IUI honors Black Maternal Health Week with town hall

Indiana University-Indianapolis hosted a guest panel Thursday, April 11 to discuss the infant and maternal health care issues modern Black American women face.

Taking place during Black Maternal Health Week, the town hall featured panelists Dr. Jill Inderstrodt, Rep. Vanessa Summers, Lauren Lancaster and Kaley Liang.

Lauren Lancaster

All well-known in their respective fields, the panelists discussed a wide range of topics from the disparities Black women face when breastfeeding to the much higher maternal mortality rates that Black women experience.

Specifically in Indiana, as mentioned by Lancaster, Black women are 2-3 times more likely to die during and directly after childbirth. A member of the Indiana Minority Health Coalition, Lancaster said Indiana ranks third in the highest number of maternal deaths, a statistic that, coupled with the lack of access to prenatal care, highlights the disparities Black women are currently facing during pregnancy.

State Legislator Vanessa Summers echoed the thought, saying “We are looking at an epidemic of African American mothers dying simply because they are pregnant.”

As a state legislator since 1991, Summers was a key figure in passing House Bill 1294 which prevents pregnant women from being shackled while incarcerated in the state of Indiana.

Summers utilized her time on the panel to promote “speaking truth to power” and encouraging those present to vote for lawmakers they feel reflect their values.

“I always go to work with the mindset of changing the minds of people for progress,” said Summers.

Dr. Jill Inderstrodt, an assistant professor in the Department of Health Policy and Management at IUI, focused her topic of discussion on Black women and breastfeeding, citing that many Black women are more acutely targeted by formula companies and statistically do not give birth at “baby-friendly” hospitals that encourage the initiation of breastfeeding rather than pushing the use of formula.

“My goal, my why, is to make sure that all moms have the pregnancy, the birth, and the motherhood that they want,” said Inderstrodt.

Dr. Jill Inderstrodt

Kaley Liang, the last to speak, discussed Black maternal wellness and the disparities that all minorities face throughout their pregnancies and during post-partum care.

The assistant director of the IUI Echo Center, Liang works directly with Project ECHO (Extension for Community Health Outcomes), whose mission is to reduce disparities in minority communities, provides learning opportunities to increase their audiences, and monitors outcomes of outreach through online databases. Project Echo is intended to help educate and encourage healthier lives for the public, particularly minorities facing health care disparities.

Aside from Project Echo, the panelists provided a multitude of ways that ordinary community members can help provide support to Black mothers including researching political candidates before voting, donating to causes that help Black mothers with access to pre-natal care, and recognizing that, overall, Black mothers want to be heard.

“Listen to Black moms. Believe Black moms,” said Inderstrodt.

To learn more about the IUI Echo Center, visit https://fsph.iupui.edu/research-centers/centers/ECHO/index.html.

Contact Staff Writer Hanna Rauworth at 317.762.7854 or follow her at @hanna.rauworth 

Women’s Empowerment Expo expected to draw thousands to Raleigh

RALEIGH, N.C. — The Women’s Empowerment Expo is coming to the PNC Arena in Raleigh this weekend starting at 2 p.m. Saturday. 


What You Need To Know

  • The Women’s Empowerment Expo is in Raleigh this weekend
  • It is one of the largest events in the southeast region for women of color
  • Motivational speaker Sarah Jakes Roberts will be at the expo along with singers Tamia & Joe and gospel recording artists Le’andria Johnson and Bobbi Storm

This is one of the largest events in the southeast region for women of color. 

Pastor and motivational speaker Sarah Jakes Roberts, well-known singers like Tamia & Joe, and gospel recording artists Le’andria Johnson and Bobbi Storm are just a few attractions. 

Karen Clark with Radio One, who helped organize the event, said this is an opportunity for women to eliminate stigma in the African-American community.

“Seminars focusing on how to help minority women get their business started, but we’ve also got some great things coming the main stage this year. We have Empower Her, that’s going to be a seminar prioritizing mental health for African-American women.  We also have a seminar on the Soft Life, how do we lean on the soft life, focus on health care,” Clark said.

The event attracts tens of thousands of people to the area every year. 

“Each year, we have tons of local vendors there so it’s an opportunity to shop and a lot of people use this as their annual girls trip. They come to Raleigh and they make a weekend out of it and come to hear some motivational speaking,” Clark said.

Feds investigate child labor at poultry plant

Labor officials say children are working dangerous jobs in some poultry plants. Photo via Creative Commons.
A flock of free range chickens. Photo via Creative Commons.
Labor officials say an LA-area poultry plant employed children in dangerous jobs. Photo via Creative Commons.

Good morning, Inequality Insights readers. I’m CalMatters reporter Wendy Fry. 

This week California Divide’s Alejandra Reyes-Velarde wrote about an L.A.-area poultry company that federal labor officials say used child labor for risky jobs and then illegally shipped poultry products that children workers had handled. 

At least two minors had been working in “oppressive” conditions, deboning raw poultry with sharp knives at a poultry processing plant in Irwindale, the U.S. Department of Labor alleged in a lawsuit. The labor department identified as defendants L & Y Food Inc. and two other associated companies.

“Instead of being in school, children younger than 18 years old stand on their feet all day in a chilled cutting room surrounded by raw chicken, using knives they must constantly sharpen, to cut and debone chicken,” attorneys for the labor department wrote in court documents. 

An attorney for L & Y Food Inc. denied the allegations and accused the labor department of planting an under-aged worker in the facilities. The labor department denies this. 

The department is asking a judge to force the companies to forfeit any money they made from selling products processed in facilities where minors worked in dangerous conditions.

The case follows a December settlement with another poultry plant operator, The Exclusive Poultry Inc. in Los Angeles, which agreed to pay $3.8 million in back pay, penalties and damages after the labor department investigated child labor violations.  

Thousands of children and youth are enslaved in labor trafficking in California and other states, according to a 2019 report by the Coalition to Abolish Slavery and Trafficking in Los Angeles. Soaring violations and widespread abuse of child labor laws in multiple sectors of the economy have brought the issue to the forefront in some state legislatures in 2024, according to the Economic Policy Institute. 


DON’T MISS

Some stories may require a subscription to read.

  • Digital democracy. This week CalMatters launched Digital Democracy, a project using the latest technologies to help Californians understand their state government and create more accountability for politicians. You can use it to look up issues and track bills important to you, such as poverty or reparations
  • Guarding homelessness? As California’s homeless population spiked nearly 40% in the past five years, there has been a boom in the use of private security around them. CalMatters’ Lauren Hepler reports local governments, nonprofits and businesses hiring guards to triage homelessness have opened a new front in the state’s housing crisis that is ripe for violence and civil rights issues, but thin on accountability and state oversight.
  • Homeless bans. A bill would make it illegal for homeless residents to camp in certain places in California, such as near schools. Its authors say a similar ban is successful in San Diego, but CalMatters’ Marisa Kendall writes encampments there are still prevalent near freeways and along riverbanks. 
  • Abortion ban. Planned Parenthood clinics in California are bracing for an uptick in patients crossing the state line for abortions after the Arizona Supreme Court upheld a nearly total prohibition on the procedure, according to CalMatters reporter Deborah Brennan.
  • Health equity. Central Valley residents face more acute challenges with health care costs, medical debt, and access to care than other Californians, a survey by the California Health Care Foundation shows. Last year 63% of respondents in the region skipped or delayed care due to cost, and 48% carried medical debt. The trends were most prevalent among Latinos and those living below the poverty line.
  • Digital discrimination. Assemblymember Mia Bonta, a Democrat from Oakland, is pushing California to confront digital discrimination, KQED reported. Her Assembly Bill 2239 would make California the first state to codify the Federal Communication Commission’s new definition of digital discrimination.
  • Antisemitism plan. Gov. Gavin Newsom’s “Golden State Plan to Counter Antisemitism” addresses rising anti-Jewish incidents in California, outlining strategies to support and protect Jewish communities, prevent antisemitism, uplift Jewish heritage and advance equity. In 2022 Jewish residents made up 3% of California’s population and 62% of its victims of reported hate crimes involving religious bias, according to the report.
  • Missing Medi-Cal. More than 700,000 undocumented Californians recently became eligible for Medi-Cal, but many are hesitant to sign up for fear of deportation, Capital and Main reports. Advocates stress the need for outreach to reassure undocumented people it’s safe to receive Medi-Cal.
  • Tax credits. Last year California implemented the Foster Youth Tax Credit to alleviate poverty among young adults connected to the foster care system. The Public Policy Institute of California just reviewed the program, saying more outreach is needed. About 2,600 current or former foster youth have claimed credits of up to $1,117 each, as of early March. The PPIC also examined if eligible undocumented immigrants are claiming the California Earned Income Tax Credit and the Young Child Tax Credit. Low-income Californians who file tax returns with Individual Taxpayer Identification Numbers (ITINs) — primarily undocumented immigrants — are eligible for both.
  • Black and white gaps. It will take more than 248 years for the economic gap to close between Black and white Californians, says a new report by the Black Policy Project, part of UCLA’s Ralph J. Bunche Center for African American Studies. From 2000-2020 the state’s Black population fell 6%, from 2.2 million to 2.1 million people. Black residents’ median household incomes remained far below — but poverty rates far above — whites’ in major metro areas, especially the Bay Area.  

