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• W3114033045 abstract "Health disparities are sustained, worsened health outcomes of a specific disadvantaged group. These health differences can be health-related quality of life, rates or severity of disease, disability, mortality, injury, or violence. Disadvantaged populations might be defined by demographic characteristics, disadvantaging environmental conditions, social vulnerability, or geography. For example, the National Institutes of Health has designated the following as United States health-disparity populations: Black/African American, Hispanic/Latino, American Indian/Alaska Native, Asian American, Native Hawaiian and other Pacific Islander, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities. We also know that the health of disadvantaged populations can be affected owing to discrimination based on age, race, color, religion, sex, gender, national origin, genetic information, veteran status, and many other considerations. The nursing discipline is committed to reducing health disparities as a collective value that is clearly stated in our Code of Ethics (Provision 8).1Emergency Nurses AssociationEmergency Nursing: Scope and Standards of Practice. Emergency Nurses Association, 2017Google Scholar Within our emergency specialty, basic and expected standards of professional performance include that “the emergency registered nurse practices in a manner that is congruent with cultural diversity and inclusion principles.”1Emergency Nurses AssociationEmergency Nursing: Scope and Standards of Practice. Emergency Nurses Association, 2017Google Scholar The purpose of this editorial is to briefly introduce the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework and a collection of health disparity–relevant papers published in this issue of the Journal of Emergency Nursing (JEN). The NIMHD Research Framework (Figure) organizes a shared mental model that emergency care specialists can apply to understand the causes and influences of health disparities.2National Institute on Minority Health and Health Disparities Research Framework. National Institute on Minority Health and Health Disparities. Research Framework, National Institutes of Health. Published 2018. Accessed November 2, 2020.https://nimhd.nih.gov/about/overview/research-framework/nimhd-framework.htmlGoogle Scholar The Framework is organized by levels of influence (top rows of Figure), domains of influence (left-hand columns of Figure), and health outcomes (bottom row of Figure). The civic engagement and public dialogue during the coronavirus disease pandemic has guided us to a long overdue and poignant focus on the need for individual, interpersonal, community, and societal antiracism commitments because racism has been an unjust and centuries-long determinant of health disparities. Although there are several racial disparities that require attention in emergency nursing, such as indigenous peoples’ health,3Leclerc A.M. Miquelon P. Rivard M.C. Transcultural health practices of emergency nurses working with Indigenous peoples: a descriptive study.J Emerg Nurs. 2020; 46 (.e232. https://doi.org/10.1016/j.jen.2019.10.018): 239-245Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar the following discussion applies the NIMHD Research Framework to Black or African American health disparities. Although those who identify their race as Black or African American may be more likely to share particular genetic,4Hardy T.M. de Mendoza V.B. Sun Y.V. Taylor J.Y. Genomics of reproductive traits and cardiometabolic disease risk in African American women.Nurs Res. 2019; 68: 135-144https://doi.org/10.1097/NNR.0000000000000337Crossref PubMed Scopus (1) Google Scholar hereditary, or biological traits (such as sickle cell trait)5Pecker L.H. Naik R.P. The current state of sickle cell trait: implications for reproductive and genetic counseling.Blood. 2018; 132: 2331-2338https://doi.org/10.1182/blood-2018-06-848705Crossref PubMed Scopus (17) Google Scholar than those with other racial identities, we also know that race is largely a social/contextual, and not biological, idea from a vast complexity of human ancestries, social structures, racial assignments, and internalized identities.6Patton E. Who is multiracial? depends on how you ask: a comparison of six survey methods to capture racial identity.https://www.pewsocialtrends.org/2015/11/06/who-is-multiracial-depends-on-how-you-ask/Google Scholar, 7Micheletti S.J. Bryc K. Ancona Esselmann S.G. et al.Genetic consequences of the transatlantic slave trade in the Americas.Am J Hum Genet. 2020; 107: 265-277https://doi.org/10.1016/j.ajhg.2020.06.012Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 8Williams T.C. Self-Portrait in Black and White: Unlearning Race. W W Norton, 2020Google Scholar In health care, new research is needed on the potential harm and misdiagnoses created by practices such as race-based adjustments in the interpretation of biological data, such as lung function testing and glomerular filtration rate, which have largely failed to take biracial and multiracial ancestry into account.7Micheletti S.J. Bryc K. Ancona Esselmann S.G. et al.Genetic consequences of the transatlantic slave trade in the Americas.Am J Hum Genet. 2020; 107: 265-277https://doi.org/10.1016/j.ajhg.2020.06.012Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,9Hobbs A.V. A Chosen Exile: A History of Racial Passing in American Life. Harvard Univerisity Press, 2016Google Scholar,10Parker K. Horowitz J. Morin R. Hugo Lopez M. Multiracial in America: Proud, Diverse, and Growing in Numbers. Pew Research Center, June 11, 2015Google Scholar Too often throughout our history, health care providers focused on individual biology or behavior as reasons for racial disparities, rather than the full multilevel range of social, community, and interpersonal influences. For example, racial health disparities are also determined by the differences in how criminal justice policy and law,11Alexander M. