Special Considerations for Health Care Providers
White health care providers know far too little about how to care for a Black person’s skin or hair, or how to understand both Black nonverbal and verbal behavior.
Physiological Assessment. Examples of possible physiological problems include the following (in observing skin problems, it is important to note that skin assessment is best done in indirect sunlight) (Bloch & Hunter, 1981):
1. Pallor. There is an absence of underlying red tones; the skin of a brown-skinned person appears yellow-brown, and that of a black- skinned person appears ashen gray. Mucous membranes appear ashen, and the lips and nailbeds are similar.
2. Erythema. Inflammation must be detected by palpation; the skin is warmer in the area, tight, and edematous, and the deeper tissues are hard. Fingertips must be used for this assessment, as with rashes, since they are sensitive to the feeling of different textures of skin.
3. Cyanosis. Cyanosis is difficult to observe in dark-colored skin, but it can be seen by close inspection of the lips, tongue, conjunctiva, palms of the hands, and soles of the feet. One method of testing is pressing the palms. Slow blood return is an indication of cyanosis. Another sign is ashen gray lips and tongue.
4. Ecchymosis. History of trauma to a given area can be detected from a swelling of the skin surface.
5. Jaundice. The sclera are usually observed for yellow discoloration to reveal jaundice. This is not always a valid indication, however, since