Lived experiences of racism in nursing care for patients in Iran: A Phenomenological study

Lived experiences of racism in nursing care for patients in Iran: A Phenomenological study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Lived experiences of racism in nursing care for patients in Iran: A Phenomenological study Naeem Abdi, Abolfazl Dehbanizadeh, Salar Dasdar, Mohammadsaeed Mirzaee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8898521/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Racism is a complex and multidimensional concept and is regarded as a significant social issue. Since racism as a social construct, has emerged from research conducted across various cultural and social context, it seems necessary to study the experiences of individuals in the culture and religion of each society. Thus, this qualitative study aimed to explore the lived experiences of racism in nursing care for patients in Iran. Methods: This qualitative study performed a phenomenological nature on 14 patients and nurses selected through the purposive sampling method with maximum variation. Data was gathered through semi-structured interviews betweenApril and September 2025 in Iran. Data analysis was done by Colaizzi method. For rigor of data, Lincoln and Guba criteria were used. The data were handled by MAXQDA software. Results: The main themes identified in this study were antecedents of racialized care experiences, consequences for patients and care quality, manifestations of mal-care affecting trust and communication, and preventive measures to promote equitable nursing practice. Conclusion Based on these results, it is suggested that educational programs for nurses and other healthcare workers regarding racism and its effects on nursing care be implemented on an ongoing basis. Racism Phenomenological study Nursing Care Introduction Racism refers to a set of political, social, economic, cultural practices, and beliefs that allocate privileges, resources, and power exclusively to a specific group. In addition, racism is a complex and multidimensional concept and is considered a significant social issue [ 1 ]. Although awareness has increased over the years, leading to the condemnation of racism, injustice and racial discrimination unfortunately persist in various areas, including healthcare services, and more specifically in nursing care [ 2 ]. Racism in nursing impacts access to healthcare and medical services, leading to disparities in the availability and quality of health services [ 3 ]. This issue is particularly unacceptable in care and treatment settings, where the fundamental principle is the equitable distribution of services and the provision of care regardless of patients' characteristics. Racism significantly exacerbates health inequities among patients [ 2 , 3 ]. Patients' experiences of racism often manifest as receiving unfair or delayed services, neglect of their pain, disrespect toward minority patients, and labelling [ 4 ]. Various studies have shown that negative experiences of racism not only cause undue stress for minority patients but also foster deep mistrust toward the healthcare system and healthcare providers, including nurses, thereby perpetuating a vicious cycle of poor health outcomes [ 5 ]. Moreover, racism affects nurse–patient interactions, undermining the core foundation of nursing, which is effective communication and interaction with patients [ 6 ]. This is particularly concerning given that nurses constitute the largest segment of the healthcare workforce in any country, and adherence to social justice is a fundamental requirement of nursing practice [ 7 ]. Overall, racism in healthcare settings—whether overt or covert—contradicts the principles of a just society [ 8 ]. Compromising patients' well-being and disrupting equitable access to high-quality healthcare leads to injustice, discrimination, and humiliation [ 9 ]. This issue has prompted many researchers and experts to analyse and examine the role of racism in patients' access to nursing care [ 10 ]. Studies indicate that racism can have profoundly detrimental effects on medical and nursing care, resulting in reduced quality of care and dissatisfaction among patients and their families. Therefore, combating racism is essential to improving the quality of healthcare services [ 11 ]. One effective approach to addressing racism is raising awareness about its existence and identifying the factors that contribute to it [ 12 ]. Various studies have demonstrated that racism is prevalent in healthcare environments, including hospitals, treatment centres, and health services. For example, a study in the United Kingdom found that Black patients, when compared to White, were subjected to fewer examinations and tests [ 13 ]. Furthermore, research conducted in the United States showed that in emergency situations, Black individuals may receive less healthcare and, in some cases, experience longer periods of pain than their White counterparts [ 14 ]. These findings underscore that racism within healthcare settings, including hospitals and clinics, is a significant issue that must be addressed in order to improve the quality of healthcare and ensure appropriate patient care. Conducting qualitative research to clarify patients' experiences of racism can help raise awareness among healthcare providers and patients about racism, leading to changes in the way nurses interact with patients [ 2 ]. A review of studies on racism shows that it is widespread in many Asian countries; however, most research in this field has been conducted in Western countries [ 15 ]. Given the prevalence of racism as a social construct, and its detrimental impact on the quality of services provided, as well as its influence by the culture of each society, and the lack of studies on this topic in Iran, it seems necessary to thoroughly explore lived experiences of racism in nursing care for patients as experienced it in real-life settings [ 16 ]. This objective can be achieved through qualitative research using a phenomenological approach with a naturalistic perspective. Thus, this qualitative study aimed to explore the lived experiences of racism in nursing care for patients in Iran. Materials and Methods Study type and Setting To better understand the lived experiences of racism in receiving nursing care, the present qualitative study performed the Husserlian descriptive phenomenological approach between April and September 2025 in Shahid Jalil and Shahid Beheshti hospitals, affiliated with Yasuj University of Medical Sciences, as public centers in southwestern Iran. To adhere to the principle of bracketing in this study and based on Husserl's method, any potential biases in conducting the interviews and the data analysis process were controlled [ 17 ]. Study participants Purposive sampling was employed to recruit participants from public hospitals in southwestern Iran. A total of fourteen participants, including nurses and patients with maximum variation were enrolled in the study. Including both nurses and patients allowed for a comprehensive exploration of racism from multiple perspectives, capturing both the provision and the receipt of care within the clinical setting. Inclusion criteria comprised having experienced racism during hospitalization, literacy, the ability to communicate effectively, and sufficient availability to participate in interviews. Exclusion criteria included unwillingness to participate and limitations in cooperation. Participant identification and recruitment were conducted through visits to approved health facilities, following authorization from relevant institutional authorities. After selecting the initial participant, eligible individuals were approached, informed about the study objectives, and invited to share their experiences. Upon obtaining informed consent, details regarding the interview process, setting, timing, and supportive arrangements were clearly explained to all participants. All of the participants accepted the researcher's request to participate in the study. None of the participants were excluded during the study. Data generation Data were collected through semi-structured interviews [ 18 ] by the first author in a comfortable environment for the participants and mostly in a private room in the hospitals. Interviews lasted between 45 and 60 minutes and were conducted either face-to-face or virtually via the WhatsApp application, according to participants’ preferences and convenience. The interview setting and modality were determined based on participants’ comfort and informed consent. After referring to the medical centers and coordinating with the relevant authorities, greeting patients and nurses, obtaining informed consent, and the necessary information the researcher selected the participants among the eligible individuals who were willing to be interviewed. Before beginning the interview, the researcher explained the purpose and necessity of the research to the participants, written informed consent was obtained from them. The participants were explained about maintaining confidentiality and recording their voices during the interview, and if they agreed, their voices would be recorded. Given that this study was a small part of a larger study titled The Emergence and Normalization of Racism in Nursing Care: A Grounded Theory Study, approved by Ethics Committee of Yasuj University of Medical Sciences, Yasuj, Iran (Approval No: IR.YUMS.REC.1403.126), in that study, according to the main goal, questions were asked about how individual biases, organizational structures, and nurse-patient interactions contribute to the emergence and normalization of racism in nursing care in Iran. Therefore, the questions raised in this study, followed the previous questions, but revolve around the main concept of this study, racism in nursing care for patients. The primary guiding question was, “Can you describe your experience with racism in receiving nursing care?” Probing questions, such as “What do you mean by this?” and “Could you elaborate further?”, were used to elicit deeper insights into participants’ experiences. Closure-oriented questions, including “Is there anything else you would like to add?”, were also employed to ensure data completeness [ 19 ]. The interviewer made field notes during all the interviews and documented all the relevant information including non-verbal cues, emotional expressions such as crying, sadness and discomfort, facial expressions, head shaking and, sighing. Data collection continued until 14 participants were interviewed. After 14 interviews, data saturation was discussed with the research team. The team agreed that the data saturation point was achieved and no major discrepancy was observed during the interviews. Data analysis Data were analysed using Colaizzi’s seven-step phenomenological method [ 20 ] (Figure S1). Following data collection through interviews, all recordings were transcribed verbatim and repeatedly reviewed to achieve immersion in the data and a deeper understanding of participants’ experiences. The transcripts were then examined line by line to identify significant statements, marking the initial coding process. Identified meanings were formulated and labelled as preliminary codes, which were subsequently grouped into subthemes based on conceptual similarities and