H&I 3: Pop Health: exam 1: racism, discrimination, and implicit bias

ANA discrimination statement

All nurses must recognize the potential impact of unconscious bias and practices contributing to discrimination, and actively seek. opportunities to promote inclusion of all people in the provision of quality health care while eradiating disparities

ANA implementations against discrimination

Intentional or blatant discriminatory practices must not be tolerated and must be immediately addressed.

• Nurses must engage in a period of self-reflection regarding their personal and professional values regarding civility, mutual respect, and inclusiveness, and resolve any potential conflicts in ways that ensure patient safety and promote the best interests of the patient (ANA, 2015).

• Nurses must seek out and support nursing practice environments that embrace inclusive strategies and promote civility and mutual respect regarding patients, coworkers, and members of the community.

• Nurses must advocate for policies that are inclusive and promote civility and human rights for all health care workers, patients, and others within the organization and community.

Nurses must encourage all health care agencies to adopt and aggressively maintain policies, procedures, and practices that embarce inclusiveness, promote civility and mutual respect, contain methods for reporting violations, and require interventions to avoid recurrence

-Nurses must work both within the profession and with other health care professionals, social workers, clergy, and

advocacy organizations to create diverse, inclusive communities that promote, protect, and sustain high-quality,

effective, efficient, and safe health care practices (ANA, 2010).

• Nurses in all environments and at all levels must embrace the concepts of justice and caring, diversity and

inclusiveness, and civility and mutual respect as guiding principles within the provision of health care.

• Nurse researchers must support and conduct research that is inclusive in nature, including diverse populations and

their health care needs.

• Nurse managers, supervisors, and administrators must assess policies to ensure support of inclusiveness, civility, and

mutual respect, acknowledging tha

racism and biology

• For about 200-300 years we have used visual differences to classify

humans into groups we call races

• We have assumed these are clear cut, distinct categories that go deep

into biology - this is not scientifically true

• Race is not biologically real

• Dr Alan Goodman Biological Anthropologist:

• "to understand why the idea of race is a biological myth requires a major

paradigm shift...a shift in perspective"

• "it's like seeing what it must have been like to understand that the world isn't

flat"

• Race is not based on biology, but an idea about difference that we

have ascribed to biology

genetics and race

• 85% of all genetic differences are among individuals of the same race

• There is apt to be as much genetic difference between different races,

as there is between people of the same race

• There is as much or more genetic diversity within racial groups as there

are between racial groups

• Geography is the better way to explain ancestral genetic similarities,

more than race

• This is because many genetic similarities were mutations that conferred survival

• Sickle cell protects against malaria so it is more common in people with ancestry

from geographic areas where malaria is endemic

what is race as an illusion

"Human variation does not map on to what we call race, no matter how we might measure it. Race as biology simply doesn't work"

• This means we cannot scientifically or biologically look to race as a biological cause of health differences

• So if "race" as we know it is not genetic or biologically traceable, why do we see such vast differences in health outcomes among people who we categorize into races?

• Because society has attached meanings and assumptions to skin color that have created enduring social inequality

• Racism and the inequalities in society that have resulted from

what is race

-not a biological construct

-refers to socially significant physical differences such as skin color, rather than biological differences

what is the variation in human DNA that attributes to physiological differences

only 1/10 of 1%

what is the social construction of race

Race is socially constructed

• People come to define a group as a race, based on physical, historical, cultural and economic factors

what is systemic racism

an umbrella term for the deep seated inequality in society and antiblack ideologies

-systemic racism is both historical and ongoing

what is structural racism

• The patterns within our institutions where there are more burdens

and less benefits given to one race compared to another

• This happens throughout the various structures in society, such as our institutions and policies, (residential segregation/housing,

education/schooling, occupation)

• Creates racial disparites

examples of structural racism in policy

-Federal housing policies created racial residential segregation that persists

today

• Racial residential segregation has been identified as an upstream cause of health disparities among Black children for both lead poisoning and childhood asthma outcomes

what is health disparity

a difference in health outcome that

impacts populations experiencing social disadvantage that is systemic, probably avoidable, and unjust

what is social disadvantage/inequality the result of

groups being treated differently at various levels of our society

what contribute to social disadvantage/inequality

macro and micro level discrimination, implicit bias, systemic and structural racism

what do the CDC and health Dept say about racism as a threat to public health

the ways that

systemic racism has created enduring social inequality, and shaped social determinants of health that lead to health disparities among people of color.

what is intersectionality

the ways that class, race, gender, ethnicity, sexual orientation, ability, status, and other markers of difference intersect to inform individual realities and lived experiences

what does intersectionality bring attention to

the ways that power operates in society to create marginalization of multiple groups, while maintaining power of other groups

what is prejudice

beliefs about groups of people based on specific characteristics or identities that make one group better than another

-the groups have hierarchical differences that are measured or judged

what is discrimination

Actions taken (either implicitly or explicitly) based on prejudiced

beliefs that result in treating groups of people differently or creating systems that take advantage of certain groups over others

two types of discrimination

-individual (micro)

