Matter for Discussion: Inequality

This matter for discussion was adopted as a resolution, and subsequently passed.

Members can view a recording of the debate here.

The death of George Floyd brought into sharp focus the extent of racial disparity across all walks of society. Today, there is new energy and importance given to discussions about racial discrimination, including structural, ideological racism and systemic white privilege (Burnett et al., 2020). The nursing profession must harness this energy to review the equity of our training and practices.

During the education of student nurses, it was observed that 94% of the mannequins/body parts (Feranda et al., 2017) used for simulation training (CPR, taking blood pressure, dressing wounds etc) were white. Racial inequality is further seen in the prominence of white case study examples and a lack of consideration for how the health conditions display for people with different skin colours. This directly impacts professionals, from nursing students to experienced practitioners.

Crucially, many may be ill-equipped to identify health problems in ethnic minorities or give consideration about cultural impacts on health. Skin cancer is one area where racial inequality can harm patient care. According to the Skin Cancer Foundations ‘Skin of Colour’ programme, the estimated five-year melanoma survival rate for Black people is 71% compared to 93% (Skin Cancer Foundation, 2022) for white people. The identification and treatment of skin
conditions, such as pressure ulcers and jaundice, may also go undiagnosed because of systemic inappropriate education.

As we reflect on the successful vaccination programme for COVID-19, we need to learn the lessons from a culturally and ethnically sensitive approach to health care. The joint approach of a public health issue, working with Ethnopharmacology, the use of culturally sensitive materials and the use of easily accessible venues was key to the success of the vaccination programme, especially with the ethnic minority community.

Mind the Gap: A Handbook of Clinical Signs in Black and Brown skin and the website created by a medical student in 2020 with the aim to highlight the lack of diversity in medical literature and education. Why did it have to be a medical student’s responsibility to raise the awareness for a problem that effects a huge proportion of our population. They went on to create ‘HUTANO’, a platform for Black and Brown people to discuss their skin health. The gaps in health care
professionals’ education should not be the responsibility of the students from ethnic backgrounds instead of everyone involved.

Ethnic minority staff makes up 22.1% of the NHS workforce with 77.9% of NHS staff in England being White, compared to 86% of the general population in England and Wales (UK Government, 2021). Despite the high representation of ethnic groups in the NHS, there remains a low number of Black nurses in senior roles which may reflect why skin colour is not considered during clinical diagnosis. Our profession must reflect on the biases that clouds our training and practices.

Prioritising these changes must happen at the highest levels of leadership and learning resources must also reflect different and multiple ethnicities to account for differences and similarities in patient assessment and diagnosis.

There must be an increase in the visibility and influence of people and professionals from racially minoritised groups in academia and leadership; this is essential to continually counter to historic colonialism and racism. Only then will the racial trauma experienced by diverse ethnic groups be reduced or removed from the provision of good quality care. Ultimately resulting in improved health
outcomes when diagnosis and treatment are done competently, from exposure and awareness of disease presentation on different people, especially those from ethnic backgrounds.

Reading lists for each agenda item can be found here.

References

Burnett A, Moorley C, Grant J, Kahind M, Sagooe R, Rivers E, Deravin L, Darbyshire P (2020) Dismantling racism in education: In 2020, the year of the nurse & midwife, “it's time.”, Nurse Education Today, 93, October 2020. https://doi.org/10.1016/j.nedt.2020.104532 

Foranda C, Baptiste D-L, Ockimey, J (2017) As Simple as Black and White: The Presence of Racial Diversity in Simulation Product Advertisements, Clinical Simulation in Nursing, 13 (1), pp. 24-27. https://doi.org/10.1016/j.ecns.2016.10.007

Mukwende, M, Tamony, P and Turner, M (2020) Mind the Gap: A handbook of clinical signs in Black and Brown skin, St George’s Hospital: London.  https://www.blackandbrownskin.co.uk/mindthegap (Accessed 25 April 2022)

Skin Cancer Foundation (2022) Skin cancer and skin of color, Available at: https://www.skincancer.org/skin-cancer-information/skin-cancer-skin-of-color/ (Accessed 22 April 2022)
UK Government (2021) NHS Workforce, Available at: https://www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest (Accessed 22 April 2022)