Anger Over Stereotypes in Textbook

Education in the health professions has for many years included instruction on the importance of asking patients about their backgrounds and beliefs, which may relate to understanding conditions they are experiencing and inform possible treatments. But those who teach future nurses and doctors stress that background is but one characteristic of a person, and that assuming too much based on such backgrounds can be insulting and even dangerous to patients.

Best practice is not to simply offer health professions students lists of stereotypes by racial, ethnic and religious groups. So when word spread last week about a section of a nursing textbook that did just that, many were horrified. Pearson, the publisher, pledged to remove the content.

In a section on pain, Nursing: A Concept-Based Approach to Learning offered the following guidance:

• "Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven."
• "Jews may be vocal and demanding of assistance."
• "Native Americans may prefer to receive medications that have been blessed by a tribal shaman."
• "Blacks often report higher pain intensity than other cultures."
• "Indians who follow Hindu practices believe that pain must be endured in preparation for a better life in the next cycle."

Such advice didn't come cheap. Amazon is selling new hardcover copies of the book for $234.98, although there are a variety of less expensive rental, ebook and used possibilities as well.

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, she noted that the recommendations are not just based on stereotypes, but could be harmful if relied upon in patient care.

Calling the material "racism across the board," Moore wrote, "These assumptions are not evidence based; they encourage nurses to ignore what a patient is actually saying (if someone tells you their pain level is high, you need to believe them), they list common behaviors as culturally specific (most people are more comfortable being honest about their pain with family members/those close to them), and they don't actually teach nurses how to engage in a culturally sensitive way."

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 responded in a series of tweets, apologizing and pledging to remove the material in question.

The company also pledged to review all of the materials it offers in nursing education to see if there are similar problems elsewhere. Late Friday, the company posted a video from Tim Bozik, Pearson's president for global product development. In the video, he apologized twice and said that the material in question "reinforced a number of stereotypes" and "was wrong." He said that the company would "recall" any other material with similar problems, and would seek "a greater level of sensitivity" in producing educational materials.