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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Suggested Citation:"Appendix D: Glossary." National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/25982.
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Appendix D Glossary Accountable care organizations: Groups of health care providers who work together to coordinate care for their patients who are covered by Medicare. Advanced practice registered nurses (APRNs): Hold at least a master’s degree in addition to the initial nursing education and licensing required for all RNs, and may continue in clinical practice or prepare for administrative and leadership positions. Community resilience: “Community capabilities that buffer it from or support effective responses to disasters,” and is of growing importance in disaster pre- paredness, particularly in underresourced areas (Wells et al., 2013, p. 1172). Compassion fatigue: “A health care practitioner’s diminished capacity to care as a consequence of repeated exposure to the suffering of patients, and from the knowledge of their patients’ traumatic experiences” (Cavanagh et al., 2020, p. 640). COVID-19: The official name for the disease identified as the cause of the novel coronavirus outbreak first identified in Wuhan, China, in 2019; CO stands for corona(virus), VI for virus, and D for disease. COVID-19 is a variant of a group of coronaviruses that can infect humans and animals and cause respiratory illnesses (CDC, 2020). Cultural competency: “A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective 415 PREPUBLICATION COPY—Uncorrected Proofs

416 THE FUTURE OF NURSING 2020–2030 work in cross-cultural situations. Competence implies the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities” (Cross et al., 1989, p. 17). Cultural humility: In health care, cultural humility is a goal in training and education that informs providers’ relationships to patients and people and in- volves “developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined population” (Tervalon and Murray-Garcia, 1998, p. 118). Cultural racism: “The ideology of inferiority in the values, language, imagery, symbols, and unstated assumptions of the larger society” (Williams et al., 2019, p. 110). Cultural taxation: Refers to the phenomenon whereby faculty who are individu- als of color are asked routinely to take on extra, uncompensated work to address a lack of diversity in their institutions. Culture of health: The Robert Wood Johnson Foundation (n.d.) defines a culture of health as “one in which good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities guides public and private decision making; and everyone has the opportunity to make choices that lead to healthy lifestyles.” Disaster: Defined as a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of expo- sure, vulnerability, and capacity, leading to one or more of the following: human, material, economic, and environmental losses and impacts (UNDRR, 2017). Discrimination: Occurs when people or institutions treat racial groups differ- ently, with or without intent, and this difference results in inequitable access to opportunities and resources (Williams et al., 2019). Downstream intervention: “Interventions and strategies that aim to provide equitable access to care and services to individuals, groups and communities, in order to mitigate the negative impacts of adverse health effects” (NCCDH, 2020). These interventions impact the individual level. Grey literature: Literature, writing, and research that is produced at all levels of government, academia, and private industry in both print and electronic formats but is not controlled by or associated with commercial publishers (Farace et al., 2005; Schöpfel and Farace, 2010). PREPUBLICATION COPY—Uncorrected Proofs

APPENDIX D 417 Health care equity: Ensuring that access to health care and high-quality care are available to all individuals and communities. Health disparities: Health differences that “adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gen- der, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion” (Carter-Pokras and Baquet, 2002; HHS, 2016). Health equity: “The state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance” (NASEM, 2017). Health inequities: “Systematic differences in the opportunities that groups have to achieve optimal health, leading to unfair and avoidable differences in health outcomes” (NASEM, 2017). Implicit bias: “Refers to the attitudes or stereotypes that affect our understand- ing, actions, and decisions in an unconscious manner” (Staats, 2013, p. 6). Intersectionality: Recognizing the complex factors that contribute to health inequities by stressing the importance of the intersection of multiple interdepen- dent social determinants that shape the health and well-being of individuals and communities. More specifically, the theoretical framework considers the inter- section of these social determinants at the “micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level” (Bowleg, 2012, p. 1267). Licensed practical nurses (LPNs)/licensed vocational nurses (LVNs): Support the health care team and work primarily under the supervision of a registered nurse (RN), advanced practice registered nurse (APRN), or physician. They per- form basic tasks, such as taking vital signs; administering medications, changing wound dressings; and ensuring that patients are comfortable and receive nutrition and hydration. LPNs/LVNs complete a 12- to 18-month education program at a vocational/technical school or community college, and are required to take a nationally standardized licensing exam in the state where they begin practice (IOM, 2011). In nursing homes, where they predominate, they supervise nurse aides to oversee care. LPNs/LVNs can become RNs through associate’s degree or baccalaureate in nursing bridge programs. Microaggressions: “Brief and commonplace daily verbal, behavioral, or envi- ronmental indignities, whether intentional or unintentional, that communicate PREPUBLICATION COPY—Uncorrected Proofs

