Article2015

Unconscious Race and Class Biases among Registered Nurses: Vignette-Based Study Using Implicit Association Testing

Adil Hussain Haider · Eric B. Schneider · Valerie K. Scott · Sandra M. Swoboda · Cheryl K. Zogg · Nitasha Dhiman +8 more

112 citations0/0 files storedJournal of the American College of Surgeons

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Social and Intergroup Psychology Racial and Ethnic Identity Research Cultural Competency in Health Care

Abstract

BACKGROUND: Implicit bias is an unconscious preference for a specific social group that can have adverse consequences for patient care. Acute care clinical vignettes were used to examine whether implicit race or class biases among registered nurses (RNs) impacted patient-management decisions. STUDY DESIGN: In a prospective study conducted among surgical RNs at the Johns Hopkins Hospital, participants were presented 8 multi-stage clinical vignettes in which patients' race or social class were randomly altered. Registered nurses were administered implicit association tests (IATs) for social class and race. Ordered logistic regression was then used to examine associations among treatment differences, race, or social class, and RN's IAT scores. Spearman's rank coefficients comparing RN's implicit (IAT) and explicit (stated) preferences were also investigated. RESULTS: Two hundred and forty-five RNs participated. The majority were female (n=217 [88.5%]) and white (n=203 [82.9%]). Most reported that they had no explicit race or class preferences (n=174 [71.0%] and n=108 [44.1%], respectively). However, only 36 nurses (14.7%) demonstrated no implicit race preference as measured by race IAT, and only 16 nurses (6.53%) displayed no implicit class preference on the class IAT. Implicit association tests scores did not statistically correlate with vignette-based clinical decision making. Spearman's rank coefficients comparing implicit (IAT) and explicit preferences also demonstrated no statistically significant correlation (r=-0.06; p=0.340 and r=-0.06; p=0.342, respectively). CONCLUSIONS: The majority of RNs displayed implicit preferences toward white race and upper social class patients on IAT assessment. However, unlike published data on physicians, implicit biases among RNs did not correlate with clinical decision making.

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References

2007Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients 2000Aversive Racism and Selection Decisions: 1989 and 1999 2003Paved With Good Intentions: Do Public Health and Human Service Providers Contribute to Racial/Ethnic Disparities in Health?2013Racial Disparities in Surgical Care and Outcomes in the United States: A Comprehensive Review of Patient, Provider, and Systemic Factors 2008Physician Implicit Attitudes and Stereotypes About Race and Quality of Medical Care 2007Interventions to Reduce Racial and Ethnic Disparities in Health Care 2011Association of Unconscious Race and Social Class Bias With Vignette-Based Clinical Assessments by Medical Students 2005Physicians’ Perceptions of Patients’ Social and Behavioral Characteristics and Race Disparities in Treatment Recommendations for Men With Coronary Artery Disease

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