Challenging anti-racism in nursing education: A moral and professional call to action

The call to implement anti-racism pedagogy in nursing education and practice is reverberating globally. Racist ideologies are foundational to systems of health inequity. An antiracist approach is critical to dismantling systemic racism and promoting optimal health outcomes in the quest for health equity. Therefore, employing an anti-racist pedagogy within nursing education that allows students and teachers to reflect on their roles in dismantling racist structures and transforming equity outcomes in practice and society, is a moral undertaking. However, for nursing education to make significant inroads in health equity, it cannot be guided by the same Eurocentric motives and value systems that continue to shape health inequities. We must transcend the boundaries of Eurocentric knowledge construction to intentionally shift how nurses think and practice within systems of inequities. Alongside the pressing and growing call for radical transformation of students and teachers through anti-racist pedagogy, we also provide directions to teaching strategies that support the uptake of anti-racism in nursing curricula and classroom engagement.

Disrupting the epistemic arrangements of nursing education canon: Reflections about a prelicensure Community Engagement series

Nursing education, as with professionalization projects, is fraught with epistemicide, false separations, and a focus on expertise over relations and accountability. This is a critical reflection of the first 5 years of a four-semester prelicensure Community Engagement course series. As the course lead, I have consistently initiated adjustments, based on experiences teaching multiple sections and synthesizing comments and feedback from students and faculty, with an eye toward longstanding and pressing concerns in the world around us. Two broad epistemic arrangements emerge from this critical excavation: (1) naturalized hierarchy, false separations, and appraisals of relevance and (2) relationality and reflection as unsettling. There is a need for sustained collective examination and shift in how the nursing education and healthcare industries curate the meanings and practice of "community," "health," and "nursing," peering out from the regulatory oversight of neoliberal forces. How might we situate student progression, program implementation, institutional contracts, and curricular standards within the contexts of nursing programs' responsibilities to local communities in light of unfolding events locally and globally and their historical antecedents? How are we all, as faculty, disrupting siloes, false separations, and the contradictions of professionalism and the biomedical model to intentionally advance health equity? May we continue to illuminate the presence of community as being everywhere, not merely in juxtaposition to acute care. May we unsettle the prevailing theorization and practices of community throughout nursing education and commit to imagining and practicing relational praxis.

Perspectives of Ethnically and Racially Diverse Nurse Faculty on the Success of Ethnically and Racially Diverse Nursing Students

BACKGROUND

Ethnically and racially diverse (ERD) nursing students experience unique challenges in the educational environment. Existing research on perspectives of ERD nurse faculty, with emphasis on their perceptions of the factors that support the academic success of ERD nursing students is limited.

PURPOSE

The purpose of this study was to explore factors that contribute to the success of ERD nursing students as perceived by ERD nurse faculty.

METHODS

This qualitative study was conducted utilizing a focused ethnography design and methodology, with the theoretical underpinning of Critical Race Theory.

RESULTS

Twelve themes emerged relating to support, resources, relationships, faculty hiring practices, program structure, instructional content, flexibility, and culture of the educational environment.

CONCLUSIONS

The perspectives of ERD nurse faculty provide an essential body of information that program administrators, faculty, and staff can utilize to positively impact the academic success of ERD nursing students.

Addressing Culturally Based Hidden Bias and RacisM (A-CHARM) Using Simulation Experiences, Nik's Story: A Quasi-Experimental Study

BACKGROUND/PURPOSE

Racism and hidden bias experienced by underrepresented nursing students contribute to a loss of confidence and anxiety. The A-CHARM nursing project developed virtual simulation experiences for nursing students to practice how to address racism. 'Nik's Story' virtual simulation was created as part of the A-CHARM project. The purpose of this study was to examine the effectiveness of an education intervention, that included Nik's story, on cultural humility and cultural diversity awareness.

