There exist many ways to recognize and manage bias in academic and professional relationships. Most common bias observed in healthcare is said to be the unconscious or implicit bias observed in the professional relationships built by the nurses, with the patients in the hospital settings (Hall et al., 2015). An example could be devotion of less time by the nurses in patient care or doing a rapid assessment in LGBTQ patients or I/V drug user patients or towards any kind of a racial, ethnic, religious minority as well. This bias could alter the attitude or association between the nurses and the patients and prevent the building of a proper therapeutic relationship between the two. A more coercive relation of power is observed in this scenario where it positions certain individuals and groups of people in a subordinated relationship with each other leading to bias. This implicit bias may lead to a reduction in the quality of care provided to the patient or some unintended disparities like not doing a proper follow-up of the patient post-discharge or just fulfilling a duty for the sake of doing it instead of completing it with adequate devotion (FitzGerald, 2017). This bias might unconsciously have an influence on the way any kind of information is processed about a person which leads to disparities which are unintended and have consequences in patient care. It arises due to hidden perceptions and memories about people (Marcelin et al., 2019). It can be mitigated by individualization where specific personal history of the individual is learnt, increasing opportunities of contact with people in different groups and dissolve stereotypes about them or replace negative images about a particular section of people with a positive image. Thus, implicit bias may come up unintentionally in professional interactions and it is necessary to provide educational sessions in order to help reduce it and improve patient care.
Cultural border crossings and shared learning help in the creation of better power relations in shared learning. Most common cultural border crossing in terms of academic and professional development in nursing includes being able to learn and understand another person’s culture, in terms of the diverse patients and individuals that the nurses interact with in their professional realm (Clary, 2016). A better example would be to improve your own understanding of the culture of the various ethnic/indigenous minorities so as to prevent biases towards them while providing health care and treatment, in practice. This cultural border crossing will help in improving power relations between the nurses and the patients in terms of improving it to a more collaborative power relation instead of a coercive relation of power. A collaborative relation of power is when the power to act is created with others where the individual is able to affirm his/her identity and amplify the power of self-expression as well. There is positive learning and more intercultural orientation in this kind of a power relation and setting which helps in establishing a more transformative pedagogy of learning. More adjustment in terms of understanding, being more accommodative and increasing own awareness about other person’s culture and way of working is required in order to improve shared learning and also, improve professional interactions as well (Rittle, 2015). Thus, it can be concluded that better and improved learning occurs in cases where adequate cultural border crossings have been achieved and helps in improving the power relations to a more collaborative nature and improve patient outcomes as well.
The practice of cultural sensitivity is essential and principal to building effective learning relationships, because it helps the nurses to step outside their own perspectives or realms to develop a better understanding of the varied and unique needs of the families and patients to whom the care is provided. It helps in acknowledging privilege and developing equity, which eventually helps in building learning relationships across cultures (Kaihlanen et al., 2019). An example could be the nurses recognizing, responding, redressing and sustaining even the subtlest form of inequity, like the nurses trying to push against common cultural assumptions about all aboriginal/indigenous patients coming for access to care. Acknowledging the privilege of the majority group and understanding the differences and the privilege not available to the minority groups will help in better development of cultural sensitivity and cultural empathy and build a better learning environment. Also, developing cultural respect and empathy towards diverse cultures and understanding their point of views and acknowledging their differences will help in better respecting them, and thus reduce the bias towards them that may develop unknowingly and improve power relations and delivery of care to the patients (Clary, 2016). Development of equity will help in identifying any kinds of denigration in the patient’s care based on his/her race or ethnicity. This will help improve practice and develop an equitable environment that is culturally sensitive. Thus, development of cultural sensitivity in terms of empathy and understanding helps in developing equity and acknowledging privilege as well, which leads to improved patient outcomes.
Diversity means a variety of things or people or cultures. It means the inclusion of a variety of different cultures, competencies and people in cross-cultural learning and work environments. Cross cultural learning will involve the understanding and development of increased ability of the individuals in an organization, or in this case nurses in the hospital or in the health workforce to understand the culture of other ethnicities , groups and minority people; their values and ethos of another culture as well. It also leads to the development of an interest in the employees to understand their own cultural background and heritage as well. For example, being educated about the different cultures and values of the colleagues- nurses, or patients that come for availing healthcare facilities. This understanding of diversity by the nurses in their professional relationships with patients and with colleague-nurses will help in developing a better cross cultural learning environment that will encourage more interactions and more collaborative power relations as well. This learning helps in improving the ability of the individual to cope with the cross-cultural interactions and also perform and respond well to new cultural environments as well (Kaihlanen et al., 2019). It helps in generating more fruitful interactions that are more learning or goal-oriented and involve cooperative environments and collaborative power relations as well. Thus, more cross-cultural learning and trainings in the work environments including diversity and inclusivity will help in the development of improved and cooperative power relations, thereby helping in improved learning and treatment outcomes as well.
Clary Muronda, V. (2016). The culturally diverse nursing student: A review of the literature. Journal of Transcultural Nursing, 27(4), 400-412.
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18(1), 19.
Hall, W., Chapman, M., Lee, K., Merino, Y., Thomas, T., Payne, K., Eng, E., Day, S. & Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influenc on health care outcomes: A systematic review. American Journal of Public Health, 105(12), 60-76.
Kaihlanen, A. M., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1), 1-9.
Marcelin, J. R., Siraj, D. S., Victor, R., Kotadia, S., & Maldonado, Y. A. (2019). The impact of unconscious bias in healthcare: how to recognize and mitigate it. The Journal of Infectious Diseases, 220(2), S62-S73.
Rittle, C. (2015). Multicultural nursing: providing better employee care. Workplace Health & Safety, 63(12), 532-538.
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