Cultural competency is necessary for comprehending and connecting individuals from different cultures. Coordination of care and its potential ethical and policy issues are crucial to understanding the context of special ethnical and religious domains. In this regard, nurses and care coordinators should possess cultural competence, which entails a desire to learn about the cultural peculiarities of others, as well as a positive outlook on cultural diversity. This research selected the Christian African American community owing to their growing population and the diversity that characterized the community. The African American population is very diversified and presents several ethical and policy issues related to care coordination. Variations are based on geographical, urban/rural, age, education, and socioeconomic variables. In 2019, around 14 percent of the country’s population, or 46.8 million individuals, self-identified as Black (Bethea, 2021). Moreover, the community is interesting owing to its drastic population growth of 29 percent from 2000 to 2021 (Bethea, 2021). The diverse experiences, language, and culture of the community contribute to the variety of African Americans in the United States. Medical mistrust and ethical issue of perinatal care were selected as illustrative phenomena that affect care coordination in the selected community.
Inhumane experiments on enslaved people, forced sterilization of African American women, and the infamous Tuskegee Syphilis Study, in which African American men were denied treatment for decades so that doctors could track the progression of the disease, are just a few examples of how black Americans have historically been mistreated by the care coordination (Nguyen, 2018). The experience of people who are discriminated against in the health care system today, from unequal access to health insurance, medical facilities, and treatment, to facility policies that make it difficult for African American Americans to access healthcare, contributes to the public’s mistrust of doctors in addition to the historical legacy of abuse (Ferdinand et al., 2020). Seven out of ten African Americans believed the healthcare system treated them unjustly, and 55 percent said they didn’t trust it, according to a study conducted in October 2020 (Ferdinand et al., 2020). Although the ACA’s coverage expansion has sped up the process of achieving affordable healthcare, many Americans, particularly African Americans, continue to face difficulty accessing affordable health care due to the high cost of many coverage alternatives.
Medical mistrust not only worsens the health of African Americans but also puts up hurdles to employment opportunities and unequal access to care coordination. Increased access to healthcare and better results for African Americans, such as early cancer detection and treatment, have been linked to increased health insurance coverage under the ACA and the Health Insurance Portability and Accountability Act (HIPPA) (Ferdinand et al., 2020). However, there are significant disparities in health status between African Americans and the white population, including maternal mortality, infant mortality, diabetes, and other health issues. Social issues that impact a person’s capacity to live a healthy and fulfilling life include economic deprivation, educational inequality, and a lack of access to health care. The negative effects of social factors on health are greatest for those members of American society who deal with racism and inequality on a daily basis and throughout their lifetimes. Medical institutions sometimes provide lower-quality care when they are situated in locations with a high African American population (Nguyen, 2018). Due to the dearth of accessible primary care and mental health services in a particular region, African Americans sometimes find themselves being significantly dependent on neighborhood health facilities, emergency or outpatient treatment, and local service providers. Some people may choose to go for medical treatment outside of the closest geographical region, however, this can be problematic for those with low means or those who reside in remote locations owing to the lack of transportation options.
To effectively address these issues in care coordination, it is crucial to adopt evidence-based strategies. They should concentrate on the standard of treatment outside of health insurance, especially how racism affects African Americans’ health. Policymakers must take into account socioeconomic determinants of health and how they impact health as part of health reform initiatives, collaborating with many sectors and community service providers while employing patient-centered approaches to care. This could result in a decline in societal mistrust of the community.
Another crucial obstacle to care coordination in the selected community is the ethical issue of perinatal care. African American women in the US are three times more likely than white women to pass away during pregnancy (Scott et al., 2019). There are several causes for this. For instance, during the postnatal period, when women undergo significant physiological changes that put them in danger of mortality healthcare workers spend less time with African American patients, dismiss their symptoms and concerns, and sever ties with them (Scott et al., 2019). The general and reproductive health of African American women and children is impacted throughout their lives by the unequal prevalence of chronic illnesses and pre-pregnancy disorders. This discrepancy can result from maternal health disparities. The American Nurses Association Code of Ethics also includes the idea that nurses practice with respect for every person, regardless of socioeconomic status, personality, or type of health problem (American Nurses Association, 2017). This is a crucial point, complete adherence to which can facilitate the complete care coordination at any level.
To lessen the avoidable causes of maternal illness and death, several efforts have been made to establish the ethical standards of perinatal care. African American women need services to improve preconception health, particularly to prevent organ malformations that happen before many women recognize pregnancy or start prenatal care (Scott et al., 2019). In order to conduct medicine ethically, it is vital to provide reproductive justice care, acknowledge the historical and religious backgrounds of African American women and families, and distance medical practice from racism and potential bias.
In order to execute complete care coordination, a number of policies should be overcome, and ethical issues assessed. Nurses need to have an understanding of socioeconomic determinants of health, health disparities, and health inequalities. Despite the expansion of coverage, African Americans continue to face persistent health issues that are disproportionately severe. It is extremely challenging to fully satisfy America’s healthcare demands due to the lack of Medicaid expansion in important states, health inequalities, and a labor deficit in the healthcare industry. And while these issues are widespread across the nation and impact many Americans, their severity is particularly apparent in the South and among African Americans. Ethical perinatal, prenatal, and postpartum care for black women requires a diverse attitude coupled with close community involvement. Partnering with patients, families, and communities should enable nurses and public health professionals to better design, implement, test, and evaluate innovative population-based programs and advocate for health equity.
References
American Nurses Association. (2017). Code of ethics with interpretative statements. Silver Spring, MD: Author. Web.
Bethea, O. C. (2021). The unmaking of “Black Bill Gates”: How the US patent system failed African-American inventors. University of Pennsylvania Law Review, 170(1), 2-17.
Ferdinand, D. P., Nedunchezhian, S., & Ferdinand, K. C. (2020). Hypertension in African Americans: Advances in community outreach and public health approaches. Progress in Cardiovascular Diseases, 63(1), 40-45.
Nguyen, A. W. (2018). African American elders, mental health, and the role of the church. Generations, 42(2), 61-67.
Scott, K. A., Britton, L., & McLemore, M. R. (2019). The ethics of perinatal care for black women: Dismantling the structural racism in “mother blame” narratives. The Journal of Perinatal & Neonatal Nursing, 33(2), 108-115.