METHOD

This quasi-experimental study included a convenience sample of final year nursing students. After informed consent, participants completed a pre-intervention questionnaire that included the Cultural Humility Scale "context for difference in perspective" subscale, and the Cultural Diversity Awareness questionnaire to assess baseline knowledge. Students participated in an education intervention that included a lecture, Nik's story virtual simulation experience, a debrief and then completed a post-education/simulation questionnaire that included usability/learner engagement questions and the Cultural Humility Scale "context for difference in perspective" subscale, and the Cultural Diversity Awareness questionnaire.

RESULTS

Forty-seven students consented and completed the pre/post intervention questionnaire. Participants rated the effectiveness, engagement and usability of the simulation experience highly. There was a significant positive change in cultural humility "context for difference in perspective" subscale (pre-scores = 6.9, SD = 3.3; post-scores = 31.0, SD = 3.8, p < 0.001), and cultural diversity awareness (pre-scores = 95.4, SD = 8.9; post-scores = 103.4, SD = 9.8, p < 0.001).

DISCUSSION

This intervention was effective in improving cultural humility and cultural diversity awareness in nursing students.

CONCLUSION

Simulation experiences regarding racism in the clinical setting provide a strategy for students to learn how to professionally navigate unwanted experiences.

Anti-oppression pedagogy in health professions: a scoping review

Health professional learners are increasingly called to learn about health inequity to reduce inequities and improve patient care and health outcomes. Anti-oppression pedagogy (AOP) addresses the need for health professional learners to understand multiple health inequities and the structures and systems that produce inequities. However, the inclusion of AOP in health professions education varies and there is a lack of clarity in its conceptualization and integration. A scoping review was conducted to address this gap and to understand how AOP is conceptualized and integrated in health professions education. Thirty-six articles met the inclusion criteria. The articles demonstrated that AOP is not commonly utilized terminology within health professions education. When AOP is integrated, it is not consistently conceptualized but is generally viewed as a broad concept that focuses on antiracism; decoloniality; intersectionality; and supporting learners to understand, critically reflect on, and act against structural and systemic forms of oppressions. In addition, there is variation in the integration of AOP in health professions education with the most common methods consisting of discussions, cases, reflection, learning through lived experiences, and the incorporation of humanities within a longitudinal curriculum. The results of this scoping review highlight the need for health professions education to develop one clear concept that educators use when teaching about anti-oppression, which may reduce working in silos and allow educators to better collaborate with each other in advancing this work. In addition, this review suggests that health professional programs should consider incorporating AOP in curricula with a broad and longitudinal approach utilizing the common methods of delivery. To better support programs in including AOP in curricula, further research is required to emphasize the benefits, provide clarity on its conceptualization, and determine the most effective methods of integration.

"We're back in control of the story and we're not letting anyone take that away from us": patient teacher programs as means for patient emancipation

While patient engagement in healthcare professions education (HPE) has significantly increased in the past decades, a theoretical gap remains. What are the varied reasons as to why patients get involved with HPE programs? With a focus on understanding what drives patient involvement with HPE programs, this study examined how a patient as teacher (PAT) program was experienced by medical students, patient teachers, and faculty within a medical school. Through a phenomenographic approach, this study captures and describes the different ways our study participants experienced a PAT program (the 'phenomenon'). 24 semi-structured interviews were conducted in total, comprised of interviews with patient teachers (N = 10), medical students (N = 10) and program facilitators (N = 4) who participated in a PAT program. Our focus was on participants' description of the program and was grounded in their experiences of as well as their beliefs about it. Our findings captured 4 layers representing the qualitatively different (yet interrelated) ways in which participants experienced/perceived and conceptualized the various aspects of their experience with the PAT program: (1) A productive disruption of the learning space (2) A re-humanization within healthcare (3) A means of empowerment and agency (4) A catalyst for change and emancipation. Our outcome space results can be visually illustrated by a nesting "Matryoshka" doll, representing the four layers and depicting the process of uncovering the less conscious layers of sense-making within this phenomenon. HPE programs that are co-produced with patients and actively involve patients as teachers have the potential, but not guarantee, to be emancipatory. To engage in PAT programs that exhibit an emancipatory potential, we need to consider transformative paradigms of education, which are aligned with social change, and disrupt the traditional teacher-learner hierarchy.

