The Time to Build Assessment Skills for Dark Skin Tone is Now
As a faculty member teaching prelicensure nursing for nearly three decades and a former adult critical care nurse, I have had the opportunity to review countless nursing textbooks. Unfortunately, we have a serious curricular blind spot regarding caring for and assessing conditions in dark skin tone patients. It is time we provide equitable education and patient care to all human beings of all skin tones for safe and effective care.
Development of Descriptive Terms for Dark Skin Tone Conditions
Consensus is needed for new and revised standard definitions of the terms and protocols currently in nursing textbooks and teaching-learning materials to incorporate dark skin tone. Terms such as erythema, pink, pallor, and non-blanching are some of the terms that need new descriptions reflecting how they represent or manifest in dark skin tone.
In addition, skin assessment protocols, guidelines, images, and overall protocols—pressure injury stages, the skin color aspect of the Apgar score, the definition and description of healthy gums in foundational texts, to mention a few—will require revision to incorporate how dark skin tone manifests. Human photos/images of dark skin tone are also needed to help students and practitioners recognize, normalize, and validate common conditions.
Evidence of the Impact of Omission
The COVID-19 pandemic and the rapid demographic changes have forced us to look at what we have been doing in nursing care and to address the provision of care for all skin tones to avoid further harm to people with dark skin tone. Evidence points to dark skin tone people having higher stages of pressure injury, undetected injuries in women after sexual assault, lack of early recognition of oxygen saturation alterations, and less accurate detection of an issue with a dark skin tone newborn using Apgar score, to mention a few.
A Call for Change
Faculty and clinical nurses can start addressing the curricular and practice blind spot by intentionally including in the teaching-learning materials how and where to assess for cyanosis, pallor, jaundice, petechiae, ecchymosis, and stage 1 pressure injury in dark skin tone patients. In addition, terms, assessment findings, and images that demonstrate and describe dark skin tone occurrence need to be standardized and not othered.
As described in our article in the March issue of AJN, “Skin Assessment in Patients with Dark Skin Tone,” terms and descriptions such as post-inflammatory hyperpigmentation, bluish hue, and changes in texture and color to the surrounding skin in dark skin tone need to be centered and reinforced in nursing education and practice. In addition, our current devices (such as oxygen saturation devices) and lighting (halogen, for example) should be readily and routinely available to assess patients in learning laboratories and clinical settings.
Nurses are encouraged to avoid referring to the assessment of dark skin tone as difficult, complex, and challenging, which further contributes to stereotypes, bias, and stigmatization. Nurse academicians and clinicians should reach out to nursing textbook publishers to request more photos/images showing conditions as manifested in dark skin tone. Manikins of dark skin tone should be standard equipment used to teach-learn clinical scenarios and conditions in nursing programs and clinical settings to practice and build assessment skills.
The aim is to foster health equity for people of all skin tones in academia and clinical practice by requesting the addition and incorporation of terms, guidelines, and protocols that include and describe conditions in dark skin tone so they are understood as part of a continuum of the normal rather than as other.
Eleonor Pusey-Reid DNP, MEd, RN, is an associate professor in the School of Nursing at the MGH Institute of Health Professions in Boston.
Totally agree, the foundation starts with education. Students/Nurses need to be introduced to the assessment in one form or another school/clinical setting. More exposure increases the chances of identifying abnormal findings and facilitation of treatment.
This is a crucial topic. The majority of text books and clinical research has historically been done in light skin tone populations. As a dark skin person, I want to know that that research is inclusive and applicable to my demographic.
I’m from Ethiopian. This findings is more important to our country; whole population is dark skin.