A major publisher has apologised and withdrawn a nursing textbook from circulation after it was revealed to contain a slew of prejudicial, arguably racist, material about the way different people respond to pain.

Pearson Education, a huge multinational, has pulled Nursing: A Concept-Based Approach to Learning from the shelves after social media erupted in disgust at a photograph of page 161, which begins: "A client's culture influences their response to, and beliefs about pain. Some cultural common differences related to pain are listed here."

What follows is quite staggering, considering the book was written in 2014 and is used to train nurses in the developed world. Extracts include:


May not request pain medicine but instead thank Allah for pain if it is the result of the healing medical process.
Pain is considered a test of faith.

Muslim clients must endure pain as a sign of faith in return for forgiveness and mercy.


Chinese clients may not ask for medication because they do not want to take the nurse away from a more important task.

Indians who follow Hindu practices believe that pain must be endured in preparation for a better life in the next cycle.


Blacks often report higher pain intensity than other cultures.

They believe suffering and pain are inevitable.


Jews may be vocal and demand assistance.

They believe pain must be shared and validated by others.


Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven.

They vary in their expression of pain. Some are stoic and some are expressive.

Native Americans

Native Americans may prefer to receive medications that have been blessed by a tribal shaman.
They may pick a sacred number when asked to rate pain on a numerical pain scale.

Racist nursing book
Pearson say the book will no longer be sold Facebook

The furore kicked off last week when American Onyx Moore uploaded a picture of the offending page to Facebook along with a lengthy critique of the contents.

She said: "This is an excellent example of how not to be even remotely culturally sensitive. These assumptions are not evidence-based, they encourage nurses to ignore what a patient is actually saying (if someone tells you their pain level is high, you need to believe them).

"They list common behaviors as culturally specific (most people are more comfortable being honest about their pain with family members/those close to them), and they don't actually teach nurses how to engage in a CULTURALLY SENSITIVE way."

Facebook and Twitter have been ablaze with people around the world making similar criticisms. Pearson has apologised and promised to stop selling the textbook.

In a statement, the publisher said: "While differences in cultural attitudes towards pain are an important topic in medical programs, we presented this information in an inappropriate manner.

"We apologise for the offense this has caused and we have removed the material in question from current versions of the book, electronic versions of the book and future editions of this.

"In addition, we now are actively reviewing all of our nursing curriculum products to identify and remove any remaining instances of this inappropriate content that might appear in other titles."