Minimizing Unconscious Bias in Nursing School Admission

Capturing Intersections of Discrimination: Quantitative Analysis of Nursing Students' Experiences

While prior literature has established that nursing students experience racism, mental health stigma, and ableism within their programs, there is a dearth of knowledge of how students experience discrimination more broadly, across intersecting identities. This analysis draws on Crenshaw's intersectionality theory to conduct an intersectional analysis of cross-sectional survey data of nursing students' experiences of discrimination. Results illustrate that discrimination operates in complex ways across students' social locations, as experiences of intersecting impacts of racism, homophobia/transphobia, mental health stigma, religious discrimination, ableism, and other forms of discrimination. Such experiences further unfold across clinical, classroom, and policy contexts.

Integrating Implicit Bias Training for Undergraduate Holistic Admission Reviewers

BACKGROUND

The need to create a diverse nursing work-force has increased the use of a holistic admission process across the country. Holistic admission processes alone are insufficient to addressing bias that may have unintentional impact on the review process. Intentionality with implicit bias training is necessary to create a more equitable admission process.

METHOD

Integration of implicit bias training was multipronged and included overview information and individual activities, including the practice of reviewing applicants. Data from the practice reviews were aggregated and used for small group discussion.

RESULTS

Since integration of implicit bias training, overall admission rates for underrepresented racial and ethnic applicants increased from 14.5% in 2019 to 29.1% in 2022.

CONCLUSION

While other factors cannot be ruled out in contributing to the increased diversity, the integration of implicit bias education and bias-mitigating strategies throughout the required training for holistic admission reviewers is beneficial to increasing diversity in nursing admissions. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Implicit Bias Toward Lesbian and Gay Persons Among Nursing Students: A Correlation Study

AIM

The purpose of this study was to measure implicit bias among nursing students toward lesbian and gay (LG) persons.

BACKGROUND

Implicit bias is identified as a contributor to the health disparities experienced by LG persons. This bias has not been studied among nursing students.

METHOD

This descriptive, correlation study used the Implicit Association Test to measure implicit bias in a convenience sample of baccalaureate nursing students. Demographic information was collected to identify relevant predictor variables.

RESULTS

Implicit bias in this sample ( n = 1,348) favored straight persons over LG persons ( D -score = 0.22). Participants identifying as male ( B = 0.19), straight ( B = 0.65), other sexuality ( B = 0.33), somewhat ( B = 0.09) or very religious ( B = 0.14), or enrollment in an RN-BSN program ( B = 0.11) predicted stronger bias favoring straight persons.

CONCLUSION

Implicit bias toward LG persons among nursing students remains a challenge for educators.

Preparing Nurse Educators to Teach Social Determinants of Health Using Backward Design

BACKGROUND

Recent national recommendations have been developed to ensure nurse educators are prepared to teach about health equity and social determinants of health. Nurse educators may not have had formal or professional development in teaching these concepts, which may pose a barrier to implementing recommendations.

METHOD

This article outlines a graduate course focused on social determinants of health to prepare future nurse educators with the knowledge, skills, and ability to address these concepts in future teaching.

RESULTS

A backward design approach facilitated the alignment of learning outcomes, assessments, and activities that resulted in Quality Matters certification in this online graduate-level course. Topics include health equity and implicit bias, and learners evaluate educational resources and develop an educational presentation of health inequities in a selected population.

CONCLUSION

This course supports the development of nurse educators to increase their skill in understanding and teaching social determinants of health and health equity. [J Nurs Educ. 2022;61(9):511-515.].

Holistic Admissions Review Integration in Nursing Programs

BACKGROUND

To address health inequities, the American Association of Colleges of Nursing, Institute of Medicine, and Association of American Medical Colleges recommend holistic admissions review (HAR) to increase health professional diversity.

METHOD

This cross-sectional study collected admissions criteria from 1,547 nursing programs. Criteria were categorized according to the experiences, attributes, and academic metrics (EAM) model, and programs were dichotomized into those with holistic admissions criteria versus none.

