Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Julie Marfell

Clinical Mentor

Dr. Hartley Feld

Committee Member

Dr. Mikayla Hare

Committee Member

Dr. Coy Flowers


Background: Kentucky is ranked 17th in the nation for the highest maternal mortality rate in the U.S. with a rate of 22.9 per 100,000, and 78 percent of those maternal deaths were considered preventable. The Non-Hispanic Black maternal death rate in the U.S. and Kentucky is 2.9 times higher than that of the Non-Hispanic White maternal counterparts (Kentucky Department of Public Health Division of Maternal and Child Health (KDPHDMCH), 2022). The fundamental cause of maternal health inequities is structural racism, which leads to poor treatment and experiences in the healthcare system (Chinn et al., 2020). Structural racism and implicit biases are the leading contributors to the Black maternal mortality rate (CDC, 2023). Evidence reveals that healthcare professionals “exhibit the same levels of implicit racial and ethnic biases as the general population” (FitzGerald & Hurst, 2017, p. 1). Healthcare providers' implicit racial and ethnic biases negatively impact patient-provider relationships, which leads to minimal patient treatment adherence and results in poor health outcomes (Hall et al., 2015).

Purpose: The purpose of this pilot study was to determine if an educational program focusing on increasing awareness of implicit bias and systemic racism for all clinical staff would increase their cultural competency.

Methods: This quasi-experimental study utilized a single clinical staff group at University of Kentucky Women’s Health – Georgetown (UKWH-G). The participants took a pre-test to assess their knowledge and attitudes before the educational program, followed by a post-test to assess these same elements after education. Also, a program evaluation was completed to analyze the appropriateness of continuing the program as a mandatory annual in-service for all clinical staff.

Results: There was no statistically significant (p=.77) difference in the educational level of the participants regarding implicit bias and systemic racism before and after the educational program. However, 88.9% of the participants reported as follows: They learned more than they knew about implicit bias and systemic racism; what they learned would impact their daily patient care delivery; they would recommend their colleagues to participate in this educational program.

Discussion: Although there was determined to be a display of basic knowledge about implicit bias and systemic racism before the educational program, there were enough important gaps in the participant’s knowledge to justify the need for the educational program. Those gaps in knowledge were identified as resolved following the educational program.

Conclusion: The majority of the study participants acknowledged due to this educational program they would make changes to the delivery of their patient care to non-Hispanic Black patients. This increased cultural competence of the clinical staff will presumably result in a more positive patient care experience for the non-Hispanic Black maternal patients with predicted improved health outcomes.