Racial trauma often is an under-recognized threat to patients' health and well-being.
Jamila 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 lower 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:
Diversity, Equity, and Inclusion for the Healthcare Employee
(1.5 contact hours) Ensuring that a healthcare system is culturally competent can reduce health disparities. Healthcare employees who have effective interpersonal and working relationships are essential to successful healthcare outcomes. Healthcare staff provide care to individuals from many backgrounds, so proper diversity, equity, and inclusion (DEI) training is important. Integrate your DEI training into your standard hiring and onboarding process.
Working With Culturally Diverse Colleagues
(0.5 contact hour) The U.S. is becoming more culturally diverse, but the nursing workforce remains largely non-Hispanic white. Cultural differences among staff can create communication challenges and lead to conflicts that affect how the healthcare team works together. Learning about cultural differences in work patterns and communication styles as well as specific strategies for working effectively within a diverse environment will improve outcomes.
Post Traumatic Stress Disorder - An Overview (1 contact hour) 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.
