From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens

Increased COVID-19 mortality among immigrants compared with US-born individuals: a cross-sectional analysis of 2020 mortality data

OBJECTIVE

Multiple studies have shown that racially minoritized groups had disproportionate COVID-19 mortality relative to non-Hispanic White individuals. However, there is little known regarding mortality by immigrant status nationally in the United States, despite being another vulnerable population.

STUDY DESIGN

This was an observational cross-sectional study using mortality vital statistics system data to calculate proportionate mortality ratios (PMRs) and mortality rates due to COVID-19 as the underlying cause.

METHODS

Rates were compared by decedents' identified race, ethnicity (Hispanic vs non-Hispanic), and immigrant (immigrants vs US born) status. Asian race was further disaggregated into "Asian Indian," "Chinese," "Filipino," "Japanese," "Korean," and "Vietnamese."

RESULTS

Of the over 3.4 million people who died in 2020, 10.4% of all deaths were attributed to COVID-19 as the underlying cause (n = 351,530). More than double (18.9%, n = 81,815) the percentage of immigrants who died of COVID-19 compared with US-born decedents (9.1%, n = 269,715). PMRs due to COVID-19 were higher among immigrants compared with US-born individuals for non-Hispanic White, non-Hispanic Black, Hispanic, and most disaggregated Asian groups. Among disaggregated Asian immigrants, age- and sex-adjusted PMR due to COVID-19 ranged from 1.58 times greater mortality among Filipino immigrants (95% confidence interval [CI]: 1.53, 1.64) to 0.77 times greater mortality among Japanese immigrants (95% CI: 0.68, 0.86). Age-adjusted mortality rates were also higher among immigrant individuals compared with US-born people.

CONCLUSIONS

Immigrant individuals experienced greater mortality due to COVID-19 compared with their US-born counterparts. As COVID-19 becomes more endemic, greater clinical and public health efforts are needed to reduce disparities in mortality among immigrants compared with their US-born counterparts.

Help-Seeking and Service Utilization Among Survivors of Intimate Partner Violence in Michigan During the COVID-19 Pandemic

This study explores formal and informal intimate partner violence (IPV) service use among women and transgender/nonbinary individuals in the state of Michigan during the COVID-19 pandemic. A total of 14.8% (N = 173) of participants experienced IPV during this period, and 70% utilized at least one formal IPV service (13.3%). Up to 22% of survivors reported wanting to seek formal help but not doing so due to fear of partner reprisal, contracting COVID-19, or COVID-related service reductions. White, pregnant, and part-time-employed survivors were most likely to seek informal help. Older, higher-income, white, part-time-employed, pregnant, and non-essential worker survivors were most likely to seek formal help.

Willingness to Receive the COVID-19 Vaccine in California: Disparities by Race and Citizenship Status

Although it is widely acknowledged that racialized minorities may report lower COVID-19 vaccine willingness compared to non-Hispanic white individuals, what is less known, however, is whether the willingness to receive the COVID-19 vaccine also differs by citizenship. Understanding disparities in vaccine willingness by citizenship is particularly important given the misleading rhetoric of some political leaders regarding vaccine eligibility by citizenship status. This study used the 2020 California Health Interview Survey (n = 21,949) to examine disparities in vaccine willingness by race/ethnicity and citizenship among Asian, Latinx, and non-Hispanic white individuals. Overall, 77.7% of Californians indicated that they were willing to receive the COVID-19 vaccine if it was made available. However, there were distinct differences by race/ethnicity and citizenship. Asian people, regardless of citizenship, had the highest predicted probability of vaccine willingness, accounting for demographic, socioeconomic, and health factors. Non-citizen Latinx and non-citizen non-Hispanic white people had higher predicted probabilities of vaccine willingness compared to their US-born counterparts, accounting for demographic, socioeconomic, and health factors. Our results reveal that although vaccine willingness may be high among non-citizen individuals, it may not necessarily translate into actual vaccine uptake. Furthermore, while individual-level factors may account for some of the differences in vaccine willingness by race/ethnicity and citizenship, other institutional and structural barriers prevent vaccine uptake.

The intersectionality-based policy analysis framework: demonstrating utility through application to the pre-vaccine U.S. COVID-19 policy response

Few guidelines exist for the development of socially responsible health policy, and frameworks that balance considerations of data, strategy, and equity are limited. The Intersectionality-Based Policy Analysis (IBPA) framework utilizes a structured questioning process to consider problems and policies, while applying guiding principles of equity, social justice, power, intersectionality, and diversity of knowledge and input. We apply the IBPA framework's guiding principles and questions to the pre-vaccine U.S. COVID-19 policy response. Results suggest the IBPA approach is a promising tool for integrating equity considerations in the development of policy solutions to urgent US public health challenges, including the COVID-19 pandemic. We found the IBPA framework particularly useful in differentiating between problems or policies and representations of problems or policies, and in considering the impacts of representations on different groups. The explicit inclusion of short-, medium- and long-term solutions is a reminder of the importance of holding a long-term vision of the equitable public health system we want while working towards immediate change.