Applying intersectionality to address inequalities in nursing education

AIM

The aim of this paper is to discuss the significance of the intersectionality framework for addressing prejudices, racism and inequalities in nursing education and clinical learning environments.

BACKGROUND

Discrimination and racism against nursing students and educators based on their gender, ethnicity, race and social identities is well-documented in the nursing literature. Despite documented discrimination and incivility based on intersectional factors, it is reported that often nurse educators show limited interest in the culture, diverse experiences and values of nursing students with culturally and linguistically diverse backgrounds.

DESIGN

Discussion paper METHODS: The discussion was based on contemporary literature about intersectionality, discrimination and racism in nursing. We completed a cursory search of literature in nursing education journal and selected nursing and health science databases. This was not a formal literature review. Using a fictional example, the application of intersectionality to address inequalities in educational settings is illustrated.

RESULTS

Intersectionality is an invaluable tool for examining interwoven power relations and power struggles arising from racial, gender, ethnic, religious and sexuality and disability-related differences. Nurse educators, students and leaders should be more cognizant of their preconceived views, sociocultural stereotypes and varied forms of sociocultural oppression affecting their interactions with each other in clinical learning environments.

CONCLUSIONS

Incorporating intersectionality can address prejudices, racism and inequalities arising due to sociocultural, ethnic, power-related and intergenerational issues among educators, students and other personnel involved in creating clinical learning environments.

Decolonisation for health: A lifelong process of unlearning for Australian white nurse educators

Indigenous nurse scholars across nations colonised by Europeans articulate the need for accomplices (as opposed to mere performative allies) to work alongside them and support their ongoing struggle for health equity and respect and to prioritise and promote culturally safe healthcare. Although cultural safety is now being mandated in nursing codes of practice as a strategy to address racism in healthcare, it is important that white nurse educators have a comprehensive understanding about cultural safety and the pedagogical skills needed to teach it to undergraduate nurses. We open this article with stories of our journeys as two white nurses in becoming accomplices and working alongside Indigenous Peoples, as patients and colleagues. Our lived experience of the inertia of healthcare and education organisations to address systemic and institutional resistance to the practice of cultural safety underpins the intention of this article. We understand that delivering this challenging and complex topic effectively and respectfully is best achieved when Indigenous and white educators work together at the cultural interface. Doing so requires commitment from white nurses and power holders within universities and healthcare institutions. A decolonising approach to nurse education at individual and institutional levels is fundamental to support and grow the work that needs to be done to reduce health inequity and increase cultural safety. White nurse accomplices can play an important role in teaching future nurses the importance of critical reflection and aiming to reduce power imbalances and racism within healthcare environments. Reducing power imbalances in healthcare environments and decolonising nursing practice is the strength of a cultural safety framework.

Enhancing sense of belonging in nursing student clinical placements to advance learning and identity development

Clinical placements are considered one of the "hallmarks" of nursing education. In these settings, students can build upon their theoretical learning by applying knowledge, practicing skills, connecting with nurses and other medical professionals, and creating opportunities to work with diverse populations. As a result, students begin to hone their nurse identity, and build confidence and self-esteem. Importantly, the development of a nursing identity through clinical placement work is improved by integrating opportunities that increase belongingness. Campus climate plays a significant role in creating the environment necessary for belongingness to flourish and leads to enhanced student learning. Taking the role of positive campus climate into consideration, this article argues that instructors supervising undergraduate nursing students in clinical learning environments must create inclusive climates for their students to increase positive educational outcomes. Specific recommendations for creating inclusive clinical learning environments are provided.

