Is it racism? Skepticism and resistance towards ethnic minority care workers among older care recipients

Racism in healthcare: a scoping review

BACKGROUND

Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts.

METHOD

The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim.

RESULTS

The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace.

CONCLUSIONS

The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.

Discrimination in In-Patient Geriatric Care: A Qualitative Study on the Experiences of Employees with a Turkish Migration Background

In most studies, nurses with a migrant background report experiences of interpersonal discrimination. These often occur in interaction with those in need of care. However, in Germany this topic has remained largely unexplored, although a large proportion of the employees in geriatric care have a migration background. The aim of the study was to investigate whether care workers with Turkish migration background in in-patient geriatric care are exposed to discrimination from residents. Furthermore, the reasons for discrimination, handling of discrimination and recommendations for in-patient geriatric facilities to avoid/reduce discrimination were examined. In a qualitative, explorative study, 24 employees with Turkish migrant background working in in-patient geriatric care were interviewed in 2017. The semi-structured interviews were evaluated using a qualitative content analysis according to Mayring. The majority (N = 20) experienced or observed discrimination. This occurred mainly in the form of xenophobic insults and rejections. They perceived visible traits (dark hair and eye color, clothing) as potential reasons. To deal with the discrimination, most of them temporarily left the scene. They recommend that institutions should primarily make the diversity of the workforce transparent to avoid/reduce discrimination. More research is needed about discrimination against care workers with migration background because discrimination may have serious psychological effects that impact employee retention and the quality of care.

Race-based experiences of ethnic minority health professionals: Arab physicians and nurses in Israeli public healthcare organizations

Increasing workforce diversity was found to contribute to the narrowing of disparities in health. However, racism toward ethnic minority health professionals has not been adequately researched. In Israel, public healthcare organizations that serve a mixed Jewish-Arab population employ Arab minority healthcare professionals. Instances of prejudice and manifestations of racism toward them, which frequently surface in public discussion and the media, have unfortunately gained little scholarly attention. We used the intergroup contact approach and the theory of the social process of everyday racism as a theoretical framework. The objective of the research was to study race-based experiences of Israeli Arab healthcare professionals.

METHODOLOGY

We used a qualitative research method that allows respondents to describe their views, experiences, beliefs and behavior in the way they think about them. During 2013 and 2014 we conducted in-depth interviews with a snowball sample of 10 Arab physicians and 13 Arab nurses who work in Israeli public hospitals. The study protocol was ethically approved.

FINDINGS

Interviewees noted institutional efforts to maintain egalitarianism and equality. However, at the micro-level, interviewees, mostly nurses, reported instances that ranged from refusal to accept treatment from an Arab nurse, through verbal abuse, to the use of physical violence against them. At the meso-level, interviewees, mostly physicians, reported experiences of institutional discrimination. At the macro-level, one physician reported policy-related discrimination in the context of the immigration of Russian Jewish physicians to Israel.

CONCLUSIONS

We recommend combining the intergroup contact approach with the social process theory of racism to examine minorities' subjective perceptions, especially in conflictual and violent contexts; conducting broad-based quantitative research in Israeli healthcare organizations, which may have important implications for the specific strategies to be used; and emphasizing the importance of institutional support. By reconstructing race-based experiences of ethnic minority health professionals, health organizations can better manage racial situations and reduce their frequency.

Is gerontology ready for anti-racist pedagogy? A survey of educators' practices and perspectives

The older population in the United States is becoming more diverse, bringing increasing attention to the ways in which diversity and multiculturalism are addressed in gerontological education. Although diversity and multiculturalism have long been recognized as important components of the aging experience, our approach to understanding their significance and impact continues to grow and change. Anti-racist pedagogy represents one catalyst to stimulate such change. To evaluate the potential for anti-racist pedagogy in gerontology, this study explored gerontological educators' (N = 121) current practices and perspectives regarding the inclusion of diversity content in their courses, as well as the extent to which they are familiar with and/or use anti-racist pedagogy in their classes. The findings suggest that greater attention to issues of race, ethnicity, and multicultural diversity throughout the gerontological curriculum is needed and wanted. Although respondents were generally unfamiliar with the name anti-racist pedagogy, many indicated that their current teaching practices employed select components of it. Overall, the findings point toward the need for continued exploration of how anti-racist pedagogy may be brought into the gerontological classroom, as well as its implications for future research, policy, and practice.

Educational mismatch and health status among foreign-born workers in Sweden

Foreign-born workers have been shown to experience poorer working conditions than native-born workers. Yet relationships between health and educational mismatch have been largely overlooked among foreign-born workers. This study uses objective and self-reported measures of educational mismatch to compare the prevalence of educational mismatch among native (n = 2359) and foreign-born (n = 1789) workers in Sweden and to examine associations between educational mismatch and poor self-rated health. Findings from weighted multivariate logistic regression which controlled for social position and individual-level demographic characteristics suggested that over-educated foreign-born workers had greater odds ratios for poor-self rated health compared to native-born matched workers. This association was particularly evident among men (OR = 2.14, 95% CI: 1.04-4.39) and women (OR = 2.13, 95% CI: 1.12-4.03) from countries outside of Western Europe, North America, and Australia/New Zealand. Associations between under-education and poor-self rated health were also found among women from countries outside of Western Europe, North America, and Australia/New Zealand (OR = 2.02, 95% CI: 1.27-3.18). These findings suggest that educational mismatch may be an important work-related social determinant of health among foreign-born workers. Future studies are needed to examine the effects of long-term versus short-term states of educational mismatch on health and to study relationships over time.

How should nurses deal with patients' personal racism? Learning from practice

This paper aims to promote practice development in the difficult area of managing patients' expressions of personal racism within the clinical environment. Racism is a global phenomenon and it is well documented that nurses experience racism within their routine practice. Nurses face unpleasant dilemmas in managing racist patients who are also vulnerable because of their health status. The paper is based on the ethnography of acute mental health nursing, conducted within a UK hospital. The study found that nurses conceptualized patients' expressions of racism as a consequence of their mental ill-health and that they managed this difficult issue through nursing methods of direct engagement, trouble avoidance and the minimization of strangeness. It is concluded that patients' racism cannot be managed by following simple, procedural rules but neither should it be managed 'behind closed doors'. A culture should be facilitated in which nurses can feel secure that colleagues and managers will take their concerns about personal racism extremely seriously and engage with, and value their contribution in working out just what to do in specific cases. The nursing methods discussed can be used as a basis for practice development in this unpleasant and uncomfortable area.

Relations between Immigrant Care Workers and Older Persons in Home and Long-Term Care

Les aidants immigrés jouent un rôle de plus en plus important dans les soins de domicile et les soins de longue durée au Canada, mais l’ampleur totale de leurs relations avec les personnes âgées dans ces cadres est relativement inconnue. Cet article examine le rôle des aidants immigrés dans les deux secteurs de domicile et de soins de longue durée, mettant l’accent sur les relations avec les anciens et les implications pour la qualité des soins. Les données proviennent des entrevues avec les travailleurs, les employeurs et les clients anciens menées dans divers services d’accueil et de soins de longue durée pour personnes âgées dans trois provinces canadiennes: l’Ontario, la Colombie-Britannique et le Québec. Les facteurs qui découlent des origines ethniques ou raciales des aidants immigrés, barrières linguistiques et facteurs contextuels tels que la pénurie de personnel en soins de différents paramètres pour les personnes âgées compliquent la relation entre les aidants immigrés et leurs clients. Dans certains cas, ces facteurs diminuent la qualité des soins. Nous indiquons quelques politiques alternatives que nos conclusions suggèrent devraient être considérées.