Dr. Eleonor Pusey-Reid has begun cataloging and categorizing imagery found in the 16 foundational textbooks most often used in Prelicensure Nursing curriculum. Using the Fitzpatrick Skin Phototype scale as a guide, her research will provide a simple, but comprehensive analysis of where nursing is in terms of representing patients with darker skin tones. 

“This is something that is really central to advancing equity of care and decreasing health disparities and inequalities,” said Pusey-Reid, an Associate Professor of Nursing. “Nurses are the nation’s largest healthcare profession so any changes we make, have the potential to impact many, many patients.” 

A 2015 study of top medical school textbooks showed that, while 40% of Americans identify as non-white, medical education textbooks over-represent lighter skin tones while failing to show disease manifestations on darker skin tones. 

Dr. Pusey-Reid hypothesized that nursing textbooks would not be immune to this problem. “Currently, there is no nursing research that evaluates the representation of different skin tones in our textbooks,” she said. 

Over the past 10 years, she has watched report after report emerge of how individuals with darker skin tones receive delayed treatment and endure disease identification problems due to their provider’s deficit in knowledge of the clinical manifestations of illnesses on dark skin tones. 

“We know this is hurting patients,” Pusey-Reid said. She cites recent reports of delayed identification of Lyme Disease in patients with darker skin tones and inaccurate oxygen reading of pulse oximeters of patients in hospitals as just some of the recent reports that have shown the difficulty that patients with darker skin tones face when accessing care. 

“We need to increase the assessment skills of nurses and clinicians in regard to darker skin tones,” she said. “We do that by first increasing dark skin tone imagery in our teaching and learning materials.”