Question

How does the community health nurse recognize bias, stereotypes, and implicit bias within the community? How should the nurse address these concepts to ensure health promotion activities are culturally competent? Propose strategies that you can employ to reduce cultural dissonance and bias to deliver culturally competent care. Include an evidence-based article that address the cultural issue. Cite and reference the article in APA format.

Answer 1

1.

As an experienced nurse, a new nurse, or a nursing student in 2018, it’s tough to admit you might be biased toward some of your patients. But it happens, and the best approach to fixing implicit bias is to recognize its presence, and then constantly reassess how you feel and your approach.

Why do nurses have inherent bias? It’s a subconscious human trait and frequently interferes with best nursing practices. An inherent bias doesn’t mean you are racist and it doesn’t mean you shouldn’t be a nurse. Recognizing an inherent bias means that you understand you might have certain feelings about populations, appearances, or mannerisms that need to be addressed and dealt with to provide the best possible care.

Here’s how to pay attention and fix it.

Notice Your Assumptions

Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.

Understand What Assumptions Trigger in You

You might find there are certain accents, specific items of clothing, or ways of speaking that cause you to tag someone with undeserved qualities. A patient’s race, accent, clothing style, or appearance can spark an instant judgment in you. Do you hold back certain levels of compassion for patients who are more short-tempered? Do you assume low standards in a disheveled, unkempt patient? Does someone’s race affect how you see them?

Know Why It Matters

An implicit bias is not only harmful because it is undeserved, but it can also lead to disparities in care. Even if you are unaware of how you are feeling, your body language, your focused attention, and your level of care can be impacted directly by the way you are feeling. Each patient deserves your full care, so understanding what might trigger you to act differently will make you a better nurse.

Know Your Patient

Talking with your patients is a good way to learn more about them. Understanding cultural differences can also help you become aware of any unconscious bias and begin to overcome it.

Talk About It

You have a bias, but you are not alone. Talking about implicit bias in your work setting opens the conversation, removes the taboo, and paves the way for better patient care and outcomes. When nurses are able to address this topic in an open and nonjudgmental manner, everyone benefits. If you are a nurse manager, holding talks, open sessions, one-on-ones, and seminars gives your staff nurses the tools to confront the issue head on and make significant changes.

Everyone knows about overt bias and the harm it causes, but implicit bias is just as dangerous, and many nurses aren’t even aware they may have a bias. Becoming aware of the problem and realizing if you have any bias is a first step toward fixing the problem.

2 The most popular and most well studied type of cultural competence intervention is cultural competency training for healthcare providers. Two general approaches have been used in creating educational interventions to address cultural competence: programs aimed at improving knowledge that is group-specific, and programs that apply generic or universal models. Concerns have been raised about cultural competency programs that use a group-specific approach to teach providers about the attitudes, values, and beliefs of a specific cultural group leading to stereotyping and oversimplifying the diversity within a particular priority group.⁴ The universal approach to training proposes that cultural competence can be taught through reflective awareness, empathy, active listening techniques, and the cognitive mechanisms contributing to cultural insensitivity or blindness, such as implicit biases or stereotype threats. Therefore, of interest is identifying the effect of varying types of cultural competence training on patient-level outcomes.

In addition to education and training, changing clinical environments can also be key to purposeful change in behavior. The National CLAS includes several standards that address the organizational level rather than the patient/provider relationship.¹ Changes in provider knowledge, attitudes, and skills is a necessary step, but for those gains to translate into culturally competent behaviors there also needs to be changes in the structures and culture of health care systems and organizations. This review is intended to focus on the effectiveness of interventions and the provider and system level, but not at the level of policy which, while important, is beyond the scope of this review.

• People first” care interventions that promote “individuation.” These interventions prompt providers to make a conscious effort to view people in terms of their individual characteristics rather than group membership, and being aware of one’s own biases and stereotypes. The interventions can also take place at the system level, engineering a system that promotes providing needed care universally, such as equitable receipt of preventive or chronic disease management.
• Cultural competence interventions that improve the ability of providers to provide health care services to patients who are unlike the providers (or the providers’ culture) in important ways. Targeted providers in such cases can include physicians, nursing staff, allied health professionals, paraprofessionals, and clinic staff who have regular contact with patients, or health system factors intended to engineer the system to support and sustain cultural competence.
• Interventions that assist patients from priority populations to competently navigate the patient-provider relationship and the larger health system
• Interventions that address physical barriers to access.
• Interventions that educate providers about, and to look for, the common secondary conditions specific to the target populations. For example, people with disabilities commonly experience an identifiable set of health conditions secondary to the disability such as urinary tract infections, asthma, obesity, hypertension, and pressure ulcers.

3.

Tapping five strategies

Knowing that unconscious bias leads to disparity, nurses must try to eliminate it. The following five strategies may help.

1. Personal awareness. This is the process of looking inward to recognize beliefs and values that can lead to unconscious bias. Recognition can lead to the development of self-regulatory behaviors to mitigate the influence of bias on patient interactions.3 Acquiring personal awareness requires an internal compass that's used to guide daily interactions. This compass can help nurses recognize acceptable and unacceptable attitudes and behaviors and stay on the right path when faced with the continual threat of unconscious bias. It forces nurses to constantly look inward and creates an awareness of how they're perceived by others, laying the foundation for a therapeutic nurse-patient relationship.

2. Acknowledgment. Without acknowledgment that a problem exists, no action can be taken to solve the problem. With acknowledgment comes the acceptance of accountability and responsibility to make a difference. Nurses and other healthcare professionals must move to suppress unconscious bias by initiating responses to foster positive behaviors, such as empathy.

3. Empathy. Healthcare professionals must be able to empathize with patients and their circumstances to understand what they're feeling. Nurses can develop empathy by making a conscious effort to understand the patient's situation, become fully immersed in the patient's point of view, and get a sense of what it's like to be walking in the patient's shoes.4 Most people naturally have a sense of empathy, but some patients and situations can raise a barrier to empathy. For example, caring for patients who participate in risk-taking behaviors that result in adverse health outcomes can make it more difficult for a caregiver to be empathetic. Refusing to acknowledge this emotional necessity can produce negative outcomes during patient interactions and care. To overcome these barriers to empathy, healthcare providers must consciously make an effort to recognize and acknowledge that the barriers exist and deliberately implement a practice that aligns with unbiased patient care.

4. Advocacy. Support for patients as they navigate a complex healthcare system is called advocacy. Nurses can be patient advocates by assisting with communication with other members of the healthcare team, identifying best treatment options, and ensuring that a patient's rights aren't overlooked. In the presence of unconscious bias, nurses' advocacy can support patients to receive the individualized care they need. Nurses must advocate for patients with tact, compassion, and professionalism, and communicate and collaborate with other healthcare team members to support the patients' needs. Patients should be able to sense that their nurses intend to do what's best for them to provide safe outcomes.

5. Education. Enhanced knowledge is central to raising awareness, recognizing the existence of unconscious bias, and reducing its prevalence. Education can be introduced in formal curricula for healthcare providers and nurses. Another approach is to offer education that focuses on sensitivity and the existence of unconscious bias in healthcare facilities. Nurses can educate others during their daily interactions to raise awareness about the consequences of unconscious bias. Routine staff meetings can provide another forum for education, giving nurses an opportunity to share their experiences and beliefs and to explore options to mitigate this challenge. Educating others about unconscious bias helps create an environment that fosters equal treatment for all patients with an open and accepting approach. Besides strengthening the knowledge base, education creates an atmosphere promoting a strong nurse-patient relationship based on empathy and understanding, ultimately resulting in high-quality and equitable patient care.