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Ethical principles serve as the moral compass in the longstanding tradition of nursing, guiding healthcare professionals in their interactions with patients and families. These principles, namely autonomy, beneficence, non-maleficence, justice, and fidelity, provide a robust framework for navigating the ethical complexities of daily nursing practice.
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Inclusive and Exclusive Language and Content in Open-Access Nursing Fundamentals Texts.

Joanne Noone1, Angie Docherty, Willow Buswell

  • 1About the Authors Joanne Noone, PhD, RN, CNE, ANEF, FAAN, is A. B. Youmans Spaulding distinguished professor and program director, Master's in Nursing Education Program, Oregon Health & Science University (OHSU), Portland, Oregon. Angie Docherty, NursD, MPH, RN, CNE, is associate professor and campus associate dean, OHSU School of Nursing, Monmouth, Oregon. Willow Buswell, MN, RN, LMT, is a registered nurse with the Multnomah County Health Department, Healthy Birth Initiative, Portland, Oregon. Julianna Joshua, MN, RN, CMSRN, recently graduated from the Master's of Nursing Education Program, OHSU School of Nursing, Portland, Oregon. Kelsie Peterson, MN, MS, BS, RN, is a lecturer, OHSU School of Nursing, Monmouth, Oregon. Marcos Sanchez, MN, RN, CEN, is a registered nurse in the Emergency Department, OHSU Hospital, Portland, Oregon. The authors acknowledge Eleonor Pusey-Reid, DNP, RN, MS, Med, for research training, generous collaboration, guidance, and support. For more information, contact Dr. Noone at noonej@ohsu.edu.

Nursing Education Perspectives
|April 28, 2026
PubMed
Summary

Nursing textbooks often contain exclusive language, hindering inclusive education. This study found exclusive terms outnumbered inclusive ones, highlighting the need for careful content review to ensure equitable learning.

Keywords:
BiasInclusive LanguageNursing TextbooksOpen Educational ResourcesQualitative Content Analysis

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Area of Science:

  • Nursing Education
  • Medical Education
  • Qualitative Research

Background:

  • Textbooks can perpetuate implicit bias, undermining inclusive pedagogy.
  • Open-access nursing fundamentals textbooks were examined for language bias.

Purpose of the Study:

  • To analyze nursing textbook content for inclusive and exclusive language.
  • To identify specific codes related to inclusivity and exclusivity in educational materials.

Main Methods:

  • Directed qualitative content analysis of ten textbook chapters.
  • Analysis used seven predefined codes for inclusive and exclusive language.
  • Codes were refined based on findings, including "disparity-based language" and "inclusive/equity language with imagery."

Main Results:

  • Exclusive codes (n=281) were more frequent than inclusive codes (n=165).
  • Analysis led to refinement of existing codes and introduction of new descriptors.
  • Specific codes identified included normalizing whiteness, stigmatizing language, and cisgenderism.

Conclusions:

  • Nursing textbooks require evaluation for language that supports safe and equitable practice.
  • Content analysis revealed a need to refine learning resources for inclusivity.
  • Ensuring educational materials align with values of equity is crucial for nursing students.