418 THE FUTURE OF NURSING 2020–2030 hostile, derogatory, or negative racial slights and insults toward people of color” (Sue et al., 2007, p. 273). Midstream interventions: “Seek to reduce exposure to hazards by improving material working and living conditions, or to reduce risk by promoting healthy behaviors” (NCCDH, 2020). These interventions impact on the individual level. Moral well-being: “The highest attainable development of innate capacities that enable humans to flourish as embodied, individuated but necessarily inter- dependent social organisms by managing the adaptive challenges of vulnerabil- ity, constraint, connection, and cooperation in an uncertain, risky environment” (Thompson, 2018, p. 4). Nursing informatics: “The specialty that integrates nursing science with multi- ple information and analytical sciences to identify, define, manage and communi- cate data, information, knowledge and wisdom in nursing practice” (ANA, 2015). Population health: “The health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig and Stoddart, 2003, p. 381). Posttraumatic stress disorder (PTSD): A “psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury” (APA, 2020). Public health: “The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society” (Acheson, 1988). Racism: An organized social system in which the dominant racial group, based on an ideology of inferiority, categorizes and ranks people into social groups called ‘races’ and uses its power to devalue, disempower, and differentially al- locate valued societal resources and opportunities to groups defined as inferior” (Williams et al., 2019, p. 106). Registered nurses (RNs): Provide preventive, primary, and acute care in collab- oration with other health professionals. Their roles vary enormously by setting but can include such activities as conducting health assessments and taking health histories, looking for signs that health is deteriorating or improving, providing counseling and education to promote health and manage chronic disease, admin- istering medications and other personalized interventions and treatments, and coordinating care. RNs are required to take a nationally standardized licensing PREPUBLICATION COPY—Uncorrected Proofs

APPENDIX D 419 exam after completing a program at a community college, diploma school, or 4-year college or university. Relational ethics: Defined in health care as actions that take place within rela- tionships and consider the existence of the other (i.e., patient, nurse) (Bergum and Dossetor, 2005). Core tenets include mutual respect, engagement, embodied knowledge, environment, and uncertainty; the most important tenet is mutual respect (Pollard, 2015). Resilience: Refers to “the capacity of dynamic systems to withstand or recover from significant disturbances” (Masten, 2007, p. 923). Resilience engineering: Focused on “understanding the nature of adaptations, learning from success and increasing adaptive capacity” (Anderson et al., 2016, p. 1). Social determinants of health (SDOH): The conditions of the environments in which “people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” These conditions in- clude education, employment, health systems and services, housing, income and wealth, the physical environment, public safety, the social environment (including structures, institutions, and policies), and transportation at the population level. SDOH are sometimes called social influences or social factors (HHS, 2020). Social justice: The concept that everyone deserves equal rights and opportuni- ties. In health care, it refers to the delivery of high-quality care to all individuals. Social needs: A person-centered concept that incorporates a person’s perception of her or his own health-related needs. Nonmedical health-related social needs can include housing instability, food insecurity, and exposure to violence that drives health care utilization and may impact health outcomes (NASEM, 2019). Structural inequities: The personal, interpersonal, institutional, and systemic drivers—such as racism, sexism, classism, ableism, xenophobia, and homopho- bia—that make those identities salient to the fair distribution of health opportu- nities and outcomes (NASEM, 2017, p. 99). Structural racism: “The processes of racism that are embedded in laws, poli- cies, and practices of society and its institutions that provide advantages to racial groups deemed as superior, while differentially oppressing, disadvantaging, or otherwise neglecting racial groups viewed as inferior” (Williams et al., 2019, p. 107). PREPUBLICATION COPY—Uncorrected Proofs