Thanks for following our work on the California Divide team. While you’re here, please tell us what kinds of stories you’d love to read. Email us at inequalityinsights@calmatters.org.

Thanks for reading,
The California Divide Team

Prostate cancer isn’t always deadly — but here’s when it can be

On Thursday, OJ Simpson, 76, lost his battle with cancer. Although the former football star became infamous for the murder trial he faced in the 1990s, in recent years, he had been photographed looking frail or walking with a cane. 

In February, it was reported that Simpson had prostate cancer. Although his family has not confirmed it, prostate cancer continues to be widely reported as the cause of death.

Prostate cancer is the second most common form of male cancer after to skin cancer. Typically the disease doesn’t kill people — in part because it typically grows slowly, the cancer is often low-grade and many treatment options are available, according to the American Cancer Society (ACS). But in some cases, it can be deadly.

Here’s what to know about this type of cancer and how it could have potentially contributed to Simpson’s death. 

It has been widely reported that OJ Simpson had been diagnosed with prostate cancer. X / @TheRealOJ32

Is prostate cancer curable?

When the cancer is localized to the prostate, often, it is curable, reports the National Institutes of Health (NIH). The ACS estimates that nearly 300,000 men will be diagnosed with this type of cancer in the year 2024 — but only around 35,250 will die from the disease. Put another way, the five-year survival rate of prostate cancer, when it is detected early, is over 99% according to the Prostate Cancer Foundation.

Between 1993 – 2013, the death rate for prostate cancer was cut in half, thought to be due to advances in screening and better treatments, according to the ACS. But in recent years, that number has stabilized, suggesting that more cancers are being caught in late stages. 

Still, an estimated 3.3 million men who had prostate cancer at some point in their lives are still living today. 

Treatment for prostate cancer includes a number of options, depending on the specific diagnosis. Patients may undergo surgery, chemotherapy, immunotherapy, radiation or targeted drug therapy. For many people, one of these treatments will work. An estimated 1 in 8 men will be diagnosed with prostate cancer, but only 1 in 39 (or 2.6%) men will die from it, according to the NIH

Typically, prostate cancer does not kill men, although it can be deadly in some cases. The five-year survival rate for the disease is over 99%. auremar – stock.adobe.com

Signs prostate cancer is deadly

As with most types of cancer, certain groups are more at risk for getting prostate cancer. The average age of diagnosis is 67, and prostate cancer is considered rare in men who are under 40. African American men and Caribbean men of African ancestry are also more at risk for the disease.

Other risk factors for the disease include obesity, family history of cancer, plus factors like high blood pressure, lack of exercise and being taller than average, according to the NIH.

If prostate cancer spreads to other parts of the body (if it metastasizes), it can become deadly. When it spreads, prostate cancer commonly moves to the bones, lungs, lymph nodes, liver or brain. It’s not known whether Simpson’s cancer had metastasized. 

When prostate cancer metastasizes, or spreads to other parts of the body, such as the lungs, bones or brain, it can become deadly. Peakstock – stock.adobe.com

According to a study from 2021, though, about 1 in 6 deaths of people living with prostate cancer didn’t die from the cancer itself. Those living with cancer can be more susceptible to other health issues, or may already have another health issue, like cardiovascular disease. Other common causes of death in people with prostate cancer include COPD (chronic obstructive pulmonary disease), and things like stroke or aneurysm.

In the US, African American men are twice as likely to die of prostate cancer compared to other groups, according to the Centers for Disease Control and Prevention (CDC). However, the CDC notes, that stat may have more to do with health inequities — a study from 2020 suggested that if health care access were equal, the mortality rate might actually be slightly lower for African American men. 

The NIH also notes that diets high in saturated fat and milk products may contribute to causing the cancer, and may increase the risk of recurrence once diagnosed.

Currently, there is no standard test to screen for prostate cancer. A doctor may draw blood for a prostate specific antigen test (PSA), or may perform a rectal exam, but both of these types of screenings require follow-ups before a diagnosis will be made. In 2018, the U.S. Preventive Services Task Force recommended that men who are 55 to 69 should make an individual decision about whether they should be screened based on a discussion with their doctors. Men over the age of 70 should not be routinely screened.

How one family owned and ran the largest Black-owned farm in Albemarle County — for generations

This is the second of a series about Buck Island, by Philip Cobbs for First Person Charlottesville. Read the first story here, and then join the author in a conversation on April 23.

My brother and I were born at home in the 1950s because my mother said she felt safer there than at the University of Virginia’s hospital. It was a tradition on the Garland Farm in Albemarle County that had been carried on for generations.

Family folklore was that Black women for generations often came to the farm — then the largest, Black-owned farm in the area, which my family now calls Buck Island — from Richmond to deliver their babies. Because Buck Island was perceived to be a safe space, it probably started early. Giving birth in safe spaces is a very old Black tradition that dates from slavery. Traveling to those places was common after Emancipation.

In the fall of 2017, a cousin gave me a clue as to why. She told me that an ancestor was part of a monument being built in Richmond. I attended the groundbreaking ceremony and discovered a new piece of my family’s history.

Two statues of women in skirts and hats face each other, with other life-size statues behind them.
Sarah Garland Boyd Jones (represented in the statue on the left) and Maggie Lena Walker (right) met as students. Both forged new paths at the turn of the century in Virginia, Jones in medicine and Walker in banking. They are commemorated at the Virginia Women’s Monument in Richmond. Philip Cobbs/Charlottesville Tomorrow

The women’s monument on the capitol grounds in Richmond is called “Voices from the Garden,” and it commemorates 12 remarkable Virginia women in life-size bronze statues. Among them is Sarah Garland Boyd Jones. The Encyclopedia Virginia says she was the first African American woman to pass the state’s medical boards examination in 1893. And while it says she was born in Albemarle County in 1866, it does not say that she was born on the Garland Plantation.

After her birth, the family moved to Henrico County and soon to Richmond.There, she trained as a teacher with a classmate named Maggie Lena Mitchell, who later became Maggie Lena Walker, also commemorated in the garden. Walker later became  the first Black woman to own a bank in the United States and they remained lifelong friends. After graduating Sarah taught at Baker School, where she met another teacher named Miles Jones; they were married on July 4, 1888. She had to give up her job because married women were prohibited from the profession. Later, her husband lost his job too when Richmond passed an ordinance limiting the number of Black male teachers. 

In 1890, she decided to go to Howard University in Washington D.C. where she received her medical degree in 1893.

Upon passing her medical examination, Sarah used her skills to bring better health care to the Richmond community. She had a home office and a office away from home where she saw both Black and white patients. She offered a free clinic for women and children. She was a champion of expanding and organizing the budding Black medical profession.

