convention in 2021, "Aspire to Inclusivity." During the poster presentation “Implicit Bias on a Boat” by Cynthia Rittenhouse and Laura Douglass, participants were provided a brief description of several individuals representing marginalized and diverse populations with the instruction to select the individuals they would save.
After the designated time for selection and reflection, additional information on these individuals to further develop their stories was provided, thus allowing for further exploration of individual bias. Permission was secured from Rittenhouse and Douglass to utilize and modify the event for participants to be more relevant to the Inland Northwest location and demographics.
The NPD team modified the scenario to evacuation from a wildfire to be more in line with an event that would reflect the potential impact of a natural disaster in our area. After testing the presentation through two groups, there was strong resistance and uncertainty due to clinical caregivers slipping into "save them all" mode, which resulted in challenges within the exercise experience. A participant suggested making the event a positive one, and thus the idea of a two week, all-expense paid tropical vacation was born.
Following this activity, using Vegas rules (a safe, nonjudgmental environment), a debrief occurred to include education on definitions and terms related to DEI. Additional education, including two short audio files from the perspectives of individuals who experience healthcare disparities, was provided. The files included one from a child with parents whose second language was English and a nonbinary individual; these files facilitated a discussion regarding other healthcare disparities.
In July 2021, full in-person orientation began, into which the exercise was incorporated. To evaluate the learning event, a QR code was created, linking to a voluntary evaluation built in REDCap, a secure web application for managing surveys and databases that meet HIPPA compliance standards. The evaluation prompt was, “After attending the diversity, equity and inclusion session today, I will be more aware of my interactions with patients and caregivers." From July to December, a total of 69 caregivers completed the survey, with 65% being registered nurses. The reported responses to the survey were: 41% Strongly Agree, 58% Agree and 1% disagree.
The conclusions were based on these formal evaluation results, which revealed incorporating interactive education on DEI increases awareness of potential (or implicit) bias and the impact of health disparity during interactions with caregivers and patients. In addition, the audience’s active participation throughout the presentation and robust conversation and engagement served as valuable feedback to the presenters.
Nursing professional development practitioners should remain apprised of societal implications, which may impact their target audiences, help them grow professionally, and will encourage them to integrate these skills into their own practice. These implications were further reinforced with the updated publication of the NPD Scope and Standards of Practice, 4th Edition, released in 2022 for purchase. Specifically, the addition of “Standard 9. Respectful and Equitable Practice” will reinforce the importance of implementing formal DEI training to better the care that is being provided.