References
What influences the inclusion of skin tone diversity when teaching skin assessment? Findings from a survey
Abstract
Background:
Understanding the variances in visual skin changes across all skin tones is important in clinical care. However, the experiences of those teaching skin assessment to pre- and post-registrant nurses are unknown.
Aims:
To determine the barriers and facilitators experienced in teaching skin assessment across a range of skin tones to pre- and post-registrant nurses.
Methods:
A cross-sectional, mixed-methods online survey was undertaken throughout February and March 2023 based on the Theoretical Domains Framework of behaviour change.
Findings:
In this self-selecting sample, most participants were aware of why it was important to include all skin tones when teaching skin assessment and were professionally motivated to include this in their practice. However, resources and support are needed to overcome an unconscious bias in teaching skin tone diversity, resulting in a lack of availability of good quality photographs and educator confidence in their own skills. Educators not considering skin tone when selecting patient cases and relying on people with dark skin tones to highlight where practice is not inclusive may also lead to insufficient exposure for students.
Conclusion:
There is some awareness of the importance of including diverse skin tones in teaching, but further education and resources are needed.
Visual signs of tissue damage caused by pressure, moisture, infection and vascular conditions of the lower limb may be missed in people with dark skin tones due to variances in the presentation of skin changes across skin tones (Wounds UK, 2021). A skin assessment that includes palpating the patient's skin to assess for temperature and skin turgor, and discussing skin symptoms and skin changes with the patient is essential to underpin diagnosis in people with dark skin tones rather than relying on visual inspection alone (Dhoonmoon et al, 2023). Inability to undertake an accurate skin assessment across all skin tones negatively affects people with dark skin because early signs of tissue damage are missed and differential diagnoses are inaccurate. This is exemplified in pressure ulcers, where people with dark skin tones are more likely to present with severe pressure ulceration than their counterparts with lighter skin tones (Oozageer Gunowa et al, 2018; Bates-Jensen et al, 2021).
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