October 26, 2017

Pearson Education has apologized for an outrageously offensive nursing textbook


A page from Nursing. Via Facebook.

Imagine you’re in hospital. Perhaps from repetitive strain injury after reading too many excellent Melville House books.

If you’re Jewish, you “may be vocal and demand assistance.” If you’re black, you’ll “believe suffering and pain are inevitable.”

Insulted? These characterizations are taken straight out of Nursing: A Concept-Based Approach to Learning, Volume I, published by Pearson Education in the UK. They’re culled from a section titled “Focus on Diversity: Cultural Differences in Response to Pain,” which purports to list “cultural common differences related to pain.” For the BBC, Rozina Sini lists a few of those differences:


  • May not request pain medicine but instead thank Allah for pain if it is the result of the healing medical process.
  • Pain is considered a test of faith. Muslim clients must endure pain as a sign of faith in return for forgiveness and mercy.


  • Chinese clients may not ask for medication because they do not want to take the nurse away from a more important task.
  • Indians who follow Hindu practices believe that pain must be endured in preparation for a better life in the next cycle.


  • Blacks often report higher pain intensity than other cultures.
  • They believe suffering and pain are inevitable.


  • Jews may be vocal and demand assistance.
  • They believe pain must be shared and validated by others.


  • Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven.
  • They vary in their expression of pain. Some are stoic and some are expressive.

Native Americans

  • 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 pain scale.

I’m a white Brit so presumably I’ll mumble an apology for making a nuisance of myself and ask for a nice cup of tea… but of course the section contains no advice on how to deal with white people.

After being shared by Lyndsay Morgan on Twitter and Onyx Moore on Facebook, the story gained traction and outraged comments came pouring in in the thousands, calling out the harmful stereotypes. “These assumptions are not evidence-based,” Moore wrote. “They encourage nurses to ignore what the patient is actually saying (if someone tells you their pain level is high you need to believe them), and they don’t actually teach nurses how to engage in a CULTURALLY SENSITIVE way.”

In a statement to Sini, the publisher responded:

While differences in cultural attitudes towards pain are an important topic in medical programs, we presented this information in an inappropriate manner.

We apologise 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.

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.

Tim Bozik, Pearson’s president of global product, also offered a statement on Youtube. “We reinforced a number of stereotypes about ethnic and religious groups,” Bozik says. “It was wrong.” He then indicates that e-book editions of the book have already been corrected, as will be all future print editions, promises an audit of all of Pearson’s nursing texts for similarly troubling material, and to “seek out external partners and experts” who can help improve the company’s “sensitivity and understanding of cultural diversity.”

The book was originally published in 2014, which means it has only taken three years for a book that presents shocking stereotypes as facts to come under scrutiny. It makes you wonder: How many other textbooks out there contain similar “advice” for health professionals?



Nikki Griffiths is the managing director of Melville House UK.