Essay On Nursing


This paper is going to discuss a male patient, who belongs to the Black, Asian, and Minority Ethnicity (BAME) group. To maintain the confidentiality of the patient pseudonym John will be used. John is an African-born 62-year-old retired bank worker, who lives in an outskirts area. He lives alone as his wife died 5 years ago due to cancer. Also, he has no children. Two years ago he developed type 2 diabetes. However, he fails to receive proper diabetes management, as he has no one to look after him. He follows a poor diet and a sedentary lifestyle. Also, the nearest hospital is 2 hours away from his home. Previously he received poor experience in the hospital visit, therefore, he tries to avoid the hospital. Due to lack of care, his condition becomes severe and his kidney starts to fail. Also, he has developed vision problems and a diabetic foot ulcer. As a result, he was bought to the city hospital to stabilize his condition.

Section 1

The selected health inequality issue will be poor care received by the patient or the biased view, behaviours and perception of the healthcare professionals of the culturally diverse patient. In this case, John has a poor experience during his last hospital visit. This is mainly because of the biased view of the healthcare professional toward the culturally diverse patient. Although this is not expected from the profession; it is still common in the contemporary healthcare setting in the United Kingdom (UK) (Hamed et al. 2022). Regarding this, Ajayi (2021) mentions without addressing institutional racism and bigotry, it is impossible to debate inequity inside the NHS. The institutions, laws, practices, and values that lead to racial disparities in accessibility to the resources, privileges, and prospects of society are known as structural prejudice. Throughout England during 2017, 26% of a sample group admitted to harbouring racial discrimination (Kelly et al. 2017), while racial discrimination continued to remain the leading cause of hate crimes. Discrimination has been examined in an increasing amount of studies as a factor that affects both physical as well as, to a lesser degree, psychological wellbeing. Racism is a well-known socioeconomic factor that affects healthcare and contributes to racial disparities in wellness. It may be viewed as a sophisticated, established structure that divides ethnicities into social classes and is rooted in historic, political, and cultural settings (Lokugamage et al. 2021). Philosophically given unequal values to these subgroups result in inequities in accessibility to authority, wealth, and prospects.

There are a number of methods via which systemic and personal racism is believed to negatively affect wellness. At the systemic level, racial prejudice may manifest itself through the unequal distribution of society's resources, which affect health (such as accommodation, work, and schooling) (Krieger 2020), unequal access to medical service, and projected worse quality of treatment (Ben et al. 2017). The disruption of biological functions connected to stress may also be a relationship between racial prejudice and poor health. Regularly experiencing racial segregation seems to be a chronic stressor that has been connected to dysregulated immunological, neuroendocrine, as well as cardiovascular functions (Lockwood et al., 2018), all of which have an influence on one's physical and emotional well-being. As a way of dealing with or evading prejudice, personal health risks (such as cigarettes or alcohol use) may be a relationship between perceived race prejudice and illness (Bernardo et al. 2017). The association between race prejudice and wellness has only been prospectively evaluated inside one UK research so far. The researchers noted that individuals who experienced racial segregation had lower mental performance ratings four years afterwards when they conducted an assessment of the UK Household Longitudinal Study (UKHLS) (Wallace et al. 2016). Additionally, they found a dose-response association between racial bias exposure and psychological health, with individuals who reported encountering racial segregation more frequently over a three-year period reporting a higher decline in mental performance. Additionally, evidence suggests, that the prevalence of racism is also associated with the prevalence of diabetes. The incidence of diabetes is significantly greater in racial and ethnic minorities compared to the general population. These discrepancies are a result of many different causes, including societal, medical, physiological, and healthcare system issues. Additionally, genetic factors are frequently cited as the main cause of the rise in diabetes incidence (Ajayi 2021). Moreover, Hackett et al. (2020) conducted a study on 4883 ethnically diverse people to know the effects of racism. According to the findings author mention, that 998 of the population, representing 20.4%, mention experiencing racial prejudice. Cross-sectionally, individuals who disclosed racial discrimination were more likely than people who did not mention it to be able to minimise long-term sickness. Racial prejudice was linked to higher levels of psychological discomfort, lower physical along with mental performance, and worse life satisfaction levels. In the future, individuals who experienced racial segregation had a higher average risk of severe chronic disease and fair to low self-rated wellbeing compared to those who did not. After controlling for baseline values, racial prejudice was linked to longer periods of psychological discomfort and worse mental performance.

