In health care settings, patients are usually faced with a myriad of challenges that in most cases, affect the levels and quality of service that they receive. The most notable problems that have been for a long time persistent in health care are gender and racial bias. In general, gender and racial bias in healthcare refer to scenarios in which disparities in the quality of service provided by health care professionals exist as a result of the gender or ethnicity of the patients. According to Carroll (2019), instances of racial and gender bias in the healthcare sector are consistent with the situation in the general population. Additionally, these biases have also been shown to affect the decision making processes in health care professionals (Carroll, 2019).
Although numerous efforts have been initiated to stem gender and racial biases in health care, implicit bias remains a challenge. According to Hall and colleagues (2015), implicit attitude, thoughts and perceptions usually exit beyond the conscious awareness of an individual. Consequently, it is difficult to control and acknowledge implicit biases because they are typically activated automatically influencing the behavior of an individual without his or her conscious volition (Hall et al., 2015). The purpose of the present study is to evaluate the prevalence of implicit gender and racial bias in health care settings and the effects that gender and racial prejudice have on the delivery of quality care to their patients. Additionally, this study will also illuminate the causative factors behind the prevalence of gender and racial bias in health care and highlight measures that can be initiated by nurse leaders to reduce racial and gender bias.
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Nurse leaders must understand the effects of gender and racial bias in health care. With this understanding, nursing leaders will be better placed to ensure that patient-provider interaction within their facility through the reduction of instances in which patients may be exposed to implicit gender or racial bias. By reducing the levels of gender and racial prejudice, nurse managers will be able to ensure that appropriate treatment protocols, communication strategies, and clinical decisions are enhanced in their facilities (Fitzgerald & Hurst, 2017). The forenamed facts are imperative in promoting equitable health care and favorable patient outcomes to all patients.
Literature Review
Disparities in the delivery of healthcare service in the United States have been present over the years. In most cases, some of the reported disparities in the level and quality of care received have been associated with the race or gender of patients illuminating that racial and gender bias to be causative for these disparities. According to the study by Hall et al. (2015), people of color comprise one group that experience disparities in healthcare. People of color face some barriers and hurdles that hinder their access to healthcare services such as acute treatment, management of chronic diseases and preventive services. Hall and colleagues (2015), and Blair and colleagues (2011 observed that people of color have reported lower levels of satisfaction with regard to the levels of care received and their interactions with health care professionals. Besides, this study also highlighted the fact that as opposed to African Americans, Asian, American Indians and Hispanic patients, white Americans are more likely to receive better health care.
Disparities in the quality of care received by patients are not only limited to racial bias but have also been shown to be as a result of gender bias. Research studies have indicated that women are most likely to experience health care disparities as opposed to their male counterparts (Gerul et al., 2019). For instance, studies have shown that it has been shown that women presented to emergency rooms with conditions such as cardiovascular complications are more likely to succumb to their conditions as opposed to men (Gerul et al., 2019).
Although there exist biological differences between men and women that can be pointed out as being causative for their differing patient outcomes, gender bias also affects the level and quality of service received by women. According to Hall and colleagues (2015), medical training has been for a long time being carried based on the average patient being a white, seventy-five-kilogram male. Consequently, women patients and their underlying conditions have been relegated, resulting in implicit gender bias. Additionally, medical equipment and devices such as surgical equipment, hip replacements, prostheses, and implants have also been implicitly designed and produced for male physician hands and bodies. The forenamed are typical examples of situations that breed gender bias in the quality of care received in clinical settings.
Implicit bias influences behaviors, attitudes and decision making among health care practitioners, albeit unknowingly (Marcelin et al., 2019). Implicit racial and gender bias in American healthcare settings have been linked to the differences witnessed in the health status, morbidity and mortality in people of color. Some of the effects associated with implicit bias, in this case, include higher infant mortality rates in African Americans, American Indians and Hispanic American communities in comparison to white Americas. Besides, in the United States, implicit bias in health care has also been linked to the high rates of premature deaths as a result of stroke and heart disease among African Americans (Fitzgerald & Hurst, 2017)
The effects of implicit bias are not only limited to the patient outcomes and adverse health conditions among people of color in America. Still, they are also manifested in their perceptions of their overall wellbeing. For instance, as compared to white and Asian Americans, American Indians, black and Hispanic Americans are more likely to rate their health poorly in addition to reporting more days of being unwell (Hall et al., 2015).
Solutions
Nurse leaders usually have a difficult time in managing implicit bias in health care settings owing to the intrinsic blind spots that characterize implicit bias (Banaji & Greenwald, 2016). Consequently, control and management of implicit racial and gender bias require nurse leaders to be constantly vigilant and committed to making a difference in their practice (Bucknor-Ferron & Zagaja, 2016). The first step in combating implicit racial and gender bias is the recognition of its existence in health care and the appreciation of the effects that the disparities that emanate from these biases have on the delivery of care and overall patient outcomes.
