An Analysis of the Diversity of Skin Colour Representation in Paediatric Nursing Practitioner Textbooks

Annabelle Huntsman; Adriene Pavek; Nathan Shen; Justin Lyon; Jonathan Palmer; Zachary Ney; Jennifer L Hamilton

doi:10.1111/jan.16614

An Analysis of the Diversity of Skin Colour Representation in Paediatric Nursing Practitioner Textbooks

J Adv Nurs. 2024 Nov 9. doi: 10.1111/jan.16614. Online ahead of print.

Authors

Annabelle Huntsman¹, Adriene Pavek¹, Nathan Shen², Justin Lyon¹, Jonathan Palmer¹, Zachary Ney¹, Jennifer L Hamilton³

Affiliations

¹ Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
² Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA.
³ College of Nursing, University of Utah, Salt Lake City, Utah, USA.

PMID: 39520203
DOI: 10.1111/jan.16614

Abstract

Aims: Our study aims to analyse 8 commonly used textbooks to determine how diverse skin tones are represented in paediatric nursing practitioner education.

Design: Literature reviewed from 2016 to 2024 demonstrated that the lack of darkly pigmented skin colour representation in health science education leads to diminished patient outcomes for these populations. Our study sought to study representation teaching images and eight commonly referenced nursing textbooks were chosen for this study, given their use in paediatric nurse practitioner education. Of the eight textbooks selected, five were analysed based on inclusion criteria.

Methods: Two investigators trained in skin prototyping coded each textbook for skin colour representation and coded during 2023-2024. Coders used the widely accepted prototyping scale, the Fitzpatrick Scale (range I-VI, with I being the lightest colour skin and VI the darkest). Teaching photographs were defined as all photos used to provide insight into a disease or diagnostic technique that included human skin. Two individual coders coded and documented data, ensuring each coder was blinded to the overall results.

Results: Our analysis of 5 textbooks revealed that 2112 images met the criteria as teaching images. Of the 2112 teaching images, 593.5 included images of type IV-VI skin (darkly pigmented skin), resulting in a 28% representation of dark skin tone images. Additionally, 2 of the 82 total illustrations included patients with dark skin tones, indicating a representation of 2.5%. However, chapters addressing conditions of child abuse/neglect (55.95%) and stigmatised social issues (infectious disease, 54.88%) displayed a disproportionate representation of patients from these demographics.

Conclusions: Our results highlight the importance of enhancing equitable representation in educational resources for nursing practitioners.

Implications for the profession/ patient care: There is room to collaborate with other health science institutions to establish clear guidelines for future improvement in expanding teaching images to include diversity representation in education.

Patient or public contribution: No patient or public contribution.

Keywords: Paediatric nurse practitioner; dark skin tone; diversity; inclusive education; nurse practitioner; nurse practitioner education; skin of colour.