differences. These subthemes were further clustered into overarching themes to develop a comprehensive and integrated description of the phenomenon under study. Finally, the rigor and trustworthiness of the findings were established in accordance with the criteria proposed by Lincoln and Guba [ 21 ], including credibility, dependability, confirmability, and transferability. Trustworthiness Credibility was ensured through prolonged engagement with the data, repeated immersion in interview transcripts, and continuous interaction with participants. Bracketing was operationalized through reflexive journaling conducted before and during data analysis to identify and minimize researcher preconceptions. To ensure that findings reflected participants’ voices, significant statements were extracted verbatim and used as the basis for meaning formulation and theme development. Member checking was conducted by sharing preliminary themes with selected participants to confirm accuracy and resonance with their lived experiences. Transferability was supported through rich descriptions of the research context, participants, and analytic procedures. Dependability was enhanced through peer debriefing, in which two qualitative research experts reviewed and refined the coding and thematic structure. An audit trail documenting analytic decisions, code development, and reflexive notes was maintained throughout the study. Confirmability was ensured through methodological transparency, reflexivity, and question triangulation using multiple probing questions. Ethical Considerations In this study, ethical approval was obtained, and informed consent was acquired from the participants. They were also assured that all information in this study would be kept strictly confidential and destroyed after the completion of the study. Furthermore, confidentiality was maintained in the presentation of the final report. Results The participants consisted of 14 individuals; the mean and standard deviation of the age of patients in this study were 46.25 ± 10.91. The mean and standard deviation of the age of nurses in this study were 34.17 ± 7.82. Demographic characteristics of the participants are presented in Table S1. Based on the phenomenological analysis, the main themes identified in this study were: Antecedents: Experiencing Care as Unequal, Tense, and Psychologically Eroding; Consequences: Erosion of Confidence, Satisfaction, and Care Quality; Mal-Care: Impacts on Trust, Job Satisfaction, and Communication; and Preventive Measures: Strategies to Mitigate Racism in Nursing Care (Table S2). Antecedents: Experiencing Care as Unequal, Tense, and Psychologically Eroding Participants’ narratives revealed that racism in nursing care was preceded by an embodied experience of unequal care, interpersonal tension, and psychological erosion, which together constituted a context in which discriminatory care was perceived and internalized. Perceived Poor Quality of Care Participants consistently described the quality of nursing care as superficial, rushed, and inattentive, which they interpreted as a manifestation of racialized neglect. This perceived reduction in care quality was not limited to technical aspects but extended to the absence of listening, assessment, and responsiveness to individual needs. Phenomenologically, this experience reflected a sense of being rendered invisible within the care encounter, undermining trust and reinforcing perceptions of inequity in healthcare delivery. I didn't feel heard at all. When the nurse came in, they rushed through things and never once asked me what my pain was or what I needed (p:3). I couldn’t understand why the nurses were so indifferent towards me. Everything felt so superficial, and I never felt like I was receiving enough care (p:6). Interpersonal Tension Racism was further preceded by a persistent atmosphere of tension that shaped nurse–patient interactions. Participants described heightened vigilance, stress, and fear of misinterpretation during encounters with nurses. This tension disrupted the therapeutic relationship, limiting open communication and fostering emotional withdrawal. From a phenomenological perspective, care interactions were experienced as unsafe relational spaces in which patients anticipated disrespect rather than support. Every time the nurses came, I felt a lot of pressure in my chest. I was stressed that they might misunderstand something or not even pay attention to my problem (p:4) If I knew the nurses were indifferent, I didn’t want to say anything because I was stressed that I might be disrespected again or not understood properly (p:12). Psychological Vulnerability Experiences of perceived discrimination were also preceded by profound psychological vulnerability. Participants reported feelings of worthlessness, self-blame, and emotional distress, which gradually eroded their sense of dignity and belonging within the healthcare system. These psychological effects functioned not only as consequences but also as antecedent conditions that shaped how subsequent care interactions were interpreted and endured, ultimately discouraging engagement with treatment and care processes. The behavior I observed from the nurses made me feel as if I had no worth. I got very depressed and upset because I figured if nobody respects me, then perhaps nobody cares anymore (p:14) The indifference and bias that I faced led to self-blame all the time. I used to feel that everything was because of my race or place of birth (p:6). Consequences: Erosion of Confidence, Satisfaction, and Care Quality Participants’ accounts highlighted those experiences of racism in nursing care produced profound and multifaceted consequences, affecting patients’ self-perception, satisfaction with care, and overall quality of healthcare delivery. Diminished Self-Confidence Discriminatory interactions undermined participants’ self-worth and confidence in engaging with healthcare providers. Patients reported feeling devalued and hesitant to express their needs or participate fully in treatment decisions. This erosion of self-confidence not only impacted emotional well-being but also impeded active engagement in care, reinforcing a cycle of marginalization. Due to either the negligence or bias expressed by nurses, my self-esteem truly suffered, and I felt as though I was of little value to others (p:7). I didn't feel valued by the nurse, which caused self-doubt and lack of confidence in what I was saying (p:11). Reduced Patient Satisfaction Participants described diminished satisfaction with care as a direct consequence of perceived discrimination. Feelings of injustice and neglect contributed to distrust in the healthcare system and reduced willingness to seek future care. Phenomenologically, these experiences reflected a sense of being unheard and invisible , which compromised the therapeutic value of nursing encounters. The care I received was not satisfying at all. They would pass by me quickly and never ask what I needed (p:3). I was treated with a lot of disrespect. I felt like no one cared about my recovery (p:12). Patient-Related Errors and Safety Risks Racism contributed to lapses in patient safety, including medication errors, misinformation, and communication breakdowns. Participants noted that discriminatory attitudes often led nurses to overlook critical patient needs, increasing the likelihood of clinical mistakes and undermining trust in care processes. “The nurse gave me the wrong medication, which wasn't suitable for my condition, and that was really scary (p:1).” When nurses show discrimination, a lot of mistakes happen, and I had to explain everything again to them (p:11). Reduced Care Productivity Prejudice disrupted effective nurse–patient communication, which in turn strained teamwork, delayed interventions, and reduced the overall efficiency of care delivery. Participants experienced these breakdowns as slower, less coordinated, and lower-quality care, demonstrating that racism can extend beyond individual interactions to affect systemic healthcare outcomes. The nurses would pass by me very quickly; they looked at my problems very superficially, and because of that, I felt like the care was very poor (p:6). The fact that the nurses would pass by me easily and without paying attention made everything slow down and didn't help improve my condition (p:7). Mal-Care: Impacts on Trust, Job Satisfaction, and Communication Participants described how racism in nursing care not only affected patients but also disrupted professional interactions and the overall care environment, creating what can be termed mal-care a deterioration in care quality arising from discriminatory behaviours. Reduced Interpersonal Trust Experiencing discrimination diminished trust between patients and healthcare providers. Participants reported that racial prejudice undermined their sense of safety and willingness to communicate openly, compromising the therapeutic relationship. This erosion of trust had tangible effects on patients’ engagement in care and health outcomes. When patients didn’t trust my performance, it really bothered me. Their reactions also clearly reflected their lack of trust (p:2). I even felt that my colleagues didn’t believe in me because they often treated me with prejudice (p:5). Decreased Job Satisfaction Racism also negatively influenced nurses’ professional satisfaction. Experiences of discrimination and perceived injustice increased workplace stress and reduced motivation, contributing to burnout and diminishing the quality of interactions within healthcare teams. This effect, in turn, could indirectly compromise patient care. I felt like no one appreciated my efforts, and this had left me with no motivation to keep working (p:8). The fact that patients acted with discrimination made me feel very dissatisfied with my job and work environment (p:9). Hindered Effective Communication Participants highlighted that prejudice impeded effective communication, creating barriers to the free exchange of information and mutual understanding. Misunderstandings, incomplete information, and reduced patient cooperation were reported, demonstrating that racism can directly compromise the quality and safety of care. When patients distanced themselves from me due to prejudice, I couldn’t establish a good connection with them (p:9). Sometimes, when I tried to connect with patients, I felt like something was blocking that connection, preventing me from making a positive impact (p:10). Preventive Measures: Strategies to Mitigate Racism in Nursing Care Participants emphasized several strategies that could prevent racism and promote equitable care in nursing practice. These measures were categorized into four interrelated themes: ongoing education, promoting cultural awareness, managing healthcare conditions, and enhancing team interactions. Ongoing Education Continuous professional education emerged as a critical preventive measure. Training programs that address cultural competence, unconscious bias, and equitable professional behaviors equip nurses with the skills to communicate effectively, demonstrate empathy, and manage discriminatory situations. Such education enhances care quality and fosters a more inclusive healthcare environment. When nurses were more aware of my condition, I felt that they took care of me. They should always