Instructional bias—awareness and reduction in perioperative education

AORN Journal,  April, 2002  by Michelle M. Byrne

• E-mail
• Print
• Link

Perioperative educators often provide education to staff members, physicians, patients, and family members. Educational topics are varied and usually result from needs assessments, mandates from accrediting bodies, or new knowledge regarding equipment, procedures, or patient populations. Perioperative educators constantly create or use instructional materials. Even though accrediting bodies and scholars have addressed the importance of understanding diversity when assessing patients and providing nursing care, there has been little discussion about how to incorporate cultural, age, and gender diversity into educational materials.

BIAS FOUND IN INSTRUCTIONAL MATERIALS

Instructional bias was first explored during the 1970s and early 1980s. Title IX of the Education Amendments of 1972 led to many studies exposing gender inequity in instructional materials, language, and social opportunities. (1) As gender bias was exposed, so too was racial or ethnic bias. (2) As a result, many textbook evaluation tools and content addressing multicultural inclusion were published more than 20 years ago. (3)

Bias in general may be identified by determining whose interest is being portrayed and whose interest is being excluded. (4) Eurocentric bias, or Eurocentrism, is defined as "the consideration of events and people exclusively from the perspective of whites who came to the United States from Europe." (5) Other forms of bias include ageism, sexism, and racism. According to one group of authors, all knowledge and perspectives have embedded bias, yet the total exclusion of groups promotes further marginalization and invisibility, which exacerbates tensions related to difference. (6) Group exclusion is one form of instructional bias that contributes to limiting, slanting, or in some way controlling information presented to students or learners. (7)

Nursing scholars have advocated for cultural Competence. (8) One model of cultural competence includes personal awareness, knowledge, skill, encounters, and desire. Cultural awareness, as it relates to nursing, is defined as

   the deliberate, cognitive process in which health care providers become
   appreciative and sensitive to the values, beliefs, lifeways, practices and
   problem solving strategies of clients' cultures. (9)

Specifically, one must examine one's own prejudice and bias. Such examination and subsequent awareness is not always easy because people have a tendency to be blind to their bias or ethnocentric perspectives. Explicit examples of bias and assumptions, therefore, may help educators and nurses become less ethnocentric in their practice. (10) Understanding one's bias is one step in an ongoing process of becoming culturally competent.

Two scholars say that language reflects the bias of society. (11) The title of their book, Failing at Fairness: How America's Schools Cheat Girls, captures their findings related to gender bias. (12) Although their research has focused on gender bias, their model can be used to describe all types of bias (eg, instructional, racial). (13) The six forms of bias represented in the model include

* invisibility or omission,

* stereotyping,

* imbalance and selectivity,

* unreality,

* fragmentation and isolation, and

* linguistic bias.

INVISIBILITY OR OMISSION

Invisibility, one form of bias, occurs when particular groups are not represented in textual content, illustrations, and reference materials. An example of invisibility or omission can be found in a popular nursing history book titled Ordered to Care: The Dilemma of American Nursing, 1850-1945. This book was authored by a European American woman who omitted the contributions and even the presence of African Americans in nursing. (14) One could read this book and not know that African American women and men are part of nursing history. The book's title implies that readers will learn about the history of American nursing, not just European American women in nursing. The title assumes inclusivity, yet the book's content excludes African Americans. Not only have African Americans been invisible in nursing history and instructional materials, some suggest that Hispanics, older adults, the disabled, and, at times, a specific gender also have been invisible in instructional materials. (15)

When invisibility occurs in educational materials or real life, it teaches people from nondominant cultures that they are less important and significant in society than people from dominant cultures. For example, the nursing profession traditionally has been made up of European American women; (16) therefore, one must question whether male nurses are represented adequately in instructional materials. Are female surgeons included? Are persons of color represented in instructional nursing materials?

When assessing or creating instructional materials, one should evaluate items for gender and cultural inclusion. Create a grid and count the number of males and females represented. Also, evaluate materials for inclusion of people of color. Census 2000 data were published in most major city newspapers and can be found on the Internet. (17) This data can be a benchmark for evaluating cultural group inclusion. For example, if the population in the area in which you practice includes 15% African American, 4% Asian, and 10% Hispanic people, use these percentages as the minimum standard for inclusion of illustrations representing people from these racial and ethnic groups.