Racial, Ethnic Differences Persist in Nurses, Nursing Assistants When Treating Sickle Cell Disease

A survey of medical-surgical nurses and nursing assistants found that biases based on race and ethnicity still persist in the care of young adults with sickle cell disease (SCD) despite generally positive attitudes toward caring for the patients, according to a study published in Pain Management Nursing. These biases could lead to lower-quality care in this subset of patients.

SCD affects approximately 100,000 Americans. It causes vaso-occlusion, which leads to ischemia and painful vaso-occlusive crises that require emergency medical care. The pain causes significant morbidity in those living with SCD. Hospital-based care for activities of daily living are provided by nursing assistants, which can affect the patient positively or negatively. Previous studies have found that health care providers have had negative attitudes toward those with SCD but no studies have focused on nurses and nursing assistants specifically. This study aimed to examine the attitudes in caring for young adults with SCD among nurses and nursing assistants according to age, race, and years of experience.

Sickle-cell and normal red blood cells | Image credit: extender_01 - stock.adobe.com

A mixed-methods study was conducted, with both quantitative and qualitative data collected. The Qualtrics Survey platform was used to collect quantitative data, with both a demographic and General Perceptions of Sickle Cell Patients Survey (GPSCPS-17) completed by participants. The GPSCPS-17 is split into 4 subscales: Negative Attitudes, Positive Attitudes, Concern Raising Behaviors, and Red Flag Behaviors. Higher scores on negative and positive attitudes indicate provider endorsement of those attitudes; on Concern Raising Behaviors, that the responder agreed that certain behaviors indicated inappropriate seeking of drugs; and on Red Flag Behaviors, that patients with SCD with certain behaviors raised provider concerns that the patient is seeking drugs.

Medical-surgical nurses and nursing assistants were recruited from the United States from all geographic regions, both full- and part-time employees included. Nurses and nursing assistants in general medical units, hematology/oncology units, and surgical units were included. Intensive care units, progressive care units, non–ward level units, and emergency department units were excluded from the study. Participants needed to be a registered nurse whose worksite was a medical-surgical unit and to have cared for at least 1 patient with SCD in the previous 6 months to be included.

There were 53 nurses and 3 nursing assistants in the study. Participants were primarily White, female, held a bachelor’s degree in nursing, worked at a teaching hospital in an urban area, and worked at health care institutions that had up to 800 beds.

The Positive and Negative Attitudes subscales included less than 5%, 6% to 20%, 21% to 50%, 51% to 75%, and more than 75% as response options. The researchers found that correlations between age and years of experience were weak and not significant for each subscale. The race and ethnicity groups were split into White and a combined group of Hispanic/Latino, Black/African American, Asian and Pacific Islander, and Multiracial. There was a significant difference between the 2 ethnicity/race categories on the Red Flag Behaviors subscale that indicated that White participants had reported more red flag behaviors, with a Cohen d statistic of 0.803, which indicated a large effect.

The mean (SD) Red Flag Behaviors score was 65.71 (22.29) of 100 compared with the mean score of the Negative Attitudes (30.73 [20.60]) and Positive Attitude (31.92 [20.66]) subscales that were scored out of 75. The change in R was significant for Red Flag Behaviors in the subscale of GPSCPS-17: F (2,50) = 5.947 (P = .018)

There were some limitations to this study. The findings could not be generalized to the full population of registered nurses and nursing assistants, and the qualitative sample size was considerably smaller, which made the qualitative themes unreliable. In addition, no nursing assistants were included in the qualitative sample and only 3 were included in the quantitative sample. Also, the original date of development of the original GPSCPS was 2010, which could make the ideas on race/ethnicity outdated. The race/ethnicity categories were also combined, which could have prevented the researchers knowing which ethnicity specifically held certain attitudes.

The researchers concluded that there were significant differences in Red Flag Behavior scores based on race/ethnicity, which indicated that structural biases continue to exist in the care of patients with SCD. This could lead to a lower quality of care in pain management for young adults with SCD.

Reference

Reich J, Cantrell MA, Smeltzer SC. Attitudes and beliefs of nurses and nurse assistants toward patients with sickle cell disease: a mixed method study. Pain Manag Nurs. Published online October 20, 2023. doi:10.1016/j.pmn.2023.09.009