Nursing Textbook Slammed for Racist Content on Pain

By Pat Anson, Editor

Blacks believe suffering and pain are inevitable. Hispanics believe pain is a form of punishment. Muslims consider pain a test of faith. Jews are vocal and demanding about pain care.

Those are some of the startling claims being made in "Nursing: A Concept-Based Approach to Learning," a nursing textbook that has a section that looks at ethnic and cultural differences in how people respond to pain.

The book advises nursing students that a patient’s culture and religion play a “critical role” in how a patient responds to acute or chronic pain, and that “nurses must approach each client with cultural competence.”

Fair enough. But then the book makes sweeping generalizations about various ethnic groups that some consider offensive and racist.


“Clients from Asian cultures often value stoicism as a response to pain. A client who complains openly about pain is thought to have poor social skills,” the book declares.

“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 scale.”

The textbook has been used by nursing students for years, but the section on diversity and culture drew little attention until a page from the book started circulating on social media this week.

“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 a patient is actually saying,” said Onyx Moore, who posted the page on Facebook. “If a patient tells you their pain level, believe them -- because *they* are the expert on their body."


“I'm so disgusted. In 2017 how is this being published?” asked one poster. “Why isn't the protocol basic compassion instead of that ignorant nonsense?”

"I’ve seen so many examples like this in my nursing textbooks. It’s infuriating," wrote another Facebook poster.

“This is horrifyingly wrong,” said another.

In response to the uproar on social media, the book’s publisher apologized and said it would drop the offending section from the textbook.

“While differences in cultural attitudes towards pain are an important topic in medical programs, we presented this information in an inappropriate manner. We apologize 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 text,” Scott Overland, Pearson Publishing’s communications director told

“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.”

Now in its second edition, “Nursing: A Concept-Based Approach to Learning” is still available for sale on Amazon, where a new hardcover can be bought for $235. First published in 2014, many of the early reviews of the book are positive, with some nursing students saying it was “indispensable” and a “life safer.”

The more recent reviews -- apparently in response to the uproar on social media -- are scathing.

“This book should cease to be printed. The fact that this is taught in schools makes me quite literally sick,” one reviewer said.

“This book is racist and if you apply it's concepts you will hurt your patients and possibly get in some uncomfortable situations or even litigation,” said another.

“If this kind of racist dreck can pass unnoticed by the authors AND editors of this book, it cannot be trusted. And they cannot be trusted. Unbelievable,” wrote another reviewer.

Pearson is the world’s biggest publisher of educational textbooks. Today the company put a video on its YouTube page in which Tom Bozik, president of Pearson’s global product development, made another apology and said the book doesn't represent the company's values.