be educated to know patients' problems more (p:14). Ongoing training helps me build better connections with patients and respond more effectively to their specific needs (p:8). Promoting Cultural Awareness Creating an inclusive culture that respects differences was highlighted as essential. Encouraging awareness of racial and ethnic diversity improves interpersonal communication, reduces discriminatory behaviors, and strengthens collaboration within healthcare teams. A culture of inclusion ensures patients feel respected and valued. If nurses were more sensitive to my culture, they might have treated me differently, and I would have felt more respected (P:1). Promoting cultural awareness in the workplace helps us pay closer attention to the needs of patients from different cultural backgrounds (P:13). Managing Healthcare Conditions Implementing fair policies and procedures within healthcare settings prevents discrimination by establishing clear standards for equitable treatment. Developing strategies to identify and address biased behaviours ensures a safer environment for patients, enhances satisfaction, and improves overall quality of care. “When nurses handle my condition attentively, I feel like my situation is taken seriously, and it makes me feel much more comfortable (P:12).” Effectively managing patients' conditions helps us provide the best possible care and ensures there is no discrimination in our approach (P:10). Enhancing Team Interactions Strengthening team coordination and sensitivity to cultural diversity reduces the likelihood of discriminatory practices. Training in communication, open dialogue, empathy, and addressing racial challenges fosters team synergy, enabling more equitable and patient-centered care. If the nursing team were more coordinated, I think they could address my issues more effectively, and it would make me feel more cared for (P:11). “Better team interactions help patients feel more comfortable and enable us to address their needs in the best possible way (P:2).” Discussion The purpose of this study was to investigate the individual experiences of participants regarding racism faced in nursing care. The results revealed four main themes: antecedents, consequences, mal-care, and preventive measures. The study’s findings indicated that substandard nursing care was often attributed to racism, leading to disparities in health, adverse outcomes, and reduced patient satisfaction. The results showed that tension caused by racial bias in nursing negatively affects nurse-patient relationships, undermining trust, care quality, and professional performance. Based on the findings of the present study, the psychological effects of racism, including stress, anxiety, and reduced self-esteem, can result in patient distrust of the healthcare system and reluctance to seek treatment or adhere to medical advice. These results align with the study by Vaismoradi et al. (2022), which identified three key categories: mutual flare-ups of racism, its hidden and overt consequences, and coping strategies. Racism undermines the dignity of both patients and nurses within healthcare systems. To eliminate racism in nurse-patient relationships, particularly in the context of globalization, culturally responsive frameworks emphasizing patient perspectives and equitable power dynamics are essential [ 6 ]. This study showed that racism in nursing care undermines patients’ self-esteem, reduces their willingness to engage with treatment, and negatively impacts health outcomes. It also reduces patient satisfaction, erodes trust in the healthcare system, and increases the risk of errors, including medication mistakes and miscommunication [ 5 , 24 ]. Additionally, prejudice interferes with effective communication, disrupts teamwork, and delays care, thus reducing productivity and overall quality [ 22 ]. Jason et al. (2024) describe structural racism as having five characteristics: oppressive racial ideologies, dynamic status, perverse effect, temporality, and an erroneous assumption of racial equality. They also identify six antecedents, including overt racial prejudice, implicit bias, racial discrimination, institutional racism, cultural racism, and systemic racism. Addressing these requires a clear conceptual understanding and development of tools aligned with the nature of structural racism [ 23 ]. The results of Wiapo et al. (2024) revealed two key themes: active colonial resistance to change and transformative, preventive nursing. Nurses can apply anti-racist praxis to redefine and improve nursing care, leadership, and education to combat racism [ 10 ]. Consistently, racism in nursing care lowers minority patients’ self-esteem, reducing communication and treatment acceptance, which negatively affects health outcomes, satisfaction, and trust, while increasing the likelihood of errors and care delays [ 5 , 24 – 26 ]. Findings reported in Merz et al. (2024) highlight racial discrimination from other health service users and spatial segregation based on ethnicity, religion, or race. While much of the literature examines the intersection of race with other social constructs, the intersectionality framework was rarely applied [ 27 ]. Anderson et al. (2021) identified emotional and physical effects of racism on nurses and students, emphasizing the need for safe spaces to openly address racism in academic and clinical settings [ 28 ]. The results of the present study showed that racism in nursing decreases patients’ trust in healthcare providers, impairs communication and collaboration, and negatively affects health outcomes. It also reduces nurses’ job satisfaction, leading to stress, burnout, and lower-quality interactions. In addition, discriminatory practices increase misunderstandings and medical errors, compromising care quality. Hamed et al. (2022) note that experiences of racism are linked to mistrust and delayed healthcare seeking. Healthcare providers from racial minorities also experience racism from both patients and colleagues, often without organizational support [ 4 ]. Racial bias among healthcare providers can negatively affect clinical decision-making. Research shows that healthcare workers often consider healthcare to be objective, overlooking issues of racism in clinical settings [ 29 ]. Johnson et al. (2022) highlighted effective strategies, including anti-racism training, reducing bias in assessments, addressing known racism in clinical environments, and preparing staff for anti-racism programs [ 30 ]. Addressing racism in nursing education requires interdisciplinary efforts. Nursing programs and faculty play a pivotal role in creating unbiased learning environments and should lead strategic anti-racism initiatives [ 31 ]. Continuing education improves cultural awareness, mitigates biases, and enhances communication. Promoting an inclusive culture and managing healthcare policies equitably reduces discrimination and strengthens teamwork, ultimately improving patient care [ 32 , 33 ]. Emami and Castro (2021) emphasize that nursing must be at the forefront of combating racism [ 34 ]. Persistent racial inequities in nursing education call for developing race consciousness and anti-racist pedagogy. Research shows that white normativity and unexamined privilege create oppressive learning environments, limiting the effectiveness of nurse educators. Advancing socially aware and equitable nursing education requires intentional efforts, particularly by white faculty, to recognize and dismantle structures that perpetuate racial dominance [ 35 ]. Limitations: One limitation of this study was low generalizability due to a limited number of participants. This limitation was addressed through purposive sampling and the inclusion of data-rich participants, enhancing the depth of insight into lived experiences. Conclusion The results of this study demonstrated that the lived experiences of racism in receiving nursing care are shaped by multiple factors, which were categorized into four main themes: antecedents, consequences, mal-care, and preventive measures. These findings indicate that racism is not merely a social phenomenon within healthcare settings but also has significant consequences for the quality of care as well as the mental and physical well-being of patients from racial minority groups. Moreover, exposure to racist care can diminish patients’ trust in the healthcare system. Based on these results, it is recommended that ongoing educational programs for nurses and other healthcare professionals be implemented to raise awareness about racism and its impact on nursing care. Additionally, the development and enforcement of effective policies and strategies to prevent and address racism in healthcare settings are essential to reduce racial discrimination and ensure a safe, equitable, and respectful environment for all patients. Furthermore, future research should focus on evaluating and designing evidence-based preventive and therapeutic interventions to mitigate racism in healthcare systems. Abbreviations AI Artificial Intelligence Declarations Ethics approval and consent to participate This study adhered to ethical principles, particularly emphasizing autonomy, non-maleficence, beneficence, and justice toward participants, as well as maintaining confidentiality in data management and reporting. This study approved by the Institutional Review Board (IRB) and the Ethics Committee of Yasuj University of Medical Sciences, Yasuj, Iran. (Approval No: IR.YUMS.REC.1403.127). In addition, the study protocol was reviewed and approved by the deputy of research and technology at Yasuj University of Medical Sciences. We confirm that All methods were carried out in accordance with relevant guidelines and regulations of Declaration of Helsinki. The ethical principles and good scientific practices defined by the Iran National Ethics Committee were followed throughout the research process. Prior to the study, necessary permissions were obtained from the administrators of the study settings. Also, all participants were informed about the study objectives, approximate time of the interview, note taking during the interview, and confidentiality of the information. Informed consent was obtained for each interview and voice recording, and they were assured they could withdraw from the study at any stage without any obligation. All of the Participants signed a written consent prior to the interview. Consent for publication Not applicable. Competing Interest The authors declare no conflict of interest. Funding No applicable. Author Contribution N.A. conducted the interviews and prepared the final report; M.S.M. performed data analysis; S.D. collected the data; A.D. was responsible for the drafting of the manuscript; all of the authors contributed to writing and translating the manuscript. Acknowledgments We express our gratitude to all contributors and individuals who assisted in conducting this study. It is noteworthy that the Grammarly software. The figure was designed using ChatGPT artificial intelligence. Data Availability The qualitative data used in this study are not publicly available due to ethical and confidentiality considerations. However, anonymized data may be made available from the corresponding author upon reasonable request, provided that appropriate ethical approval has been obtained. References Jones-Schenk J. Racism in Nursing. J Contin Educ Nurs. 2022;53(11):481–2. https://doi.org/10.3928/00220124-20221006-03 . Crenshaw N, Lewis L, Foronda CL. Racism in clinical nursing practice: a qualitative study. BMC Nurs. 2025;24(1):105. https://doi.org/10.1186/s12912-024-02521-8 . Aponte J, Roldós MI. National Institutes of Health R-series Grants portfolio of racism and healthcare, 2017–2022. BMC Public Health. 