Racism, colonialism and the implications for nursing scholarship: A discussion paper

AIM

A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry.

DESIGN

Discussion paper.

DATA SOURCES

A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022.

IMPLICATIONS FOR NURSING

The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing.

CONCLUSION

Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship.

NO PATIENT OR PUBLIC CONTRIBUTION

The paper is a discursive paper using pertinent nursing literature.

IMPACT

For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.

'Should I stay or should I go?': A mixed methods study on nurse retention during challenging times

BACKGROUND

The World Health Organization estimates that between 80,000 and 180,000 medical personnel perished as a result of COVID-19. Although studies about nurses' organizational commitment during the COVID-19 pandemic have been conducted, the sources of motivations and resilience strategies of nurses in providing a quality healthcare service amidst the COVID-19 pandemic have yet to be explored.

OBJECTIVE

This study aimed to investigate how motivation and resilience influence nurses to serve and cater to patients during the COVID-19 pandemic.

METHODS

A sequential exploratory mixed approach was used in this study between July and August 2022. The Connor-Davidson Resilience Scale (CD-RISC-10), Work Extrinsic and Intrinsic Motivations scale (WEIMS), and Garbee and Killacky's Intent to Stay Scale (GKISS) were used to measure resilience, motivation, and intention to stay, among 50 nurses within Metro Manila. Quantitative data were analyzed using quantile regression, while qualitative data from eight participants were analyzed using thematic analysis.

RESULTS

The majority of the nurses were working 12 hours and above (52%) and earning a bi-weekly income of PHP 15,001 to 20,000 (96%). The GKISS scores of most respondents indicated their likelihood of remaining in their current profession was moderately low (Mdn = 12.5; IQR = 12-14). It was also found that there was no sufficient statistical evidence to conclude that intention to stay was associated with resilience (p = 0.914) and work motivation (p = 0.560). The qualitative strand of this study explored the significant influences of motivation, resilience strategies, and sources of intention to stay among Filipino nurses while facing the COVID-19 pandemic. The primary motivations of nurses lie in family, passion for work, and career development, while the resilience strategies include adaptiveness, time management skills, and self-fulfillments. On the other hand, the intent to stay greatly lies in serving the people and the country.

CONCLUSION

This study concludes that positive and negative resilience and motivations from different facets of the social life of Filipino nurses, including passion, familial ties, patient care, and faith are the antecedents influencing the intention to serve in the healthcare service. In terms of staying for an extended period in a nursing career, the study found that institutionalized interventions, adequate compensation and benefits, and a good workplace are determinants of staying longer in the Philippines as Filipino nurses.

"I'm sick of being called a hero - I want to get paid like one": Filipino American frontline workers' health under conditions of COVID-19 and racial capitalism

Although the era of COVID-19 has reaffirmed the vital role of frontline workers in maintaining a functional society, the ongoing pandemic has taken a devastating toll on their health and well-being. In the United States, Filipino American frontline workers in healthcare and service industries have endured threats to their health, safety, and economic livelihood throughout the pandemic and against the broader backdrop of racialized and xenophobic hate directed toward Asian Americans. Drawing on a qualitative approach, the current study explores work-related health risks and effects of the pandemic for Filipino American frontline workers. Data come from the qualitative arm of a larger mixed-methods study that used a community-based participatory research approach. The current analysis is based on focus group data with thirty-five Filipino American frontline workers, a majority of whom were migrants, that worked across healthcare, caregiving, education, childcare, food services, and retail industries. Situated through the lens of racial capitalism, themes included: (1) work-related stress, tensions, and trauma, (2) anti-Asian racism and intersections with age- and gender-based violence, and (3) working while ill and distressed. Study findings can inform interventions and policies to improve health, occupational environments, and labor conditions in order to support minoritized communities disproportionately affected by COVID-19.

Re-socializing pre-health education in the context of COVID: Pandemic prompts for bio-social approaches

COVID-19 has underlined the critical importance of bringing biosocial and biopsychosocial approaches to pre-health education. Given the striking social inequalities that the pandemic has both exposed and exacerbated, we argue that bridging between the biomedical and social sciences with such approaches is now more appropriate and urgently needed than ever. We therefore call for the re-socialization of pre-health education by teaching to develop socio-structural competencies alongside physical and biological science knowledge. We suggest that community partnerships, which address local inequalities and their global interdependencies, should be encouraged as an essential element in all pre-health education. Educators should also support such partnerships as opportunities for students who come from more minoritized and impoverished social backgrounds to see their own social knowledge–including community-based knowledge of health-injustices revealed by the pandemic–as the basis of biopsychosocial expertise. By prioritizing this reconceptualization of pre-health education, we can empower future health workers to prepare more adequately for future health crises in ways that are socially aware and structurally transformative.

