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.

[Guest856929]

Back to the relevant subject at hand, how can the nursing field attract more candidates from marginalized communities? I think it is important to have an array of people from different backgrounds in any medical setting. 

[Charles Barrow]

On 2/5/2021 at 1:25 AM, karllotta said:

I am not and was not offended and already apologized for what I incorrectly said. I also wasn’t speaking to you in my last post but to some other individual who only read what I said to you and wrote something about no evidence to you using color etc. The individual was wrong in my opinion.. Not sure where this went past you but your choice of words and your lack of interest in what I have to say doesn’t cause me any problem. I do not know you. I do not attach a race to your comments. You do not know me. You still do not know my race and I told you I wasn’t sure of it either.I already told you I was wrong and in my opinion you are wrong to continue to push forward with this rhetoric. It’s not surprising to me because I have lived with people my whole life who can’t just move on. I believe you should but again, just an opinion. From an awesome inclusive RN. Proud of that. Proud to be able to help others. Proud to keep learning and keep growing. Have a great day.

I assume, maybe incorrectly, that by “wrong” you don’t mean morally or ethically wrong.  In context, the only other interpretive option is that by wrong you mean that “the individual” was incorrect when he wrote, “I see no evidence …”; that he, in fact, did see “evidence that …”  Or maybe you simply intended to reiterate your sorrow “that you [TheMoon] feel the need to categorize people by the color of their skin” rather than accept the implicit challenge made by the “other person” that you provide evidence that TheMoon feels “the need to categorize people ...”  An acceptance of this challenge would require either a clear articulation of what you mean by “need” or, at the very least, a clear articulation of TheMoon’s words from which your understanding of the word “need” can be inferred.  After all, yours is a curious use of “need” which, when applied to human beings, suggests something that is essential to their physical (e.g. biological), psychological, and/or social well-being as Abraham Maslow does in his “hierarchy of needs.” Knowledge of what constitutes a human need, along with the response of the “other person” should help answer your question, “I don’t know what good that [categorizing “people by the color of their skin”] does but I’m asking if you have some reason?”

[CalicoKitty, BSN, MSN, RN]

13 minutes ago, cynical-RN said:

Back to the relevant subject at hand, how can the nursing field attract more candidates from marginalized communities? I think it is important to have an array of people from different backgrounds in any medical setting. 

I think I've been lucky in many ways that most of my work experiences (both in science research) and nursing have been very diverse. But, I do find the diversity has often been immigrants, rather than "African Americans". In my research position, there were many immigrants (from S. America, Europe, Asia), "white" Americans and I believe 2 (over 6 years) "black" Americans.  In one of my nursing positions, the unit was mostly "black", but of those, most of my coworkers were African, and only a few American born.  In my current and previous positions, I still find that most of the staff is "white" Americans and immigrants (primarily from Philippines and Ethiopia in my area). I think I am working with more American born people of color.

When I went to nursing school, my class size was, large. It was private, 2nd degree and a bit expensive. There were very few non-white people in that program that I remember.  I think finances can make it hard to get more "marginalized" groups involved. My program required a previous bachelors, which many don't. So, many people with financial challenges would likely go for shorter programs where they can work at the same time and less expensive programs that may be harder to get into. Without a BSN, it is harder to find hospital jobs in my area, so I don't know about racial and American vs. Immigrant nurses in other areas of nursing.

There are a lot of other aspects to help get 'mariginalized' people into healthcare. Some of it is society and groups of people that distrust hospitals. Much of that distrust is founded on some of the abuses groups of people have suffered.  Honestly, I'm sure there are plenty of good literature sites out there, but I think getting a more inclusive healthcare team would require a lot of changes.

[Guest856929]

23 minutes ago, CalicoKitty said:

I think I've been lucky in many ways that most of my work experiences (both in science research) and nursing have been very diverse. But, I do find the diversity has often been immigrants, rather than "African Americans". In my research position, there were many immigrants (from S. America, Europe, Asia), "white" Americans and I believe 2 (over 6 years) "black" Americans.  In one of my nursing positions, the unit was mostly "black", but of those, most of my coworkers were African, and only a few American born.  In my current and previous positions, I still find that most of the staff is "white" Americans and immigrants (primarily from Philippines and Ethiopia in my area). I think I am working with more American born people of color.

