1.1. Literature review
The research team searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database to obtain current article abstracts published in academic journals between January 2017 and June 2021. English language abstracts were retrieved if the following search terms were in both the title and article abstract: structural racism (n = 58), institutional racism (n = 11), institutional discrimination (n = 5), structural discrimination (n = 3), or institutional procedural discrimination (n = 0). Of the abstracts found, specific articles focusing on nursing and defining or measuring the aforementioned terms were retrieved.
Most article abstracts were reviews, opinions, calls to action, commentaries, or conceptual articles. No articles were found with the search term of institutional procedural discrimination. Nurses from various specialties offered insights on structural racism. These specialties included public health (de Valpine & Lewis, 2021; Waite & Nardi, 2019), perinatal and neonatal (Scott et al., 2019), geriatric (Medina‐Walpole, 2021), and academic nursing (Murray & Loyd, 2020; Nardi et al., 2020). Addressing bias in institutions was highlighted as an area of importance, especially institutional racism (Agyepong, 2021; Santos Ferreira et al., 2020; Thurman et al., 2019).
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Few researchers completed data‐based research. As an example of such, Randolph et al. (2020) described historical distrust of health services as a finding. Bower et al. (2020) identified perceptions of systems that perpetuated biased maternal health services, such as retail, justice, and school systems. More studies are needed that explore the actual health impacts of types of institutionalized discrimination, such as institutional procedural discrimination, institutional racism, and other institutional discrimination.
Two nurse‐led research teams conducted systematic literature reviews. Thurman et al. (2019) found that researchers mostly focused on interpersonal experiences of discrimination and racism. They noted a lack of consistency in defining institutional racism. Nardi et al. (2020) also observed this and applied an ecological model of overlapping systems and suggested that institutional racism operates through organized “practices and policies” (p. 697).
After finding no article abstracts about institutional procedural discrimination in CINAHL, additional searches were conducted using social work, public health, and law databases. In the field of law, institutional procedural discrimination is based on procedural justice theory (Tyler, 1988), that suggests “that one’s satisfaction with legal or clinical interactions is primarily influenced by the quality of the procedural experience rather than the outcome of the interaction” (Kopelovich et al., 2013, p. 114). Institutional procedural discrimination operates in organizational policies and practices, such as in the ways decisions are made. Institutional procedural discrimination focuses on institutional agreements concerning the types of decisions, timing of discussions, conditions, and deadlines to privilege one group over another in the process. The institutional procedural experience is shaped by the visible and invisible norms, rules, customs, and power relations embedded in how organizational policies are decided and administered. Institutional procedures can result in selecting, crediting, and awarding the time orientation, language, thinking processes, and value systems of the group in power in making these decisions (Kopelovich et al., 2013 & Tyler, 1988).
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Institutional conditions create and sustain the policies and practices that constitute institutional racism. Williams et al. (2019) noted that institutional discriminatory practices and processes depend on groups within institutions creating and reinforcing discriminatory practices as norms. Institutional racism changes the institutional arrangements to limit the resources and services to those in the minority, and confer hidden privileges to majority members (Williams, 2018). Examples of resources might be funds or the time to complete work. Examples of services might be providing non‐Western services and multilingual resources. Organizational practices can create hidden pathways for sustaining institutional racism or other types of discrimination beyond individual racial bias.
Other types of institutional discrimination may include ageism, ableism, religious intolerance, language bias, cultural xenophobia, colonialism, and Western domination of ideas and ways of being (Sundstrom & Kim, 2014; Waite & Nardi, 2019). That is, other institutional discrimination can be viewed as organizational‐level discrimination embedded in institutional ways of being and institutional guidelines. Those ways of being and guidelines are based upon language, country of origin, culture, relationship‐based working, gender, income, ability, thinking styles, and religion that privilege some groups over others.
Institutional procedural discrimination, institutional racism, and other institutional discrimination are separate, yet related concepts. The focus on institutional discrimination is different from a focus on discrimination as those individual actions of unequal treatment, exclusion, and marginalization (Williams, 2018). Scholars have called for a shift in focus from examining self‐reported individual and discriminatory bias towards the interrogation of institutional norms (Groos et al., 2018; Williams, 2018). The overall purpose of this longitudinal CBPR was to examine three types of institutional discrimination and their relationship with health. The next section defines the types of institutional discrimination.
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