Words Matter

Abstract

In health care, as in society, racism operates on multiple levels and contributes greatly to health and social inequities experienced by black Americans. In addressing racism, however, health care has primarily focused on interpersonal racism rather than institutionalized forms of racism that are deeply entrenched and contribute to racial inequities in health. In order to meaningfully address health inequities, health care must extend its focus beyond the interpersonal level. The purpose of this integrative literature review is to identify how and to what extent peer-reviewed nursing literature and professional nursing organizations have explicitly addressed institutionalized racism. A systematic search of relevant nursing literature published since 2008 yielded 29 journal articles that focused on black Americans' experience of institutionalized racism in health and health care; the articles explicitly named racism as institutionalized, institutional, systemic, systematic, or structural. This review summarizes author-identified implications of institutionalized racism for nursing education, research, and practice, and offers suggestions for use by the nursing profession to dismantle racist policies, practices, and structures.

Discourse of race and racism in nursing: An integrative review of literature

“…The results of our review add to the recent work by Hardeman et al (2018) and Thurman et al (2019). The systematic review by Hardeman et al of the 50 highest impact journals in public health showed that the explicit naming of institutionalized racism in public health literature is rare.…”

“…Following the data extraction criteria described by Whittemore and Knafl (2005), we determined the terms used to describe racism and institutionalized racism, and the context under which the terms were discussed. Following similar methods to Hardeman et al (2018) and Thurman et al (2019), we evaluated whether racism and institutionalized racism were central or secondary concepts in each article. Racism and institutionalized racism were considered to be central based on whether removal of the term and related discussion would significantly change the meaning and significance of the article (Hardeman et al, 2018;Thurman et al, 2019).…”

“…The systematic review by Hardeman et al of the 50 highest impact journals in public health showed that the explicit naming of institutionalized racism in public health literature is rare. Thurman et al (2019), in response to the call by Hardeman et al (2018), conducted an integrative review of nursing literature published after 2008, following President Obama winning the presidential election, focusing on the impact of institutionalized racism on Black Americans. They showed that institutionalized racism was explicitly named in few published reports, and interpreted this finding as contentment with the status quo that allows racism and its effects to endure.…”

“…Hall and Fields (2013) assert that the profession has not adequately addressed its participation in the relative silence on race, racial issues, and its role in preserving racism and its consequences. In response to Jones (2002) call to address institutionalized racism in health care, Thurman et al (2019) in their review focused more directly on the health inequities that result from institutionalized racism. Our paper adds to that knowledge by emphasizing the impact upon nurses of color as well as the educational and practice settings.…”

Pandemic racism – and the nursing response

“…They have called on their profession and its partners (in other health professions, government and decision-making bodies, and within communities) to do its part in redressing these structural inequities and ensuring a more level playing field in accessing the resources for health (Thorne, 2017). They have helped us imagine how to socialize the next generation of nurses in understanding the relevance of this issue through their educational programs, and they have helped inform nursing policy documents that encode our ethical and professional commitments to this work (Thurman, Johnson, & Sumpter, 2019).…”