Inclusion as Intervention: Equity at the Bedside
Written by Linn
〰️
Written by Linn 〰️
The hospital bed appears simple: a narrow space designed for healing. Yet within its rails, the politics of inclusion and exclusion are written as clearly as vital signs. Who receives care promptly, whose pain is believed, whose culture is respected—these questions unfold in intimate encounters as much as in policy documents. At the bedside, inclusion is not abstract principle but active intervention, shaping outcomes in ways often overlooked by institutions.
Mary Seacole’s story makes this visible. Denied official recognition by the British War Office during the Crimean War because of her race, she built her own “British Hotel” to provide shelter, food, and care to soldiers. Her intervention was more than charity. It was a direct response to exclusion, a declaration that care belongs to all, regardless of race or class. Seacole did not wait for permission to practice inclusion; she enacted it through presence, through work, through defiance.
Hazel Johnson-Brown, who became the first Black woman general in the U.S. Army and later led the Army Nurse Corps, carried this tradition forward. Her leadership challenged assumptions about who could hold authority in military medicine. At every bedside she had once served, her presence expanded the image of who could embody nursing, reframing inclusion as both professional equity and patient justice. Their legacies remind us that inclusion has always required intervention, often against entrenched systems of exclusion.
Nursing theory reinforces this truth. Madeleine Leininger’s transcultural nursing argued that care cannot be separated from culture. To exclude cultural practices—whether rituals around birth, mourning, or healing—is to exclude the patient themselves. Inclusion here is not sentimental courtesy but clinical competence. A nurse who ensures that a patient’s cultural rituals are respected is not merely “being nice”; they are practicing effective care that leads to better outcomes. Inclusion is evidence-based, not optional.
Yet inequities persist. Research shows that patients of color are less likely to have their pain believed, that LGBTQ+ patients face disproportionate dismissal, that those who do not speak English encounter unsafe communication gaps. These are not marginal errors but systemic exclusions with measurable consequences. The nurse who advocates for an interpreter, who ensures equitable pain management, or who affirms a patient’s gender identity is not adding extra duties to their role. They are intervening in inequity, restoring trust and dignity at the most intimate level of care.
Inclusion is also shaped by silence. The patient who hesitates to share their fears because of stigma teaches us that exclusion often works invisibly. To intervene requires not only skill but awareness: the ability to recognize what is not being said. Nurses cultivate this awareness by listening not only to symptoms but to silences, by recognizing when cultural shame, fear of judgment, or histories of discrimination inhibit disclosure. The bedside becomes the stage where trust is either withheld or restored, and nurses often hold the decisive role in tipping that balance.
The risk, as with emotional labor, is that inclusion is demanded endlessly but rarely supported. Nurses are expected to bridge language gaps, to mitigate cultural misunderstandings, to advocate within rigid hierarchies, often without resources or recognition. True inclusion requires structural change: staffing that allows time for advocacy, policies that ensure cultural safety, education that equips nurses to navigate difference without exhaustion. Intervention must be collective as well as individual.
Philosophy underscores why this matters. Emmanuel Levinas argued that responsibility arises in the face of the other, that ethics is born in encounter. At the bedside, the encounter is not neutral. It reveals histories of inequality, injustices written on the body. To respond inclusively is to affirm the patient’s dignity against forces that have denied it. In this way, inclusion becomes not only clinical act but ethical obligation.
The future of nursing depends on seeing inclusion not as extra, but as central. Technology may advance, but without equity it will only widen disparities. Inclusion ensures that innovation does not leave patients behind. Education must prepare nurses not only to master procedures but to intervene when bias, exclusion, or inequity threaten care. Policy must acknowledge that inclusion requires investment, not just intention.
We began with the image of the hospital bed as a narrow frame, seemingly apolitical. But by looking closely, we see it differently: as a site where equity is enacted, where histories of exclusion meet possibilities of justice. Inclusion at the bedside is never neutral. It is intervention—quiet, constant, and essential.
