The publishers of a textbook for nurses have been slammed for containing racial material.
The textbook, called Nursing: A Concept-Based Approach to Learning, Volume I, contains a chapter that contains advice for nurses when administering pain relief to people from different ethnic backgrounds.
In a chapter headed "Diversity and culture", the book claimed Jewish people "may be vocal and demanding of assistance" and "believe pain must be shared and validated by others".
It also details how to deal with Arabs/Muslims, black people, Hispanics, Asians and Native Americans.
The book, published by Pearson, was available in the US market as well as Canada and Australia.
Shocked readers responded calling the chapter "offensive and racist".
The image of the page was shared on Facebook on Monday by Onyx Moore in California. She posted: "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 the patient is actually saying.
"If someone tells you their pain level is high you need to believe them."
In a statement Pearson said: "While differences in cultural attitudes towards pain are an important topic in medical programmes, we presented this information in an inappropriate manner. We apologise for the offence 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 text.
"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.
"We appreciate the concern shown by the students who raised this issue."
The offending page contains headings for different communities. Here are some of the excerpts:
Arabs/Muslims
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.
Asians
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
Blacks often report higher pain intensity than other cultures.
They believe suffering and pain are inevitable.
Jews
Jews may be vocal and demand assistance.
They believe pain must be shared and validated by others.
Hispanics
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.