Broadening the Environmental Lens to Include Social and Structural Determinants of Women's Health Disparities

BACKGROUND

Due to the physical, metabolic, and hormonal changes before, during, and after pregnancy, women-defined here as people assigned female at birth-are particularly susceptible to environmental insults. Racism, a driving force of social determinants of health, exacerbates this susceptibility by affecting exposure to both chemical and nonchemical stressors to create women's health disparities.

OBJECTIVES

To better understand and address social and structural determinants of women's health disparities, the National Institute of Environmental Health Sciences (NIEHS) hosted a workshop focused on the environmental impacts on women's health disparities and reproductive health in April 2022. This commentary summarizes foundational research and unique insights shared by workshop participants, who emphasized the need to broaden the definition of the environment to include upstream social and structural determinants of health. We also summarize current challenges and recommendations, as discussed by workshop participants, to address women's environmental and reproductive health disparities.

DISCUSSION

The challenges related to women's health equity, as identified by workshop attendees, included developing research approaches to better capture the social and structural environment in both human and animal studies, integrating environmental health principles into clinical care, and implementing more inclusive publishing and funding approaches. Workshop participants discussed recommendations in each of these areas that encourage interdisciplinary collaboration among researchers, clinicians, funders, publishers, and community members. https://doi.org/10.1289/EHP12996.

Representation of dark skin tones in foundational nursing textbooks: An image analysis

PURPOSE

This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts.

BACKGROUND

The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice.

METHODS

Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone).

RESULTS

Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks.

CONCLUSIONS

Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark.

RELEVANCE TO CLINICAL PRACTICE

All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.

Nursing Students' Perceptions of Racism in Nursing and Health Care

BACKGROUND

Due to the dearth of literature regarding teaching racism in health care and the commitment of nursing organizations to address racism in health care, this project examined nursing students' perceptions of racism in nursing and health care to identify effective teaching strategies for addressing racism in curricula.

METHOD

This study used a mixed-methods pre- and postintervention design to examine multiple methods of teaching nursing students about racism in health care. Frequencies, descriptive statistics, and content analysis were used to analyze data.

RESULTS

Sixty-six graduate and undergraduate students participated in the study. Mean responses on a postintervention survey increased for all but one item. Content analysis of student-guided reflective journal entries yielded four themes: uncomfortable topic yet necessary to discuss, new awareness, courage to advocate, and application to practice.

CONCLUSION

Effective teaching methods to address this issue include open discussions, storytelling, and case studies. [J Nurs Educ. 2023;62(10):563-569.].

Developing anti-racist undergraduate nursing education: themes and action

The impact of racism on health is undeniable. However, undergraduate nurse education in the UK is not adequately addressing the racism within the profession. Literature on anti-racist nursing education was reviewed to uncover the most effective strategies for nurse educators to develop this approach. The literature describes a climate of denial and defensiveness among nurse educators. It urges nurse educators to develop racial literacy, and explores nursing curricula, recommending intersectionality as a way to teach about health disparities, with a move away from a culturalist perspective. There is growing recognition that institutions need to address issues around the retention of Black students, and robust reporting systems are required to respond to allegations of racism. Institutions also need to provide evidence-based anti-racist training for staff. The conclusion here is that, without institutional support, there is little nurse educators can do alone to change the culture of racism in nurse education. Thus, this review is a starting point for nurse educators interested in anti-racist nursing education.

Melting the Snowy White Peaks: The needs, expectations and experiences of Black, Asian and minority ethnic student nurses to support equitable nursing education and career progression

BACKGROUND

There is an under-representation of Black, Asian and minority ethnic nurses in senior positions within the UK's national healthcare system.

OBJECTIVES

To understand student nurses' perspectives on the role of race and ethnicity on career expectations, course learning and delivery, and areas for additional training and skill development for all nurses in understanding structural inequalities in healthcare.

DESIGN

Qualitative study involving semi-structured interviews.