In this case, the Antiracism policy can be implemented to reduce the prevalence of racism. Harprit Hockley, Head of Equality and Inclusion in the NHS England (NHSE) East of England team, created the East of England anti-racism strategy in accordance with the People Plan as well as People Promise, which was then published on July 1, 2021 (NHS England, 2022). For clients, the practice upholds an equal opportunity policy. The non-discrimination strategy seeks to prevent patients from being treated less favourably due to their gender, ethnicity, colour, country, ethnicity, or national origin, as well as their gender identity, sexual orientation, or handicap. The focus of these policies should be to improve health equity (NHS England, 2022). Hence, healthcare professional needs to focus on improving their existing healthcare service. Regarding this 2010-2015 compassionate care policy is essential. According to this policy, individuals who utilise health and wellness assistance have the obligation to receive compassionate care from staff members who possess the knowledge as well as the time to do so. This policy highlights the implementation of a new national friend and relatives measure beginning on April 1, 2013, asking service users if they might refer family members to the facility or A&E unit if they required comparable treatment or assistance (GOV.UK, 2022). The NHS could utilise this information to enhance the facilities, and the consumer may identify hospitals that are functioning well. As part of this strategy, individuals are also given information regarding care services to assist them with making decisions. For instance, "provider quality profiles" (GOV.UK, 2022) educate users about the education and experience of employees in social assistance services. All of these steps will help to improve the level of fairness in the care facility, thus lowering the prevalence of discrimination against the culturally diverse community (GOV.UK, 2022). Additionally, with the introduction of personal health funds, persons having disabilities and chronic diseases would have more flexibility, independence, and influence over the medical treatment and assistance they get. This policy also focuses on improving patient safety and providing care with respect and dignity. Therefore, the implementation of this policy will promote high-quality care for the patient and thus improve patient satisfaction and clinical outcome (GOV.UK, 2022).

Section 2

According to John's condition, the self-management initiative should include shared decision-making. Shared decision-making (SDM) is a key element while developing a care plan for culturally diverse patients. Hawley and Morris (2017) the Foundation for Informed Medical Decision Making describe SDM as a cooperative approach that enables consumers including their medical practitioners to jointly decide on the best possible medical information in addition to the person's preferences and beliefs. SDM respects both the technical expertise of the healthcare professionals as well as the client's entitlement to full disclosure of all available treatment options as well as any associated risks and advantages. While enabling healthcare professionals to have faith in the treatment they recommend, this procedure gives patients the assistance they have to bring the greatest, individually tailored clinical decision.
In order to accomplish SDM, individuals first need to be taught so that they accurately grasp the benefits and drawbacks of their alternatives, as well as then they need to be involved to seek out the information they do not already grasp and to express their beliefs, interests, and views. Certain patients from ethnic and racial minorities might be more vulnerable to having an inadequate understanding of treatment compared to patients from the bulk, according to a study (Hawley and Morris 2017). For instance, BAME community patient has limited health understanding compared to other patients. Additionally, evidence suggests SDM is necessary for diabetes management.  SDM encourages the use of knowledge that is patient-oriented. A fundamental tenet of evidence-based healthcare is that knowledge is important but never enough to establish a medical judgment since patient preferences and circumstances must also be taken into account. SDM aids in the implementation of this tenet. SDM discussions are built on collaboration between the service user and the physician, take on the evidence base about the various treatment choices, and take the patient's interests, opinions, and circumstances into consideration while evaluating alternatives. SDM is suited for diabetes treatment because managing diabetes frequently necessitates taking different management alternatives into account that are important to individuals, like how they make major needs on a patient's condition and living style (Kashaf et al. 2017). SDM has been demonstrated to be practical and beneficial for communicating evidence with consumers and incorporating people in decision-making alongside their providers.
The concept of SDM is associated with the ethical principle of autonomy. The idea of autonomy holds that everyone ought to have access to information and be capable of making choices about their own lives without outside interference. This only implies that all relevant information should be provided to the decision-maker so they may make an informed choice. According to the concept of autonomy, it is morally acceptable for people to live according to their plans. Varkey (2021) mentions when opposing moral values come into play, autonomy must be balanced against them and, in certain cases, could be overturned. An apparent instance could be when a patient's independent activity results in injury to other people. Individuals who are lacking the ability to act independently are not covered by the autonomy concept. Opponents of the notion of autonomy challenge the emphasis on the person and suggest a more expansive idea of relational liberty. However, a healthcare provider needs to ensure the autonomy of the patient in every step of the decision-making.

