Quick facts

Year: 2021 

Country: United States of America  

Institution: Public University in the Pacific Northwest of the United States 

Learners: Pre-qualifying registered nurses doing a Bachelor of Science in Nursing degree. 

Aims: The aim of the article was to help White nursing students understand racism as a structural and systemic problem, rather than solely as individual prejudice.

The intervention sought to challenge existing assumptions about race and racism, encourage critical self-reflection, and cultivate a sense of personal and professional responsibility for antiracist practice through intentionally discomforting learning experiences. 

Why was the education intervention developed?

Students often believed healthcare was neutral, objective and fair, making it difficult to recognise how policies, systems, and practices contribute to racialised health inequalities.

The intervention was developed to address the limited antiracism education in nursing programmes, where race is often treated superficially.

Many white nursing students misunderstood racism as individual prejudice rather than a structural issue. 

What was involved in the education intervention?

The educational intervention involved a structured “place-based mapping” project. Students first attended teaching sessions on systemic racism in healthcare and society.

They then chose a real-world location, such as a neighbourhood or school, where systemic racism could be observed. 

Students researched the chosen area using historical and contemporary evidence and mapped it as an example of structural racism affecting areas such as housing, policing, education, or healthcare.

This was followed by a reflective assignment in which students connected their findings to course content and examined their assumptions, emotional responses and professional responsibilities. 

The intervention aimed to create “dissonant encounters” by confronting students with uncomfortable realities of systemic racism. Guided reflection and classroom dialogue supported learning through discomfort rather than avoiding it. 

How was the education intervention evaluated?

The intervention was evaluated using qualitative methods. Students completed structured written reflections after engaging with the mapping project, describing what they learned, their emotional responses and how their understanding of racism had changed.  

The authors analysed these reflections using thematic analysis, drawing initially on an existing thematic coding framework from earlier related research and refining it empirically as new themes emerged.

This approach allowed the authors to identify patterns in students’ awareness, emotional reactions and understanding of racism as a systemic and structural issue. 

What was the impact of the education intervention?

The intervention shifted how students understood racism, from viewing it as individual prejudice to recognising it as systemic and structured through policies, institutions and everyday environments.

The place-based mapping activity made racism visible in familiar settings, helping students connect theoretical concepts to real-world contexts.  

Students reported strong emotional responses including discomfort, guilt, shock, and defensiveness. These reactions were not treated as failure but as evidence of meaningful learning.

Reflection showed increased awareness of personal identity, white privilege and positionality within systems of power.

Some students began to express responsibility for challenging racism within their future professional practice, though the study did not measure long-term behaviour change.  

Key learnings

• Teaching racism as a structural and systemic issue, rather than as individual behaviour, helped students develop a deeper and more accurate understanding.  

• Place-based approaches made racism visible within familiar environments, supporting the connection between theory and real-world contexts.  

Challenges
 

• Some students responded with defensiveness, guilt or emotional withdrawal, requiring skilled facilitation to manage strong emotional reactions. 

•  The intervention also risked placing an emotional burden on students from minority backgrounds, who may have experienced distress or re-exposure to harm when racism was discussed.  

Recommendations
 

• Educators should receive training to manage emotional responses and provide appropriate support for vulnerable learners.  

• Future research should examine the long-term impact of such interventions on professional nursing practice.