After acknowledging the presence of implicit racial and gender bias, nurse leaders must initiate strategies that will aid nurses to develop their awareness of this issue. Considering that implicit biases emanate unconsciously and vary from one individual to another, creating an avenue through which nurse will be in a position to evaluate and recognize their unconscious bias is helpful in the development of self-regulatory behaviours among them. In return, that will work to mitigate bias in their interactions with patients (Bucknor-Ferron & Zagaja, 2016). Additionally, through enhanced personal awareness, nurses can develop appropriate internal compasses to guide their interactions with patients.
Education is another vital tool at the exposure of nursing leaders in their efforts to reduce instances of racial and gender bias in health care. Primarily, through educational sessions, self-awareness among nurses can be enhanced positively, impacting their overall perceptions and attitudes towards patients (Bucknor-Ferron & Zagaja, 2016). Additionally, through educating nurses on racial and gender bias issues, nurse leaders are better placed to emphasize the need for nurses to build therapeutic relationships with their patients based on empathy even in scenarios that may prove difficult for nurses to be empathetic. Moreover, nurse leaders should provide forums where nurses can interact and educate each other on how to handle bias in their professional duties (Bucknor-Ferron & Zagaja, 2016). It should be noted that by enabling an environment in which nurses are free to share their experiences, nurse leaders provide an avenue for various options to mitigate against this challenge are availed.
Another critical intervention that nurse leaders can initiate to tackle racial and gender bias within their facilities is advocacy. In this regard, nurse leaders should be on the forefront leading by example in supporting patients in issues such as navigation of the health care system, communication with other members of the health care team, championing for patient rights, and the identification of the best treatment plans for patients (Bucknor-Ferron & Zagaja, 2016). Besides, nurse leaders should also emphasize the need for nurses to perform their duties professionally and with both compassion and tact to minimize instance in which bias may crop up.
Although the forenamed interventions are essential in reducing instances of racial and gender bias in healthcare, the best intervention that nurse leaders may initiate in their facilities is the enhancement of cultural competence among nurses. The rationale behind applying this method emanates from the fact that racial and ethnic diversity are presently on the rise in society, thereby increasing the chances for racial and gender bias in healthcare. In practice, through enhanced cultural competence, nurses will be in a position to understand the cultural differences and beliefs possessed by different members in diverse patient populations, consequently reducing racial and gender bias within healthcare facilities. In clinical settings, cultural competence can be achieved through commitments by nurse leaders to expand cultural knowledge within their facilities. Secondly, nurse leaders also have to ensure that they create supportive environments in which staff members can achieve and develop greater understandings of cultural issues.
Moreover, nurse leaders should create working environments where nurses can interact with their colleagues and patients from different cultural and social backgrounds (Gerull et al., 2019). Lastly, nurse leaders have to be proactive in the resolution and recognition of emerging conflicts within their facilities. In this regard, nurse leaders have to encourage staff members to report any instances of gender or racial bias within their facilities.
Conclusion
Racial and gender bias in health care has been linked to disparities witnessed in the provision of care. Although the bias, in this case, is usually implicit, it has a significant impact on the quality of care as well as patient outcomes for affected individuals. Nurse leaders have an essential role in mitigating against the prevalence of racial and gender bias in their facilities. Several interventions can be put in place by nursing leaders to mitigate this challenge. However, individual acknowledgement of the presence of unconscious bias among health care professionals is paramount in achieving success. The elimination of implicit racial and gender bias is crucial in ensuring that barriers faced by patients within the health care system are eradicated and that all patients receive equitable care.
References
Banaji, M. R., & Greenwald, A. G. (2016). Blindspot: Hidden biases of good people . Bantam.
Blair, I. V., Steiner, J. F., & Havranek, E. P. (2011). Unconscious (implicit) bias and health disparities: where do we go from here? The Permanente Journal , 15 (2), 71–78.http://www.thepermanentejournal.org/files/Spring2011/HealthDisparities.pdf
Bucknor-Ferron, P., & Zagaja, L. (2016). Five strategies to combat unconscious bias. Nursing , 46 (11), 61-62. https://doi.org/10.1097/01.nurse.0000490226.81218.6c
Carroll, A. E. (2019, February 25). Doctors and racial bias: still a long way to go. The New York Times. https://www.nytimes.com/2019/02/25/upshot/doctors-and-racial-bias-still-a-long-way-to-go.html
Fitzgerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics , 18 (1), 19. https://doi.org/ 10.1186/s12910-017-0179-8
Gerull, K. M., Loe, M., Seiler, K., McAllister, J., & Salles, A. (2019). Assessing gender bias in qualitative evaluations of surgical residents. The American Journal of Surgery , 217 (2), 306-313. https://doi.org/ 10.1016/j.amjsurg.2018.09.029.
Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K. … Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal of Public Health , 105 (12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903
Marcelin, J., Siraj, D., Victor, R., Kotadia, S., & Maldonado, Y. (2019). The impact of unconscious bias in healthcare: How to recognize and mitigate it. The Journal of Infectious Diseases , 220 (2), S62-S73. https://doi.org/10.1093/infdis/jiz214
