Implicit Bias in Patient Care: An Endemic Blight on Quality Care

Health Care Students' Perceptions of Bias During Their Clinical Training and Insights on Mitigating It

PURPOSE

To understand health care students' perception of implicit bias and examine their insights to create a bias-free training environment.

METHODS

Clinical phase students from one university's 4 health care programs participated in this study. Students were surveyed regarding their knowledge of implicit bias and perception of their experiences in the clinical learning environment.

RESULTS

The response rate was 50.9%, N = 161. In total, 52.6% reported having prior training on implicit bias, and 55% self-reported that they had personally observed preceptors who exhibited an implicit bias toward patients based on race, ethnicity, or other qualities. There was no statistically significant relationship between those with prior training on implicit bias and being able to identify implicit bias exhibited by preceptors. Participants also expressed their unwillingness to report an incident unless it is confidential due to fear of retribution.

CONCLUSION

This study found that health care students from one university's 4 health care programs perceived implicit bias in their clinical learning environment, which they believe could be improved by taking intentional steps. Some suggestions provided were "Safe space to report and openly discuss bias," "Education/training on implicit bias," "Time for self-reflection," and "Hiring process that evaluates/trains against implicit bias." The implication of our study is to create a bias-free training environment that will help interrupt the propagation of biases contributing to health disparity. Further research should examine a national population and identify interventional methods and outcomes in multiple health care disciplines.

Hospital Nurses' Experiences of Providing Care for Muslim Patients in the United States

INTRODUCTION

Understanding a patient's culture is imperative to providing holistic patient care. The purpose of the study is to describe and explore the lived experiences of non-Muslim hospital-employed registered nurses providing care for Muslim patients in the United States.

METHOD

This study used a qualitative exploratory research design based on semi-structured interviews utilizing Husserlian phenomenology. A snowball technique was used to recruit the participants.

RESULTS

Ten nurses who cared for hospitalized Muslim patients were interviewed and three major themes emerged from the participants' narratives: Nurse-Patient Relationship, Nurses' Knowledge and Western Health Care Systems, and Family Influence.

DISCUSSION

Muslim patients have cultural expectations and differences that may not be anticipated by nurses, which affects nurses' experiences when providing care. As the Muslim population continues to grow in the United States, there is a need for increased education on culturally congruent care to assure the highest quality of nursing care.

The State of the Science of Nurses' Implicit Bias: A Call to Go Beyond the Face of the Other and Revisit the Ethics of Belonging and Power

This article summarizes the current state of nurses' implicit bias and discusses the phenomenon from Levinas' face of the Other and ethics of belonging, Watson's human caring and unitary caring science, and Chinn's peace and power theory. Nurses' implicit bias is a global issue; the primary sources of nurses' implicit bias include race/ethnicity, sexuality, health conditions, age, mental health status, and substance use disorders. The current research stays at the descriptive level and addresses implicit bias at the individual level. This article invites nurses to go beyond "the face of the Other" and revisit the ethics of belonging and power.

The time is now: addressing implicit bias in obstetrics and gynecology education

Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.

Racism and Professional Competence: Nursing Students in Interracial Evaluations

BACKGROUND

This pilot study examined the association of internal and external motivation of White nursing students to avoid appearing racist while interacting with standardized patients in a simulation-based learning experience (SP-SBLE). The influence of nursing students' preexisting motivations to avoid racism were examined for their effect on clinical performance in their SP-SBLE.

METHOD

White nursing students (N = 50) completed measures of motivations to avoid racism prior to their end of semester practical examination. Students were then randomly assigned to an SBLE with a SP portraying chest pain.

RESULTS

White students interacting with White SPs performed better than White students interacting with Black SPs.

CONCLUSION

Concern about appearing racist may interfere with White students' ability to perform well in a clinical setting because it may draw cognitive resources away from the clinical task. This is a first step in understanding how nursing students' perceptions may contribute to racial inequities in health. [J Nurs Educ. 2022;61(1):41-45.].

Assessing knowledge, attitudes and beliefs of nurses about LGBTQ older adults using a documentary video

BACKGROUND

Statistics reveal that lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience health disparities and barriers to accessing healthcare because of discrimination and fear of disclosing sexual orientation. Nurses receive limited education on LGBTQ health issues and even less information specifically about LGBTQ older adults. This study exposed novice nurses to the documentary, Gen Silent, which details LGBTQ older adult experiences.

OBJECTIVES

The objective of the study was to increase participants' understanding of LGBTQ older adult health disparities and experiences.

DESIGN

A one-group, pre-/post-test design was conducted to test the effect of the documentary on knowledge and attitudes about LGBTQ older adult issues.

SETTINGS

The project was set in five academic and community-based hospitals located in the mid-Atlantic region.

PARTICIPANTS

A total of 379 nurses attending a nurse residency program participated in the study.

METHODS

A questionnaire including a 16-item standardized scale and an open-ended question asking how participants would change their practice was administered before and immediately after the intervention. We assessed change in pre- and post-test knowledge scores using Wilcoxon Sign Rank test and summarized themes of the open-ended question.

RESULTS

Findings revealed statistically significant increases in 9 of the 16 items on the scale showing an increase of knowledge and inclusive attitude. Answers to the open-ended question revealed that most participants would ask patients for preferred pronouns and take steps to increase their own understanding of LGBTQ patients and their needs.

CONCLUSION

This research supports the use of a documentary as an intervention to facilitate education related to LGBTQ older adults. Further research is needed exposing healthcare professionals of varied experience in diverse healthcare settings to LGBTQ education.

Eradicating Racism From Maternity Care Begins With Addressing Implicit Bias

Black women have long experienced racism in various areas of their lives. Pregnancy is one of the times in a woman's life when she is most vulnerable, and she should not have to worry that her health care will be subpar simply because she is Black. Most health care providers do not intend to harm their patients; however, systemic racism and the unconscious biases we hold may cause harm. Training nurses and other health care providers about implicit bias is one step toward eradicating racism from maternity care.