RESULTS

Only 43% of nursing programs considered holistic admissions criteria. Regionally, rates varied from 35% in the South to 54% in the West. The rate of HAR integration exceeded 67% in only six states.

CONCLUSION

Nursing programs have not widely integrated HAR despite evidence that academic metric use alone disadvantages qualified underrepresented students. HAR implementation can be facilitated by standardizing how HAR is operationalized and applying best evidence to rubric development that appropriately weighs admissions criteria based on the EAM model, and also training reviewers for unbiased candidate evaluation. [J Nurs Educ. 2022;61(7):361-366.].

Implementation of an unconscious bias course for the National Research Mentoring Network

PURPOSE

Increased awareness and mitigation of one's unconscious bias is a critical strategy in diversifying the Science, Technology, Engineering, Mathematics, and Medicine (STEMM) disciplines and workforce. Greater management of unconscious bias can enhance diverse recruitment, persistence, retention, and engagement of trainees. The purpose of this study was to describe the implementation of an asynchronous course on unconscious bias for people in STEMM. Specifically, we explored who engaged with the course and reflections from participation.

METHOD

A five-part, asynchronous Unconscious Bias Course was developed and was hosted on a national mentoring platform starting in July 2020. To examine course engagement, we assessed the demographics of course participants and completion. Participant responses to reflection questions after each module were also synthesized using qualitative methods.

RESULTS

Overall, 977 people registered for the course and 42% completed all modules. In the reflection responses, participants reflected on their unconscious biases in their lived experiences and how it relates to actions, judgements, external factors, stereotypes, and un-intentionality. Participants also reflected on microaggressions, their impact on the recipients and others, and the relationship between microaggressions and unconscious bias. Participants reported four key strategies used by allies against unconscious bias: immediately acting (83%), reflection (46%), improving the organizational culture (30%), and individual-level ally-ship (44%). Strategies for self-awareness included: reflection, pausing/breathing, and self-observation.

CONCLUSION

The assessment of the Unconscious Bias Course implementation revealed the course reached a wide cross-section of people in STEMM and demonstrated that participants were able to reflect on the underpinnings of the course. This course, and its suite of offerings, support a nationwide effort to mitigate bias and prepare individuals to be culturally competent in a diverse society in order to foster a STEMM environment that caters to individuals' success and diversification of these fields.

A theoretical framework to promote minority PhD and DNP student success in nursing education

BACKGROUND

Nursing PhD and DNP programs lack diversity and cultural responsiveness and, as a result, minority students are underrepresented in these programs. Stressors specific to being a member of a minority population, defined as minority stress, contribute to a range of barriers for ethnic/racial minority, male and LGBTQ PhD and DNP students. There is an urgent need for faculty and administrators to support minority doctoral student success by taking proactive steps to identify and begin to deconstruct these barriers. Doctorally-prepared nursing faculty serve as mentors and role models for doctoral students, provide exemplars for how to use scientific humility to research health inequities, implement evidence-based practice and develop the next generation of nurse scientists. Combating educational inequities for minority doctoral students is a first step in advancing health equity beyond academia.

PURPOSE

The purpose of this paper is to develop a theoretical synthesis to promote minority PhD and DNP student success in academia.

THEORETICAL FRAMEWORK

The minority doctoral student success (MDSS) framework was developed using Schneider's attraction-selection-attrition framework, key concepts from the literature, and professional and personal experience to capture the minority doctoral student experience. A systems approach was used to identify multi-level influences on the minority student experience, including antecedents at each stage of the academic journey, and how minority stress and opportunity inherently affect the process.

CONCLUSIONS

Diversity is essential to reimagine nursing doctoral education. This theoretical framework provides an approach to understanding the minority PhD and DNP student experience and the role of faculty and the academic organization in mediating barriers and creating opportunities to enhance diversity, equity, and inclusion.