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. The New Press, 2020Google Scholar public education segregation,12Rooks N. Cutting School: Privatization, Segregation, and the End of Public Education. The New Press, 2020Google Scholar and housing discrimination13Taylor K.-Y. Race for Profit: How Banks and the Real Estate Industry Undermined Black Homeownership. University of North Carolina Press, 2019Crossref Google Scholar,14Castner J. Barnett R. Huntington-Moskos L. Folz R.J. Polivka B. Home environment allergen exposure scale in older adult cohort with asthma.Can J Public Health. Published online June 16, 2020. 2020; 16https://doi.org/10.17269/s41997-020-00335-0Crossref Scopus (2) Google Scholar as societal structures were applied, with clear evidence of long-standing structural racism and injustices. Although a full explanation and application of each level and domain of the NIMHD Research Framework is beyond the scope of this editorial, I encourage the emergency care community to use this Framework as a shared mental model for needs assessments and interventions that prioritize eliminating racial disparities in individual clinical practices, health care organizations, educational programs, research initiatives, and policies that we lead and influence. As an example of addressing quality of care (“Health Care System” domain and “Societal” level of influence in the NIMHD Research Framework) in this issue of JEN, Bulgin et al15Bulgin D. Bonnabeau E. Alexander A. et al.An interrupted time series analysis of the dissemination of a sickle cell vaso-occlusive episode treatment algorithm and a case management referral form for individuals with sickle cell disease in the emergency department.J Emerg Nurs. 2021; 47: 40-49https://doi.org/10.1016/j.jen.2020.06.001Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar worked to disseminate a sickle cell vaso-occlusive episode algorithm to emergency care clinicians in North Carolina. Jonassaint16Jonassaint C.R. If you can’t assess it, how can you treat it? Improving pain management in sickle cell disease..J Emerg Nurs. 2021; 47: 10-15https://doi.org/10.1016/j.jen.2020.10.007Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar provides commentary on research about innovative painamations assessments, which are electronic visual depictions of sickle cell pain, to strengthen medical decision-making and patient-clinician relationship (“Interpersonal” level of influence and “Health Care System” domain in the NIMHD Research Framework). The NIMHD Research Framework does not only apply to antiracism and racial health disparity interventions, but also to any health disparity for marginalized or vulnerable groups. The impressive collective efforts of our authors, reviewers, and editorial team allowed us to assemble papers on health disparity and vulnerable or potentially marginalized populations in this issue of JEN regarding emergency care or special considerations for people who are deaf;17Pickens B. Letter to the editor: communicating with the American Sign Language user in the emergency department.J Emerg Nurs. 2021; 47: 16-17https://doi.org/10.1016/j.jen.2020.09.0004Crossref PubMed Google Scholar transgender;18Davis W.D. Patel B. Thurmond J.K. Emergency care considerations for the transgender patient: complications of gender-affirming treatments.J Emerg Nurs. 2021; 47: 33-39https://doi.org/10.1016/j.jen.2020.07.009Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar new immigrants;19Montayre J. Ho M.H. Factors associated with ED use among new Asian immigrants in New Zealand: a cross-sectional analysis of secondary data.J Emerg Nurs. 2021; 47: 157-166https://doi.org/10.1016/j.jen.2020.07.011Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar reside in a low- or middle-income country;20French S. Gordon-Strachan G. Kerr K. Bisasor-McKenzie J. Innis L. Tanabe P. Assessment of interrater reliability of the emergency severity index after implementation in emergency departments in Jamaica using a learning collaborative approach.J Emerg Nurs. 2021; 47: 58-65https://doi.org/10.1016/j.jen.2020.07.003Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar children with displaced gastrostomy tubes;21Weszelits S, Rodish M, O’Connor A. Displaced gastrostomy tube in the pediatric emergency department: implementing an evidence-based algorithm and quality improvement project. J Emerg Nurs. 2021;47(1):113-122. https://doi.org/10.1016/j.jen.2020.09.007Google Scholar or people who suffer from rare disease,22Gill J, Oakley D, Onwuemene O. Strategies to aid identification of aphoresis PowerFlow ports: a case report. J Emerg Nurs. 2021;47(1):21-27. https://doi.org/10.1016/j.jen.2020.10.004Google Scholar sickle cell disease,15Bulgin D. Bonnabeau E. Alexander A. et al.An interrupted time series analysis of the dissemination of a sickle cell vaso-occlusive episode treatment algorithm and a case management referral form for individuals with sickle cell disease in the emergency department.J Emerg Nurs. 2021; 47: 40-49https://doi.org/10.1016/j.jen.2020.06.001Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar or opioid use disorder.23Strout T. Baumann M. Wendell L. Understanding ED buprenorphine initiation for opioid use disorder: a guide for emergency nurses.J Emerg Nurs. 2021; 47: 139-154https://doi.org/10.1016/j.jen.2020.10.001Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Our shared value within the specialty of providing excellent