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Overcoming Antiquated Practices: Modernizing Critical Care for Health Equity | S2E4 - Amplified RN News Show

Learn how nurse advocates can remove outdated tests and equipment to improve health equity and patient outcomes with ANA\California Member and media-trained nurse, Samantha Gambles-Farr MSN, FNP, CCRN, RNFA


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Jared Fesler 0:17

Welcome to the Amplified RN News Show where we're turning up the volume on nursing news in California. I'm your host, Jared Fesler and today we're going to be diving into the topic of modernizing critical care for equity and how we can overcome antiquated practices. We're joined today by ANA\California member and media train nurse, Samantha Gambles-Farr. Samantha, thank you so much for being here today. Can you tell us a little bit about why you're an expert on this topic?

Samantha Gambles-Farr 0:42

Thank you, Jared. It is my ultimate pleasure to be here today. My name is Samantha Gambles-Farr, I am a nurse practitioner intensiveness. What does that mean? I specialize and work in intensive service settings such as the surgical ICU trauma, CT ICU neurocritical care. In that position, I have been working for 15 years, and I've been a nurse for almost 25 years. And in that time, I have dealt with critical care issues, as well as health inequity and racial disparities along the continuum of health care. So I'm so happy to be here. And thank you for having me. And thank you, for ANA\California for creating this platform for us.

Jared Fesler 1:27

Of course, happy to have you here. So let's get into the meat of the problem here. We know that nurses are utilizing tests that help assess patients and provide care. And what you're saying is these tests may be out of date, is that correct?

Samantha Gambles-Farr 1:44

100%. So in and thinking about what we were going to talk about today, I started thinking about a couple of tests that are very common that we use, especially in this post pandemic phase of health care, utilizing tests such as the pulse ox glomerular filtration rate, or GFR. And then even assessing things as simple as pain. We have recognized and we know that for a long time that some of the tests are very antiquated as it relates to how they're formalized. And then how we actually utilize them in medicine.

Jared Fesler 2:21

Does this mean that it's providing incorrect readings or that we are not measuring certain data points? What does it look like? What is the actual problem?

Samantha Gambles-Farr 2:33

So the actual problem started from this has been a problem for several decades, actually, we recognize or we should have recognized the research that was done decades ago, pointing specifically to things such as pulse ox and the incorrect readings that we get on them based upon melanin based on darker skin tones. So the way that, for example, pulse ox works is that it utilizes LED light and photosensitivity and light absorption. Well, when you have melanated, darker skin, that absorption may be at a lower rate, which can affect the amount of actual true pulse ox or oxygen saturation that the patient has. Why is that important? That's important because for patients who are critically ill in critical care, that is the reading that we utilize as a nurse practitioner intensivist as a bedside nurse, as a physician to treat that patient. And so our patients could be suffering with more hypoxia than actually is presented in GFR. A lab tests for many, many decades, the inclusion of race specifically for African Americans was one of the factors in calculating that, amount or that rate. Why is that important? That means that patients are being based, are being treated on brace. And we know that that is not a physiological difference that we have as people. And so why is that being included? It's based in racial bias and race and racism. And then as it relates to pain, we all know, science has shown us and research has shown us for years that people of color are not treated with the same amount of pain medications, despite having the same amount of pain as their Caucasian counterparts. Why is that important? Paying decreases healing it can slow healing, and just honestly is just a humanistic side that we need to treat because we know that the stressors of pain can actually prolong healing as well.

Jared Fesler 4:55

So if this research has been around for decades, why our health system are institutions still using these tests? And what can be done to address this?

Samantha Gambles-Farr 5:07

For many years, you know, if you the research was very small, the voices are much louder. Now we understand that as it relates to racial equality and medicine, we can't forget the history of medicine, the history of medicine was not created for people of color, not even for women. Medicine was created for Caucasian white men, and all of our research, even to this day research as it relates to medicine, any new practices, it's hard to recruit people of color into these research studies, this continues to be a problem. And so the data points that we have, at times do not include other races, ethnic background sex. And so that is the primary problem, but also just us recognizing our implicit bias has always been a problem in healthcare, and continues to be a problem to this day.

Jared Fesler 6:08

Is this also is this issue, or is this research being taught within the educational programs? Or are they many of the nurses encountering this and perhaps their own implicit bias within health institutions themselves?

Samantha Gambles-Farr 6:24

No, it's being taught. And it has been taught for decades. I remember when I was in my nursing program, it was a well known fact, and it is touted and repeated by educators. It's just a pervasive message that is passed down from people doing the research, the people who are in are implying the research. And then it follows its way into the bedside. And it's real implications for our patients, because it is something that is being taught in healthcare institutions. I would, I mean, just, I think in 2014, I might be wrong about that year, but they did a research on medical students. And about 40% of those medical students still believe that black people have thicker skin than their white counterparts. That's less than 10 years ago. And we know that we are behind the times. So if that can be happening just 10 years ago, we'll somehow just having just being a black person, an African American or African person or a person with deeper melanin, somehow someone believes that your skin is thicker than theirs. I think that that has real implications about how we treat our patients on a day-to-day basis.

Jared Fesler 7:41

So how can we start creating sustainable change in this area today, for the nurses would be educators or APRNs, and also for the patients themselves? What is the first step that you're asking nurses and patients take to address this issue?

Samantha Gambles-Farr 7:58

Well, as educators and as bedside clinicians, whether whatever your role is, I think the important thing is to stay up to date with research, and know what is actually happening in the setting of health care. It is a daunting task to keep up with things that are associated with healthcare and healthcare related issues. However, as professionals, it is our duty to provide the best evidence based medicine that we can for our patients. And understanding what is actually happening as it relates even to the postdocs at this point in time. There is a lot of conversation. There's a lot of research in going on as it relates to the pulse ox. However, the research has been done and the proof has is there. We need to now start applying the information that we know and changing how we're actually treating patients with the knowledge that we have. The other thing that needs to happen is that there needs to be a revamping or even a recalculation. I don't know what that looks like. But we have to fix the systems and protect this and protect this population of patients that we know have been marginalized and overlooked in medicine for so long. The second thing is that we need to be involved in the change being involved in the change. Asking for a seat at the table. There's a reason why nurses are the number one most trusted profession is because we're there at the front lines and we are actually implying a lot of not just doing the orders but having thoughtful conversations and treatments as it relates we are part of the solution. And I think we really have to think of ourselves in that manner. The third thing is to make sure when it comes to education that we are teaching and keeping up to date with the same Same information just like the bedside nurse. And being involved in policies that said health care, healthcare advocacy and policy is very important, because it shapes the landscape of health care. And if we're not at that table, then we're on the menu.

Jared Fesler 10:16

California just came out with a new law requiring implicit bias to be taught in all continuing education, webinars and courses. So it seems like there's a small step in the right direction, but there's still many things that can be done within the tests that institutions are using and within the research and information that is being taught within nursing schools across the state. So Samantha, Gambles-Farr, thank you so much for being on the show today. For those that are tuning in. Stay tuned. We have more episodes coming soon. Thank you so much.

Samantha Gambles-Farr 10:49

Thank you.


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