Meaningful inclusion of diverse voices: The case for culturally responsive teaching in nursing education

Enhancing Cultural Competence in Undergraduate Nursing Students: An Integrative Literature Review of Strategies for Institutions of Higher Education

INTRODUCTION

Globally, health care organizations need to provide quality, culturally congruent health care to increasingly diverse patients. Nursing education institutions must therefore produce culturally competent nursing professionals to provide safe and culturally congruent care. This review aimed to identify and outline strategies to enhance cultural competence of undergraduate nursing students.

METHODOLOGY

The integrative literature review followed the five steps of Lubbe et al. searching the university Libguides, EBSCOhost, Scopus, and Google Scholar databases for literature published between 2014 and 2023 that met the inclusion criteria. The methodological quality was ensured through the John Hopkins Evidence-based Appraisal Tool.

RESULTS

Five themes emerged as strategies that can enhance cultural competence for nursing students: integrating cultural competence into undergraduate nursing curriculum, cultural immersion, innovative pedagogical approaches, role of nurse educators, and students' assessment.

CONCLUSION

Findings provide nurse educators with evidence-based information on strategies to enhance cultural competence of undergraduate nursing students at nursing education institutions.

Día de Muertos: A confluence of gross anatomy, culture, and spirituality

Is there room for spirituality and reflection in gross anatomy? While Jesuit institutions have incorporated contemplation and reflection into their curricula for centuries; the integration of reflective practices into the gross anatomy curriculum has gained traction in recent years. Additionally, more emphasis has been placed on diversity, equity, inclusion, and belonging within health professions education. As a Jesuit, Catholic university that is simultaneously classified as a Hispanic-Serving Institute (HSI), Regis University was well-positioned to integrate reflective and celebratory activities in honor of Día de Muertos (the Day of the Dead) into a graduate level anatomy course for Doctor of Physical Therapy students. From a communal ofrenda (altar) to a celebration during a lecture to a reflective ceremony honoring body donors in the laboratory, students and faculty constructed a learning environment that incorporated spirituality and culture into anatomy in a thoughtful manner. Furthermore, by seeking student input on the design of this innovative educational experience, each of these activities aided in fostering a sense of cultural and spiritual belonging for Hispanic and Latine students who are historically marginalized in health professions, thereby promoting diversity, equity, inclusion, and belonging through a gross anatomy course.

Using Simulation to Improve Communication Skills

Ineffective communication is implicated in 80% of medical errors, costing the United States approximately $12 billion annually. Teaching communication skills is a component of nursing curricula linked to improved patient outcomes. Simulation-based experience (SBE) is a strategy for healthcare professionals to learn communication skills. Providing nurses with the ability to practice nurse-nurse, nurse-physician, nurse-patient, and team communication skills in a psychologically safe learning environment provides an opportunity for skill development and meaningful self-reflection. The multiple modalities for SBE support needed communication techniques for skill development and acquisition to improve patient outcomes.

Developing and Implementing a Diversity, Equity, and Inclusion Curriculum Self-reflection Process at a School of Public Health

We critically reviewed the motivations, processes, and implementation methods underlying a faculty-driven diversity, equity, and inclusion (DEI) curriculum self-reflection project in the Rutgers School of Public Health. This case study offers guidance on a curriculum self-reflection tool that was developed through the school's Curriculum Committee to promote DEI throughout the school's curricula. We review the key steps in this process and the unique aspects of developing and implementing such evaluations within higher education. The study draws on faculty experience, was informed by students and staff within the Curriculum Committee, and builds on existing knowledge and tools. A flexible 6-step framework-including guiding principles and strategic approaches to planning, developing, and implementing a DEI curriculum self-assessment-is provided to assist instructors, curriculum committees, DEI groups, and academic leaders at schools of public health interested in refining their courses and curricula. Academic units experience contextual challenges, and while each is at a different stage in curriculum reform, our findings provide lessons about integrating the assessment of DEI in school curriculum in a systematic and iterative way. Our approach can be applied to diverse academic settings, including those experiencing similar implementation challenges.

