Discuss How might an advanced practice professional nurse or those engaged in advanced nursing practice effect change in practice and policy to address disparities (ethnicity, gender, racial, mental health or others)?

Address this question from the perspective of your specific concentrations lens. What community health issues will you address? Throughout my young practice as a nurse, I have cared for multiple children who suffered from sickle cell disease. This nursing situation showed me that there is a need for a practice change regarding pain management of the sickle cell patient. On this day at work, I was floated to the oncology unit. All the sickle children are usually admitted to the oncology floor for management during the sickle cell crisis, which consists of hydration, pain management, sometimes blood transfusion, and administration of Hydroxyurea. I was informed by the charge nurse that I would be getting a 15-year old sickle cell, male patient who has been admitted multiple times prior for sickle management. As I was getting report from the emergency room nurse, I noticed that she did not mention any pain medication administration. I asked her, and she stated, Patient looks relaxed and comfortable and is talking to his mom. Pain was assessed an hour ago, and the patient stated it was 5/10, which is very common for him and his baseline. No pain medication given at this time. Once the patient arrived to the unit, at first glance, he looked comfortable. During my initial assessment, however, he seemed a little restless and uncomfortable. I asked about his pain, and he said it was an 8/10 and increasing. I quickly informed the physician, who ordered pain medications. From this situation, I have gathered that there is a disparity when it comes to sickle cell disease, but, more importantly, a disparity when it comes to pain management of the sickle cell patient. Sickle cell disease (SCD) is a set of genetic abnormalities primarily affecting persons of African and Mediterranean descent (Killogh, 2010, p. 75, para. 2). It is more common in African Americans, with 1 in 13 black babies being born with sickle cell trait (Krisberg, 2016, p. 5 para. 5). Sickle patients are frequently admitted to the emergency room for treatment of pain, infections and other complications. Almost 90 percent of SCD admissions to hospitals are for pain crises (Killlough, 2010, p. 77) According to Stone (2015), pain from Sickle crisis if often undertreated and it most likely due to racial and gender bias (para. 16). Minorities are often undertreated for pain, Latinos were twice as likely to receive no pain medication during the emergency room visit that non-Hispanic whites were (Stone, 2015, para 15). Other factors can be the fact that there is a lack of knowledge in the health care team on pain management during a sickle crisis episode. Pain is subjective. Therefore, it varies from person to person and, sometimes, patients are labeled as drugs seekers, when their pain is not managed by the current pain therapy in place. The patient is seen as being the problem, instead of trying to find a better drug regimen (Killough, 2010). There is a lack of knowledge on African Americans and drugs, which would help identify which class of drugs would alleviate the pain that occurs during sickle crisis. All this results in an undertreatment of pain. As a nurse practitioner, I plan to bring awareness to this problem by gathering information and a presentation, along with pamphlets on sickle patients and pain management. Due to lack of research on pain management in African Americans with sickle cell disease, a goal should be to conduct research on the oncology unit. Another goal would be to gather data on different pain medications, identify, what works best, and create another pain management plan that targets this specific population. Another priority is to educate the parents and encourage them to be their childs advocate. Lastly, it is important to educate the staff on how to properly assess pain in the sickle cell patient, in order to properly medicate the patient and prevent breakthrough pain.