Similarly, the concepts of SDM support patient autonomy. Moreover, as John belongs to a culturally minor group, it is important to develop a care plan which is culturally oriented. Hence, during the formation of the care plan, the healthcare provider needs to discuss relevant information with John to develop a shared decision. Therefore, obtaining informed consent from the patient is necessary. The person or patient should meet the following criteria in order to provide informed consent for the clinical procedure: (I) be able to grasp and make decisions; (ii) be given a complete disclosure; (iii) accept the disclaimer; (IV) act willingly, and (v) assent to the recommended course of action (Varkey 2021). Hence, obtaining informed consent from John will help to make a proper decision, and reduce the chance of an ethical problem. Also, by doing so, the nurse can develop a specific care plan that meets John's health needs. These self –management will support his behaviour changes. John will understand the relevance of following a proper diet and active lifestyle. Also, it will help to improve his health literacy level.


Maintaining good health is among the United Nation’s Sustainable Development Goals (SDGs). According to this goal, improving the overall health of the populace is necessary (UNDP, 2022). Hence, John's health needs to be improved. He needs to be educated about healthy lifestyle choices, and proper diet. Also, he needs to have access to fair healthcare services. This is important to prevent discrimination within the healthcare service. Moreover, it is crucial to reduce the level of inequality in healthcare.


Ajayi, O., 2021. A perspective on health inequalities in BAME communities and how to improve access to primary care. Future healthcare journal, 8(1), p.36.
Ben, J., Cormack, D., Harris, R. and Paradies, Y., 2017. Racism and health service utilisation: A systematic review and meta-analysis. PloS one, 12(12), p.e0189900.
Bernardo, C.D.O., Bastos, J.L., González‐Chica, D.A., Peres, M.A. and Paradies, Y.C., 2017. Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review. Obesity Reviews, 18(9), pp.1040-1049.
GOV.UK, 2022. 2010 to 2015 government policy: compassionate care in the NHS. [online] GOV.UK. Available at: <> [Accessed 13 August 2022].
Hackett, R.A., Ronaldson, A., Bhui, K., Steptoe, A. and Jackson, S.E., 2020. Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom. BMC public health, 20(1), pp.1-13.
Hamed, S., Bradby, H., Ahlberg, B.M. and Thapar-Björkert, S., 2022. Racism in healthcare: a scoping review. BMC public health, 22(1), pp.1-22.
Hawley, S.T. and Morris, A.M., 2017. Cultural challenges to engaging patients in shared decision-making. Patient education and counselling, 100(1), pp.18-24.
Kashaf, M.S., McGill, E.T. and Berger, Z.D., 2017. Shared decision-making and outcomes in type 2 diabetes: a systematic review and meta-analysis. Patient education and counselling, 100(12), pp.2159-2171.
Kelley, N., Khan, O. and Sharrock, S., 2017. Racial prejudice in Britain today. London: NatCen Social Research and Runnymede Trust.
Krieger, N., 2019. Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm-An Ecosocial Analysis. Annual Review of Public Health, 41, pp.37-62.
Lockwood, K.G., Marsland, A.L., Matthews, K.A. and Gianaros, P.J., 2018. Perceived discrimination and cardiovascular health disparities: a multisystem review and health neuroscience perspective. Annals of the New York Academy of Sciences, 1428(1), pp.170-207.
Lokugamage, A.U., Rix, E.L., Fleming, T., Khetan, T., Meredith, A. and Hastie, C.R., 2021. Translating cultural safety to the UK. Journal of Medical Ethics.
NHS England, 2022. NHS England — East of England » Antiracism strategy. [online] NHS England. Available at: <> [Accessed 13 August 2022].
UNDP, 2022. Sustainable Development Goals. [online] United Nations Development Programme (UNDP). Available at: <> [Accessed 13 August 2022].
Varkey, B., 2021. Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), pp.17-28.
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