2023;23(1):2511. https://doi.org/10.1186/s12889-023-17407-8 . Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health. 2022;22(1):988. https://doi.org/10.1186/s12889-022-13122-y . Sim W, Lim WH, Ng CH, Chin YH, Yaow CYL, Cheong CWZ, et al. The perspectives of health professionals and patients on racism in healthcare: A qualitative systematic review. PLoS ONE. 2021;16(8):e0255936. https://doi.org/10.1371/journal.pone.0255936 . Vaismoradi M, Fredriksen Moe C, Ursin G, Ingstad K. Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review. J Adv Nurs. 2022;78(9):2665–77. https://doi.org/10.1111/jan.15267 . Rasheed SP, Younas A, Mehdi F, Challenges. Extent of Involvement, and the Impact of Nurses' Involvement in Politics and Policy Making in in Last Two Decades: An Integrative Review. J Nurs Scholarsh. 2020;52(4):446–55. https://doi.org/10.1111/jnu.12567 . Digital Object Identifier (DOI). Elias A, Paradies Y. The Costs of Institutional Racism and its Ethical Implications for Healthcare. J Bioeth Inq. 2021;18(1):45–58. https://doi.org/10.1007/s11673-020-10073-0 . Togioka BM, Young E. Diversity and Discrimination in Health Care. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025. StatPearls Publishing LLC.; 2025. Wiapo C, Adams S, Komene E, Davis J, Clark T. An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand. J Clin Nurs. 2024;33(8):2936–48. https://doi.org/10.1111/jocn.17205 . Salami B, Wong JP. Special Issue on Anti-Racism, Health, and Nursing. Can J Nurs Res. 2025;57(1):3–4. https://doi.org/10.1177/08445621251313497 . Watson-Thompson J, Hassaballa RH, Valentini SH, Schulz JA, Kadavasal PV, Harsin JD, et al. Actively Addressing Systemic Racism Using a Behavioral Community Approach. Behav Soc Issues. 2022;31(1):297–326. https://doi.org/10.1007/s42822-022-00101-6 . Iacobucci G. Most black people in UK face discrimination from healthcare staff, survey finds. BMJ. 2022;378:o2337. https://doi.org/10.1136/bmj.o2337 . Soares WE 3rd, Knowles KJ 2nd, Friedmann PD. A Thousand Cuts: Racial and Ethnic Disparities in Emergency Medicine. Med Care. 2019;57(12):921–3. 10.1097/MLR.0000000000001250 . Raghuram P. New racism or new Asia: what exactly is new and how does race matter? Asian Migration. and New Racism: Routledge; 2022. pp. 194–204. Hosseinabadi-Farahani M, Arsalani N, Hosseini M, Mohammadi E, Fallahi-Khoshknab M. Nurses' experiences of discrimination in health care: A qualitative study in Iran. J Educ Health Promot. 2023;12:100. 10.4103/jehp.jehp_648_22 . Abraham DM. A Methodological Framework for Descriptive Phenomenological Research. West J Nurs Res. 2025;47(2):125–34. https://doi.org/10.1177/01939459241308071 . Peters K, Halcomb E. Interviews in qualitative research. Nurse Res. 2015;22(4):6–7. 10.7748/nr.22.4.6.s2 . McGrath C, Palmgren PJ, Liljedahl M. Twelve tips for conducting qualitative research interviews. Med Teach. 2019;41(9):1002–6. https://doi.org/10.1080/0142159X.2018.1497149 . Praveena K, Sasikumar S. Application of Colaizzi’s method of data analysis in phenomenological research. Medico Legal Update. 2021;21(2):914–8. Ahmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Health. 2024;2:100051. https://doi.org/10.1016/j.glmedi.2024.100051 . Adegoke K, Adegoke A, Dawodu D, Kayode T. Systemic Racism in Canadian Healthcare: A Policy and Equity Analysis. J Prim Care Community Health. 2025;16:21501319251386672. https://doi.org/10.1177/21501319251386672 . Smith JW, Mayo A. Structural racism: A concept analysis. Nurs Outlook. 2024;72(6):102295. https://doi.org/10.1016/j.outlook.2024.102295 . Cuevas AG, O'Brien K, Saha S. African American experiences in healthcare: I always feel like I'm getting skipped over. Health Psychol. 2016;35(9):987–95. Thompson C. The experience of racial discrimination among ethnic minority healthcare professionals in Ireland. Eur J Pub Health. 2023;33(Supplement2):ckad160. https://doi.org/10.1093/eurpub/ckad160.059 . Weech-Maldonado R, Lord J, Davlyatov G, Ghiasi A, Orewa G. High-Minority Nursing Homes Disproportionately Affected by COVID-19 Deaths. Front Public Health. 2021;9:606364. https://doi.org/10.3389/fpubh.2021.606364 . Merz S, Aksakal T, Hibtay A, Yücesoy H, Fieselmann J, Annaç K, et al. Racism against healthcare users in inpatient care: a scoping review. Int J Equity Health. 2024;23(1):89. https://doi.org/10.1186/s12939-024-02156-w . Iheduru-Anderson K, Shingles RR, Akanegbu C. Discourse of race and racism in nursing: An integrative review of literature. Public Health Nurs. 2021;38(1):115–30. https://doi.org/10.1111/phn.12828 . Ray K. Clinicians’ racial biases as pathways to iatrogenic harms for black people. AMA J ethics. 2022;24(8):768–72. 10.1001/amajethics.2022.768 . Johnson R, Browning K, DeClerk L. Strategies to Reduce Bias and Racism in Nursing Precepted Clinical Experiences. J Nurs Educ. 2021;60(12):697–702. https://doi.org/10.3928/01484834-20211103-01 . Iheduru-Anderson KC, Wahi MM. Proposal for a global agenda to eliminate racism in nursing and nursing education. Civil society and social responsibility in higher education: International perspectives on curriculum and teaching development. Volume 21. Emerald Publishing Limited; 2020. pp. 17–43. Roitenberg N. Improving Nursing Care in Long-Term Care Facilities for Older Adults by Addressing the Social Diversity of the Nursing Staff. SAGE Open Nurs. 2025;11:23779608251318840. https://doi.org/10.1177/23779608251318840 . D’Souza MS. Antidiscrimination pedagogical approaches to enhance diversity and inclusion in undergraduate nursing education: A critical analysis. J Nurs Educ Pract. 2025;15(4):10–8. Emami A, de Castro B. Confronting racism in nursing. Nurs Outlook. 2021;69(5):714–6. https://doi.org/10.1016/j.outlook.2021.06.002 . Bell B. White dominance in nursing education: A target for anti-racist efforts. Nurs Inq. 2021;28(1):e12379. https://doi.org/10.1111/nin.12379 . Additional Declarations No competing interests reported. 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In addition, racism is a complex and multidimensional concept and is considered a significant social issue [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although awareness has increased over the years, leading to the condemnation of racism, injustice and racial discrimination unfortunately persist in various areas, including healthcare services, and more specifically in nursing care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Racism in nursing impacts access to healthcare and medical services, leading to disparities in the availability and quality of health services [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This issue is particularly unacceptable in care and treatment settings, where the fundamental principle is the equitable distribution of services and the provision of care regardless of patients' characteristics. Racism significantly exacerbates health inequities among patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Patients' experiences of racism often manifest as receiving unfair or delayed services, neglect of their pain, disrespect toward minority patients, and labelling [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Various studies have shown that negative experiences of racism not only cause undue stress for minority patients but also foster deep mistrust toward the healthcare system and healthcare providers, including nurses, thereby perpetuating a vicious cycle of poor health outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, racism affects nurse\u0026ndash;patient interactions, undermining the core foundation of nursing, which is effective communication and interaction with patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This is particularly concerning given that nurses constitute the largest segment of the healthcare workforce in any country, and adherence to social justice is a fundamental requirement of nursing practice [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Overall, racism in healthcare settings\u0026mdash;whether overt or covert\u0026mdash;contradicts the principles of a just society [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Compromising patients' well-being and disrupting equitable access to high-quality healthcare leads to injustice, discrimination, and humiliation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This issue has prompted many researchers and experts to analyse and examine the role of racism in patients' access to nursing care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Studies indicate that racism can have profoundly detrimental effects on medical and nursing care, resulting in reduced quality of care and dissatisfaction among patients and their families. Therefore, combating racism is essential to improving the quality of healthcare services [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. One effective approach to addressing racism is raising awareness about its existence and identifying the factors that contribute to it [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Various studies have demonstrated that racism is prevalent in healthcare environments, including hospitals, treatment centres, and health services. For example, a study in the United Kingdom found that Black patients, when compared to White, were subjected to fewer examinations and tests [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, research conducted in the United States showed that in emergency situations, Black individuals may receive less healthcare and, in some cases, experience longer periods of pain than their White counterparts [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These findings underscore that racism within healthcare settings, including hospitals and clinics, is a significant issue that must be addressed in order to improve the quality of healthcare and ensure appropriate patient care. Conducting qualitative research to clarify patients' experiences of racism can help raise awareness among healthcare providers and patients about racism, leading to changes in the way nurses interact with patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A review of studies on racism shows that it is widespread in many Asian countries; however, most research in this field has been conducted in Western countries [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Given the prevalence of racism as a social construct, and its detrimental impact on the quality of services provided, as well as its influence by the culture of each society, and the lack of studies on this topic in Iran, it seems necessary to thoroughly explore lived experiences of racism in nursing care for patients as experienced it in real-life settings [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This objective can be achieved through qualitative research using a phenomenological approach with a naturalistic perspective. Thus, this qualitative study aimed to explore the lived experiences of racism in nursing care for patients in Iran.