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Join us for an enlightening episode as we sit down with Kashica J. Webber-Ritchey, an assistant professor of nursing, to discuss the pressing issue of equity in health care, particularly for Black nurses. Kashica shares her first-hand experiences and research findings, highlighting the challenges faced by underrepresented nurses and the importance of listening to their voices. We delve into the impact of social determinants of health, the dual pandemic faced by Black nurses during COVID-19, and the need for systemic changes to support these invaluable health care professionals. Don’t miss this insightful conversation as we explore strategies to create a healthier and more inclusive medical field.
Kashica J. Webber-Ritchey is an assistant professor of nursing.
She shares her story and discusses her KevinMD article, “Nursing for change: Prioritizing Black nurses’ health and well-being.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome Kashica Webber-Ritchey. She’s an assistant professor of nursing. Her KevinMD article is titled “Nursing for change: Prioritizing Black nurses’ health and well-being.” Kashica, welcome to the show.
Kashica J. Webber-Ritchey: Thank you for having me, Kevin.
Kevin Pho: So we’ll get into the article in a little bit. Just briefly share your story and journey to where you are today.
Kashica J. Webber-Ritchey: Yes. I have about 10 years of clinical practice in the areas of medical-surgical, intensive care, and outpatient ambulatory surgery, and I’ve been working at DePaul University School of Nursing as an assistant professor since 2015. That’s located in Chicago, Illinois, in the Lincoln Park area.
Kevin Pho: All right. So tell us some of your areas of interest when it comes to your research.
Kashica J. Webber-Ritchey: Well, my area of research is dedicated to reducing health disparities. One of my programs of research that I’m building on is looking at childhood obesity in African American children, looking at and incorporating the parental role in reducing childhood obesity in this group.
Kevin Pho: All right. So before we get to the article, tell us a little bit about those disparities, maybe some data from your research.
Kashica J. Webber-Ritchey: Yes. So particularly in regard to this piece, as I said, my research is dedicated to reducing health disparities. I’ll kind of walk you through how the piece came to be. Well, the first confirmed COVID-19 case in the U.S., which we know about, was reported on January 21, 2020. It appeared quite contained but accelerated quite rapidly. And so my thought process during this time, beginning in March 2020: My team and I were hearing these stories of the devastating impact of COVID-19 on people’s lives and what our fellow colleagues were witnessing while practicing on the front lines. And so the question that we wanted to answer was, how can I, as a nurse scientist, support our nursing colleagues on the front lines? And so the examination of nursing practice during COVID-19 was born.
What we did was conduct semi-structured interviews among 100 U.S. nurses to get their experience. I’d like to note that the 100 U.S. nurses that we interviewed were a diverse sample, with 63 percent identifying as members of an underrepresented racial and ethnic group. And just so that we’re all aware, we were seeing how COVID-19 impacted the lives of all, but we were also seeing how it was disproportionately impacting Black and brown communities and the nurses who are working in these settings, serving underserved communities. So there was some dialogue brought on early in the pandemic among scholars, health care professionals, and researchers that looked at highlighting the role that social determinants of health were playing in the disproportionate impact of COVID-19.
And, well, let’s just dive into social determinants of health. These are those conditions in our environments where people live, work, learn, play, worship, and age that impact our health, that impact health functioning as well as the quality of life.
And so, specifically, with our diverse sample of nurses, I wanted to know about the experience of Black nurses. So I was able to serve as the lead qualitative investigator of a team of eight, analyzing the interview transcripts of the 20 Black nurses to get their experience from that larger qualitative study. What we found was the presence and absence of social support. That was our main theme that was revealed, along with some subthemes, and it was consistent with House’s 1981 conceptual model of the four types of social support that exist. That is emotional support, which involves the provision of empathy, care, and trust. Appraisal support is the communication of information that’s relevant to self-evaluation. Informational support is providing information about the environment that can aid in the problem-solving process during this time. And lastly, instrumental support is the provision of tangible aids, such as goods and services.
So Black nurses shared their accounts of how there was absence and presence of those four types of support, but for some, the social support was inadequate for them.
Kevin Pho: So when you talk about the lack of those four social supports, tell us some stories of what exactly that would look like in those families without social supports, just to really paint us a picture.
Kashica J. Webber-Ritchey: Yeah. So these nurses were looking for support within their organization. When I say the presence and absence of support, the nurses said that during this time they were being given lunch and cupcakes in a break area, but that really wasn’t what was needed during this troubling time for them. It was more so needing adequate communication so they could do their jobs, given this rapidly changing work environment that they were seeing while practicing.
Kevin Pho: So what other findings did you have from that research study? What other things did they report back to you?