COVID-19 Vaccine Uptake among Healthcare Workers: A Systematic Review and Meta-Analysis

The vaccine-induced immunity of healthcare workers (HCWs) is crucial to controlling the COVID-19 pandemic. Therefore, we conducted a systematic review and meta-analysis to assess the COVID-19 vaccine uptake among HCWs worldwide and to identify predictors of vaccination. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL, and medRxiv up to 25 August 2022. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We found 25 studies including 491,624 vaccinated HCWs, while the full sample included 555,561 HCWs. The overall proportion of vaccinated HCWs was 77.3%. Vaccine uptake for studies that were conducted in North America (85.6%) was higher than the proportion for studies that were conducted in Asia (79.5%), Europe (72.8%), and Africa (65.6%). The overall prevalence of COVID-19 vaccine uptake was 83.6% and 77.4% for physicians and nurses, respectively. Older age, white race, physicians' profession, seasonal influenza vaccine, direct COVID-19 patient care, and confidence in COVID-19 vaccine safety and effectiveness were positive predictors of vaccine uptake, while history of SARS-CoV-2 infection was a negative predictor. Deep understanding of the factors that influence HCWs' decisions to receive a COVID-19 vaccine is critical to implementing tailored communication strategies for HCWs who are at risk for not getting vaccinated.

Preliminary Observations from The FILLED Project (FILipino Lived Experiences during COVID-19)

Health outcomes for Asian American subgroups are often aggregated, masking unique experiences and disparities exacerbated by the COVID-19 pandemic, specifically among Filipino Americans (FilAms). The FILLED (Filipino Lived Experiences during COVID-19) Project launched a cross-sectional online survey between April-August 2021 among FilAm adults in Southern California to document community issues and outcomes during the pandemic. Among 223 participants, 47.5% were immigrants, 50.9% identified as essential workers, and 40.6% had a pre-existing health condition before the pandemic. Despite high rates of health insurance (93.3%), 24.4% of the sample did not have a regular health care provider. During the pandemic, 32.7% needed mental health help but did not get it and 44.2% did not know where to get such services. Most respondents felt that the COVID-19 vaccination was a personal responsibility to others (76.9%) and the majority had received at least one dose of a COVID-19 vaccine (82.4%). Regarding COVID-19 impact, participants reported moderate-severe changes in their daily routines (73.5%), access to extended social support (38.9%), housing issues (15.4%), and access to medical care (11.6%). To our knowledge, this study is the first community-driven effort highlighting FilAm community experiences in Southern California, where the highest proportion of FilAms in the United States reside, specifically after the COVID-19 vaccine was made widely available. The observational findings may help community leaders, policy makers, and public health researchers in the design, development, and implementation of post-pandemic intervention strategies used by community-partnered projects that address FilAm and sub-Asian group health disparities at grassroots to societal levels.

Nursing competency inventory and professional competence of graduating students in six Asian countries: A cross-sectional study

AIMS

To investigate graduating nursing students' nursing and professional competencies and the predictors of their competencies.

BACKGROUND

Across Asian countries, there is a paucity of literature that explores graduating nursing students' competency and professional competence during the ongoing COVID-19 pandemic.

DESIGN

Descriptive, cross-sectional, and predictive approaches.

METHOD

Convenience sampling was used among graduating nursing students from the six Asian countries (n = 375). The STROBE guidelines for cross-sectional studies were used. Two self-report instruments were utilized to collect data. We conducted multiple linear regression analyses to assess the predictors of nursing competency and professional competence domains.

RESULTS

Country of residence and general point average (GPA) showed statistically significant multivariate effects. Value-based nursing care and critical thinking and reasoning domains recorded the highest in professional competence and competency inventory for nursing students, respectively. Country of residence, GPA, and preferred nursing major were significant predictors of graduating nursing students' nursing competency and professional competence domains.

CONCLUSION

Our study's findings revealed a high level of diversity among nursing students regarding ethical care obligations, caring pedagogies, and lifelong learning, all of which may be ascribed to their distinct culture, background, and belief systems.

Learning to love ourselves again: Organizing Filipinx/a/o scholar-activists as antiracist public health praxis

A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers our voices, FilCHA shifts power through partnerships in which people who directly experience the conditions that cause inequities have leadership roles and avenues to share their perspectives. We used Pinayism to guide our study of FilCHA, not just for the current crisis State-side, but through a multigenerational, transnational understanding of what knowledges have been taken from us and our ancestors. By naming our collective pain, building a counterspace for love of the community, and generating reflections for our communities, we work toward shared liberation. Harnessing the collective power of researchers as truth seekers and organizers as community builders in affirming spaces for holistic community wellbeing is love in action. This moment demands that we explicitly name love as essential to antiracist public health praxis.

