Kruse Julie A, Collins Jennifer L, Vugrin Margaret
School of Nursing, Oakland University, United States.
Health Sciences Center, Texas Tech University, United States.
Int J Nurs Stud Adv. 2022 Mar 4;4:100073. doi: 10.1016/j.ijnsa.2022.100073. eCollection 2022 Dec.
The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients' health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered; interactions between patients and providers; and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias.
To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias.
Integrative review.
The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions' students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis.
Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment.
Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias.
医护人员对患者下意识产生的想法、感受和态度会对患者的健康结果产生负面影响。与医护人员隐性偏见相关的系统评价发现，他们对老年人、有色人种、残疾人、精神疾病患者、肥胖患者、社会经济地位较低者以及女性存在负面隐性偏见。隐性偏见会影响所提供护理的质量、安全性和专业性；患者与医护人员之间的互动；以及患者对治疗建议的认可。医护专业学生和医护人员需要参与基于证据的教育策略，以管理和减少偏见。
回顾有关针对医护专业学生和医护人员使用的教育策略的证据，以提高他们对隐性偏见的认识、减少偏见并改善对偏见的态度。
综合评价。
文献综述于2020年7月完成，并于2021年2月和2021年6月进行了两次更新，使用了九个数据库，包括《学术搜索完整版》™、Embase®、教育资源信息中心数据库（ERIC®）®、Ovid、PubMed®、Scopus®和科学网™。使用的关键词与教育、医护专业学生、医护人员、隐性、偏见、不文明行为、微侵犯和微攻击有关。纳入了2011年至2021年发表的文献。Covidence软件用于初步筛选和全文分析。
本次综述分析了39篇文章。用于指导隐性偏见原则的最常用教育策略包括讨论小组、模拟和基于案例的学习、意识预测试、使用专家主持人、承诺采取行动/改变以及汇报总结。成功策略的共同要素包括精心的项目规划、仔细挑选项目主持人（他们是内容专家）、对参与者的支持以及系统层面的投入。
不同的教育策略在各项研究中都成功地解决了隐性偏见问题。对未来研究的建议包括解决抽样策略和数据收集方面的局限性，以阐明教育策略与参与者结果之间的关系。有必要提供教育机会，促使医护人员探索他们对他人的隐性偏见，以便提供考虑到多样性、公平性和包容性的护理，同时也限制个人的隐性偏见。