Sarah became a doctor when the medical profession was undergoing rapid discovery. The importance of hygiene and the need for sterilization were new concepts that needed to be taught. She instructed Black nurses by training these new techniques and their importance.  

Her husband went to Howard and also became a doctor in 1901. Together they helped establish the Richmond Hospital Association in 1902. The association opened the first hospital for the Black people of Richmond, who were suffering from a lack of available medical service. This later became Richmond Community Hospital.

Unfortunately, her life was cut short when she died in 1905 at the age of 39 of a massive stroke. Her funeral was attended by hundreds and the eulogy was given by prominent white physician Dr. Ben Johnston.

This story was published as a part of Charlottesville Inclusive Media’s First Person Charlottesville project. Have a story to tell? Here’s how.

This is the second of a series about Buck Island, by Philip Cobbs for First Person Charlottesville. Subscribe to get free emails from Charlottesville Tomorrow with future stories.

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To better understand this trailblazer, we need to take a look at where Sarah Garland Boyd Jones was born. The Garland Plantation was purchased by Thomas Garland from John Campbell in 1835. My great great grandfather Thomas was a complicated man. The 1830 census records his household as having 10 slaves and seven free persons of color.

But how he interacted with those 17 people can only be imagined.

Thomas was appointed a magistrate in Albemarle County in 1838 and was the director of the Rivanna Navigation Company in the early 1850s. He had a white wife who lived in Charlottesville, but they had no children. He did have 13 children with his enslaved housekeeper, Elizabeth Allen, the first being Sarah’s mother Ellen Garland who was born in 1838. When Thomas died in 1874, he left a well-written will that bequeathed his estate to Elizabeth Allen and their children.

I have often thought of what Sarah’s life must have been like. She was born a year after the Civil War ended. Her grandmother was once owned by her grandfather, a man she surely knew. Elizabeth Allen must have been an inspiration to her — a woman who went from enslavement to owning a large farm, a woman who managed to pass that estate on to her children. Elizabeth Allen died in 1909, outliving Sarah by four years. 

Both Sarah and her mother, Ellen Garland Boyd, were the oldest of their siblings. They both married industrious men who were respected members of their community. Her father, George Boyd, was a well known builder in Richmond who constructed landmarks such as Maggie Walker’s home, now a National Historic site. Miles and Sarah were active in the Grand Fountain of the United Order of True Reformers, an African American fraternal organization dedicated to mutual aid. They founded the first Black bank in the United States and Sarah’s father built the hall which housed it. Everyone alive then remembered enslavement and many were part of the first generation of Black people to experience freedom. They diligently worked to uplift their people.

I believe the farm I remembered and experienced was in many ways like the plantation, and later farm, that Sarah knew and remained connected to. It was a safe space. I now understand why there was a medical presence on Buck Island, why my mother felt safer giving birth there. I remember an elderly Aunt Malie, who lived on the next hill. (I have a vivid childhood memory that once, when she opened her dresser drawer and there was a snake in it, she came to our house in a panic.) I knew Aunt Malie had been a nurse, but I didn’t know she was Sarah’s youngest sister until she was nominated to be in the women’s monument. I’d heard of her other sister, Marie, who was also a doctor and married Miles after Sarah’s death. When I saw a picture of Sarah, I was taken by her close resemblance to my mother. Elizabeth Garland Cobbs, who was named after her great grandmother Elizabeth Allen.

Stories passed down from generation to generation are precious, especially in the African American community. But like most precious materials, they must be gleaned. Often, I heard that Thomas Garland was closely related to Thomas Jefferson, in part because the Garland plantation was so close to Jefferson’s plantation. When referring to her birthplace, Sarah is known to have said she was born within sight of Monticello. The Garland Plantation was also next to Jefferson’s sister’s plantation, Monteagle, which was owned by Charles Lewis, but they had moved to Kentucky almost 30 years before Thomas Garland purchased his land.

In my search for my family’s history, I have found no direct family relationship between Thomas Garland and Thomas Jefferson. In a 1901 history of Albemarle County the white author Rev. Edgar Woods says this of Thomas Garland: “He was a man of amiable temper and unsavory reputation.” The choices Thomas Garland made were not appreciated by his white community.

Another origin story that has been passed down in my family is that Elizabeth Allen was of Native American descent. These stories are common among African American families and are hard to prove. It is true that Native Americans were enslaved along with African Americans in Virginia. I have heard a compelling story that Elizabeth Allen’s grandmother was an enslaved Native American who won her freedom, but her children remained in enslavement.

There are many documented cases of enslaved people trying to gain their freedom based on their Native American lineage. There were enslaved people of Native American descent in Virginia who did not gain their freedom until Emancipation. This is an often overlooked chapter of Virginia history and therefore so is the interaction between these enslaved people groups. If my ancestors were part of that intersection, I would be honored and humbled.

I have thought of how my family navigated the issue of race in the times in which they lived. My mother grew up knowing her grandfather, one of Thomas Garland’s children. James Garland born in 1852 and died in 1942. As I learn more about history, I ponder what he must have experienced in his long life. Was he able to put his experiences into words to share with my mother? I think much of what he lived through might have been too difficult to describe.

The legacy I believe James Garland, Sarah Garland Boyd Jones and the rest of my family left was a determination to live a life of equality, in an unreasonable world. And that determination was linked to my family’s land, Buck Island in Albemarle County.

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Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence and Justice in the Use of Physical Restraints

Introduction

The moral issues are naturally more focused in human-centred care.1 Patients are often vulnerable and require professional help and care, and care involves close interaction with them.2 Complex situations arise when caring for patients, and nurses have difficulty making decisions, often facing the greatest legal and ethical responsibilities.2

Many patients in intensive care units (ICUs) experience hallucinations, delirium and agitation.3 Furthermore, they may exhibit abnormal behaviours such as aggression, tube pulling, trying to get out of bed, throwing objects and hurting themselves and others.4 Therefore, intensive care nurses may use restraints to ensure patient safety. Physical restraints avoid the physical damage caused by the use of chemical restraints and do not require caregivers to constantly hold patients down to control limb movements. This is therefore a commonly used method in ICUs,5 with approximately one-third of patients in ICUs requiring physical restraints.6 The definition of physical restraints is the use of any manual technique, such as the use of physical force, materials or equipment, to limit the mobility of the arms, legs, body or head to remove or reduce a patient’s free movement. These techniques harm the patient’s freedom, health and comfort.7 As a result, most intensive care nurses face moral dilemmas when deciding whether to use physical restraints.8 Not using physical restraints may cause physical and mental damage to patients, but using physical restraints is often against the patient’s wishes.2 Nurses, as the implementer, usually experience moral dilemmas over using physical restraints because they need to weigh patient autonomy against patient safety.2 The moral dilemmas faced by nursing staff can have a significant impact on the quality of patient care. Some studies have focused on factors that influence the moral issue of nurses, as well as experiences of physical restraints.9,10 These studies indicate that even if nurses guide physical restraints as necessary, they still face moral issue. Therefore, this paper examines the use of physical restraints in medical settings through the four universal principles of ethics of autonomy, beneficence, non-maleficence and justice to help the nursing profession. Through these principles, the author will critically explore whether the use of physical restraints by nurses is ethical in practice and what moral issues exist. This paper also explores the conflicts and moral dilemmas that nurses face in mechanical restraints. Moreover, the nurse, as a moral agent in ethical decision-making, will be critically discussed. Patient consent and nurse decision-making will be incorporated into an analysis of care ethics. Finally, suggestions are made on changes to education and clinical practice.

This study searched both Chinese (CNKI) and English databases (Pubmed, NCBI), with keywords such as nursing, nurse, physical constraints, and moral dilemmas. The retrieved literature was screened based on inclusion and exclusion criteria. Inclusion criteria: 1) The theme is the moral dilemma of nurses regarding physical constraints; 2) Can obtain the full text. Exclusion criteria: 1) Conference papers; 2) Unable to obtain full text.

