What Nurses Should Know About Racial Trauma and Its Impact on Patients

By | 2021-06-28T11:52:57-04:00 June 28th, 2021|8 Comments

Racial trauma often is an under-recognized threat to patients’ health and well-being.

racial traumaJamila Holcomb, PhD, LMFT, a faculty member at Florida State University and a Relias contributor, explains what nurses need to know about racial trauma in this interview.

Holcomb teaches courses on parenting, adolescent development, and public policy related to children and families. She also is a licensed marriage and family therapist specializing in individual, family, and trauma counseling.

Q: What is racial trauma and trauma-informed care?

A: Racial trauma is the physical, emotional, and psychological pain associated with experiencing or witnessing racism. The act of witnessing is key. Pain can come from watching someone being victimized as a result of racism. Trauma-informed care describes care guided by the evidence surrounding racial trauma.

Q: What’s an example of racial trauma?

A: Repeatedly hearing media reports on the death of George Floyd can be experienced as a vicarious kind of trauma. The symptoms are similar to post-traumatic stress disorder. People may have increased heart rate, nightmares, and may feel on edge. Nurses might see their patients experiencing more depression symptoms, distrust, or feelings of being unsafe. It can make us more distracted, easily irritable, and disrupt our sleep.

With racism, because it happens so frequently, racial trauma can pile on and create more long-term mental health concerns and long-term physical concerns such as cardiovascular disease and hypertension.

Q: Whom does it affect?

A: Racial trauma can affect all people of color. It can affect white individuals. If you are the victim or you watch someone who looks like you be victimized, that’s going to impact you differently than if you are white. A white person might feel guilt or shame as a result of someone from their community enacting harm on someone else.

Q: How does it affect treatment or outcomes?

A: Because of racism and discrimination, we know that providers will often give less quality care to people of color. Research says Black individuals are less likely to receive medical treatment when they’re in need. They are also less likely to receive pain medication or are given less pain medication based on biases. These are implicit biases that are going to impact the nursing profession and quality of care. Also, nurses who are not aware of racial trauma might minimize or dismiss a patients’ symptoms as not real or as being exaggerated.

We do see racism linked to outcomes in terms of high death rates. For instance, Black moms are dying at a higher rate than any other race in the months before and after giving birth.

Q: Are there additional questions nurses should be asking?

A: On standard intake medical forms, when asking people their history, I do think it’s important to include their experiences with racism and discrimination as a way to open the door to talk about that. They can indicate any symptoms that might be happening because of racism. Then, nurses can follow up with support and treatment options. Providers feel awkward talking about race, so if we include it in the paperwork, it does the talking for us.

Q: How does this pertain to different care settings?

A: Nursing homes, for instance, have been under incredible stress due to the pandemic in the last year. But then we also have the experience of Black patients in nursing homes having compounded trauma. They are at the same time experiencing the trauma of Breonna Taylor’s death, for instance.

Q: Why is it not talked about more?

A: As a society, we haven’t taught everyone how to sit in discomfort, and we’ve been running away from it. To be quite frank, before last year, people didn’t really believe it had a long-term impact. I think the pandemic has slowed everybody down and allowed us to witness and sit with pain in a way we never had before.

Q: How can nurses push workplaces to recognize racial trauma?

A: Survey patients. You can do a climate assessment of your hospital and ask patients how well you’re doing at addressing unique experiences related to race.

Ask staff as well: How supported do you feel in this work environment?

What we’ll find is that nurses of color don’t feel as supported in these spaces, and clients of color are not going to feel as supported, and that will tell upper management we have to do something different. Usually, the difference starts with training the providers. Nurses can identify trainers they want to bring in. That takes the pressure off upper management.

In the case of recent hate crimes against Asians, nurses can put pressure on upper management to put out a statement regarding the violence and being vocal about being an anti-racist organization. That communicates your goal of doing better in this area.

Q: Where can people get more information?

A: I have developed webinars on the subject available on the Relias website.