When I went to nursing school, my class size was, large. It was private, 2nd degree and a bit expensive. There were very few non-white people in that program that I remember.  I think finances can make it hard to get more "marginalized" groups involved. My program required a previous bachelors, which many don't. So, many people with financial challenges would likely go for shorter programs where they can work at the same time and less expensive programs that may be harder to get into. Without a BSN, it is harder to find hospital jobs in my area, so I don't know about racial and American vs. Immigrant nurses in other areas of nursing.

There are a lot of other aspects to help get 'mariginalized' people into healthcare. Some of it is society and groups of people that distrust hospitals. Much of that distrust is founded on some of the abuses groups of people have suffered.  Honestly, I'm sure there are plenty of good literature sites out there, but I think getting a more inclusive healthcare team would require a lot of changes.

Insightful response. Thanks. Similarly, in my anecdotal experiences, I have noticed that I have encountered more black immigrant RNs than AAs. I think it could be geographical. I have never lived in the South, but I'm assuming that the demographic differences there perhaps constitutes of relatively more RNs than in the North. 

In the ICUs that I worked, I only met 3 AA RNs, one was a traveling nurse from the South, and the other two were biracial. 

In grad school, I looked at the graduation calendar and could only identify (based on last names, which is quite fallible) 2 AAs in ten years and about 10 black immigrants. The gaping chasm leaves much more to be desired.

I'm not quite sure about the causation of the evident disparity of AAs being represented. I think you put forth some valid assertions. Perhaps the socioeconomic complexities that many AAs face play a significant role. I think that STEM courses and nursing in particular should be more emphatic in promoting these degrees as viable options in 'marginalized' communities.

Parenting and role models are also variables to consider. The ubiquity of certain professionals among people who look like you tends to lead generations into the same ventures. I think sports and the entertainment industries have done excellent marketing to the AA communities. If science can take the same approach, perhaps we will see more representation, albeit STEM courses are for the most part devoid of glamour. 

Prior to integration, I think there were relatively more black nurses as there were black hospitals and institutions. Paradoxically, with the advent of integration, there seemingly has been an inverse proportion of AAs as one ascends up the hierarchy of medical professions. Shortly before his death, Dr. King pondered that he was afraid that he might have integrated his people into a burning building. Nonetheless, I am hopeful that things will start trending in the right direction.

[guest965675]

1 hour ago, cynical-RN said:

Redundant and irrelevant! 

Having read some of your 41 AN replies, I see where your mindset is at. If you are not insightful enough to see the blatant ignorance in the quoted statement, I think your mindset is stagnated in the not-so-distant past of the Jim Crow era that was the epitome of divide and rule.

You have been quite active lately. I'll let you wallow in the miasma of the honeymoon sunrays. Feel free to not reply to me henceforth, but I won't hold my breath on you resisting the urge to continue to soil this thread with your profane ignorance. Have a good weekend ma'am! Signed by a Black Man.

Have a great day . Try to get some help with your anger issues. Signed a human

[Guest856929]

28 minutes ago, karllotta said:

Have a great day . Try to get some help with your anger issues. Signed a human

???? Classic & original retort. Thanks. Insatiable urge? Signed, “Angry black hue-man” 

[Davey Do]

On 2/4/2021 at 2:35 AM, TheMoonisMyLantern said:

 None of us asked to be born in the bodies we were born in.

In the karmic concept, by those who ascribe to reincarnation, it is believed that we actually do choose the bodies in which we are born.

In this instance, Edgar Cayce related, while in a hypnotic state in communication with the Universal Soul, basically said that many Blacks were plantation owners in another life.

What better way to increase the akashic record and rise in soul development than to become one of those who was sinned against in a former lifetime?

Empathy is expressed in akin with the idiom, "Walk a mile in another's shoes".