Experiences of recruitment and retention in academia: A collaborative autoethnography of early-career faculty members of color

BACKGROUND

Recruitment and retention of diverse faculty in schools of nursing continues to be an important challenge but little has been written from the perspectives of early-career faculty of color on their decision to join academia and their retention.

PURPOSE

We aim to understand the perspectives of a cluster hire of early-career faculty of color on their recruitment, mentorship and support received, and resources needed for long-term retention.

METHODS

Five faculty members conducted a joint autoethnography of their perspectives through recruitment, hiring, and first year as faculty. Two group discussions were analyzed for emergent themes using thematic analysis, maintaining reflexivity.

DISCUSSION

Four themes were identified: Intentionality to diversity faculty, Plan for professional development, Clear antiracism diversity equity and inclusion standards, and Retention enablers and barriers.

CONCLUSION

We provide strategies (e.g., targeted resources, diverse cluster hires, building community) to inform recruitment and retention of early-career faculty of color.

Development and Implementation of an Asynchronous Online Interprofessional Course in LGBTQ+ Health

BACKGROUND

The lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) community faces discrimination in health care. Nurses interact with LGBTQ+ individuals in a wide variety of health care settings. Baccalaureate nursing and health professions students do not receive adequate education on topics of LGBTQ+ health in academic or clinical settings, and additional nursing education is needed on LGBTQ+ health.

METHOD

Existing courses were analyzed, and themes and structures were assessed. Course learning outcomes were developed, along with a timeline and a course outline. The course was structured as an asynchronous online course to be deployed in a learning management system.

RESULTS

A senior-level asynchronous online nursing elective course was developed on LGBTQ+ health for an urban public university. The course was structured using a life-span approach with additional topics.

CONCLUSION

Widespread development of courses on LGBTQ+ health should be implemented in all schools of nursing. [J Nurs Educ. 2023;62(10):584-588.].

Emergency Providers' Knowledge and Attitudes Toward Hospice and Palliative Care: A Cross-Sectional Analysis Across 35 Emergency Departments in the United States

Background: Emergency providers' knowledge and attitudes may be a barrier to adopting hospice and palliative care practice. Objective: To assess provider characteristics associated with knowledge and attitudes toward hospice and palliative care (KAHP). Design: Cross-sectional analysis. Setting/Subjects: Emergency physicians, advanced practice providers (APPs), and nurses from 35 U.S. emergency departments (EDs) enrolled in a provider-focused intervention. Measurement: The outcome measures were the total and subscale scores of the KAHP scale. The predictor variables were age, sex, race/ethnicity, and years of practice. We reported the observed association using a linear mixed-effects regression model. Results: The mean KAHP score, rated from 10 to 50, was 36. Increased years of practice were associated with increased mean self-reported knowledge and attitudes scores among APPs and nurses. Conclusion: Understanding the provider characteristics associated with hospice and palliative care adoption in the ED may inform the development of interventions for specific providers. ClinicalTrials.gov (NCT03424109).

What cultural values determine student self-efficacy? An empirical study for 42 countries and economies

Self-efficacy is a vital personal characteristic for student success. However, the challenge of cross-cultural comparisons remains as scalar invariance is hard to be satisfied. Also, it is unclear how to contextually understand student self-efficacy in light of cultural values in different countries. This study implements a novel alignment optimization method to rank the latent means of student self-efficacy of 308,849 students in 11,574 schools across 42 countries and economies that participated in the 2018 Program in International Student Assessment. We then used classification and regression trees to classified countries with differential latent means of student self-efficacy into groups according to Hofstede's six cultural dimensions theory. The results of the alignment method recovered that Albania, Colombia, and Peru had students with the highest mean self-efficacy, while Slovak Republic, Moscow Region (RUS), and Lebanon had the lowest. Moreover, the CART analysis indicated a low student self-efficacy for countries presenting three features: (1) extremely high power distance; (2) restraint; and (3) collectivism. These findings theoretically highlighted the significance of cultural values in shaping student self-efficacy across countries and practically provided concrete suggestions to educators on which countries to emulate such that student self-efficacy could be promoted and informed educators in secondary education institutes on the international expansion of academic exchanges.

