Importance: Patients from socially disadvantaged backgrounds experience disproportionately worse health care outcomes. Nurses provide most care to patients in hospitals and are informants of health care quality and equity.

Objective: To understand what hospital nurses say helps or hinders their ability to provide quality care to socially disadvantaged populations.

Design, setting, and participants: This qualitative study involved a directed content analysis of open-text responses from the RN4CAST-NY/IL survey, which was conducted between April and June 2021. Participants were registered nurses licensed to work in 58 New York and Illinois hospitals identified as high-performing (25 hospitals) and low-performing (33 hospitals) for COVID-19 mortality outcomes in 2021 from a larger quantitative study. The Social Ecological Model informed the study codebook; inductive and deductive coding of the data and content analysis were conducted from March to October 2024.

Exposure: Direct care hospital nurses who participated in the RN4CAST-NY/IL survey.

Main outcomes and measures: Open-text responses were from nurses who answered the survey question, "What helps (or hinders) your ability to provide quality care to vulnerable populations? (e.g. low SES, housing insecurity/homeless, racial/ethnic minorities, immigrant, limited English proficiency)?"

Results: A total of 1084 nurses (mean [SD] age, 47.1 [18.2] years) responded to the survey. Most respondents identified as female (986 respondents [91.0%]) and were staff or direct care nurses (765 respondents [70.6%]) with at least a bachelor's degree (968 respondents [89.6%]). With regard to race and ethnicity, 127 respondents (11.8%) were Asian, 156 (14.5%) were Black or African American, 89 (8.3%) were Hispanic, 693 (64.2%) were White, and 97 (8.9%) were other races. They had a mean (SD) of 18.9 (14.0) years of experience. Six themes described what helped or hindered quality care: (1) profits over patients, (2) care continuity and hospital-community partnerships, (3) insufficient staffing and time constraints, (4) technology to address language barriers, (5) patients' determinants of health, and (6) individual nurses' beliefs and backgrounds. Nurses proposed improving health care workforce diversity, strengthening community resources for patients, and advancing tailored cultural competency education as solutions to improve care for socially disadvantaged patients.

Conclusions and relevance: In this qualitative study and directed content analysis of 1084 open-text responses, nurses identified systemic, institutional, community, and individual clinician-level approaches to improve care for socially disadvantaged populations for equitable care delivery. Nurses' direct care experiences can inform hospital strategies to improve care for this population.

重要性： 社会弱势背景的患者在医疗保健结果方面遭遇不公正待遇，表现得更为糟糕。护士为医院中的大多数病人提供护理，并且是医疗服务质量和公平性的信息来源。

目的： 了解医院护士认为哪些因素有助于或阻碍他们向社会弱势群体提供优质护理的能力。

设计、设置和参与者： 这项定性研究涉及对RN4CAST-NY/IL调查中开放式文本回复的定向内容分析，该调查于2021年4月至6月期间进行。参与者是从一个更大规模的数量化研究中挑选出的，在2021年的COVID-19死亡率结果方面表现优秀（25家医院）和较差（33家医院）的纽约州及伊利诺伊州58所医院中的注册护士。社会生态模型为该研究代码手册提供了信息；数据进行了归纳和演绎编码，并在2024年3月至10月期间完成了内容分析。

暴露： 参与RN4CAST-NY/IL调查的直接护理医院护士。

主要结果和测量指标： 护士对调查问题的回答中的开放式文本回复：“什么有助于（或阻碍）您向脆弱人群提供高质量护理的能力？（例如低SES、住房不安全/无家可归者、种族/民族少数群体、移民、英语能力有限等）？”

结果： 总共有1084名护士（平均[标准差]年龄，47.1[18.2]岁）回复了调查问卷。大多数受访者为女性（986名参与者 [91.0%]），且多为一线或直接护理护士（765名参与者 [70.6%]），其中至少有学士学位的占968人（89.6%）。就种族和民族而言，127位受访者（11.8%）是亚裔，156位（14.5%）是黑人或非裔美国人，89位（8.3%）是西班牙裔，693位（64.2%）为白人，而有其他种族背景的受访者占97位（8.9%）。他们平均拥有18.9年（标准差14.0年）的工作经验。六个主题描述了有助于或阻碍优质护理的因素：（1）重利润轻病人；（2）持续性护理和医院-社区合作；（3）人员配置不足与时间限制；（4）解决语言障碍的技术；（5）病人的健康决定因素；以及（6）个别护士的信念及背景。护士们提出了改善医疗工作者多样性的建议，强化患者所在社区资源的支持，并推进定制化的文化胜任力教育作为提升弱势群体护理质量的方法。

结论与相关性： 在这项定性研究和对1084名开放式文本回复的定向内容分析中，护士们指出了系统、机构、社区及临床医生个人层面的方法来改善面向社会弱势群体的护理服务，实现公平的医疗保健提供。护士们的直接护理经验可为医院针对此类人群优化护理措施的战略决策提供参考。