The National Commission to Address Racism in Nursing defines racism as "assaults on the human spirit in the form of actions, biases, prejudices, and an ideology of superiority based on race that persistently causes moral suffering and physical harm of individuals and perpetuates systemic injustices and inequities."1 Those who experience racism and discrimination are often patients with poor access to health care, who have poor health care outcomes, and who suffer from mental health issues. In a 2022 review that evaluated the impact of racism on the nurse-patient relationship, a thematic analysis of the findings led to the development of three categories: bilateral ignition of racism, hidden and manifest consequences of racism, and encountering strategies.2
Bilateral ignition of racism is when both patients and nurses hold racist beliefs and stereotypes that influence their behaviors and negatively impact their interactions. Racism perpetuated by nurses is often rooted in implicit bias and stereotypical attitudes toward patients of color or those with limited language skills, substance dependencies, or mental illness. Hidden and manifest consequences of racism arise when nurses work in an environment influenced by racist attitudes, creating feelings of insecurity and uncertainty. Nurses may fear making mistakes or crossing cultural boundaries, which only increases their work-related stress and ability to provide appropriate care. Encountering strategies are employed by nurses and patients to address and minimize the impact of racism in the nurse-patient relationship. Respect, trust, and active participation in nursing care were found to be effective in countering stereotypical and racist behaviors. Nurses who provided compassionate care, communicated respectfully, and addressed patients' concerns received positive feedback from patients.
The review concluded that racism threatens patients' and nurses' dignity and that a framework of action is needed. It's clear that cultural competence and having race-based conversations must be recognized as crucial aspects of patient care. Addressing race-related issues allows nurses to understand the unique experiences, perspectives, and health care disparities faced by patients from diverse racial backgrounds. The following strategies can create frameworks for addressing racism and promoting cultural competence in nursing:
Developing a common language and protocol. For conversations involving race and equity to be successful, individuals must commit to staying engaged and involved in dialogue, even when that dialogue may be uncomfortable. Ngounou and Gutierrez developed four principles to promote race equity in education: a need for professional learning about race and equity through a systems-thinking lens, a willingness to experience discomfort, people sharing their stories, and accepting nonclosure.3 These principles are built upon the "four agreements of courageous conversation," a protocol introduced by Glenn Singleton in Courageous Conversations About Race: A Field Guide for Achieving Equity in Schools, to establish norms for race-based conversations: stay engaged, experience discomfort, speak your truth, and expect and accept nonclosure.4 Singleton suggests that in order to engage and sustain conversations about race, individuals need to acknowledge their "personal, local, and immediate" racial experience, and focus on the ways race has impacted their lives.4 When this is done, individuals will be better positioned to isolate and unpack race and understand its impact on the systems in which they participate.
Targeted professional development and education can provide context on the history of racism in nursing and increase the willingness to engage in race-based conversations. Topics like racism, equity, and health care justice require long-term commitment because nurses and supervisors may overestimate their ability and competency when engaging in such complex topics. While uncomfortable, it is necessary for nurses to engage in learning and open discussion about racism within the profession, as it allows individuals to identify the root causes of their biases and work toward eradicating them.
Enacting accountability measures. The only way we learn and grow is through feedback. Self-assessments and a 360[degrees] feedback process allow for gathering feedback from various stakeholders to assess cultural competency, understand areas of strengths and growth, and create action plans to further one's development. Additionally, leadership teams can use data to evaluate whether equitable medical care is provided to patients.
Addressing racism in the nurse-patient relationship is crucial for providing equitable and compassionate care. By actively engaging in these efforts, nurses and other health care professionals can work toward eliminating racism and providing quality care to all patients.
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