Aligning Nursing Ethics With Critical and Open Pedagogy in Nursing Education: A Literature Review

BACKGROUND

There is a need to increase access to nursing education that is meaningful and socially just.

PURPOSE

To investigate the alignment of critical and open pedagogy in nursing education with nursing principles of ethics.

METHOD

Narrative thematic synthesis literature review of Canadian and American sources related to nursing education.

RESULTS

Thematic analysis of 29 full-text sources that align nursing ethical principles with critical and open pedagogy in nursing education.

CONCLUSION

Critical and open pedagogy aligns with nursing practice ethics and facilitates meaningful and socially just nursing education experiences.

Performance checklist and its influence on knowledge and satisfaction of intensive care nurses: A quasi-experimental study

AIM

The purpose of this study was to evaluate the impact of using a performance checklist on knowledge and satisfaction of intensive care nurses.

METHOD

This study was a quasi-experimental study and performed on 70 intensive care nurses in two groups. Performance checklists had to be filled by the nurses in experiment group during central venous pressure (CVP) measurement procedure. Knowledge and the nurses about standards of CVP measurement and their satisfaction were evaluated in both groups by a researcher-made questionnaire. The data were analysed using the SPSS software.

RESULTS

In the experiment group, the level of knowledge significantly increased after the intervention (p = .001) and the majority of nurses (85.7%) had a high level of satisfaction. Also, there was a significant difference between mean knowledge scores of the two groups after the intervention (p = .006).

CONCLUSION

This showed that applying performance checklists can influence nurses' knowledge and should consider a simple indirect educational method.

Beyond Humility: Empowering Minoritized Learners Through Culturally Reflective Medicine

In the wake of the Black Lives Matter and other antiracism justice movements, medical education is evolving to incorporate health equity principles for all medical students and residents, while also increasing institutional diversity recruitment of minoritized physicians. As the demographics of U.S. medical trainees shift to reflect a rapidly evolving patient population, the prevalence of culturally concordant patient-physician visits, where patients share elements of language, religion, customs, and identities with their physician, is also expected to increase. However, existing antiracist curricula are standardized to all learners and there is a dearth of cultural sensitivity training designed specifically for minoritized learners to interrogate the culturally concordant space they share with patients and mentors. In this article, the authors propose a new model for minoritized learners' cultural training, culturally reflective medicine (CRM) that identifies unanticipated tensions that may arise as minoritized learners bridge both White and Eurocentric professional and personal identities, examines how intersectionality can both strengthen encounters and lead to shared blind spots, and empowers minoritized physicians with tools for self- and group reflection to advocate for their communities. CRM is contextualized within the current landscape of cultural sensitivity training in medical education. The authors provide 2 clinical vignettes to demonstrate how CRM can unveil more nuanced understandings of health disparities than existing cultural training. As institutions work toward diversity, equity, justice, and antioppression, CRM provides a novel framework for redesigning medical education that better acknowledges and incorporates the unique knowledge of minoritized learners.

Culturally Responsive Teaching in Nursing Education

Culturally responsive teaching is a vital skill for nurse educators. A diverse nursing workforce is needed in the US to represent the population’s demographics. Recruiting, retaining, and engaging a diverse student body is critical to addressing issues of disparities and cultural sensitivity in health care. In a project to promote success among diverse nursing students, nurse educators collaborated to create and present faculty development programs to build culturally responsive teaching skills. This article includes examples of culturally responsive teaching and describes the project and the faculty development curriculum and teaching materials produced.

Critical Race Theory: A Framework for the Re-Education of American Nurses

The nursing profession has been predominantly white and female since the time of Florence Nightingale. The United States 2020 census revealed a changing demographic landscape in which white people are no longer the majority race; this shift will continue well into the future based on who is having babies. Calls to diversify the nursing workforce and address disparities and inequities in health care continue. Nursing faculty who shape curricula are challenged to create a more inclusive framework to teach students about care. Without focused attention on how to prepare future nurses to care for all people, patient safety and quality of care are at stake. This article suggests using critical race theory as a framework to re-educate American nurses.

