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.

Skin Assessment in Patients with Dark Skin Tone.

ABSTRACT: There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of both common and serious integumentary and general health issues in people with dark skin tones. Nurses must be exposed to such learning resources to be adequately prepared to care for patients with diverse skin tones and to help reduce health disparities and promote health equity. This article provides faculty, nursing students, and clinicians with basic information about the assessment of dark skin tone and calls for action in academia and professional practice to ensure nurses and nursing students can effectively perform skin assessments in all patients.

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.].

Microaggressions: Black students' experiences - A qualitative study.

BACKGROUND: Studies in other disciplines have shown that Black college students experience microaggressions on campus. This affects campus learning climates, posing a risk to students' success. PURPOSE: The purpose of this secondary analysis is to describe Black nursing students' experiences with microaggression at a predominantly white institution. METHODS: In this secondary analysis of a descriptive qualitative study, principles of thematic analysis were used to code, categorize, and synthesize interview data from 16 nursing alumni participants specifically to examine microaggression. RESULTS: The thematic analysis of the data revealed microaggressive behaviors experienced by Black nursing students. Three salient themes emerged: microaggressions among peers, from faculty members to students, and in the clinical setting. CONCLUSION: This study offers critical insights into the microaggressions that Black students experience. These microaggressions interfere with students' learning and highlight the need for academic institutions to take measures to dismantle these behaviors. These findings can illuminate to faculty and students the roles they play in perpetuating racism and subjecting students of color to detrimental psychological distress.

The importance of addressing racial microaggression in nursing education.

The Pandemic laid bare how embedded racism is within our structures, institutions and societal systems. We are bearing witness to long standing issues now manifesting as deep inequities that have been overlooked. In both academic and clinical instruction and settings there is a need for a culture shift to empower recipients of racialized aggression and enable allies, active bystanders and leaders to respond in ways that promote values that extend our shared humanity. Using research, experience and observations the authors provide best practices for responding to and dismantling microaggressions. In addition, they discuss the impact of microaggression within nursing education and clinical settings. These include recommendations for student recipients, applicable to classroom and clinical settings, and intervention proposals for allies, active bystanders and leaders.

Creating a culture of success: A framework for addressing at-risk student.

The lack of diversity in nursing and the projected nursing shortage is a clarion call for higher education to create inclusive programs where all students can thrive. Despite an increase in enrollment, attrition remains an issue. To address the looming nursing shortage, colleges and universities are expected to increase the enrollments in baccalaureate and accelerated baccalaureate programs. As traditional and nontraditional students are admitted into nursing programs, institutions and nursing programs will be faced with tackling issues students who are historically labeled as "at-risk" may have. To help these students succeed, colleges and universities must come up with new ways to work with at-risk students. In this paper, we are proposing a new framework for how faculty in nursing programs can perceive "at-risk" students by systematically examining the factors that lead to this at-risk status. The framework proposes that students encounter a plethora of individual and institutional critical elements, categorized into domains. By understanding the critical elements that impact student outcomes, nursing programs will be better able to strategize ways to effectively support and sustain student success.

The intersection of climate change with the era of COVID-19.

The purpose of this integrative review is to examine recent literature on the intersection of SARS-CoV-2 (COVID-19 novel coronavirus) and climate change that will lead to a greater understanding of the complexities of the urgent pandemic linked with the emerging climate crisis. A literature search for peer-reviewed, English language, literature published since the pandemic emerged was conducted using Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, and the Cochrane Library. The final sample yielded a total of 22 commentaries, editorials, discussion papers, and a research study that explicitly addressed the intersection of COVID-19 and climate change. Sixty articles emerged in the initial review of the intersection of the COVID-19 pandemic and climate change with the final yield of 22 articles deemed valid for inclusion after full text review. With the emergence of COVID-19 and scholarly discourse that addresses the intersection of the pandemic with climate change, key issues emerged that intersect with policy /advocacy, social justice, and nursing's public health role in clinical practice, education, policy/advocacy, and research/scholarship. Five themes that emerged included the role of public health in COVID-19 and climate change efforts; global approach addressing human-environment issues; intersection of COVID-19 and climate change from a community and global perspective; impacts of COVID-19, climate change and the environment and professional associations and specialty organizations' views and responsibilities with a lens on COVID-19 and climate change. Despite the importance of addressing racial inequities as well as systemic and structural racism that impacts those most affected by climate change and pandemics such as COVID-19, no literature addressed this topic. Public health nursing has a critical role in addressing climate change and the pandemic response to COVID 19 in the 21st century.

The Experiences of Black Nursing Alumni at a Predominantly White Institution.

BACKGROUND: Despite increasing minority enrollment in nursing programs, student attrition remains a persistent problem. PURPOSE: The purpose of this study was to describe the experiences of a diverse group of black alumni at a predominantly white institution in the United States. METHOD: In this qualitative descriptive study, researchers conducted focus group interviews with 16 recent graduates of accelerated baccalaureate and direct-entry nurse practitioner programs. RESULTS: Four themes emerged as barriers to success: burden of exclusion and isolation, lack of diversity among students and faculty, struggling to find mentors, and cultural assumptions. Five themes captured the strategies alumni adopted to succeed: strength in numbers, helpful mentors, resilience, faith, and self-silencing. CONCLUSION: Participants experienced challenges but successfully navigated the program until they graduated. The study findings lay the groundwork for the development of programs that foster success for all students.