420 THE FUTURE OF NURSING 2020–2030 Systemic racism: According to The Aspen Institute, “In many ways ‘systemic racism’ and ‘structural racism’ are synonymous. If there is a difference between the terms, it can be said to exist in the fact that a structural racism analysis pays more attention to the historical, cultural and social psychological aspects of our currently racialized society” (The Aspen Institute, 2016). Telehealth: “The use of electronic information and telecommunications tech- nologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administra- tion” (HHS, 2020). Trauma-informed: “A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for re- covery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization” (SAMHSA, 2014, p. 13). Upstream interventions: These “interventions and strategies focus on improving fundamental social and economic structures in order to decrease barriers and im- prove supports that allow people to achieve their full health potential” (NCCDH, 2020). These interventions impact the community level. Well-being: An inherently complex concept, encompassing an individual’s ap- praisal of physical, social, and psychological resources needed to meet a particu- lar psychological, physical, or social challenge (Dodge at al., 2012) White privilege: Defined by The Aspen Institute (2016) as “whites’ historical and contemporary advantages in access to quality education, decent jobs and liveable wages, homeownership, retirement benefits, wealth, and so on.” REFERENCES Acheson, E. D. 1988. On the state of the public health [the fourth Duncan lecture]. Public Health 102(5):431–437. ANA (American Nurses Association). 2015. Nursing: Scope and standards of practice, 3rd ed. Silver Springs, MD: Nursesbooks.org. Anderson, J. E., A. J. Ross, J. Back, M. Duncan, P. Snell, K. Walsh, and P. Jaye. 2016. Implementing resilience engineering for healthcare quality improvement using the CARE model: A feasibility study protocol. Pilot and Feasibility Studies 2:61. doi: 10.1186/s40814-016-0103-x. APA (American Psychiatric Association). 2020. What is posttraumatic stress disorder? https://www. psychiatry.org/patients-families/ptsd/what-is-ptsd (accessed April 10, 2021). The Aspen Institute. 2016. 11 terms you should know to better understand structural racism. https:// www.aspeninstitute.org/blog-posts/structural-racism-definition (accessed March 3, 2021). PREPUBLICATION COPY—Uncorrected Proofs

