A mixed-methods evaluation of unconscious racial bias training for NHS senior practitioners to improve the experiences of racially minoritised students.

OBJECTIVE: The degree awarding gap indicates that racially minoritised higher education students receive lower degree classifications relative to their white peers. While the reasons for this are complex, research suggests that educator and practitioner attitudes and behaviour towards racially minoritised students are a significant contributing factor. This preregistered study evaluates the effectiveness of unconscious racial bias training (URBT) to enhance National Health Service senior practitioner's recognition of how racial inequalities negatively impact racially minoritised students. DESIGN: A mixed-methods study with a pretest and post-test design was conducted in the higher education and healthcare practice environment. METHODS: Forty-nine NHS senior practitioners completed a 4-hour URBT workshop with activities focusing on activating stereotypes, exploring differences between unconscious and implicit bias, discussing the development of bias, and reflecting on student experiences of prejudice, harassment and discrimination. They completed pre- and post- quantitative measures that assessed the effectiveness of URBT and changes in racial competency, awareness and perceptions of unconscious racial bias. Qualitative measures explored the usefulness and perceived applications of URBT, and a 1-month follow-up assessed further how it had been applied within practice. RESULTS: Participants reported positive evaluations of URBT, higher perceived racial competency, awareness and perceptions of racial bias (ps<0.001, dz>0.35). After 1 month, key themes from qualitative responses suggested that participants had increased self-awareness and were exploring how to set up mentoring and working groups, change recruitment and progression processes, and diversify the taught curriculum. CONCLUSIONS: URBT may be one effective strategy to enhance awareness and encourage reflections of racial bias. We discuss how reducing racial inequalities requires a multifaceted approach that affords upfront conversations about systemic racism, implements effective initiatives, policies and procedures, and engages in continuous evaluation.

The lived experiences of racial bias for Black, Asian and Minority Ethnic students in practice: A hermeneutic phenomenological study.

AIM: This study explored the lived experiences of racial bias for Black, Asian and Minority Ethnic students undertaking an undergraduate or post-graduate degree in nursing, midwifery and allied health courses in the United Kingdom. BACKGROUND: Previous research indicates that students from Black, Asian and Minority Ethnic groups have fewer opportunities to succeed at university and this has brought about a race awarding gap in their degree attainment. The reasons for this awarding gap are complex and multi-factorial and it is crucial that the lived experiences of racial bias are explored from the student perspective. DESIGN: A hermeneutic phenomenological approach was adopted to elicit individual and collective experiences in the practice environment, a mandatory component of the student's degree. METHODS: A focus group and individual semi-structured interviews were conducted to collect data from sixteen participants and analysed using thematic analysis RESULTS: Three encompassing themes were identified which included a sense of not belonging, trauma impact on mental health and understanding covert and overt racism. Participants reported incidences of racism and appeared to be traumatised by their experiences within practice and the university. They also reported poor mental health and well-being as shared experiences and a lack of confidence in the university and practice to mitigate racial issues. CONCLUSIONS: Meaningful action must be taken by universities and practice partners to advance racial inequality initiatives by having robust anti-racism action plans and processes. These should be co-created with students and staff to reduce the race awarding gap.

Exploring the experiences of being an ethnic minority student within undergraduate nurse education: a qualitative study.

BACKGROUND: Students studying in a country where another language is spoken face multiple challenges including their ability to fully integrate with peers and academic pressures in trying to obtain an undergraduate nursing degree. The aim of the study was to explore the lived experiences of students, from varying cultural and ethnic backgrounds, undertaking an undergraduate nursing degree. METHODS: The study adopted a qualitative design and eight individual semi-structured interviews were conducted. The interviews were analysed using manifest content analysis according to Graneheim and Lundman. RESULTS: Students reported feelings of isolation and the lack of opportunities to integrate with native students within academia and practice. The need for personal support was a crucial factor that was independent of gender and students reported challenges related to both language and culture during the programme. CONCLUSIONS: Suggestions arising from this study includes appropriate support systems within academia and practice. It is imperative that universities and practice settings promote and integrate cultural awareness within academia and practice in meeting the needs of students and providing culturally appropriate nursing care, thereby providing opportunities for all students to become competent and professional practitioners.

Students' perceptions of self-direction in pre-registration nurse education.

This study explored to understand the lived experiences of a group of pre-registration nursing students' in a United Kingdom Higher Education setting, in the context of increasing responsibility for self-direction throughout the learning process. Care is underpinned by evidence, knowledge and problem solving skills, predicated on enhanced student capability to ensure self-direction in learning. A hermeneutic phenomenological approach framed within an interpretative paradigm enabled exploration to seek out individual and collective perceptions of the learning process. Four over-arching themes were identified: Divergent perceptions of self-directed learning, Adult learning needs and transition, Motivation and Understanding responsibility. Students appeared very dependent and, paradoxically, demanded both variety and consistency from educators in assisting them to develop as they progressed through the course. Within these themes, anxiety and vulnerability were shared motifs in students' experiences. Clear expectations of responsibilities and roles in learning is key to supporting students from the beginning of the undergraduate programme. Teacher and student interaction is important in developing and enabling critical engagement in learning with clear directions and guidelines.

Using systematic reviews to inform nursing practice.

Health care is constantly being reformed to improve the safety and quality of services, and nurses are integral to the provision of this safety and quality. As a result of concerns raised by recent high-profile care failings, there is an expectation that the nursing profession should be able to meet the changing demands of an increasingly complex healthcare environment, based on the best available evidence. This article describes the use of systematic literature reviews to recognise appropriate evidence and develop guidelines to inform nursing practice, thereby enabling safe, high quality nursing care. It uses an example from the literature to illustrate the process of systematic review.

Developing compassion in pre-registration education.

Compassion is a fundamental aspect of nursing and student nurses have to be able to demonstrate compassion in practice. Nurse educators in higher education institutions and clinical settings need to work together to prepare and support student nurses to deliver compassionate care. This article discusses the key components of compassionate care, and how students can be enabled to deliver high-quality care within rapidly changing, complex environments. A second article in this issue explores how nurses can be recruited with the values of the 6Cs (page 12).

Creating supportive environments for students.

Appropriate clinical placements are an essential part of pre-registration nurse education. They provide students with the opportunity to learn practical skills and gain knowledge, so students' learning is heavily dependent on the quality of support mentors provide. At the end of each clinical placement, student nurses are asked to evaluate the experience. One recurring theme to emerge from these evaluations is that students often perceive mentors to be too busy to provide the required level of support. This can lead to increased levels of anxiety for students as they may feel unsupported. Mentors are one of the critical factors affecting students' ability to learn and cope on their placements. This article examines the current situation and highlights how mentors can enhance the clinical experience for students.

Developing evidence-based practice among students.

In response to government initiatives and the rise in patient empowerment, nurses are increasingly being challenged to deliver high-quality care supported by evidence-based practice. This can be a challenge for nurse educators providing the foundation for pre-registration student nurses. Evidence-based practice within nursing is achieved by developing and supporting patient-centred approaches to care using the most current evidence. This facilitates the development of a questioning approach incorporating the four principles of healthcare ethics--beneficence, non-maleficence, autonomy and justice.

Exploring the factors contributing to drug errors and how to improve knowledge.

Medicines administration is one of the high risk areas for nursing practice and a matter of considerable concern for practitioners, policymakers and the public. Drug errors can lead to devastating consequences for patients and for nurses' careers. It is an integral part of nurses' role, underpinned by legal and professional requirements (Nursing and Midwifery Council, 2008a). This article reviews the situation and makes suggestions on how to improve knowledge.