Why Black History is Important in Nursing Education

[Stacy Winters]

(Image: 1920, Library of Congress, Negro Red Cross Canteen, Meridian, Mississippi)

Forty-five years ago, President Gerald Ford declared February as Black History Month to recognize the many accomplishments of prominent  Black Americans throughout history. Black History Month also highlights the experiences of African Americans from 1619 when the first African slaves arrived in the United States to the present day. In nursing, we traditionally celebrate the memory and work of well-known African American nurses like,  Sojourner Truth and Harriet Tubman, but fail to acknowledge racism and the atrocities imposed upon the bodies of Black Americans for the sake of science. Black history is American history.  It is nursing history.

Nursing educational programs not only create and shape nursing practice, but thought. Interweaving Black history into the nursing curricula is the first step in decolonizing nursing curricula and reducing implicit bias in healthcare today.  As nurses, we must be aware that patients are people first with unique experiences, backgrounds and history.

It is more important now than ever that nurses understand the history of African Americans, their relationship with the medical community, and why some African Americans still fear going to hospitals or getting vaccines. The fear is real.  It is Iatrophobia or the fear of a medical examination, harm, exploitation and/or mistreatment.

Perhaps some historical accounts can shed some light as to why some African Americans avoid the healthcare system.  From 1619 to 1730,  African American slaves were treated as property, receiving little to no medical treatment.  In the mid-1800s,  James Marion Simms performed gynecological techniques on Black women without anesthesia or their consent in order to perfect his surgical techniques and to get published in medical journals. In 1913, sterilization laws were enforced. Anyone declared to have a mental illness could be sterilized. African Americans were four times more likely to be sterilized than their white counterparts. In 1932, the United States Public Health Service performed a study on sharecroppers in Tuskegee, Alabama to understand the effects of syphilis on Black men without their consent.  This experiment known as the Tuskegee Experiment lasted for 40 years.  The men remained untreated even though there was treatment available.  The treatment was penicillin. These are only a few accounts of systemic racism in healthcare throughout history.

Time cannot erase the indelible effects of medical apartheid. Mistrust persists today even as we battle Covid-19.  Currently, reports show that rates of Covid-19 are three times higher among African Americans, yet many refuse to get vaccinated for the virus.  According to the Pew Research Center, only 42% of African Americans state that they would get the vaccine compared to 61% of Whites. History provides insight into why some African Americans mistrust healthcare. Can we blame their skepticism? Perhaps not. 

The vestiges of medical racism stain the memories of many African Americans for generations. As frontline workers and trusted professionals, it is key that nurses be aware of the sorted history of medicine and the African American community.  Contextualizing culture creates compassion.  Understanding history is the first step in that process.

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References

Bennett, C., Hamilton, E. K., & Rochani, H. (2019). Exploring race in nursing: Teaching nursing students about racial inequality using the historical lens. OJIN Online J Issues Nurs, 24(2).

Funk, C. & Tyson, A. (3 December 2020). Intent to Get a COVID-19 Vaccine Rises to 60% as Confidence in Research and Development Process Increases. https://www.pewresearch.org/science/2020/12/03/intent-to-get-a-covid-19-vaccine-rises-to-60-as-confidence-in-research-and-development-process-increases/

Hollander, M. A., & Greene, M. G. (2019). A conceptual framework for understanding iatrophobia. Patient education and counseling, 102(11), 2091-2096.

Joyner, T. & Lee, J. S. (20 April 2020). Health and race disparities in America have deep roots: A brief timeline. https://www.freep.com/story/news/local/michigan/2020/04/20/timeline-health-race-disparities/5145641002/

Minority Nurse. (2017). Reflecting on Black History Month and Nursing. https://minoritynurse.com/reflecting-on-black-history-month-and-nursing/

Washington, H. A. (2006). Medical apartheid: the dark history of medical experimentation on Black Americans from colonial times to the present. New York: Doubleday.

[guest965675]

I appreciate your sentiments but why do you ask “why do white people”? That was my point and the author had great insight. Sorry that you feel the need to categorize people by the color of their skin. I don’t know what good that does but I’m asking if you have some reason? Maybe I can learn something. I truly don’t know my heritage. Some of it is sketchy. The racism should stop. 

