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Using Video to Unpack Bias in Nurse-Maternity Patient Communications

Moore Fellowship Funds Three-Year Research Project for Rebecca Clark

June 20, 2023

By:

Hoag Levins

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A new fellowship enables LDI Senior Fellow and School of Nursing faculty member Rebecca Clark to expand her health equity research. (Photo: Hoag Levins)

Rebecca Clark, LDI Senior Fellow and Assistant Professor at the University of Pennsylvania School of Nursing, has been selected for a Betty Irene Moore Fellowship for Nurse Leaders and Innovators that provides $500,000 for a three-year research project focused on improving communications within maternity medicine teams.

“It was such a great and amazing surprise,” said Clark, PhD, RN. “I knew faculty members from the Nursing School and Penn Medicine had nominated me for this, but I thought it was a real long shot.” Clark is a nurse, midwife, health services researcher, and Core Faculty member at Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR).

Headquartered at the University of California, Davis School of Nursing, the annual Moore fellowship program is funded by the Gordon and Betty Moore Foundation and designed to foster the next generation of nurse leaders. Gordon Moore, who died earlier this year, was the co-founder of the Intel Corporation, the world’s largest manufacturer of semiconductor chips. The Foundation has funded a total of six annual cohorts of the program and Clark is one of 16 nurse scientists selected to be Fellows of the fourth cohort.

Nursing-Science Research

The Moore fellowship recognizes and advances early- to mid-career nursing scholars with the potential to “accelerate leadership in nursing-science research, practice, education, policy, and entrepreneurship.”

Heather M. Young, National Program Director for the fellowship, emphasized that “by tackling crucial health care challenges with novel strategies (our fellows) hold the potential to revolutionize population health and inject fresh perspectives into vital discussions within the field of nursing.”

Since earning her master’s in nursing from Penn in 2010 and her PhD from Johns Hopkins University in 2018, Clark’s research has been focused on identifying system-level changes crucial to improving birth equity and outcomes. Earlier in her career, as a midwife in West Virginia, she worked with opioid-dependent mothers and continues to focus on the inpatient maternity care challenges faced by patients from marginalized communities.

Bias in Patient Communications

Her three-year Moore Fellowship research will explore how video feedback can be used to improve communication in inpatient maternity settings between the health care team and patients.

“Communication is a leading root cause of preventable maternal mortality in this country and Black women bear the brunt of that,” said Clark. “Throughout the qualitative research literature as well as in social media, Black maternity patients repeatedly say, ‘no one listened.’ Think about Serena Williams to understand that better. She knew she was having a pulmonary embolism, but she was told ‘no, you’re fine. Go back to your room.'”

“Most health care providers want to be empathetic but there’s a lot we’re not aware of happening in the various ways we interact with patients–what we hear, what we don’t hear, what body language and other cues we miss,” said Clark. “We’re so used to doing what we do that we don’t see that someone has turned away or that their eyes have glazed over, or that they said something really important to us and we didn’t respond to it. This can lead to the perpetuation of disparate care and outcomes.”

“In this research project we want to do what professional athletic teams do–use video to record the event and do a post-mortem on the action afterwards. We want to record the interactions between the nurse and the woman who’s given birth and then analyze that video afterwards to identify what went well with the communication, what didn’t, what new insights it provided, and what could be done differently next time.”