care to all patients is evident in the study by Wolf and Delao24Wolf L. Delao A. Establishing research priorities for the emergency severity index using a modified Delphi approach.J Emerg Nurs. 2021; 47: 50-57https://doi.org/10.1016/j.jen.2020-09.005Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar to ascertain the priorities for future emergency nurse triage research. From an Emergency Nurses Association (ENA) expert panel of 14 nurses, the single research question that was ranked as the highest priority was “How do cultural considerations affect triage accuracy?” We at JEN are committed to continuing to publish high-quality evidence to inform these cultural considerations to support personalized, compassionate care for all. This issue of JEN also includes 2 randomized controlled trial research papers testing interventions to reduce disparities for vulnerable groups across the lifespan on the topics of children’s pain and fear during health care procedures25Düzkaya DS, Bozkurt G, Ulupınar S, Uysal G, Uçar S, Uysalol M. The effect of a cartoon and an information video about intravenous insertion on pain and fear in children aged 6 to 12 years in the pediatric emergency unit: a randomized controlled trial. J Emerg Nurs. 2021;47(1):76-87. https://doi.org/10.1016/j.jen.2020.04.011Google Scholar and adolescent automobile driver injury prevention.26McDonald C.C. Fargo J.D. Swope J. Metzger K.B. Sommers M.S. Initial testing of a web-based intervention to reduce adolescent driver inattention: a randomized controlled trial.J Emerg Nurs. 2021; 47: 88-100https://doi.org/10.1016/j.jen.2020.07.012Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In regard to gender-specific considerations and disparities in emergency care, this issue includes a manuscript on testing an external female urinary catheter as part of an organizational initiative to reduce catheter-related urinary tract infections27Root N, Horigan A, Lough M. External female urinary catheter: implementation in the emergency department. J Emerg Nurs. 2021;47(1):131-138. https://doi.org/10.1016/j.jen.2020.09.008Google Scholar and a case review on identifying testicular torsion in teenage males.28Martin H, Noble M. Consideration of testicular torsion in young males with abdominal pain is essential: a case review. J Emerg Nurs. 2021;47(1):186-191. https://doi.org/10.1016/j.jen.2020.09.006Google Scholar Furthermore, evidence on interventions such as pictorial discharge instructions, which are promising interventions to reduce health disparities for those with low health literacy, is included here as a systematic review of randomized controlled trials.29Dermody S, Hughes M, Smith V. The effectiveness of pictorial discharge advice versus standard advice following discharge from the emergency department: a systematic review and meta-analysis. J Emerg Nurs. 2021;47(1):66-75. https://doi.org/10.1016/j.jen.2020.07.005Google Scholar For readers who wish to test their own knowledge on the care of pediatric patients with displaced gastrostomy tubes, the authors have generously provided a copy of the knowledge assessment used in their quality improvement project.21Weszelits S, Rodish M, O’Connor A. Displaced gastrostomy tube in the pediatric emergency department: implementing an evidence-based algorithm and quality improvement project. J Emerg Nurs. 2021;47(1):113-122. https://doi.org/10.1016/j.jen.2020.09.007Google Scholar Although this issue contains a collection of manuscripts aligned with the theme of health disparities, the entire issue contains our usual breadth and depth of topics to support emergency workforce health, emergency clinical practice, leadership, and research methods. As we work collectively to reduce and eliminate health disparities, ENA members can access additional professional development and education entitled “Structural Racism in Health Care” on the ENA website with their member login.30Structural racism in health care. Emergency Nurses Association.https://www.ena.org/shop/catalog/education/free-ce/structural-racism-in-healthcare/c-23/c-99/p-360Google Scholar Not only do we collectively value the specialty culture, knowledge, skills, and attitudes to ensure fair and equitable emergency care for our patients and their families, but our work also continues to address inequalities within the emergency nursing workforce. As a specialty workforce, we do not represent the ethnic and racial diversity of the patients we serve. In a national sample analysis, we found that 13% of emergency nurses identified as Hispanic, 73% as White non-Hispanic, 6% as Black non-Hispanic, 4% as Asian non-Hispanic, only 2% as multiracial, and <2% each as Pacific Islander, Native American, or Other.6Patton E. Who is multiracial? depends on how you ask: a comparison of six survey methods to capture racial identity.https://www.pewsocialtrends.org/2015/11/06/who-is-multiracial-depends-on-how-you-ask/Google Scholar,31Castner J. Norful A.A. Cato K. Chang B.P. Emergency nursing workforce, burnout, and work environments in the United States: a national sample survey Analysis. Annals of Emergency Medicine 2020;76(suppl 4):s114. Research Forum abstracts from the American College of Emergency Physicians Unconventional. Virtual Conference, 2020Google Scholar We at JEN continue to welcome original research, program development and evaluation, and evidence-based commentary on achieving an ethnic and racially representative emergency nursing workforce. Jessica Castner is Editor-in-Chief of Journal of Emergency Nursing, Grand Island, NY and Member, Western New York Chapter. Twitter: @DrCastner. ORCID identifier: http://orcid.org/0000-0001-9889-3844." @default.
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