What did you receive your fellowship for?
I was nominated for a project I led to deliver a unique programme of cultural awareness training for maternity, neonatal and health care professionals. It sought to address health inequalities in maternity care and was part of a wider programme of work to reduce the rate of stillbirths, neonatal death and brain injuries among ethnic minority and vulnerable communities.
What was the need for your project?
According to an published in 2020, Black women are still four times more likely to die in pregnancy and childbirth than White women. Asian women and those with mixed ethnicity are two times more likely to die than White women.
This disparity could be caused by many things, such as a patient’s previous life experiences, racist attitudes, microaggressions, dismissal of concerns and breakdown of trust with any health professional or figure of authority, which could all affect interactions with maternity services, and lead to poor health outcomes.
These health inequalities were exacerbated by COVID-19. At one point during the pandemic, I was redeployed into a neonatal unit in Broomfield Hospital so I could see the real impact the pandemic was having in a clinical setting. It was hard to be a part of.
It was eye-opening to learn what the pandemic revealed about health inequalities among ethnic minority people and vulnerable communities. NHS England had to roll out additional support for pregnant Black and Asian women, as research found heightened risks for these women and birthing people. It showed Black pregnant women were eight times more likely to be admitted to hospital with COVID-19, and Asian women were four times more likely.
It was a very scary time; a lot of people were dying and a lot of those people looked like me. This triggered me to think about what actions we could take to improve this.
A lot of people were dying and a lot of those people looked like me. This triggered me to think about what actions we could take to improve this
What did you do in response?
With the support of my team, I created the Looking Beyond Ethnic Minorities and Inequalities Workstream and worked with several partners on this, including local maternity and neonatal systems, and the Office for Health Improvement and Disparities.
This aimed to establish a support mechanism for our local maternity and neonatal systems to ensure operational actions were taken to improve access, experience and outcomes for the people identified to be most at risk of COVID-19 or having the worse outcomes within our society.
This was an opportunity to give a voice to people from ethnic minorities and other vulnerable communities who access maternity services across the East of England.
There are some challenges health professionals can experience when trying to support a culturally diverse group. These can include the lack of adequate interpreting services, a reluctance to engage with health professionals due to mistrust, or fears about immigration status.
I also understand that for many ethnic minority groups, health care in the UK can be seen as confusing and often inaccessible due to a lack of appropriate information and a reliance on people having access to digital devices. The NHS system might be quite different from health care services in their country of origin.
Because of this, one of the main parts of the workstream was to deliver a programme of cultural awareness training.
What was the purpose of the training?
Workshops were delivered to professionals working across neonatal, maternity and perinatal mental health services including midwives, nurse practitioners and special health visitors. The sessions were led by facilitators representing their communities, for example, African, Gypsy and Traveller, Muslim and Asian, Eastern European as well as asylum-seekers and refugees.
The focus was to understand not just what health care professionals wanted to learn, but also what these community groups wanted us to learn to understand them better. We did this to ensure that when we talked about culture, we were engaging people from those communities and learning from their experiences in their own words.
This unique and innovative approach provided health care professionals with information about the cultural background of each group, challenging the stereotypes that exist and providing realistic and effective engagement strategies. Within these workshops, the professionals could ask open and honest questions to different groups and identify methods to remove barriers and improve engagement techniques as a result. This has been the first phase of the project, and the work has empowered me so much. IÃÛÌÒÖ±²¥™m so proud of it. I can see the difference itÃÛÌÒÖ±²¥™s making.
We should broaden access to cultural awareness training. This will start addressing some of those unconscious biases towards ethnic groups, countries, cultures, and customs. The workshops could also begin to address discrimination and systematic racism by empowering and equipping people to be advocates and allies by thinking differently, and start supporting people with actions, such as having policies, guidelines and education curriculums that achieve real outcomes.
What keeps you motivated to continue to advance the profession?
IÃÛÌÒÖ±²¥™ve never thought that I go above and beyond in my job, IÃÛÌÒÖ±²¥™ve always thought that if youÃÛÌÒÖ±²¥™re going to do a job, then do it right.
All the projects and programmes IÃÛÌÒÖ±²¥™ve been involved in, IÃÛÌÒÖ±²¥™ve done because IÃÛÌÒÖ±²¥™ve felt that even if I could make a difference to one patientÃÛÌÒÖ±²¥™s life, that was worth it ÃÛÌÒÖ±²¥“ that person could be a family member or a friend.
For me, my passion has always been in improving the patientÃÛÌÒÖ±²¥™s experience. If we can make the experience a good one, then access to the service and the outcomes become better. We often talk about this the other way around, making the access to care better so the experience is improved, but I like to think of it in the opposite way.
If the health care service experience is improved, people will talk about it with their friends and families. This then improves access and hopefully outcomes, as people will seek help from health care early and we can then provide early interventions and treatments.
Tendai Nzirawa received the RCN Fellowship in 2022. She is the Maternity Clinical Improvement Lead at the Eastern Academic Health Science Network, the Chair of the Paediatric Pan London Oxygen Group and East of England Regional Lead for the Neonatal Nurses Association. She is currently managing a maternity and neonatal ethnic minority staff development programme to improve representation of ethnic minorities at senior positions, Band 7 and above.
About RCN Fellowships
The RCN Fellowship and Honorary Fellowship recognise practitioners, researchers, educationalists and leaders who share the RCN's commitment to advancing the art and science of nursing and the improvement of health care.
A small number of new Fellowships and Honorary Fellowships are awarded each year. Nominees are put forward by peers to acknowledge their experience, accomplishments and dedication to the nursing profession.
Nominations for the 2023 awards are open until 16 January. Find out more about how to nominate RCN Fellows.
The RCN often calls on the expertise and experience of Fellows to help with developing our professional policy positions, practice standards and services.
to learn about different cultures can address health inequalities in maternity services.
