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Inclusive Healthcare Practices to Improve Quality of Care

Nurses who practice inclusive healthcare improve patient outcomes and advance principles aimed at health and wellness equity for entire communities.

Inclusive practices can be as simple as using gender-affirming language and preferred pronouns and being sensitive to racial, ethnic and religious identification. However, they are also as complex as identifying and challenging personal implicit biases.

By putting those practices to work, nurses are advancing a systemic program of diversity, equity and inclusion that challenges elements called social determinants of health (SDoH). Inclusive practices involve strategies for addressing SDoH, such as income, social exclusion, environment and education. Research has found that those factors and others are critical to positive outcomes and should be part of nurse education.

“Studies have indicated that medical outcomes account for about 10–20% of a patient’s health outcomes, whereas things like economic stability, education, housing and access to health care comprise the other 80–90%,” according to an article on a study from the World Health Organization (WHO).

Nurses who want to learn from the research on health equity can benefit from an online Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) program, like the one offered by the University of North Carolina Wilmington (UNCW).

What Is Implicit Bias and How Does It Affect Patient Outcomes?

Bias can be explicit (conscious motivation of interactions with certain groups) or implicit (an attitude toward those members of which a person is unaware). Although implicit bias is unconscious, it creates negative associations and damages personal interactions.

Examples of implicit bias and resulting negative patient outcomes include:

  • Unconscious racial bias in medicine. Studies have determined that unconscious negative associations with Black, Native American, Hispanic and other patients of color make those in minority groups less likely to receive adequate access to healthcare, which increases their chances of delayed treatments and poorer outcomes in comparison to white patients.
  • Implicit sex and gender bias in healthcare. A Medical News Today article reports that a literature review of 77 published papers found some practitioners are more likely to discount chronic pain in women, deeming it an emotional rather than physical issue than in men. Similarly, unconscious bias is associated with the reluctance of transgender people for fear of inappropriate treatment.
  • Impact of sexual identity bias in medical care. According to Medical News Today, most cisgender, heterosexual healthcare professionals implicitly treat straight patients better than people in the LGBTQ+ community. Another study found that 80% of medical students held implicit biases against LGBTQ+ people. These biases cause members of the LGBTQ+ community to avoid treatment, resulting in higher incidences of cancer, substance abuse and obesity.

According to the Annual Review of Public Health, biases “permeate the health care system,” and “addressing bias remains a fundamental professional responsibility.”

What Are Strategies for Addressing Implicit Bias to Make Nursing More Inclusive?

Implicit bias in nursing can lead to poor outcomes through inadequate patient assessments, inappropriate interpretation of symptoms and conditions, less time spent with patients and insufficient follow-up.

An article by the professional development organization Lippincott Nursing Center recommends a strategy for identifying and eliminating implicit bias with the following techniques:

  • Pay attention to gut feelings. Nurses who take a moment to think before meeting with a patient to recognize any negative emotions — such as discomfort, anxiety or fear — associated with implicit bias. Reflecting on those emotions and their meaning and origin will help uncover negative stereotypes.
  • Be mindful and in the moment. Rid the mind of distractions, assumptions and judgments to focus on the task. As another implicit bias recognition strategy, mindfulness enables nurses to identify negative stereotypes before acting automatically on them. It is also related to the foundations of nursing: ethics, empathy and compassion.
  • Adhere to nursing best practices. Developing strong therapeutic relationships and culturally competent, patient-centered care dissolves negative implicit biases and creates positive patient connections. Commitment to practicing the Code of Ethics for Nurses — which states that nurses must practice “with compassion and respect for the inherent dignity, worth, and unique attributes of every person” — is the Golden Rule for inclusive healthcare.

Inclusive healthcare practices improve overall patient care, and nurses with a strong foundation in implementing these inclusive practices can support their organizations and patients.

UNCW’s online RN to BSN program strives to bolster the foundation of their graduates regarding health equity with courses like Transcultural Health Care and Population and Community Health Nursing, both of which foster culturally sensitive patient care.

Learn more about the University of North Carolina Wilmington’s online RN to BSN program.

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