护理的未来：健康公平

分享智慧

共同成长

Full text

In his Notes on Surgical Nursing, published in England in 1874, Dr J. H. Barnes wrote that a surgical nurse needs to “have an eye as well to the future as the immediate present.”1(p71) Although he was referring to the nurse’s need to anticipate what might be required during a surgical procedure, the same could be said about nurses’ need to look to the future and the evolution of the nursing profession.

A few years after I graduated with my bachelor’s degree in nursing, the Institute of Medicine (now the National Academy of Medicine) published The Future of Nursing: Leading Change, Advancing Health.2 This report recognized the importance of the role of nurses in improving health care, and provided recommendations to strengthen the nursing workforce through education and enhanced roles in practice and leadership. Ten years later, the National Academies of Sciences, Engineering, and Medicine has released a follow-up report, The Future of Nursing, 2020-2030: Charting a Path to Achieve Health Equity.3 While the former report spoke to strengthening the expertise of the nursing workforce, the 2021 report provides an agenda for using that expertise.3

Although it is not possible to thoroughly summarize this more than 500-page report here, the emphasis of the report is that nurses should be prepared for and engaged in “the complex but essential work of advancing health equity, addressing [social determinants of health], and meeting social needs of individuals and families.”3(pxv) According to the Robert Wood Johnson Foundation,

Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care. 4

Achieving health equity encompasses working to eliminate differences in health outcomes and access to health care that are based on systemic barriers, such as lower socioeconomic status, racism, and other forms of discrimination.3 The nine major recommendations from the 2021 National Academy of Medicine report are aimed at nursing organizations, government agencies, public health organizations, payers, education programs, employers, and nurse leaders to help prepare nurses for these efforts. The first recommendation reads, in part, “In 2021, all national nursing organizations should initiate work to develop a shared agenda for addressing social determinants of health and achieving health equity.”3(p13)

AORN’S EFFORTS

As a nursing organization, AORN is dedicated to improving health care equity through efforts to strengthen diversity, equity, and inclusion (DEI).5 The goals in AORN’s DEI plan are to increase diversity in the workforce, its membership, and its board of directors; to develop and implement programs that support communities of color; and to educate perioperative teams on the effects of health care disparities on outcomes of surgical care.5 The AORN National Committee on Education has been charged with exploring the significance of social determinants on health care of the perioperative patient and evaluation in the preoperative environment. There is a lot of work being done within AORN in regards to diversity, equity, and inclusion. For the most up-to-date look at this important work, please visit the AORN DEI web page at http://www.aorn.org/about-aorn/dei. This web page contains links to blogs, articles, position statements, and continuing education.

CONCLUSION

All patients deserve to receive the highest quality of health care regardless of race, nationality, ethnicity, culture, sexual orientation, gender, gender identity, age, education, and mental or physical ability. As patient advocates who work in many different types of communities, facilities, and roles, nurses are well positioned to collaborate with other medical professionals to improve health equity for all citizens. The resources AORN provides are important tools to help our members move equity initiatives forward.

全文翻译（仅供参考）

在1874 年在英国出版的《外科护理笔记》中，JH Barnes 博士写道，外科护士需要“既要着眼于眼前，也要着眼于未来”。

1 

(p71)虽然他指的是护士需要预测手术过程中可能需要什么，但同样可以说护士需要展望未来和护理行业的发展。

在我获得护理学士学位几年后，医学研究所（现为美国国家医学院）出版了《护理的未来：引领变革，促进健康》一书。

2

该报告承认护士在改善医疗保健方面的作用的重要性，并提出了通过教育和增强实践和领导作用来加强护理人员队伍的建议。十年后，美国国家科学院、工程院和医学院发布了一份后续报告《护理的未来，2020-2030：制定实现健康公平的道路》。3虽然前一份报告谈到加强护理人员的专业知识，但 2021 年的报告提供了使用该专业知识的议程。

3

尽管无法在此全面总结这份超过 500 页的报告，但该报告的重点是护士应做好准备并从事“促进健康公平、解决[健康的社会决定因素]的复杂但必不可少的工作” ，并满足个人和家庭的社会需求。” 3 (pxv)根据罗伯特伍德约翰逊基金会的说法，

健康公平意味着每个人都有公平公正的机会尽可能保持健康。这需要消除贫困、歧视等健康障碍及其后果，包括无力和无法获得薪酬公平的好工作、优质教育和住房、安全环境和医疗保健。 

4

实现健康公平包括努力消除基于系统性障碍（例如较低的社会经济地位、种族主义和其他形式的歧视）在健康结果和获得医疗保健方面的差异。3 2021 年美国国家医学院报告中的九项主要建议针对护理组织、政府机构、公共卫生组织、付款人、教育计划、雇主和护士领导，以帮助护士为这些工作做好准备。第一条建议部分内容是：“到 2021 年，所有国家护理组织都应着手制定一项共同议程，以解决健康问题的社会决定因素并实现健康公平。” 3 (p13)

奥恩的努力

作为一家护理组织，AORN 致力于通过努力加强多样性、公平性和包容性 (DEI) 来改善医疗保健公平性。5 AORN 的 DEI 计划的目标是增加劳动力、成员和董事会的多样性；制定和实施支持有色人种社区的计划；并就医疗保健差异对手术护理结果的影响对围手术期团队进行教育。5AORN 国家教育委员会负责探索社会决定因素对围手术期患者的医疗保健和术前环境评估的重要性。AORN 在多样性、公平性和包容性方面做了很多工作。有关这项重要工作的最新信息，请访问 AORN DEI 网页，网址为http://www.aorn.org/about-aorn/dei。此网页包含指向博客、文章、立场声明和继续教育的链接。

结论

不论种族、国籍、民族、文化、性取向、性别、性别认同、年龄、教育和心理或身体能力如何，所有患者都应该获得最高质量的医疗保健。作为在许多不同类型的社区、设施和角色中工作的患者倡导者，护士有能力与其他医疗专业人员合作，以改善所有公民的健康公平。AORN 提供的资源是帮助我们的成员推进公平倡议的重要工具。

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