RACIAL BIAS IN HEALTHCARE AND THE NURSE’S ROLE IN ANTI-RACIST CHANGE

ERIN WEISERT, WAGNER COLLEGE HONORS PROGRAM IMPLICIT BIAS

¡Implicit biases are unconscious associations that lead to a negative perception of another person based on factors such as race or gender. ¡Healthcare providers with higher incidence of implicit bias have been found to have poorer patient communication and lower patient satisfaction (Maina et al, 2018). IMPACT OF BIAS IN HEALTHCARE SETTING ¡ System level factors such as health insurance and unequal distribution of health services affect people of color at a much higher rate HEALTH than . ¡ These disparities are not directly related to DISPARITIES racial bias. In the healthcare setting disparities are more often seen in high-discretion activities such as testing, referral to a specialist, and drug prescriptions. IMPLICIT ASSOCIATION TEST

Words or pictures are shown and participants must associate them with one of the categories rapidly.

The speed in which associations are made are used to calculate the IAT score, a measurement of implicit bias.

Maina et al. 2018, found White, Hispanic, and Asian providers all had similar levels of implicit bias.

Black healthcare providers showed lower levels of implicit bias. HISTORY OF RACIAL BIAS IN HEALTHCARE

¡Racial health disparities have been exacerbated by COVID-19 but have existed nearly as long as the medical system.

¡People of color (POC) have been targeted by scientists and institutions for unjust research and experimentation— leading to a distrust in the medical system still felt by POC today.

¡Peripheral trauma: racially or ethnically targeted events that increase adverse physical and mental health outcomes among minority groups, even among members not directly targeted or the concept that racially/ethnically targeted events have effects on members that were not directly affected. 1793 EPIDEMIC

¡Dr. Benjamin Rush petitioned Black leaders to encourage Black community members to assist as grave diggers, body and trash collectors, and housekeepers. ¡Dr. Rush falsely believed were immune to yellow fever. ¡5,000 people died from the yellow fever outbreak, 10% of them were black despite making up only 6% of Philadelphia's population. TUSKEGEE SYPHILIS STUDY

¡In 1932 the Public Health Service and the Tuskegee Institute, 600 Black men told they were being treated for “bad blood.” ¡The participants not made aware of their diagnosis. ¡2/3 of the participants had Syphilis. ¡They were never treated even after treatment became available. ¡The US Government gave a $9 million settlement to the families. THE GUATEMALA SYPHILIS EXPERIMENT

¡In 1946-1948 1,300 people were inoculated with sexually transmitted diseases.

¡These people were largely sex workers, prisoners, and mental health patients.

¡The goal was to effect of penicillin in the treatment of Syphilis and Gonorrhea.

¡The US Public Health Service worked with the Guatemalan government to facilitate this.

¡This experiment could not have been done on US land as it was deemed an unethical medical experiment. FORCED STERILIZATION

¡As far back as the 1800’s the has participated in sterilization of marginalized people.

¡33 State’s Committees permitted forced sterilization. ¡In 1927 the Supreme Court upheld the decision for the sterilization of disabled people. ¡Mississippi Appendectomy is a term for a hysterectomy without consent was performed.

¡The State Board of Eugenics reported that around 40% of the women this procedure was operated on were Native American or Black. ¡From 2006-2007 The State of California sterilized a small group of female prisoners. MODERN DAY RACIAL HEALTH DISPARITIES COVID-19

¡ People of Color have died from/ been infected with COVID-19 at a higher rate than White people. ¡ Out of every 100,000 COVID-19 related deaths 92.3 were Black, 74.3 were Latinx, and 45.2 were white ¡ Distrust in the vaccine safety: ¡ 55% of White people surveyed said they will get the vaccine in contrast to less than 30% of Black people. ¡ Capitalizing on the heightened awareness of healthcare disparities that has followed the COVID-19 pandemic is important to lessen ’s impact on poor health outcomes. PAIN MANAGEMENT

¡In many disciplines, Black people are less likely to be prescribed narcotic pain medication than White people. ¡In a study of pain management after appendectomies in children, Black children were one-fifth as likely to be prescribed opiate pain medication postoperatively as White children. ¡In a survey of nurses and nursing students, many believed that Black people have a heightened pain threshold. ¡A lower likelihood of black patients to be prescribed opiates is the largest impact of racial bias in pain management. ¡ Black communities are less likely to have pharmacies that carry certain opiate pain medication. ¡Black children were one-fifth as likely to be prescribed opiate pain medication postoperatively as White children. MATERNAL MORTALITY

¡Prenatal visits are essential for the diagnosis and monitoring of pregnancy related health problems. ¡Black women are less likely to have access to/attend.