[TheMoonisMyLantern, LPN, RN]

1 hour ago, karllotta said:

I appreciate your sentiments but why do you ask “why do white people”? That was my point and the author had great insight. Sorry that you feel the need to categorize people by the color of their skin. I don’t know what good that does but I’m asking if you have some reason? Maybe I can learn something. I truly don’t know my heritage. Some of it is sketchy. The racism should stop. 

We are categorized by multiple things race, religion, sexuality, gender, political affiliation, nationality, health and we all fit in multiple categories and contribute to a sense of idenity. One is not superior to the other. None of us asked to be born in the bodies we were born in. Racism should stop but unless you face the fact that it exists, how it effects people, how can you change it? Some people get angry when you talk about how racism still exists and how it needs to change.

 

[Stacy Winters, MSN, APRN, NP]

The United States government categorizes people on every form.  Nursing did not create the categories.  
Here we are in 2021 trying to correct inequalities.  The commentary I wrote was designed to shed light on inequality and provide the reader context as to why health disparities persists in the US today.  I did not go into the social determinants of health and historical policies designed to keep people of color from having equal access to public education, housing and healthcare but we must remember that such policies also played and play a part in disparities today.  

[Jedrnurse, BSN, RN]

2 hours ago, Stacy Winters said:

...but we must remember that such policies also played and play a part in disparities today.  

Yup, it's alive and "well", that's why it still needs to be talked about. (and action taken as well...)

[Stacy Winters, MSN, APRN, NP]

Yes.  The discussion begins with us. 

[guest965675]

7 hours ago, TheMoonisMyLantern said:

None of us asked to be born in the bodies we were born in. Racism should stop but unless you face the fact that it exists, how it effects people, how can you change it? Some people get angry when you talk about how racism still exists and how it needs to change.

 

And again I am asking about the “why do white people” as I believe part of the problem is the way people use the term racism and who it pertains to? Truly not trying to win an argument but I would never post anything like that about any race. Why do purple people do this? I misread what the author said and apologized for what I wrote because I was wrong the way I presented it. Like I said racism should stop. All of it. I do appreciate this article and the author and I learned from them. Are you angry about talking about racism because I am not.

[Stacy Winters, MSN, APRN, NP]

I am happy that we are about to speak about grace and racism. We must acknowledge that the construct of race is just that, a construct.  American was built on the false notion of a an artificial construct of race and perpetuated the notion of White superiority in policies from the time of slavery.  Black history celebrates the accomplishments of Blacks in spite of systemic racism.  Black Americans became scientists, doctors, nurses, etc. during a period of history that separate but equal was the law.  In the midst of it all, Black Americans excelled and thrive.  We can celebrate the accomplishments and recognize the past simultaneously.  History provides us a unique perspective to understand and challenges us to pivot.  Once a person is aware of the past, we can no longer say we did not know.  This is similar to the Trail of Tears or the Holocaust.  We serve diverse persons and must accept that they arrive before us with not only their experiences, but the experiences of their foremothers and forefathers 

[TheMoonisMyLantern, LPN, RN]

21 hours ago, karllotta said:

When will we be able to stop with the black and white. Anyone remember what the American Indians survived. Much, much more than any other group. Let’s start with a First Americans month in January. Then when we all celebrate that you can tell me what’s next. Stop with the political BS.

You're 1st post on this forum sounded as though you were offended by the OP because of what American Indians had been through. It is not uncommon for some white to get defensive and offended when racism towards Blacks and other minorities are discussed. You clarified that you misread the post and that the OP was able to explain it to you, that's great.

[nursel56]

On 2/2/2021 at 7:51 AM, Stacy Winters said:

It is more important now than ever that nurses understand the history of African Americans, their relationship with the medical community, and why some African Americans still fear going to hospitals or getting vaccines. The fear is real.  It is Iatrophobia or the fear of a medical examination, harm, exploitation and/or mistreatment.

