• Giving nicknames : A healthcare provider may use a nickname if a patient of a different ethnicity has a name that is difficult to pronounce . Though this may seem harmless , it can be perceived as disrespectful .
• Questioning cultural values or communication styles : A healthcare provider may ask a patient “ where are you from ?” or “ where were you really born ?” based a patient ’ s appearance , or the provider may offhandedly call a culturally-driven response to a question “ odd .” These responses or reactions can send a message that the
• Assuming healthcare status : A healthcare provider may assume a patient ’ s healthcare or healthcare payment status based on race or appearance ; this can interfere with identifying the real healthcare issue and administering proper treatment .
• Failing to use interpretation services : A healthcare provider may not choose to use an interpreter for every interaction with a non-English speaking patient . For a patient , however , every interaction matters . Even the act of walking in the room may require a brief explanation like , “ I wanted to see if you ’ d eaten your lunch .”
• Showcasing dismissive behavior : A healthcare provider may exhibit dismissive body language or actions as they go about their daily routines , like spending less time with diverse patients , avoiding eye contact , or adopting a closed posture like folded arms .
These are just a few of the many examples of microaggressions that can erode the provider-patient relationship and can have detrimental effects on health outcomes . Although these actions may be unintentional or may seem small , they add up and contribute to an inequitable health system , which can result in unequal care for all people .
Become More Culturally Competent Nurses need to take time to understand cultural differences when treating patients or communicating with colleagues . Creating an inclusive environment is critical in the healthcare field . Nurses can take several direct steps in their daily responsibilities to address individual and systemic biases and racism , including :
• Documentation . Every microaggression or negative interaction with patients should be recognized and addressed .
• Find an advocate . Look for people in your workplace who will support your movement toward ensuring all patients are delivered quality care .
• Stand up against injustice . Politely correct team members when they are wrong ; microaggressions are often unintentional . If you notice a microaggression , politely correct the person privately .
• Educate yourself . Independent research on how you can improve yourself as a healthcare professional is key .
Nurses have a professional , moral , and ethical obligation to confront racism and discrimination in all its forms . They must work to recognize unconscious bias and promote inclusion for all people in order to provide quality care . Some steps nurses can take to create a more equitable healthcare system include :
• Learn about , identify , and recognize implicit biases . Although nurses may not think they are biased , it is important to work to identify blind spots that can be harmful ( Bucknor-Ferron , 2016 ). For example , nurses may not take time to understand the cultural differences between themselves and the patients they ’ re treating ; that can be harmful .
• Understand cultural differences . This can be done through personal awareness , acknowledgement , empathy , advocacy , and education .
• Understand how racism affects health . Racism contributes to health inequities , so it ’ s critical that nurses educate themselves on the effects of social determinants such as poverty and gender on healthcare and structural determinants of health ( Pérez-Stable , 2019 ). Structural and interpersonal racism can shorten the lives of members of marginalized communities ( Taylor , 2019 ; Ojo , 2020 ). For example , Black people are more likely to die prematurely from heart disease , stroke , COVID-19 , and police violence than white people ( Healy , 2020 ). These systematic disparities can also have a significant impact on Black people ’ s mental health . Additionally , although Asian Americans are one of the fastest growing minority populations , with about 12 million people living in the United States , they remain one of the most under-studied populations ( Ngo Metzger , 2004 ). Asian Americans are more likely to report issues with the care that they ’ ve received in comparison to white people .
• Recognize challenges non-white nurses face . Whether it ’ s a racist patient or racist colleagues , many non-white nurses face discrimination in the workplace on a daily basis ; this can impact their mental health and ability to do their jobs ( Farmer , 2013 ; N . A ., 2013 ). For example , throughout the pandemic , many Asian-American healthcare workers have reported a sharp increase in verbal abuse and physical attacks ( Jan , 2020 ). This comes as a result of patients blaming people of Asian descent for the spread of COVID-19 .
• Engage in self-reflection . Nurses should seek out ways to support inclusiveness , civility , and mutual respect to ensure patient safety ( Warren , 2018 ). It ’ s not enough to be “ not racist ,” nurses must educate themselves and be actively anti-racist in order to make positive , long-lasting personal changes , and changes in the field of nursing and beyond .
20 NSNA IMPRINT n NOVEMBER / DECEMBER 2020 n www . nsna . org