SETTINGS

University in south-east England, UK.

PARTICIPANTS

15 nursing students (14 women, one man) from a range of ethnic backgrounds, age-groups and nationalities.

METHODS

Interviews lasting 30-60 min were conducted with nursing students and thematic analyses undertaken.

RESULTS

Four inter-related themes were constructed: altered career expectations, lack of understanding, absent discussion of racism and missing representation. Experiences of racism were not uncommon for students from Black, Asian and minority ethnic backgrounds and these experiences affected these students' career expectations. Students described a lack of understanding about racism and that it was a taboo topic on their course and in placements.

CONCLUSIONS

Findings highlight an urgent need for universities to challenge existing nursing curricula to ensure inclusive, anti-racist educational provision that works equitably for all future nurses. The importance of representation was highlighted among those who deliver courses, in the content of nursing curriculum through inclusive education, decolonised curricula and with student voices embedded to enable the development of culturally-competent nursing graduates.

Racism, colonialism and the implications for nursing scholarship: A discussion paper

AIM

A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry.

DESIGN

Discussion paper.

DATA SOURCES

A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022.

IMPLICATIONS FOR NURSING

The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing.

CONCLUSION

Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship.

NO PATIENT OR PUBLIC CONTRIBUTION

The paper is a discursive paper using pertinent nursing literature.

IMPACT

For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.

Justice, Equity, and Inclusion in a School of Nursing: A Quality Improvement Program

BACKGROUND

Despite the increased racial and ethnic diversity in the general population of the United States, the nursing workforce remains mostly White. Schools of nursing (SON) have increased recruitment and enrollment; however, students who represent racial and ethnic minoritized groups experience microaggressions, injustice, and social exclusion. This quality improvement program sought to equip faculty with skills to create a just and inclusive SON. The program was guided by the Institute for Healthcare's Model for Improvement.

METHOD

Five workshops were developed and implemented during two semesters. Workshops were led and moderated by a diversity, equity, and inclusion consultant.

RESULTS

After the workshops, participants committed to create an inclusive environment, intervene when microaggressions occurred, implement curricular changes, and recognize themselves as members of a privileged group. Postworkshop discussions and reflections led to new initiatives in the SON.

CONCLUSION

This faculty development program demonstrates programs to enhance justice, equity, and inclusion can be implemented successfully within SON. [J Nurs Educ. 2023;62(1):20-27.].

R.E.A.C.T: A framework for role modeling anti-racism in the clinical learning environment

PURPOSE

In 2020, medical schools across the U.S. were called to task by students who demanded a response to structural racism in medicine. Many medical schools made anti-racism declarations and pledged to promote more inclusive learning environments. Much of the focus was on changing the pre-clinical curriculum and less on the everyday interactions that occur in clinical settings. As medical educators, we have an obligation to reinforce statements of solidarity by role modeling behaviors that demonstrate anti-racism in clinical practice.

METHODS

This article proposes a framework that provides practical steps for role modeling anti-racism in the clinical learning environment. These steps are drawn from a review of the literature on role modeling, constructs from Social Cognitive Learning Theory, and anti-racism praxis.

RESULTS

The resulting framework uses the acronym R.E.A.C.T to describe practical steps that include Reflecting on implicit biases, Educating ourselves on historical and current forms of structural racism, Assessing the use of race in clinical practice and asking how racism is impacting a clinical interaction, Calling out behaviors that perpetuate racism, and Treating everyone with dignity and respect.

CONCLUSIONS

The R.E.A.C.T framework is of value to medical educators because it provides practical steps on role modeling anti-racism in the clinical learning environment. The framework calls medical educators not to merely passively 'react,' but to be introspective, proactive, and intentional in their response to racism. Examples are provided on how each step can be actualized and adapted for different learning environments.

