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Improve Quality of Care With Inclusive Healthcare Practices

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By putting those practices to work, nurses are advancing a systemic program of diversity, equity and inclusion that challenges elements called Social Determinants of Health (SDoH). Inclusive practices involve strategies for addressing SDoH such as income, social exclusion, environment and education. Research has found that those factors and others are critical to positive outcomes and should be part of nurse education

“Studies have indicated that medical outcomes account for about 10–20% of a patient’s health outcomes, whereas things like economic stability, education, housing and access to health care comprise the other 80–90%,” according to an article on a World Health Organization (WHO) study.

What Is Implicit Bias and How Does It Affect Patient Outcomes?

Bias can be explicit (conscious motivation of interactions with members of certain groups) or implicit (an attitude toward those members of which a person is unaware). Although implicit bias is unconscious, it creates negative associations and damages personal interactions.

Examples of implicit bias and resulting negative patient outcomes include:

Unconscious racial bias in medicine

Studies have determined that unconscious negative associations with Black, Native American, Hispanic and other patients of color make those in minority groups less likely to receive adequate access to healthcare, which increases their chances of delayed treatments and poorer outcomes in comparison to white patients.

Implicit sex and gender bias in health care

A literature review of 77 published papers found some practitioners are more likely to discount chronic pain in women, deeming it an emotional rather than physical issue, than in men. Similarly, unconscious bias is associated with the reluctance of transgender people for fear of inappropriate treatment.

Impact of sexual identity bias in medical care

Most cisgender, heterosexual healthcare professionals implicitly treat straight patients better than people in the LGBTQ+ community, according to research. Another study found that 80% of medical students held implicit biases against LGBTQ+ people, and members of the LGBTQ+ community avoid treatment for that reason, which results in higher incidences of cancer, substance abuse and obesity.

Such implicit biases and others “permeate the health care system,” according to the Annual Review of Public Health, and “addressing bias remains a fundamental professional responsibility.”

What Are Strategies for Addressing Implicit Bias to Make Nursing More Inclusive?

Implicit bias in nursing can lead to poor outcomes through inadequate patient assessments, inappropriate interpretation of symptoms and conditions, less time spent with patients and insufficient follow-up.

An article by the professional development organization Lippincott Nursing Center recommends a strategy for identifying and eliminating implicit bias with the following strategies:

Paying attention to “gut feelings”

Nurses who take a moment to think before meeting with a patient to recognize any negative emotions — discomfort, anxiety or fear, for instance — that are associated with implicit bias. Reflecting on those emotions, what they mean and where they originated will help uncover negative stereotypes.

Being mindful and in the moment

Rid the mind of distractions, assumptions and judgments to focus on the task. As another implicit bias recognition strategy, mindfulness enables nurses to identify negative stereotypes before acting automatically on them. It also is related to the foundations of nursing: ethics, empathy and compassion.

Adhering to nursing best practices

Developing strong therapeutic relationships and culturally competent, patient-centered care dissolves negative implicit biases and creates positive relationships with patients. Commitment to practicing the Code of Ethics for Nurses — which states that nurses must practice “with compassion and respect for the inherent dignity, worth, and unique attributes of every person” — is the Golden Rule for inclusive healthcare.

Inclusive healthcare practices improve overall patient care, and nurses with a strong foundation in implementing these inclusive practices will be equipped to support their organizations and patients.

Learn more about the University of Louisiana Monroe’s RN to BSN online program.

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