Kashica J. Webber-Ritchey: Oh, well, there were stories. When I say presence and absence, there was presence of emotional support, for example, from their family and friends. A story that I just remember quite vividly was that one of the participants shared how their friend was at the grocery store and called them on the phone, asking them, knowing that they’re working these long hours and experiencing this devastating time, “Can I get you some groceries?” And that was a form of support that they found very helpful. It’s just: How can they be supported and be able to make it through this time?
Kevin Pho: So in response to the findings from your study, what are some solutions or fixes that you would recommend?
Kashica J. Webber-Ritchey: Great question. So what I recommend, and the most important point I’d like to point out, is that it was great that we were able to get a good, diverse sample and have these 20 Black nurses participate in our study. I ask that at this time we continue this dialogue of hearing the voices of Black nurses, so we can find out how we can better support them in doing their job.
Kevin Pho: What are some specific ways health care institutions can do this?
Kashica J. Webber-Ritchey: Yes. What I would recommend is that big approach, and this strategic approach cannot be developed without Black nurses having a seat at the table in developing these strategies. The ultimate strategy that we need to figure out is how to optimize their health and well-being as they’re practicing and being able to do their job.
Kevin Pho: So in your study, you’re showing that Black nurses have a lack of these supports, and also, in the professional workplace, they’re facing all the issues that were affecting pretty much every health care professional during COVID as well. So it’s a tremendous amount of stress that Black nurses are facing, both at home and at work.
Kashica J. Webber-Ritchey: Yeah, as you mentioned, yes, nurses as well as other health care professionals were still under this strain. I’d like to point out, though, that a recent survey highlighted how nurses are one of the most trusted professionals, and so being able to support them is really important, since the patients really rely on nurses. So it’s very important to figure out how we can make their work environment better.
Kevin Pho: Now, if you didn’t have a study like this with the voices of Black nurses, would they normally be heard?
Kashica J. Webber-Ritchey: No. And that’s why I’m glad that this study allowed the opportunity to engage, to start this dialogue, and I feel like this dialogue should be continued. We should really be conscientious of making sure that we’re giving them their voices and making them feel welcome to share their experiences, so they can be heard.
Kevin Pho: So what are some other ways that underrepresented minorities can get their voices heard, especially in the health care field? What are some other ways they could share their voices?
Kashica J. Webber-Ritchey: Got you. So when we’re conducting our studies, making sure that we get some diversity in our samples is the key. Just making sure we’re conscientious about that, making sure that the sample is representative of these populations that are vulnerable, is important.
Kevin Pho: So what’s the next step? We are now talking in May of ’23, and COVID recently has gone from pandemic to endemic. So what do you see as the future in terms of addressing some of these inequalities when it comes to underrepresented groups in health care?
Kashica J. Webber-Ritchey: Well, what I see is taking time to really reflect on what we went through, and continue to go through, and learn from this experience and apply what we learn to future health emergencies and other pandemics that I’m sure will come in this world. But we can learn. There were a lot of lessons learned, so that we could develop strategies to prevent some of those things that occurred during this COVID-19 pandemic.
Kevin Pho: Any findings from this study that were unexpected, that surprised you?
Kashica J. Webber-Ritchey: Oh, what surprised me? OK, yeah. One thing I’d like to point out is that while we were able to learn about the Black nurses’ experience of how they felt that there was presence and absence of social support, these sentiments were echoed across our 100 U.S. nurses. So for example, one of the studies that came to be, published, I want to say, in SAGE Open Nursing, looked at moral distress, and moral distress was high across our 100 nurses. And definitely, we need to really focus in on how we can prevent those things from happening, not even just during a pandemic, but just being able to help nurses do their jobs on a day-to-day basis and having that supportive infrastructure.
Kevin Pho: Kashica Webber-Ritchey is an assistant professor of nursing. Her KevinMD article is titled “Nursing for change: Prioritizing Black nurses’ health and well-being.” Tell us some of your take-home messages that you want to leave with the KevinMD audience.
Kashica J. Webber-Ritchey: Yes. Well, my two messages: When we’re collaborating, make sure that we’re collaborating with all populations, to make sure their voices are represented, and we can really make some powerful changes in doing that. Black nurses practicing during COVID-19 experienced a significant amount of stress, and that’s important to point out because, as I said, nurses in general are working in these underserved communities. Nurses practice in the areas that they’re members of, and so it’s very important to understand how to help them navigate the challenging work environments.
And as I said before, and I do like to point out again, a strategic approach is necessary so we can better optimize their health and well-being. We must prioritize listening to people from within vulnerable populations, as well as their nurses, so we can address systematic inequities and injustice that exist across all medical specialties, and so we can achieve better health outcomes effectively.
Kevin Pho: Thank you so much for sharing your time and insight. Thanks again for being on the show.
Kashica J. Webber-Ritchey: OK, thank you, and have a great day.
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