The higher COVID-19 death rates among Black communities have accentuated the structural inequities linked to poor health, which threaten the lives of Black Americans and other underserved populations. These intersecting realities have brought many other health professionals, along with myself, to consider the impact of institutional racism and its barriers in operationalizing a healthcare system that marginalizes those who need it the most.
I have spent my career using non-traditional models of patient-centered care, e.g., community-based participatory research (CBPR), emphasizing self-efficacy to promote disease prevention and risk reduction in the Black community. Racial and ethnic minorities represent one of the fastest-growing segments of our society.
In July 2017, 41.4 million people in the United States identified as black alone, representing 12.7% of the total population. African Americans are the second-largest minority population, following the Hispanic/Latino population. In 2017, most blacks lived in the South (58% of the black U.S. population), while 27% of white people lived in the South. Health disparities, the burden of diseases, and other adverse health conditions among Blacks or African American populations remain stark and continue to widen.
According to Census Bureau projections, the 2015 life expectancies at birth for blacks are 76.1 years, with 78.9 years for women and 72.9 years for men. For non-Hispanic whites, the projected life expectancies are 79.8 years, 82.0 years for women, and 77.5 years for men. The death rate for African Americans is generally higher than whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide.
The coronavirus pandemic is disproportionately sickening and killing Black people. According to the National Urban League, black Americans are infected with COVID-19 at nearly three times the rate of white Americans. Based on data from Johns Hopkins University, the report also shows black Americans are twice as likely to die from the virus. This same report asserts that blacks were more likely to have preexisting conditions predispose them to COVID-19 infection.
Once entering the healthcare system, seven of 10 of African Americans say the health care system mistreats people based on race “very often” or “somewhat often,” a notable increase from 56%, when a similar question was asked in 1999, and the numbers appear to be getting worse. One in 5 Black adults says they were mistreated because of race in the past year when seeking health care for themselves or a family member.
Many have recently questioned the efficacy of the COVID-19 vaccine and consider whether its use and distribution have been racialized. This distrust could worsen an already catastrophic Black health crisis if African Americans are reluctant to participate in testing, vaccination, or treatment.
Their responses have reflected a timeworn piece of Black wisdom: “when white America catches a cold, Black America gets pneumonia.” Overall, our health care system has not been ready to confront these issues head-on. But these numbers are difficult to ignore.
As the pandemic grinds on, the barriers hindering African Americans from equal benefits of the health care system must be considered. We must seek to adopt strategies to overcome distrust and engage local Black communities by eliminating systemic bias in health care with sustained actions, resources, leadership, and commitment.
To improve the nation’s health, we, as nurse coaches, must begin to cultivate and encourage the design of strategies and action plans that integrate five elements of cultural competent care into nurse coaching and nursing practice. Targeting these 5 key elements of culturally competent care are integral if we are to reduce and eliminate disparities impacting people of color.
5 Key Elements of Culturally Competent Care
An open attitude: Consider there is much you do not know and be ready to receive new information with an open mind. Be prepared to expose yourself to diverse ideas and alternative viewpoints, and anywhere else, you can engage with people you might consider different from yourself.
Self-awareness: “Black people say unconscious racial bias has been a significant barrier in their lives, posing as much or more of a problem than structural racism and individual discrimination.” Shine a light onto your own culture, beliefs, values, and worldview. Objectively explore what you may subconsciously be bringing to every interpersonal interaction.
“Nurse coaches are aware that presence and caring compassion are essential for genuine empathy.” (Dossey). Presence invokes respect, and it is this respect that fosters meaningful awareness in the nurse-coach client relationship.
Awareness of others: The nurse coach’s capacity for self-reflection and intervention helps facilitate others’ awareness and the recognition that all individuals have a story. From this place, nurse coaches bear witness to the client’s account, which may not match up with your own. The capacity for self and others’ awareness “includes a willingness to be free of fixed ideas,” or perspectives.
Cultural knowledge: Given the changing demographics in the U.S., familiarity with various cultural characteristics, including values, belief systems, history, and social mores, we must engage in a deliberate focus on meeting the needs of clients with diverse experiences and from backgrounds that may differ significantly from our own. We must begin to develop nurse coaches who possess the knowledge, skills, and attitudes necessary to care and coach in the local community, nation, and world. Directing specific attention toward incorporating coursework to develop nurse coaching’ global and cultural competencies are essential, yet insufficient. Within the context of practice, experiential learning is where the most significant education takes place.
Nurse coaching programs must consider various strategies to ensure nurse coach candidates have coursework and experiential learning to adequately prepare us to enact the practices and develop the dispositions vital to the success of the nurse coach in diverse settings.
Cultural skills: Cultural knowledge can develop into cultural skills, which includes asking more “powerful” and informed questions about your clients’ beliefs and practices surrounding health and well-being. The ability to adapt our communication style to different individuals, groups, and cultures, the use of deep listening skills, establishing relationships based on mutual trust and respect, implementing processes that promotes culturally competent care and inclusion, can all be used to build a nurse coaching community which transforms our practice(s) into equitable, and non-oppressive environments.
As we continue to learn more about ourselves and others, we adjust our approaches and assumptions. Successfully engaging all five elements of culturally competent care opens the door to the development of cultural competence and respectfully meets ALL clients’ needs, regardless of their racial or ethnic backgrounds.
Being “color-blind” is not enough.
As nurse coaches, we must seek to embrace anti-racist practices in healthcare and eliminate the use of stereotypes and biases from our nursing practice. Faulty assumptions about race may have systemically racist effects on health care delivery for large populations of Black individuals who suffer health inequities.
The Nurse Coach’s Core Essentials, organized along with the Core Values, provide a strong foundation for integrating these critical elements for nurse coaching’s cultural competency. As Dossey notes: “Nurse Coaches are uniquely positioned to cultivate cultural competencies within the context of health, illness, family community and culture.”
During Black History Month, we celebrate those who have helped move the us forward. As we continue to build on what they have achieved, the community can be our most significant source of strength. As nurse coaches, we are part of a community that can help each other feel empowered and inspired to grow, whether facing moments of injustice or celebrating small victories.
We must fully embrace the notion of race as a social (non-biological) construct through which systemically racist policies and practices are justified.
We must seek to disavow ourselves from potentially racist assumptions completely. In doing so, we may undo the very thing that may lead us to harm the same individuals we seek to help.
We must shine a bright light on racism as an essential contributor to generations of poor health and health inequities for Black and other marginalized communities.
RN, MS, CNS, FNP | SENIOR LECTURER, SCHOOL OF NURSING, CLEMSON UNIVERSITYALUMNA, INTERNATIONAL NURSE COACH ACADEMY (INCA) || PERSONAL WEBSITE
Ms. Lanham is a senior lecturer in the School of Nursing at Clemson University. In 1988 she graduated from Clemson University with a B.S. in Nursing and again in 1994 with a M.S. in Nursing M.S. She holds Advanced Practice Nursing — Family Nurse Practitioner certification from the University of South Carolina. In her career she has demonstrated excellence in teaching by incorporating innovative, evidenced based pedagogies which engage and prepare new nurses to practice in a diverse and dynamic work environments. She engages in promotional activities to enhance teaching, scholarship, service, and expert clinical practice. Ms. Lanham works to promote expertise and skill among undergraduate nursing students in the delivery of culturally appropriate and competent nursing care for an increasingly diverse society. Her research program emphasizes cultural awareness, global health, health disparities, innovative pedagogy, telehealth, and health information/mobile technology.