Reiterating a Need for Antiracism Praxis in Nursing and Psychiatric Nursing Education

BACKGROUND

The reemergence of the Black Lives Matter movement in 2020 reinforced the need for antiracist and decolonizing praxis in all areas, including nursing education, the burden for which has fallen predominantly on visible minorities. To enact the needed change within health care systems and nursing education, White nurses must recognize their privilege and become active participants in the conversations and change.

METHOD

This two-phase qualitative study explored nursing and psychiatric nursing students' experiences of racism and antiracism education at a small western Canadian university.

RESULTS

Anonymous qualitative surveys (n = 24) and structured interviews (n = 9) with nursing and psychiatric nursing students highlighted the difficulties and complexities of recognizing racism and a present lack of antiracism praxis in educational and health care settings.

CONCLUSION

Nursing educators must reevaluate structural and behavioral aspects of nursing education to support genuine antiracism praxis. [J Nurs Educ. 2022;61(8):439-446.].

Social Justice in Nursing Education: A Way Forward

BACKGROUND

Systemic racism and inequity are embedded in higher education, especially in nursing. By disregarding health disparities and inequities, a hidden curriculum is endorsed, implicitly letting both instructors and students know that not addressing these subjects is acceptable.

METHOD

Needs assessments were performed to assess faculty and student attitudes about the needs for justice, equity, diversity, and inclusion (JEDI) concepts. Using the Plan-Do-Study-Act model, the School of Nursing leadership, faculty, and students created taskforces to implement anti-oppression curricula throughout prelicensure courses.

RESULTS

Anti-oppression curricula and workshops were piloted successfully in the first semester of prelicensure nursing. Student feedback was positive with constructive suggestions. JEDI curriculum mapping was completed across the prelicensure nursing curriculum.

CONCLUSION

JEDI concepts must be integrated across nursing curricula to identify gaps. Forming a collaboration between leadership, faculty, and students is an optimal way to proceed as they all are invested and accountable for change. [J Nurs Educ. 2022;61(8):447-454.].

Critical Race Theory: A Framework for the Re-Education of American Nurses

The nursing profession has been predominantly white and female since the time of Florence Nightingale. The United States 2020 census revealed a changing demographic landscape in which white people are no longer the majority race; this shift will continue well into the future based on who is having babies. Calls to diversify the nursing workforce and address disparities and inequities in health care continue. Nursing faculty who shape curricula are challenged to create a more inclusive framework to teach students about care. Without focused attention on how to prepare future nurses to care for all people, patient safety and quality of care are at stake. This article suggests using critical race theory as a framework to re-educate American nurses.

Defusing Land Mines: Keywords About Race in Nursing Education

BACKGROUND

The call for nurse educators to facilitate conversations about racism with learners has become inescapable. Yet, nurse educators in the United States indicate they feel unprepared or uncomfortable leading classroom conversations about race.

METHOD

Keyword analysis maps the multiple meanings of vocabulary, creating a common foundation for productive dialogue. Selection of keywords is subjective, but each keyword must meet three criteria: a term that is in common use, definitions that change according to time and perspective, and use that illuminates larger phenomena.

RESULTS

Five keywords when teaching about racism are Caucasian, colorblind, diversity, reverse racism, and underrepresented minority. Each keyword carries connotations that may be perceived as upholding egalitarian ideals without acknowledging the pernicious mechanisms of racism itself.

CONCLUSION

Familiarity with keywords provides educators with solid ground for engaging in often ambiguous and troubling dialogues about racism. [J Nurs Educ. 2022;61(7):408-412.].

A discussion of White fragility to facilitate cultural competence development in a foundations of pharmaceutical care class

INTRODUCTION

The objective of this study was to explore pharmacy students' emotional reaction to the concept of White fragility and garner ideas about improving pharmacy curriculum to initiate constructive patient engagement across racial divides.