Moral Dilemmas Faced by Nursing Staff

Nursing is an interactive process. The attitude of caregivers towards the use of restraints varies.5,11 Some caregivers regard its use as inhumane, leaving them with a sense of guilt. However, for patient safety, restraints has to be used. To prevent falls and self-harm, older adults may face more physical restraints.12 The autonomy of the elderly should be respected, and nurses should follow the principle of benefit without harm; however, this leads to a moral dilemma. When the elderly refuse treatment or exhibit self-harming behaviours, nurses must carefully consider the safety of the patients rather than their autonomy. If safety cannot be guaranteed, nurses may bear legal responsibility. Therefore, they may be more inclined to sacrifice the patient’s autonomy.2 In addition, moral dilemmas can also cause mental-health issues for nurses. The nurses have negative emotions such as sadness, helplessness, tension and guilt when facing ethical conflicts.13 These negative emotions make them doubt their own ability and also lead to clinical misjudgement in their daily nursing activities. These findings are consistent with the previous research.14 Whether to restrain or not is a double-edged sword in terms of ethical considerations, and the resulting physical and mental damage to nurses affects the quality of nursing. This impacts nursing objectives, creating a vicious circle. In this regard, nurse response measures can be divided into three categories:14 maintaining a positive attitude and taking action to solve the problem, adopting a negative attitude towards the problem and negative actions, and failing to respond or take action. The researchers suggest that hospital managers encourage nurses to adopt positive attitudes and actions to improve the quality of care of the elderly and mobilise confidence and enthusiasm in their work through the analysis of an ethical-dilemma response scale. In addition, one of the purposes of nursing is to promote patient comfort and guarantee patient well-being. When nursing staff respect the independent decision-making power of elderly patients requiring restraints, they must also consider the well-being of other elderly people.

Ethical Judgement of Physical Restraints Use

As the traditional paternalistic medical model worldwide is being gradually reformed, the autonomy of patients is becoming increasingly valued. In traditional models, patients are cared for but are not decision-makers.15 The emphasis on autonomy is the result of social transformation; however, it is also derived from the four principles of medical ethics – autonomy, beneficence, non-maleficence and justice.16

Autonomy

Autonomy is a concept deeply rooted in Western culture, involving humanity and respect.17 An autonomous person can guide their daily life according to their beliefs and values.18 Liberty is an integral part of autonomy and refers to the ability of patients to make decisions without being manipulated or coerced.19

Although there is no absolute autonomy, in clinical practice, patient autonomy is often violated.20 According to its definition, the principle of restraints is incompatible with autonomy because both procedures involve restricting patient freedom in some manner and against their will.19 In the healthcare profession, experts in their respective fields jointly provide nursing commensurate with their professional knowledge, and patients are expected to accept medical advice while receiving nursing services, which forms the basis of the concept of compliance.19 Compliance means a tendency to succumb or acquiesce, and the underlying assumption is that the caregiver has sufficient relevant knowledge to decide what the patient’s best interests are to determine the greatest possible outcome for the patient, resulting in appropriate intervention measures. Research found that when the key value-guiding behaviour of medical staff is to generate the most significant benefit for patients, patients lose their voice.21 Because of the unequal relationship between patients and caregivers, professional caregivers have a responsibility to create an environment that promotes patient autonomy.19

Medical professionals seek to protect the autonomy of patients because protecting their autonomy respects their personality.22 In a qualitative study, nurses stated that they tried their best to explain why they used physical restraints and what kind of controls they used. However, because most patients in this situation have limited mental status, informed consent is usually not obtained.23 Nevertheless, most nurses do participate in a decision-making process with patients’ families.23 Restraints use, as with any treatment, violates a person’s autonomy unless patients or their agents have provided informed consent or the requirement for informed consent has been excluded.22 Hence, providing this information to patients is considered a necessary condition when considering the use of restraints and shows respect for patients as humans.23 Thus, in treatment, the value of autonomy can be expressed through adequate informed consent procedures and joint decision-making.

Guidance from the US Department of Health and Human Services clearly outlines patients’ rights in the use of restraints.24 It states that freedom from restraints is a patient’s right and that these coercive measures should only be used in situations that threaten the lives of patients or staff.24 Therefore, in certain unavoidable circumstances, the use of restraints might be the only option for the team responsible for patient safety.19 For example, when patients are aggressive, hurting themselves or others, staff have the right to expect protection and have tools to ensure their own safety and that of other patients. Thus, in particular circumstances, nursing staff must use physical restraints in violation of the patient’s autonomy.

Beneficence and Non-Maleficence

The use of restraints protects patients and reduces self-harm, but it may causes psychological damage to the patient.6,9 The Center for Ethics and Human Rights (2012) states that nurses’ primary commitment is to patients, whether individuals, families, groups, communities or populations.25 It also notes that directly or indirectly restricting or isolating patients is considered a violation of the primary goals and ethical traditions of the nursing industry. Therefore, physical restraints use conflicts with the nurse’s moral responsibilities of beneficence and non-maleficence to patients. Moreover, these two moral principles are inevitable results of each other.19 In healthcare, beneficence refers to the promotion of patient well-being by healthcare staff through research or implementing active therapeutic interventions, and non-maleficence is the responsibility of the clinician not to harm, intentionally or otherwise, the patient.26 To hurt someone means to negatively affect or disadvantage someone in some manner.16 The harmfulness and lethality of restraints use have been verified in relevant medical fields, such as those related to the elderly, rehabilitation and psychiatry.27,28 Therefore, when applying physical restraints to patients, attention should be paid to avoiding harm.

Notably, a patient’s exercise of autonomy may conflict with clinical moral obligations.19 Nursing staff want to provide what they consider to be the most suitable care for patients, but they must also acknowledge their preference during the nursing process. Competent clinicians and nurses follow the principle of beneficence. However, they may not realise that from a professional and patient perspective, the understanding of the nature and content of “good” may differ.23 Increasing evidence suggests that patients and practitioners may view patient care differently.29 However, except in situations where security is a real concern, the use of restraints is contrary to the principles of non-maleficence and beneficence. Based on the evidence, the use of such under-researched procedures is controversial and dangerous.20

Justice

Justice refers to the fair treatment and rights granted to others and the equitable distribution of resources,30 although some groups may face more restrictive behaviours in relation to justice (eg children, young people and African Americans).31 These people are therefore considered vulnerable in the healthcare system. In the United States, parents regard their minor children as personal property, leaving these children with no right to express themselves.19 In this context, judicial issues have diverged from mainstream medical considerations. When patients are violated or they become a danger to others, the issues of justice and physical restraints come to the forefront.19 Specifically, blindly applying physical restraints to aggressive patients does not promote interpersonal relationships or interaction. Therefore, physical restraints should be considered critically because ignorance of justice leaves patients vulnerable to prejudice and unfair treatment.32 Although the use of physical restraints in the care process is unavoidable in some cases, restrained patients should be treated as humans and their basic needs met.

