The Secret Drama at the Patient's Bedside-Refusal of Treatment Because of the Practitioner's Ethnic Identity: The Medical Staff 's Point of View

Patient racism toward nurses in a divided society: The case of Jews and Arabs in Israel

AIM

This study examines whether racism exists among Jewish and Arab patients in Israel, as reflected in patient preference for receiving treatment from a nurse with the same ethnic background.

BACKGROUND

We examine the relationship between racism and the level of trust in a nurse from a different ethnic group than the patient, as well as the preferred level of social distance, in the context of ongoing conflicts between the Jewish majority and the Arab minority in Israel.

METHODS

A cross-sectional study was conducted using a unique study questionnaire that asked 534 Jewish and 478 Arab respondents to express their preference for an Arab and a Jewish nurse.

RESULTS

Among both the Jews and the Arabs, there is a similar tendency of racism toward nurses of the dissimilar ethnic group. This racism was also prevalent among participants who live in a mixed environment or those who studied or are studying and worked or work in a mixed environment. As the trust in nursing staff members from the other group increases, the level of racism decreases. The greater the social distance the participants felt from the members of the other group, the more racist the attitudes they expressed.

CONCLUSIONS

Both Jews and Arabs preferred to be treated by nurses of their own ethnic group. In contrast to the contact hypothesis theory, participants who live in a mixed environment did not express fewer racist preferences. We conclude with some useful practical suggestions aimed at decreasing racism in health care.

CLINICAL RELEVANCE

Findings imply that prospective patients prefer to receive nursing care from nurses of their own ethnic group and trust these nurses more than they trust nurses of different ethnic group.

Constructing Discrimination Rights: Comparisons Among Staff in Long-Term Care Health Facilities

BACKGROUND AND OBJECTIVES

Despite increased attention to racial and gender justice in the workplace in recent years, discrimination complaints remain vastly underreported. Building on legal consciousness theory-which explains how individuals invoke (or do not invoke) legal principles to define everyday experiences-this study examines how long-term care facility staff understand experiences of discrimination by residents and why staff fails to report discrimination.

RESEARCH DESIGN AND METHODS

This qualitative comparative study uses in-depth semistructured ethnographic interviews to compare experiences among facility staff (n = 80) at three levels (floor staff, mid-management, and upper-management). The qualitative content analysis incorporated both inductive and deductive coding approaches.

RESULTS

Findings reveal extensive unreported instances of discrimination from residents. Staff at all levels rarely invoked discrimination concepts to describe interactions between residents and staff. Floor staff framed residents' discriminatory behavior as a condition of employment or attributed resident behavior to their health or cognitive status. Mid-management framed experiences around staff safety. Upper-management acknowledged staff rights without invoking discrimination rhetoric.

DISCUSSION AND IMPLICATIONS

By avoiding naming experiences as discrimination and blaming residents, most floor staff never reached the claiming process that would result in a report or complaint of discrimination. Managers' framings also shaped how front-line staff and managers named, blamed, and claimed experiences of discrimination and help explain why staff may be hesitant to report discrimination by residents. These findings suggest the need for new and targeted policy and practice approaches that address the nuances accompanying how staff understands workplace experiences as discrimination.

Racial Discrimination in Patient Care-Preserving Relationships With Integrity

The following case study describes what is known as the health care system's open secret of allowing a patient or family to refuse care from a clinician of another race. This article explores the ethical tension between autonomy, nonmaleficence, justice, and duty to treat as it relates to racism and the potential harm to clinicians, health care teams, and organizations. When racism is experienced within the clinical setting, clinician knowledge, organizational training, and moral character are essential for identifying and addressing it effectively. Racial discrimination and related mistreatment are not part of a responsive and proactive moral community. This article explores creative solutions that preserve patient-clinician relationships without sacrificing personal integrity when racism is encountered.

Racism in healthcare: a scoping review

BACKGROUND

Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts.

METHOD

The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim.

RESULTS

The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace.

CONCLUSIONS

The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.

Ingroup Bias in Healthcare Contexts: Israeli-Jewish Perceptions of Arab and Jewish Doctors

The influence of group membership on perceptions of outgroup members has been extensively studied in various contexts. This research has indicated a strong tendency for ingroup bias – preferring the ingroup over the outgroup. We seek to further expand on the growing literature regarding the effects of group membership within healthcare contexts. Focusing on the Arab-Jewish context in Israel, the present study explored the influence of group membership on Israeli-Jewish participants’ evaluations when exposed to potential malpractice. Specifically, participants (n = 165) read a description of an Israeli-Jewish or Israeli-Arab physician who was either culpable or non-culpable of malpractice. Consistent with our predictions, findings generally indicated more negative evaluations of the Israeli-Arab physician, regardless of objective culpability. We conclude by discussing the study’s limitations and implications.

Preferring patient-physician concordance: the ambiguity of implicit ethnic bias

BACKGROUND

Much of the current literature on racial/ethnic bias in healthcare focuses on practitioners' implicit biased attitudes regarding patients, identifying it as a factor contributing to health disparities. Little attention has been paid, however, to patients' bias against practitioners from other ethnic group.

AIM

To explore patients' bias towards practitioners from other ethnic group.

METHOD

In-depth interviews were conducted during 2018 with 38 Israeli Jewish and Arab patients.

FINDINGS

While many participants (more Jews than Arabs) reported that they perceive medical treatment as neutral and value the physician's professionalism and attitude, others (more Arabs than Jews) attested that they do prefer to be treated by physicians of their own ethnic group. Jewish patients who prefer Jewish physicians described bias against Arab physicians: Feelings of fear and distrust, particularly in light of the conflictual situation in Israel. They also considered Arab physicians less professional than Jewish ones. Arab patients who prefer Arab physicians described their need for culturally and linguistically competent healthcare and praised close informal relations with Arab physicians, contrasting them with past offensive and humiliating experiences with Jewish physicians.

CONCLUSIONS

Findings reveal several factors that impact Jewish and Arab Israeli patients' preference for patient-physician concordance, some of which reflect patients' implicit bias. This phenomenon - together with practitioners' implicit bias against patients - should be recognized as contributing to the ambiguity of ethnic relations in clinical encounters, particularly in conflictual societies.

Experiences of Jewish and Arab Healthcare Practitioners Treating Terrorists in Israel

The growing number of terror attacks worldwide draws attention to the difficulties that healthcare practitioners experience when they treat terrorists or suspected terrorists. Research literature on the challenges faced by healthcare practitioners treating terrorists in conflict areas is limited. In-depth interviews were conducted during 2016-2017 with 50 Jewish and Arab healthcare practitioners (managers, physicians, and nurses) employed in 11 public hospitals in Israel, who treat Palestinian terrorists and security prisoners, in the context of a prolonged and violent national conflict. Jewish practitioners find it emotionally difficult to treat terrorists and security prisoners. They face an ethical dilemma when called upon to save the lives of those who took life and find themselves identifying with the victims. Arab practitioners identify with both sides of the conflict. Three coping strategies were described: maintaining a humanistic standpoint; adherence to a standard of detached professionalism; and refusal to treat terrorists and security prisoners.