-institutional (macro)

what is macrolevel discrimination

oppression and discrimination that happens in the larger society

example of macrolevel discrimination

Includes social institutions, systems,

structures, media, organized religion,

government, education, political system,

economic

what is microlevel discrimination

describes connections among people and issues as seen from a personal or individual perspective

example of microlevel discrimination

family, peers, friends, neighbors

-an intimate or daily interaction

what is individual level racism an example of

microlevel discrimination

what is another form of microlevel discrimination

internalized oppression

what is internalized discrimination

attitude and

behaviors internalized among people who are oppressed themselves by others. These ideas turn inward and reflect thoughts about oneself that reflect the negative

stereotypical beliefs and ideologies that the dominant culture has directed at them

what are microaggressions

unintentional, daily, quick statements or actions of a discriminatory nature, based on dominant culture ideology/discriminatory belief systems

what are racial microaggressions

daily commonplace insults and racial slights that cumulatively affect the psychological well-being of people of color (belittlement, whether intention or unintentional)

who can microaggressions be directed towards

any marginalized group and be multi-layered

ex of microaggression towards transgender

"so have you had the surgery yet"

ex of microaggression towards LGBTQ people

"thats so gay"

ex of microaggression towards nursing students

"youre so smart, why didnt you become a doctor"

Prejudice has to do with beliefs and judgments, and discrimination are the actions taken based on these beliefs

true

Nurse Smith holds beliefs about a certain racial group being less friendly compared to othergroups. This is an example of:

prejudice

Would microaggressions be most accurately

categorized as prejudice and/or

discrimination?

discrimination

bias definition

subjective preference toward a particular viewpoint or belief that prevents a person from maintaining objectivity

Celina is a Latina transgender women in urgent care for an

infection on her hand. The nurse has never taken care of a trans

person before and catches herself staring at Celina repeatedly.

While taking Celina's vitals the nurse asks, "You know at first I

thought you were a real woman." This is an example of:

microaggression

how do biases develop

repeated exposure to stereotypical associates and prejudices which become automated in our long-term memory

what are biases influenced by

-our background, cultural environment, and personal experiences

-biased media representations

-social experiences

definition of implicit/unconscious bias

attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner

-both favorable and unfavorable

-activated without awareness or intentional control (subconscious)

what is implicit/unconscious bias

stereotypes or cultural concepts that influence our decisions and behaviors

how does our brain make sense of massive amounts of data

by categorizing and assigning good/bad judgements

-helps us respond quickly by putting people into groups

what are the unconscious groups we create shaped by

the society we grew up in

how does implicit bias work

Tendency to default to implicit biases is heightened in

stressful situations (nurses are often in stressful situations!)

what happens when we are in stressful situations

our unconscious brain categorizing kicks in

what can our unconscious brain impact in stressful situations

-pt assessments and hx taking

-technical skills and interventions

-time spent with pts

-empathy

-pt education

consequences of implicit biases and pt care

-inadequate pt assessments

-inappropriate diagnoses or tx decisions

-less time involved in pt care

-pt discharges with insufficient follow up

what is the cause of health disparities

implicit bias

do racial and ethnic minorities receive lower quality health care than non-minorities

yes

who may nurses hold implicit biases towards

-elderly

-obese

-LGBT

-mentally ill

-use injection drugs

how do we acknowledge implicit bias

• Having implicit bias is a part of the human condition

• Our brains are managing information using the filters we were given

• We can identify the biases that are causing harm and intervene to

change our behavior

• First step is to identify them, then use strategies to reduce them

what is the implicit assessment test

an effective way to identify any implicit biases you may have

do we all have implicit biases

yes this means we are human and reflecting

the culture around us. This is not bad. It is simply a reality that we can do something about to reduce the harm it is having on health care we are providing

what is counterstereotypic imaging

replace an image of a stereotypical group member with the image of someone who is in that group but does not fit that stereotype

what is emotional regulation

recognize negative reactions (fear, anxiety, frustration) to pts from vulnerable groups and intentionally strive to be empathetic, patient and compassionate

what is individuation

mindfully seek to see the pt as an individual instead of a member of the stigmatized group

-address any assumptions that are coming up about the group so they are not impacting care of the individual

what is mindfulness

calm our thoughts, take a deep breath, pause before speaking

what is perspective taking

purposely and empathetically think about what the patient is thinking and feeling, stimulating feelings of caring and compassion

-put yourself in their shoes

what is partnership building

intentionally frame the clinical encounter as one where the nurse and pt are equals, working collaboratively toward a shared goal

true or false: implicit biases started forming at a young age and are further shaped as someone matures

true

which aspects of nursing care might be impacted by implicit bias

-body language

-focused attention

-level of care

when is it more likely for implicit bias to impact our actions

under stressful situations

what is self-reflection

a process of observing- not judging ourselves, but observing our thoughts, feelings, actions, and speech

research has shown that unconscious biases may cause us to make decisions that contribute to

health disparities

what is the best first step in helping to reduce health disparities among populations that experience discrimination

understand one's own implicit biases

what is self-reflection a conscious exploration of

• Your reactions, emotions, thoughts, stories

• How it feels in your body (tense, excited,

nervous, calm, disconnected)

what is a self-reflection an honest exploration of

• Your assumptions & beliefs

• Where did these come from - which ideologies

are you influenced by?

• Is this impacting your actions? (words are actions)

what is our goal as nurses in terms of observing and evaluating

practice observation without evaluation

-strategy for empathic communication

-strategy for self-empathy

evaluations in nursing

• Judgment about what we see because our emotion gets mixed

in

• Based on our reactions,

emotions, assumptions, or our own needs not being met

observations in nursing

• Expression of what we observe

• Stimulates a reaction within us

• But we separate out what is outside of us from what is our inside reaction

• Like a video camera recording what we can see and hear

• Without our inner commentary

emotions to notice for self-reflection

• Frustration, shock, disbelief, anger, judgments, denial

• May be learning something new that is clashing with your personal beliefs or assumptions about a certain group of people

• May be hitting close to home, your own personal experiences, your own internalized

oppressions

• May be pointing at a need you have for compassion, justice, fairness, clarity, understanding

• Explore where you may be making evaluations vs observations

• Practice the strategies for reduci