A few years ago, Mercer’s nursing program used a textbook titled Nursing: A Concept Based Approach to Learning Vol. 1, 2nd Edition from Pearson publications that contained racial and ethnic bias.
In one example marked “Focus on Diversity: Cultural Differences in Response to Pain” the book said that “Blacks often report higher pain intensity than other cultures. They believe suffering and pain are inevitable. They believe in prayer and laying on of hands to heal pain and believe that relief is proportional to faith” (161).
Professor Elizabeth Mizerek, Director of Nursing and a Diversity, Equity and Inclusion committee member, says, “When [the bias] came to our attention, we went back and right away looked at it and we were like ‘oh God this is awful, this is not what we want.’’”
Professor Mizerek says the nursing program evaluates its curriculum regularly to avoid that kind of bias and misinformation.
She says, “That’s part of what we’re working on just looking at the books and saying is this the best book? Is this the best resource?… Does it meet our needs to support student learning?”
For decades many medical textbooks have treated racial and ethnic minorities, particularly Blacks, as impervious to or more tolerant of pain and the results have impacted how doctors and nurses treat patients and the level of care they receive.
According to a study in Proceedings of the National Academy of Sciences of the United States of America, (PNAS), “…patients were asked to report how much pain they were experiencing, and physicians were asked to rate how much pain they thought the patients were experiencing. Physicians were more likely to underestimate the pain of black patients (47%) relative to nonblack patients (33.5%).”
Another PNAS study of nearly one million children diagnosed with appendicitis “revealed that, relative to white patients, black patients were less likely to receive any pain medication for moderate pain and were less likely to receive opioids.”
Elizabeth Baur, a white first-year Nursing major at MCCC, says “I do not believe black people have thicker skin than white people or any other ethnicity and this definitely does not make them more tolerable to pain.”
Nevertheless, countless students at MCCC and at colleges nationwide have been exposed to the Pearson book and potentially others like it over the years.
Dr. Pamela Price, MCCC’s Library Director, who is Black and also serves on the Diversity, Equity and Inclusion Committee, says, “Yes, [the librarians] are concerned. We’re concerned and this is something that’s talked about on a national level through the American Library Association.” She continues, “I think that we have also taken a look at ourselves personally, a look at ourselves professionally to see how collectively the library community works with matters such as this.”
According to the article “Anger Over Stereotypes in Textbook,” from Inside Higher Education in 2017, “Onyx Moore, a wellness advocate, appears to be the person who first spotted the material and shared it online in a post that has been widely shared on social media.” The article added, “Many others quickly joined in, saying that they were stunned that a major nursing textbook could be teaching such stereotypes. People involved in health professions education were particularly vocal.”
Pearson’s President Tim Bozik sent out a series of tweets apologizing for the content and saying the material would be removed. He also expressed his apologies in a YouTube video posted in October 2017. Bozik said, “Hello, I’m Tim Bozik and I lead Global Product Development at Pearson, and I want to apologize. In an attempt to help nursing students think through the many facets of caring for the patients, we reinforced a number of stereotypes about ethnic and religious groups. It was wrong.”
Pearson ultimately recalled those textbooks and this helped MCCC’s and other nursing programs begin to switch to more appropriate learning material.
MCCC Nursing faculty member Professor Adena Romeo-Ratliff says, “We did not switch right away but the company put out a retraction and correction in their ebook version of the text that our students then could access for free… We then switched hard copy textbooks once the new version became available which I believe was 2 years ago.”
Pearson recalling their old version of those textbooks plus the efforts of the nursing program to improve their curriculum may help future nurses take minority groups’ pain seriously in the medical environment.
Elizabeth Baur says, “No one should be afraid that a doctor or a nurse is going to dismiss their pain… It is the job of doctors and nurses to listen to the patient and believe them.”
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NOTE: This article has been edited to clarify that while it is not certain that MCCC students in specific have been exposed to other books like Pearson’s the possibility of encountering racist materials in medical textbooks over the decades is very high.
