Implications for practice and research

• Nurses need to understand the multifaceted nature of carrying out inclusive and comprehensive skin assessments, ensuring they are responsive to the multiplicity of skin tones among diverse patient populations.

• Fostering an inclusive learning environment by integrating innovative learning and teaching methods and education materials that specifically address the complexities of skin assessments across diverse skin tones, promotion of evidence-based guidelines and culturally sensitive care is paramount.

• There is a need for further research to examine more comprehensively the preparation for, and operationalising of, skin assessments among patients with diverse skin tones.

Context

Adequately equipping nurses with the knowledge, skills and attitudes to provide comprehensive skin assessments for patients with diverse skin tones is essential in informing quality and safe care for all patients.1 Skin assessments in this context refer to observations made to changes in skin colour, texture, moisture and temperature that may indicate manifestations of illness and includes skin integrity and wound healing assessments. However, there is a dearth of evidence and attention paid to skin assessments across diverse skin tones in the nursing literature and educational materials.1 2 Nursing textbooks play an essential role in supporting the preparation of nursing students in carrying out comprehensive skin assessments among patients with varying skin tones. This paper3 reports on the limited attention paid to diverse skin tones in nursing textbooks and calls for greater attention to this in the future.

Findings

The inter-rater reliability results obtained were 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 DST. In total, 14 192 photo images and drawn computer-generated graphics across 15 nursing textbooks met the inclusion criteria and were analysed. The majority of photo and graphical images which were light skin toned (n=6156; 60.9%). Medium skin tones (n=1958; 19.4%) and more specifically DST (n=1238; 12.3%) were less frequently observed across the fifteen commonly used nursing textbooks. In summary, there were over four times more light skin tone photo images than DST photo images and there were over thirty times more light skin tone graphical images, than DST graphical images.

Commentary

Carrying out holistic skin assessments is paramount in negotiating patient care needs and can inform patient management decisions and ultimately patient outcomes.4 Nurses need support in adopting inclusive approaches to carrying out comprehensive skin assessments and this requires the development of knowledge, skills and attitudes to respond appropriately to the needs of patients with diverse skin tones. There is a scarcity of evidence and nurse educational materials that offers an accurate interpretation of the importance of understanding how to adopt inclusive approaches to skin assessments that are cognisant of skin tone diversity. In particular, the lack of attention to identifying the complexities of carrying out skin assessments across diverse skin tones in nurse education textbooks is concerning. Nonetheless, it is important to acknowledge that skin tone and patients with DST is not equated to race, nationality or ethnicity. However, there is a need to reframe skin assessment as a complex nursing intervention that requires in-depth understanding of authentic and inclusive skin assessments that are responsive to patients with diverse skin tones. Thus, the call to action extends beyond awareness, necessitating active engagement in research initiatives, curriculum and educational material development, and ongoing dialogue to reshape the narrative and practice surrounding skin assessments everywhere in healthcare.