My honest reaction to this is that it was a total reality check for me not long ago when a politically conservative African American nurse told me about this fear and that it cut across the usual ways we sort demographic and socioeconomic characteristics. I had known of the Tuskegee Study for years and probably filed it away mentally as a different time. I had also wanted to know about my own subconscious false beliefs, if they were there, but subconsciously I thought I was doing pretty good with that. There's always more to learn.

I also wish I had known about the prevalence of that feeling sooner, because I worked in family practice clinics for years and had very diverse groups of patients. It wouldn't change my nursing practice, but it would have helped me understand that what I perceived to be an individual characteristic was not totally that, which would figure into how I understood the patient's attitude toward their diagnosis and treatment plan. 

Along the lines of what Karllotta was saying, I'm not really comfortable with the terms "white" and "black". They have a built in polarization, but they are shorthand as well, so I use them anyway.

Thanks for your article. 

I didn't know President Ford created Black History Month. That thought makes me smile.

[Charles Barrow]

21 hours ago, karllotta said:

I appreciate your sentiments but why do you ask “why do white people”? That was my point and the author had great insight. Sorry that you feel the need to categorize people by the color of their skin. I don’t know what good that does but I’m asking if you have some reason? Maybe I can learn something. I truly don’t know my heritage. Some of it is sketchy. The racism should stop. 

I see no evidence that TheMoonisMyLantern feels “the need to categorize people by the color of their skin.”  People in the U.S. and most other countries tend to be socialized early in life to distinguish between individuals who are members of different racial categories to the point that it is done without deliberation.  To what end?  Those who believe that “racism should stop” can only recognize that racism exists if, among other things, they distinguish between members of different races.  Similarly, the only way they can know whether or not racism has stopped (increased, decreased, or remained the same over time and across geographic locations) is if, among other things, they distinguish between members of different races.

[Charles Barrow]

11 hours ago, Stacy Winters said:

I am happy that we are about to speak about grace and racism. We must acknowledge that the construct of race is just that, a construct.  American was built on the false notion of a an artificial construct of race and perpetuated the notion of White superiority in policies from the time of slavery.  Black history celebrates the accomplishments of Blacks in spite of systemic racism.  Black Americans became scientists, doctors, nurses, etc. during a period of history that separate but equal was the law.  In the midst of it all, Black Americans excelled and thrive.  We can celebrate the accomplishments and recognize the past simultaneously.  History provides us a unique perspective to understand and challenges us to pivot.  Once a person is aware of the past, we can no longer say we did not know.  This is similar to the Trail of Tears or the Holocaust.  We serve diverse persons and must accept that they arrive before us with not only their experiences, but the experiences of their foremothers and forefathers 

You are correct; racism is a construct.  So too is race.  More precisely, race and racism are social and theoretical constructs.

[Charles Barrow]

13 hours ago, karllotta said:

And again I am asking about the “why do white people” as I believe part of the problem is the way people use the term racism and who it pertains to? Truly not trying to win an argument but I would never post anything like that about any race. Why do purple people do this? I misread what the author said and apologized for what I wrote because I was wrong the way I presented it. Like I said racism should stop. All of it. I do appreciate this article and the author and I learned from them. Are you angry about talking about racism because I am not.

It seems to me that the best place to begin a discussion of racism is to define and conceptualize it.  In my experience, this occurs only in academe.  Outside of the academy – in blogs such as this one, in the media, in casual conversations, etc. – people are likely to talk past each other if they have different understandings of what racism entails and don’t make these understandings known to each other.  For example, some people understand racism in the way it used to be defined in Webster – a belief that the members of some racial groups are genetically and culturally inferior or superior to other racial groups.  Using this definition, a person could reasonably claim that racism in the U.S. is relatively rare.  By contrast, another person might reasonably argue that racism is as American as apple pie or at least one of the central values of the American way of life based on the definition of racism as a belief, attitude (e.g., prejudice), behavior (e.g., individual discrimination), or institutional practice (e.g., institutional discrimination) that favors one racial/ethnic group over another.  When two people get together to discuss a controversial phenomenon such as racism, the discussion is highly likely to go nowhere or be counterproductive if neither party knows how the other party defines concepts relevant to the discussion.