92% of participants will gain awareness about implicit bias in health care and mitigation strategies.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
CEUFast, Inc. is an AOTA Provider of professional development, Course approval ID#03713. This distant learning-independent format is offered at 0.2 CEUs Intermediate, Categories: Professional Issues & Foundational Knowledge. AOTA does not endorse specific course content, products, or clinical procedures. AOTA provider number 9575.
92% of participants will gain awareness about implicit bias in health care and mitigation strategies.
After completing this course, the learner will be able to:
IB is unintentional and attributed to the reflexive neurological system that drives the brain's automatic processing function. As such, an individual's feelings, attitudes, and decisions are involuntary, and their subsequent actions may conflict with their stated views (NCC, 2021). Consequently, the effects of IB can be difficult to identify and measure, and actions resulting from it often are challenging to recognize and control.
Racial and ethnic minority groups have experienced hardships for as long as anyone can remember.
There are specific examples of discrimination in healthcare that have left lasting impressions and resulted in defining types and acts of discrimination and racism.
Throughout history, structural racism has resulted in policies and laws that allocate resources in ways that disempower and devalue individuals, resulting in inequitable access to high-quality care.
Here are some examples of laws that were supposed to promote equality but made systemic issues more difficult:
Because of the history of historical racism, underrepresented groups still struggle today. Interpersonal interactions, professional prospects, and quality of life are all affected by the historical roots of racism.
IB presents challenges in health care when it manifests itself inappropriately and unconsciously contributes to health disparities.
With the shift towards diversity and equity, there come barriers to inclusion. Such barriers may include attitudinal barriers, physical barriers, a lack of or inappropriate education, organization, and policy barriers.
Attitudinal barriers are a common and basic type of barrier that can contribute to and lead to the formation of other barriers.
Education can serve as a barrier to inclusion. If education is not inclusive, does not provide information on resources, or introduces bias, it is a barrier to inclusion.
The social constructs of race, ethnicity, and culture affect identity in many ways.
Unfortunately, with identity comes discrimination for the differences that set us apart.
Priming is another way to measure reactions related to inherent and subconscious attitudes. The Priming Test is designed to measure the strength of the association between two stimuli, or targets and particular attributes, or primes. The targets are comparable categories, and the primes are associated with those categories.
Affect Misattribution Procedure (AMP) is another test used to measure and evaluate implicit bias. The AMP presents multiple images that are assigned to two categories. Examples of categories include products, ethnic groups, or people. The second category may be neutral, such as a gray image. Then an icon is displayed with a character, which is judged as positive or negative. According to the logic of the measurement, the effect associated with the image is transferred to the character (Payne, 2005).
These are just some examples of common tests used to measure and evaluate implicit bias. There are others; however, they may not be commonly used and their validity has not been verified.
Learning about common types of IB and their unintended effects between health professionals and patients is a strategy for building IB awareness. The following list is not intended to be exhaustive but to present a range of IBs that may influence provider-patient or institutional decisions (Brecher et al., 2021; NCC, 2021; Smith, 2021). Reflect on how your beliefs may confirm or conflict with the examples and how you might be affected in these scenarios:
Recognizing the need to mitigate IB, address health disparities, and further ensure the quality of care provided by licensed healthcare providers among diverse populations, required IB health provider training is emerging across the US. These laws empower policymakers, healthcare licensure boards, and healthcare settings to improve health professionals' IB knowledge to effect positive change in care systems. Likewise, they present opportunities for data collection to measure IB changes and evaluate patients' health outcomes over time. The following list includes examples of recent legislation to address IB in professional health care:
Communication is a form of self-concept, and when performed with intention and clarity, it is very effective. Unfortunately, communication can also be harmful and detrimental. It is important to implement communication techniques to avoid misinterpretation or miscommunication.
Listen- Assess the patient's understanding of health and disease. Providers should have humility and be curious, which promotes foundational trust.
Explain- Convey health perceptions without bias and be open-minded to others' understanding of health based on culture.
Acknowledge- Respect the differences in views, perspectives, and understandings.
Recommend- Propose and develop a care plan through understanding, support, and collaboration.
Negotiate- Incorporate culturally-relevant interventions in partnership with the patient (Ladha et al., 2018).
A 66-year-old Hispanic male resides in a rural community. He contacts their primary care provider's (PCP) office with the following complaints: temperature 100.2 degrees Fahrenheit x three days, headache, body ache, fatigue, nasal congestion with a runny nose. They underwent a Covid-19 polymerase chain reaction (PCR) test at their local pharmacy yesterday, received their positive test result today, and are anxious to speak to their PCP about treatment.
A telehealth appointment is conducted with their PCP. The patient's condition warrants community-based treatment, and strategies are discussed. The patient specifically asks about medication to cure Covid-19. They had heard about it from a friend and believed many people get it through their local livestock supply store. Their PCP responds that they understand from speaking with other local healthcare professionals that some are recommending Ivermectin therapy, which coincidentally is available for livestock. The PCP proceeds to write that prescription to be filled at the pharmacy.
Discussion of outcomes
The Centers for Disease Control and Prevention (CDC, 2021) reports that the US Food and Drug Administration has not authorized the use of Ivermectin to prevent or treat COVID-19. Likewise, Ivermectin has not been recommended by the National Institutes of Health's COVID-19 Treatment Guidelines Panel for treating COVID-19. The PCP's decision to prescribe this medication appears to be influenced by their implicit bias (IB) to conform with their patient's request and some colleagues' anecdotal treatment recommendations. It is not an evidence-based treatment decision. Rather, the treatment decision is consistent with conformity bias, a type of IB.
Strengths and weaknesses of the approach used in the case
Typically, healthcare professionals intend to provide optimal care to all patients, but IB may negatively impact their aim. IB is the human tendency to make decisions outside of conscious awareness and based on inherent factors rather than evidence (Fitzgerald & Hurst, 2017).
Conformity bias is an IB associated with the tendency to be influenced by other people's views (Brecher, 2021).
IB is the unconscious and, therefore, the unintentional human tendency to make decisions based on inherent factors rather than evidence. No one is immune, not even healthcare professionals. Recognizing common types of IB by building self-awareness and participating in voluntary or mandatory training are steps health professionals may take to minimize its impact on their care. Likewise, State governments' mandates specific to IB in healthcare are embedding training across health professions and care settings into law. More research is needed to measure how IB training may change health providers' short- and long-term beliefs, practices, and patients' perceptions. Ultimately, these steps are intended to minimize IB among healthcare providers, reduce barriers to equitable care, close the gap in health disparities between diverse populations, and meet patients' needs.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.