APPENDIX D 421 Bergum, V., and J. B. Dossetor. 2005. Relational ethics: The full meaning of respect. Hagerstown, MD: University Publishing Group. Bowleg, L. 2012. The problem with the phrase women and minorities: Intersectionality—an important theoretical framework for public health. American Journal of Public Health 102(7):1267–1273. Carter-Pokras, O., and C. Baquet. 2002. What is a “health disparity”? Public Health Reports 117(5): 426–434. Cavanagh, N., G. Cockett, C. Heinrich, L. Doig, K. Fiest, J. Guichon, S. Page, I. Mitchell, and C. Doig. 2020. Compassion fatigue in healthcare providers: A systematic review and meta-analysis. Nursing Ethics 27(3):639–665. CDC (Centers for Disease Control and Prevention). 2020. About COVID-19. https://www.cdc.gov/ coronavirus/2019-ncov/cdcresponse/about-COVID-19.html (accessed April 10, 2021). Cross, T. L., M. P. Benjamin, and M. R. Isaacs. 1989. Towards a culturally competent system of care. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center. Dodge, R., A. Daly, J. Huyton, and L. Sanders. 2012. The challenge of defining wellbeing. Interna- tional Journal of Wellbeing 2(3):222–235. doi: 10.5502/ijw.v2i3.4. Farace, D. J., J. Frantzen, Greynet, and Grey Literature Network Service. 2005. Work on grey in progress. Sixth international conference on grey literature, NYAM conference center, New York, December 2004. Amsterdam: TextRelease. HHS (U.S. Department of Health and Human Services). 2016. Disparities. http://www.healthypeople. gov/2020/about/foundation-health-measures/Disparities (accessed January 28, 2016). HHS. 2020. Social determinants of health. https://www.healthypeople.gov/2020/topics-objectives/ topic/social-determinants-of-health (accessed April 10, 2021). IOM (Institute of Medicine). 2011. The future of nursing: Leading change, advancing health. Wash- ington, DC: The National Academies Press. Kindig, D., and G. Stoddart. 2003. What is population health? American Journal of Public Health 93(3):380–383. Masten, A. 2007. Resilience in developing systems: Progress and promise as the fourth wave rises. Development and Psychopathology 19:921–930. NASEM (National Academies of Sciences, Engineering, and Medicine). 2017. Communities in ac- tion: Pathways to health equity. Washington, DC: The National Academies Press. NASEM. 2019. Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health. Washington, DC: The National Academies Press. NCCDH (National Collaborating Centre for Determinants of Health). 2020. Glossary: Upstream/ downstream. https://nccdh.ca/glossary/entry/upstream-downstream (accessed April 10, 2021). Pollard, C. 2015. What is the right thing to do: Use of a relational ethic framework to guide clinical decision-making. International Journal of Caring Sciences 8(2):362–368. Robert Wood Johnson Foundation. n.d. What is a culture of health? https://www.evidenceforaction. org/what-culture-health (accessed April 10, 2021). SAMHSA (Substance Abuse and Mental Health Services Administration). 2014. SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14- 4884. Rockville, MD: Substance Abuse and Mental Health Services Administration. Schöpfel, J., and D. J. Farace. 2010. Grey literature. In Encyclopedia of Library and Information Sciences, 3rd ed., edited by M. J. Bates and M. N. Maack. Boca Raton, FL: CRC Press. Staats, C. 2013. State of the science: Implicit bias review. Columbus, OH: Kirwan Institute for the Study of Race and Ethnicity. http://kirwaninstitute.osu.edu/docs/SOTS-Implicit_Bias.pdf (ac- cessed April 10, 2021). Sue, D. W., C. Capodilupo, G. Torino, J. Bucceri, A. Holder, K. Nadal, and M. Equilin. 2007. Racial microaggressions in everyday life: Implication for clinical practice. American Psychologist 64(4):271–286. doi: 10.1037/0003-066X.62.4.271. PREPUBLICATION COPY—Uncorrected Proofs

422 THE FUTURE OF NURSING 2020–2030 Tervalon, M., and J. Murray-Garcia. 1998. Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved 9(2):117–125. Thompson, L. J. 2018. Moral dimensions of wellbeing. Paper presented at the Society for Business Ethics Annual Conference, Chicago IL, August 10–12, 2018. UNDRR (United Nations Office for Disaster Risk Reduction). 2017. Terminology. https://www.undrr. org/terminology/disaster. Wells, K. B., J. Tang, E. Lizaola, F. Jones, A. Brown, A. Stayton, A. Plough. 2013. Applying community engagement to disaster planning: Developing the vision and design for the Los Angeles County Community Disaster Resilience Initiative. American Journal of Public Health 103(7):1172–1180. doi: 10.2105/ajph.2013.301407. Williams, D., J. Lawrence, and B. Davis. 2019. Racism and health: Evidence and needed research. Annual Review of Public Health 40:105–125. doi: 10.1146/annurev-publhealth-040218-043750. PREPUBLICATION COPY—Uncorrected Proofs

Next: Appendix E: The Future of Nursing 20202030: Meeting America Where We Are: Supplemental Statement of William M. Sage, M.D., J.D. »
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The decade ahead will test the nation’s nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions.

A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone.

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.

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