Culturally Competent Care Is Essential for Black Patients, According to This Maternity Nurse

It is widely known that Black families often face difficulty in finding Black health care providers, or quality care providers, who take their health care concerns seriously.

Naseema McElroy, RN, is a labor and delivery nurse in Oakland, California who has witnessed many joyous and memorable moments in her 13 years of practice. She's also seen countless situations in which Black people and parents have been treated unfairly. She's seen their pain ignored and watched providers suggest unnecessary or delayed procedures that could put them at risk. She's also seen seemingly innocent comments lead to misunderstandings from a medical professional's inability to provide culturally competent care.

Issues like these lead to higher rates of perinatal mortality, infant death, and lower levels of general well-being for Black parents than for their white counterparts. Though more medical institutions are increasing efforts to address unconscious bias, Black people are still more likely to die giving birth in comparison to white people and Black infants are 2.3 times more likely to die than white babies.

"The unfair treatment of Black women doesn't always revolve around glaring mistakes," says McElroy. Sometimes it's little things such as saying they are a problem patient when it's really a patient who feels ignored. [Looking at] their interpretation of certain responses or behaviors as red flags when they may be specific to that culture."

Through a number of viral Instagram posts, McElroy has highlighted how common the mishandling of patient concerns is when culturally competent care isn't within reach. One video, which has been liked over 400,000 times, describes a situation in which a patient was seemingly hitting herself in the head repeatedly. The health care staff assumed the patient was displaying troubling behavior, warranting a psychiatric evaluation.

When brought to McElroy's attention, she explained to the attending nurse that patting your head is common practice for Black people who have an itch they can't scratch due to their hairstyle. Once explained, the nurse who suggested the psychiatric evaluation agreed to remove it, as seen in the video.

"They try to justify it, but part of their nursing care is to do an assessment and ask questions to get a better understanding of the situation," says McElroy.

In this situation, and many like it, these professionals did not adhere to the standard nursing assessment guidelines, she says. Those guidelines dictate that the attending nurse gather background information through objective observation and questions about a patient's family history, pain, personal and medical background, and more to aid in administering appropriate medical care.

Through inquiry, she's learned that many of those nurses are apprehensive about following up on their concerns with questions. So instead, she observes medical professionals follow their first thought which sometimes involves calling child protective services, recommending psychiatric evaluations, or leaving derogatory comments such as "refusal," "difficult" or "drug seeker" in their medical records.

"You were afraid to ask, but you're not afraid to put in a consult that can jeopardize this person's life," says McElroy. "It's fear, implicit bias, and not caring. It's laziness and other things that compound to affect the care of Black parents and their children."

And those comments can follow patients around sometimes unbeknownst to them potentially affecting their care; especially if their medical records are transferred to other doctors. It can also lead to difficulty in getting insurance to cover certain things, she added.

A study revealed that Black patients are 2.54 times more likely than white patients to have negative descriptors in their health records. Changing these practices requires a vast systemic overhaul and better education regarding bias and culturally competent care for medical professionals.

According to a survey published in the Journal of Nursing Regulation 6.7% of registered nurses identify as Black or African American. And unfortunately, it's not just the white nurses who are making assumptions. McElroy has brought up her concerns to Black nurses and points out they can be just as guilty because many of these issues are ingrained in medical education.

The viral video garnered over 7,000 comments from people sharing similar situations, expressing their shock at the scenario and echoing the need for more change and advocacy for culturally competent care in the medical system.

As a healthcare professional, not even she is immune to that treatment, says McElroy, as she's been the target of misguided assumptions when having her children receive medical care.

"You have to advocate for yourself to get the basic level of care most people receive," she says. Unfortunately, even proper due diligence isn't always easy for patients to decipher the information in their medical charts if it's hard to understand medical jargon. If they have one, she suggests Black patients ask a knowledgeable and able healthcare professional in their circle to review and decipher their medical records.

Acknowledging everyone doesn't have access, "Sometimes I take for granted that I have the knowledge that others don't have. So I had to use my voice and I feel like I'm someone people can trust and maybe people will find positive solutions." As result, she's gotten several messages from people thanking her for sharing her knowledge publicly and providing talking points for their own care.

And she's not the only one speaking up to bring awareness and assist Black patients. Medical school student, Joel Bervell, created a series of videos on social media discussing racial bias in medicine. There's also, Irth, an app for reading reviews of medical professionals from their Black patients.

"We have to keep talking about this so people know it's not just anecdotal but a national crisis that brings change," she says.

Still, McElroy who faced retaliation when confronting her workplace about the inconsistent treatment of their Black patients, understands it's also difficult for nurses to speak up when they fear losing their jobs.

"Money is power and freedom and when you don't have the money you're less inclined to speak up about injustices even if you are in disagreement with them," she says. So in addition to highlighting situations of incompetent care on social media, and plans to start an advocacy group for Black parents, McElroy provides fellow nurses with tips to achieve financial freedom or align with the Financial Independence, Retire Early (F.I.R.E) Movement.

Money funds everything that you stand for. "When you are in a financial insatiable place it's harder for you to stand up because you are in fear of losing your job," she says. "Standing up can mean probation or not getting paid. And not being paid for a few weeks can take most people out."

Until more medical professionals feel comfortable speaking up and more changes to the system are made, she plans to continue discussions on her platform about culturally competent care. "I've seen a positive impact," says McElroy. I've had people thank me for this because they didn't even know what to look out for or what to say to their doctor."