Reflecting Culturally Responsive and Communicative Teaching (CRCT) through Partnership Commitment

The strategic approach to enhance cultural skills is aligned with social feeling and sense of belonging as an important element to underlie the interaction pathway with others’ diverse backgrounds. Such an approach of teaching model could be transformed and prepared to encourage ability to communicate and relate to others from diverse backgrounds. The following phase of sufficient integration amongst cognitive, social and emotional substance is reflect in the culturally responsive and communicative teaching (CRCT). This mode is an important element to advance the diverse students amidst an increasingly complex and pluralistic society. This paper is aimed at examining CRCT by having a critical look into the partnership commitment amongst interracial teachers’ daily school interaction. Data collection was conducted with 10 interracial teachers with a focus on the approach of how their partnership commitment is reflected and practiced in their daily school interaction. Thematic analysis was employed to obtain the main points of data to give insight into the multicultural school society. The findings reveal that an understanding of CRCT articulated into partnership engagement commitment has a core of three main points. These are: expanding self-awareness on cultural identity; enhancing culturally mediated emotion of social situations; and developing instructional practice for cultural sensitivity. The implication for students’ experiential learning in the multicultural classroom was also discussed. The contribution of this paper can be exerted among those involved in the education sectors. These include students, educators, principals, learning facilitators, researchers, educational technologist, instructional designers and practitioners. This is also included among the researchers who are interested in exploring, understanding and developing discerning perspectives on diversity and diverse learners in 21st century education. This study is expected to contribute by giving solving skills with the strategic approach articulated into a particular guideline to give a clear understanding in responding the multicultural classroom in the interracial school society context. This study is considered to elaborate the good feedback on the importance of CRCT in responding to emerging trends on the facades of diversity among diverse learners.

Revisioning Assessment and Evaluation in Nursing Education Through Critical Caring Pedagogy: Using Authentic Examinations to Promote Critical Consciousness

Instead of instilling in nursing students critical thinking to challenge injustice and oppression in nursing practice, nurse educators often rely on outdated traditional approaches to education. This situation is certainly true in traditional methods of evaluation that often propagate a banking mode of learning. One of the most commonly used methods of evaluating students is traditional examinations, which have recently become a source of pedagogical conflict among educators. In this article, we outline how educators unknowingly encourage surface learning, uncaring practices, oppression, inequity, and cheating when they rely on traditional examinations. We draw on critical caring pedagogy and universal design for learning to advocate for increased use of authentic assessment in nursing education. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A31.

Implementation of diversity, equity, and inclusion dialogue for second-year dental students

PURPOSE

Dental schools can support diversity and inclusion efforts through curricula targeted at providing a safe space for students to learn from each other and about themselves. Opportunities to learn about different backgrounds can improve levels of cultural sensitivity and improve inclusion. The aim of this study was to describe the implementation of a diversity dialogue tool for second-year dental students and evaluate student responses to this activity.

METHODS

Following a 3-h small group diversity, equity, and inclusion (DEI) dialogue, students completed a 3-2-1 reflective activity to determine new ideas that they encountered, ideas they would like to try, and things that they would like to know more about.

RESULTS

Of the 66 students that participated in the DEI dialogue, 44 participated in the reflective activity for a response rate of 66%. Four significant new ideas were encountered including the concept of intersectionality (25%), the effects of race, racism, and identity on health (20.5), how to react to bias or discrimination (20.5%), and identity and their effect on perceptions of health and wellness (15.9). Three ideas students might try included being more open to learning about others' identity (52.3%), communicating openly with patients and peers (34.1%), and communicating calmly when dealing with bias or discrimination (13.6%). Two things students would like to know more about included how to handle situations of discrimination and bias (27.3%) and the existence of health disparities and how to address them (15.9%).

CONCLUSION

Creating an opportunity for a DEI dialogue led to students encountering new information (intersectionality; effect of bias on health), identified targeted areas of future behavioral change (open and calm communication with others), and provided insight into areas of student interest (dealing with bias and addressing health disparities).

