A $1.3 million grant will enable WSU researchers to study how a training program originally developed for law enforcement can help nurses recognize their unconscious biases.
Lois James, assistant dean of research at the Washington State University College of Nursing, and Stephen James, an assistant professor in the WSU Elson S. Floyd College of Medicine, recently received the National Institute of Minority Health Disparities grant to adapt their Counter Bias Training Simulation program for use with nurses. Studies have shown that patients can receive different treatment, leading to different outcomes, based on their race, gender, weight, sexual orientation, and other characteristics.
“My main goal is to reduce the impact bias has on people’s lives,” Lois James said. “For the most part that’s in environments and professional groups where there’s some degree of hierarchy, a slight power differential such as between a provider and a patient.”
She added, “I’m not just studying bias for the sake of understanding it, but for the sake of improving it.”
Counter Bias Training Simulation (CBTsim) uses video simulations featuring diverse actors. In the police version, trainees make decisions during the simulation, then reflect on their actions afterward. Studies have shown that making people aware of their unconscious biases helps them control their interactions in the workplace.
Under the NIMHD grant, the WSU researchers will develop “CBTsim Healthcare” based on known disparities. Next, they’ll conduct a randomized trial with 100 nurses from Providence Health & Services to test the training’s effectiveness at decreasing bias in healthcare delivery and promoting patient-provider relationships.
Lois James said it’s likely the scenarios will cover gender, race, sexual orientation, and socioeconomic status such as homelessness, but the first phase of the study will involve research into various biases and how they affect care.
The grant application notes that race and ethnicity “is arguably… the biggest predictor of healthcare disparities.” Research studies have shown, for example, that decisions on administering pain medication appear to be affected by implicit bias, with white patients receiving more postoperative pain medication from nurses than patients of color.
Once CBTsim Healthcare is developed, the nurses in the study will undergo baseline testing at the WSU College of Nursing simulation laboratory, including testing their ability to interact with patients in ways that promote positive patient-clinician relationships. Then half will take part in CBTsim Healthcare and the other half will watch a 1-hour lecture on implicit bias, which is the standard training practice. Both groups will be tested afterward in the simulation lab, then tracked for six months in the hospital to measure patient satisfaction with nursing care.
If CBTsim Healthcare is successful, it could be adapted for use with doctors, pharmacists, and other health professions. The ultimate goal is to reduce health inequities that cost lives and money.