METHODS

An online questionnaire was distributed to 160 first-year pharmacy students after reading the article "White Fragility" for a Foundations of Pharmaceutical Care Course. Class prep questions included (1) How can the college and you improve the capacity and stamina of Whites, so they are prepared to teach and initiate constructive patient engagement across racial divides? and (2) Recognizing that emotions play a critical role in learning, how does the information in the "White Fragility" article make you feel? Responses were analyzed using a constant comparative method by all three authors; discrepancies were resolved by consensus.

RESULTS

Of the 160 students across two campuses, 157 submitted responses. Four major categories of college culture, curriculum, educational topics, and educational suggestions or enhancements emerged "to improve the capacity and stamina of Whites." With regard to the observed feelings after reading "White Fragility," seven categories of feelings (frequency) emerged, including awareness (49%), discomfort (38.2%), empathy (19.7%), defensiveness (16.6%), frustration (15.9%), empowerment (11.5%), and curiosity (8.3%).

CONCLUSIONS

This student cohort is at the beginning of their intercultural journey in pharmacy. Many indicated that more emphasis on and discussion about issues like White fragility and racism would benefit their ability to care for people from a wide variety of cultures to optimize patient outcomes.

Doulas, Racism, and Whiteness: How Birth Support Workers Process Advocacy towards Women of Color

Systemic racism is embedded in healthcare settings and is linked to high maternal mortality rates for Black women in US Society. Doulas, or birth support workers, are uniquely positioned to advocate for women of color going through the birthing process, but little is understood on how doulas come to terms with race, racism, and whiteness in maternal healthcare settings. Using qualitative in-depth interviews with 11 doulas in northeast Florida, this research study found that doulas’ advocacy for maternal justice leads to an intersection with racial justice through their support of minority women clients. Doulas shared stories of racial injustice when they compared their white and Black client experiences, leading to shifting strategies to address racism in maternal healthcare settings. Doulas also grappled with their connection to whiteness through their own identities and interaction with white and minority clients. Many doulas shared a need for anti-racism training and recruitment of Black doulas to meet the needs of women of color going through the birthing process.

Developing the "Upstreamist" through Antiracism Teaching in Pharmacy Education

Objective. To present antiracism teaching as a key modality and an upstream approach to addressing health disparities in pharmacy education. Relevant theoretical frameworks and pedagogical strategies used in other health disciplines will be reviewed to present how antiracism curricula can be integrated into pharmacy educational outcomes.Findings. Various disciplines have incorporated antiracism pedagogy in their respective programs and accreditation standards. While challenges to implementation are acknowledged, structural racism continues to compromise health outcomes and should be centralized when addressing health disparities.Summary. Pharmacy curricula has explored and implemented cultural competency as a means to address the social determinants of health. By intentionally addressing racism in the context of health disparities, student pharmacists will further acknowledge racism as a public health issue and a systemic barrier to patient-centered care.

Nursing is never neutral: Political determinants of health and systemic marginalization

The nursing community in the United States polarized in September 2020 between Dawn Wooten's whistleblowing about forced hysterectomies at an immigration center in Georgia and the American Nurses Association's refusal to endorse a presidential candidate despite the Trump administration's mounting failures to address the public health crisis posed by the COVID-19 pandemic. This reveals a need for more attention to political aspects of health outcome inequities. As advocates for health equity, nurses can join in recent scholarship and activism concerning the political determinants of health. In this paper, we examine recent work on the political determinants of health with an aim to add two things. First, we seek to build further on the notion of "political" determinants of health by distinguishing policy and governance structures from dynamics of politicization through appeal to critical disabilities studies. Second, we seek to apply this further nuanced approach to challenge rhetorical uses of "vulnerable populations," where this phrase serves to misrecognize systemic institutionalized forces that actively exploit and marginalize people and groups. By refocusing attention to political systems organized around and perpetuating inequitable health outcomes, nurses and other health care professionals-as well as those whom they serve-can concentrate their effort and power to act on political determinants of health in bringing about more equitable health outcomes.