Contributor: Serena Tobar

Implicit bias is a quiet yet powerful influence in healthcare. It affects decisions, communication, and patient outcomes—often without our awareness (FitzGerald & Hurst, 2017). As nurses, we strive to provide equitable and compassionate care, but unconscious assumptions can obstruct that goal. In addition to academic knowledge, nursing theories offer practical frameworks for changing how we view and serve our patients.

During a recent experience caring for my mother, I repeatedly observed obesity bias during her hospitalization for a small bowel obstruction. Despite her worsening condition, the surgical team refused to discuss operative options solely because of her weight. After several days with a nasogastric tube and no improvement, I had to involve a patient advocate. Only then did the surgeon engage in shared decision-making, outlining risks and benefits and allowing her to choose. Reflecting on this, I felt distraught. With over 20 years in healthcare, I knew how to navigate the system, but what about patients and families without that advantage? How many are denied life-saving interventions because of obesity or other biases?

When exploring the impact of implicit bias on patient care, two nursing theories act as strong guides: Jean Watson’s Theory of Human Caring and Madeleine Leininger’s Transcultural Nursing Theory. Together, they provide a framework for reducing bias and promoting culturally sensitive, human-centered care.

Jean Watson’s Theory of Human Caring: Seeing the Person Beyond the Bias

Watson’s theory of Human Caring reminds us that nursing is not just a series of tasks; it is a relationship-centered practice. Her theory highlights “caring moments,” those intentional interactions where nurses engage with patients as unique individuals (Watson, 2008). These moments break through autopilot behaviors, where bias often exists.

How Watson’s Theory Helps Reduce Bias:

• Mindfulness and Reflection: Caring science motivates nurses to pause and evaluate their assumptions.
• Human Connection: Empathy and genuine presence help us see the person, not the stereotype.

Practical Strategies:

• Start each shift with a grounding exercise to focus on caring.
• After patient encounters, ask yourself: “Did I make assumptions? How did I demonstrate caring?”
• Practice active listening. Allow patients to share their stories freely without filtering them through preconceived notions.

Madeleine Leininger’s Transcultural Nursing Theory: Cultural Competence as a Bias Buffer

Bias often persists when there is a lack of understanding. Leininger’s theory promotes culturally appropriate care; care that reflects patients’ cultural values, beliefs, and practices (Leininger & McFarland, 2006). This approach moves us away from stereotypes and toward personalized care.

How Leininger’s Theory Helps Reduce Bias:

• Encourages cultural assessment over assumptions.
• Promotes open-ended questions that invite patients to share what matters most.
• Builds trust through respect for diversity.

Practical Strategies:

• Ask before acting: “What is important to you during your care?”
• Use cultural assessment tools like Leininger’s Sunrise Model.
• Engage in ongoing cultural competence training.

Exploring Our Own Biases: The Implicit Association Test

To reduce bias, we need first to recognize it. Harvard University’s Project Implicit provides a free Implicit Association Test (IAT) that helps individuals identify unconscious attitudes toward race, weight, gender, and other social categories. Nurses and healthcare professionals can use this tool to reflect on their own biases and start the journey toward more equitable care. You can take the test at Harvard’s Project Implicit site.

Bringing It Together: A Dual Theory Approach

Watson and Leininger complement each other perfectly. Watson helps us connect on a personal level, while Leininger ensures that connection respects cultural identity. Together, they create a comprehensive approach to reducing bias. Nurses can incorporate both theories into education, bedside practice, and leadership efforts.

Reflective Caring + Cultural Competence = Equitable Care

References

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8

Leininger, M., & McFarland, M. R. (2006). Culture care diversity and universality: A worldwide nursing theory (2nd ed.). Jones & Bartlett Learning.

Project Implicit. (n.d.). Take a Test. Harvard University. https://implicit.harvard.edu/implicit/takeatest.html

Rinehart, J. (2020, September 26). Madeleine Leininger: Transcultural nursing theory. Nurseslabs. https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). University Press of Colorado.

About Serena Tobar

Serena Tobar is an education resource specialist for Memorial Hermann Southwest Hospital and Visiting Professor for Chamberlain University. She is pursuing a Ph.D. in Nursing Science at Texas Woman’s University. Over the last 22 years, she has worked in various areas of nursing, including home health, acute care, hospital education, and academic education. Outside of employment, Serena enjoys reading and writing and has published a short collection of poems.