Maximising intercultural learning opportunities: learning with, from and about students from different cultures

Nurses continue to experience challenges when caring for culturally diverse patients and while working with staff from different cultural, ethnic and linguistic backgrounds. The widening landscape of cultural diversity in the nursing classroom provides a vehicle for intercultural learning, supporting intercultural competence development. However, students must embrace culturally diverse learning environments and maximise opportunities to learn with, from and about students from different cultural backgrounds. This requires developing the courage, curiosity and commitment to maximise all intercultural learning opportunities. Drawing on experiences of international students studying in culturally diverse classrooms, this article presents some practical suggestions for meaningfully engaging and capitalising on intercultural learning opportunities.

Cultural competence development: The importance of incorporating culturally responsive simulation in nurse education

The continued reports of declining standards of care for culturally diverse patients, highlights the urgent need for nurse educators to critically examine how cultural competence development is facilitated in everyday teaching. Nurses frequently report experiencing difficulties when adapting caring practice to culturally diverse groups. Subsequently, there needs to be a rooting of continuous cultural competence development threaded throughout undergraduate curricula. Simulation pedagogy can be used as a vehicle for nurturing cultural competence, but this requires a review of how culturally responsive simulation is structured and designed. This paper focuses on culturally responsive simulation as a means of improving the preparation of nurses for working in a broadening culturally diverse healthcare context by outlining fundamental considerations when integrating cultural competence development in everyday simulation.

The development of an online diversity and inclusion community: Promoting a culture of inclusion within a college of nursing

Societal demographics are rapidly changing and driving the need to develop a culturally aware and sensitive nursing workforce. Nursing faculty are essential to transform academic and healthcare settings into culturally responsive environments. Yet, there isn't a "one size fits all" plan for faculty to foster diversity and inclusion (D&I) within academic nursing. For instance, cultural humility best practices in academia are limited as D&I interventions historically focus on cultural competency. Cultivating cultural humility exceeds developing cultural competency. Cultural humility incorporates elements of self-reflection/critique (acknowledging assumptions and beliefs), learning from others (listening and being open), and partnership-building (gaining appreciation and respect), all of which encompasses a life-long process. The purpose of this paper is to outline the development of an online D&I communication platform for a college of nursing. We present lessons learned and helpful recommendations for others promoting culturally responsive educational environments. This work is important as limited literature exists outlining the development of online communication platforms where faculty, students, and staff can foster cultural humility. Adopting cultural humility into the fabric of the college of nursing can lead to open communication, a greater understanding of one another, and an opportunity to improve relationships with diverse individuals and patient populations.

Nursing Students’ Perception of the Clinical Learning Environment

Introduction:

Clinical learning environment placements provide opportunities for students to develop their skills, socialize to the profession and bridge the gap between academic and workplace learning. This study was conducted to investigate Saudi nursing students’ perceptions of their clinical learning environment and supervision in the hospital setting.

Methods:

A sample of 90 final year student nurses completing practicums at a tertiary hospital in Riyadh was included in this cross-sectional study utilizing the Clinical Learning Environment and Supervision plus Nurse Teacher scale.

Results:

Overall, students perceived their clinical learning environment positively. Among sub-scores, that for the leadership style of ward manager was the highest. Supervision types, nursing-teacher teacher-visit frequency and grade point average positively and significantly impacted student’s perceptions, while university type and practicum duration did not.

Conclusion:

Students confirmed the ward manager’s leadership style as the most significant influencing their perceptions. However, the nursing teacher’s role had the lowest mean score, suggesting the need for its enhancement and clarification and indicating the need for better communication and collaboration between nursing schools and the clinical training hospital.

The needs of LGBTI+ people within student nurse education programmes: A new conceptualisation

There is a growing body of international research evidence highlighting concerns around social exclusion and discrimination, significant health inequalities and health needs, and barriers to accessing effective healthcare for LGBTI + people. However, ways in which the healthcare needs of LGBTI + people can be addressed in student nurse education programmes have yet to be fully explored. The aim of this discussion paper is to present the evidence to support the inclusion of LGBTI + health throughout the nursing curriculum. A new conceptualisation of the full and effective integration of LGBTI + health content across and within the nursing curriculum is proposed. This can be achieved by further developing theory, skills simulation and practice learning opportunities. There is a need to ensure that nursing students are positioned and adequately prepared to effectively address concerns of social justice, reducing health inequalities, and providing responsive person-centred care for LGBTI + health service users.