Healthcare academics must recognise the need for equity, rather than equality. Pathway Lead in Community Nursing and Teaching Fellow at the University of Surrey, Neesha Oozageer Gunowa, writes about the need for skin tone diversity in nurse practice and education.
Nursing has long worked to legitimise itself as a profession through its devotion to empirical knowledge, but it is important to consider if nurse educators are considering which areas have not been explored in significant detail due to whiteness being the norm. Through my PhD work, which focuses on nurse education and skin tone diversity through the lens of pressure ulcers, it was seen that nurse academics only briefly acknowledged pressure damage among people with dark skin tones in the classroom (Oozageer Gunowa et al., 2020). Terms referring to visual changes in skin tone and appearance were often white centric with words such as pinkness, redness and mottling frequently used. This tokenistic approach to inclusion may appear to be an omission due to a lack of evidence, however, the impact on the next generation of nurses leads to serious consequences including longer hospital stays, health inequities, psychological and physical trauma for people with dark skin tones. The Black Lives Matter movement reminds us that this omission and health inequity forms part of structural racism and needs to be addressed.
We simply cannot continue to superficially educate tomorrow’s nurses while avoiding responsibility for the transformations we need to make. I have published numerous collaborative papers and blogs as well as presented at international conferences to disseminate my work. The language used by both clinicians and educators is often a barrier to tackling long standing issues surrounding change in care related to racial identity (Oozageer Gunowa et al., 2021). People often shy away from discussions due to the fear of upset, made to feel uncomfortable, offence or coming across as ignorant. With a fear or even a lack of terminology and language relating to people with dark skin tones health inequity has been solidified.
Nurse academics must recognise the need for equity rather than equality. We need to acknowledge that there is a difference across skin tones and by ignoring these differences we are causing more harm to a defined population group. As nurse academics and clinicians, we need to move away from a colour-blind approach where colour is seen to be invisible and appreciate the differences so that actions can be taken for a change in healthcare and nurse education. These actions need to encompass the awareness that the presentation of pressure ulcers may not always be visible and that national campaigns focusing on redness are actually encouraging health disparities and fuelling the view that white is the ‘norm’. Recommendations include nurse academics moving forward in their thinking and delivery of care to question practice, research and education in relation to white normativity. Nurse academics need to empower and encourage nurses to speak up about inequities in healthcare. Moving forward, we need to truly call out racism and white supremacy in all its forms by recognising that being tokenistic and ignorant to differences can lead to health inequalities faced by people with dark skin tones.
Sometimes we need to look beyond the obvious in order to enable clinical excellence to occur.