Considering Skin Color in Patient Assessment and Care
How Nurses Can Be More 'Color Aware'
Could differences in skin color make a difference in how a person is diagnosed and treated? Experts say yes, it can, and yes, it often does. And unfortunately, that can lead to health disparities for minority populations.
Nurses care for people from a wide range of backgrounds and cultures – and a wide variety of skin colors, too. So, as a nurse, you must be aware of the role that skin color may play in healthcare.
“There are so many different shades of colors, even within each ethnicity or race,” said Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, a faculty member for Walden University’s Master of Science in Nursing program. “It is important for nurses to be aware of different shades of color and how illnesses, infections, certain diseases may present themselves.”
“It is very important for nurses to be able to recognize how a client’s skin color may affect the presentation of signs and symptoms for various conditions,” agreed Danielle Leach, MSN, RNC-NIC, a faculty member at Arizona College of Nursing in Tempe, Arizona.
Making Patient Assessments That Are More Than Skin Deep
Don’t Make Assumptions
Every patient is different, and it’s important to remember that. “A nurse must be able to examine beyond the surface of each patient, regardless of their skin color,” says Morgan. “In essence, you can’t judge a book by its cover.”
So, a complete health history and thorough physical examination should be the order of the day with every patient, according to both Morgan and Leach.
“A client with darker skin may present with symptoms of hypoxia but may not appear pale or cyanotic at first glance,” she said. “If the nurse does not assess certain areas such as mucous membranes, where these characteristics may be more apparent, critical assessment information can be easily missed.”
Another example of a condition that may present differently, depending on the patient’s skin color: psoriasis.
This chronic skin condition affects about 125 million people worldwide, according to the National Psoriasis Foundation. It seems to affect white people more often, but some believe it may be underdiagnosed in people of color. Experts note that psoriasis often presents differently when it develops on darker skin, which may lead to misidentification. Instead of the red scaly patches of skin that appear on lighter colored skin, psoriasis plaques may take on a brown, gray or purple shade. Or the plaques may have a thicker layer of scales that makes it harder to get a good look at them. If a healthcare professional isn’t aware of these differences in presentation, they might miss them or downplay them.
Additionally, there are some special considerations for treatment of psoriasis in people of color. For example, phototherapy is sometimes recommended for psoriasis. However, in people with darker skin tones, it can sometimes cause patches of skin to darken and become more noticeable, according to the American Academy of Dermatology. They might prefer a different treatment as a result.
Approaching each patient as an individual and not making assumptions can help avoid the possibility of missing something, but it’s also crucial for nurses to learn more about the role of skin color in healthcare.
In fact, it's an issue that will only grow in importance, since minority populations are expected to continue growing in the United States. The population that you will care for will be increasingly diverse.
“Taking time to educate yourself about the health of people from different ethnic and cultural backgrounds is vital to providing culturally competent and appropriate care,” Morgan said.
If you teach nursing students or mentor younger nurses, you might also take up the cause and look for opportunities.
Because textbooks have tended to show pictures of mostly Caucasian skin, Leach deliberately tries to incorporate pictures of patients with a variety of skin colors into presentations for her health assessment course so her students can see the differences. She also suggests that nurses seek out continuing education modules and peer-reviewed journal articles to learn more about the differences in skin color and how they can affect diagnosis and prognosis.
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