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October 30, 2017

Nursing textbook recalled after backlash for stereotyping how racial, ethnic groups experience pain

Daily Briefing

    Following backlash over a nursing textbook that included stereotyped descriptions of how different racial, ethnic, and religious groups supposedly respond to pain, textbook publisher Pearson Education has apologized and vowed to recall all copies of the book.

    How to address health inequity in your community

    The textbook, titled "Nursing: A Concept-Based Approach to Learning," contained a section that was titled "Cultural Differences in Response to Pain." Some of the guidance included:

    • "Arabs/Muslims … may not request pain medicine but instead thank Allah for pain if it is the result of a healing medical procedure";
    • "Blacks often report higher pain intensity than other cultures" and think that "suffering and pain are inevitable";
    • Filipinos view pain as "the will of God";
    • "Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven";
    • "Indians who follow Hindu practices believe that pain must be endured in preparation for a better life in the next cycle";
    • "Jews may be vocal and demanding of assistance"; and
    • "Native Americans may prefer to receive medications that have been blessed by a tribal shaman."

    The book, which sells for around $235 on Amazon, was brought to the public's eye by Onyx Moore, a wellness advocate, who posted a picture of the section on social media. Moore called the material "racism across the board," saying, "These assumptions are not evidence based; they encourage nurses to ignore what a patient is actually saying (if someone tells you their pain level is high, you need to believe them), they list common behaviors as culturally specific (most people are more comfortable being honest about their pain with family members/those close to them), and they don't actually teach nurses how to engage in a culturally sensitive way."

    She also argued that the chart "lumps together various groups whose belief-systems vary widely," mentioning that both Jews and Muslims could fall under any of the racial categories that were mentioned in the section.

    Pearson apologies

    The backlash over the textbook led Pearson to apologize and vow to recall any copies of the book containing the material.

    "While differences in cultural attitudes towards pain are an important topic in medical programs, we presented this information in an inappropriate manner," the company said in a statement to Mic. "We apologize for the offense this has caused and we have removed the material in question from current versions of the book, electronic versions of the book, and future editions of this text. In addition, we now are actively reviewing all of our nursing curriculum products to identify and remove any remaining instances of this inappropriate content that might appear in other titles."

    The company also said that the material "does not reflect our values as a company and how we want to serve students" and that it is working with its editorial board to determine how the material was published in the first place.

    Tim Bozik, an executive at Pearson in charge of global product development, also issued a video apology for the book. "In an attempt to have nursing students think through the many facets of caring for their patients, we reinforced a number of stereotypes of a number of ethnic and religious groups. It was wrong," he said. "We should have been more thoughtful about the information we put into our curriculum." He added that the company is reviewing its other nursing textbooks for similar content and that "if we find it, we will remove it" (Parker, Atlanta Journal-Constitution, 10/21; Jaschik, Inside Higher Ed, 10/23; Hilliard, The Boston Globe, 10/20).

    How to address health inequity in your community

    With the shift in health care to focus on optimizing the health of individuals and communities, health care organizations are creating new strategies to address health care disparities in access and patient outcomes.

    Advisory Board has created the Health Disparities Initiative, which provides actionable resources on a series of strategic imperatives and special topics to achieve equity of care. Interested in seeing research or resources that address your biggest health equity problems?

    Download our resource, "Building Community Partnerships to Reduce Disparities," which includes studies featuring providers who have successfully partnered with community organizations to address health disparities and social determinants of health. You'll also find tools that can guide your organization’s community partnership strategy.

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