Imagine asking to live a life in another type of person's body in a subsequent lifetime and gain in soul development in order to, once again, reunite with the Universal Soul.

[Wedgepressure, ADN, EMT-B]

I don't feel it's necessary to categorize people by the color of their skin. It's also not necessary for nurses to be educated to do so.  

[herring_RN, ASN, BSN]

This photo of many family members was taken in 1942. The beautiful woman and good looking man sitting with their youngest child are my husband's parents. All these children and the oldest, who was in the army, were delivered by a lay midwife, who had been trained by one of the first licensed RN nurse midwives: https://frontier.edu/about-frontier/history-of-fnu/

Among those children's kids and grandkids are many health professionals, but the doctors are two of the then girls, who were teachers and earned heir PhDs in middle life. Several nurses, a radiology tech, a paramedic, and a respiratory therapist. We have two attorneys, a police officer, and a former criminal/drug addict, who are cousins. 

I grew up close to town In Oklahoma. Our family then had Negro, White, and Cherokee members. (Now the range in backgrounds is VERY mixed) My cousin, who was adopted, is Black and an ER doctor. His grades were better than 4.0. He didn't use the Native American scholarship his younger siblings did as he went through OU and then medical school with an academic scholarship. He liked ER because he liked being an employee with time of, even vacations.

While most stayed in Oklahoma our nuclear family came to California when I was 12. Lost of trips to and from Oklahoma, and one wonderful family reunion on New Orleans along with emails and phone calls keep us close.

One sister-in-law married a man in the Navy and lived with his parents in Mississippi while he was overseas. She developed a fear of White people during that time. She was the SIL who was rude to White people in our side of the family until she got to know us. I feel closer to her because if our relationship being difficult at first. 

I think most of us in the USA have to deal with racism because of our history. Following the Golden Rule is a simple way to treat each other, but not always simple to accomplish. 

 

 

[Davey Do]

Very, very cool, herring! Thanks for sharing your beautiful relations.

My work wife Eleanor and I had many long talks on our perspectives growing up. Eleanor grew up in town in a predominantly Black neighborhood, and I grew up in a rural setting. A Black family, who settled out here in the 1890's and continues to live on a relatively large farm about a country mile up the road, is one of the oldest families in this area. My family moved to this area in 1959.

Eleanor  got her BSN from a mid-Illinois State College the same year I got my LPN. Eleanor once said that her children have no idea of the freedoms they enjoy, compared to when she was growing up and going to school.

Since Eleanor has given me written permission to post her image on allnurses, this is a pic taken of her and I believe it was around the time she got her nursing degree:

 

 

This is a pic of Eleanor and me taken a few years ago:

 

 That is one cute couple, even if I do say so myself.

[herring_RN, ASN, BSN]

13 minutes ago, Davey Do said:

Very, very cool, herring! Thanks for sharing your beautiful relations.

My work wife Eleanor and I had many long talks on our perspectives growing up. Eleanor grew up in town in a predominantly Black neighborhood, and I grew up in a rural setting. A Black family, who settled out here in the 1890's and continues to live a country mile up the road, is one of the oldest families in this area. My family moved to this area in 1959.

Eleanor  got her BSN from a mid-Illinois State College the same year I got my LPN. Eleanor once said that her children have no idea of the freedoms they enjoy, compared to when she was growing up and going to school.

Since Eleanor has given me written permission to post her image on allnurses, this is a pic taken of her and I believe it was around the time she got her nursing degree:

 

 

This is a pic of Eleanor and me taken a few years ago:

 

 That is one cute couple, even if I do say so myself.

Thank you Davey! I remember so many of your illustrations of your vehicle, colleagues and situations at work with  empathy and humor. Thank Eleanor for letting you post her pictures. She is beautiful!

Our youngest granddaughter is getting married this Summer. She and her intended gave permission to post their announcement photo below:

[nursel56]

@herring_RN @Davey Do Thank you so much for sharing these family photos. Herring, I remember you shared a picture of some of your family members some years back. They were kicking back in backyard patio chairs, I believe.