Data Disaggregation Reveals Disproportionate Levels of COVID-19 Risk Among Filipinxs in the USA

Background

Recognizing the disproportionate rates of COVID-19 infection and death experienced by Filipinxs in the USA, this study examines whether data disaggregation reveals meaningful differences between Filipinxs, non-Asians, and other groups often aggregated into the problematic “Asian and Pacific Islander” category across a series of social and health variables associated with COVID-19 risk.

Methods

Using data from the California Health Interview Survey (CHIS, 2017–18; N = 42,330) and the National Survey on Drug Use and Health (NSDUH, 2018–19; N = 135,516), we ran chi-squared tests yielding Wald F-values to compare Filipinxs with other “Asians and Pacific islanders” and non-Asians across 10 social and 4 health-related variables. Health conditions included asthma, diabetes, heart conditions, and high blood pressure.

Results

Filipinxs were much more likely to report diabetes (CHIS: 12.6%; NSDUH: 14.4%) than other Asian/PI respondents (8.4%; 8.0%) or non-Asians (10.8%; 10.1%), as well as asthma and high blood pressure. Filipinxs were also disproportionately employed in the healthcare and service occupations (CHIS: 36.7%) in comparison to other Asian/PI respondents (19.0%) and non-Asians (22.4%).

Discussion

Across several variables, Filipinxs have less in common with other Asians and Pacific Islanders than with non-Asians. Combining these groups can obscure patterns that affect health and the risks of contracting or dying from COVID-19.

Intersectionality and nursing leadership: An integrative review

AIMS AND OBJECTIVES

This review aimed to synthesise international research about how intersectionality has been used to explore issues within the nursing profession. The objectives were to determine which intersecting variables have been explored, how intersectionality has been operationalised, and the implications for nursing leadership.

BACKGROUND

Barriers to health system leadership created at the intersection of gender, race, ethnicity, professional cadre and other socially constructed categories exist in the health workforce. Consequently, an intersectionality paradigm has been recommended to explore power, privilege and oppression issues in the nursing profession.

DESIGN

An integrative systematic review method was selected for its ability to include diverse methodologies. The review complies with the PRISMA guidelines for reporting systematic reviews.

METHOD

The search terms nurs* nurses nursing AND Intersectionality intersectional intersectionalism, intersect were used in December 2021 to search the Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) PsycINFO, PubMed, Ovid, ProQuest and the first ten pages of Google Scholar from 2011 to 2021. Directed content analysis was applied to the data.

RESULTS

Access to education, absence of expectations as a career and patriarchal structures support male nurses into positions of leadership in healthcare systems. Intra-group differences highlight the paradox of homogenous categories for ethnicity and gender. Being a member of an ethnic minority group hinders career progression regardless of gender. The aftereffects of colonisation exist within the nursing space.

CONCLUSIONS

This review is the first to synthesise research using intersectionality to explore the impact of socially constructed identities on nursing leadership. There is a dearth of evidence specific to this topic, ignoring the diversity within this professional group. Future research should include intersectionality to discover how social categories empower or impede a nurse's career progression to leadership roles.

RELEVANCE TO CLINICAL PRACTICE

An intersectionality paradigm can encourage nurses to attend to issues of power, privilege and oppression in the profession and their practice.

Race/Ethnicity Differences in COVID-19 Vaccine Uptake Among Nurses

INTRODUCTION

There is evidence for relatively lower COVID-19 vaccine uptake among people of color in the United States. The purpose of this study was to investigate associations between race/ethnicity and COVID-19 vaccine uptake among nurses.

METHODS

Nurses in Southern California (N = 1183) completed a one-time, web-based survey to assess COVID-19 vaccine perceptions and uptake.

RESULTS

In all, 82.8% of respondents (N = 979) received at least one COVID-19 vaccine dose. Identifying as East Asian was associated with 14% higher odds of COVID-19 vaccine uptake relative to identifying as White (odds ratio [OR] = 1.14/95% confidence interval [CI] = [1.06, 1.24]); identifying as Filipino was associated with 14% higher odds of uptake (OR = 1.14/95% CI = [1.08, 1.20]); and identifying as Hispanic/Latinx was associated with 6% higher odds of uptake (OR = 1.06/95% CI = [1.00, 1.12]).

DISCUSSION

Although nurses and people of color have been identified as groups with low levels of COVID-19 vaccine uptake, this study found that nurses of color received the vaccine at higher levels than their White counterparts.

The Impact of Structural Inequities on Older Asian Americans During COVID-19

Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.