Community Health: Bias, Stereotypes, Implicit Bias, and Resolve

How does the community health nurse recognize bias, stereotypes, and implicit bias within the community?

Bias describes an explicit form of bias which is centered on one’s discriminatory values and beliefs (Marcelin et al. 2019). It is targeted in nature and can manifest in terms of race, prejudice, homophobia or bigotry. One notable example of bias in medical profession is the famous Tuskegee syphilis study where black men were targeted to investigate the impacts of untreated, latent syphilis (Marcelin et al. 2019). Implicit bias refers to attitudes or associations that unintentionally change one’s perception (Staats & Patton 2013).

Resolving implicit bias, stereotypes and bias is very difficult. Among dedicated community health nurses (CHNs), it may be particularly hard to consider the likelihood of harboring unconscious stereotypes and bias. The truth is that CHNs live in a society where stereotypes regarding groups of people are ever-present, and it follows that everyone has implicit bias. The best way to resolve these concept is to acknowledge their presence, and constantly reassess how one feels. Language barrier and regional inflections may cause a nurse to assume a community or an individual has certain behaviors, beliefs or traits they might disagree with.

Nurses can recognize that feeling or assumption when they are trying to promote health, when explaining behavior change and treatment or when responding to patient’s needs.  Hall et al. (2015) indicate that unconscious bias is significantly associated with patient-provider interactions, treatment decisions and treatment adherence. Recognizing unconscious stereotypes and bias implies that CHNs understand they might have some feelings about groups of people, mannerism and appearances that require being resolved to better serve the community. 

How should the nurse address these concepts to ensure health promotional activities are culturally competent?   

The first step is to acknowledge the problem and understand why it matters. If one is not aware of how they are feeling towards certain groups of people, their focused attention, their body language and their level care will be affected directly by the way they feel.  It is when the problem is acknowledge that one moves to resolve it. Resolving conscious bias requires sufficient time and training to change one’s attitudes and actions in addition to a different set of tools. 

For implicit bias and stereotype, deliberate self-reflection is necessary. The nurses can reflect on their own beliefs, and behaviors to ascertain how implicit bias and stereotypes may emerge when interacting with a member of a different group or background and correct. If nurses understand that stereotyping and unconscious bias are normal facets of human cognition and often unintentional, they can be more open to learning about the concepts and how they affect delivery of care.

Propose strategies that can be employed to reduce cultural dissonance and bias to deliver culturally competent care.

Talking with the patient and community members is a best way to learn more about them. This may give the nurse a basic understanding of cultures or orientations the patient hails from. It is also best that the nurse sees the patient as an individual and individuate him or her as opposed to a stereotype. A nurse needs to recognize where a response is centered on implicit bias and consciously alter the response. Respecting and appreciating cultural differences can help the nurse become aware of any implicit bias and stereotype and start to correct it. Talking about stereotypes and implicit bias in work setting can open the conversion and open the way for better interaction.

Reference

Hall, W. J. et al. (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):e60-76.doi: 10.2105/AJPH.2015.302903

Marcelin, J. et al. (2019).The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It. The Journal of Infectious Diseases, 220(2), s62-s71      

Staats, C, & Patton, C. (2013). State of the science: implicit bias review: the  Ohio  State  University  Kirwan  Institute  for  the  study  of  race and ethnicity. OH: The Kirwan Institute for the Study of  Race  and  Ethnicity  at  The  Ohio  State  University. 1–102.