RESUMEN
PURPOSE: This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts. BACKGROUND: The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice. METHODS: Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone). RESULTS: Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks. CONCLUSIONS: Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark. RELEVANCE TO CLINICAL PRACTICE: All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.
Asunto(s)
Diversidad Cultural , Educación en Enfermería , Enfermedades de la Piel , Pigmentación de la Piel , Libros de Texto como Asunto , Humanos , Negro o Afroamericano , Reproducibilidad de los Resultados , Estados Unidos , Libros de Texto como Asunto/normas , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/etnología , Enfermedades de la Piel/enfermería , Educación en Enfermería/normas , BlancoRESUMEN
Epidermal growth factor receptor (EGFR) targeting tyrosine kinase inhibitors (TKIs) can result in significant skin toxicities that may impact patients' quality of life. While these skin reactions are well documented in patients with lighter skin, there is a paucity of literature and images to guide clinicians in their assessment in patients with darker skin tones. Given that dermatological reactions in patients with darker skin are not well represented, this can result in the undertreatment or mistreatment of these otherwise common toxicities. Herein, we present a case of a female patient with a darker skin tone with metastatic non-small cell lung carcinoma (NSCLC) with EGFR-TKI-related skin toxicity and her clinical course.