There can be no objections to the statement that restraints may violate people’s rights.33 However, does this mean it should never be used? The American Nurses Association (ANA) states that nurses must be compassionate and treat all patients with respect for their inherent dignity, value and unique attributes.25 Research noted that effective care should pay attention to all aspects of the patient as a person, including physical, psychological and moral aspects.34 However, the medical environment is complex, and sometimes, how to provide ethical care is unclear, especially when deciding the correct course of action is challenging, potentially leading to moral conflict.35 For example, when patients are unable to make decisions or claim rights by themselves, their rights are easily violated. Therefore, nurses must understand the importance of human rights so that they can protect the rights of patients and provide ethical care in particular circumstances.35

Legal Considerations of Physical Restraints

In addition to ethical considerations, the use of restraints is accompanied by legal constraints and norms. Studies11,36 have shown that injuries caused by falls are the main reasons for the prosecution of nursing homes. Falls not only cause physical injury to the elderly but also result in nursing homes facing compensation claims for medical expenses. In 2000, Japan established long-term care insurance37 to care for the elderly population. In addition, Japan’s Ministry of Health and Welfare passed legislation to prohibit the use of physical restraints among elderly patients with long-term care insurance. However, in terms of medical insurance, it is legal for medical workers to use restraints. This is because long-term care insurance is separate from medical insurance. The common reason for prosecution in disputes related to medical accidents is that the right of informed consent of family members is not guaranteed.11 In the present study, we must highlight the right of informed consent of family members and the right of medical staff to provide treatment. In the nursing of elderly patients, staff have the right to decide their patients’ nursing plan. Therefore, when using physical restraints, the key factor is whether nursing staff have abused their power. Article 483 of Chapter 42 of the Federal Code of the United States36 and the law on the reform of nursing homes38 clearly stipulate that it is prohibited for caregivers to use physical restraints on elderly patients for the purpose of discipline or convenience, and the patient has the right to reject the restraints used. The establishment of these laws and regulations, to a certain extent, regulates the scope of the use of restraints and avoids the abuse of power by medical staff for convenience. Others have proposed that a restraints restriction order should be introduced to limit the use of restraints.37 When assessing whether the elderly need to be restrained to support treatment, medical staff should carefully consider the potential hazards and consequences rather than simply using physical restraints for treatment purposes. The elderly need medical staff to take responsibility for the abuse of restraints. In 1974, US legislators became aware of the problems of restraints use in nursing homes and introduced a series of regulations for the elderly. However, many of these regulations have not been implemented. The right of informed consent of the family requires the caregiver to decide whether to strictly implement the obligation to inform or whether to explain the related adverse consequences of restraints use to the family members in detail as well as to consider the prevention and control measures for adverse consequences. If caregivers do not carefully observe the skin at the restraints site, the improper use of restraints can lead to related complications in elderly patients. Thus, the dereliction of duty can directly cause physical and mental damage.11 Legal warnings and implementation help reduce the use of restraints. Studies have found that after the implementation of relevant laws, some nursing homes reduced the use of physical restraints, and caregivers became more cautious when using restraints.39,40 The right of informed consent is the main manifestation of autonomy among the elderly and their families in relation to treatment. This not only requires legal protection but also caregivers to respect the rights and interests of the elderly and their families rather than facilitate their use of restraints on elderly patients.

As many countries call for a reduction in the use of restraints in nursing homes and the development of research on alternative forms of restraints, the use of restraints has been reduced11 but not eliminated. In 2013, the Australian Evidence-Based Healthcare Centre published three principles of physical restraints: try not to use physical restraints, remove them as soon as possible and find alternative methods whenever possible. Nursing homes may not accept a reduction in the use of restraints because it will increase their costs.32 A consultation of a large amount of literature found that the physical and mental harm caused by restraints is undeniable and inevitable, and the occurrence of harm can only be minimised and reduced. Reducing the excessive use of restraints is more important than simply avoiding its use or reducing the restraints rate. Nursing of the elderly in nursing homes is essentially different from that of hospital patients, and nursing staff should be cautious in the use of restraints. Caregivers of elderly patients should change their view of restraints use and focus on nursing before considering restraints use. A reduction in predictive restraints can reduce restraints use. For elderly patients who require restraints, caregivers must prevent and treat any related physical injuries. In addition, caregivers should take measures to alleviate the negative emotions they experience when using restraints, for example, through psychological care, counselling and support. The cultivation of empathy among nursing staff can enhance the relationship between them and the elderly in their nursing duties and encourage elderly patients to actively cooperate with the implementation of nursing operations. Nursing staff should strengthen their communication with elderly patients, establish a positive relationship with them, observe and understand their wishes and needs, and take corresponding measures. Studies have shown that the education and training of nursing staff should be strengthened.41 However, it is not enough to address the issue only in this manner.14 Researchers have proposed alternative restraints methods to reduce restraints injuries, such as providing support for the self-care ability of elderly patients by improving environments that are potentially harmful to them, reducing the factors that induce mental disorders, enhancing training and encouraging active participation in daily life41,42. In 2002, the Department of Health and Social Services in Quebec, Canada, drafted guidance for medical institutions on the use of alternative forms of restraints.43 The guidance describes the issue of protecting the dignity of elderly patients while reducing the potential risks and injuries of physical restraints. However, alternative restraints methods cannot completely replace the role of restraints. In 2009, the Norwegian government introduced the Patients’ Rights Act. This Act stipulates that medical staff can use physical restraints when the method of alternative restraints is ineffective and the patient is unconscious. In addition, the use of restraints requires the advantages of restraints use to outweigh the disadvantages.44 At present, China has no unified standard guidelines for the use of physical restraints.45 Nursing homes developed later in China than in some other countries. Therefore, China must establish a set of standards specifically for the use of physical restraints for the elderly residents of these homes. There are relevant guidelines in other countries.46 Nursing managers can refer to the existing literature, reports and other materials and consider China’s national conditions to formulate appropriate standards to guide the use of restraints for the elderly by caregivers.

Current Situation in China

In China, nurses face challenges and moral dilemmas when using physical restraints. Overall, for various reasons, China’s health services are not developing as fast as in Western countries. Moreover, although the population is large, the number of registered nurses in China is lower than the global average.47 Understaffed healthcare institutions are faced with a patient load that exceeds their capacity, but they also need to provide nursing services that meet the standards. This leads to a heavy workload for nurses. Therefore, when faced with agitated patients, it is easy for nurses to physically resist aggression because other options consume resources (eg in terms of time and personnel), which is challenging in clinical situations.2

Nurses have a dilemma as to whether to use physical restraints, and they feel helpless and fearful when facing aggressive patients.48 Nurses need to balance the ethical principle of beneficence, ensuring the safety of the patient, and the principle of autonomy of the person.49 Whether to use physical restraints and the extent of use is determined by the nurse’s attitude and clinical culture.32 The ANA noted that imposing physical restraints on patients may be caused by peer pressure and demands,25 and these intentions might not be in the interests or in line with the wishes of the patient. At present, being able to use physical restraints in harsh conditions is critical for medical staff. According to ethical principles, in cases where physical restraints cannot be eliminated, the focus should be on the method which was used. Therefore, moral considerations should be based on autonomy, beneficence, non-maleficence and justice.

Obtaining informed consent from patients is the basis for respecting patient autonomy. However, according to the Chinese Mental Health Commission (2009), in an emergency (for example, when the patient poses a direct danger to others), it is legal to use physical restraints without the patient’s consent.50 Given that most patients admitted to hospital are ill and unable to determine what is in their best interests, the informed consent of close relatives is feasible in China because it is consistent with traditional beliefs. Moreover, when considering the possibility of doctor–patient disputes, informed consent is equally crucial for the protection of healthcare staff.

Suggestions for Clinical Practice

It was necessary for the elaboration and implementation of protocols on intervention to support decision making was observed.51 According to the Irish Mental Health Commission (2014), the principles and requirements that support physical restraint must be specified in an organisation’s guidelines to standardise and monitor nursing practices and ensure that treatment goals can be achieved.52 Only in this way can the binding treatment goals exceed the side effects of restraints use;53 otherwise, illegal behaviour may result in abuse resulting from the use of physical restraints.32 Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision-making process.54 Employee training is a meaningful way to reduce the use of physical restraints and provide training to nurses to familiarise them with guidelines, respond to violent behaviours and regulate their behaviour. China’s National People’s Congress (2012) requires nurses to strictly abide by the National Mental Health Law – only after a comprehensive evaluation of the patient and the recording of the results in the electronic medical record can physical restraints be used.55 Moreover, to reduce the side effects of restraints use, unless the restraints is removed, medical staff should conduct a medical examination promptly. The restraint-free model requires an approach to safety from a holistic perspective, with the involvement of all team members and the family.56

Summary

The moral dilemma associated with physical restraints use is a double-edged sword, and the damage it causes to nurses both physically and mentally affects the quality of nursing. This has consequences for nursing objectives, forming a vicious circle. The use of physical restraints faces many challenges in terms of autonomy, beneficence, non-maleficence and justice. Although nurses played a crucial role in the decision-making process of using physical restraints, changing the healthcare climate and the hospital management mode for unplanned extubation are fundamental measures to reduce physical restraints use.57 Many countries have developed guidelines and principles that regulate restraints use, reduce its physical and mental harm to patients and improve the moral dilemma of nursing staff. In China, nursing staff face more serious moral dilemmas related to restraints use. Therefore, China must develop guidelines for restraints use in response to the current situation in the country.