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy type and Setting\u003c/h2\u003e \u003cp\u003eTo better understand the lived experiences of racism in receiving nursing care, the present qualitative study performed the Husserlian descriptive phenomenological approach between April and September 2025 in Shahid Jalil and Shahid Beheshti hospitals, affiliated with Yasuj University of Medical Sciences, as public centers in southwestern Iran. To adhere to the principle of bracketing in this study and based on Husserl's method, any potential biases in conducting the interviews and the data analysis process were controlled [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy participants\u003c/h3\u003e\n\u003cp\u003ePurposive sampling was employed to recruit participants from public hospitals in southwestern Iran. A total of fourteen participants, including nurses and patients with maximum variation were enrolled in the study. Including both nurses and patients allowed for a comprehensive exploration of racism from multiple perspectives, capturing both the provision and the receipt of care within the clinical setting. Inclusion criteria comprised having experienced racism during hospitalization, literacy, the ability to communicate effectively, and sufficient availability to participate in interviews. Exclusion criteria included unwillingness to participate and limitations in cooperation. Participant identification and recruitment were conducted through visits to approved health facilities, following authorization from relevant institutional authorities. After selecting the initial participant, eligible individuals were approached, informed about the study objectives, and invited to share their experiences. Upon obtaining informed consent, details regarding the interview process, setting, timing, and supportive arrangements were clearly explained to all participants. All of the participants accepted the researcher's request to participate in the study. None of the participants were excluded during the study.\u003c/p\u003e\n\u003ch3\u003eData generation\u003c/h3\u003e\n\u003cp\u003eData were collected through semi-structured interviews [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] by the first author in a comfortable environment for the participants and mostly in a private room in the hospitals. Interviews lasted between 45 and 60 minutes and were conducted either face-to-face or virtually via the WhatsApp application, according to participants\u0026rsquo; preferences and convenience. The interview setting and modality were determined based on participants\u0026rsquo; comfort and informed consent. After referring to the medical centers and coordinating with the relevant authorities, greeting patients and nurses, obtaining informed consent, and the necessary information the researcher selected the participants among the eligible individuals who were willing to be interviewed. Before beginning the interview, the researcher explained the purpose and necessity of the research to the participants, written informed consent was obtained from them. The participants were explained about maintaining confidentiality and recording their voices during the interview, and if they agreed, their voices would be recorded. Given that this study was a small part of a larger study titled The Emergence and Normalization of Racism in Nursing Care: A Grounded Theory Study, approved by Ethics Committee of Yasuj University of Medical Sciences, Yasuj, Iran (Approval No: IR.YUMS.REC.1403.126), in that study, according to the main goal, questions were asked about how individual biases, organizational structures, and nurse-patient interactions contribute to the emergence and normalization of racism in nursing care in Iran. Therefore, the questions raised in this study, followed the previous questions, but revolve around the main concept of this study, racism in nursing care for patients. The primary guiding question was, \u0026ldquo;Can you describe your experience with racism in receiving nursing care?\u0026rdquo; Probing questions, such as \u0026ldquo;What do you mean by this?\u0026rdquo; and \u0026ldquo;Could you elaborate further?\u0026rdquo;, were used to elicit deeper insights into participants\u0026rsquo; experiences. Closure-oriented questions, including \u0026ldquo;Is there anything else you would like to add?\u0026rdquo;, were also employed to ensure data completeness [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The interviewer made field notes during all the interviews and documented all the relevant information including non-verbal cues, emotional expressions such as crying, sadness and discomfort, facial expressions, head shaking and, sighing. Data collection continued until 14 participants were interviewed. After 14 interviews, data saturation was discussed with the research team. The team agreed that the data saturation point was achieved and no major discrepancy was observed during the interviews.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analysed using Colaizzi\u0026rsquo;s seven-step phenomenological method [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] (Figure S1). Following data collection through interviews, all recordings were transcribed verbatim and repeatedly reviewed to achieve immersion in the data and a deeper understanding of participants\u0026rsquo; experiences. The transcripts were then examined line by line to identify significant statements, marking the initial coding process. Identified meanings were formulated and labelled as preliminary codes, which were subsequently grouped into subthemes based on conceptual similarities and differences. These subthemes were further clustered into overarching themes to develop a comprehensive and integrated description of the phenomenon under study. Finally, the rigor and trustworthiness of the findings were established in accordance with the criteria proposed by Lincoln and Guba [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], including credibility, dependability, confirmability, and transferability.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrustworthiness\u003c/h3\u003e\n\u003cp\u003e Credibility was ensured through prolonged engagement with the data, repeated immersion in interview transcripts, and continuous interaction with participants. Bracketing was operationalized through reflexive journaling conducted before and during data analysis to identify and minimize researcher preconceptions. To ensure that findings reflected participants\u0026rsquo; voices, significant statements were extracted verbatim and used as the basis for meaning formulation and theme development. Member checking was conducted by sharing preliminary themes with selected participants to confirm accuracy and resonance with their lived experiences. Transferability was supported through rich descriptions of the research context, participants, and analytic procedures. Dependability was enhanced through peer debriefing, in which two qualitative research experts reviewed and refined the coding and thematic structure. An audit trail documenting analytic decisions, code development, and reflexive notes was maintained throughout the study. Confirmability was ensured through methodological transparency, reflexivity, and question triangulation using multiple probing questions.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eIn this study, ethical approval was obtained, and informed consent was acquired from the participants. They were also assured that all information in this study would be kept strictly confidential and destroyed after the completion of the study. Furthermore, confidentiality was maintained in the presentation of the final report.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe participants consisted of 14 individuals; the mean and standard deviation of the age of patients in this study were 46.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.91. The mean and standard deviation of the age of nurses in this study were 34.17\u0026thinsp;\u0026plusmn;\u0026thinsp;7.82. Demographic characteristics of the participants are presented in Table S1. Based on the phenomenological analysis, the main themes identified in this study were: Antecedents: Experiencing Care as Unequal, Tense, and Psychologically Eroding; Consequences: Erosion of Confidence, Satisfaction, and Care Quality; Mal-Care: Impacts on Trust, Job Satisfaction, and Communication; and Preventive Measures: Strategies to Mitigate Racism in Nursing Care (Table S2).\u003c/p\u003e \n\u003ch3\u003eAntecedents: Experiencing Care as Unequal, Tense, and Psychologically Eroding\u003c/h3\u003e\n\u003cp\u003eParticipants\u0026rsquo; narratives revealed that racism in nursing care was preceded by an embodied experience of unequal care, interpersonal tension, and psychological erosion, which together constituted a context in which discriminatory care was perceived and internalized.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePerceived Poor Quality of Care\u003c/h2\u003e \u003cp\u003eParticipants consistently described the quality of nursing care as superficial, rushed, and inattentive, which they interpreted as a manifestation of racialized neglect. This perceived reduction in care quality was not limited to technical aspects but extended to the absence of listening, assessment, and responsiveness to individual needs. Phenomenologically, this experience reflected a sense of \u003cem\u003ebeing rendered invisible\u003c/em\u003e within the care encounter, undermining trust and reinforcing perceptions of inequity in healthcare delivery.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI didn't feel heard at all. When the nurse came in, they rushed through things and never once asked me what my pain was or what I needed (p:3).\u003c/p\u003e\u003cp\u003eI couldn\u0026rsquo;t understand why the nurses were so indifferent towards me. Everything felt so superficial, and I never felt like I was receiving enough care (p:6).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eInterpersonal Tension\u003c/h2\u003e \u003cp\u003eRacism was further preceded by a persistent atmosphere of tension that shaped nurse\u0026ndash;patient interactions. Participants described heightened vigilance, stress, and fear of misinterpretation during encounters with nurses. This tension disrupted the therapeutic relationship, limiting open communication and fostering emotional withdrawal. From a phenomenological perspective, care interactions were experienced as \u003cem\u003eunsafe relational spaces\u003c/em\u003e in which patients anticipated disrespect rather than support.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eEvery time the nurses came, I felt a lot of pressure in my chest. I was stressed that they might misunderstand something or not even pay attention to my problem (p:4)\u003c/p\u003e\u003cp\u003eIf I knew the nurses were indifferent, I didn\u0026rsquo;t want to say anything because I was stressed that I might be disrespected again or not understood properly (p:12).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePsychological Vulnerability\u003c/h2\u003e \u003cp\u003eExperiences of perceived discrimination were also preceded by profound psychological vulnerability. Participants reported feelings of worthlessness, self-blame, and emotional distress, which gradually eroded their sense of dignity and belonging within the healthcare system. These psychological effects functioned not only as consequences but also as antecedent conditions that shaped how subsequent care interactions were interpreted and endured, ultimately discouraging engagement with treatment and care processes.