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  • Perspective
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Culturally competent care in the neonatal intensive care unit, strategies to address outcome disparities

Abstract

In the past two years, we have witnessed social unrest, the unequal effects of a pandemic across our society, and a focus on how systems in the United States produce unequal outcomes along racial and cultural divides. With increased national awareness, there has also been a call for change in healthcare, specifically racial inequities in Neonatal Intensive Care Unit (NICU) outcomes (1). While race may be a data point used to classify outcomes, it has no basis in biology, and merely identifying it does not make it simple to address. To address these inequities we need to look past the social construct of race and to the social aspects of our care in the NICU. Focusing on small and large changes that we can make as individuals, units, and as a specialty that can improve the care and outcomes of this at-risk patient population. This perspective focuses on culturally congruent care, trauma-informed care, and other approaches to reduce disparities in neonatal outcomes.

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All data provided in this manuscript are available from the included references.

References

  1. Barfield WD, Cox S, Henderson ZT. Disparities in neonatal intensive care: context matters. Pediatrics. 2019;144:e20191688.

  2. Sigurdson K, Mitchell B, Liu J, Morton C, Gould JB, Lee HC, et al. Racial/ethnic disparities in neonatal intensive care: a systematic review. Pediatrics. 2019;144:e20183114.

  3. Trent M, Dooley DG, Douge J, Section On Adolescent H, Council On Community P, Committee On A. The impact of racism on child and adolescent health. Pediatrics. 2019;144:e20191765.

  4. Singh GK, Yu SM. Infant Mortality in the United States, 1915–2017: large social inequalities have persisted for over a century. Int J MCH Aids. 2019;8:19–31.

    Article  Google Scholar 

  5. Travers CP, Carlo WA, McDonald SA, Das A, Ambalavanan N, Bell EF, et al. Racial/ethnic disparities among extremely preterm infants in the United States From 2002 to 2016. JAMA Netw Open. 2020;3:e206757.

    Article  Google Scholar 

  6. Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172:1061–9.

    Article  Google Scholar 

  7. Burris HH, Hacker MR. Birth outcome racial disparities: a result of intersecting social and environmental factors. Semin Perinatol. 2017;41:360–6.

    Article  Google Scholar 

  8. Gautham KS. I can’t breathe. J Perinatol. 2021;41:641–3.

    Article  Google Scholar 

  9. Harris LM, Forson-Dare Z, Gallagher PG. Critical disparities in perinatal health-understanding risks and changing the outcomes. J Perinatol. 2021;41:181–2.

    Article  Google Scholar 

  10. Witzig R. The medicalization of race: scientific legitimization of a flawed social construct. Ann Intern Med. 1996;125:675–9.

    Article  CAS  Google Scholar 

  11. Burris HH, Parker MG. Racial and ethnic disparities in preterm birth outcomes: a call to action for neonatal providers. J Perinatol. 2021;41:365–6.

    Article  Google Scholar 

  12. Tylor EB. Primitive culture. New York: Harper; 1958.

  13. Schim SM, Doorenbos A, Benkert R, Miller J. Culturally congruent care: putting the puzzle together. J Transcult Nurs. 2007;18:103–10.

    Article  Google Scholar 

  14. Clarke S. Cultural congruent care: a reflection on patient outcome. J Healthcare Commun. 2017;2:51.

    Article  Google Scholar 

  15. Schim SM, Doorenbos AZ. A three-dimensional model of cultural congruence: framework for intervention. J Soc Work End Life Palliat Care. 2010;6:256–70.

    Article  Google Scholar 

  16. Schim SM, Doorenbos AZ, Miller J, Benkert R. Development of a cultural competence assessment instrument. J Nurs Meas. 2003;11:29–40.

    Article  Google Scholar 

  17. Wiebe A, Young B. Parent perspectives from a neonatal intensive care unit: a missing piece of the culturally congruent care puzzle. J Transcult Nurs. 2011;22:77–82.

    Article  Google Scholar 

  18. Hendson L, Reis MD, Nicholas DB. Health care providers’ perspectives of providing culturally competent care in the NICU. J Obstet Gynecologic Neonatal Nurs. 2015;44:17–27.

