Visual representation of clinical conditions across skin tones in nursing textbooks: a quantitative image analysis.

Nursing textbooks frequently omit clinical examples on darker skin tones, failing to show how conditions manifest across diverse populations. This limits students' assessment and diagnostic skills and reinforces healthcare inequities. This analysis of nursing textbook imagery reveals a widespread visual bias favoring lighter skin as the clinical default, perpetuating structural gaps in health education and weakening nurses' ability to identify conditions in all patients. Notably, only 2% of graphic illustrations showed dark skin.