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe behavior I observed from the nurses made me feel as if I had no worth. I got very depressed and upset because I figured if nobody respects me, then perhaps nobody cares anymore (p:14)\u003c/p\u003e\u003cp\u003eThe indifference and bias that I faced led to self-blame all the time. I used to feel that everything was because of my race or place of birth (p:6).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eConsequences: Erosion of Confidence, Satisfaction, and Care Quality\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; accounts highlighted those experiences of racism in nursing care produced profound and multifaceted consequences, affecting patients\u0026rsquo; self-perception, satisfaction with care, and overall quality of healthcare delivery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDiminished Self-Confidence\u003c/h2\u003e \u003cp\u003eDiscriminatory interactions undermined participants\u0026rsquo; self-worth and confidence in engaging with healthcare providers. Patients reported feeling devalued and hesitant to express their needs or participate fully in treatment decisions. This erosion of self-confidence not only impacted emotional well-being but also impeded active engagement in care, reinforcing a cycle of marginalization.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDue to either the negligence or bias expressed by nurses, my self-esteem truly suffered, and I felt as though I was of little value to others (p:7).\u003c/p\u003e\u003cp\u003eI didn't feel valued by the nurse, which caused self-doubt and lack of confidence in what I was saying (p:11).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eReduced Patient Satisfaction\u003c/h2\u003e \u003cp\u003eParticipants described diminished satisfaction with care as a direct consequence of perceived discrimination. Feelings of injustice and neglect contributed to distrust in the healthcare system and reduced willingness to seek future care. Phenomenologically, these experiences reflected \u003cem\u003ea sense of being unheard and invisible\u003c/em\u003e, which compromised the therapeutic value of nursing encounters.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe care I received was not satisfying at all. They would pass by me quickly and never ask what I needed (p:3).\u003c/p\u003e\u003cp\u003eI was treated with a lot of disrespect. I felt like no one cared about my recovery (p:12).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePatient-Related Errors and Safety Risks\u003c/h2\u003e \u003cp\u003eRacism contributed to lapses in patient safety, including medication errors, misinformation, and communication breakdowns. Participants noted that discriminatory attitudes often led nurses to overlook critical patient needs, increasing the likelihood of clinical mistakes and undermining trust in care processes.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The nurse gave me the wrong medication, which wasn't suitable for my condition, and that was really scary (p:1).\u0026rdquo;\u003c/em\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWhen nurses show discrimination, a lot of mistakes happen, and I had to explain everything again to them (p:11).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eReduced Care Productivity\u003c/h2\u003e \u003cp\u003ePrejudice disrupted effective nurse\u0026ndash;patient communication, which in turn strained teamwork, delayed interventions, and reduced the overall efficiency of care delivery. Participants experienced these breakdowns as slower, less coordinated, and lower-quality care, demonstrating that racism can extend beyond individual interactions to affect systemic healthcare outcomes.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe nurses would pass by me very quickly; they looked at my problems very superficially, and because of that, I felt like the care was very poor (p:6).\u003c/p\u003e\u003cp\u003eThe fact that the nurses would pass by me easily and without paying attention made everything slow down and didn't help improve my condition (p:7).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eMal-Care: Impacts on Trust, Job Satisfaction, and Communication\u003c/h2\u003e \u003cp\u003eParticipants described how racism in nursing care not only affected patients but also disrupted professional interactions and the overall care environment, creating what can be termed \u003cem\u003emal-care\u003c/em\u003e a deterioration in care quality arising from discriminatory behaviours.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eReduced Interpersonal Trust\u003c/h2\u003e \u003cp\u003eExperiencing discrimination diminished trust between patients and healthcare providers. Participants reported that racial prejudice undermined their sense of safety and willingness to communicate openly, compromising the therapeutic relationship. This erosion of trust had tangible effects on patients\u0026rsquo; engagement in care and health outcomes.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen patients didn\u0026rsquo;t trust my performance, it really bothered me. Their reactions also clearly reflected their lack of trust (p:2).\u003c/p\u003e\u003cp\u003eI even felt that my colleagues didn\u0026rsquo;t believe in me because they often treated me with prejudice (p:5).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eDecreased Job Satisfaction\u003c/h2\u003e \u003cp\u003eRacism also negatively influenced nurses\u0026rsquo; professional satisfaction. Experiences of discrimination and perceived injustice increased workplace stress and reduced motivation, contributing to burnout and diminishing the quality of interactions within healthcare teams. This effect, in turn, could indirectly compromise patient care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI felt like no one appreciated my efforts, and this had left me with no motivation to keep working (p:8).\u003c/p\u003e\u003cp\u003eThe fact that patients acted with discrimination made me feel very dissatisfied with my job and work environment (p:9).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eHindered Effective Communication\u003c/h2\u003e \u003cp\u003e Participants highlighted that prejudice impeded effective communication, creating barriers to the free exchange of information and mutual understanding. Misunderstandings, incomplete information, and reduced patient cooperation were reported, demonstrating that racism can directly compromise the quality and safety of care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen patients distanced themselves from me due to prejudice, I couldn\u0026rsquo;t establish a good connection with them (p:9).\u003c/p\u003e\u003cp\u003eSometimes, when I tried to connect with patients, I felt like something was blocking that connection, preventing me from making a positive impact (p:10).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ePreventive Measures: Strategies to Mitigate Racism in Nursing Care\u003c/h2\u003e \u003cp\u003eParticipants emphasized several strategies that could prevent racism and promote equitable care in nursing practice. These measures were categorized into four interrelated themes: ongoing education, promoting cultural awareness, managing healthcare conditions, and enhancing team interactions.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eOngoing Education\u003c/h2\u003e \u003cp\u003eContinuous professional education emerged as a critical preventive measure. Training programs that address cultural competence, unconscious bias, and equitable professional behaviors equip nurses with the skills to communicate effectively, demonstrate empathy, and manage discriminatory situations. Such education enhances care quality and fosters a more inclusive healthcare environment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen nurses were more aware of my condition, I felt that they took care of me. They should always be educated to know patients' problems more (p:14).\u003c/p\u003e\u003cp\u003eOngoing training helps me build better connections with patients and respond more effectively to their specific needs (p:8).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003ePromoting Cultural Awareness\u003c/h2\u003e \u003cp\u003eCreating an inclusive culture that respects differences was highlighted as essential. Encouraging awareness of racial and ethnic diversity improves interpersonal communication, reduces discriminatory behaviors, and strengthens collaboration within healthcare teams. A culture of inclusion ensures patients feel respected and valued.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf nurses were more sensitive to my culture, they might have treated me differently, and I would have felt more respected (P:1).\u003c/p\u003e\u003cp\u003ePromoting cultural awareness in the workplace helps us pay closer attention to the needs of patients from different cultural backgrounds (P:13).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eManaging Healthcare Conditions\u003c/h2\u003e \u003cp\u003eImplementing fair policies and procedures within healthcare settings prevents discrimination by establishing clear standards for equitable treatment. Developing strategies to identify and address biased behaviours ensures a safer environment for patients, enhances satisfaction, and improves overall quality of care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When nurses handle my condition attentively, I feel like my situation is taken seriously, and it makes me feel much more comfortable (P:12).\u0026rdquo;\u003c/em\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eEffectively managing patients' conditions helps us provide the best possible care and ensures there is no discrimination in our approach (P:10).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eEnhancing Team Interactions\u003c/h2\u003e \u003cp\u003eStrengthening team coordination and sensitivity to cultural diversity reduces the likelihood of discriminatory practices. Training in communication, open dialogue, empathy, and addressing racial challenges fosters team synergy, enabling more equitable and patient-centered care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf the nursing team were more coordinated, I think they could address my issues more effectively, and it would make me feel more cared for (P:11).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Better team interactions help patients feel more comfortable and enable us to address their needs in the best possible way (P:2).