Conclusion

The moral dilemma faced by nurses regarding physical constraints was mainly based on four principles. At present, there was no clear evidence to support or not support the physical restraints behavior in the intensive care unit. This study focuses on how to consider the interests of patients and better implement physical restraints. Relevant agencies should develop clear guidelines for the use of physical restraints based on evidence-based practice. Guidelines for restraints use that are suitable for countries and regions can be developed based on four principles. Moreover, education and consultation programmes should be developed and implemented for nurses. For issues related to the use of physical restraints, the programme content should be based on ethical nursing practices, patient rights, physical restraints guidelines and legal management principles. The actions and beliefs of experienced practitioners should be carefully considered. Therefore, more attention should be paid to common methods of physical restraints in medical treatment. Attention should also be paid to the workload and psychological state of nursing staff, as these are related to their attitude towards patients and their judgement on whether to adopt restraints. This article critically examined the use of physical restraints through moral principles and discussed the moral dilemma of nurses in relation to this issue.

Data Sharing Statement

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Ethics Approval and Consent to Participate

An ethics statement is not applicable because this study is based exclusively on published literature.

Funding

The project was supported by the “Construction and empirical study of a pre hospital emergency training program for families of high-risk patients with sudden cardiac death based on action promotion theory” (HNSYHLKT202209). Funding agencies did not play a role in study design, data collection, analysis and interpretation, and manuscript writing.

Disclosure

The authors report no conflicts of interest in this work.

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Breaking the silence: Megan Thee Stallion addresses mental health and stigma

(The Dallas Examiner) – “Black don’t crack they say, but it can. I can. We all can,” said Grammy-winning musician, Megan Thee Stallion, as she opened up about her mental health journey in public service announcements for “Seize the Awkward.”

Megan starred in the campaign’s latest series of PSAs that are aimed at encouraging young adults to create safe spaces for their friends in hopes of promoting open and honest conversations about mental well-being.

“[My friend] checks in on me, and I check in with her. It feels really good to have somebody that supports me that way,” she said. “I know a lot of times I’m presenting to my friends like I got it together…nothing is wrong with me.”

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The rapper serves as a role model against stigma as she gets personal about the importance of opening up to people that can be trusted and the pressures to be strong. The PSA has been seen nationwide through a series of digital, broadcast and social formats.

“I got involved with this campaign because I genuinely know how it feels like where I don’t want to open up, and I don’t want to talk about it,” Megan explained. “And I don’t tell people, ‘No, I don’t like this,’ ‘This is affecting me this way,’ ‘I’m sad,’ ‘I don’t want to do that.’ And I know what it feels like to be in your head and feel like, I can’t talk to anybody about this. I don’t want anybody to know. I’m embarrassed about how I feel.”

Now she encourages other young women to open up about how they feel and tell someone they can trust. Also, be there for your friends to open up to you, as well.

When selecting the trusted messenger for the campaign, Deb Leiter, senior vice president of campaign development, emphasized the importance of authenticity and the ability to connect with teens and young adults, particularly within the African American community.

“Megan telling her personal experiences and her story and as someone the public really perceived as this strong, tough woman serves as a role model for others,” Leiter said. “She’s showing how important it is to be vulnerable and to open up.”

The rate of mental illness among African Americans is slightly lower than that among White Americans. However, 39% of Black Americans sought mental health care as opposed to the 52% of White Americans, according to a 2021 study conducted by the Substance Abuse and Mental Health Services Administration.

Many factors have contributed to the low use of resources – from the high prevalence of misdiagnosis to cultural pressures. Experts have stated that stigma from the community continues to be the leading culprit.

For the Black community, stigma has taken on a unique form due to its medical experiences. Black patients have historically been misdiagnosed at higher rates than White patients. Additionally, Black Americans have historically been exploited through medical experiments. Distrust of the medical establishment consequently led to a reluctance to discuss mental health and views receiving care as a sign of weakness, according to the National Institution of Health.

Beyond the numbers lies a narrative that’s quietly unfolding within the Black community. Gen Z, composed of people born between 1996 and 2010, is leading the revolution of destigmatizing mental health through open conversation across various mediums. Digital platforms have been able to serve as a vital space for this generation to connect with others who share similar struggles, including celebrities who openly discuss their mental health journeys. Gen Z is more willing to talk about mental health as well as seek treatment at higher rates than any previous generations, according to the American Psychology Association.

Dr. Natasha Gresham, director of the Center for Counseling and Behavioral Health at The Potter’s House, had not heard about therapy until she was 22. Growing up in a religious community she thought counseling wasn’t something that could fit into the culture.

“It was something that rich White people do,” she said. “It was nothing that a person of faith did because we had God and prayer, and that’s all you needed.”

Gresham said religion has often been used to diminish the legitimacy of seeking mental health care but, as a faith-based counselor, she said that the two concepts can complement each other, only if faith has played a major part in the person’s life.

“I don’t try to make you believe what I believe. We invite whatever your higher power is into that session,” she said. “Since I work in a Christian-based center we’re inviting God into sessions to help us open our minds and thoughts.”

Gresham highlighted that the real misconception is people think mental health can’t be incorporated into their daily lives. She said that counseling can help navigate normal life things like divorce, raising kids, dealing with substance abuse or transitioning into a new job.

“We all have mental health. We don’t all have a mental illness, and just because life is life-ing we need counseling. It’s a safe place to discuss our feelings and emotions,” Gresham said. “It doesn’t mean something is wrong with you.”

Experts have stated that reducing the stigma surrounding mental health could increase the likelihood that individuals who need care will seek and help establish more opportunities and spaces to connect with those who face the same struggles.

Leiter explained that the campaign hoped to foster open dialogues about mental wellness within the Black community across all age groups. The initiative’s focus on the Black community stemmed from a recognition of the unique mental health barriers faced by its members. Megan’s role as a spokesperson conveys this message.

“I really think it’s a universal kind of message because we all have struggles and go through tough times,” Leiter said.

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Francis Collins: Why I’m going public with my prostate cancer diagnosis

Over my 40 years as a physician-scientist, I’ve had the privilege of advising many patients facing serious medical diagnoses. I’ve seen them go through the excruciating experience of waiting for the results of a critical blood test, biopsy or scan that could dramatically affect their future hopes and dreams.

But this time, I was the one lying in the PET scanner as it searched for possible evidence of spread of my aggressive prostate cancer. I spent those 30 minutes in quiet prayer. If that cancer had already spread to my lymph nodes, bones, lungs or brain, it could still be treated — but it would no longer be curable.

Why am I going public about this cancer that many men are uncomfortable talking about? Because I want to lift the veil and share lifesaving information, and I want all men to benefit from the medical research to which I’ve devoted my career and that is now guiding my care.

Five years before that fateful PET scan, my doctor had noted a slow rise in my PSA, the blood test for prostate-specific antigen. To contribute to knowledge and receive expert care, I enrolled in a clinical trial at the National Institutes of Health, the agency I led from 2009 through late 2021.

At first, there wasn’t much to worry about — targeted biopsies identified a slow-growing grade of prostate cancer that doesn’t require treatment and can be tracked via regular checkups, referred to as “active surveillance.” This initial diagnosis was not particularly surprising. Prostate cancer is the most commonly diagnosed cancer in men in the United States, and about 40 percent of men over age 65 — I’m 73 — have low-grade prostate cancer. Many of them never know it, and very few of them develop advanced disease.

Why am I going public about this cancer that many men are uncomfortable talking about? Because I want to lift the veil and share lifesaving information.

