Pressure injuries and skin tone diversity in undergraduate nurse education: Qualitative perspectives from a mixed methods study.

Neesha Oozageer Gunowa,Helen Aveyard,Marie Hutchinson,Joanne Brooke,Debra Jackson

doi:10.1111/jan.14965

Abstract

To, firstly, explore student and academic nurse perceptions of classroom content about the assessment and identification of pressure injuries across skin tone diversity and, secondly, to describe the impact of classroom content on student nurse understanding of pressure injury in people with dark skin tones. Qualitative case study employing focus groups and semi-structured interviews. Five higher education institutions in the United Kingdom were purposively chosen. At each of the five-case sites, one focus group with student nurses and one semi-structured interview with a nurse academic were conducted between May 2018 and April 2019. The participants' narratives were transcribed verbatim and analysed via thematic analysis. Classroom learning was predominately framed through a white lens with white normativity being strongly reinforced through teaching and learning activities. This reinforcement of white normativity was evidenced through two main themes: (i) dominance of whiteness in the teaching and learning of pressure injuries in undergraduate nurse education and (ii) the impact and implications for student nurses of whiteness as the norm in pressure injury teaching. Nurses responsible for the design and delivery of teaching and learning experiences for nursing students need to ensure meaningful teaching and learning experiences. This learning should assist future nurses to interrogate their complicity in a system of white dominance. Nurse education delivered today influences and shapes nurses of the future. Nurses are the cornerstone of healthcare and play a significant role in the delivery of equitable healthcare. Nurse academics have a duty of care to inform and highlight health inequities in nursing and ultimately to enhance equity in care.

Highlights

Pressure injuries are a global concern and are indicative of care quality and experiences of patient care (Li et al, 2020)
Thematic analysis revealed an overtone of blindness to skin tone diversity in the nurse education, which left skin tone variances
University policy and nursing theoretical frameworks were employed by students and academics to evidence a commitment to skin tone diversity

Summary

Introduction

Pressure injuries are a global concern and are indicative of care quality and experiences of patient care (Li et al, 2020). The resurgence of the Black Lives Matter movement (Black Lives Matter, 2020) serves as a stark reminder that there exists a system of privilege based on race across the globe This concept does not evade healthcare as it is well known that people of colour are devastatingly affected by early onset of disease and disproportionately affected by leading causes of death compared with their white counterparts (Baptiste et al, 2020). The consequences of early-stage pressure injuries not being detected and pressure injuries worsening without the usual preventative measures in people with dark skin tones expose deeply entrenched racial inequity (Coates, 2008). Failure to address this inequity risks perpetuating inadequate pressure injury care for people with dark skin tones. In practice, there is evidence of shying away from potential confrontation in relation to seeing and addressing differences based on skin colour (Moorley et al, 2020)

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Conclusion