In health care, as in society, racism operates on multiple levels and contributes greatly to health and social inequities experienced by black Americans. In addressing racism, however, health care has primarily focused on interpersonal racism rather than institutionalized forms of racism that are deeply entrenched and contribute to racial inequities in health. In order to meaningfully address health inequities, health care must extend its focus beyond the interpersonal level. The purpose of this integrative literature review is to identify how and to what extent peer-reviewed nursing literature and professional nursing organizations have explicitly addressed institutionalized racism. A systematic search of relevant nursing literature published since 2008 yielded 29 journal articles that focused on black Americans' experience of institutionalized racism in health and health care; the articles explicitly named racism as institutionalized, institutional, systemic, systematic, or structural. This review summarizes author-identified implications of institutionalized racism for nursing education, research, and practice, and offers suggestions for use by the nursing profession to dismantle racist policies, practices, and structures.
College of Pharmacy (Dr Thurman) and School of Nursing (Drs Johnson and Sumpter), The University of Texas at Austin.
Correspondence: Whitney A. Thurman, PhD, RN, Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Stop A1930, Austin, TX 78712 (firstname.lastname@example.org).
The authors would like to thank Roxanne Bugocka for her assistance with the literature search strategy, Michelle Wright for her assistance with an earlier draft of this manuscript, and 3 anonymous reviewers for their helpful suggestions on this review. Editorial support with manuscript development was provided by the Cain Center for Nursing Research and the Center for Transdisciplinary Collaborative Research in Self-management Science (P30, NR015335) at The University of Texas at Austin School of Nursing.
The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.