    Article  Google Scholar 

  19. Leininger MM. The theory of Culture Care Diversity and Universality. NLN Publication: Washington DC, USA; 1991.

  20. Caruso Brown AE. Acquiescence is not agreement: the problem of marginalization in pediatric decision making. Am J Bioeth. 2021;23:1–19.

    Google Scholar 

  21. Nimmon L, Stenfors-Hayes T. The “Handling” of power in the physician-patient encounter: perceptions from experienced physicians. BMC Med Educ. 2016;16:114.

    Article  Google Scholar 

  22. Mohottige D, Boulware LE. Trust in American medicine: a call to action for health care professionals. Hastings Cent Rep. 2020;50:27–9.

    Article  Google Scholar 

  23. Sanders MR, Hall SL. Trauma-informed care in the newborn intensive care unit: promoting safety, security and connectedness. J Perinatol. 2018;38:3–10.

    Article  CAS  Google Scholar 

  24. Marcellus L. Supporting women with substance use issues: trauma-informed care as a foundation for practice in the NICU. Neonatal Netw. 2014;33:307–14.

    Article  Google Scholar 

  25. Lefkowitz DS, Baxt C, Evans JR. Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the Neonatal Intensive Care Unit (NICU). J Clin Psychol Med Settings. 2010;17:230–7.

    Article  Google Scholar 

  26. Hubbard DK, Davis P, Willis T, Raza F, Carter BS, Lantos JD. Trauma-informed care and ethics consultation in the NICU. Semin Perinatol. 2021;9:151527.

    Google Scholar 

  27. Patriksson K, Nilsson S, Wigert H. Immigrant parents’ experiences of communicating with healthcare professionals at the neonatal unit: an interview study. J Neonatal Nurs. 2019;25:194–9.

    Article  Google Scholar 

  28. Ardal F, Sulman J, Fuller-Thomson E. Support like a walking stick: parent-buddy matching for language and culture in the NICU. Neonatal Netw. 2011;30:89–98.

    Article  Google Scholar 

  29. Cakici JA, Dimmock DP, Caylor SA, Gaughran M, Clarke C, Triplett C, et al. A prospective study of parental perceptions of rapid whole-genome and -exome sequencing among seriously Ill infants. Am J Hum Genet. 2020;107:953–62.

    Article  CAS  Google Scholar 

  30. American Community Survey, Language Spoken at Home. https://www.census.gov/acs/www/about/why-we-ask-each-question/language/.

  31. Canedo JR, Miller ST, Myers HF, Sanderson M. Racial and ethnic differences in knowledge and attitudes about genetic testing in the US: Systematic review. J Genet Couns. 2019;28:587–601.

    Article  Google Scholar 

  32. David R, Collins JW Jr. Why does racial inequity in health persist? J Perinatol. 2021;41:346–50.

    Article  Google Scholar 

  33. Metzl J. Dying of whiteness: how the politics of racial resentment is killing America’s heartland. 1st ed. New York: Basic Books; 2019. viii, p. 341.

  34. Horbar JD, Edwards EM, Ogbolu Y. Our responsibility to follow through for NICU infants and their families. Pediatrics. 2020;146:e20200360. https://doi.org/10.1542/peds.2020-0360.

  35. Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212–5.

    Article  CAS  Google Scholar 

  36. Jones CP. Toward the science and practice of anti-racism: launching a national campaign against racism. Ethn Dis. 2018;28:231–4.

    Article  Google Scholar 

  37. South EC, Butler PD, Merchant RM. Toward an equitable society: building a culture of antiracism in health care. J Clin Invest. 2020;130:5039–41.

    Article  CAS  Google Scholar 

  38. Valdez P. What can I do? A call for pediatric providers to engage in antiracism and social justice for the health of their patients. J Dev Behav Pediatr. 2020;41:504–5.

    Article  Google Scholar 

  39. Campinha-Bacote J. A path to antiracism through the lens of cultural humility. J Transcult Nurs. 2021;32:191.

    Article  Google Scholar 

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Acknowledgements

Dr. Lena Hatchett, Loyola University Chicago, Neiswanger Institute for Bioethics and Healthcare Leadership for review and guidance.

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Correspondence to Carrie Torr.

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Torr, C. Culturally competent care in the neonatal intensive care unit, strategies to address outcome disparities. J Perinatol 42, 1424–1427 (2022). https://doi.org/10.1038/s41372-022-01360-2

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