The publishers of a textbook for nurses that has been criticised by social media users for containing racist material, have apologised for the offence caused and removed the offending passages.
Nursing: A Concept-Based Approach to Learning, contains advice for nurses when administering pain relief to people from different ethnic backgrounds.
It begins: "A client's culture influences their response to, and beliefs about pain. Some cultural common differences related to pain are listed here."
The page contains headings for different communities. Here are some of the excerpts:
- May not request pain medicine but instead thank Allah for pain if it is the result of the healing medical process.
- Pain is considered a test of faith. Muslim clients must endure pain as a sign of faith in return for forgiveness and mercy.
- Chinese clients may not ask for medication because they do not want to take the nurse away from a more important task.
- Indians who follow Hindu practices believe that pain must be endured in preparation for a better life in the next cycle.
- Blacks often report higher pain intensity than other cultures.
- They believe suffering and pain are inevitable.
- Jews may be vocal and demand assistance.
- They believe pain must be shared and validated by others.
- Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven.
- They vary in their expression of pain. Some are stoic and some are expressive.
- Native Americans may prefer to receive medications that have been blessed by a tribal shaman.
- They may pick a sacred number when asked to rate pain on a numerical pain scale.
The image of the page was shared on Facebook on Monday by Onyx Moore in California. She posted: "This is an excellent example of how not to be even remotely culturally sensitive.
"These assumptions are not evidence based, they encourage nurses to ignore what the patient is actually saying.
"If someone tells you their pain level is high you need to believe them."
Her post has been widely shared on both Facebook and Twitter attracting thousands of comments from users, most of whom expressed outrage at what they perceived as racist stereotyping.
One Facebook user posted: "I'm so disgusted. In 2017 how is this being published?"
Another user commented: "How old is this book? Like... 200 years old?"
But another Facebook user suggested: "I know this looks awful, but I don't think it's as much about thinking other cultures don't experience pain. It's about how they express/interpret their pain."
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By the middle of the week, Ms Moore's Facebook post was gaining traction across other social media platforms. Lyndsay Morgan in California tweeted the post. She told the BBC: "Seeing the page in a textbook like this is shocking for me as a Jewish disabled woman.
"When I'm in hospital I want a nurse to see me for what I am - someone who needs medical attention not as a Jew that needs attention and validation."
The social reaction to the post prompted an apology by the textbook's publisher Pearson.
We agree that it is wrong. We have removed it from current electronic and future print editions and apologize for its publication.— Pearson (@pearson) October 18, 2017
Further apologies were issued on Pearson's Twitter page as the criticisms on social media increased amid fresh accusations that the excerpts were not limited to one textbook but featured in at least one other.
We hear you. We take full responsibility and are taking steps to correct this problem and ensure this does not happen again. 1/— Pearson (@pearson) October 19, 2017
One Twitter user compared the content to Nazi propaganda: "It legit short-circuited my brain for a minute when I read it. I'm used to seeing that in eugenics-era books."
On Friday Pearson uploaded a two-minute video on its YouTube channel of Tim Bozik the president of the company's global development addressing the complaints.
In a statement to the BBC the publisher said: "While differences in cultural attitudes towards pain are an important topic in medical programs, we presented this information in an inappropriate manner.
"We apologise for the offense this has caused and we have removed the material in question from current versions of the book, electronic versions of the book and future editions of this.
"In addition, we now are actively reviewing all of our nursing curriculum products to identify and remove any remaining instances of this inappropriate content that might appear in other titles."