-What is your position in the hospital and what does that role entail?

I am a registered nurse who works in the Intensive Care Unit (ICU), caring for those that are
critically ill. In addition to this, I am the rapid response nurse who responds to rapid response
calls and code blues throughout the hospital and rounds on decompensating patients.

-In your schooling that got you to this position, to what extent were health inequities discussed in
your coursework? Do you feel like the topics were discussed adequately, and that they were
taken seriously by your classmates?

Health inequities were briefly discussed in my introduction to healthcare class in undergraduate

studies. We spent a couple of weeks on the topic and had to research and reflect upon the matter
to get a better understanding of it. However, at the time students did not seem to take the topic
seriously given the lack of emphasis and time spent discussing health inequities. 

-Can you discuss the ways in which you have seen discrimination and bias from healthcare
providers in the hospital? Perhaps give an example?

I have seen instances in which I've seen healthcare providers have to step back from providing
care to a patient because it went against their own beliefs. For example, there was a doctor who
was taking care of a Jehovah's Witness patient and the patient needed a blood transfusion in
order to improve in condition, but the patient refused due to personal religious beliefs. The MD
had to step aside and allow another provider to take over the patient's plan of care because of the
difference in religious beliefs. 

-Can you discuss the way you have seen health inequities in your unit’s own patient population?

Given our hospital's location, we typically see patients who come from the parts of town with
abundant resources and then the part of town closest to the hospital, where the homeless
population is rampant.

-Can you discuss the way you have seen medical mistrust manifested in patient and staff
interactions?

I have witnessed firsthand, patients refuse care, shut down, and/or become combative when they
feel mistrust with their providers. These patients most of the time do not allow for any
subsequent interventions to take place and deny further care to the point where they request to
leave against medical advice.

-Many patients can be combative and non-receptive to medical staff because of medical mistrust,
low health literacy, or perception of discrimination. Have you seen this?

Yes I have seen one too many times where patients have become hostile due to the lack of
understanding and knowledge they have regarding their plan of care and what is actually going
on with themselves. After reflecting on their actions, I have come to find that they act out in this
fashion in defense of their lack of knowledge and because they feel like they aren't being seen or
heard.

-Do you think you or your colleagues objectively consider the context of a person’s identity and
how it historically has been treated (or mistreated) by the medical community when treating a
patient? Do you think you/they should?

I think as nurses we are at an advantage when it comes to patient care because we spend a great
amount of time with the patients when providing their care. This, as a result, allows us to
understand their background, life story, and all that they've endured up until that point, which
gives us a better understanding on how we should provide care that caters to their specific needs.
However, there will always be implicit biases that we all have, and we could of course be better
and take steps to reduce such biases in order to provide culturally competent care.