Examining fundamental nursing textbooks for inclusivity and exclusivity content: A directed qualitative content analysis

Background: Growing awareness of social inequities and injustices in education highlights the urgent need to address harmful mechanisms, policies, and norms within health education curricula and systems. Purpose: This study examines inclusivity and exclusivity content in four fundamental nursing textbooks and contributes to the broader discourse on fostering equitable health education. Methods: A Directed Qualitative Content Analysis on 32 chapters from four fundamental nursing textbooks was systematically conducted. Seven codes within inclusivity and exclusivity themes were deductively developed from the literature. Inclusivity codes included equity language and contextualized race-based prevalence. Exclusivity codes included normalizing Whiteness in assessment, stigmatizing and negative descriptors, race-based prevalence without context, cisgenderism, and othering. Two trained analysts independently reviewed the chapters, assigning texts to these codes. Discrepancies were resolved by team consensus. Results: A total of 118 inclusivity instances: equity language (n =109) and race-based prevalence with context (n = 9). Exclusivity codes were more prevalent (n = 642), including normalizing Whiteness (n = 398), stigmatizing descriptors (n = 106), cisgenderism (n = 59), and othering (n = 32). Conclusion: The study highlights inclusive language in fundamental nursing textbooks but reveals significant exclusive language perpetuating negative generalizations, including marginalized identities and race prevalence without context. This content undermines person-centered care and hinders understanding the complex interplay between intersectionality, social justice, and social determinants of health.