Two books I’d recommend are “How to Be an Antiracist” by Ibram Kendi and “My Grandmother’s Hands,” by Resmaa Menakem, which describes racism’s effect on the body.

Take these courses related to cultural diversity and PTSD:

Harmonize Diversity and Improve Health Outcomes
(1 contact hr)

Healthcare today thrives on teamwork and partnering with patients to achieve exceptional health outcomes for staff and patients alike. Positive and productive relationships depend on personal and team awareness of various personality types across the continuum of their partners and their willingness to bridge the gaps among those differences to create a harmonic work climate. This module introduces the concept of personality sensitivity and gives examples of how training can improve performance, satisfaction, and outcomes.

Cultural Differences Impact Interpersonal Communication
(1 contact hr)

Working cross-culturally requires you to appreciate the impact cultural differences have on interpersonal communication. Transcultural healthcare workers are sensitive to these differences and strive to determine the most appropriate and effective ways to interact with diverse colleagues. When you communicate and collaborate productively with your colleagues, you are much more likely to deliver culturally relevant care to your patients and improve the overall patient experience.

Post Traumatic Stress Disorder – An Overview
(1 contact hr)

Post-traumatic stress disorder (PTSD) was once primarily associated with the survivors of war but is now recognized as affecting people who have experienced diverse types of psychological traumas. The U.S. Department of Veterans Affairs National Center for PTSD (2019) estimates that at some point during their lives, 7% to 8% of the U.S. population will suffer from PTSD. This educational activity will discuss the background, assessment, and treatment of PTSD.


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About the Author:

Marcia Frellick
After 25 years of writing/editing for newspapers and magazines, Marcia Frellick launched her freelance career in 2008 writing about all aspects of healthcare. Her work has appeared in The Chicago Tribune, Chicago Sun-Times, the Los Angeles Times, Medscape Medical News, American Medical News, Nurse.com magazine, Hospitals & Health Networks magazine and Northwestern University magazine.


  1. Avatar
    Guardiannursingagency June 28, 2021 at 3:28 pm - Reply

    I have honestly never read such overwhelmingly good content like this. I agree with your points and your ideas. This info is really great. Thanks.

  2. Avatar
    Holly Levan July 10, 2021 at 5:29 pm - Reply

    It isn’t just non white that racial trauma. It’s just noted more in other cultures because when something bad happens to a Caucasian it isn’t broadcast all over media like when it happens to another race.

  3. Avatar
    Bruce July 10, 2021 at 6:15 pm - Reply

    What a load of woke nonsense. How about you get back to nursing real trauma and illness. At the most racial trauma is as much a mental illness as sexual dysphoria.

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      Rosalind Sartin July 14, 2021 at 4:58 am - Reply

      If you’re a nurse, i feel bad for your patients and coworkers. Racism is real, it needs to be dealt with and not swept under the rug.

  4. Avatar
    Sherry Graves July 11, 2021 at 5:50 pm - Reply

    Here’s an idea. Why don’t we stop focusing on race and instead focus on delivering outstanding patient care. I have worked with patients and coworkers of different races and cultures in several workplace settings for almost 30 years. The overwhelming majority of these people do not focus on this sort of divisive content. We treat each other as human being who deserve compassion and care.

    • Avatar
      Melinda August 2, 2021 at 12:00 pm - Reply

      Very well said. I totally agree!

  5. Avatar
    Rebecca Lindoo July 12, 2021 at 1:12 pm - Reply

    Excellent article. Insightful,
    Thank you

  6. Avatar
    Anne M Walter July 13, 2021 at 9:03 am - Reply

    It is sad that any race has to feel discriminated. It is a great idea to be open minded and be able to accept that some people are being and or feeling discriminated. I think that most nurses have the natural compassion and empathy to see this, surpass it, and provide the priority care to keep patients healthy. Also, it is good to be informed of the emotional as well as physical spectrum of patients when providing care. No one should ever feel discriminated for any reason, so overall it seems that this information could be helpful.

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