But in my case, things took a turn about a month ago when my PSA rose sharply to 22 — normal at my age is less than 5. An MRI scan showed that the tumor had significantly enlarged and might have even breached the capsule that surrounds the prostate, posing a significant risk that the cancer cells might have spread to other parts of the body.

New biopsies taken from the mass showed transformation into a much more aggressive cancer. When I heard the diagnosis was now a 9 on a cancer-grading scale that goes only to 10, I knew that everything had changed.

Thus, that PET scan, which was ordered to determine if the cancer had spread beyond the prostate, carried high significance. Would a cure still be possible, or would it be time to get my affairs in order? A few hours later, when my doctors showed me the scan results, I felt a rush of profound relief and gratitude. There was no detectable evidence of cancer outside of the primary tumor.

Later this month, I will undergo a radical prostatectomy — a procedure that will remove my entire prostate gland. This will be part of the same NIH research protocol — I want as much information as possible to be learned from my case, to help others in the future.

While there are no guarantees, my doctors believe I have a high likelihood of being cured by the surgery.

My situation is far better than my father’s when he was diagnosed with prostate cancer four decades ago. He was about the same age that I am now, but it wasn’t possible back then to assess how advanced the cancer might be. He was treated with a hormonal therapy that might not have been necessary and had a significant negative impact on his quality of life.

Because of research supported by NIH, along with highly effective collaborations with the private sector, prostate cancer can now be treated with individualized precision and improved outcomes.

As in my case, high-resolution MRI scans can now be used to delineate the precise location of a tumor. When combined with real-time ultrasound, this allows pinpoint targeting of the prostate biopsies. My surgeon will be assisted by a sophisticated robot named for Leonardo da Vinci that employs a less invasive surgical approach than previous techniques, requiring just a few small incisions.

Advances in clinical treatments have been informed by large-scale, rigorously designed trials that have assessed the risks and benefits and were possible because of the willingness of cancer patients to enroll in such trials.

I feel compelled to tell this story openly. I hope it helps someone. I don’t want to waste time.

If my cancer recurs, the DNA analysis that has been carried out on my tumor will guide the precise choice of therapies. As a researcher who had the privilege of leading the Human Genome Project, it is truly gratifying to see how these advances in genomics have transformed the diagnosis and treatment of cancer.

I want all men to have the same opportunity that I did. Prostate cancer is still the No. 2 killer of men. I want the goals of the Cancer Moonshot to be met — to end cancer as we know it. Early detection really matters, and when combined with active surveillance can identify the risky cancers like mine, and leave the rest alone. The five-year relative survival rate for prostate cancer is 97 percent, according to the American Cancer Society, but it’s only 34 percent if the cancer has spread to distant areas of the body.

But lack of information and confusion about the best approach to prostate cancer screening have impeded progress. Currently, the U.S. Preventive Services Task Force recommends that all men age 55 to 69 discuss PSA screening with their primary-care physician, but it recommends against starting PSA screening after age 70.

Other groups, like the American Urological Association, suggest that screening should start earlier, especially for men with a family history — like me — and for African American men, who have a higher risk of prostate cancer. But these recommendations are not consistently being followed.

Our health-care system is afflicted with health inequities. For example, the image-guided biopsies are not available everywhere and to everyone. Finally, many men are fearful of the surgical approach to prostate cancer because of the risk of incontinence and impotence, but advances in surgical techniques have made those outcomes considerably less troublesome than in the past. Similarly, the alternative therapeutic approaches of radiation and hormonal therapy have seen significant advances.

A little over a year ago, while I was praying for a dying friend, I had the experience of receiving a clear and unmistakable message. This has almost never happened to me. It was just this: “Don’t waste your time, you may not have much left.” Gulp.

Having now received a diagnosis of aggressive prostate cancer and feeling grateful for all the ways I have benefited from research advances, I feel compelled to tell this story openly. I hope it helps someone. I don’t want to waste time.

Francis S. Collins served as director of the National Institutes of Health from 2009 to 2021 and as director of the National Human Genome Research Institute at NIH from 1993 to 2008. He is a physician-geneticist and leads a White House initiative to eliminate hepatitis C in the United States, while also continuing to pursue his research interests as a distinguished NIH investigator.

Pregnant Black women feel lost in the medical system. Doulas offer guidance – and a voice.

Marquisa Gaines-Nickelson’s labor was accompanied by a soundtrack: the voices of R&B titans like Mary J. Blige, Al Green, and Anita Baker. Her husband and “labor DJ” Mazi Nickelson curated the music that reverberated through the delivery room. The playlist was part of a birth plan that they prepared with the help of their doula, Melody Cunningham.

The pair wanted their daughter, Sanaa, to get a taste of their personalities even as she drew her first breath.

Why We Wrote This

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Having someone to talk to helps many first-time parents feel more confident. For Black expectant mothers, doulas have helped restore trust in a medical system that has a history of mistreating them.

Empowering expectant parents to ask for what they want is just one piece of what Ms. Cunningham does as a birthing doula, an advocate trained to provide guidance and support to pregnant people and their families.

The United States has the worst maternal outcomes in the developed world, driven in part by stark racial inequities. According to the Centers for Disease Control and Prevention, Black women died of pregnancy complications at rates 2.6 times higher than their white peers in 2021.

Doula Dashanna Hanlon hopes that she can leave a legacy that leads to more joyful births, like Sanaa’s. “We talk so often about the awfulness of, you know, Black maternal health,” she says. “But there is so much joy in those rooms.”

Marquisa Gaines-Nickelson’s labor was accompanied by an unexpected soundtrack: the voices of R&B titans like Mary J. Blige, Al Green, and Anita Baker. Her husband and “labor DJ” Mazi Nickelson diligently curated the music that reverberated through the delivery room in Cambridge, Massachusetts. The playlist was part of a birth plan that they prepared with the help of their doula, Melody Cunningham.

For the first-time parents, those details mattered a great deal, and Ms. Cunningham was essential to making them a reality. The pair wanted their daughter, Sanaa, to get a taste of their personalities even as she drew her first breath. “Some of the smallest details can turn out to be big ones,” Mr. Nickelson says. “Having Melody there to help us navigate that space … we appreciated that a lot.” 

Empowering expectant parents to ask for what they want is just one, albeit important, piece of what Ms. Cunningham does as a birthing doula, an advocate trained to provide guidance and support to pregnant people and their families. The care doulas offer isn’t like that given by an OB-GYN or midwife. Instead, they provide nonmedical help: counsel on what to expect; advocacy during delivery and doctor’s appointments; and a place to express emotions ranging from excitement, to, for many Black families, fear.

Why We Wrote This

A story focused on

Having someone to talk to helps many first-time parents feel more confident. For Black expectant mothers, doulas have helped restore trust in a medical system that has a history of mistreating them.

That fear comes with a history. The United States has the worst maternal outcomes in the developed world, driven in part by stark racial inequities. According to the Centers for Disease Control and Prevention, Black women died of pregnancy complications at rates 2.6 times higher than their white peers in 2021, the most recent year for which data is available. 

As Black expectant mothers try to navigate a medical system in which they have little confidence, Black doulas have become trusted members of their pregnancy teams. 

Black Americans across the board eye American health care warily. In a 2020 poll by the Kaiser Family Foundation and The Undefeated, only 56% of Black respondents said they trusted their local hospitals, compared with 70% of white ones. 

Melanie Stetson Freeman/Staff

Stephanie Crawford with her son, Amani, in their home in Boston, April 9, 2024. Stephanie is a birthing doula who offers guidance to Black women navigating pregnancy. She is also a kindergarten teacher and is working toward a Ph.D. in early childhood education.

That mistrust is earned, says Dr. Allison Bryant, an OB-GYN and associate chief health equity officer at Massachusetts General Brigham. She points to a long history of medical mistreatment still felt by Black people and other groups. Indeed, doctors forcibly sterilized Black, Latina, and Indigenous women well into the 1970s. 

“We in the medical system have not done a great job of earning that trust back,” Dr. Bryant says. “So people come into the delivery rooms with that sort of context.”

