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纠结的过去,更健康的未来:改善美国印第安人/阿拉斯加原住民健康公平的护理策略。

Tangled pasts, healthier futures: Nursing strategies to improve American Indian/Alaska Native health equity.

机构信息

College of Nursing, University of Arizona, Tucson, AZ, USA.

Department of Mexican American Studies, Institute for LGBT Studies, College of Nursing, University of Arizona, Tucson, AZ, USA.

出版信息

Nurs Inq. 2020 Oct;27(4):e12367. doi: 10.1111/nin.12367. Epub 2020 Jun 16.

DOI:10.1111/nin.12367
PMID:32548947
Abstract

American Indian/Alaska Native (AI/AN) populations in the United States continue to experience overall health inequity, despite significant improvement in health status for nearly all other racial-ethnic groups over the past 30 years. Nurses comprise the bulk of healthcare providers in the U.S. and are in an optimal position to improve AI/AN health by transforming both nursing education and practice. This potential is dependent, however, on nurses' ability to recognize the distinct historical and political conditions through which AI/AN health inequities have been produced and sustained. Nurse providers, educators, and leaders must in turn recognize how the sustained conditions of marginalization and expropriation that underpin current AI/AN health inequities continue to shape contemporary AI/AN health outcomes. This manuscript builds upon the extant literature of AI/AN historical health policy and utilizes decolonial theorizations of nursing and a cultural safety framework to propose a series of immediately actionable steps for nursing intervention into AI/AN health inequity. Ultimately, we suggest that it is crucial for nurses to collaborate with AI/AN individuals and communities across educational and clinical settings to further refine these approaches in alignment with the disciplinary obligation of promoting social justice within healthcare.

摘要

美国的美洲印第安人/阿拉斯加原住民(AI/AN)群体仍然面临整体健康不平等问题,尽管在过去 30 年中,几乎所有其他种族群体的健康状况都有了显著改善。护士是美国医疗保健提供者的主要组成部分,他们通过转变护理教育和实践,处于改善 AI/AN 健康的最佳位置。然而,这一潜力取决于护士识别独特的历史和政治条件的能力,这些条件导致了 AI/AN 健康不平等,并使其得以持续存在。护士提供者、教育者和领导者必须认识到,构成当前 AI/AN 健康不平等的边缘化和剥夺的持续条件如何继续影响当代 AI/AN 健康结果。本文档以现有的 AI/AN 历史健康政策文献为基础,利用护理的去殖民理论化和文化安全框架,提出了一系列护理干预 AI/AN 健康不平等的即时可行步骤。最终,我们认为,护士与 AI/AN 个人和社区在教育和临床环境中合作至关重要,以便与促进医疗保健中的社会正义的学科义务保持一致,进一步完善这些方法。

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