Person-Centered Strategies to Promote Health Equity and Tackle Stigmatization: The Role of the Clinical Nurse Specialist.

INTRODUCTION: Discrimination and stigmatization in emergency departments continue to threaten equitable and safe patient care, particularly for individuals with psychiatric disorders and other marginalized groups. This could include people who are homeless or who are discriminated against because of their sexuality or gender or for other reasons. Traditional education focused solely on knowledge transfer has proven insufficient to address these issues. Person-centered practice, grounded in values, beliefs, and authentic relationships, offers a promising framework to foster equity, inclusion, and reflection among health care professionals. This project explored how person-centered, active learning strategies, facilitated by clinical nurse specialists, can promote awareness of bias and discrimination within emergency care teams.

METHODS: A practice development project titled "The Year of Education" was implemented in the emergency department of the University Hospital Basel in January 2024. Rooted in McCormack's person-centered practice framework, the initiative integrated active learning, reflection, and person-centered approaches across monthly educational themes. Two immersive learning interventions are described: (1) a self-experience simulation contrasting stigmatizing and inclusive handovers and (2) a reflective listening exercise using audio recordings of former psychiatric patients describing their experiences with coercive interventions. Each session was facilitated by clinical nurse specialists and followed by group discussions and qualitative evaluations using written reflections and team feedback.

RESULTS: Participants showed increased self-awareness of stigmatizing behaviors. The learning interventions fostered empathy and critical reflection, prompting staff to reconsider routine practices such as the presence of too many people during psychiatric crises or giving handovers behind closed curtains. Staff expressed that these experiences deepened their understanding of patient perspectives and strengthened person-centered approaches in daily practice.

DISCUSSION: The interventions demonstrated that person-centered, reflective education can meaningfully shift attitudes and communication patterns within emergency care. Although the project lacked a formal quantitative evaluation, its perceived impact led to its continuing as the emergency department's educational strategy. Embedding advanced practice nurse roles focused on health equity may be a further step toward less stigmatization and more equity in the emergency department.