S. Davis is associate professor and assistant dean, Diversity, Equity, and Inclusion, School of Nursing, The George Washington University, Washington, DC.
A.-M. O'Brien is clinical assistant professor, School of Nursing, The George Washington University, Washington, DC.
Acad Med. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S58-S65. doi: 10.1097/ACM.0000000000003688.
A major goal of Healthy People 2020 is healthy equity, or the attainment of the highest level of health for all groups of people. Yet, disparities based on race remain the most persistent and difficult to address. Getting at the root causes of disparities, inequities, and injustices is essential for health equity to become a reality. The authors elucidate the urgent need for the nursing profession (and all health care professions) to push beyond cultural humility to structural competency and shift the focus from individuals to institutions, systems, practices, and policies to address racism, bias, and discrimination as root causes of disparities and inequities in health, health care delivery, and health care outcomes.Through a case study approach, the authors demonstrate the need for faculty to contextualize learning to help integrate the necessary historic and contemporary drivers of racism, bias, and discrimination into health care. They discuss strategies for faculty to develop the knowledge, skills, and attitudes to teach about the importance of addressing structural racism and discrimination in health care. Through a "no shame, no blame" approach, the authors encourage faculty to develop the courage to engage with students, colleagues, other health care professionals, and communities in conversations about racism, bias, and discrimination.
《2020 年健康人》的主要目标是健康公平，即实现所有人的最高健康水平。然而，基于种族的差异仍然是最持久和最难解决的。要实现健康公平，就必须从根本上解决差异、不平等和不公正的问题。作者阐明了护理专业（和所有医疗保健专业）超越文化谦逊、达到结构能力的紧迫性，并将重点从个人转移到机构、系统、实践和政策，以解决造成健康、医疗服务提供和健康结果差异和不平等的种族主义、偏见和歧视的根源。通过案例研究方法，作者展示了教师需要使学习情境化的必要性，以帮助将导致种族主义、偏见和歧视的必要历史和当代因素纳入医疗保健。他们讨论了教师发展知识、技能和态度的策略，以教授解决医疗保健中结构性种族主义和歧视的重要性。通过“不羞愧，不责备”的方法，作者鼓励教师培养勇气，与学生、同事、其他医疗保健专业人员和社区就种族主义、偏见和歧视进行对话。