¡Patients of color and poor patients are more likely to be perceived as noncompliant and difficult by healthcare providers. ¡The United States has one of the highest maternal mortality rates out of developed countries.

¡Out of every 100,000 live births there were 40.8 pregnancy related deaths among Black mothers and 29.7 in American Indian/Alaskan Native mothers.

¡Most maternal deaths occur 43 days to 1 year after delivery with the leading cause being cardiovascular complications. ¡Two thirds of these deaths may be preventable ¡Black men are most likely to distrust the medical system. ¡A study found that black men were more likely to delay DISTRUST IN preventative health screenings. THE MEDICAL ¡Medical screenings/treatments included. ¡ routine checkups, cholesterol screening, blood pressure SYSTEM screening. ¡Factors the contribute to medical mistrust among Black men are perceived and everyday racism. BIAS TOWARDS NURSES OF COLOR

¡Nurses of color reported that their motivation and confidence were negatively impacted by racism. ¡Barriers that Nurses of color face in the workplace include:

¡Fear of losing their jobs for reporting racism ¡Feelings of isolation being the only minority nurse

¡Black and Latinx nurses reported discrimination from patients and coworkers. ¡Both groups reported others expressing doubts about their qualifications and credentials as well as patients requesting nurses of a different race.

¡Nurses reported that all of these forms of discrimination impacted their work performances poorly. ¡Very few nursing leadership positions are held by nurses of color. ¡Minority nurses are less likely to be hired LACK OF POC for leadership positions, especially if there are not already any people of color already in leadership positions. IN NURSING ¡Black nurses especially felt a disrespect by their peers that diminished their confidence LEADERSHIP and deterred them from applying for higher positions. WHITENESS IN NURSING EDUCATION

¡Florence Nightingale is considered the founder of the nursing profession. ¡Nightingale opened the first nursing school in 1860. ¡Only white but only allowed women were allowed to study there. ¡94% of simulation body parts used in nursing education are White. ¡To this day the nursing profession is predominately White. REDUCTION OF RACIAL BIAS ANTI-RACIST ADVOCACY

¡Acknowledging the presence of systemic racism is not enough.

¡The healthcare system must work as a team to dismantle racist practices ingrained in nursing practice.

¡Experts suggest a three-step framework that aligns with both the nursing process and nursing practice. 1. Honoring the voices of those on the receiving end of racism and listen to understand their struggles. 2.Apply the lessons learned 3. Move forward and adopt the anti-racist changes in a sustainable manner.

¡ A sustainable approach to change is of the utmost importance if there is to be a permanent change towards making nursing practice actively anti-racist. LEADERSHIP RESPONSIBILITIES

¡. Nursing leadership must be active in creating education for nurses in a way that the notions of racism are unveiled. ¡Facilitate critical self-reflection and open dialogue about racism between nurses ¡U.S. nursing leadership must lead the way and act as advocates for a shift in nursing practice that actively works to dismantle institutionalized racism. ¡For a change to be adopted effectively it must come from nursing leaders at all levels ¡Including in the classroom, at the bedside, and in the boardrooms. ¡ To achieve health equity, those who hold decision making power must ensure they are making decisions that are actively anti-racist ¡One way reduce racial disparities is equal-status contact.

¡This is when a multiracial/ethnic group of people share power equally in a situation.

¡Effective and meaningful anti-racism education

¡Educate health care providers on cultural diversities and barriers that minority populations face in healthcare STRATEGIES TO ¡Hiring of a diverse staff at all levels of practice. REDUCE BIAS ¡Speaking out against racism behavior when it is seen REFERENCES

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