Research shows that doulas can significantly reduce negative outcomes and lower anxiety among expectant mothers.

Doula work is steeped in a deep sense of community and a history that stretches back hundreds of years. Dr. Bryant points to “granny midwives” – highly skilled Black women who, for centuries during slavery and following emancipation, provided obstetric care for women living in the rural South. Though they laid the foundation for modern doula work and midwifery, they were pushed out as obstetrics became institutionalized in hospitals.  

To Stephanie Crawford, a Boston-based doula, part of that model’s success came from the women’s deep connections to the people for whom they cared. The midwives were familiar members of their communities – mothers, sisters, friends, and cousins. Ms. Crawford says that sense of collaboration is an essential building block for the deep, trusting relationships she relies on to care for her clients. 

During the initial meeting, the first thing she does is listen. It’s not her job to tell mothers and their families how a pregnancy should go, she says. Her job is to work with them, to guide them, and to make them feel informed enough that they can make decisions about their own care.

Melanie Stetson Freeman/Staff

Doula Stephanie Crawford holds items she uses to teach pregnant women what to expect during a birth, April 9, 2024.

Ms. Crawford understands the importance of feeling ownership over a pregnancy. She’s been in her clients’ shoes. She’s Black. She’s given birth twice. She knows that hospitals and doctor’s offices can feel intimidating, that it can sometimes feel as if decisions are not yours to make. More than that, she understands how heartbreaking a pregnancy can be. Her first one, in 2011, ended in a stillbirth.

In some ways, her second pregnancy was remarkably similar to her first. It was another boy, and his birthday ended up being a mere three days from her first son’s. But having a doula made all the difference – so much so that she became one herself.

“I would do the birth 10 times again,” she says. Her son turned 5 in February. “My goal as a doula is just creating that same kind of experience for others, so that people can be more informed, intentional, and just own their journey a little bit more.”

Ms. Crawford says it comes down to the details. Mothers and their families don’t always know what they can ask for in the delivery room. But those small things – like not wearing a hospital gown or playing a favorite song during labor – can make people feel empowered. “That means something to people,” Ms. Crawford says. “Being able to have things that feel good to you.”

Joanne Dorgilus, another Boston-based doula, wants clients to feel as if they’re talking to a family member or a close friend. “I’m one of your girlfriends,” she says, chuckling while she talks about her work. Letting her clients see her naturally cheerful, “jokey-joke” personality is her way of easing anxiety and creating camaraderie.

Beyond that intentionally cultivated closeness, having a knowledgeable Black advocate in the room can be comforting. Research has shown that people are more satisfied with care from doctors who share their race. 

“Cultural competency cannot be bought,” says Ms. Cunningham. “It cannot be taught. It’s just something that is there. And it makes for a more comfortable experience, which makes for … the increased likelihood of a healthy and happy birth.” 

Sanaa, Mrs. Gaines-Nickelson and Mr. Nickelson’s daughter, will be 2 in July. The couple is hoping to have a second child soon, perhaps without the help of a doula this time. “I feel more confident in knowing what I know a little bit now,” Mrs. Gaines-Nickelson says. “I think I can guide myself.” 

Ms. Cunningham and other doulas interviewed emphasize that they value the expertise of physicians. The issues are more systemic than any one doctor. And even when clinicians are treating their patients equitably, they can sometimes struggle to break through entrenched power dynamics that make it difficult for Black women to speak up. 

Even though they don’t “catch the baby,” Ms. Dorgilus says, doulas are “putting their feet down and making the changes that we need to do to help women around the world.”

Black women “feel like they hadn’t been heard, and their voices haven’t been included in some of the decision-making process,” Dr. Bryant says. “In some instances that I’ve seen with my own eyes, the doula can sort of understand where the patient is coming from, and sometimes be able to be an advocate and a voice for that individual.”

Dashanna Hanlon, a doula based in the Greater Boston area, hopes that she can leave a legacy that leads to more joyful births, like Sanaa’s. “We talk so often about the awfulness of, you know, Black maternal health,” she says. “But there is so much joy in those rooms.”

Addressing underfunding at HBCUs will ensure educational equity and enhance social progress

(Duvalier Malone Enterprises) – Historically Black Colleges and Universities have been at the heart of higher education in the United States. This resulted from their origins after the slavery period and subsequent segregation era, which negatively affected Black people. Nonetheless, HBCUs have had a long period of underinvestment, despite their extensive legacy and importance to society.

The recent revelation that Black land-grant universities have been shortchanged by an astonishing $13 billion over the past three decades and the controversy surrounding Tennessee State University, with a $2.1 billion funding gap by the state, starkly illuminate the urgent need to finally address this systemic injustice. Addressing underfunding at HBCUs will ensure educational equity and enhance social progress.

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HBCUs serve as critical learning centers for African American students and other marginalized populations. When these institutions lack enough resources, they are unable to provide the same quality of academic programs, support services and facilities as those of their White counterparts. Let us consider outdated laboratories that hinder studies in the sciences; insufficient student counseling that reduces mental health help among learners; and aging dorms that create an unfit living atmosphere. This maintains the vicious circle of systemic disadvantage that restricts access to top-notch education and its transformative possibilities. By ensuring equitable funding for HBCUs, we level the playing field, empowering students from diverse backgrounds to unleash their full potential and overcome all barriers on their way to success.

Addressing underfunding at HBCUs will enhance social progress. HBCUs are proven engines of social and economic progress. A significant number of Black STEM graduates are educated by these institutions, filling gaps associated with high-demand fields such as health care and technology. Moreover, they usually constitute the mainstays of economies, generating employment opportunities, stimulating economic activity, and providing avenues for upward mobility. Take the case of North Carolina A&T State University, where research centers foster entrepreneurship within the local community. Without adequate funding flowing into HBCU coffers, society pays the price in terms of lost potential from talented students who could have made a difference but never had the opportunity, stifling innovation and leading to those socio-economic disparities that pull our country back. By properly financing HBCUs, we unlock their potential as vehicles toward progress, leaving behind more just societies with equal opportunities for everyone.

While some states have cited reasons such as limited budgets, smaller enrollments, or obsolescent notions about HBCUs as reasons for not fully funding them like other state colleges and universities, historical discrimination remains at the core of the systemic underfunding faced by HBCUs. They were established as a result of the segregation period, during which African Americans were denied admission into existing land-grant colleges. Many states ignored the Second Morrill Act of 1890, which required equal funding for HBCU land grants. However, it is important to note that even with such federal requirements, some states have never matched their one-to-one funding obligations towards these institutions, as stipulated in the letter from education secretary Miguel Cardona and Tom Vilsack, secretary of agriculture. Ongoing lawsuits on discriminatory underfunding, like the $577 million settlement for Maryland’s HBCUs, attest to deep-seated inequalities that still persist today.

The gross underfunding of HBCUs is a glaring and inexcusable oversight. National organizations, educational advocates and citizens alike must rally to address this inequity. It is imperative that we recognize HBCUs not only as crucibles of Black excellence but as foundational institutions within American higher education. Their historic underfunding is not merely an oversight; it is a reflection of persistent racial disparities that undermine our collective progress.

To correct this anomaly, we need to adopt a multi-faceted approach. First, federal and state policymakers must ensure equitable funding for HBCUs, recognizing their unique roles and contributions. Second, national organizations must leverage their platforms to advocate for these changes, bringing the issue into the national discourse. Finally, it is essential for all of us to support HBCUs, understanding that their success is integral to the success of our nation.

The path forward requires more than acknowledgment; it demands action. By collectively advocating for fair funding and equitable treatment, we can begin to rectify these decades of neglect. It is time for all of us to stand with HBCUs, ensuring they have the resources needed to continue their mission of education, empowerment and excellence.

Duvalier Malone is the CEO of Duvalier Malone Enterprises, a global consulting firm. He is also a motivational speaker, community activist and the author of Those Who Give A Damn: A Manual for Making a Difference.

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