\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to investigate the individual experiences of participants regarding racism faced in nursing care. The results revealed four main themes: antecedents, consequences, mal-care, and preventive measures. The study\u0026rsquo;s findings indicated that substandard nursing care was often attributed to racism, leading to disparities in health, adverse outcomes, and reduced patient satisfaction. The results showed that tension caused by racial bias in nursing negatively affects nurse-patient relationships, undermining trust, care quality, and professional performance. Based on the findings of the present study, the psychological effects of racism, including stress, anxiety, and reduced self-esteem, can result in patient distrust of the healthcare system and reluctance to seek treatment or adhere to medical advice. These results align with the study by Vaismoradi et al. (2022), which identified three key categories: mutual flare-ups of racism, its hidden and overt consequences, and coping strategies. Racism undermines the dignity of both patients and nurses within healthcare systems. To eliminate racism in nurse-patient relationships, particularly in the context of globalization, culturally responsive frameworks emphasizing patient perspectives and equitable power dynamics are essential [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This study showed that racism in nursing care undermines patients\u0026rsquo; self-esteem, reduces their willingness to engage with treatment, and negatively impacts health outcomes. It also reduces patient satisfaction, erodes trust in the healthcare system, and increases the risk of errors, including medication mistakes and miscommunication [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Additionally, prejudice interferes with effective communication, disrupts teamwork, and delays care, thus reducing productivity and overall quality [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Jason et al. (2024) describe structural racism as having five characteristics: oppressive racial ideologies, dynamic status, perverse effect, temporality, and an erroneous assumption of racial equality. They also identify six antecedents, including overt racial prejudice, implicit bias, racial discrimination, institutional racism, cultural racism, and systemic racism. Addressing these requires a clear conceptual understanding and development of tools aligned with the nature of structural racism [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The results of Wiapo et al. (2024) revealed two key themes: active colonial resistance to change and transformative, preventive nursing. Nurses can apply anti-racist praxis to redefine and improve nursing care, leadership, and education to combat racism [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Consistently, racism in nursing care lowers minority patients\u0026rsquo; self-esteem, reducing communication and treatment acceptance, which negatively affects health outcomes, satisfaction, and trust, while increasing the likelihood of errors and care delays [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Findings reported in Merz et al. (2024) highlight racial discrimination from other health service users and spatial segregation based on ethnicity, religion, or race. While much of the literature examines the intersection of race with other social constructs, the intersectionality framework was rarely applied [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Anderson et al. (2021) identified emotional and physical effects of racism on nurses and students, emphasizing the need for safe spaces to openly address racism in academic and clinical settings [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The results of the present study showed that racism in nursing decreases patients\u0026rsquo; trust in healthcare providers, impairs communication and collaboration, and negatively affects health outcomes. It also reduces nurses\u0026rsquo; job satisfaction, leading to stress, burnout, and lower-quality interactions. In addition, discriminatory practices increase misunderstandings and medical errors, compromising care quality. Hamed et al. (2022) note that experiences of racism are linked to mistrust and delayed healthcare seeking. Healthcare providers from racial minorities also experience racism from both patients and colleagues, often without organizational support [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Racial bias among healthcare providers can negatively affect clinical decision-making. Research shows that healthcare workers often consider healthcare to be objective, overlooking issues of racism in clinical settings [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Johnson et al. (2022) highlighted effective strategies, including anti-racism training, reducing bias in assessments, addressing known racism in clinical environments, and preparing staff for anti-racism programs [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Addressing racism in nursing education requires interdisciplinary efforts. Nursing programs and faculty play a pivotal role in creating unbiased learning environments and should lead strategic anti-racism initiatives [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Continuing education improves cultural awareness, mitigates biases, and enhances communication. Promoting an inclusive culture and managing healthcare policies equitably reduces discrimination and strengthens teamwork, ultimately improving patient care [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Emami and Castro (2021) emphasize that nursing must be at the forefront of combating racism [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Persistent racial inequities in nursing education call for developing race consciousness and anti-racist pedagogy. Research shows that white normativity and unexamined privilege create oppressive learning environments, limiting the effectiveness of nurse educators. Advancing socially aware and equitable nursing education requires intentional efforts, particularly by white faculty, to recognize and dismantle structures that perpetuate racial dominance [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eOne limitation of this study was low generalizability due to a limited number of participants. This limitation was addressed through purposive sampling and the inclusion of data-rich participants, enhancing the depth of insight into lived experiences.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study demonstrated that the lived experiences of racism in receiving nursing care are shaped by multiple factors, which were categorized into four main themes: antecedents, consequences, mal-care, and preventive measures. These findings indicate that racism is not merely a social phenomenon within healthcare settings but also has significant consequences for the quality of care as well as the mental and physical well-being of patients from racial minority groups. Moreover, exposure to racist care can diminish patients\u0026rsquo; trust in the healthcare system. Based on these results, it is recommended that ongoing educational programs for nurses and other healthcare professionals be implemented to raise awareness about racism and its impact on nursing care. Additionally, the development and enforcement of effective policies and strategies to prevent and address racism in healthcare settings are essential to reduce racial discrimination and ensure a safe, equitable, and respectful environment for all patients. Furthermore, future research should focus on evaluating and designing evidence-based preventive and therapeutic interventions to mitigate racism in healthcare systems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArtificial Intelligence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study adhered to ethical principles, particularly emphasizing autonomy, non-maleficence, beneficence, and justice toward participants, as well as maintaining confidentiality in data management and reporting. This study approved by the Institutional Review Board (IRB) and the Ethics Committee of Yasuj University of Medical Sciences, Yasuj, Iran. (Approval No: IR.YUMS.REC.1403.127). In addition, the study protocol was reviewed and approved by the deputy of research and technology at Yasuj University of Medical Sciences. We confirm that All methods were carried out in accordance with relevant guidelines and regulations of Declaration of Helsinki. The ethical principles and good scientific practices defined by the Iran National Ethics Committee were followed throughout the research process. Prior to the study, necessary permissions were obtained from the administrators of the study settings. Also, all participants were informed about the study objectives, approximate time of the interview, note taking during the interview, and confidentiality of the information. Informed consent was obtained for each interview and voice recording, and they were assured they could withdraw from the study at any stage without any obligation. All of the Participants signed a written consent prior to the interview.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interest\u003c/strong\u003e \u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eN.A. conducted the interviews and prepared the final report; M.S.M. performed data analysis; S.D. collected the data; A.D. was responsible for the drafting of the manuscript; all of the authors contributed to writing and translating the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe express our gratitude to all contributors and individuals who assisted in conducting this study. It is noteworthy that the Grammarly software. The figure was designed using ChatGPT artificial intelligence.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe qualitative data used in this study are not publicly available due to ethical and confidentiality considerations. However, anonymized data may be made available from the corresponding author upon reasonable request, provided that appropriate ethical approval has been obtained.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJones-Schenk J. Racism in Nursing. J Contin Educ Nurs. 2022;53(11):481\u0026ndash;2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3928/00220124-20221006-03\u003c/span\u003e\u003cspan address=\"10.3928/00220124-20221006-03\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrenshaw N, Lewis L, Foronda CL. Racism in clinical nursing practice: a qualitative study. BMC Nurs. 2025;24(1):105. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12912-024-02521-8\u003c/span\u003e\u003cspan address=\"10.1186/s12912-024-02521-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAponte J, Rold\u0026oacute;s MI. National Institutes of Health R-series Grants portfolio of racism and healthcare, 2017\u0026ndash;2022. BMC Public Health. 2023;23(1):2511. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-023-17407-8\u003c/span\u003e\u003cspan address=\"10.1186/s12889-023-17407-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamed S, Bradby H, Ahlberg BM, Thapar-Bj\u0026ouml;rkert S. Racism in healthcare: a scoping review. BMC Public Health. 2022;22(1):988. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-022-13122-y\u003c/span\u003e\u003cspan address=\"10.1186/s12889-022-13122-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSim W, Lim WH, Ng CH, Chin YH, Yaow CYL, Cheong CWZ, et al. The perspectives of health professionals and patients on racism in healthcare: A qualitative systematic review. PLoS ONE. 2021;16(8):e0255936. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0255936\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0255936\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaismoradi M, Fredriksen Moe C, Ursin G, Ingstad K. Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review. J Adv Nurs. 2022;78(9):2665\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jan.15267\u003c/span\u003e\u003cspan address=\"10.1111/jan.15267\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRasheed SP, Younas A, Mehdi F, Challenges. Extent of Involvement, and the Impact of Nurses' Involvement in Politics and Policy Making in in Last Two Decades: An Integrative Review. J Nurs Scholarsh. 2020;52(4):446\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jnu.12567\u003c/span\u003e\u003cspan address=\"10.1111/jnu.12567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Digital Object Identifier (DOI).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElias A, Paradies Y. The Costs of Institutional Racism and its Ethical Implications for Healthcare. J Bioeth Inq. 2021;18(1):45\u0026ndash;58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11673-020-10073-0\u003c/span\u003e\u003cspan address=\"10.1007/s11673-020-10073-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTogioka BM, Young E. Diversity and Discrimination in Health Care. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright \u0026copy; 2025. StatPearls Publishing LLC.; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiapo C, Adams S, Komene E, Davis J, Clark T. An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand. J Clin Nurs. 2024;33(8):2936\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jocn.17205\u003c/span\u003e\u003cspan address=\"10.1111/jocn.17205\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalami B, Wong JP. Special Issue on Anti-Racism, Health, and Nursing. Can J Nurs Res. 2025;57(1):3\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/08445621251313497\u003c/span\u003e\u003cspan address=\"10.1177/08445621251313497\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson-Thompson J, Hassaballa RH, Valentini SH, Schulz JA, Kadavasal PV, Harsin JD, et al. Actively Addressing Systemic Racism Using a Behavioral Community Approach. Behav Soc Issues. 2022;31(1):297\u0026ndash;326. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s42822-022-00101-6\u003c/span\u003e\u003cspan address=\"10.1007/s42822-022-00101-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIacobucci G. Most black people in UK face discrimination from healthcare staff, survey finds. BMJ. 2022;378:o2337. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmj.o2337\u003c/span\u003e\u003cspan address=\"10.1136/bmj.o2337\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoares WE 3rd, Knowles KJ 2nd, Friedmann PD. A Thousand Cuts: Racial and Ethnic Disparities in Emergency Medicine. Med Care. 2019;57(12):921\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MLR.0000000000001250\u003c/span\u003e\u003cspan address=\"10.1097/MLR.0000000000001250\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaghuram P. New racism or new Asia: what exactly is new and how does race matter? Asian Migration. and New Racism: Routledge; 2022. pp. 194\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHosseinabadi-Farahani M, Arsalani N, Hosseini M, Mohammadi E, Fallahi-Khoshknab M. Nurses' experiences of discrimination in health care: A qualitative study in Iran. J Educ Health Promot. 2023;12:100. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jehp.jehp_648_22\u003c/span\u003e\u003cspan address=\"10.4103/jehp.jehp_648_22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbraham DM. A Methodological Framework for Descriptive Phenomenological Research. West J Nurs Res. 2025;47(2):125\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/01939459241308071\u003c/span\u003e\u003cspan address=\"10.1177/01939459241308071\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeters K, Halcomb E. Interviews in qualitative research. Nurse Res. 2015;22(4):6\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7748/nr.22.4.6.s2\u003c/span\u003e\u003cspan address=\"10.7748/nr.22.4.6.s2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGrath C, Palmgren PJ, Liljedahl M. Twelve tips for conducting qualitative research interviews. Med Teach. 2019;41(9):1002\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/0142159X.2018.1497149\u003c/span\u003e\u003cspan address=\"10.1080/0142159X.2018.1497149\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePraveena K, Sasikumar S. Application of Colaizzi\u0026rsquo;s method of data analysis in phenomenological research. Medico Legal Update. 2021;21(2):914\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Health. 2024;2:100051. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.glmedi.2024.100051\u003c/span\u003e\u003cspan address=\"10.1016/j.glmedi.2024.100051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdegoke K, Adegoke A, Dawodu D, Kayode T. Systemic Racism in Canadian Healthcare: A Policy and Equity Analysis. J Prim Care Community Health. 2025;16:21501319251386672. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/21501319251386672\u003c/span\u003e\u003cspan address=\"10.1177/21501319251386672\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith JW, Mayo A. Structural racism: A concept analysis. Nurs Outlook. 2024;72(6):102295. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.outlook.2024.102295\u003c/span\u003e\u003cspan address=\"10.1016/j.outlook.2024.102295\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCuevas AG, O'Brien K, Saha S. African American experiences in healthcare: I always feel like I'm getting skipped over. Health Psychol. 2016;35(9):987\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson C. The experience of racial discrimination among ethnic minority healthcare professionals in Ireland. Eur J Pub Health. 2023;33(Supplement2):ckad160. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/eurpub/ckad160.059\u003c/span\u003e\u003cspan address=\"10.1093/eurpub/ckad160.059\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeech-Maldonado R, Lord J, Davlyatov G, Ghiasi A, Orewa G. High-Minority Nursing Homes Disproportionately Affected by COVID-19 Deaths. Front Public Health. 2021;9:606364. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2021.606364\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2021.606364\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMerz S, Aksakal T, Hibtay A, Y\u0026uuml;cesoy H, Fieselmann J, Anna\u0026ccedil; K, et al. Racism against healthcare users in inpatient care: a scoping review. Int J Equity Health. 2024;23(1):89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12939-024-02156-w\u003c/span\u003e\u003cspan address=\"10.1186/s12939-024-02156-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIheduru-Anderson K, Shingles RR, Akanegbu C. Discourse of race and racism in nursing: An integrative review of literature. Public Health Nurs. 2021;38(1):115\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/phn.12828\u003c/span\u003e\u003cspan address=\"10.1111/phn.12828\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRay K. Clinicians\u0026rsquo; racial biases as pathways to iatrogenic harms for black people. AMA J ethics. 2022;24(8):768\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/amajethics.2022.768\u003c/span\u003e\u003cspan address=\"10.1001/amajethics.2022.768\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson R, Browning K, DeClerk L. Strategies to Reduce Bias and Racism in Nursing Precepted Clinical Experiences. J Nurs Educ. 2021;60(12):697\u0026ndash;702. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3928/01484834-20211103-01\u003c/span\u003e\u003cspan address=\"10.3928/01484834-20211103-01\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIheduru-Anderson KC, Wahi MM. Proposal for a global agenda to eliminate racism in nursing and nursing education. Civil society and social responsibility in higher education: International perspectives on curriculum and teaching development. Volume 21. Emerald Publishing Limited; 2020. pp. 17\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoitenberg N. Improving Nursing Care in Long-Term Care Facilities for Older Adults by Addressing the Social Diversity of the Nursing Staff. SAGE Open Nurs. 2025;11:23779608251318840. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/23779608251318840\u003c/span\u003e\u003cspan address=\"10.1177/23779608251318840\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Souza MS. Antidiscrimination pedagogical approaches to enhance diversity and inclusion in undergraduate nursing education: A critical analysis. J Nurs Educ Pract. 2025;15(4):10\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmami A, de Castro B. Confronting racism in nursing. Nurs Outlook. 2021;69(5):714\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.outlook.2021.06.002\u003c/span\u003e\u003cspan address=\"10.1016/j.outlook.2021.06.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBell B. White dominance in nursing education: A target for anti-racist efforts. Nurs Inq. 2021;28(1):e12379. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/nin.12379\u003c/span\u003e\u003cspan address=\"10.1111/nin.12379\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Racism, Phenomenological study, Nursing Care","lastPublishedDoi":"10.21203/rs.3.rs-8898521/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8898521/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Racism is a complex and multidimensional concept and is regarded as a significant social issue. Since racism as a social construct, has emerged from research conducted across various cultural and social context, it seems necessary to study the experiences of individuals in the culture and religion of each society. Thus, this qualitative study aimed to explore the lived experiences of racism in nursing care for patients in Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis qualitative study performed a phenomenological nature on 14 patients and nurses selected through the purposive sampling method with maximum variation. Data was gathered through semi-structured interviews betweenApril and September 2025 in Iran. Data analysis was done by Colaizzi method. For rigor of data, Lincoln and Guba criteria were used. The data were handled by MAXQDA software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe main themes identified in this study were antecedents of racialized care experiences, consequences for patients and care quality, manifestations of mal-care affecting trust and communication, and preventive measures to promote equitable nursing practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e Based on these results, it is suggested that educational programs for nurses and other healthcare workers regarding racism and its effects on nursing care be implemented on an ongoing basis.\u003c/p\u003e","manuscriptTitle":"Lived experiences of racism in nursing care for patients in Iran: A Phenomenological study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-25 09:43:16","doi":"10.21203/rs.3.rs-8898521/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"237405aa-c235-4c3a-af6c-c76083ae9c00","owner":[],"postedDate":"March 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T09:12:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-25 09:43:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8898521","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8898521","identity":"rs-8898521","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}