From a clinical standpoint, we know that while visual changes in the appearance of Caucasian skin are easily observed, changes in darker skin pigmentation can be more difficult to spot. It is also true that examples of Caucasian skin are well represented in training resources and supporting academic literature, but other skin tones are not.
I work at Nottingham University Hospitals NHS Trust as a clinical educator in shared governance and have been fortunate enough to participate in the Nightingale Fellowship, an international program focused on promoting excellence in care. Through local and national networking, I became more and more aware of the issue of training needs around assessing different skin tones and decided that my scholarship should focus on diversity and inclusion. in the integrity of the skin.
This orientation was also informed by the national wound care strategy, which highlights that when wound care is informed by research evidence, it improves healing rates, improves patient experience and makes better use of NHS resources.
Within my trust, feedback collected by the BAME Shared Governance Board from patients, caregivers and colleagues showed variation in knowledge and a lack of confidence in assessing the skin of patients of color, confirming that this subject required further investigation.
I continue to learn more about this problem, but to date I have identified a lack of research on various patient groups with regards to skin care, a lack of diversity in clinical photos, and a lack of ‘black or brown educational tools in the clinical setting. All of these factors lead to varying knowledge among staff assessing the skin of patients of color.
“I recommend expanding skin care research programs to ethnic minority groups to ensure that the needs of everyone in our diverse population are taken into account.”
Another important finding that emerged from this work is that language barriers, as well as cultural and religious beliefs, can impact patient compliance with medical instructions. Having staff members who understand these issues and can explain evidence-based information to patients will help improve excellence in care, including wound care and healing.
I recommend expanding skin care research programs to ethnic minority groups to ensure that the needs of everyone in our diverse population are taken into account. Local recommendations include curriculum review and diversity of undergraduate and postgraduate training.
The BAME Shared Governance Board is also liaising with the Nottingham University Hospital Institute of Care Excellence to obtain various educational aids. Evidence also shows that having a variety of dressings, such as dressings available in different skin tones, will have a positive impact and help raise awareness of diversity, culture and inclusion.
The scholarship has enabled me to raise awareness of this important topic and I have now joined the Trusts Skin Integrity Strategy group which I will use as an opportunity to work collaboratively to ensure inclusion and diversity.
Our Trust is currently developing their Skin Integrity Strategy and has garnered feedback from patients and colleagues to ensure it is inclusive. I will also continue to work with our Nursing and Midwifery Research Manager to promote this issue to research teams. I have been able to share my findings with the Head Nurses and other Nightingale Fellows in my confidence and have received very positive feedback.
Most of the skin guidelines apply primarily to patients with fair skin, and there is a need to increase knowledge and incorporate guidelines focused on BAME skin integrity. The inclusive skin integrity strategy being developed is a positive step towards raising awareness of this issue. However, there is also a need to review the curriculum to diversify undergraduate and postgraduate education.
Onyinye Enwezor is a Clinical Educator in Shared Governance, Inclusive BAME Leader and Chairman of the BAME Shared Governance Board at the Nottingham University Hospitals NHS Trust as well as a Nightingale Fellow